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1.Introduction
The new generation of technological tools, in particular in the field of telecommunication, has trained people to be continuously in touch with other individuals. This virtual link is revolutionary in the way of feeling, and if coupled with innovative sensing architectures could be revolutionary also in the way of acting. There is an emerging need for renovation in our health managing system; people need to be more and more conscious of their health status, and more interactive with the social assistance services . Remote health monitoring can be accepted and used only if the monitoring device is based on a comfortable sensing interface, easy to use and easy to customize; the new interface must allow continuous remote control, in a natural environment without any discomfort for the users and without interfering with their daily activities . The textile approach to the implementation of sensing elements embedded in clothing items allows one to achieve long-term monitoring of patients at low cost and to easily customize the sensor configuration according to the needs of each individual. Sensing interfaces designed to be minimally invasive, based on flexible technologies conformable to the human body, are also cost effective in providing assistance, for example, in rehabilitation from cardiac diseases or in the prevention of acute crisis, and for the monitoring of professional workers engaged in extreme environmental or stressful conditions. Finally, by providing direct feedback to the users, they can act on the level of awareness and allow better control of their own conditions. In the WEALTHY system, conductive and piezoresistive yarns are used to manufacture a knitted garment possessing distributed functional regions. Conductive and piezoresistive yarns are integrated and used as sensors, connections, and electrodes. The simultaneous recording of vital signs allows parameters extrapolation and the definition of new indeces correlated to the whole set of recorded signals that contribute to make alert messages and personalized synoptic tables of patients health.

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2.The WEALTHY system

Strain fabric sensors based on piezoresistive yarns, and fabric electrodes realized with metal based yarns, enable the realization of wearable and wireless instrumented garments capable of recording physiological signals, to be used during the routinely activity, to be wear instead of a classical garment without any discomfort for the user. Respiration, electrocardiogram, electromiogram, activity sensors, temperature, can be listed as physiological variables to be monitored through the proposed system. A miniaturized short-range wireless system can be integrated in the sensitive garment and used to transfer the signals to WEALTHY box/PCs, PDA and mobile phones. Alert functions can be implemented in the monitoring system by means of an intelligent signals correlation, the system can be personalised and an appropriate set of information can be delivered to a professional target and used to set synoptic patient table. The system is addressed for the monitoring of patients with heart disease who are at intermediate risk (i.e. not requiring hospitalisation but requiring a close home/outpatient care); for example, those recovering from an acute heart attack or from cardiac surgery and those with severe chronic heart failure. Professional personnel at risk, (working alone, working in a dangerous environment), subject to physical and physiological stress can also be assisted during their performance without any impediment to their activity.

3.WEALTHY Functions
WEALTHY system is developed as the integration of several functional modules. The main functions of portable modules are shown in Fig.1, namely: sensing, pre-processing, processing and transmission. The garment interface is connected with the portable WEALTHY device where the local processing as well as the communication with the network is performed. A knitted fabric platform containing insulated conductive tracks connected with sensors and electrodes has been implemented to make the cloth.

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Fig.1: Wealthy function overall Most signals are transmitted unprocessed to the Monitoring System, described in Figure where they can be analyzed offline. In order to reduce the needed data capacity of the wireless link to the Central Monitoring System, some sensors. Signals are processed by the portable patient unit (PPU) to extract essential parameters. Local preprocessing of signals has to be decided in a trade-off between the gain in term of wireless link occupancy and the increase of needed local processing power. ECG signals are sampled on the PPU at 250Hz, a local processing is applied in order to extract parameters with a higher sampling rate, so that ECG parameters, such as heart rate (HR) value and QRS duration can be computed with a significant number of samples. In order to decrease the amount of data transmitted by GPRS, the ECG signal is decimated to obtain a sampling rate of 100Hz. Respiration and movement activity come from piezoresistive sensors, sampled at 16Hz. Signals from these sensors are transmitted without local processing. The PPU is designed to have a simple user interface, a few LEDs and a buzzer for user warning purpose and a button to let him manually trigger an alarm. The PPU electronics is built on an Europe form factor board (160mm x 100mm) and packaged in a metallic enclosure. It contains the necessary functions to condition

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physiological signals, such as filtering, digital analysis and to perform specific higher level processing like HR extraction, run the application, as well as communicate over GPRS with a monitoring center. All the circuits, sensors and communication module are powered by a 1100mAh/3.6V lithium battery. The battery autonomy ranges between a few hours and eight hours, depending on the level of use of the GPRS link. It can be recharged using a dedicated front panel connector. The final aim is to recognize those parameters that define an event. Several statistical tools based on a multifunctional analysis, may be used for this purpose. In order to offer full mobility to the patient or the user, the acquired signals are transmitted wirelessly from the PPU to the remote Monitoring System. The communication is based on TCP/IP that is the standard protocol for GPRS communication. For GPRS bandwidth limitation reason, the monitoring centre shall select the ECG lead to be transmitted (one at the time). All signals are sent in quasi real-time to the remote Monitoring Centre.

