materials

Article
A Hybrid Textile Electrode for Electrocardiogram
(ECG) Measurement and Motion Tracking
Xiang An * and George K. Stylios
Research Institute for Flexible Materials, Heriot-Watt University, Edinburgh TD1 3HF, UK; G.Stylios@hw.ac.uk
* Correspondence: xa30@hw.ac.uk




Received: 27 July 2018; Accepted: 28 September 2018; Published: 2 October 2018


Abstract: Wearable sensors have great potential uses in personal health monitoring systems, in which
textile-based electrodes are particularly useful because they are comfortable to wear and are skin
and environmentally friendly. In this paper, a hybrid textile electrode for electrocardiogram (ECG)
measurement and motion tracking was introduced. The hybrid textile electrode consists of two parts:
A textile electrode for ECG monitoring, and a motion sensor for patient activity tracking. In designing
the textile electrodes, their performance in ECG measurement was investigated. Two main influencing
factors on the skin-electrode impedance of the electrodes were found: Textile material properties,
and electrode sizes. The optimum textile electrode was silver plated, made of a high stitch
density weft knitted conductive fabric and its size was 20 mm × 40 mm. A flexible motion sensor
circuit was designed and integrated within the textile electrode. Systematic measurements were
performed, and results have shown that the hybrid textile electrode is capable of recording ECG
and motion signals synchronously, and is suitable for ambulatory ECG measurement and motion
tracking applications.

Keywords: textile electrode; ECG; motion sensor; skin-electrode impedance

1. Introduction
With the miniaturization of electronics, improvements in performance of low-power microprocessors,
and the development of artificial intelligence, personal health monitoring systems are becoming
possible. Wearable electronics, wireless communications, textile sensors, mobile computing,
and cloud computing are becoming increasingly important in personal health monitoring systems.
Wearable sensors and textile electrodes are particularly suitable for some long-term health monitoring
applications, such as electrocardiogram (ECG) measurement and motion tracking.
Textile electrodes are usually made of conductive yarns by weaving, knitting or embroidering
processes; or by coating or printing conductive polymers on non-conductive fabrics. In the studies of
textile electrodes, most textile electrodes are knitted structure [1–3]. Priniotakis et al. [4] compared
the knitted and woven textile electrodes by using an electrochemical cell; the results show that the
knitted structure has the lowest contact resistance. Woven and embroidered textile electrodes have also
been researched with some success [5]. However, there is no consistent conclusion as to which type of
textile structure (knit, woven, embroidered) performs best in ECG recording, because it involves many
factors, such as the structure of the fibers and yarns, the fabric density, and the manufacturing process.
The conductive material type for making the textile electrode is another important factor that affects
the performance of the electrode. Many studies have used silver plated textile materials to make textile
electrodes [2,5,6]. Other conductive materials have also been studied [7–10]. Rattfalt [11] made textile
electrodes with 100% stainless steel and 20% stainless steel, which showed the acceptable stability of
electrode potentials. However, stainless steel is highly direct current voltage (DC) polarizable and
very alloy dependent [12]. Jang et al. [13] explored the possibilities of copper (Cu) sputtered fabric as

Materials 2018, 11, 1887; doi:10.3390/ma11101887 www.mdpi.com/journal/materials

Materials 2018, 11, 1887 2 of 18

ECG electrode. Conductive polymers have also been used for making textile electrodes. Pani et al. [14]
made textile electrodes with poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate) (PEDOT:PSS)
coated woven fabric to monitor ECG signals.
Compared with conventional silver/silver chloride (Ag/AgCl) rigid metal electrodes, textile
electrodes have the advantage of being soft, flexible and breathable, allowing the wearer to feel more
comfortable than conventional metal plate electrodes in long-term monitoring. In addition, as textile
electrodes can be easily integrated into a garment by weaving, knitting or sewing, there is no need
for any adhesive to attach on the body, so they are skin friendly (no skin irritation or discomfort) and
environmentally friendly (electrodes are reusable). Based on these advantages, many researchers have
used textile electrodes in the development of wearable ECG systems [7,15–18].
In this paper, a hybrid textile electrode is proposed. It consists of two parts: A textile electrode
for ECG measurement, and a motion sensor for patient activity tracking. Although there are some
studies that combine motion sensors and textile electrodes into a wearable system [17–20], this is the
first time that the motion sensor is directly integrated into the textile electrode. There are good reasons
for designing this hybrid textile electrode. First of all, motion signals that recorded in synchrony with
ECG signals are beneficial in the diagnosis of heart disease. Some studies [21–24] have found that
heavy physical exertion can be the trigger of the onset of arrhythmia and acute myocardial infarction.
Furthermore, changes in posture (sitting up or standing up) may also be the cause of arrhythmia,
known as postural tachycardia syndrome (PoTS) [25]. Therefore, the motion signals recorded in
synchronization with the ECG signals can help the cardiologist find the cause of the heart disease
by providing information about the patient’s physical activity when the ECG shows an abnormality.
Moreover, tracking daily physical activity and ECG can also help prevent the sudden death in patients
with coronary heart disease, because some studies have shown that sudden death is related to physical
exertion [26–28]. Secondly, since the hybrid textile electrode is placed on the patient’s chest to measure
the ECG, the motion sensor on the hybrid electrode can also obtain information about the patient’s
respiration by tracking the movement of the chest while the patient remains stationary (sitting or
standing). The measured respiration along with the ECG can also be used to diagnosis a common
heart disease—respiratory sinus arrhythmia.
Due to the absence of conductive gel/paste, textile electrodes usually have much higher and more
unstable skin-electrode impedance than conventional Ag/AgCl wet electrodes. And the complexity
and instability of fabric structure itself also make the characteristics of textile electrodes different from
conventional metal plate electrodes. Therefore, in this paper, the electrical properties of the dry textile
electrode at the skin-electrode interface were first studied. Based on that, the electrode material and
size were investigated, and an optimum textile electrode was made. In order to integrate a motion
sensor with a textile electrode, a small flexible printed circuit board (FPCB) was designed. A hybrid
textile electrode was finally fabricated by integrating an optimum textile electrode with the small
flexible motion sensor circuit board.

2. The Skin-Electrode Interface of Textile Electrode

Textile electrodes, like conventional metallic plate electrodes, are in contact with human skin
as electrical conductors. The difference from metallic plate electrodes is that the conductive metal
is electroplated onto the textile substance or blended into the yarn. Therefore, the electrochemical
reactions occurring at the interface between the conventional metal electrode and the skin also occur
at the interface between the textile electrode and the skin. The interface is called the skin-electrode
interface. Neuman [29] proposed an equivalent circuit for modelling the electrical characteristics of the
skin-electrode interface for conventional metal electrodes, as shown in Figure 1.
 Materials 2018, 11, 1887 3 of 18
Materials 2018, 11, x FOR PEER REVIEW 3 of 18

Figure 1. The
Figure electrical
1. The equivalent
electrical circuit
equivalent of the
circuit skin-electrode
of the interface
skin-electrode [29].
interface [29].

In In
thethe case
case of of
dry dry textile
textile electrodes,
electrodes, although
although they
they dodo notnot have
have a aconductive
conductive gel/paste
gel/paste onon
thethe
electrode
electrode surface,
surface, thethe skin
skin moisture
moisture andand perspiration
perspiration cancan
alsoalso
be be considered
considered as as a thin
a thin electrolyte
electrolyte
layer
layer between
between thethe textile
textile electrode
electrode andandthethe skin.
skin. “Dry”
“Dry” electrodes
electrodes areare really
really only
only drydry
whenwhen first
first
applied,
applied, skin
skin moisture
moisture andand perspiration
perspiration will
will quickly
quickly accumulate
accumulate under
under thethe electrode
electrode [30].
[30]. Therefore,
Therefore,
thethe equivalent
equivalent circuit
circuit forfor conventional
conventional metal
metal electrodes
electrodes is is also
also applicable
applicable to to textile
textile electrodes.
electrodes.
According
According to the
to the equivalent
equivalent circuit,
circuit, the skin-electrode
the skin-electrode impedance
impedance of theof the textile
textile electrode Z
electrode Zcan
Textile
be can be calculated
calculated as follows:
as follows:
RRd R Re
Z =R
ZTextile = Rs +
+ ++RRsub++ , , (1)(1)
11 +
+ jωR
jωRdCCd 1 1++jωR
jωRCe Ce
where
where R Rrepresents the charge transfer resistance and C represents the capacitance across the
d represents the charge transfer resistance and Cd represents the capacitance across the
electrode-electrolyte interface,
electrode-electrolyte interface, R Rrepresents the resistance of epidermis layer, C represents the
e represents the resistance of epidermis layer, Ce represents the
capacitance
capacitance induced by the nonconductive stratumcorneum
induced by the nonconductive stratum layer, R
corneumlayer, represents the
Rs represents theresistance
resistanceofofthe
sweat,R R represents
thesweat, represents the
the overall
overall resistance
resistance ofof the
the tissue
tissue underneath
underneath thethe epidermis
epidermis layer.
layer.
sub
The skin-electrode impedance of the dry textile electrode is
The skin-electrode impedance of the dry textile electrode is usually much higher usually much higher than
thanthethe
conventional wet electrode. In most cases, the value of Z
conventional wet electrode. In most cases, the value of ZTextile is up to several hundred kΩ. Due totothe
is up to several hundred kΩ. Due
thefact
factthat
that
thethe human
human skinskin
has ahas a highly
highly nonhomogeneous
nonhomogeneous multi-layered
multi-layered structure,
structure, the electrical
the electrical properties
properties of the skin vary along different body parts, which also mean
of the skin vary along different body parts, which also mean that the skin-electrode impedances of that the skin-electrode
impedances of the two
the two electrodes atelectrodes at different
different skin locations skin
arelocations
generallyare generally
different. different.
Webster [29]Webster
has found [29] hasthe
that
found that the impedance imbalance introduces noise into ECG signals.
impedance imbalance introduces noise into ECG signals. Olsen [31] has found that the impedance Olsen [31] has found that
theimbalance
impedance wasimbalance
typically 50was typically
percent 50individual
of the percent ofskin-electrode
the individual skin-electrode
impedance. impedance.
Therefore, the most
Therefore, the most effective way to reduce the impedance imbalance of dry textile
effective way to reduce the impedance imbalance of dry textile electrodes is to reduce the skin-electrode electrodes is to
reduce the skin-electrode impedance. Thus, the optimum textile electrode should
impedance. Thus, the optimum textile electrode should be made of a material having low skin-electrode be made of a
material having low skin-electrode
impedance characteristics. impedance characteristics.

