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Wearable Technology in Medicine and Health Care

Wearable Technology in Medicine and Health Care

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Wearable Technology in Medicine and Health Care

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Jul 26, 2018


Wearable Technology in Medicine and Health Care provides readers with the most current research and information on the clinical and biomedical applications of wearable technology. Wearable devices provide applicability and convenience beyond many other means of technical interface and can include varying applications, such as personal entertainment, social communications and personalized health and fitness. The book covers the rapidly expanding development of wearable systems, thus enabling clinical and medical applications, such as disease management and rehabilitation. Final chapters discuss the challenges inherent to these rapidly evolving technologies.

  • Provides state-of-the-art coverage of the latest advances in wearable technology and devices in healthcare and medicine
  • Presents the main applications and challenges in the biomedical implementation of wearable devices
  • Includes examples of wearable sensor technology used for health monitoring, such as the use of wearables for continuous monitoring of human vital signs, e.g. heart rate, respiratory rate, energy expenditure, blood pressure and blood glucose, etc.
  • Covers examples of wearables for early diagnosis of diseases, prevention of chronic conditions, improved clinical management of neurodegenerative conditions, and prompt response to emergency situations
Jul 26, 2018

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Wearable Technology in Medicine and Health Care - Academic Press



Raymond Kai-Yu Tong, Professor and Chairman, Department of Biomedical Engineering (BME), Chinese University of Hong Kong (CUHK)

Wearable Technology in Healthcare and Medicine is written for biomedical, and other clinical and technical professionals. Since wearable technology advances at an ever-increasing pace, we have included new and exciting topics, which reflect the modern technology for the clinical and biomedical applications. To successfully and smoothly apply wearable products, it requires to work with various key stakeholders in governments, manufacturers, hospitals, and medical doctors. Throughout the book, we present the main applications and challenges in the biomedical implementation of wearable devices. Government bodies will find this book useful to understand the state of the art of wearable technology to support their policy to improve the modern healthcare system. The medical device industry can use it to better understand and access this emerging market. Academics and students will find this book very important for their careers in biomedical engineering and wearable device–related fields.

This book would not have been possible without contributions from outstanding experts in various topics discussed in it. I wish to express my gratitude to all of them for their precious efforts and strong support. I would like to thank my research student, Melisa Junata, for her assistance.

Finally, many thanks to my family (parents, Wai-chuen Tong, and Lai-lin Tsui, and daughter and sons, Lok-ching, Lok-tin, and Lok-ting), for their support, encouragement, and patience. They have been my driving forces.

Chapter 1

Wearable Technology in Medicine and Health Care


Melisa Junata and Raymond Kai-Yu Tong,    Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong


Research teams worldwide have contributed to this book. A wide array of wearable technology is covered in this book literally from head to toe. We have smart glasses for surgeons, smart textiles, upper-limb exoskeleton, and lower-limb exoskeleton. The sensors and technology behind these innovations are discussed deeply in the following chapters. Other topics that act as a result of the inventions of these wearables—big data, patents, regulations, and designs—will help readers to understand the underlying factors that must be considered to deliver these technologies safely and effectively to patients and the general public.


Wearable technology; overview; introduction; aging population; personalized medicine; Internet of things; smart eyewear; robotics; sensors; smart textiles; big data

In this era of continuous innovations, the health care world that we are living in will look different in the future. We heard all about new technology innovations in the health-care world. They all promise different outcome and leap from what we have discovered before. A hearing aid is the earliest form of wearable technology that people have ever created [1]. But with the developments in the computing world and the rise in ubiquitous computing technology that gets smaller by size, wearable technology will be a definite part of our future.

It was unimaginable for people in the early forms of computer years that now we can have a smartwatch that will detect our steps and our heartbeat as we walk. It was a significant breakthrough for people to have portable computers wherever and anywhere we go. As time goes on, they are no longer restricted to workplace and home. Wearable technology enables us to wear these devices. We got used to the recent wearable technology that focuses on fitness and health. However, these are not the only ones coming. More advanced devices have a broader use and more sophisticated than before. Rather than consumer-centered, the development of the device is trying to cater health-care professionals as well. This book is comprised of chapters of wearable technology that goes into different facets of technology and impacts health care like never before.

Wearable technology itself is evolving and proliferating in both commercial and research worlds. From Fig. 1.1, we can see how the projected size of the global market for wearable devices in health care grows incrementally from 2015 to 2021. With this trend, we can be confident that the wearable technology will be a big part of health care and medicine sector in the future and there is a significant market for them.