3.1 WEALTHY Central Monitoring System The WEALTHY Central Monitoring System is a s/w module interpreting physical sensor data received from the PPU and representing them in simple, graphical forms. It will be used by the proper staff in order to judge the automatically generated alerts and forward only the critical alerts to the doctors and the patients.The user will be able to watch the health status of all patients connected to the Central Monitoring System (through the WEALTHY garments). The definition of the monitoring profiles will provide an easy to use monitoring of the patients health status in real time and with different fully customisable views.

Fig.2: WEALTHY Monitoring System

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Simultaneously, the user will be able to review the generated alerts and using past medical data will determine the true and false alerts and correspondingly contact doctors through direct phone calls and online alerts. This Central Control module is not necessary in order for the Monitoring System to work. It is an optional module ensuring the minimal generation of false alerts to the doctors and will be necessary for large scale hospitals dealing with hundreds of patients.

3.2 The Central Monitoring System performs the following tasks  Coordinates and controls the data flow between the different actors.  Collects and stores the data transmitted by the sensors integrated in the WEALTHY garment through the Portable Patient Unit (PPU).  Continuously monitors vital health parameters of the patients.  Generates alerts to inform doctors for critical health situations.  Gives access to the central database to doctors and other health professionals.  Presents to the qualified users the health situation of the patients using different userfriendly interfaces. All the Monitoring System modules are able to run on a single computer without the need of dedicated high-end servers. The WEALTHY platform will give the possibility to monitor and assist patients through a remote medical advice service. The use of intelligent systems provide to physicians the data to timely detect and manage health risks, diagnose early illness or injury, recommend treatment that would prevent further deterioration and, finally, to make confident professional decisions based on objective information all in a reasonably short time.

4.WEALTHY Interface
Strain fabric sensors based on piezoresistive fabric or yarns, and fabric electrodes made with metal based yarns, enable the realization of wearable and wireless instrumented garments capable of recording physiological signals, to be used during the routinely activity, to be worn instead of a classical garment without discomfort for the user. Respiration, electrocardiogram, electromiogram, activity sensors, temperature, may be listed among the physiological variables that can be monitored through the proposed system.

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Piezoresistive fabric sensors have been realized by using lycra

fabric

coated with carbon loaded rubber, as well as by weaving a commercial electroconductive yarn . These fabrics behave as strain gauge sensors and show piezoresistive properties in response to an external mechanical stimulus. The coated lycra fabric has been used to detect respiration signal, due to the higher efficiency shown in term of quality of the signal, compared with the other fabric sensor. The Europa yarn has been used for the activity sensors and knitted in the multifunctional fabric. The behavior of a knitted piezorestive sensor is different when stretched towards wale or course direction.

Fig.3: Particular of WEALTHY interface Electrodes have been realized with a yarn where two stainless steel wires are twisted around a viscose textile yarn . Electrodes were knitted by using tubular intarsia technique to get a double face, using the external non conductive- part to isolate the electrode from the external environment. The basal yarn (not sensitive) was the same yarn used as core for the conductive electrode yarn. To improve the electrical signal quality in dynamic condition a hydrogel membrane, has been used. The use of the membrane affects also the comfort as electrodes have a rough surface and a prolonged contact with the body can give rise to skin irritations. The contact between conductive fabric and skin can be improved by increasing the adherence of the garment with the use of an higher percentage of elastic component in the yarns. Another approach is the use of conducting rubber or silicon as coating layer for the electrodes. Connections have been realized by means of tubular intarsia technique. A supplementary layer has been woven by using of vanis technique. The final SSGMCE,Shegaon

connection is a multi layered structure where the conductive surface is sandwiched between two insulated standard textile surfaces. The same conductive yarn is used for the electrodes as well as for the realization of connections, a particular of the textile prototype is shown in Figure 3.

5.Garment Model and Realization

The knitted fabric was made with a flat-knitting machine. A draft position of the sensors was implemented on the knitted fabric and then by means of the use of models it was possible to cut the fabric in a way to get the sensors in the desired configuration. The garment was finally sewn, which means that the final position of sensors and connections was achieved in the manufacturing phase. In Fig. 4, the position of electrodes and respiration sensors in the prototype model A is depicted, as well as the position of movement sensors in Fig. 4. Respiration activity is monitored using the coated lycra fabric. Every breath causes a variation in circumference of the thorax and abdomen with an elongation of sensors that change their resistance. As can be seen from Fig.4, the garment is elastic enough to fit the body shape and the conductive elements are all integrated in the textile to allow perfect comfort during the monitoring of signals.

