Wearable Technologies for Health: Current and Future By Dr. RGS Asthana Senior Member IEEE

Wearable Technologies for Health: Current and Future 

By

Dr. RGS Asthana

Senior Member IEEE

Figure 1: History of wearable Technology till 2013 [4]

Summary

Health and technology 2030  [1, 15] refers to healthcare approach at not only exploring but also exploiting the potential of new technologies useful  for improving health of patients by providing best diagnosis and treatment by encouraging research, education and services in all relevant disciplines of health. Figure 1 [4] depicts the history of wearable technology. The first common and very useful wearable device was hearing aid.  Devices to monitor personal health and robot-assisted surgery and regenerative technologies are hints of things to come provided research in Artificial Intelligence field progresses in ways that increases the belief of healthcare players, i.e., doctors, nurses, patients and regulators [2, 11].

mHealth [6] has great potential to reduce the costs of healthcare, while improving the quality. The mobile may chime alarms to all relevant people after identifying disease(s) based on parameters monitored by either directly by it or the healthcare apps connected to it.  It may also advise treatment and provide all help in ordering medicine or arranging ambulance or managing doctor’s appointment or admission in hospital based on the seriousness of the case of the individual.

Clothes will be the better choice than wrist wearables in time to come as they will seemingly be less cumbersome.  Clothes will be capable of measuring all body vitals. Many of wearable glasses and clothes will be connected to Internet in a few years.

Keywords

Wearable Technology, mHealth, Clothes, Pillow, Fitness Trackers,  Hololens, Smart Shoes, Wearable Robotics

Review of Wearable Technology

With the growing aging population [1, 15], dominance of chronic diseases, and rising healthcare costs, world is going through a major change, from the hospital-centered system to an individual-centered system.  The first wearable technology was eyeglasses in the13th century. Later, in the 16th century, the earliest portable and wearable clocks were invented.  Another early example of wearable technology came in the form of an abacus ring, during the 17th century in China. The first common and very useful wearable device of recent times is digital hearing aid in 1987.

As per SNS research report [2, 3] wearable device shipments are likely to grow at a compound annual growth rate (CAGR) of 29% between 2016 and 2020. By 2018 and 2020, wearable devices market will be worth $12 and $40 billion respectively.  The Chinese wearable tech market is estimated to represent 360 million people by 2030.  Leading smartphone OEMs, Apple and Samsung are already in smart watch market with a combined share of nearly 75%. New business models will emerge, particularly, in the enterprise space. More than 56 million Health and fitness related wearable devices will be used by people by 2018. The key emphasis in smart watch and medical bands is on health applications only.

This is mainly brought through recent developments in wearable medical technology enabling not only the accessibility but also the affordability of healthcare so that critical parameters as well as the biochemical variables of the patient can be monitored continuously for extended periods of time, making early disease detection and timely response to health threats possible. The wearable technology will be available in form of intelligent biomedical clothing forming body area networks for communication of the data to the healthcare providers.

Smart wearables like the Apple Watch (See Figure 2) and Microsoft’s HoloLens [25] {self-contained holographic computer enabling interaction with high‑definition holograms depicted in figure 3} indicate tomorrow’s status in computing. Further Android Wear, Tizen, and WatchOS are moving ahead with improved user interfaces, user experiences, and applications. 

In addition, mHealth offers opportunities to the pharmaceutical industry ranging from R&D activities to securing the supply chain and struggling to fight Counterfeit Drugs exploiting SMS Technology [7].

Figure 2: Apple watch

Figure 3: Microsoft Hololens [25]

Technology for developing World

Below are a few examples of recent advances in health technology for developing world.

·         Project Masiluleke [12] is handling the HIV/AIDS emergency in South Africa using mobile phone technology. It not only prompts patients of scheduled clinic visits but also advises patients on use of   low-cost HIV self-testing with counseling support via mobile phone technology.  This project is very good example of mHealth described in this article in the following section.