3. Electrode Material
3. Electrode Material
Various
Variousmaterials
materialshave been
have used
been to to
used produce
produce conductive
conductive textiles that
textiles areare
that either embedded
either embedded into
into
fabrics as conductive yarns, or plated with electrically conductive components, such as
fabrics as conductive yarns, or plated with electrically conductive components, such as carbon, copper,carbon,
copper,
nickel,nickel, or silver.
or silver. However,However, when choosing
when choosing materials materials
that willthat
comewill
intocome intowith
contact contact with the
the human skin,
human
as in skin, as in
the case ofthe
ECGcase of ECG electrodes,
electrodes, their biocompatibility
their biocompatibility becomes
becomes very very important
important as the is
as the electrode
electrode
directlyisapplied
directly applied
onto onto the
the human human
body. body.
Different Different
from frommaterials,
most other most other materials,
silver silver
is not only is not
innocuous
only innocuous
to human skin,tobut
human skin, but also
also antibacterial antibacterial
[32–35]. [32–conductive
Therefore, 35]. Therefore, conductive
fabrics made from fabrics
silvermade
plated
nylon
from yarns
silver are favored
plated for making
nylon yarns textile for
are favored electrodes
makingby weaving
textile or knitting.
electrodes When compared
by weaving with
or knitting.
woven
When fabrics, knitted
compared fabricsfabrics,
with woven usuallyknitted
are more flexible,
fabrics stretchable,
usually are more andflexible,
can takestretchable,
up easily theandcurvature
can
of up
take the easily
body when attached.ofSo,
the curvature theinbody
this paper,
when four different
attached. So, inknitted conductive
this paper, fabrics made
four different knittedfrom
silver plated
conductive nylon
fabrics yarn from
made were considered
silver plated as electrode
nylon yarn materials, shown in Table
were considered 1, and their
as electrode electrical
materials,
properties
shown were1,investigated
in Table on a skinproperties
and their electrical dummy. Electrode material TE1
were investigated onisaa skin
silverdummy.
plated knitted fabric
Electrode
material TE1 is a silver plated knitted fabric purchased from Shieldex (MedTex P-130, Shieldex,
purchased from Shieldex (MedTex P-130, Shieldex, Bremen, Germany), material TE2 is made of 4 ply
Bremen, Germany), material TE2 is made of 4 ply silver plated nylon yarn (235/34 dtex 4-ply,
Materials 2018, 11, 1887 4 of 18

silver plated nylon yarn (235/34 dtex 4-ply, Shieldex, Bremen, Germany), material TE3 is made of 2 ply
silver plated nylon yarn (117/17 dtex 2-ply, Shieldex, Bremen, Germany) and material TE4 is a silver
plated spacer fabric purchased from Shieldex (Spacer Fabric B, Shieldex, Bremen, Germany). Figure 2
shows the scanning electron microscope (SEM) micrograph of a silver plate nylon yarn. The average
diameter of a silver plated nylon monofilament is about 0.028 mm.
Figure 2. The
Figure 2. The scanning
scanning electron
electron microscope
microscope (SEM)
(SEM) micrograph
micrograph of
of aa silver
silver plated
plated nylon
nylon yarn.
yarn.
Figure 2. The
Figure 2. The scanning
scanning electron
electron microscope
microscope (SEM)
(SEM) micrograph
micrograph of
of aa silver
silver plated
plated nylon
nylon yarn.
yarn.
Table1.1.The
Table
Table 1. The The properties
properties ofofthe
The properties of
thefour
of the four
four selected
selected conductive
conductive
four selected conductive
knitted
knitted fabrics.
fabrics.
conductive knitted fabrics.
fabrics.
Table
Table 1.
1. The properties
properties of thethe four selected
selected conductive knitted
knitted fabrics.
Fabric
FabricFabric YarnYarn
Yarn
Electrode Materials Components Structure Structure Fabric
Fabric Yarn
Yarn
ThicknessDiameterDiameterWales/cm Courses/
Courses/
Wales/cmCourses/
Courses/cm
Electrode
Electrode Materials
Materials Components
Components Structure Thickness
Thickness Diameter Wales/cm Courses/
Electrode Materials
Electrode Materials Components
Components Structure Thickness
Structure Thickness Diameter
(mm) Diameter Wales/cm
(mm) Wales/cm cm
cm
(mm)
(mm) (mm)
(mm) cm
cm
(mm)
(mm) (mm)
(mm)
78% silver
78% silver
silverplated
78%
78%
78%silver
silver
plated
plated nylon
nylon Weft
WeftWeft 0.45 ±0.45
TE1
TE1
TE1 nylonnylon
plated
plated 66 + 22% Weft
nylon Weft 0.45 ± 10%
10%± 10%0.13
0.13 ±±0.13
20%
20%± 20% 28/cm28/cm 30/cm
28/cm 30/cm
30/cm
TE1
TE1 66 + 22%
66Elastomer knitted
knitted0.45
0.45 ±± 10%
10% 0.130.13 ±± 20%
20% 28/cm
28/cm 30/cm
30/cm
66
66 +++ 22%
22%
22%
knitted
knitted
knitted
Elastomer
Elastomer
Elastomer
Elastomer

100% silver
100% silver
silver
100%
100%silver
silver Weft
WeftWeft 1.25 ± 10% 0.60 ± 20%
TE2 100%
plated nylonplated Weft 5/cm 6/cm
TE2
TE2
TE2 plated
plated nylon
nylon Weft
knitted 1.25 ±±1.25
1.25 10%
10% 0.60 ±±0.60
± 10%
0.60 20%
20% 5/cm
± 20% 5/cm
5/cm 6/cm6/cm
6/cm
TE2 plated nylon
nylon
66 66 knitted1.25
knitted
knitted ± 10% 0.60 ± 20% 5/cm 6/cm
66
66 knitted
66

100% silver
100% silver
silver
100%
100% silver Weft
Weft
TE3
TE3 plated
100% nylon
silver
plated nylon Weft
plated knitted 0.70
0.70 ±± 10%
WeftWeft 0.70 10%
10% 0.30
0.30 ±±±0.30
20%
20% 8/cm
8/cm 12/cm
12/cm
TE3
TE3
TE3 plated nylon
plated
66
nylon knitted 0.70 ±±0.70
10% 0.30
± 10%
0.30 ± 20%20% 8/cm
± 20% 8/cm
8/cm 12/cm
12/cm
12/cm
nylon
Materials 2018, 11, x FOR PEER REVIEW66 66 knitted
knitted
knitted 4 of 18
66
66

Shieldex, Bremen, Germany),94%material

94% silver
silver TE3 is made of 2 ply silver plated nylon yarn (117/17 dtex
Weft
Weft
94%
94% silver
silver Weft
Weft
2-ply, plated
Shieldex, Bremen, Germany) nylon knitted
and material 17/cm 28/cm
TE4 plated nylon WeftTE4
knitted 2.50 is a10%silver plated spacer fabric purchased
17/cm 28/cm from
TE4
TE4
94% silver
plated
plated
66 +
plated
nylon
nylon
6%
knitted
knitted
3D 2.50 ±±± 10%
2.50
0.18
0.18 ±±± 20%
10% 0.18 20% 17/cm
17/cm
20% (surface) 28/cm
28/cm
17/cm (surface)
28/cm
TE4 (Spacer Fabric B, nylon
Shieldex
TE4 Shieldex,
66 + 6%Bremen,
66 ++ 6%
66 6% 3D
knitted
3D 2.50 ±2.50
Germany).
3D 10% 0.18 ±0.18
± Figure
10% 20%
2 shows
± the
(surface)
20%
(surface) scanning
(surface)
(surface)electron
66 + 6%
elastomer 3D
spacer (surface) (surface)
(surface) (surface)
elastomer
elastomer spacer
spacer
microscope (SEM) micrograph of a silverspacer
elastomer
elastomer plate
spacer nylon yarn. The average diameter of a silver plated
nylon monofilament is about 0.028 mm.
3.1. Experimental
3.1. Experimental Method
Experimental Method
Method
3.1.
3.1. Experimental Method
The electrical
The electrical properties
electrical properties
properties of of
of human skin
skin have
human skin great
have great variations
great variations
variations and and dependent
and dependent upon
dependent upon time
time and
upon time and
The
The of
electrical properties of ahuman
human skin have
have great 3a)
variations and dependent upon time and
and
location
location of the
the skin
skin [36].
[36]. Thus,
Thus, a skin
skin dummy
dummy (Figure
(Figure 3a) is
is used
used to
to measure
measure the
the skin-electrode
skin-electrode
location
location of the
of to skin
theavoid
skin the[36]. Thus,
Thus, aa skin
[36].unwanted skin dummy (Figure
dummyvariation 3a)
3a) is
(Figure inducedis used
used to
to measure
measure the
the skin-electrode
skin-electrode
impedance
impedance to to avoid
avoid thethe unwanted impedance
unwanted impedance
impedance variation
variation induced
induced by by the
by the human
the human skin.
human skin. The
skin. The design
design of
The design of
impedance
impedance to avoid the unwanted impedance variation induced by the human skin. The design of
of
the skin
the skin dummy
skin dummy
dummy is is based
is based
based onon Westbroek’s
on Westbroek’s electrochemical
Westbroek’s electrochemical cell
electrochemical cell [4,37,38],
cell [4,37,38], which
[4,37,38], which consists
which consists of
consists of a Polyvinyl
of aa Polyvinyl
Polyvinyl
the
the skin dummy istube
based on Westbroek’s electrochemical cell [4,37,38], whichthe
consists of fluid.
a Polyvinyl
chloride (PVC)
chloride (PVC)
(PVC) tube filled
tube filled with
filled with 0.9%
with 0.9%
0.9% of of NaCl
of NaCl solution
NaCl solution
solution to to simulate
to simulate
simulate the body
the body
body fluid. Two
fluid. Two
Two
chloride
chloride (PVC) tube filled with 0.9% of NaCl solution to simulate the body fluid. Two
polyvinylidene fluoride
polyvinylidene fluoride (PVDF)
fluoride (PVDF) membranes
(PVDF) membranes
membranes are are installed
are installed on
installed on the
on the two
the two open
two open ends
open ends of
ends of the
of the PVC
the PVC tube
PVC tube to
tube to
to
polyvinylidene
polyvinylidene fluoride (PVDF) membranes are installed on the two open ends of the PVC tube to
simulate the
simulate the skin
the skin barrier
skin barrier between
barrier between
between thethe body
the body fluid
body fluid and
fluid and the
and the textile
the textile electrodes.
textile electrodes. The
electrodes. The PVDF
The PVDF membranes
PVDF membranes
membranes
simulate
simulate the skin barrier between the body fluid and the textile electrodes. The PVDF membranes
were
were obtained
obtained from
from Merck
Merck®® (Darmstadt,
®
(Darmstadt, Germany),
Germany), and and are
are the
the same
same membranes
membranes that
that were
were used
used in
in
were
were obtained
obtained from
from Merck
Merck® (Darmstadt,
(Darmstadt, Germany),
Germany), and and are
are the
the same
same membranes
membranes that
that were
were used
used in
in

Figure 2. 2.The
Figure Thescanning electronmicroscope
scanning electron microscope (SEM)
(SEM) micrograph
micrograph of aofsilver
a silver plated
plated nylon
nylon yarn.
yarn.

