UNIT I INTRODUCTION TO WEARABLE SYSTEMS AND

SENSORS
Wearable Systems- Introduction, Need for Wearable Systems,
Drawbacks of Conventional Systems for Wearable Monitoring,
Applications of Wearable Systems, Types of Wearable Systems,
Components of wearable Systems. Sensors for wearable systems-Inertia
movement sensors, Respiration activity sensor, Inductive
plethysmography, Impedance plethysmography, pneumography,
Wearable ground reaction force sensor.

Chapter 1
Wearable Systems- Introduction
Wearable technology is any kind of electronic device designed to be
worn on the user's body. Such devices can take many different forms,
including jewelry, accessories, medical devices, and clothing or
elements of clothing. The term wearable computing implies processing
or
communications capabilitiwesw, wb.EutngignTrreeea.lcitoym, the
sophistication among wearables can vary.

The most sophisticated examples of wearable technology

include artificial intelligence (AI) hearing aids, Google Glass and
Microsoft's HoloLens, and a holographic computer in the form of a
virtual reality (VR) headset. An example of a less complex form of
wearable technology is a disposable skin patch with sensors that transmit
patient data wirelessly to a control device in a healthcare facility.

Need for wearables

Fundamentally, wearables can perform the following basic functions or
unit operations
• Sense
• Process (Analyze)
• Store
• Transmit
• Apply (Utilize)
Of course, the specifics of each function will depend on the application
domain and the
wearer, and all the processing may occur actually on the individual or at
a remote location
(e.g., command and control center for first responders, fans watching the
race, or viewers
enjoying the mountaineer’s view from the Mount Everest base camp).

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Figure 2 is a schematic representation of the unit operations associated

with obtaining and
processing situational data using wearables. For example, if dangerous
gases are detected by a wearable on a first responder, the data can be
processed in the wearable and an alert issued. Simultaneously, it may be
transmitted to a remote location for confirmatory testing and the results
– along with any appropriate response (i.e., put on a gas mask) – can be
communicated to the user in real-time to potentially save a life . This
same
philosophy can also be used by an avid gamer who might change his
strategy depending on what “weapons” are available to him and how his
opponents are performing. Each of these scenarios requires personalized
mobile information processing, which can transform the sensory data
into information and then to knowledge that will be of value to the
individual responding to the situation. While wearables are being used in
many fields, as discussed, this chapter will focus primarily on wearables
in the healthcare domain. Wearables provide an unobtrusive way to
longitudinally monitor an individual – not just during the day but, over
the individual’s life-time. Such an expansive view of the individual will
be valuable in detecting changes over time and help in early detection of
problems and diseases leading to preemptive care and hence, a better
quality of life. Inferring the potential of wearables in other application
domains should be straightforward and can be accomplished by
instantiating the fundamental principles and concepts presented here.
Attributes of wearables
A sensor is defined as “a dewvwicwe.EunsegdgTtoredee.ctoecmt,
locate, or quantify energy or matter, giving a signal for the detection of a
physical or chemical property to which the device responds”. Not all
sensors are necessarily wearable, but all wearables, as discussed earlier
and shown in Figure 2, must have sensing capabilities. The key
attributes required of an ideal wearable are shown in Figure 4. From a
physical standpoint, the wearable must be lightweight and the form
factor should be variable to suit the wearer. For instance, if the form
factor of the wearable to monitor the vital signs of an infant prone to
sudden infant death syndrome prevents the infant from (physically) lying
down properly, it could have significant negative implications. The same
would apply to an avid gamer – if the form factor interferes with her
ability to play “naturally,” the less likely that she would be to adopt or
use the technology. Esthetics also plays a key role in the acceptance and
use of any device or technology. This is especially important when the
device is also seen by others i.e., the essence of fashion. Therefore, if the
wearable on a user is likely to be visible to others, it should be
esthetically pleasing and, optionally, even make a fashion statement
while meeting its functionality. In fact, with
wearables increasingly becoming an integral part of everyday lives, the
sociological facets of the acceptance of wearables open up exciting
avenues for research. Ideally, a wearable should become such an integral
part of the wearer’s clothing or accessories that it becomes a “natural”
extension of the individual and “disappears” for all intents and purposes.
It must have the flexibility to be shape-conformable to suit the desired
end-use; in short, it should behave like the human skin. The wearable
must also have the multifunctional capability and be easily configurable
for the desired end-use application. Wearables with single functionality
(e.g., measuring just the heart rate) are useful, but in practical
applications, more than one parameter is typically monitored; and,
having multiple wearables – one for each function or data stream –
would make the individual look like a cyborg and deter their use even if
the multiple data streams could be effectively managed. The wearable’s
responsiveness is critical, especially when used for real-time data
acquisition and control (e.g., monitoring a first responder in a smoke-
filled scene). Therefore, it must be “always on.” Finally, it must have
sufficient data bandwidth to enable the degree of
interwacwtwiv.iEtyn,ggwThreiceh.coims key to its successful use.
Finally, wearables can be classified based on their field of application,
which can range from health and wellness monitoring to position
tracking. “Information processing” is listed as one of the application
areas because many of these traditional functions such as processing e-
mail can now be done on a wearable in the form of a wristwatch. It is
important to note that not all the classes are mutually exclusive. For
instance, a wearable can be multifunctional, active, noninvasive, and be
reusable for health monitoring. The proposed taxonomy serves two key
functions: First, it helps in classifying the currently available wearables
so that the appropriate ones can be selected depending upon the
operating constraints; second, it helps in identifying opportunities for the
design and development of newer wearables with performance attributes
for sp ecific areas that need to be addressed.
Taxonomy for wearables
Figure 5 shows the proposed taxonomy for wearables. To begin with,
they can be classified as a single function or multifunctional. They can
also be classified as invasive or noninvasive. Invasive wearables
(sensors) can be further classified as minimally invasive, those that
penetrate the skin (subcutaneous) to obtain twhwe
ws.iEgnngaglsT, reoer.caosman implantable, such as a pacemaker.
Implantable sensors require a hospital procedure to be put into place
inside the body. Noninvasive wearables may or may not be in physical
contact with the body; the ones not in contact could either be monitoring
the individual or the ambient environment (e.g., a camera for capturing
the scene around the wearer or a gas sensor for detecting harmful gases
in the area). Noninvasive sensors are typically used in systems for
continuous monitoring because their use does not require extensive
intervention from a healthcare professional.
Wearables can also be classified as active or passive depending upon
whether or not they need the power to operate; pulse oximetry sensors
fall into the former, while a temperature probe is an example of a passive
wearable that does not require its power to operate. Yet another view of
wearables is the mode in which the signals are transmitted for processing
wired or wireless. In the former, the signals are transmitted over a
physical data bus to a processor; in the wireless class of wearables,
the
communications capability is built into it, which transmits the signals
wirelessly to a monitoring unit.