·         Matternet [13] is delivering medicines through automated drones and Mercedes – Benz vans [used for precision landing] to almost inaccessible places in the World.  

·          A disposable credit card-sized mChip has been developed at Columbia University which uses a microfluidic optical chip to diagnose infectious diseases like HIV and syphilis in minutes [13].   The chip was successfully field tested in Rwanda.  A version of the mChip that tests for prostate cancer has also been developed by Claros Diagnostics and was approved in 2010 for use in Europe.

·         Startup X2AI [14] built an AI Application for mental healthcare. It is named Tess. It provides mental health services like psychotherapy and cognitive behavioral therapy.  It can be accessed through SMS, Facebook messenger, and many internet browsers. The company recently demoed their technology in a Syrian refugee camp.

Other Examples   [8]

·         The current market is dominated by wrist wearables like fitness trackers and OS based smart watches from manufacturers like Apple and Samsung. 

·         The effort is now in monitoring critical parameters w.r.t. health such as ECG, EEG, EMG, blood pressure, blood glucose monitoring, aiding in timely and accurate diagnosis. These wearables currently have applications in pain / stress / anxiety management.

·         Despite the presence of new players, several well-known non-healthcare stakeholders such as Apple, Adidas, Asus, Acer, Huawei, Intel, LG, Microsoft, Nike, Philips, Samsung, Sony and Xiaomi have strengthened their position on the market, specifically in activity regarding fitness tracking. 

·         With more and more people becoming aware about smart wearables, trends on social media platforms have demonstrated the growing popularity. 

·         Venture capitalists have funded number of projects totaling over 3 billion USD.

·         We expect smart wearables market to grow at an annualized rate of 13.6% over the coming 15 years.  As the market evolves, North America and Europe will continue to be the biggest contributors. 

Mobile Healthcare or mHealth [6]

As healthcare providers will continue to pursue maximizing their patient outreach while minimizing costs, many view mobile healthcare (or mHealth) to not only improve healthcare nut also cost–efficiency. mHealth refers to the usage of mobile communications technology to increase access to healthcare information and   diagnostic services.

For mobile network operators mHealth an opportunity to grow their subscribers base, particularly, by adopting healthcare centric wearables. These operators wish   to offer services beyond simple connectivity. Many operators already offer branded or co-branded end-to-end mHealth solutions to their customer bases.

Diabetes: non-invasive Glucose Monitoring

Glucowise™ is a non-invasive, 100% pain-free device (May not fall under strict definition of wearable) that makes traditional blood sampling a thing of the past. But this device is so useful for a diabetic that I wanted to mention it anyway.  The unique sensor technology of this device will allow him to monitor blood glucose levels without the need to pierce skin.

Simple yet highly reliable, Glucowise™ [8] {see figure 4} will exceed industry standards for self-monitoring blood glucose accuracy. One can sample as often as one likes and wherever one likes.

Figure 4: Glucowise -- a non-invasive Glucometer [8] integrated to mobile

The information collected by the monitor will be integrated with mobile through   a mobile app, allowing one not only to track his readings over time but also merge data with other information regarding one’s blood glucose levels. Further, it will also be possible to integrate this data with other databases and mobile health apps and platforms, of course with necessary permissions. Such applications can give a big Philip to mHealth.

Clothes [10, 20]

The idea of smart clothing is not new but little has come of it.  Companies like Samsung, Google, OMSignal, Hexo Skin, and Under Armour  wish to make the clothes on your back as smart as the phone in your pocket. Since most wearables are fitness-focused, so will be the smart clothing.  The smart clothes have to be wearables for everyone. Slipping on a smart t-shirt or hooking on a smart bra in the morning doesn’t require any extra effort [23].  Today to know about your body's vital signs, all you need to do is to get dressed.