3.1. Experimental Method

Table 1. The properties of the four selected conductive knitted fabrics.
The electrical properties of human skin have great variations Yarn
Fabric and dependent upon time and
location of the skin [36]. Components
Thus, a skin dummy Courses/
Electrode Materials Structure(Figure 3a) is used
Thickness to measure
Diameter the skin-electrode
Wales/cm
cm
impedance to avoid the unwanted impedance variation(mm) induced by(mm)
the human skin. The design of
the skin dummy is based on Westbroek’s electrochemical cell [4,37,38], which consists of a Polyvinyl
78% silver
chloride (PVC) tube filled with 0.9%
plated of NaClWeft
nylon solution to simulate the body fluid. Two polyvinylidene
TE1
fluoride (PVDF) membranes66 are installed on the two 0.45
open± ends
10% of0.13
the ±PVC
20%tube 28/cm
to simulate 30/cm
the skin
+ 22% knitted
barrier between the body fluid and the textile electrodes. The PVDF membranes were obtained from
Elastomer

100% silver
Weft
TE2 plated nylon 1.25 ± 10% 0.60 ± 20% 5/cm 6/cm
knitted
66
 Materials 2018, 11, 1887 5 of 18
Materials
Materials 2018,
2018, 11, 11, x FOR
x FOR PEER
PEER REVIEW
REVIEW 5 of5 18
of 18

Merck ® (Darmstadt, Germany), and are the same membranes that were used in P.J. Xu’s [39] dynamic
P.J.P.J. Xu’s
Xu’s [39][39] dynamic
dynamic evaluation
evaluation system.
system. The
The porepore size
size of of
thethe PVDF
PVDF membranes
membranes in in
ourour evaluation
evaluation
evaluation
system
system is 100 system.
is 100
nm,nm, The
as as pore
thisthis size
size
size of the
is large
is large PVDF
enough
enough membranes
to to allow
allow in
thethe our evaluation
electrolyte
electrolyte to to system
flow
flow is
freely
freely 100 nm, as
through
through thethis
the
size is large
perforated
perforated enough [40].
membrane
membrane to [40].
allow the electrolyte to flow freely through the perforated membrane [40].

(a)(a) (b)(b)
Figure
Figure
Figure 3.
3. Skin-electrode
3. Skin-electrode
Skin-electrode impedance
impedance
impedance measurement
measurement on on
measurement aa skin
a skin
on dummy:
dummy:
skin (a) (a)
dummy: Skin
(a) Skin dummy;
dummy;
Skin (b)(b)
dummy; testtest
(b) setup.
setup.
test setup.

Four
Four textile
textile electrodes
electrodes made madefromfrom materials
materials TE1, TE1, TE2,
TE2,TE2,
TE3 TE3
TE3andand
andTE4TE4werewere tested
tested ononthethe skin
skin
dummy, as shown in Table 1. The structure of the textile electrodes
dummy, as shown in Table 1. The structure of the textile electrodes used in the measurement, shown in
dummy, as shown in Table 1. The structure of the textile electrodes used
used inin
thethe measurement,
measurement, shown
shown
in in Figure
Figure
Figure 4, 4,consists
4,itit it consists
consists of
ofoftwo
two two
parts:parts:
parts:AA A square
square
square area area
of
area of of
size 15size
size 15 15
mm ×mm
mm × 15
15× mm,
15 mm,
which
mm, which is the
is theiselectrode
which the electrode
surface
electrode
surface
that is in that is
contact in contact
with the with
skin the
dummy; skin a dummy;
rectangular a rectangular
area of
surface that is in contact with the skin dummy; a rectangular area of size 7 mm × 50 mm is the size area
7 mm of
× size
50 7
mm mm
is the× 50 mm
electrode iswire
the
electrode wire
that is connected
electrode that is
wire that istoconnected connected
an impedance to an
to an meter.impedance
impedanceIn themeter.meter.
measurement,In the measurement,
the textile electrode
In the measurement, the textile
the textile electrode
is electrode
placed onisthe is
placed
placed onon
top surface thetheof top
top the surface
skin
surface of of
dummythethe skin
and
skin isdummy
dummyfixed and and
with is fixed
isa fixed
weight withwith
of 100 ag,weight
a weight of of
which 100
applied
100 g, awhich
g, which force applied
of 0.98
applied aN a
force of 0.98 N to the electrode. A self-adhesive Ag/AgCl electrode
force of 0.98 N to the electrode. A self-adhesive Ag/AgCl electrode is placed on the bottom surface to a
to the electrode. A self-adhesive Ag/AgCl electrode is placed on is placed
the bottom on the bottom
surface to surface
serve as to
serve
serve as as
reference aelectrode.
reference
a reference Aelectrode.
electrode. A high-precision
high-precision LCR-Bridge
A high-precision LCR-Bridge
meter (HM8118,
LCR-Bridge meter
meter (HM8118,
HAMEG
(HM8118, HAMEG
instruments,
HAMEG instruments,
Mainhausen,
instruments,
Mainhausen,
Germany) is
Mainhausen, Germany)
used
Germany) in this issystem
is usedusedin in
tothis
this system
measure
system the
to to measure
impedance.
measure thethe impedance.
Two measurements
impedance. Two Two measurements
were done were
measurements in were
here.
done in here. First, impedances were measured at the frequency
done in here. First, impedances were measured at the frequency of 100 Hz, and measurements wereone
First, impedances were measured at the frequency of 100 Hz, of
and 100 Hz,
measurementsand measurements
were last forwere
lastlast
forfor
hour. one one
Second, hour.
hour. Second,
impedances
Second, impedances
were measured
impedances werewere measured
within
measured within
awithin
frequency a frequency
range ofrange
a frequency 20range
Hzoftoof202020
Hz Hz
kHzto to 20
when
20 kHzkHz
the
when
when thethe
skin-electrode skin-electrode
impedance
skin-electrode impedance
is stabilized.
impedance is stabilized.
Measurements
is stabilized. Measurements
Measurements were performed were
were performed in in
in a conditioned
performed a conditioned
laboratory
a conditioned
laboratory where the room temperature was controlled ◦ Catand
where
laboratory the room
where temperature
the room was controlled
temperature was at 20 ± 2at
controlled 20 20
± 2±the
°C2 °C andthethe
relative
and relative
humidity
relative athumidity
humidity65 ± 2%. at 65
at 65 ± ±
2%.2%.

Figure
Figure
Figure Structure
4. Structure
4. Structure oftextile
of aof a textile electrode
electrode forfor
thethe skin-electrode
skin-electrode measurement.
measurement.

3.2. Results
Results and Discussion
Discussion
3.2.3.2.
Results andand Discussion
As shown
shown inin Figure
Figure 5, 5, the skin-electrode
skin-electrode impedances
impedances of of all four
four textile
textile electrodes
electrodes show
show aa similar
similar
AsAsshown in Figure 5, thethe
skin-electrode impedances of all all
four textile electrodes show a similar
trend: Impedances
trend: Impedances are rapidly
rapidly decreasing
decreasing within
within the first
first few
few minutes and then gradually become
trend: Impedances areare rapidly decreasing within thethe first few minutes
minutes and
and then
then gradually
gradually become
become
stable. However, their differences are also noticeable. In the first few minutes of measurement,
stable. However, their differences are also noticeable. In the first few minutes of measurement, thethe
stable. However, their differences are also noticeable. In the first few minutes of measurement,
the electrode
electrode TE1 TE1the
hasfastest
the fastest impedance drop among the four electrodes, and its impedance
electrode TE1 hashas
the fastest impedance
impedance dropdrop among
among thethe four
four electrodes,
electrodes, andand
its its impedance
impedance tends
tends to to
tends to be stable in thetime.
shortest time. Moreover, after the stabilization period, the skin-electrode
be be stable
stable in the
in the shortest
shortest Moreover,
time. Moreover, after
after thethe stabilization
stabilization period,
period, thethe skin-electrode
skin-electrode impedances
impedances
of of
thethe four
four electrodes
electrodes areare different,
different, from
from thethe highest
highest to to
thethe lowest
lowest impedance
impedance TE2,TE2, TE3,
TE3, TE4,TE4,
TE1TE1
respectively.
respectively.
Materials 2018, 11, 1887 6 of 18

Materials 2018, 11, x FOR PEER REVIEW 6 of 18

impedances of the four electrodes are different, from the highest to the lowest impedance TE2, TE3,
Materials
TE4, TE1 2018, 11, x FOR PEER REVIEW
respectively. 6 of 18
2500

2000
2500
(Ω) (Ω)
1500
Impedance
2000 TE1

1000
1500 TE2
Impedance

TE1
TE3
500
1000 TE2
TE4
TE3
5000
0 600 1200 1800 2400 3000 3600 TE4
0 Time (second)
0 600 1200 1800 2400 3000 3600
Time (second)
Figure 5. Skin-electrode impedance in 1 h.
Figure 5. Skin-electrode impedance in 1 h.
Figure 5. Skin-electrode
Figure 6 shows the skin-electrode impedance overimpedance in 1 h.
the frequency range. The impedance of the
fourFigure 6 shows
electrodes the skin-electrode impedance
is frequency-dependent: over the
As the frequency frequency
increases, therange. The impedance
impedance decreases, of the
which
four Figure 6 shows the skin-electrode impedance over the frequency range. The impedance
is consistent with the capacitive behavior of the skin-electrode interface. However, the differences is
electrodes is frequency-dependent: As the frequency increases, the impedance decreases, of
whichthein
four electrodes
consistent
these four withisthe
frequency-dependent:
electrode capacitive behavior
materials are As
also clearly frequency
of theshown increases,
skin-electrode
in the the impedance
interface.
impedance However,
curves. decreases,
the TE1 which
differences
Electrode in
has the
is consistent
these
smallest with thematerials
fourimpedance,
electrode capacitive behavior
as well asare also
the of the
clearly
smoothest skin-electrode
shown interface.
in the impedance
impedance-frequency However,
curves.
curve. the differences
Electrode in
TE1 has the
these four electrode materials are also clearly shown in the
smallest impedance, as well as the smoothest impedance-frequency curve.impedance curves. Electrode TE1 has the
smallest impedance, as well as the smoothest impedance-frequency curve.
1400
1200
1400
(Ω) (Ω)

1000 TE1
1200
Impedance

800 TE2
1000 TE1
600 TE3
Impedance

800 TE2
400 TE4
600 TE3
200
400 TE4
0
200
20 200 2000 20000
0 Frequency (Hz)
20 200 2000 20000
Figure 6. Skin-electrode
Frequencyimpedance
(Hz) versus frequency.
Figure 6. Skin-electrode impedance versus frequency.