Figure 1.1 Projected size of the global market for wearable devices in the health-care sector from 2015 to 2021 [2].

From Fig. 1.2 we can see that the term wearable technology in the medical world arises from 1946 with two studies published that year. Then the studies start to grow steeply from the year 2010 onward. The exponential growth observed from 2010 onward is a sign that more scientists are developing as well as assessing wearable technology that is going to be deployed in the health-care world.

Figure 1.2 Number of studies resulted from a PubMed search with wearable technology AND (health care OR medicine) as the keyword [3].

With increasing number of global aging population, paired with home-based health care and rehab, as well as personalized medicine, wearable technology seems like an integral part of the future medicine [4]. The chapters that follow contribute toward the different technological development that has recently turned into media buzzword heard daily: smart eyewear, robotics, Internet of things (IoT), and big data. Some chapters also talk about the intangible parts of technology: patent and regulatory. But they are not only buzzwords, they are also different growing developments in which any technology are going after.

Smart eyewear is a wearable computer glasses that add information alongside or to what the wearer sees [5]. Boillat and Rivas from Stanford University School of Medicine (United States) demonstrate how the use of smart eyewear in the surgery room will enable surgeons and other health professionals to perform things that were impossible or challenging to be done before. This concept is enabled by commercial smart eyewear such as Google Glass and it has benefited time efficiency and live collaboration.

Robotics is defined as a field of engineering that deals with machines that manage a task by mimicking human behavior [6]. Contributions for this book spans widely on wearable robotics. Varghese et al. from Imperial College London (United Kingdom) provide us a review of upper-limb wearable robotics for rehabilitation. The all-in-one review encompasses the design and mechanism of the upper-limb robots, as well as the challenges we may face to put this promising device out there for clinical applications. Shen et al. from the University of California, Los Angeles (United States), discuss the recent progress of upper-limb wearables for rehabilitation and also talk about their research team’s EXO-UL8 bilateral upper arm rehabilitation wearable. The next robotic wearable review covers the lower-limb wearable for rehabilitation in stroke patients by Yeung and Tong from the Chinese University of Hong Kong (HKSAR, China). They cover the mechanical, electronic, and control design of the lower-limb wearable that is relevant for its clinical application.

The IoT refers to a type of network to connect anything with the Internet through sensors and other monitoring and transmitting equipment to interact and communicate in order to reach common goals such as smart recognition, positioning, tracking, monitoring, and administration [7]. With IoT, health-care devices can be more interconnected than ever and this allows health care to be able to be administered out of conventional point-of-care such as hospitals and clinics to homes and elderly centers.

Sensors is one of the component that enables IoT to happen. Yeo and Lim from the National University of Singapore (Singapore) take us into a greater depth that many upper-limb wearable technologies are faced with, the sensors for upper-limb monitoring and they also discuss on how these technologies meet the requirements of upper-limb monitoring as well as the challenges involved. Victorino et al. from the Simon Fraser University (Canada) expanded the upper-limb sensor discussion by getting into details on the emerging force myography, which has shown capable of doing accurate continuous sensing of finger’s movement.

Smart textile is another technology that we can adopt for use in wearable technology. McKnight et al. from North Carolina State University (United States) talk about the process and the challenges that is involved in creating sensing fabrics and how they can be integrated with the day-to-day textile that we normally wear, but still stay robust to perform its functions. Abtahi et al. from the University of Rhode Island in collaboration with Providence Veteran Affairs Medical Centre and Rhode Island Hospital (United States) describe the future potential of wearable smart textile to change the medical practice; they make their point by demonstrating their application of smart textile on their WearUP smart glove for Parkinson’s disease patients. Xiloyannis et al. from Nanyang Technological University (Singapore) illustrate the possible switch that we may have from hard robots to more user-friendly made-from-fabric exosuit. They demonstrate the exosuit potential with their application for assisting elbow movements.

It is well understood that with more sensing technologies, we also created an even bigger pool of data to be monitored and makes sense of. Big data is a term that describes large volumes of high velocity, complex, and variable data that require advanced techniques and technologies to enable the capture, storage, distribution, management, and analysis of the information [2]. Shi and Wang from Northeastern University (China) and Nagoya Institute of Technology (Japan), respectively, discuss about human body communication-based wearable technology that involves sensing and transmitting vital signs. Vashist and Luong from Immunodiagnostic Systems (Belgium), and University College Cork (Ireland), respectively, illustrate an overview of the wearable technologies that are available commercially for personalized mobile health-care monitoring and management. Slevin and Caulfield from University College Dublin (Ireland) explore how the benefits and uses of data generated by patients will change the future of health care.

