Textile Research Journal Article

Design of Intelligent Garment with Transcutaneous Electrical

Nerve Stimulation Function Based on the Intarsia Knitting
Technique
Li Li1, Wai Man AU and Yi Li
Abstract This paper describes the work that was Institute of Textiles and Clothing, The Hong Kong
carried out on the design for intelligent wearable Polytechnic University, Hung Hom, Kowloon, Hong Kong
garment with transcutaneous electrical nerve stim-
ulation (TENS) function from a knitwear design Kam Man Wan
perspective. It is perceived that good design is Department of Electronic and Information Engineering,
essential for the development of textile-related The Hong Kong Polytechnic University, Hung Hom,
products for medical function. The knitwear tech- Kowloon, Hong Kong
nique, garment design skill, Chinese acupuncture
therapeutic method and TENS technology were
Sai Ho Wan
integrated interactively in an intelligent TENS
School of Nursing, The Hong Kong Polytechnic
garment. The garment was observed to have more
University, Hung Hom, Kowloon, Hong Kong
advantages than ones incorporating TENS device,
such as it readily, quickly and easily targeted the
back of the body; it was more flexible in the treat-
Kwok Shing Wong
ment by accommodating different numbers and Faculty of Arts and Sciences, Institute of Education, Tai
locations of acupuncture points; it was light, wash- Po, New Territories, Hong Kong
able, flexible, inexpensive and relatively simple to
manufacture. This work aimed to develop a knit-
wear design based on intarsia knitting technique
by using proposed textile electrode and conduc-
tive yarn to create a novel therapeutic method for
healthcare through dressing. Experimental results
revealed that the knitwear could achieve better
results in performance than those incorporating
the TENS therapeutic method.

Key words healthcare, intelligent wearable gar-

ment, knitwear design, transcutaneous electrical
nerve stimulation

In the treatment of various types of diseases, pains and dis-
orders of the body, it is often advantageous to give the
afflicted area electrical stimulation, or more desirable still,
to stimulate the nervous system. This transcutaneous elec-
trical nerve stimulation (TENS) therapy is applied typi-
cally via conductive silica gel hydro pads to the treatment
region where front-end of body nerves are stimulated by
the electrical current [1]. Current TENS products made of
conductive silica gel hydro material do serve to reduce skin
resistance, but they are generally supplied in two to four
pieces and do not readily target the back of the body. Their
stickiness could cause discomfort. They cannot be laun-
dered; repeated use is unhygienic. With the rapid develop-
1
Corresponding author: QT715, The Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong; e-mail: lily.li@
polyu.edu.hk