The difference in skin-electrode impedance can be explained by the stitch density of these fabrics.
Figure 6. Skin-electrode
The difference in skin-electrode impedance impedance
can beversus frequency.
explained by the stitch density of these
As demonstrated in Table 1, the four electrode materials are all made of silver plated yarn, and they
fabrics. As demonstrated in Table 1, the four electrode materials are all made of silver plated yarn,
are all made by knitting. Textile Electrodes TE1, TE2, TE3explained
are all weft knitted structures, electrode
andThe
theydifference
are all made in skin-electrode impedance
by knitting. Textile can be
Electrodes TE1, TE2, TE3by arethe
all stitch densitystructures,
weft knitted of these
TE4 is
fabrics. a knitted
As TE4 3D
demonstratedspacer structure, but its surface layer is also weft knitted, as shown in Figure 7.
electrode is a knittedin3DTable
spacer1, the four electrode
structure, materials
but its surface areisall
layer alsomade
weftofknitted,
silver plated yarn,in
as shown
The
and most significant
they7.are difference between these four fabrics is their stitch density and the yarn diameter.
Figure Theallmost
made by knitting.
significant Textile Electrodes
difference between these TE1,four
TE2,fabrics
TE3 are is all weft
their knitted
stitch structures,
density and the
ElectrodeTE4
electrode TE1 is
hasa the highest
knitted 3D stitch density
spacer structure, andbut
theitssmallest
surface yarn
layer diameter,
is also whilst
weft electrode
knitted, as TE2 has
shown in
yarn diameter. Electrode TE1 has the highest stitch density and the smallest yarn diameter, whilst
the lowest
Figure stitch
7. The mostdensity and the largest yarn diameter. The measured skin-electrode impedance is
electrode TE2 hassignificant
the lowest difference betweenand
stitch density thesethe
four fabricsyarn
largest is their stitch density
diameter. and the
The measured
positively
yarn related to
diameter. Electrodethe yarn diameter and negatively related to stitch density.
skin-electrode impedanceTE1 has the highest
is positively relatedstitch
to the density and the smallest
yarn diameter yarn diameter,
and negatively related towhilst
stitch
electrode
density. TE2 has the lowest stitch density and the largest yarn diameter. The measured
skin-electrode impedance is positively related to the yarn diameter and negatively related to stitch
density.
Materials
Materials 2018,
2018, 11,
11, x FOR PEER REVIEW
1887 7 7of
of 18
18
Materials 2018, 11, x FOR PEER REVIEW 7 of 18

(a) Plain knit (b) 3D spacer weft knit

(a) Plain knit (b) 3D spacer weft knit
Figure 7. Knitted fabric structure.
Figure
Figure 7. Knitted
7. Knitted fabric
fabric structure.
structure.
According to the geometrical model of a plain knitted fabric, suggested by Munden [41], the
According to thetogeometrical
According model
the geometrical of a plain
model knitted
of a plain fabric,fabric,
knitted suggested by Munden
suggested [41], the
by Munden basic
[41], the
basic basic
structure of a knitted
structure of a
fabric
knitted
is a isloop
fabric a
thatthat
loop
consists of of
consists
parts ofof
parts
circles joined
circles joined
by
by
straight
straight
lines,
lines,
as
as
structure of a knitted fabric is a loop that consists of parts of circles joined by straight lines, as shown
shown in
shown Figure 8.
in FigureThis
8. ismodel
This is
model based on Peirce’s
is basedassumptions assumptions
on Peirce’s assumptions [42]: The
[42]: The bending resistance
bendingofresistance of the
in Figure 8. This model based on Peirce’s [42]: The bending resistance the yarnsofwasthe
yarnsyarns
was negligible
wasthat and and
negligible thatthat
the yarn
the yarnwaswas circular in cross-section.
circular in cross-section.
negligible and the yarn was circular in cross-section.

Figure 8. Loop
Figure model
8. Loop according
model to to
according Munden [41].
Munden [41].
Figure 8. Loop model according to Munden [41].
The length
The length of a single looploop
of a single can can
be calculated
be calculated by by
Equation
Equation (2):(2):
The length of a single loop can be calculated by Equation (2):
l 𝑙==2𝑙2·= 2∙𝑙 +2∙𝑙
𝑙 ++2·2l BC
l∙AB ∙𝑙
(2)
(2)
(2)
where 𝑙 is the straight length between point A and point B on the loop, 𝑙 is the semicircle
l𝑙AB isisbetween
wherelength thestraight
the straight Blength
pointlength between
between
and point C, c point point
is the A A and
and
course point point
spacing, B on Bthe
d is onloop,
the yarn l BC is 𝑙the Equation
the loop,
diameter. is the semicircle
semicircle (3)length
is the
length
between between
point B
calculation point𝑙 Bpoint
ofand and
that point
C, C,on
c is
based c isthe
the the Peirce’s
course course spacing,
spacing,
model d the
d isof isplain
the yarn
yarn diameter.
diameter.
weave Equation(4)
Equation
[43]. Equation (3) is
(3) is the
the
calculation of
calculation 𝑙ofthat
ofl AB 𝑙that based
based
that on Peirce’s
on the
proposed the Peirce’s
by Munden model model
of plain
[41]. ofweave
plain [43]. weave [43]. Equation
Equation (4) is the
(4) is the calculation
calculation of 𝑙 that
of l BC that proposed byproposed
Munden [41].by Munden [41].
9 𝑑
𝑙 "= 𝑐 1+ (3)
9
 16𝑑2𝑐#
𝑙 = 𝑐 1 +9 d (3)
l AB = c 1 + 16 𝑐 (3)
16 c 𝑐
𝑙 = 0.544 (4)
c 2𝑐 𝑑
𝑙 ==0.544
l BC 0.544 (4)
(4)
Noting that the loop is a 3D structure, d𝑑
and the section of the loop between B and C is actually
coveredthat
Noting by athe higher
loop loop andstructure,
is a 3D only the and section
the between
section ofA the andloopB and its mirror
between B andcanC directly
is actually get
between
contact
covered by with
by aahigher the
higherloop skin.
loop So,
and the
onlyeffective skin contact length in a single loop can be estimated by
and only thethe section
section between
between A and A Band andBits and its mirror
mirror can directly
can directly get contactget
contactEquation (5):
with thewith
skin. the skin.effective
So, the So, theskin
effective
contact skin
lengthcontact lengthloop
in a single in acan single loop can by
be estimated beEquation
estimated (5):by
Equation (5): 9 𝑑
𝑙 "= 2𝑐 1  +  # . (5)
9 d16 2 𝑐
l1 = 2c 1 + 9 𝑑 . (5)
𝑙 = 2𝑐 1 16 + c . (5)
16 𝑐
Materials 2018, 11, 1887 8 of 18

Therefore, the effective contact area per square centimeter can be estimated by Equation (6):
"  2 #
9 d
S = 2 · C ·W · c 1 + · D, (6)
16 c

where W is the number of wales per cm, C is the number of courses per cm, c is the course spacing
equals to 10/C, D is the effective contact width of the yarn and skin. D is related to the yarn diameter,
fiber diameter, and the deformation rate of the yarn and the skin.
According to Equation (6), the stitch density C ·W is positively related to the effective skin contact
area. When the stitch density increases, it actually increases the effective skin-electrode contact
area. As we know from the electrical equivalent circuit of the skin-electrode interface in Figure 1,
the skin-electrode interface has both resistive behavior and capacitive behavior. The resistive behavior
can be expressed by Equation (7), and the capacitive behavior can be expressed by Equation (8):

l
Re = ρ , (7)
A
A
Ce = ε , (8)
d
where ρ is the electrical resistivity of the material, l is the fabric thickness, A is the skin-electrode contact
area, ε is the permittivity of the dielectric layer, d is the distance between the electrode and the skin.
According to Equations (7) and (8), the increase in the effective skin-electrode contact area will results
in a decrease in resistance and an increase in capacitance and according to Equation (1), reduction
in resistance and increase in capacitance will eventually lead to a reduction in the skin-electrode
impedance. Therefore, increasing the stitch density can effectively reduce the skin-electrode impedance.
In addition, the increased stitch density also helps to accumulate sweat under the electrode, so that the
skin-electrode impedance drops in a shorter time, meaning a shorter impedance stabilization period.
In ECG monitoring, small skin-electrode impedance means small noise interference; a smooth
impedance-frequency curve means that low-frequency signals have less amplitude distortion.
So according to our results, electrode material TE1 shows the best performance among all four
electrode materials, not only because it has the smallest skin-electrode impedance, but also because
it has the smoothest impedance-frequency curve and the shortest impedance stabilization period.
Therefore, conductive fabric TE1 is an optimum material for making the hybrid textile electrode.

4. Electrode Size
The size of the electrode has also been reported as having a significant influence on skin-electrode
impedance and on the ECG signal’s quality [44]. Puurtinen et al. [45] studied different sizes of textile
electrodes and found that the skin-electrode impedance increases with decreasing of the electrode
size. Marozas et al. [9] also found that textile electrodes with a contact area smaller than 4 cm2 might
cause distortions to the signal’s low-frequency spectrum. Therefore, in order to choose the optimum
electrode size of the proposed hybrid electrode, the electrode size and its influence on the ECG signal
have to be investigated.

4.1. Experimental Method

Three different electrode sizes were investigated, the electrodes were all made from conductive
fabric TE1. Conventional wet ECG electrodes (2228, 3M, Minnesota, USA) were also used to
measure the ECG for comparison purposes. Table 2 listed the areas and dimensions of the four
different electrodes.
Materials 2018, 11, 1887 9 of 18
Materials
Materials 2018,
2018, 11,
11, xx FOR
FOR PEER
PEER REVIEW
REVIEW 99 of
of 18
18

Table 2. Electrodes
Table
Table 2. in in
2. Electrodes
Electrodes different size.
in different
different size.
size.

Large
Large Textile
Large Textile
Textile Medium
Medium Textile
Medium Textile
Textile Small
Small Textile
Small Textile
Textile Conventional
Conventional
Conventional Wet
Electrode
Electrode
Electrode Electrode
Electrode
Electrode Electrode
Electrode
Electrode Electrode
Wet
Wet Electrode
Electrode

Shape
Shape of
of
Shape of Electrodes
Electrodes
Electrodes

Electrode
Electrode
Area (cm2 )
Electrode 888 4.5
4.5
4.5 2.25
2.25
2.25 2.27
2.27
2.27
Area
Area (cm
(cm22))
Electrode Dimension 2 × 4 (w × L, cm) 1.5 × 3.0 (w × L, cm) 1.5 × 1.5 (w × L, cm) 1.7 (ϕ, cm)
Electrode
Electrode
22 ×× 44 (w
(w ×× L,
L, cm)
cm) 1.5
1.5 ×× 3.0
3.0 (w
(w ×× L,
L, cm)
cm) 1.5
1.5 ×× 1.5
1.5 (w
(w ×× L,
L, cm)
cm) 1.7
1.7 (φ,
(φ, cm)
cm)
Dimension
Dimension
ECG signals were measured with these four different electrodes on the chest of a female subject.
All ECG signals were recorded using ADS1292ECG-FE (Texas Instruments, Dallas, TX, USA), with only
ECG
ECG signals
the 50 Hz notch filter were
were measured
signalsoperatingmeasured with
with
and all these
these
other four
four different
filtersdifferent
switched electrodes
off. Theon
electrodes on the
the chest
sample chest of
of aaoffemale
rate female subject.
subject.
the signal was
All
All ECG
ECG signals
signals were
were recorded
recorded using
using ADS1292ECG-FE
ADS1292ECG-FE (Texas
(Texas Instruments,
Instruments, Dallas,
Dallas,
500 Hz, a reference electrode was used to reduce the common-mode noise. All electrodes were secured TX,
TX, USA),
USA), with
with
only
only the
the 50
50 Hz notch
notch filter
filter operating
operating and
and all
all other filters
filters switched
switched off.
off. The
The sample
sample rate
rate ofof the
the signal
on the skin with a Hz
30 mmHg pressure applied byother
an elastic chest band. signal
was
was 500
500 Hz,
Hz, aa reference
reference electrode
electrode was
was used
used to
to reduce
reduce the
the common-mode
common-mode noise.
noise. All
All electrodes
electrodes were
were
secured
secured on
on the
the skin
skin
4.2. Results and Discussion with
with aa 30
30 mmHg
mmHg pressure
pressure applied
applied by
by an
an elastic
elastic chest
chest band.
band.