The main problem with current fitness bands and smart watches is that you need to charge them at least once in 2/3 days.  Imagine if your coat, pants, socks, or shoes have also to be charged then life will be tough.  Since you wear clothing all the time, making the fabric that covers your body smarter would make it easier than ever to keep tabs on your overall wellness without forcing you to go to the gym, or wear anything that you wouldn’t normally wear (see figure 5).  The technology uses conductive yarns, commonly made with silver woven into fabrics which acts as sensors and detects electrical signals, acting as electrocardiograms (ECGs) and electromyograms (EMGs) to measure heart rate and muscle activity respectively.

Clothing Plus - a Finnish company - works on integrating technology [21] and sensors into clothes for sports and medical applications. It offers HRM solutions to custom e-textile development and enables fitness and healthcare brands to reach the market faster, form powerful user experiences and establish durable consumer connections.

Smart watches and bands may have limitations of design but smart clothes don’t have such issues.  Fashion Industry has worked a lot on cloth design and embedding sensors in them and it may not be a big issue.

Figure 5: wearable smart clothing

Think of a scenario where patients are given same type of smart shirt to wear in a ward in hospital.  The doctor comes on round and all the body vitals are measured automatically and shown to the doctor. This is possible but to put it in the hospital environment one needs to take lot of clearances and this scenario could be a few years away.

Socks designed by Danish company Ohmatex [24] monitor edema -- fluid retention commonly in the feet and legs -- by electronically measuring the circumference of the wearer's leg.  

Smart Pillow

On world sleep day, CityZen Sciences with Advansa fibers announced [11] the first connected digital pillow. The smart pillow will track sleep cycles, noise, and also movements. It not only monitors but also processes the sleep data and helps people to improve their sleeping habits.

Fitness Trackers

The right activity tracker for you will be based on your individual needs and your lifestyle. Some will look for just step counting and reliable sleep tracking; others want the benefits of continuous heart rate tracking and feedback on workouts [16].You have fitness trackers from number of vendors [16] viz. Vivosmart HR+ from Garmin: Key features include (KFI) - step counter, sleep monitoring, 24/7 heart rate monitoring, GPS; Charge 2 from Fitbit: KFI - step Counter, sleep monitor, 24/7  monitoring  of heart rate, breathing training, VO2 Max -- a numerical measurement of your body’s ability to consume oxygen [18]; Ray from Misfit: KFI - step count, sleep monitor, buzzes for smartphone notifications; Alta from Fitbit: KFI - step counter, sleep monitor, customizable bands and notifications; best for Stroller pushing parents: Shine 2 from Misfit: KFI - step tracking, sleep monitoring, smartphone notifications, waterproof for swim tracking; UP3 from Jawbone: KFI -   Heart rate (resting and passive), step counter, sleep Monitor; Moov Now from Moov: KFI – steps counter, sleep monitor, advanced sports coaching, run/bike tracking; Cost effective: Xiaomi Mi Band Pulse from Xiaomi,: KFI

– Heart Rate tracking, step counter, sleep monitor, smart alarms, incoming call alerts; Vivoactive HR from Garmin: KFI - Daily steps, 24/7 heart rate, GPS, run/bike/golf tracking i.e. Multi-sport support, notifications; Gear Fit 2 from Samsung: KFI – step counter, sleep monitor, GPS and optical heart rate; Hagen from Skagen: KFI- Step Counter, sleep monitor and discreet notifications etc.

Similarly, you have smart OS based watches from number of vendors [17] with OS Viz. Android, Android Wear (works only with paired Android device), Samsung’s Tizen, Linux, Apple watch iOS and MediaTek’s LinkIt. The watches mainly concentrate on health related apps, many of which are available in health bands also. Sleep analysis on iPhone picked from Apple watch in Sleep++ app is shown in figure 6.  Sleep++ V2.0 [22] has better sleep analysis algorithm to help user get a better understanding of sleep patterns.