With all of the things happening for wearable technology, patent and regulatory is something that we need to consider when we want to bring this technology out to the marketplace. Burmaoglu et al. from Izmir Katip Celebi University (Turkey), University of Novi Sad (Serbia), Ss. Cyril and Methodius University (FYR Macedonia), and University College Dublin (Ireland) talk about how wearable technology in health-care patents evolve over time. Parker et al. from University of Toronto Mississauga (Canada) follows by presenting the chapter on the interconnected truth between design and regulations. This is a very essential chapter noting that regulations are strongly tied with the overall design of the medical device and its delivery to the market.

All in all, we hope that this book and its contents can help widen the horizon of its readers on what we can do to improve medicine and health care with more advanced wearable devices for clinical professionals and patients.


1. Mills M. Hearing aids and the history of electronics miniaturization. IEEE Annals of the History of Computing. 2011;33(2):24–44.

2. TechAmerica Foundation’s Federal Big Data Commission, Demystifying big data: a practical guide to transforming the business of Government.

3. PubMed Search (accessed 29.01.18.).

4. Majumder S, Mondal T, Deen MJ. Wearable sensors for remote health monitoring. Sensors (Basel, Switzerland). 2017;17(1):130.

5. Mann S. Vision 2.0. IEEE Spectrum. 2013;50(3):42–47.

6. Simpson J, Weiner E. Oxford English Dictionary 3rd ed. Oxford UK: Clarendon; 2013.

7. Morabito G, Giusto D, Iera A, Atzori L. The Internet of Things 1st Edition Berlin: Springer; 2010.

Chapter 2

Empowering Medical Staff With Smart Glasses in Operating Rooms

Thomas Boillat¹ and Homero Rivas²,    ¹Stanford University School of Medicine, Stanford, CA, United States,    ²Division of Bariatric and Minimally Invasive Surgery, Stanford Medical Center, Stanford, CA, United States


With head-up mounted displays, cameras, voice command controls, and wireless access, smart glasses have drawn the attention of many surgeons (SUs). Research demonstrates that the materiality of smart glasses provides new affordances that allow medical professionals to rapidly and easily access functionalities that have traditionally been troublesome, including taking pictures, getting remote assistance, and accessing patient information during surgeries. While Google has been the largest player with its Glass released in mid-2013, several other actors are penetrating the smart glass market. In this chapter, we intend to investigate the capacities of currently available smart glasses and their abilities to address existing challenges in the operating room (OR). In addition to considering the activities of SUs, we broaden our scope to analyze the activities of nurses and anesthesiologists, and as a result, show how different OR actors can benefit from smart glasses and the most appropriate candidates to support such activities.


Smart glasses; operating rooms; surgery; surgical checklists; augmented reality


We would like to thank Peter Grantcharov for his help in collecting data related to the different smart glasses as well as the Swiss National Science Foundation and the Foundation of the University of Lausanne (Switzerland) for funding (P1LAP2–168407) part of this study.

2.1 Introduction

Health care is a knowledge-intensive field where education, experience, and rules, among many other factors affecting all stakeholders, intertwine into a complex ecosystem. Therefore, to guide medical staff’s activities and manage knowledge, information technologies (ITs) have become key [1]. A place where ITs have a critical place and new devices are constantly evaluated is the operating room (OR). While the number of computers and screens exceeds the number of people in OR, accessing the right information at the right time remains a challenge. A promising technology that might change this story, though, is smart glasses. The main concept behind smart glasses is not new, but it has reached a higher level of fidelity and maturity. Before being smart, these glasses were mainly known for their head-up mounted displays (HMDs).

Compared to traditional computers, smart glasses provide novel affordances that enable individuals to access computing resources in different ways [2]. In many fields, smart glasses primarily serve the purpose of improving efficiencies and security at work. When applied to an order picking scenario, smart glasses reduce pick error by 80% and completion time by 38% compared to traditional paper-based forms [3].

For more than two decades, HMDs have been experimented with in ORs. They are particularly appreciated for their capacity to display information such as patient electrocardiograms in a medical staff’s field of view [4]. Thus, HMDs do not constrain any movements, keeping both hands free while providing information that would not be accessible otherwise. HMDs took another dimension in 2013 when Google introduced the Glass. In addition to the HMD, Google placed multiple sensors on the unit, including a GPS, accelerometers, and gyroscopes to sense the context in which the glasses are used. Equipped with Wi-Fi and Bluetooth connections to access the Internet, the glasses can provide contextual and personalized services. All of this new hardware and software have transformed HMDs to what is presently referred to as smart glasses.