Figure
4.2. 9 shows
4.2. Results
Results andthe
and original ECG signals recorded with three pairs of dry textile electrodes and
Discussion
Discussion
one pair of Figure
wet
Figure electrodes,
99 shows
shows the the Figure
original
original 10ECG
shows
ECG the recorded
signals
signals power spectral
recorded with
with three
threedensity
pairs
pairs of ofdry
of alltextile
dry ECG electrodes
textile signals.
electrodesAs and
andcan
be seenonefrom
one pair Figure
pair ofof wet 9, baseline
wet electrodes,
electrodes, Figuredrift exists
Figure 10 10 showsin all
shows the ECG
the power signals,
power spectral this
spectral density is mainly
density of of all due
all ECG to
ECG signals.body
signals. As respiration
As can
can bebe
and its effect
seen
seen fromon body
from Figurevolume
Figure 9,
9, baseline
baselinechange
drift causing
drift exists
exists in skin-electrode
in all
all ECG
ECG signals, impedance
signals, this
this is mainlyimbalance.
is mainly due
due to bodyAs
to body the sizeand
respiration
respiration of the
and
electrodeitsincreases,
its effect
effect onon body the baseline
body volume
volume change drift effect
change causing
causingcaused by respiration
skin-electrode
skin-electrode impedance
impedance is significantly
imbalance.reduced.
imbalance. As
As thethe sizeSmall
size of
of thesize
the
electrode
electrode increases,
textile electrodes have thethe
increases, the baseline
baseline
largest drift
drift effect
baseline effect
drift caused
caused
compared by
by respiration
to otheris
respiration significantly
iselectrodes.
significantlyFigure reduced.
reduced. 10Small
Small
shows size
size
that
textile
the energy of electrodes
textile electrodes
the drifted have
have the
the largest
baseline is inbaseline
largest baseline
the frequencydrift
drift compared
compared
range of to other
to0–0.5
other Hz, electrodes.
electrodes.
and that Figurethe 10
Figure 10 shows that
shows textile
smallest that
the
the energy
energy of
of the
the drifted
drifted baseline
baseline is
is in
in the
the frequency
frequency range
range of
of 0–0.5
0–0.5 Hz,
Hz, and
and that
that the
the smallest
smallest textile
textile
electrode has the largest baseline drift noise. Besides the baseline drift, high-frequency noise can
electrode
electrode has has thethe largest
largest baseline
baseline driftdrift noise.
noise. Besides
Besides thethe baseline
baseline drift,drift, high-frequency
high-frequency noise noise can
can also
also
also be observed in all graphs, because of the presence of electromagnetic fields in the vicinity of
be
be observed
observed in in all
all graphs,
graphs, because
because of of the
the presence
presence of of electromagnetic
electromagnetic fields fields in in the
the vicinity
vicinity of of the
the
the patient.
patient.
The smallest dry textile electrode introduces more high-frequency
high-frequency noise than all others.
patient. The The smallest
smallest dry dry textile
textile electrode
electrode introduces
introduces more more high-frequency noise noise than than allall others.
others.
However, the high-frequency
However,
However, the
the high-frequency
high-frequency interference is also
interference
interference is decreased
is also
also decreased
decreased withwith increased
with increased
increased electrode
electrode
electrode size.
size.Although
size. Althoughthe
Although
ECG signal
the
the ECG has been
ECG signal
signal has filtered
has been by a
been filtered 50
filtered by Hz notch
by aa 5050 Hz filter,
Hz notch the
notch filter, 50 Hz
filter, the
the 50 alternating
50 Hz Hz alternating current
alternating current (AC)
current (AC) power
(AC) power
power line
interference
line and its third
line interference
interference andharmonic
and its
its third (150 Hz)(150
third harmonic
harmonic areHz)
(150 clearly
Hz) are observed
are clearly
clearly observedin thein
observed inspectrum
the
the spectrum
spectrum of theof smallest
of the
the smallest
smallest size
size
electrode. electrode.
sizeHowever,
electrode.in However,
the spectrum
However, in
in the
theofspectrum
the largest
spectrum of
of the
size
the largest size
size electrode,
electrode,
largest only the 150
electrode, only
onlyHz the 150
150 Hz
theharmonic Hz harmonic
frequency
harmonic
frequency
frequency and
can be observed, can
can itsbe observed,
be energy
observed, level and
andis its
its energy
energy
similar with level
thatis
level isofsimilar
similar with
with that
the conventional that of ofwetthe conventional
conventional wet
theelectrode. wet
electrode.
electrode.
In comparison with wet electrodes, dry textile electrodes usually introduce more noise (including
the baselineIn In comparison
drift noise andwith
comparison with
the AC wet
wetpowerelectrodes,
electrodes, dry
dry textile
line interference)textile electrodes
electrodes
into the ECG usually
usually
signals.introduce
introduce
However, more
morethe noise
noise
result
(including
(including the the baseline
baseline drift drift noise
noise and and thethe AC AC power
power line line interference)
interference) into into the the ECGECG signals.
signals.
for the largest size textile electrode is comparable to that of the wet electrode, meaning that the dry
However,
However, the the result
result forfor the
the largest
largest sizesize textile
textile electrode
electrode is is comparable
comparable to to that
that of of the
the wet
wet electrode,
electrode,
textile electrode
meaning
meaning that
having
that thethe dry
a large
dry textile
electrode
textile electrode
size
electrode having
can perform
having aa large
equallysize
large electrode
electrode size
well can
for ECG monitoring.
can perform
perform equallyequally well
Therefore,
well for
for ECG
ECG
the electrode size
monitoring. of
monitoring. Therefore, 2 cm ×
Therefore, the 4 cm is an
the electrode optimum
electrode size size of size
of 22 cm for
cm ×× 44 cm making
cm isis an our
an optimum hybrid
optimum size textile
size forfor makingsensor.
making our our hybrid
hybrid
textile
textile sensor.
sensor.
Materials 2018, 11, x FOR PEER REVIEW 10 of 18
Materials 2018,
Materials 11, x
2018, 11, 1887
FOR PEER REVIEW 1010of
of 18
18

Figure 9. Resting electrocardiogram (ECG) signals recorded by different electrodes.

Figure 9. Resting electrocardiogram (ECG) signals recorded by different electrodes.
Figure 9. Resting electrocardiogram (ECG) signals recorded by different electrodes.

Figure10.
Figure Powerspectral
10.Power spectraldensity.
density.
Figure 10. Power spectral density.
Materials 2018,
Materials 11, 11,
2018, x FOR PEER
x FOR REVIEW
PEER REVIEW 11 11
of of
18 18
Materials 2018, 11, 1887 11 of 18

5. Motion
5. Motion Sensor
Sensor FPCBFPCB
5. Motion Sensor FPCB
ToTotrack trackhuman humanactivity,activity,microelectromechanical
microelectromechanical(MEMS) (MEMS)motion motionsensor sensorMPU-9250
MPU-9250
(InvenSense,
To track
(InvenSense, Calgary,
human
Calgary, AB, Canada)
activity,
AB, was used
microelectromechanical
Canada) was used in in
thethe
design of of
(MEMS)
design thethe
hybrid
motion
hybrid textile
sensor electrode,
MPU-9250
textile electrode, because
(InvenSense,
because of of
itsCalgary,
miniature AB, size and
Canada) powerful
was used features.
in the The
design MPU-9250
of the hybrid is a multi-chip
textile
its miniature size and powerful features. The MPU-9250 is a multi-chip module consisting of electrode, module
because consisting
of its of
miniature a a
3-Axis
size
3-Axis gyroscope,
andgyroscope, 3-axis
powerful 3-axis accelerometer,
features. The MPU-9250
accelerometer, 3-axis
3-axis magnetometer
is amagnetometer
multi-chip moduleand a digital
and aconsisting motion
digital motion processor
of a 3-Axis all in
gyroscope,
processor a
all in a
small
3-axis
small 3 ×accelerometer,
3 3× ×3 1× mm1 mm package.
3-axis
package. In In
order
magnetometer
order to to
integrate
and thethe
a digital
integrate motion
motion
motion sensor
processor
sensor with allthe
with atextile
inthe small electrode,
3×
textile 3 × 1 mm
electrode, a a
flexible
package.printed
In circuit
order to board
integrate (FPCB)
the is
motionspecially
sensor designed.
with the The
textileFPCB
flexible printed circuit board (FPCB) is specially designed. The FPCB offers power supplies to the offers
electrode, power
a flexible supplies
printed to the
circuit
MPU-9250
board
MPU-9250 and
(FPCB) andtransmits
is transmits
specially the thedetected
designed.
detected motion
The FPCBdata
motion from
offers
data power
from thethesensor
supplies
sensor toto the
to the
themicrocontroller
MPU-9250
microcontroller and (MCU).
transmits
(MCU).
Thetheprinted
detected transmission
motion data lines
from in
the the
sensorFPCB to thealso serve as
microcontroller an
The printed transmission lines in the FPCB also serve as an electrode lead between the textileelectrode
(MCU). The lead between
printed the
transmission textile
lines
electrode
in the and
FPCB the
also input
serve of
as the
an amplifier.
electrode As
lead shown
between in Figure
the 11,
textile the FPCB
electrode
electrode and the input of the amplifier. As shown in Figure 11, the FPCB consists of two parts: The consists
and the of
input two
of parts:
the The
amplifier.
first
As part
shown
first part is is
ain mini-circuit
aFigure 11, the
mini-circuit board
FPCBwith
board electronic
consists
with of twocomponents
electronic parts: onon
The first
components it;
part the
it; is
thesecond part
a mini-circuit
second partisboard
printed
is with
printed
transmission
electronic lines
componentsfor transmitting
on it; the bio-potential
second part is signals
printed and motion
transmission data
lines
transmission lines for transmitting bio-potential signals and motion data to the MCU. The size of the tofor the MCU.
transmitting The size of the
bio-potential
first part
signals
first is
part 10
and mm
motion
is 10 mm × 7×data
mm.
7 mm. Figure
to the 12:12:
MCU.
Figure (a)The
shows
(a) size the
shows toptop
of the
the view
first of of
part
view the
is 10FPCB;
the mmFPCB; ×(b) shows
7(b)
mm. shows thethe
Figure rear
12: view
(a)view
rear of of
shows
thethe
FPCB;
top
FPCB; and
view and(c) shows
of (c)
the FPCB;
shows thetheflexibility
(b) shows of rear
the
flexibility thethe
of FPCB.
view of the FPCB; and (c) shows the flexibility of the FPCB.
FPCB.

Figure 11.11.
Figure The flexible
The printed
flexible circuit.
printed circuit.