Figure 6: sleep analysis picked from apple watch on iPhone in Sleep++ app

Shoes with Wearable Tech

Smart watches or fitness trackers will soon be a thing of the past as Lenovo showed a pair of smart running shoes that come with features found in such devices during the Tech World Show held in San Francisco on June 9, 2016 [26]. 

Figure 7: Lenovo Shoe with LED Light and 3D Scanner [26]

These shoes are not only for walking, but they have 3D scanner in the insole to monitor users' health as well. This scanner can track body fat percentage, amount of sweat during workout and weight.  Besides, shoes can act as a mobile game controller and have LED lights along the bottom (see figure 7).

Insoles provide benefits to enable standing, walking and running not only relaxed but also a pleasure activity. Insoles offer a valuable location for wearables to fetch useful data and this is being done by smart engineers. Good insoles [27] can provide pain relief from a variety of foot and leg pains.

Wearable Supportive Robots Technology

Cyberdyne Inc. [28] has created a robotic exoskeleton – Hybrid Assisted Limb (HAL) – to help disabled people mobile again, enabling them to stand up, walk and even climb stairs.  The exoskeleton, which is worn much like the suit in the movie Iron Man, is built to be used in medical rehabilitation or to help people who have suffered a stroke or spinal cord injury.

Through a number of different sensors and motors, the device, made by Ekso Bionics [29], aids people walk via its mechanical legs. If users move their leg slightly forward, the suit will give mechanical assistance to help the person take a step by sensing the movement. "It's essentially a wearable robot," Nathan Harding, co-founder and CEO of Ekso Bionics, told CNBC.

User-oriented robots run parallel to the wearer's lower limb, which implies robotic leg exoskeletons [30]. Figure 8 shows a picture of the supportive Robotics technology.

Figure 8:  Supportive Robotics [31]

Smart Glass wearables                                                                         

Smart glasses will soon become a part of our daily lives as these glasses will provide plethora of  functionalities like integrating augmented reality, generating and projecting live images at a high resolution with information during our activities, and even letting us manipulate 3D objects with ease.

A recently developed ‘artificial vision’ wearable technology device [36] aims to help the almost 250 million people suffering from low vision globally achieve everyday tasks with more ease than using traditional assistive reading devices, according to a study presented at the latest meeting of the American Academy of Ophthalmology (AAO).

The Orcam, ‘My Eye’ [37] is a hands-free device that can be clipped to eyeglasses. It features a miniature camera that sees, recognizes and converts visual information into the spoken words. Further, focuses on the revolutionary text-to-speech to read any printed text, on any surface, including newspapers, books, computer screens, restaurant menus, labels on supermarket products, and street signs, instantly relaying it to the user through a built-in mini speaker.  In short, ‘My eye’ gives total independence to the user.

At present, market is overcrowded with augmented reality and other glasses/ devices [32].   After a few years, we will know what is good and what we really need. Smart glasses Market is to grow 141% in next 4 years [36].   

3D - printed Bone Implants [33, 34]

Researchers create printable file for the implant from CT scans of the patient to 3 D print an implant. The key issue, however, is material to be used which also can flow through the printer and can withstand temperature changes without variation in properties. The material used [34] in latest implants is very similar to bone, making it ideal for acceptance by a recipient’s body.  The implant made of this material can remain for longer periods of time in body of the recipient than metal implants.  These implants do not disrupt X-rays as its metal counterparts did and are “osteoconductive” – Wikipedia [35] defines it as the “material serves as a scaffold for new bone growth that is perpetuated by the native bone.”

One of the main things is the concept of aesthetic bone grafting in juveniles. The material [33] would grow back to the patient’s own bone and allow the child to grow with the implant.

Oxford Performance Materials (OPM) is an original equipment manufacturer (OEM) of medical devices [34]. The FDA approval of OPM’s first biomedical device paves the way for more 3D-printed medical devices to come which will, ultimately, lead to more affordable, less toxic and more customized implants with a quicker turn-around time, overall.