While the list of smart glasses providers grows nearly every month, it remains unclear how this relatively new technology can be leveraged in ORs and how it can enhance medical staff’s capabilities. In this chapter, we intend to address this gap by analyzing the tasks executed by nurses, anesthesiologists (ANs), and surgeons (SUs) in ORs and the capacities of current smart glasses to support them. It will show the opportunities offered by the different smart glass types and conclude with our vision of how smart glasses will shape ORs in the future.

2.2 Smart Glasses

2.2.1 Definition

Smart glasses are a wearable technology that builds on spectacle frames to display contextualized information in a person’s field of view [2]. The main piece of hardware is a head-mounted display that allows users to access texts, pictures, and videos. They are also equipped with a front-end camera, touchpad, microphone, and a series of sensors (e.g., accelerometer, gyroscope, GPS) [5]. Smart glasses are either connected to a mobile device (e.g., smartphone, tablet) or to a Wi-Fi network that enables access to the Internet or a company’s information system. Compared to smartphones that require users to hold them in one hand, smart glasses offer new affordances [2]: they can be used hands-free via voice commands, and information is immediately displayed and accessible directly in their user’s field of view. The front-end camera digitally reproduces, via pictures or videos, what their user sees. These affordances offer new opportunities to use computing capacities for supporting tasks that could not benefit from any other technologies (e.g., laptop computers, smartphones) due to physical constraints. For instance, in the field of inspection and maintenance, technicians and engineers can access checklists to guide them while their two hands are occupied [6]. Another field seen has a good candidate for the use of smart glasses is surgery for two reasons: SUs and some medical staff (e.g., scrub nurses (SNs)) handle themselves in a sterile environment and can therefore not touch any nonsterile objects (e.g., screens), while they need to focus their attention on patients rather than screens.

2.2.2 Overview of Available Smart Glasses

Google Glass has had a prominent place in the smart glass market. It was released mid-2013 via the Explorer Program to approximately 8000 partners, mostly developers. Given Google’s notoriety, Glass has attracted a lot of interest and has been under the radar of many IT companies, analyst firms, universities, as well as industries. However, this popularity also led to many disillusions when Google suddenly stopped selling its Glass with unclear intentions of the future of its product. Though Google is not the inventor of smart glasses, it has shaped the market. Many other IT suppliers have benefited from Google Glass’ user experience and use cases to design their own smart glasses.

Current smart glasses can be classified along three categories according to their materiality [7]: (1) smart eyewear (EW), which consists of a monocular lens that does not obstruct the field of view. It is mainly used to access information and capture pictures and videos, and is considered as extending smartphones’ capacities, (2) augmented reality (AR) headsets are binocular lenses covering both eyes. They usually allow users to see through their glasses while the binocular lenses enable 3D capabilities, and (3) virtual reality (VR) headsets completely obstruct the field of view to immerse users in different worlds. Many of the EW and AR smart glasses are designed to support health care in an OR environment, while VR headsets by nature cannot be used in the OR. However, VR may have a few applications in simulation, management of phobias by desensitization and education, for instance.

Table 2.1 presents a nonexhaustive list of EW and AR headsets that are foreseen by analyst firms as the best candidates to be used in OR.

Table 2.1








hVia Google Glass partners.


Among this list, two are EW headsets: Google Glass 2 and the Vuzix M300. The former is the new Google Glass headset that has been distributed to developers mid-2016 and currently available through Google’s partner network. Aside from being able to fold the frame, the second version is very similar to the first one from a design perspective. The screen is still located on the right-hand side, while the headset is still very light, with a weight below 50 g. The Vuzix M300 is considered Google Glass’s direct competitor. Its screen can be placed either on the left- or on the right-hand side and can be adjusted horizontally; however, it is slightly heavier than the Google Glass. The five other headsets are designed for AR and have two screens. The ODG R-7 is the closest AR headset to a traditional pair of glass (Fig. 2.1). It contains two screens with a resolution of 1280*720p, mounted behind 60%–80% transparent glasses. Optionally, traditional transparent glasses can be mounted. The Sony SmartEye and the Epson BT-300 are the most accessible AR headsets for consumers. They are controlled through an additional external touchpad linked to the glasses via a wire. The AiR Glasses by Atheer is characterized by its three cameras that enable users to navigate through and within applications via finger gestures. The glass is linked to an additional case in which the battery and part of the hardware are located. Lastly, the Microsoft Hololens uses holographs to increase user immersion and highly leverage finger gestures, too.