(a)(a) (b)(b)

(c)(c)
Figure
Figure12.12.
The
12. motion
The motionsensor mini
sensor flexible
mini printed
flexible circuit
printed board
circuit (FPCB):
board (a)(a)
(FPCB):
(FPCB): Top
(a) view;
Top
Top (b)(b)
view; rear view;
rear view;
(c)(c)
thethe
flexibility of
flexibility the
of FPCB.
the FPCB.
the flexibility of the FPCB.
 Materials 2018, 11, x FOR PEER REVIEW 12 of 18
Materials 2018, 11, 1887 12 of 18
6. Fabrication
Materials 2018, 11, xof thePEER
FOR Hybrid Textile
REVIEW Electrode 12 of 18

In order to integrate
Hybridthe miniElectrode
FPCB into the textile electrode, we used silver conductive
6.6.Fabrication
Fabrication ofofthethe Hybrid Textile
Textile Electrode
adhesive (CW2400, Chemtronics, Kennesaw, GA, USA) to bond the rear side of the mini circuit
board Inwith
In orderthe
order to
to integrate sidethe
integrate
rear ofmini
the FPCB
mini
the FPCBintointo
conductive the textile electrode,
the textile
fabric together, towe
electrode, usedwesilver
establish used conductive adhesive
silver conductive
a coherent ECG signal
(CW2400,
adhesive Chemtronics,
(CW2400, Kennesaw,
Chemtronics, GA,
Kennesaw, USA) GA,to bond
USA) the
to rear
bond
transmission line, as demonstrated in Figure 13. The biopotential signal is transmitted from side
the of the
rear mini
side ofcircuit
the board
mini with
circuit
the
the rear
board
textile sidethe
with
electrode of the
rear conductive
through sidethe thefabric
of silver together,fabric
conductive
conductive to establish
together,
adhesive layera coherent
tothe
to ECG
establish
ECG asignal transmission
coherent
electrode ECG signal
connection line,
point
as demonstrated
transmission
of the FPCB,line, and inasFigure
then13.reaches
itdemonstrated The biopotential
in inputsignal
theFigure 13. theis transmitted
of The biopotentialfrom signaltheistextile
amplifier electrode
transmitted
through through
thefrom the
printed
the
textilesilver conductive
electrode
transmission through
line. adhesive
the silver
Electrical layer to the
conductive
insulation ECG electrode
is also adhesive
importantlayer connection
to the ECG
for making point of
the electrodethe FPCB, and
connection
hybrid textile it then
pointA
electrode.
reaches
of
thick, the input
the transparent,
FPCB, and of it the biopotential
then
flexible reaches theamplifier
silicon coating input
(FSC, through
of Electrolube, the Leicestershire,
the biopotential printed transmission
amplifier through
UK) line.
the Electrical
is brushed printed
on the
insulation
top surfaceis of
transmission also
line.
the important
Electrical
mini circuitfor making
board the
insulation hybrid
is also
to textile
important
provide electrode.
insulationfor making
of theA electronic
thick, transparent,
the hybrid textileflexible
components electrode.silicon
with A
the
coating
thick,
outside (FSC,
transparent,Electrolube,
world. Theflexible Leicestershire,
flexiblesilicon
siliconcoating UK)
coating(FSC, is brushed on
Electrolube,
is a solvent the top surface
based Leicestershire, of
conformal coating the mini
UK) designedcircuit
is brushed board
to on theto
protect
provide
top surface
printed insulation
of the
circuit boards.of the
mini electronic
circuit
As seen board components
in Figure 14, the with
to provide the
insulation
FPCB outside
of the
is integrated world. The
electronic
with flexible silicon
components
the conductive coating
with
fabric. theis
a solvent
outside basedThe
world. conformal coatingcoating
flexible silicon designed is atosolvent
protectbased
printed circuit boards.
conformal coating As seen into
designed Figure
protect 14,
the FPCB
printed is integrated
circuit boards. As with
seentheinconductive
Figure 14, fabric.
the FPCB is integrated with the conductive fabric.

Figure
Figure 13.
13. The
The layout
layout of
of the
the hybrid
hybrid textile
textile electrode.
electrode.

Figure 13. The layout of the hybrid textile electrode.

Figure The integration

Figure 14. The integration of
of the
the circuit board and the conductive fabric.

Non-conductive
Non-conductive fabric
Figurefabric
14. Theand
and non-conductive
non-conductive
integration sponge
sponge
of the circuit filler
boardfiller
and thefabric
fabric are also
are
conductive also used for
used
fabric. for making
making thethe
hybrid textile
hybrid textile electrode.
electrode. Non-conductive
Non-conductive fabric fabric serves
serves as
as an
an insulating
insulating layer.
layer. Non-conductive
Non-conductive spongesponge
Non-conductive
fabric provides support fabric
for and
the non-conductive
flexible circuit sponge
board and filler
the fabric
conductive are also
fabric. used
Figure
fabric provides support for the flexible circuit board and the conductive fabric. Figure 15 illustrates for
15 making
illustratesthe
the
hybrid
top top
the andtextile
and electrode.
the Non-conductive
the cross-sectional
cross-sectionalviews views of fabric
of the hybrid serves aselectrode.
textile
the hybrid an insulating
textile layer.
TheThe
electrode. middleNon-conductive
rectangular
middle rectangular sponge
area is the
area is
fabric
the provides
conductive
conductive support
fabric fabric for the by
surrounded
surroundedflexible
theby circuit board and
non-conductive the conductive
fabric.
the non-conductive The skinThe
fabric. fabric.
contact Figure
skinarea 15area
of the
contact illustrates
conductive
of the
the topisand
fabric
conductive the
20 mm ×cross-sectional
fabric 40 mm.
is 20 mm Figure
× 40views
16
mm. of
shows the
Figurethehybrid textile
topshows
16 view theelectrode.
and the
toprear
view The
andofmiddle
view therear
the rectangular
hybrid
viewtextile area is
electrode.
of the hybrid
the conductive
textile electrode.fabric surrounded by the non-conductive fabric. The skin contact area of the
conductive fabric is 20 mm × 40 mm. Figure 16 shows the top view and the rear view of the hybrid
textile electrode.
Materials
Materials2018,
2018,11,
11,xxFOR
FORPEER
PEERREVIEW
REVIEW 13
13 of
of 18
18
Materials 2018,11,
Materials2018, 11,1887
x FOR PEER REVIEW 1313ofof18
18

(a)
(a)
(a) (b)
(b)
(b)
Figure
Figure15.
Figure
Figure 15.The
15.
15. Theillustration
The
The illustrationof
illustration
illustration ofthe
of
of thestructure
the structureof
structure oftextile
of textile electrode:
textileelectrode: (a)
electrode:(a)
(a) Top
(a)Top view;
Topview;
Top (b)
view;(b)
view; side
(b)side
(b) view.
sideview.
side view.
view.

(a)
(a) (b)
(b)
(b)
Figure
Figure16.
16.Hybrid
Hybridtextile
Hybrid
Hybrid textileelectrode:
textile electrode:(a)
electrode: (a)Top
(a) Topview;
Top (b)
view;(b) rear
(b)rear view.
rearview.
view.
view.

7.
7.7.Hardware
7.Hardware Setup
HardwareSetup
Hardware Setup
The
The
The measurement
The measurement
measurement system
measurement system configuration isis
system configuration
configuration
configuration is shown
shownin
shown ininFigure
Figure17.
Figure 17.
17.
17. It
ItItis Itbased
isis is based
based
based ononan
on on
anMSP
an an
MSPMSP
MSP 430
430
430
430 microcontroller
microcontroller (Texas
microcontroller
microcontroller (Texas
(Texas Instruments,
(Texas Instruments,
Instruments,
Instruments, Dallas, Dallas,
Dallas,
Dallas, TX, TX,
TX, USA) USA) with
USA) with build
with build
build in
build in high-performance
in high-performance
in high-performance12-bit
high-performance 12-bit
12-bit
12-bit
Analog-to-digital
Analog-to-digital converter
Analog-to-digital
Analog-to-digital converter (ADC)
converter
converter (ADC) for
(ADC)
(ADC) for data
for
for dataacquisition
data
data acquisition and
acquisition andsystem
and systemcontrol.
system
system control.
control.A
control. A low
Alow
A power,
lowpower,
low 24-bit
power,24-bit
power, 24-bit
24-bit
Analog
Analog
Analog front-end
front-end
Analog front-end ADS1292R
ADS1292R
front-end ADS1292R (Texas
ADS1292R (Texas Instruments,
(Texas
(Texas Instruments, Dallas,
Instruments, TX, USA)
Dallas,
Instruments, Dallas, TX, is
TX, used
USA)
TX, USA) for the
is
USA) isis used ECG
used measurements;
for
used for the
the ECG
for the ECG
ECG
and a motion tracking
measurements;
measurements;
measurements; and aa
and
and device
motionMPU-9250
a motion
motion tracking
tracking
tracking device (InvenSense,
device
device MPU-9250
MPU-9250Calgary, AB, Canada)
(InvenSense,
(InvenSense,
(InvenSense, Calgary,
Calgary, is embedded
Calgary, AB,
AB,Canada)
AB, in the
Canada)
Canada) isisis
textile
embeddedelectrode
embedded in
in theto
the track
textile
textile movement.
electrode
electrode to
to The
track
track measured
movement.
movement. ECG
Theand motion
measured
measured signals
ECG
ECG
embedded in the textile electrode to track movement. The measured ECG and motion signals are and
andare transferred
motion
motion signalsinto
signals are
are a
Bluetooth
transferred
transferred module
into
transferred into a RN41
into aa Bluetooth(Microchip,
Bluetooth module
Bluetooth module Chandler,
module RN41 RN41 Arizona,
(Microchip,
RN41 (Microchip, USA) and
Chandler,
(Microchip, Chandler, send
Arizona,
Chandler, Arizona, to
Arizona, USA) a remote
USA) and
USA) and computer
send
and send to
send to or
a
to aa
mobile
remote
remote device
computer
computer wirelessly.
oror mobile
mobile device
device
remote computer or mobile device wirelessly. wirelessly.
wirelessly.

Figure 17.
Figure 17. The system setup.
Figure
Figure17.
17.The
Thesystem
systemsetup.
setup.
Materials 2018, 11, 1887 14 of 18
Materials 2018, 11, x FOR PEER REVIEW 14 of 18

8. 8.
TheTheImplementation
Implementation of the
ofPEER
Materials 2018, 11, x FOR Hybrid
Hybrid Textile
theREVIEW Textile Electrode for
for ECG
ECGMonitoring
Monitoringand
andMotion
Motion Tracking
Tracking
14 of 18

InIn order
order
8. The to the
testperformance
the performance
to Implementation
test of the
of theTextile
of the Hybrid hybrid hybrid
textile
Electrode textile
electrodes,
for electrodes,
we have
ECG Monitoring we have
andundertaken
Motion undertaken
measurement
Tracking
measurement
using using
order to test the performance of the hybrid textile electrodes, we have undertakenwith
a femaleInsubject. a female
Two subject.
hybrid Two
textile hybrid
electrodes textile
and electrodes
one textileand one
electrode textile
with electrode
the same the
structure
same structure were sewn onto an elastic chest band, as seen in Figure 18.
were sewn onto an elastic chest band, as seen in Figure 18. The Electrodes were placed on the subject’s
measurement using a female subject. Two hybrid textile electrodes and one textile The
electrode Electrodes
with the were
placed
chest andon same
thestructure
were subject’s
secured were sewn
chest
onto theonto
and anwith
were
skin elastic
securedachest
30ontoband,
mmHg theasskin
seenwith
in Figure
pressure, 30 18.
aapplied Theby
mmHg Electrodes
pressure,
an elasticwere
applied by
chest band.
an elasticplaced
chest on the subject’s
band. under chest
Signalstwowereand were secured onto
recordedactivities: the skin
under twoSitting with
everyday a 30 mmHg pressure, applied by
Signals were recorded everyday and activities:
walking. Sitting and walking.
an elastic chest band. Signals were recorded under two everyday activities: Sitting and walking.