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Components of wearable Systems.
The main components of wearable devices are as follows

1. Control
Wearable-specific microcontrollers are small, so as to be comfortable
and discrete. On the other hand, the distinctive shapes and colors can
function as a decorative element. Several of the boards available are
hand- washable (minus the power source). Read the documentation
carefully.

2. Input/Output
In place of pins, these boards have metal eyelets which you can loop
conductive thread through to sew soft circuit connections. Some boards
also have snaps — or eyelets large enough to solder on snaps — for easy
removal.

3. Conductive Textiles
A material containing metwalws,ws.EuncghgaTsresei.lcvoemr or
stainless steel, through which an electrical current can flow is said to be
conductive. Wearable systems can make use of these materials in a
variety of ways, such as:
 Thread for making circuits
 Fabric for capacitive touch sensors
 Hook-and-loop for switches

4. Sensors
Sensors gather information about the environment, the user, or both.
Examples of the former include light, temperature, motion (ACC), and
location (GPS). Examples of the latter include heart rate (ECG), brain
waves (EEG), and muscle tension (EMG). A few wearable
microcontrollers have basic sensors onboard. Other manufacturers offer
a range of external sensor modules that connect to the main board.

5. Power
When scoping out a wearable design one of the first things to consider is
the power requirement. Do you just want to illuminate a few LEDs, or
do you want to run a servomotor? Boards with an integrated holder for a
lithium coin battery are nice for low-power projects that need to be self-
contained. However, boards with a standard JST connector (with or
without a circuit to charge LiPo batteries) are more versatile.

6. Actuators
One generic way to describe a wearable system is: In response to X,
where X is the input from a sensor, Y happens. Actuators such as LEDs,
buzzers or speakers, and servomotors are what make things happen.

7. Networking
To communicate with smart devices, the internet, or other wearable
systems, you need wireless connectivity. In addition to Wi-Fi and
Bluetooth, wearable-friendly options include:
 BLE, which has lower pwowwwe.rEncgognTsureme.pctoiomn
than classic Bluetooth, a range of 50m, and a data transmission rate
up to 1 Mbps
 NFC, a radio frequency field with a range of approximately 20cm and
data transmission rate up to about 400 Kbps

Types of Wearable Systems

1. Smartwatches:

These days, the watches are tech-enabled. They double up as a fitness

tracker, and sleep monitor in addition to being the classic time-keeping
device. Smartwatches provide us with many other features including
enabling us to make & attend phone calls and check messages. Some
watches have the feature of playing FM radio or audio & video files with
a Bluetooth headset. They generally connect to the smartphone via an
app and act as a supporting device. They are often referred to as a
‘Wearable
Computer’ on your wrist because of the bundle of features that can use
through the touchscreen.

2. FitnessTrackers:

Fitness Trackers are among the wearable technology devices wearable

on the wrist. Fitness trackers were primarily launched to perform the
function of pedometer, i.e. counting the number of steps but they have
evolved to become an overall health monitor since then. They perform
various functions including tracking your heartbeat, monitoring your
sleep, calories burned, and other metrics. They share the data to the app
on the smartphone. In toto, they make a perfect health tracker. Some
devices are enabled to regularly share the information on the metrics of
the wearer to their physicians to keep them informed and help early
detection of any issue.

3. SmartJewelry: www.EnggTree.com

Jewelry no more acts like pieces of ornaments on your neck or hand,

they have become smart. Smart Jewelry are those wearables like
necklaces, wrist bands, bracelets, or rings that are tech-enabled to help
you track your steps, track monitor your heartbeat & sleep, and some
even notify you of incomingcalls.

4. GameSimulators:

The rise of VR in gaming has given rise to many wearable devices that
simulate an environment and make the experience more realistic,
engrossing, and adventurous. The devices include VR Headsets (also
called Head-Mounted Displays or HMDs) that create a visual simulation
and bands that come with built-in sensors to detect your movements.
These bands enable you to control your movements through hand
gestures.

5. SmartClothing:

The advancement of technology with IoT has fostered many inventions

including Smart Clothes. Smart clothes are also popularly known as E-
Textile as they come integrated with electronic devices that measure the
health metrics of the wearer. Smart clothes help measure health-related
aspects like heart rate, respiration rate, sleep, the body temperature, and
provide you with that information. Smart clothing also includes smart
shoes that examine your health, steps, fatigue, and collect other metrics
to help you improve health and prevent injury.

6. SmartGlasses:

Ranging from simple smart glasses that are equipped with Bluetooth
w w w .E n g g Tr e e .c o m
wireless music and hands-f re e c al l in g t o t h e glasses
that can live stream
videos to take photos, to advanced smart glasses that are AR-enabled to
give you an immersive experience, these smart glasses are the of
eyewear. Smart glasses can enable the user to read text messages and
reply to them hands-free. Smart glasses by some companies are
equipped with features like internet access and browsing
through voice commands.

7. HeartbeatTrackers&BloodPressureMonitors:

There are fitness trackers for a specific use case like monitoring the
heartbeat or regularly measuring the blood pressure. These devices help
track the metrics among the people who suffer from related diseases.
The fitness trackers record and provide the measurements to the wearer
regularly. Some devices are enabled to share the data with the physician.

8. SmartEarbuds:
New to enter the wearable technology market are earbuds. Though
Bluetooth earbuds are existing for a while now, they aren’t considered
among wearable technology because they do not collect and send data.
But some companies are making earbuds smart. Smart earbuds have a
built-in gyroscope, GPS, and compass. The sensors in the earbuds relay
the information to the smartphone, which enables it to know your
direction and movement. Hence, the smart earbuds are equipped to
provide directions in real-time.

9. SmartContactLens:

Smart Contact Lens is among the recent inventions made possible with
IoT. The smart contact lenses currently available in the market are
helpful for medical reasons. It helps monitor eyes for various diseases
like Diabetes, Glaucoma, and cataracts. It helps in the
treatment of
farsightedness. Apart from medical reasons, some companies are
w w w .E ng g
working on smart contact lenses tha t a re A R -
T r e e .c o m
e n a b le d , work on solar power, and
capture and store images and videos. Smart lenses are among the
implantable devices.
Applications of wearables
Currently other applications within healthcare are being explored, such
as:

 Applications for monitoring of glucose, alcohol, and lactateor blood

oxygen, breath monitoring, heartbeat, heart rate and
its variability, electromyography (EMG), electrocardiogram (ECG)
and electroencephalogram (EEG), body temperature, pressure (e.g. in
shoes), sweat rate or sweat loss, levels of uric acid and ions – e.g. for
preventing fatigue or injuries or for optimizing training patterns,
including via "human-integrated electronics"
 Forecasting changes in mood, stress, and health
 Measuring blood alcohol content
 Measuring athletic performance
 Monitoring how sick the user is
 Detecting early signs of infection
 Long-term monitoring of patients with heart and circulatory problems
that records an electrocardiogram and is self-moistening
 Health Risk Assessment applications, including measures
of frailty and risks of age-dependent diseases
 Automatic documentation of care activities
 Days-long continuous imaging of diverse organs via a
wearable bioadhesive stretchable high-resolution ultrasound imaging
patch or e.g. a wearable continuous heart ultrasound imager (potential
novel diagnostic and monitoring tools)
 Sleep tracking
 Cortisol monitoring for measuring stress
 Measuring relaxation or alertness e.g. to adjust their modulation or to
measure efficacy of modulation techniques
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m
 Epidermal skin technology. According to Science Daily, the
Terasaki Institute for Biomedical Innovation invented wearable
electronic skin for monitoring health. A next-generation of
wearables, this ultra-thin e-skin patch can be attached to the
wearer's chest area along with a small wireless transmitter by using
water spray and can be worn for up to a week. It is sensitive
enough to pick up and record electro signals, such as heartbeats
and muscle movements, which can be sent to healthcare providers
via the cloud so they can monitor the user's vitals remotely. This
powerful wearable is a steppingstone for monitoring chronic
illnesses such as heart failure and diabetes.

 Health monitoring. People use wearable technology to track and

receive notifications for their heart rate and blood pressure, watch
their calorie intake or manage their training regimens. The
COVID- 19 pandemic boosted the use of wearable technology, as
consumers gained a broader awareness of personal hygiene and
taking
 precautions to prevent the spread of infections. Apple, for instance,
updated its Cardiogram app by introducing a new sleeping beats-
per-minute feature that monitors heart rate fluctuations for
COVID- 19 patients.

 Entertainment and gaming. The gaming and entertainment

industries were the first to adopt VR headsets, smart glasses and
controllers. Popular VR head-mounted displays, such as Oculus
Quest, Meta Quest and Sony PlayStation VR, are used for all types
of entertainment purposes, including gaming, watching movies and
virtual traveling.

 Fashion and smart clothing. Clothing known as smart clothing,

or intelligent fashion, has been gaining wide popularity over the
past few years. Smart jackets, such as Levi's jacket made with
Google's Project Jacquard technology whose threads are composed
of electrical fibers, enable the wearer to answer calls, play music or
take photos right
frowmwwth.EenirggsTlereeev.ecso.mSmartwatches, wristbands,
smart shoes and smart jewelry are also popular examples of
wearable technology.

 Military. These wearables include technology that tracks soldiers'

vitals, VR-based simulation exercises and sustainability
technology, such as boot inserts that estimate how well the soldiers
are holding their equipment weight and how terrain factors can
affect their performance.

 Sports and fitness. Sports use wearable athletic devices that are
either built into the fabric of the sports apparel or are incorporated
into sports equipment, such as bats and balls. The GPS and
Bluetooth-linked devices relay real-time data to coaches for
analysis through connected electronic devices such as laptops.
Besides wearable athletic devices, familiar wearable technology
such as Fitbit, Apple Watch, Garmin, Samsung Galaxy Watch and
Polar are
 used extensively to track various areas of the player's health and
performance metrics.

Advantages of Wearable Technology

 Rapid data results can help drive improvements. Having

immediate data to make decisions and drive improvements may
be helpful, rather than waiting for more formal or detailed
assessments.
 Detailed data can supplement loss analysis and loss
trends. Additional data can help identify specific trends in your
claims history.
 Can help build a business case for senior management. It can
be challenging to help senior management make decisions or
determine if some of your funding should be spent on
improvements. The data from wearable technology devices can
help support your bwuwsiwn.eEsnsgcgaTsreefeo.crotmhat
spend.
 Data from wearable sensors offers promising job risk
analysis and evaluation opportunities for safety and
ergonomics practitioners. Most ergonomic assessments or
evaluations require additional time to observe and manually
collect data. Having instant data can save time and expedite
ergonomic assessments or evaluations.
 Enhance employee wellness programs. More organizations are
starting to promote wellness programs for employees. Some
wearable technology devices can assist with easily tracking
wellness program data that could supplement or support your
efforts.

Disadvantages of Wearable Technology

 Requires a time commitment to review and analyze data. A
team or committee may need to review the large amount of data
that is generated from the devices.
  Requires financial commitments and planning. You may
need senior management or finance team approval prior to the
full implementation stage. The cost of wearable technology
depends on how many employees and locations are involved.
 Devices could lead to distraction. For many employees,
wearing this device for an entire shift can be distracting,
especially if the device has haptic feedback or vibration
reminders.
 Data security and privacy could be compromised with legal,
financial, and personal consequences. An information
technology (IT) department will need to ensure the data
generated from the devices is secured for authorized individuals
and ensure proper consent is obtained from each individual
whose data is being collected.
 Devices could lead to over-trust or under-trust. This could be
challenging when reviewing all the data to determine realistic
trends. Sometimes this results in trusting or not trusting all the
reviewed data before making any decisions or improvements.