Fig.4: Garment Model( Prototype A)

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Fig. 5 shows the prototype B, with the four electrodes used for the impedance pneumography. The garment also has the electrodes to acquire the ECG signal, precordial and Einthoven leads.

Fig.5: Garment Model( Prototype B) Fig.6 shows the prototype C Garment Model designed for the new born babies where the continuous monitoring of different medical parameters are required.

Fig.6: Garment Model( Prototype C)

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6.Biosensors, Biosignals and Power consumption

6.1 Biosensors and Biosignals This section provides a list of several sensing technologies as depicted in Table 1, which can be integrated as part of a wearable health-monitoring system, along with their corresponding measured physiological signals. The measurement of these vital biosignals and their subsequent processing for feature extraction, leads to a collection of real-time gathered physiological parameters, which can give an overall estimation of the users health condition at any given time. Table 1: Biosensors and Biosignals Type of Bio-signal
Electrocardiogram(ECG)

Type of Sensor
Skin/Chest electrodes

Discription of measured data

Electrical activity of the heart(continuous waveform showing the contraction and relaxation phases of the cardiac cycles). Refers to the force entered by circulating blood on the walls of blood vessels, especially the arteries. A measure of the bodys ability to generate and get rid of heat. Number of movements indicative of inspiration and expiration per unit time(breathing rate). Frequency of cardiac cycle. Electrical activity of the skeletal muscles. Measurment of electrical spontaneous brain activity and other brain potentials. Measurment of acceleration forces in 3D space.

Blood pressure

Arm cuff-based monitor

Body and/or skin temperature Respiration rate

Temperature probe or skin patch Piezoelectric/piezoresistive sensor

Heart rate

Pulse oximeter/skin electrodes Electromyogram(EMG) Skin electrodes Electroencephalogram(EEG) Scalp-placed electrodes Body movements Accelerometer

6.2 Power consumption The power consumption for monitoring different medical parameters and their processing is shown in Table 2. Table 2: Power consumption for monitoring and processing

Function
Data transmission ECG Read-out amplifier for textile sensors Body temperature sensors SpO2 sensors Respiration sensors

Power Consumption
about 50 mW about 1mW 50 mW 45 mW Below 1 mW

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7.Features
 The system is having low weight and size.  The system is comfortable, in order not to interfere with users movments and daily activity.  The system is not affecting the users appearance.  Ultra low power consumption for long-term, maintenance free health monitoring.  The developed system is applicable and useful to real-life scenarios/health condition.  The system incorporates a friendly and easy-to-use interface.  The system produces reliable and accurate results.  The performances of the conductive fabric are not affected by the washing process.  Potentiality of upgrading, enhancing and easily incorporating additional components to the developed system.

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8.Conclusion
The innovative approach of this work is based on the use of standard textile industrial processes to realize the sensing elements. Transduction functions implemented in the same knitted system, where movements and vital signs are converted into readable signals, have been successfully simultaneously acquired. This sensing garment, where sensors, electrodes, and bus structures are all integrated in the textile material, makes it possible to perform normal daily activities while the clinical status is monitored by a specialist, without any discomfort. The use of textile technology is cost effective in the realization of customized sensorized interfaces that can be specialized according to the final target and the specific application.

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Refrences
1. Wearable Sensors: Opportunities and Challenges for Low-Cost Health Care Richard R. Fletcher, Member, IEEE, Ming-Zher Poh, Student Member, IEEE and Hoda Eydgahi. 2. A Wearable Health Care System Based on Knitted Integrated Sensors Rita Paradiso, Giannicola Loriga, and Nicola Taccini IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 9, NO. 3, SEPTEMBER 2005. 3. A Survey on Wearable Sensor-Based Systems for Health Monitoring and Prognosis. Alexandros Pantelopoulos and Nikolaos G. Bourbakis, Fellow, IEEE IEEE TRANSACTIONS ON SYSTEMS, MAN, AND CYBERNETICS PART C: APPLICATIONS AND REVIEWS, VOL. 40, NO. 1, JANUARY 2010. 4. Handbook of Biomedical instrumentation TATA McGRAW HILL, Second Edition By R.S.Khandpur Websites 1. http://www.eetimes.com

2. http://www.wikipedia/wearable health monitoring system wiki.htm.com 3. http:// www.wealthy-ist.com

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