Conclusion 

“Wearables will become the world’s best-selling consumer electronics product after smartphones,” CNBC reports, citing forecasts by market research firm Euromonitor [5].  Even wearable robots will provide much greater functionality in the coming years.  Now wearables range from fitness monitors to smart watches to clothing to 3D printing of implants. Are implants in category of wearables?

The operating systems which are likely to survive are Android Wear and Apple Watch OS. Tizen from Samsung will be unable to survive long for lack of apps and LinkIt may dominate the lowest end of products.

Everyone in the healthcare ecosystem will benefit from mHealth including mobile network operators, healthcare service providers, pharmaceutical companies, healthcare insurers, government healthcare institutions, infrastructure/device vendors, application developers and software/service vendors. Since, wearables are at nascent stage of development today so there is great opportunity for one to become an expert provided one knows about developments and technologies applicable to this field both forward and backward.

In article on Health and Relevant Technology 2030 [15], the authors described key emerging technologies viz. 3D printing, big data & analytics, robotics, Artificial Intelligence and last but most important Internet of things.  Time will tell that all of these technologies will have major role in development of wearable technology.

It is now known that wrist wearables like health bands and smart watches will soon be overshadowed due to their limited functionality and the wearable tech will move to clothes, socks and shoes as we wear them in every day of our lives. We need to think beyond step counting like bands and create tech that gives practical ideas to improve our well-being. Wrist does not seem to be the right place to put too many sensors in a wrist based device. The key issue in use of such device is necessity to charge them very often.  All of these devices as well as glasses we wear and the augmented reality devices will provide more and more functionality online   and therefore all devices will need to be connected to Internet [3].

References

[1] Wearable Medical Systems for p-Health

http://ieeexplore.ieee.org/document/4711366/

[2] The Wearable Technology Ecosystem: 2016-2030 - Opportunities, Challenges, Strategies, Industry Verticals and Forecasts 

http://www.businesswire.com/news/home/20160504005813/en/Wearable-Technology-Ecosystem-2016-2030---Opportunities-Challenges

[3] Future 2030 by Dr. RGS Asthana, Senior Member, IEEE

https://www.facebook.com/HealthnWelnes/publishing_tools/?refSource=pages_manager_bar

http://www.thetimes.co.uk/tto/health/news/article4157020.ece

[4] Figure 1: History of Wearable Technology

https://www.google.co.in/search?q=wearable+technology&biw=1280&bih=709&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwizs4GKiuvPAhVBuI8KHQKFAZQQ_AUIBygC#imgrc=a50N9Z1KvapHiM%3A

[5] Wearable Technology

http://online.grace.edu/news/business/the-past-present-future-of-wearable-technology/

[6] The mHealth (Mobile Healthcare) Ecosystem: 2015 - 2030 - Opportunities, Challenges, Strategies & Forecasts

http://www.cbs58.com/story/33076914/the-mhealth-mobile-healthcare-ecosystem-2015-2030-opportunities-challenges-strategies-forecasts

[7] Mobile Healthcare (mHealth) Market 2030 Forecasts – Increasing Penetration of Smartphones, Tablets and Wearables Driving Growth

http://www.aboutpharma.com/blog/2016/09/01/mobile-healthcare-mhealth-market-2030-forecasts-increasing-penetration-of-smartphones-tablets-and-wearables-driving-growth/

[8] Imagine living a healthier life with GlucoWise

http://www.gluco-wise.com/

[9] Smart Wearables in Healthcare, 2016-2030 - Industry to Grow at an Annualized Rate of 13.6%

https://globenewswire.com/news-release/2016/09/26/874444/0/en/Smart-Wearables-in-Healthcare-2016-2030-Industry-to-Grow-at-an-Annualized-Rate-of-13-6.html

[10] Why smart clothes, not watches, are the future of wearables
http://www.digitaltrends.com/wearables/smart-clothing-is-the-future-of-wearables/