Sensors for Wearable Systems

Introduction
When designing wearable systems to be used for physiological and
biomechanical parameters monitoring, it is important to integrate sensors
easy to use, comfortable to wear, and minimally obtrusive. Wearable
systems include sensors for detecting physiological signs placed on-body
without discomfort, and possibly with capability of real-time and
continuous recording. The system should also be equipped with wireless
communication to transmit signals, although sometimes it is opportune
to extract locally relevant variables, which are transmitted when needed.
Most sensors embedded into wearable systems need to be placed at
specific body locations, e.g. motion sensors used to track the movements
of body segments, often in direct contact with the skin, e.g.
physiological sensors such as pulse meters or oximeters. However, it is
reasonable to embed sensors within pieces of clothing to make the
wearable system as less obtrusive as possible. In general, such systems
should also contain some elementary processinwg
wcawp.EabnigligtTierseeto.cpomerform signal pre-processing and
reduce the amount of data to be transmitted. A key technology for
wearable systems is the possibility of implementing robust, cheap
microsystems enabling the combination of all the above functionalities
in a single device. This technology combines so-called micro-electro-
mechanical systems (MEMS) with advanced electronic packaging
technologies. The former allows complex electronic systems and
mechanical structures (including sensors and even simple motors) to be
jointly manufactured in a single semiconductor chip. A generic wearable
system can be structured as a stack of different layers. The lowest layer
is represented by the body, where the skin is the first interface with the
sensor layer. This latter is comprised of three sub-layers: garment and
sensors, conditioning and filtering of the signals and local processing.
The processing layer collects the different sensor signals, extracts
specific features and classifies the signals to provide high-level
outcomes for the application layer. The application layer can provide the
feedback to the user and/or to the professional, according to the specific
applications and to the user needs. Recent developments embed signal
processing in their
systems, e.g. extraction of heart rate, respiration rate and activity level.
Activity classification and more advanced processing on e.g. heart
signals can be achievable exploiting miniaturization and low-power
consumption of the systems. Examples of data classification are[1, 2, 3]:
classification of movement patterns such as sitting, walking or resting by
using accelerometer data [4] or ECG parameters such as ST distance
extracted from raw ECG data [5, 3]; another example is the estimation of
the energy consumption of the body [6, 7]; in [8] the combined use of a
triaxial accelerometer and a wearable heart rate sensor was exploited to
accurately classify human physical activity; estimation of upper limb
posture by means of textile embedded flexible piezo resistive sensors
[9]. Examples of integrated systems for health monitoring are in [10,
11]. In the following paragraphs, two classes of sensors which can be
easily integrated into wearable systems are reported and described. More
specifically, inertial sensors to monitor biomechanical parameters of
human body and sensors to capture physiological signs are addressed,
describing the operating principles and indicating the possible fields of
application.
Sensors for Wearable
Systems Biomechanical
Sensors
Biomechanical sensors are thought to be used to record kinematic
parameters of body segments. Knowledge of body movement and
gesture can be a means to detect movement disturbances related to a
specific pathology or helpful to contextualize physiological information
within specific physical activities. An increasing of heart rate, for
example, could be either due to an altered cardiac behavior or simply
because the subject is running.
Inertial Movement Sensors
Monitoring of parameters related to human movement has a wide range
of applications. In the medical field, motion analysis tools are widely
used both in rehabilitation and in diagnostics. In the multimedia field,
motion tracking is used for the implementation of life like videogame
interfaces and for computer animation. Standard techniques enabling
motion analysis are based on stereo-photogrammetric, magnetic and
electromechanical systems. These devices are very accurate but they
operate in a restricted area and/or they require the application of
obtrusive parts on the subject body. On the other hand, the recent
advances in technology have led to the design and development of new
tools in the field of motion detection which are comfortable for the user,
portable and easily usable in non-structured environments. Current
prototypes realized by these emergent technologies utilize micro-
transducers applied to the subject body (as described in the current
paragraph) or textile-based strain sensors. The first category, instead,
includes devices based on inertial sensors (mainly accelerometers and
gyroscopes) that are directly applied on the body segment to be
monitored. These sensors can be realized on a single chip (MEMS
technology) with low cost and outstanding miniaturization.
Accelerometers are widely used for the automatic discrimination of
physical activity and the estimation of body segment inclination with
respect to the absolute vertical. Accelerometers alone are not indicated
for the estimation of the full orientation of body segments. The body
segment orientatiwown wc.aEnnbgegTersetiem.caotmed by using the
combination of different sensors through data fusion techniques (Inertial
Measurement Units, IMU). Usually, tri-axial accelerometers
(inclination), tri-axial gyroscopes (angular velocity), magnetometers
(heading angle) and temperature sensors (thermal drift compensation)
are used together. Main advantages of using accelerometers in motion
analysis are the very low encumbrance and the low cost. Disadvantages
are related to the possibility of obtaining only the inclination information
in quasi-static situations (the effect of the system acceleration is a noise
and the double integration of acceleration to estimate the segment
absolute position is unreliable). Accelerometers are widely used in the
field of wearable monitoring systems, generally used in the monitoring
of daily life activities (ADL). Physical activity detection can be
exploited for several fields of application, e.g. energy expenditure
estimation, tremor or functional use of a body segment, assessment of
motor control, load estimation using inverse dynamics techniques [26,
27] or artificial sensory feedback for control of electrical neuromuscular
stimulation [28, 29, 30]. Usually, three-axial accelerometers are used.
They can be assembled by mounting three single-axis accelerometers in
a box with their sensitive axes in orthogonal directions or using a sensor
based on one mass [31]. An accelerometer measures the acceleration and
the local gravity that it experiences. Considering a calibrated tri-axial
accelerometer (the accelerometer signal (y) contains two factors: one is
due to the gravity vector (g) and the other depends on the system inertial
acceleration (a), both of them expressed in the accelerometer reference
frame :The inclination vector (z) is defined as the vertical unit vector,
expressed in the accelerometer coordinate frame [4]. In static conditions,
only the factor due to gravity is present and the inclination of the
accelerometer with respect to the vertical is known. In dynamic
conditions, the raw accelerometer signal does not provide a reliable
estimation of the inclination, since the inertial acceleration is added to
the gravity factor. This estimation error grows as the subject movements
become faster (e.g. running, jumping). Many algorithms have been
developed and tested to perform a reliable estimation of the subject body
 inclination: most of them use low pass filters with very low cut-off
frequency in order to extract z[4] (i.e. introducing a
conwsiwdewr.aEbnlgegtTimreee.dcoelmay), others implement more
complex techniques which use a model-based approach mainly based on
Kalman filter techniques. An example of integration of these sensors in a
garment was developed in the frame of the Proetex project (FP6-2004-
IST-4-026987), which aimed at using textile and fibre based integrated
smart wearables for emergency disaster intervention personnel. The
ProeTEX motion sensing platform is used to detect long periods of user
immobility and user falls to the ground and it is realized by means of
two tri-axial accelerometer modules. One accelerometer is placed in the
higher part of the trunk (collar level) in order to detect inactivity and
falls to the ground. The second sensor is placed in the wrist region and
its aim is to achieve more accuracy in inactivity detection, since an
operator can move his arms while his trunk is not moving. The core of
the motion sensor is the processing algorithm described in, which allows
to perform a reliable estimation of the body inclination even in the case
of intense physical activity such as running or jumping. This algorithm
allows a good estimation of subject activities and generated fall alarms
with very high sensitivity and extremely low level of false positives.