Figure 2.1 ODG R-7—the closest model to a traditional pair of glass.

Through a smart glass’s materiality, one can have a good idea of the ability of each headset to be worn by medical staff. This is referred to as the wearability. The heavier the headset and the greater the requirement for hand interactions, the more impractical it becomes for medical staff, given that most of the time their hands are occupied or must remain sterile. Table 2.1 summarizes the characteristics of the selected smart glasses.

2.3 Current Uses and Benefits of Smart Glasses in ORs

Much research has been conducted to analyze the extent to which smart glasses can support medical staff in ORs. In 1995, ANs were among the first to clinically evaluate smart glasses’ capacities in ORs [4]. Their study focused on one of the main ANs’ challenges: accessing a patient’s vital signs while being away from their traditional screens. Over the years, many scholars have investigated the benefits of smart glasses in anesthesiology. Research shows that smart glasses reduce the number of times ANs have to shift their attention between patients and screens [8], in addition to helping them detect events when physically constrained [9,10]. Accessing vital signs can also be critical for SUs when an AN is not present in the OR (e.g., endoscopy) or when performing a risky surgery. Evaluated in a laboratory setting, SUs wearing smart glasses (Google Glass) to access vital signs spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy, and recognized critical desaturation 8.8 seconds earlier than the group of SUs without smart glasses [11]. Another study shows that SUs can benefit from smart glasses in order to access patient information during surgeries, such as CT scans, X-rays, or notes from previous procedures [12,13].

Smart glasses are not only used in ORs to ease and speed the access to information; SUs have shown great interest in using them to get remote assistance while performing surgeries. Given the position of the camera adjacent to a SU’s eye, smart glasses can capture what a SU really sees [5]. Traditionally, static cameras located at headlights or from a peripheral cameraman have been used. However, this has often been obstructive to the field of view of the SUs and surgical teams. Through Wi-Fi connections, smart glasses can also broadcast video to anyone who has an Internet access to communicate with SUs using the built-in microphone and speaker [14,15]. Remote assistance is particularly useful for junior physicians as well as critical cases when the advice of experts is required to ensure patients’ safety [5]. Finally, studies report that smart glasses are also used to document cases. SUs can easily take pictures, videos, or notes during surgeries via voice commands. This shortens the documentation process and can be used for conducting further research [16].

2.3.1 Capacities of Smart Glasses

Based on their materiality and the different uses taken from existing studies presented earlier, smart glasses can be evaluated along their capacities (Table 2.2). A indicates an inability to support a distinct use, while +++ indicates complete ability. For instance, the small screen of the Google Glass can perfectly display short content, such as a few lines of text or a simple picture. Thus, it receives +++ for this ability. However, Google Glass cannot make long content easily readable, and for this reason it receives a + under this category. Capacity assessments were determined by the authors based on direct experience with the smart glasses, interpretation of other reviewers’ assessments, or a combination of the two.

Table 2.2

2.4 Activities Performed in ORs Among the Medical Staff

In order to have a comprehensive understanding of how smart glasses can support medical staff, we describe the main activities of circulating nurses (CNs), SNs, ANs, and SUs. For each of these activities, we also describe their underlying requirements as well as their constraints and challenges. We then show how the capacities of smart glasses can address these constraints and challenges to eventually increase the effectiveness and efficiencies of medical staff’s activities along with patient safety.

2.4.1 Circulating Nurse Activities and requirements

The roles of CNs vary among hospitals and clinics. In small institutions, CNs welcome, prepare (e.g., install an IV), and accompany patients to the OR. In large institutions, CNs do not leave the OR. Their activities start with picking up supplies from the inventories (Table 2.3—No. 1). Surgeries require 20–100 different supplies depending on their type (e.g., laparoscopic, robotic, open) and on the SU. Most of the time, CNs work with preference cards or checklists to ensure the correct supplies are gathered, where after they prepare equipment and machines such as laparoscopic cameras (Table 2.3—No. 2). Across the different surgical specializations, CNs may need to manipulate up to 50 different devices, some of them being very complex (e.g., surgical robots). After installing the patient on the table (Table 2.3—No. 3), the CNs will go through a safety checklist along with an AN to confirm patient identity, procedure, patient concerns, etc. (Table 2.3—No. 4). Finally, at the end of the surgery or when medical shifts occur, CNs count the supplies with an SN to ensure nothing has been forgotten in the patient’s body (Table 2.3—No.

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