Figure18.
Figure 18.The
The chest
chestband.
band.
Figure 18. The chest band.
Figure 19 shows the original, unfiltered signal that is recorded with the hybrid textile
Figure 19 shows the original, unfiltered signal that is recorded with the hybrid textile electrodes.
electrodes. Figure 19a shows the resting ECG and its corresponding motion data; Figure 19b shows
FigureFigure
19athe 19 shows
shows
exercisetheECG the ECG
resting
and its
original,
and unfiltered
its corresponding
corresponding
signal that
motion data. Allmotion
is recorded
data;present
ECG signals
with
Figure 19bthe
baseline
hybrid
shows the textile
drift and exercise
electrodes. Figure 19a shows the resting ECG and its corresponding
ECG and its corresponding motion data. All ECG signals present baseline drift and high-frequency
high-frequency noise. The baseline drift is mainly caused by the motion
respiration, as data;
the Figure
hybrid 19b
textile shows
the exercise
noise. ECGwere
Theelectrodes
baseline and
drift itsis corresponding
integrated
mainlyinto acaused motion
chest band,bythe data.
thechest All ECG
movement
respiration, assignals
during present
therespiration
hybrid baseline
induces
textile motiondrift and
electrodes were
artefacts noise.
high-frequency into theTheECGbaseline
signals. As shown
drift is in Figurecaused
mainly 19a, chestby movement
the during respiration
respiration, as the was textile
hybrid
integratedcaptured
into a chest band,
by the motion
the chest
sensor
movement
in synchronization
during respiration
withmovement
the ECG. Theduring
induces motion
accelerometer’s
artefacts
data induces
into
on the Z motion
the
electrodes were integrated into a chest band, the chest respiration
ECG signals.
axis As
has shown
the sameintrendFigure 19a,
as the chestdrift
baseline movement during
of the resting ECG.respiration
The gyroscope’s wasdata
captured
on the Xbyaxisthe motion
artefactsalso
intoshows
the aECG signals. Ashigh-frequency
shown in Figure 19a, chest movement during respiration was
sensor in synchronization similarwith
trend.theTheECG. The accelerometer’s data isonmainly
noise in ECG signals the Zinduced
axis has thepower
from same trend as
capturedline
by interference,
the motionbecausesensortextile
in synchronization with the ECG. The accelerometer’s data on the Z
the baseline drift of the resting ECG.electrodes have high data
The gyroscope’s and unbalanced
on the X skin-electrode
axis also shows impedance,
a similar trend.
axis has thus
the same trenddifferential
introducing as the baseline
mode noisedriftintoofthe
the resting
ECG signals.ECG. The gyroscope’s
The waveform of exercise data on the X axis
ECG shows
The high-frequency
more
noise in
interference
ECG
thanThe
signals is mainlytoinduced
the high-frequency
resting ECG, due noise motion
from power
artefacts caused
line interference,
by walking
because
motion.from
As power
textile
also shows a similar trend. in ECG signals is mainly induced
electrodesshown
have in high and unbalanced skin-electrode impedance, thus introducing differential mode
line interference,Figure 19b, textile
because walking electrodes
motion was have capturedhighby the
andmotion sensor in skin-electrode
unbalanced synchronization withimpedance,
noise
thusinto the ECGdifferential
the ECG.
introducing
Thesignals. The
accelerometer
modewaveform
data and the
noise into of exercise
the ECG ECG
gyroscope data shows
illustrate
signals.
the more interference
motion
The waveform
pattern.
of exercisethanECG theshows
resting
ECG, due to motion artefacts caused by walking motion. As shown
more interference than the resting ECG, due to motion artefacts caused by walking motion. As in Figure 19b, walking motion
was captured
shown by the
in Figure motion
19b, walking sensor in synchronization
motion was captured by with
the the ECG.sensor
motion The accelerometer
in synchronizationdata and withthe
gyroscope data illustrate the motion pattern.
the ECG. The accelerometer data and the gyroscope data illustrate the motion pattern.

Figure 19. Cont.

Materials 2018, 11, 1887 15 of 18
Materials 2018, 11, x FOR PEER REVIEW 15 of 18

(a) (b)
Figure 19.19.
Figure Signals
Signalsrecorded
recordedby
by the hybridtextile
the hybrid textileelectrode:
electrode:(a)(a)
Sit;Sit;
(b)(b) walk.
walk.

According
Accordingto to
thethe
results presented
results in Figure
presented 19, the
in Figure 19,hybrid textile electrode
the hybrid is capable
textile electrode is of recording
capable of
ECG and tracking
recording motion
ECG and at themotion
tracking same time. Although
at the the recorded
same time. AlthoughECG the signals
recordedwereECGcontaminated
signals wereby
baseline drift and
contaminated byhigh-frequency
baseline drift noises, the magnitudenoises,
and high-frequency of the the
noise did not corrupt
magnitude of thethenoisemorphology
did not
ofcorrupt
the recorded ECG. Therefore,
the morphology the presence
of the recorded ECG.of these noises
Therefore, is tolerable
the presence and the
of these performance
noises is tolerableof the
and
the performance
hybrid of thein
textile electrode hybrid textile electrode
ECG monitoring in ECG monitoring
is reasonable, is reasonable,
and the integrated motionandsensor
the integrated
was very
motion in
accurate sensor was very
capturing accurateby
movement inthe
capturing
hybridmovement by the hybrid textile electrode.
textile electrode.

9.9.Conclusions
Conclusions
This
Thispaper
paperpresents
presentsa anew
newhybrid
hybridtextile
textileelectrode
electrodethat
thatintegrates
integratesmotionmotionsensor
sensorMPU9250
MPU9250 with with a
a textile-based
textile-based electrode.
electrode. ThisThis proposed
proposed hybrid
hybrid textile
textile electrode
electrode is not
is not onlyonly suitable
suitable for long-term
for long-term ECG
ECG monitoring,
monitoring, but alsobut also capable
capable of tracking
of tracking the patient
the patient activityactivity simultaneously.
simultaneously.
InInthe
thedesign
designofofthe
thehybrid
hybrid textile,
textile, the
the performances
performances of of textile
textile electrodes
electrodeshave havebeenbeenstudied.
studied.
Fourelectrode
Four electrodematerials
materialswere
were investigated,
investigated, and the conductive
conductive fabricfabric TE1TE1 waswaschosen
chosentotobebethe the
optimumelectrode
optimum electrode material.
material. According
According to theto the skin-electrode
skin-electrode impedance impedance
measurement,measurement, the
the conductive
conductive
fabric TE1 notfabric TE1has
only not only
the has the smallest
smallest skin-electrode
skin-electrode impedance,
impedance, butbut alsohas
also has the
the smoothest
smoothest
impedance-frequency curve and the shortest impedance stabilization period. Thestudy
impedance-frequency curve and the shortest impedance stabilization period. The studyon onthe
the
electrodesize
electrode sizehas
hasproven
proventhat
thatdry
drytextile
textileelectrodes
electrodeswith
with the
the size
size ofof 22 cm
cm × × 44cm
cmcancanperform
performequally
equally
well
well as as commercial
commercial wetwet electrodes
electrodes in ECGin ECG monitoring.
monitoring. Therefore,
Therefore, the size theof size of the textile
the hybrid hybridelectrode
textile
electrode was found optimum at 2 cm × 4 cm. In order to integrate the motion
was found optimum at 2 cm × 4 cm. In order to integrate the motion sensor MPU9250 with the textile sensor MPU9250 with
the textile base, a flexible printed circuit board (FPCB) has been specially designed
base, a flexible printed circuit board (FPCB) has been specially designed for this purpose. The size of for this purpose.
The size of the FPCB is only 1 cm × 0.7 cm, which makes it easy to integrate into the textile electrode.
the FPCB is only 1 cm × 0.7 cm, which makes it easy to integrate into the textile electrode.
The combination of motion signals and ECG signals offers great potential for cardiology clinical
The combination of motion signals and ECG signals offers great potential for cardiology clinical
trials cardiac rehabilitation patient care, and in general wellbeing and sports. The motion signals
trials cardiac rehabilitation patient care, and in general wellbeing and sports. The motion signals
recorded in synchronization with the ECG signals can help the cardiologist find the cause of the
recorded in synchronization with the ECG signals can help the cardiologist find the cause of the
heart disease by providing information about the patient’s physical activity when the ECG shows an
heart disease by providing information about the patient’s physical activity when the ECG shows
abnormality. By tracking daily physical activity and alerting the patient when the patient is
an abnormality. By tracking daily physical activity and alerting the patient when the patient is
over-exercised can also help prevent the sudden death in patients with coronary heart disease.
over-exercised can also help prevent the sudden death in patients with coronary heart disease.
Furthermore, sports and exercise can also be monitored with these new technologies that can
Furthermore, sports and exercise can also be monitored with these new technologies that can provide
provide better data than the commonplace heart beat monitors.
better data than the commonplace heart beat monitors.
Author Contributions: Conceptualization, X.A. and George K.S.; Methodology, X.A.; Software, X.A.;
Author Contributions: Conceptualization, X.A. and George K.S.; Methodology, X.A.; Software, X.A.; Validation, X.A.
Validation, X.A. and G.K.S.; Formal Analysis, X.A.; Investigation, X.A.; Resources, G.K.S.; Data Curation, X.A.;
and G.K.S.; Formal Analysis, X.A.; Investigation, X.A.; Resources, G.K.S.; Data Curation, X.A.; Writing—Original
Writing—Original
Draft Draft
Preparation, X.A.; Preparation, &X.A.;
Writing—Review Writing—Review
Editing, & Editing,
G.K.S.; Visualization, G.K.S.; Visualization,
X.A.; Supervision, G.K.S. X.A.;
Supervision, G.K.S.;
Funding: This research received no external funding.
Funding: This research received no external funding
Conflicts of Interest: The authors declare no conflict of interest.
Conflicts of Interest: The authors declare no conflict of interest
Materials 2018, 11, 1887 16 of 18