Respiration Activity sensor

The Respiratory monitoring is one of the most challenging aspects of
recording vital signs continuously and accurately due to movement
artifacts and the limitations of filtering or feature recognition
algorithms. These challenges make it difficult to consistently capture
reliable respiratory data, particularly during physical activity or under
real-world conditions.
Types of Monitoring Methods
Respiratory activity is measured by collecting data on lung air
exchange—the amount of air inhaled and exhaled over a given period of
time. Methods used in literature can be categorized into direct and
indirect techniques.
Direct Methods
Direct methods involve the measurement of airflow exchanged in the
lungs during respiration. The most common direct method is using a
spirometer, which directly measures airflow during both inhalation and
exhalation. A spirometer is highly accurate but requires a mouthpiece,
which is impractical for wearable systems. The mouthpiece restricts
movement, interferes with natural breathing patterns, and can cause
discomfort for the user, making it unsuitable for continuous, daily
monitoring.
 Limitations:
o Non-wearable: The mouthpiece of a spirometer makes it
intrusive and disruptive to daily activities.
o User discomfort: Continuous use for monitoring normal
activities is not feasible due to the need to breathe through the
device.
o Interference with natural breathing: The presence of a
mouthpiece affects natural respiratory mechanics and can
introduce bias in data collection.
Indirect Methods
Indirect methods estimate respiratory activity by measuring parameters
correlated to breathing, such as changes in thorax circumference,
cross-sectional area, or trans-thoracic impedance. These methods do
not require direct measurement of airflow but instead rely on mechanical
or electrical changes associated with respiration.
Techniques for Indirect Monitoring:
1. Chest and Abdominal Surface Movements:
Indirect methods measure the displacement of the lung, which is
transferred to the chest wall. By observing rib cage and abdominal
motion, an estimate of lung volume variation can be made. Several
devices have been developed for this purpose, including:
o Mercury-in-rubber strain gauges: Measure changes in
circumference but are bulky and difficult to integrate into
wearables.
o Linear differential transducers: Detect movement, but their
application is similarly restrictive for daily use.
 o Magnetometers and optical techniques: These methods
provide accurate data on movement but are impractical for
continuous, mobile monitoring.
2. Advanced Indirect Techniques:
o Stereo Photogrammetry: This technique allows for the
estimation of three-dimensional coordinates of thoracic points
to measure volume variations. However, it is highly
cumbersome, expensive, and limited to research
environments or laboratory settings.
Wearable-Compatible Indirect Methods
Wearable systems for respiratory monitoring utilize indirect methods
that can be minimally invasive and comfortable for daily use. Some of
the most commonly used methods in this category include:
1. Respiratory Inductive Plethysmography (RIP):
This method involves placing elastic bands with embedded sensors
around the rib cage and abdomen. These sensors detect changes in
thoracic and abdominal circumference during breathing. The
signals generated are proportional to the lung's air volume. RIP is
widely used in wearable respiratory monitoring systems because it is
non-invasive and does not interfere with natural breathing.
2. Impedance Plethysmography:
This technique uses electrical impedance to measure respiratory
activity. Electrodes are placed on the body, and variations in the
impedance between the electrodes correspond to breathing
movements. The main advantage of impedance plethysmography is
its ability to integrate with wearable devices, allowing for
continuous monitoring without causing discomfort.
3. Piezoresistive and Piezoelectric Pneumography:
In these methods, piezoresistive sensors change their electrical
resistance when stretched or compressed during breathing. The
sensors are often embedded in fabrics or garments, making them
ideal for wearable applications. Similarly, piezoelectric sensors
generate electrical signals in response to mechanical stress caused
by breathing movements. Both technologies are minimally invasive
 and can be easily integrated into everyday clothing or other
wearable systems, providing continuous, real-time respiratory
monitoring.
Challenges in Respiratory Monitoring
 Movement Artifacts: Wearable systems must address motion
artifacts caused by body movements during physical activity. These
artifacts can obscure or distort the respiratory signal, leading to
inaccurate measurements.
 Signal Processing: Filtering algorithms and feature recognition
techniques must be refined to distinguish between actual respiratory
signals and noise, improving the reliability of data collected in real-
world scenarios.
Conclusion
While direct methods like spirometry provide accurate measurements,
they are impractical for continuous use in everyday settings due to their
intrusive nature. Indirect methods, such as respiratory inductive
plethysmography, impedance plethysmography, and
piezoresistive/piezoelectric pneumography, are more suitable for
wearable systems. These methods are minimally invasive, do not
interfere with natural breathing, and can provide reliable continuous
respiratory monitoring. However, challenges like movement artifacts
and signal processing limitations must be addressed to improve the
accuracy and practicality of these wearable systems.
In summary, indirect wearable methods offer promising solutions for
continuous respiratory monitoring, with applications ranging from
medical diagnostics to personal health tracking, despite the technical
hurdles involved in ensuring accurate data collection during normal,
daily activities.

Inductive Plethysmography
The Inductive plethysmography (also known as Respiratory Inductive
Plethysmography (RIP)) is a non-invasive method used to monitor
respiratory patterns by measuring the cross-sectional area changes of the
rib cage and abdomen. This method relies on the placement of two
elastic conductive wires around the thorax and abdomen, forming a key
part of respiratory monitoring systems in clinical settings, home care,
and even athletic performance tracking.

1. Principle of Operation:
Inductive plethysmography functions by detecting the changes in the
cross-sectional areas of the thorax and abdomen during the respiratory
cycle. As a person breathes, both the rib cage and abdominal regions
expand and contract. These changes in body dimensions alter the cross-
sectional area, which the system translates into respiratory volume data.
The conductive wires used in this technique are insulated and typically
sewn in a zigzag pattern onto elastic bands. These wires act as inductive
coils, which are important for modulating the output of an electric
oscillator circuit. The electrical current passing through the wires
generates a magnetic field, and as the body expands and contracts during
breathing, it causes changes in the magnetic field's flow.
2. Self-Inductance and Output Frequency Modulation:
Each coil formed by the zigzag arrangement of the conductive wires
experiences changes in self-inductance as the rib cage and abdomen
move. Specifically, as the cross-sectional area of the thorax or abdomen
changes, the magnetic field generated by the coils is altered. This
variation in the magnetic field affects the self-inductance of each coil,
which in turn modulates the frequency of the sinusoidal oscillator output
signal.
The principle behind this modulation is that the oscillating current
flowing through the coils generates a sinewave. Any change in the cross-
sectional area, due to respiration, influences the magnetic flux through
the coils, leading to a change in inductance. This change modulates the
frequency of the oscillator, which can be measured and used to
determine respiratory parameters like breathing rate and tidal volume.