[11] The Kickstart to Success

https://www.wearable-technologies.com/2016/10/the-kickstart-to-success/

[12] Project Masiluleke

http://www.poptech.org/project_m

[13] Matternet partners with Mercedes-Benz

https://mttr.net/

[14] Bridging the Mental Healthcare Gap With Artificial Intelligence

http://singularityhub.com/2016/10/10/bridging-the-mental-healthcare-gap-with-artificial-intelligence/

[15] Health and Relevant Technology 2030 by Dr. Geeta Asthana, Senior Consultant, Fortis Escorts Heart Institute and Dr. RGS Asthana, Senior Member, IEEE

https://plus.google.com/113904112609362672954/posts/iWae7zxYKKx

[16] Best fitness trackers 2016: Fitbit, Garmin, Misfit and more

http://www.wareable.com/fitness-trackers/the-best-fitness-tracker

[17] What operating System Do Wearable devices run on?

http://www.makeuseof.com/tag/what-operating-systems-do-wearable-devices-run-on/

[18] How important is VO2 Max? What Does yours actually mean?

https://runnersconnect.net/running-training-articles/is-vo2-max-worth-spending-for/

[19] Sleep Time: Sleep Cycle Smart Alarm Clock Tracker, Insights Analysis, Better Soundscape

https://itunes.apple.com/in/app/sleep-time-sleep-cycle-smart/id555564825?mt=8

[20] Why smart clothes, not watches, are the future of wearables
http://www.digitaltrends.com/wearables/smart-clothing-is-the-future-of-wearables/

[21] Clothing Plus

http://www.clothingplus.com/

[22] Sleep++ 2.0 upgrades sleep tracking with the Apple Watch

https://9to5mac.com/2016/02/11/sleep-plus-plus-2-tracking-apple-watch/

[23] How a high-tech bra could be your next doctor

http://edition.cnn.com/2015/05/07/tech/smart-clothes-track-your-health/

[24] Ohmatex: Edema monitoring Socks

http://www.ohmatex.dk/

[25] Bring ideas to life.

https://www.microsoft.com/microsoft-hololens/en-us

[26] Lenovo Shows Off A Pair Of Smart Shoes: Here's What They Can Do

http://www.techtimes.com/articles/164376/20160611/lenovo-shows-off-a-pair-of-smart-shoes-heres-what-they-can-do.htm

[27] Walk on Smart Insoles: The Next Move in Activity Tracking

https://www.wearable-technologies.com/2016/04/walk-on-smart-insoles-the-next-move-in-activity-tracking/

[28] Wearable robotic suit could help disabled to walk

http://www.computerworld.com/article/2524256/app-development/wearable-robotic-suit-could-help-disabled-to-walk.html

[29] With the right tool anything is possible

http://eksobionics.com/

[30] Wearable lower limb robotics: A review

https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0208521613000065?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0208521613000065%3Fshowall%3Dtrue&referrer=http:%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS0208521613000065

[31] Source of Figure 7 https://www.google.co.in/search?q=wearable+robotic+lower+limb&biw=1280&bih=709&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjhgOyJlPrPAhVCQY8KHTx7CTMQ_AUIBigB&dpr=1

[32] 10 Forthcoming Augmented Reality & Smart Glasses You Can Buy

http://www.hongkiat.com/blog/augmented-reality-smart-glasses/

[33] 3D Printing Bones

https://www.asme.org/engineering-topics/articles/bioengineering/3d-printing-bones

[34] The First 3D Printed Polymer Implant to Receive FDA Approval

https://3dprintingindustry.com/news/the-first-3d-printed-polymer-implant-to-receive-fda-approval-5821/

[35] Bone grafting: Osteoconduction

https://en.wikipedia.org/wiki/Bone_grafting#Osteoconduction

[36] Two examples of how enterprise wearables are starting to make their mark

http://www.wearabletechnology-news.com/categories/eyewear/

[37] My Eye

http://www.orcam.com/