References
1. Scilingo, E.P.; Gemignani, A.; Paradiso, R.; Taccini, N.; Ghelarducci, B.; De Rossi, D. Performance evaluation
of sensing fabrics for monitoring physiological and biomechanical variables. IEEE Trans. Inf. Technol. Biomed.
2005, 9, 345–352. [CrossRef] [PubMed]
2. Mestrovic, M.A.; Helmer, R.J.; Kyratzis, L.; Kumar, D. Preliminary study of dry knitted fabric electrodes for
physiological monitoring. In Proceedings of the Intelligent Sensors, Sensor Networks and Information 3rd
International Conference, Melbourne, Australia, 3–6 December 2007; pp. 601–606.
3. Paradiso, R.; Loriga, G.; Taccini, N. A wearable health care system based on knitted integrated sensors.
IEEE Trans. Inf. Technol. Biomed. 2005, 9, 337–344. [CrossRef] [PubMed]
4. Priniotakis, G.; Westbroek, P.; Van Langenhove, L.; Hertleer, C. Electrochemical impedance spectroscopy as
an objective method for characterization of textile electrodes. Trans. Inst. Meas. Control 2007, 29, 271–281.
[CrossRef]
5. Pola, T.; Vanhala, J. Textile electrodes in ECG measurement. In Proceedings of the Intelligent Sensors,
Sensor Networks and Information 3rd International Conference, Melbourne, Australia, 3–6 December 2007;
pp. 635–639.
6. Beckmann, L.; Kim, S.; Dueckers, H.; Luckhardt, R.; Zimmermann, N.; Gries, T.; Leonhardt, S. Characterization
of textile electrodes for bioimpedance spectroscopy. In Proceedings of the Ambience: International Scientific
Conference Smart Textile—Technology and Design, Boras, Sweden, 19–20 September 2008; pp. 79–83.
7. Paradiso, R.; Loriga, G.; Taccini, N.; Gemignani, A.; Ghelarducci, B. WEALTHY-a wearable healthcare system:
New frontier on e-textile. J. Telecommun. Inf. Technol. 2005, 105–113.
8. Catrysse, M.; Puers, R.; Hertleer, C.; Van Langenhove, L.; Van Egmond, H.; Matthys, D. Towards the
integration of textile sensors in a wireless monitoring suit. Sensor Actuat. A-Phys. 2004, 114, 302–311.
[CrossRef]
9. Marozas, V.; Petrenas, A.; Daukantas, S.; Lukosevicius, A. A comparison of conductive textile-based and
silver/silver chloride gel electrodes in exercise electrocardiogram recordings. J. Electrocardiol. 2011, 44,
189–194. [CrossRef] [PubMed]
10. Ankhili, A.; Tao, X.; Cochrane, C.; Coulon, D.; Koncar, V. Washable and Reliable Textile Electrodes Embedded
into Underwear Fabric for Electrocardiography (ECG) Monitoring. Materials 2018, 11, 256. [CrossRef]
[PubMed]
11. Rattfält, L.; Lindén, M.; Hult, P.; Berglin, L.; Ask, P. Electrical characteristics of conductive yarns and textile
electrodes for medical applications. Med. Biol. Eng. Comput. 2007, 45, 1251–1257. [CrossRef] [PubMed]
12. Martinsen, O.G.; Grimnes, S. Bioimpedance and Bioelectricity Basics; Academic Press: Cambridge, MA,
USA, 2011.
13. Jang, S.; Cho, J.; Jeong, K.; Cho, G. Exploring Possibilities of ECG Electrodes for Bio-monitoring Smartwear
with Cu Sputtered Fabrics. In Human-Computer Interaction. Interaction Platforms and Techniques. HCI
2007; Lecture Notes in Computer Science; Jacko, J.A., Ed.; Springer: Berlin/Heidelberg, Germany, 2007;
Volume 4551.
14. Pani, D.; Dessì, A.; Saenz-Cogollo, J.F.; Barabino, G.; Fraboni, B.; Bonfiglio, A. Fully textile, PEDOT: PSS based
electrodes for wearable ECG monitoring systems. IEEE Trans. Biomed. Eng. 2016, 63, 540–549. [CrossRef]
[PubMed]
15. Paradiso, R. Wearable health care system for vital signs monitoring. In Proceedings of the Information
Technology Applications in Biomedicine, Birmingham, UK, 2003; pp. 283–286.
16. Carvalho, H.; Catarino, A.P.; Rocha, A.M.; Postolache, O. Health monitoring using textile sensors and
electrodes: An overview and integration of technologies. In Proceedings of the International Symposium on
Medical Measurements and Applications, Lisbon, Portugal, 2014; pp. 70–75.
17. Castiglioni, P.; Faini, A.; Parati, G.; Di Rienzo, M. Wearable Seismocardiography. In Proceedings of the 29th
Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Lyon, France,
22–26 August 2007; pp. 3954–3957.
18. Jourand, P.; De Clercq, H.; Corthout, R.; Puers, R. Textile integrated breathing and ECG monitoring system.
Procedia Chem. 2009, 1, 722–725. [CrossRef]
Materials 2018, 11, 1887 17 of 18

19. Di Rienzo, M.; Rizzo, F.; Parati, G.; Brambilla, G.; Ferratini, M.; Castiglioni, P. MagIC system: A new
textile-based wearable device for biological signal monitoring. Applicability in daily life and clinical setting.
In Proceedings of the 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference, Shanghai,
China, 17–18 January 2005; pp. 7167–7169.
20. Bifulco, P.; Cesarelli, M.; Fratini, A.; Ruffo, M.; Pasquariello, G.; Gargiulo, G. A wearable device for recording
of biopotentials and body movements. In Proceedings of the Medical Measurements and Applications
Proceedings, Bari, Italy, 30–31 May 2011; pp. 469–472.
21. Mittleman, M.A.; Maclure, M.; Tofler, G.H.; Sherwood, J.B.; Goldberg, R.J.; Muller, J.E. Triggering of acute
myocardial infarction by heavy physical exertion–protection against triggering by regular exertion. New Engl.
J. Med. 1993, 329, 1677–1683. [CrossRef] [PubMed]
22. Hansson, A.; Madsen-Härdig, B.; Olsson, S.B. Arrhythmia-provoking factors and symptoms at the onset of
paroxysmal atrial fibrillation: A study based on interviews with 100 patients seeking hospital assistance.
BMC Cardiovasc. Disor. 2004, 4, 13. [CrossRef] [PubMed]
23. Lampert, R.; Joska, T.; Burg, M.M.; Batsford, W.P.; McPherson, C.A.; Jain, D. Emotional and physical
precipitants of ventricular arrhythmia. Circulation 2002, 106, 1800–1805. [CrossRef] [PubMed]
24. Kohl, H.W., III; Powell, K.E.; Gordon, N.F.; Blair, S.N.; Paffenbarger, R.S., Jr. Physical activity, physical fitness,
and sudden cardiac death. Epidemiol. Rev. 1992, 14, 37–58. [CrossRef] [PubMed]
25. Benarroch, E.E. Postural tachycardia syndrome: A heterogeneous and multifactorial disorder.
Mayo Clin. Proc. 2012, 87, 1214–1225. [CrossRef] [PubMed]
26. Cobb, L.A.; Weaver, W.D. Exercise: A risk for sudden death in patients with coronary heart disease. J. Am.
Coll. Cardiol. 1986, 7, 215–219. [CrossRef]
27. Burke, A.P.; Farb, A.; Malcom, G.T.; Liang, Y.H.; Smialek, J.E.; Virmani, R. Plaque rupture and sudden death
related to exertion in men with coronary artery disease. J. Am. Med. Assoc. 1999, 281, 921–926. [CrossRef]
28. Siscovick, D.S.; Weiss, N.S.; Fletcher, R.H.; Lasky, T. The incidence of primary cardiac arrest during vigorous
exercise. N. Engl. J. Med. 1984, 311, 874–877. [CrossRef] [PubMed]
29. Webster, J.G. Medical Instrumentation-Application and Design; John Wiley & Sons: Hoboken, NJ, USA, 2009.
30. Geddes, L.A.; Valentinuzzi, M.E. Temporal changes in electrode impedance while recording the
electrocardiogram with ‘dry’ electrodes. Ann. Biomed. Eng. 1973, 1, 356–367. [CrossRef] [PubMed]
31. Olson, W.; Schmincke, D.; Henley, B. Time and frequency dependence of disposable ECG electrode-skin
impedance. Med. Instrum. 1978, 13, 269–272.
32. Tiller, J.C.; Liao, C.J.; Lewis, K.; Klibanov, A.M. Designing surfaces that kill bacteria on contact. Proc. Natl.
Acad. Sci. USA 2001, 98, 5981–5985. [CrossRef] [PubMed]
33. Lansdown, A.B. A pharmacological and toxicological profile of silver as an antimicrobial agent in medical
devices. Adv. Pharmacol. Sci. 2010. [CrossRef] [PubMed]
34. Lee, H.J.; Jeong, S.H. Bacteriostasis and skin innoxiousness of nanosize silver colloids on textile fabrics.
Text. Res. J. 2005, 75, 551–556. [CrossRef]
35. Samberg, M.E.; Oldenburg, S.J.; Monteiro-Riviere, N.A. Evaluation of silver nanoparticle toxicity in skin
in vivo and keratinocytes in vitro. Environ. Health Perspect. 2009, 118, 407–413. [CrossRef] [PubMed]
36. Tregear, R.T. Physical Functions of Skin; Elsevier: New York, NY, USA, 1966; Volume 5.
37. Priniotakis, G.; Westbroek, P.; Van Langenhove, L.; Kiekens, P. An experimental simulation of human body
behaviour during sweat production measured at textile electrodes. Int. J. Cloth. Sci. Technol. 2005, 17, 232–241.
[CrossRef]
38. Westbroek, P.; Priniotakis, G.; Palovuori, E.; De Clerck, K.; Van Langenhove, L.; Kiekens, P. Quality control of
textile electrodes by electrochemical impedance spectroscopy. Text. Res. J. 2006, 76, 152–159. [CrossRef]
39. Xu, P.J.; Zhang, H.; Tao, X.M. Textile-structured electrodes for electrocardiogram. Text. Prog. 2008, 40,
183–213. [CrossRef]
40. Liu, H.; Tao, X.; Xu, P.; Zhang, H.; Bai, Z. A dynamic measurement system for evaluating dry bio-potential
surface electrodes. Measurement 2013, 46, 1904–1913. [CrossRef]
41. Hearle, J.W.; Grosberg, P.; Backer, S. Structural Mechanics of Fibers, Yarns and Fabrics; Wiley Interscience:
Hoboken, NJ, USA, 1969; Volume I.
42. Peirce, F.T. Geometrical principles applicable to the design of functional fabrics. Text. Res. J. 1947, 17, 123–147.
[CrossRef]
43. Peirce, F.T. 5—The geometry of cloth structure. J. Text. Inst. Trans. 1937, 28, T45–T96. [CrossRef]
Materials 2018, 11, 1887 18 of 18

44. Xiang, A.; Orathai, T.; George, K.S. Investigating the Performance of Dry Textile Electrode for wearable
End-Uses. J. Text. Inst 2018, in press.
45. Puurtinen, M.M.; Komulainen, S.M.; Kauppinen, P.K.; Malmivuo, J.A.; Hyttinen, J.A. Measurement of noise
and impedance of dry and wet textile electrodes, and textile electrodes with hydrogel. In Proceedings
of the Engineering in Medicine and Biology Society, New York, NY, USA, 30 August–3 September 2006;
pp. 6012–6015.

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