3. Lung Volume Approximation:

To achieve accurate respiratory volume measurements, inductive
plethysmography assumes that the cross-sectional area measured by the
thorax and abdomen coils corresponds to the volume changes in the
respective lung compartments. The lung volume is estimated as the sum
of the volume changes in the rib cage and abdominal regions. This
method can approximate lung volume with an error of less than 10%
under optimal conditions.
This approximation is based on the idea that the thorax and abdomen
move in sync with the respiratory cycle. While breathing, the rib cage is
responsible for a significant portion of the lung volume change,
especially during deep breathing, while the diaphragm (causing
abdominal movement) also plays a vital role in controlling lung volume.
The combined movement of these two compartments gives a fairly
accurate estimate of the total lung volume.
4. Components of the System:
Conductive Wires: These act as inductive coils, and their arrangement in
a zigzag pattern enhances their ability to stretch and contract with the
thorax and abdomen. The elastic nature of the wires allows them to
return to their original position after each breath cycle.
Oscillator Circuit: This circuit generates the sinewave current that flows
through the conductive coils. The frequency of this current changes
based on the inductance of the coil, which in turn varies with the
respiratory movements.
Magnetic Field: The coils generate a magnetic field that fluctuates with
each breath, causing changes in self-inductance and consequently
modulating the output frequency of the oscillator.
Signal Processing: The changes in frequency are processed and
converted into meaningful data that represent the individual's breathing
patterns, including respiratory rate, tidal volume, and even respiratory
effort.
5. Advantages of Inductive Plethysmography:
Non-invasive: RIP is a completely non-invasive method, making it ideal
for long-term monitoring in both hospital and home settings.
Comfortable: The system consists of elastic, lightweight bands that can
be easily worn, ensuring that the patient or user remains comfortable
throughout the monitoring period.
Real-time Monitoring: Inductive plethysmography provides real-time
data, allowing for continuous monitoring of respiratory activity. This is
particularly useful in conditions like sleep apnea, asthma, and chronic
obstructive pulmonary disease (COPD).
Accuracy: While there may be a small margin of error, inductive
plethysmography offers fairly accurate estimates of lung volume and
respiratory activity, especially when calibrated properly.
6. Clinical and Practical Applications:
Sleep Studies: RIP is commonly used in polysomnography to monitor
breathing patterns during sleep and detect conditions like sleep apnea.
Respiratory Disorders: It helps in the diagnosis and management of
patients with respiratory diseases like asthma, COPD, and restrictive
lung diseases.
Fitness Monitoring: Athletes can use inductive plethysmography to
monitor their breathing efficiency during training sessions, ensuring
optimal performance.
Post-operative Monitoring: It is used to track breathing in patients
recovering from surgery, especially those at risk of respiratory
complications.
7. Limitations:
Accuracy: While RIP can provide good approximations of lung volume,
it may not be as precise as other methods like spirometry, especially in
patients with abnormal breathing patterns or chest wall deformities.
Calibration: The system requires proper calibration to ensure accurate
measurements. Factors like body position, movement, and tightness of
the bands can affect the readings.
Limited Information on Gas Exchange: While RIP measures the
mechanical aspects of breathing, it does not provide information on gas
exchange, such as oxygen or carbon dioxide levels, which are crucial in
some clinical settings.
Advancements in wearable technology and wireless communication are
likely to improve the capabilities of inductive plethysmography.
Integration with smart devices and cloud-based systems can provide
more convenient, real-time tracking and analysis, while minimizing
manual data processing.
In conclusion, inductive plethysmography is a versatile and non-invasive
tool for respiratory monitoring that provides accurate and continuous
data on breathing patterns. By using the principles of self-inductance and
frequency modulation, it offers an effective way to estimate lung volume
and detect respiratory disorders. Despite its limitations, it remains a
valuable method in both clinical and non-clinical settings, with ongoing
developments likely to expand its applications in healthcare and fitness.
Impedance Plethysmography
Impedance plethysmography is a non-invasive technique used for
measuring various respiratory and cardiovascular parameters, such as
breathing rate, tidal volume, lung water, functional residual
capacity, and cardiac output. This method involves injecting a high-
frequency, low-amplitude current through a pair of electrodes placed
on the thorax and measuring the resulting changes in trans-thoracic
electrical impedance.
1. Basic Principle of Operation:
The key principle behind impedance plethysmography is the relationship
between the electrical impedance of the thorax and the flow of air
through the lungs. When air enters the lungs during inhalation, the
volume of the thorax increases, which in turn changes the electrical
impedance. As air leaves the lungs during exhalation, the impedance
decreases. This cyclical change in impedance is directly related to
respiratory activity and can be used to monitor breathing patterns.
The electrical impedance of the thorax is influenced by both the tissue
composition (such as muscle, bone, and lung tissue) and the volume of
air within the lungs. Since air has a significantly different impedance
compared to tissue, any change in lung volume due to breathing can be
detected by measuring impedance.
2. Electrode Configurations:
There are two main configurations for impedance plethysmography:
 Two-Electrode Configuration: In this configuration, a pair of
electrodes is placed on the thorax. One electrode injects the high-
frequency current, and the other electrode measures the impedance.
This configuration is simpler but may have some limitations in
terms of accuracy, as it measures impedance changes over a
localized region.
 Four-Electrode Configuration: In this more advanced
configuration, two electrodes are used to inject the current, and two
additional electrodes are used to measure the voltage drop across the
thorax. This configuration provides more accurate and stable
measurements because it reduces the effect of contact impedance at
the electrode-skin interface.
3. Electrode Materials and Integration:
The electrodes used in impedance plethysmography can be made from
fabric materials and can be integrated into wearable garments. This
allows for comfortable, continuous monitoring of respiratory parameters.
Electrodes can even be embedded into an undershirt or other clothing,
making this method ideal for long-term, unobtrusive monitoring in both
clinical and home settings. This sensorized garment technology
provides flexibility and comfort for patients or individuals being
monitored.
4. Parameters Monitored:
Impedance plethysmography is capable of monitoring several important
physiological parameters:
 Breathing Rate: By measuring the cyclical changes in thoracic
impedance, the technique can accurately track the rate of breathing.
 Tidal Volume: The volume of air inhaled and exhaled with each
breath, known as tidal volume, can be estimated by analyzing the
amplitude of the impedance changes.
 Functional Residual Capacity (FRC): This refers to the volume of
air remaining in the lungs after a normal exhalation. Changes in
impedance can give an estimate of FRC.
  Lung Water: Impedance plethysmography can detect the presence
of excess fluid in the lungs (pulmonary edema), as water has
different electrical conductivity compared to air and lung tissue.
 Cardiac Output: By analyzing the impedance waveform, cardiac
output (the amount of blood the heart pumps per minute) can also be
estimated.
5. Advantages:
 Non-Invasive: Impedance plethysmography is a completely non-
invasive method, meaning that it does not require any internal
probes or catheters. This makes it comfortable for the patient and
reduces the risk of infection.
 Continuous Monitoring: The use of wearable electrodes or
garments allows for continuous, real-time monitoring of
respiratory and cardiovascular parameters. This is particularly useful
in critical care, sleep studies, and home health monitoring.
 Portability: The ability to integrate the electrodes into garments
makes the system highly portable, allowing patients to move freely
while still being monitored.
6. Limitations:
 Sensitivity to Movement: One of the challenges of impedance
plethysmography is its sensitivity to motion artifacts. Movements
of the body, such as physical activity or changes in posture, can
affect the impedance readings and introduce noise into the
measurements.
 Accuracy: While impedance plethysmography provides valuable
insights into respiratory and cardiovascular health, its accuracy can
be affected by factors such as skin conductivity, electrode
placement, and the individual’s body composition. It may not be as
precise as other invasive methods for measuring parameters like
cardiac output.
7. Applications:
 Respiratory Monitoring: Impedance plethysmography is widely
used in respiratory monitoring for patients with chronic respiratory
 diseases such as chronic obstructive pulmonary disease (COPD) and
asthma. It is also used in sleep studies to monitor breathing patterns
and detect disorders like sleep apnea.
 Cardiac Output Measurement: The ability to estimate cardiac
output non-invasively makes this technique useful in critical care
settings, where continuous monitoring of heart function is crucial.
 Pediatrics and Neonatology: Since the method is non-invasive and
does not require the use of rigid sensors, it is often used in pediatric
and neonatal care to monitor the breathing and heart function of
infants.
 Sports Science: Impedance plethysmography is also finding
applications in sports science, where athletes' breathing patterns and
cardiovascular performance are monitored during training to
optimize performance and recovery.
Impedance plethysmography is a versatile and non-invasive method for
monitoring respiratory and cardiovascular parameters, making it highly
useful in both clinical and non-clinical settings. By integrating electrodes
into wearable garments, it provides an unobtrusive way to continuously
monitor critical health indicators like breathing rate, tidal volume, and
cardiac output. However, careful attention to electrode placement,
motion artifacts, and individual variability is necessary to ensure
accurate measurements.
Overall, the ease of use, comfort, and real-time monitoring capabilities
make impedance plethysmography a valuable tool in modern healthcare,
sports science, and home monitoring applications.

Pneumography
Pneumography refers to the process of recording respiratory movements,
often used to study breathing patterns for medical or research purposes.
This technique measures changes in the volume of air in the lungs, which
occur during inhalation and exhalation, and is typically carried out using
sensors that track chest or abdominal movements.
Pneumography Based on Piezoresistive Sensor
Piezoresistive pneumography is a method used to monitor respiratory
activity by tracking changes in the cross-sectional variations of the rib
cage. This is achieved through piezoresistive sensors, which change their
electrical resistance when they are stretched or shortened, making them
sensitive to thoracic circumference variations that occur during breathing.
1. Working Principle:
Piezoresistive sensors operate on the principle that mechanical
deformation (stretching or compressing) causes changes in their electrical
resistance. In the context of pneumography, these sensors are placed on
the chest or abdomen, and they detect the expansion and contraction of
the rib cage as the subject inhales and exhales. The stretching of the
sensor during inhalation increases its resistance, while the shortening
during exhalation decreases it. These variations in resistance are then
converted into electrical signals that correspond to the subject’s breathing
patterns.
2. Sensor Materials:
Piezoresistive sensors can be made using simple elastic wires, which
are placed around the chest or abdomen, or using more advanced
sensorized textile technology. The latter involves embedding a
conductive mixture directly into a fabric, creating a flexible and
lightweight sensor. The conductive material is applied in a way that does
not alter the mechanical properties of the fabric, ensuring that the
garment remains wearable and unobtrusive. This makes it ideal for long-
term respiratory monitoring, as it is comfortable for the wearer and does
not restrict movement.
3. Advantages of Sensorized Textiles:
The use of sensorized textiles in piezoresistive pneumography offers
several benefits:
 Lightweight and Unobtrusive: The fabric is lightweight and adheres
well to the body, allowing for comfortable wear over long periods.
This makes it suitable for continuous monitoring without causing
discomfort.
 Wearability: The sensorized garment retains the original flexibility
and stretchability of the fabric, ensuring that the subject can wear it
as easily as any regular clothing. This is particularly important for
 individuals who require long-term respiratory monitoring, such as
patients with chronic respiratory diseases.
 Non-invasive: Piezoresistive pneumography offers a non-invasive
method of respiratory monitoring, eliminating the need for internal
sensors or more cumbersome devices like chest belts, making it ideal
for both clinical and home use.
4. Placement of Sensors:
To accurately capture respiratory data, the piezoresistive sensors are
strategically placed on the rib cage or abdomen. In some cases, two
conductive wires or bands are applied, as shown in Figure 1.3, to measure
the expansion and contraction of the thoracic cavity during breathing.
These sensors capture real-time data on breathing patterns, including
breath rate, depth of breathing, and potential irregularities such as apnea.
5. Data Processing:
The changes in electrical resistance detected by the piezoresistive sensors
are processed and analyzed to provide a variety of respiratory metrics.
These include:
 Breathing rate: The number of breaths per minute.
 Tidal volume: The amount of air moved in and out of the lungs with
each breath.
 Respiratory irregularities: Identification of breathing problems such
as apnea (temporary cessation of breathing) or irregular breathing
patterns.
6. Applications:
Piezoresistive pneumography is widely used in various fields, including:
 Medical Monitoring: It is particularly useful for patients with
respiratory conditions such as asthma, chronic obstructive pulmonary
disease (COPD), or sleep apnea. The non-intrusive nature of the
technology allows for continuous, long-term monitoring of
respiratory patterns without discomfort.
 Fitness and Sports: Athletes can use piezoresistive sensors to monitor
their breathing efficiency during training, helping them optimize
 performance and detect signs of fatigue.
 Wearable Technology: With the rise of wearable health technology,
piezoresistive sensors integrated into garments are becoming popular
for everyday health monitoring. These wearable devices allow users
to track their respiratory health in real time and receive feedback on
their fitness or potential medical issues.
7. Advantages Over Traditional Methods:
Compared to traditional respiratory monitoring methods like spirometry
or chest belts, piezoresistive pneumography offers several advantages:
 Comfort: The sensorized textiles provide a much more comfortable
and natural way of monitoring respiration compared to bulky
equipment.
 Ease of Use: The system is easy to wear, making it suitable for
patients in everyday environments, rather than requiring them to visit
a clinic for monitoring.
 Continuous Monitoring: Unlike traditional tests that provide only a
snapshot of respiratory function, piezoresistive pneumography can
continuously monitor breathing over extended periods, offering more
comprehensive insights into respiratory health.
With advancements in sensor technology and wearable electronics,
piezoresistive pneumography is expected to evolve further. Future
innovations may include integrating more advanced sensors that can
monitor multiple physiological parameters simultaneously (such as heart
rate and oxygen levels) or enhancing the accuracy and sensitivity of the
sensors. The development of more sophisticated data analysis techniques
could also allow for better prediction and diagnosis of respiratory
conditions.
Piezoresistive pneumography, utilizing flexible piezoresistive sensors and
sensorized textiles, offers a non-invasive, comfortable, and effective way
to monitor respiratory activity. Its applications in medical diagnostics,
sports science, and wearable technology make it a valuable tool for
continuous respiratory monitoring, providing both patients and healthcare
professionals with valuable real-time data on breathing patterns and
respiratory health.
Pnemography Based on Piezoelectric Sensor
This Piezoresistive pneumography is a method used to measure
respiratory activity by detecting variations in the circumference of the
thorax. One advanced method for implementing this involves the use of
a piezoelectric cable or strip that is fastened around the chest. This
technology monitors the expansion and contraction of the rib cage
during breathing and converts it into measurable signals.
1. Piezoelectric Cable Construction:
A common implementation of this technology involves using a coaxial
cable whose dielectric material is a piezoelectric polymer, such as
p(VDF-TrFE) (polyvinylidene fluoride-trifluoroethylene). This material
is sensitive to mechanical stress and can generate an electric charge
when deformed. The cable can be easily integrated into a textile belt,
which is designed to be worn around the chest. The integration of the
piezoelectric material into a textile ensures that the device is
lightweight, flexible, and comfortable for continuous wear.
2. Working Principle:
The piezoelectric sensor embedded in the cable responds to thorax
movements—the expansion during inhalation and the contraction during
exhalation. When the thorax expands, the cable is stretched, and the
piezoelectric polymer generates a charge variation proportional to the
amount of mechanical deformation. This charge is then converted into
an output voltage using a charge amplifier, which allows for the signal
to be processed and analyzed.
3. Signal Processing:
The output voltage produced by the piezoelectric cable is directly
proportional to the degree of thoracic expansion, meaning that the
system provides a real-time measurement of the breathing pattern. A
local processor can be used to analyze this data. A key feature of this
system is the ability to perform a Fast Fourier Transform (FFT) in real
time. FFT is a mathematical algorithm that transforms a signal from its
original domain (time) into a representation in the frequency domain. By
applying FFT to the respiratory signals, the breathing rate can be easily
extracted.
4. Advantages:
 Non-invasive and Comfortable: The piezoelectric cable sewn into
 a textile belt ensures that the monitoring system is non-intrusive
and allows for continuous monitoring without restricting the
wearer’s movements.
 Real-time Monitoring: With the implementation of FFT, the
system allows for real-time analysis of respiratory patterns, which
is crucial for detecting irregularities in breathing, such as apnea or
hyperventilation.
 High Sensitivity: The piezoelectric polymer is highly sensitive to
even minor thoracic movements, making it ideal for detecting both
normal breathing and more subtle variations, such as shallow
breaths.
5. Applications:
This piezoelectric-based pneumography system is valuable in various
settings:
 Medical Monitoring: It is used to monitor patients with respiratory
conditions like asthma, sleep apnea, or chronic obstructive
pulmonary disease (COPD). The ability to continuously track
breathing without requiring invasive equipment makes it suitable for
long-term monitoring.
 Fitness and Rehabilitation: Athletes and patients undergoing
physical rehabilitation can use this technology to monitor their
respiratory function, ensuring that they maintain proper breathing
patterns during physical exertion.
6. Future Potential:
The use of piezoelectric polymers in pneumography opens up new
avenues for developing wearable health-monitoring systems. The
technology can potentially be integrated into smart garments, enabling
real-time respiratory monitoring for a broader range of applications,
including daily health tracking and sports performance enhancement.
Additionally, integrating such systems with smartphones or cloud-based
platforms would allow for remote monitoring by healthcare providers.
In summary, piezoresistive pneumography using piezoelectric cables
provides a non-invasive, real-time, and highly sensitive method for
tracking respiratory activity. Its applications span from clinical settings
to fitness monitoring, and future developments may lead to more
widespread use in everyday health management.
Wearable GRF Sensor System
The quantitative analysis of gait variability using kinematics and kinetic
characterizations can be helpful to medical doctors in monitoring
patients’ recovery status in clinical applications. Moreover, these
quantitative results may help to strengthen their confidence in the
rehabilitation. Walking speed, stride length, the centre of mass (CoM)
and the centre of pressure (CoP) have been considered as factors in the
evaluation of walking gait. According to one study on slip type falls,
friction force was used to draw up important safety criteria for detecting
safe gait, so the transverse components of ground reaction force (GRF)
may provide important information for quantifying gait variability. Many
kinds of stationary systems such as force plates and instrumented
treadmill devices are available to measure CoP and triaxial GRF.
Because a stationary force plate cannot measure more than one stride, in
studies of continuous walking, a complex system consisting of many
force plates and a data fusion method must be constructed . Therefore,
the force plate technology probably imposes some constraints on our
ability to measure human movement and is not feasible for
measurements in everyday situations. An instrumented treadmill or
dynamometric platform formed by laying two force plates under a
treadmill can overcome some limitations of the system with distributed
multiple force plates in successive measurements of the GRF for gait
evaluation. However, a guide used to constrain the direction of the foot
is necessary to ensure that subjects walk along a
swtrwaiwg.hEtnlgingeT,rebee.ccaoumse if a human body segment
motion analysis system is not available for a simultaneous measurement
of the foot orientation, any technique based on force plates
conventionally requires subjects to walk along a pre-defined specific
path. Although gait variability can be assessed in straight walking , gait
analysis concentrating solely on straight-line walking or running may
not adequately interpret gait variability, because turning or walking
direction changes probably have effects on extrinsic gait variability . To
overcome such limitations of stationary devices in GRF measurement,
many researchers are developing wearable sensors attached to shoes .
Pressure sensors have been widely used to measure gaits and the
distributed vertical component of GRF and to analyze the loading pattern
on the plantar soft tissue during the stance phase of gait , but in these
systems the transverse components of GRF (friction forces) which are
one of the main factors leading to falling, have been neglected. By fixing
two externally mounted sensors beneath the front and rear boards of a
special shoe, researchers have developed an instrumented shoe for
ambulatory measurements of CoP and triaxial GRF in successive
walking trials, and
the application of the instrumented shoe to estimate joint moments and
powers of the ankle was introduced in. The mounted sensor itself,
having a height of 15.7 mm, increases the height and weight of the shoe,
and affects normal walking gait. Moreover, its application study was
restricted to human kinetics analysis using the spatio temporal
measurements of GRF and CoP.

A wearable GRF sensor system was constructed using five small

triaxial force
sensors (USL06-H5-500N-C, weight: 15 g, size: 20 mm × 20 mm × 5
mm). The GRF and CoP measured using the wearable sensor system
were expressed in a global coordinate system which was located on the
interface between the instrumented shoe and the ground. The origin of
the global coordinate system was fixed to a point around the anatomical
centre of the ankle when the sensor system was worn on the foot. The x-
axis was chosen to represent the anterior-posterior direction on the
interface plane contacting with the floor, which was based on landmarks
from the shoe. The z-axis wwawswm.EandgegTvreereti.ccaolm, and
the y-axis was chosen such that the resulting global coordinate system
would be right-handed. By mounting the five triaxial sensors on an
aluminum plate beneath the shoe, we can accurately align all five local
coordinate systems defined for each triaxial sensor with the global
coordinates. Fxi, Fyiand Fzi ( I = 1, 2, 3, 4 and 5) indicate triaxial forces
measured by the distributed five triaxial sensors, and (xi, yi) is defined
as the position of each triaxial sensor, for example, (x5, y5) indicates the
position of the sensor placed on the forefoot. The total weight of the
sensor shoe is about 300 g, and the shoe size is 250 mm.