Textile Research Journal Vol 80(3): 279–286 DOI: 10.1177/0040517509105276 © The Author(s), 2010. Reprints and permissions:
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TRJ 280 Textile Research Journal 80(3)
ment of technology, intelligent garments are becoming one
of the major developments in the textile industry, espe-
cially for intelligent medical and athletic textiles [2–5].
TENS is often used in the treatment of a variety of pain-
ful conditions. A considerable number of studies has dem-
onstrated the effectiveness of TENS on various pain
conditions if patients use them continuously in the proper
way. TENS stimulates the large afferent fibers, which may
reduce the transmission of pain signals through the small
nociceptive afferent fibers, consequently inhibiting pain
discrimination and perception [6]. Furthermore, some
researches have demonstrated that patients treated by
TENS with acupuncture point stimulation give better results
[6–8].
The commercial products of available electrodes are
shown in Figure 1. They are commonly used, but their
property is undesirable for use in intelligent garment. In
current medical treatment products, most of the electrodes
are made of silica gel hydro pads that can be absorbed to
skin, which can be repeatedly used for several tens of
times. The performance of this kind of electrode is excel-
lent. However, their shortcomings are obvious: they are
prone to fragmentation, not washable and uncomfortable
due to their stickiness. A possible solution to solve this
problem is to lay a conductive ointment between the con-
ductor and skin to reduce the resistance. Nevertheless, this
is seldom used in practice due to its uncomfortable feeling
and spreading to neighboring.
Fabric electrodes are frequently used in smart clothing
requiring a good contact to skin, such as acquiring breath,
temperature and electrocardiogram signal. A simple way
to achieve good contact is to increase the contact area and
pressure. However, the bulky electrode is less flexible and
high contact pressure will introduce discomfort. Therefore,
most often, a water filler is used to increase the moisture
and conductivity of skin, sacrificing convenience.
This study aimed to develop a wearable TENS garment
with incorporated Chinese acupuncture therapy for long-
term continuous treatment and establish a novel therapeu-
tic method for healthcare. TENS garment design is dis-
cussed, followed by textile electrode design and TENS
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Figure 1 Commonly used products
for electrode and conducting mate-
rial: conductive silica gel hydro
pads (left panel) and conductive
ointment (right panel).
signal generator design. Two experimental set-ups were con-
ducted to evaluate the newly proposed intelligent clothing
prototype incorporating textile electrodes and conductive
yarns.
Experiments
Design of TENS Intelligent Knitwear
Materials
The knitting yarn was made with 100% pearl fiber of 40S/2
Nm and the conductive yarn was made with silver-coated
yarn of 40S/2 Nm with electrical resistance of 1.58 Ω/cm.
This knitwear was knitted on a 14 G flat knitting machine
comprising mainly of intarsia stitches, and the wale and
course densities were 9.3 and 6.9 unit loop per 10 mm,
respectively, and it was not washed nor ironed before test-
ing.
Acupuncture Points for Pain Relief
The acupuncture points of ‘Dazhu’, ‘Jianwaiyu’, ‘Jianjin’,
‘Dazhui’, ‘Jianyu’ and ‘Jugu’ are shown in Figure 2. The
function of acupuncturing at these points can reduce
shoulder and neck pain according to the theory of tradi-
tional Chinese medicine. The above acupunctures were
proposed by Dr. Li Guihe, who is an experienced doctor in
traditional Chinese medicine [9]. This group of acupunc-
ture points was used in TENS knitwear design for treat-
ment of shoulder and neck pain. The acupuncture points
were located with reference to the ‘Human Acupuncture
Point Model’ and matched with the clothing prototype. In
practice, each acupuncture point is presented as a small
area on the surface of the body, instead of a tiny point.
Therefore, they could be precisely matched in the clothing
without difficulty.
 Design of Intelligent Garment with Transcutaneous Electrical Nerve Stimulation Function Based L. Li et al. 281 TRJ

effective therapy [10]. Therefore, in this study, the garment

Figure 2 Chinese acupuncture points for pain relief.
Knitwear Design
The measurement settings and design details of the TENS
knitwear are shown in Figure 3. In the case of the intelli-
gent clothing, the distribution of clothing pressure is an
important factor, especially for medical intelligent cloth-
ing, because the majority of this kind of product is made of
elastic fabric that requires tight contact with skin for
dimensions were smaller than would be the case for
normal clothing (the standard size is based on Hong Kong
retailing knitwear with M size, chest: 39cm; shoulder: 34;
neck:18; arm: 19; waist: bust–4 cm), and 2x1 Ribs knitting
stitch at two sides was used for elastic because the stitches
are more elastic than others [11]. The sewing lines at two
shoulders were moved forward by 3 cm and the width of
collar opening was narrowed in order to accommodate the
electrodes to be located at the acupuncture points. All of
the linking lines were stitched by hand to ensure contact
between clothing and skin. The confining pressure was
maintained to be within the comfortable clothing pressure
range (1.96–3.92 kPa).
Silver conductive yarn was knitted into knitwear to
serve as electrodes and conducting wires. Green colored
circles represent the terminals of the electrodes, which
were located at acupuncture points for pain treatment.
Design of Washable Textile Electrode
Four kinds of washable textile electrode were designed in
comparison with original electrodes. A metal button was
installed at the electrode of this textile material, which
could be buttoned with knitwear, as shown in Figure 4.

Figure 3 Measurement settings

and design details.

Figure 4 Frontal and rear views of

textile electrodes 1, 2, 3 and 4.
Electrode 1: conductive meshes
fabric with hand sewing; electrode
2: conductive fabric with adhesives;
electrode 3: conductive fabric with
hand sewing; and electrode 4:
conductive fabric with hand sewing.

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TRJ 282 Textile Research Journal 80(3)
The textile electrodes consisted of one piece of absorb-
ent fabric (amethyst color), conductive fabric (resistance:
0.1 Ω/cm), conductive mesh fabric (resistance: 0.2 Ω/cm),
absorbent sponge and metallic dual-lock button (diameter
10 mm), as illustrated in Figure 5.
Design of TENS Signal Generator
Two metal buttons (labeled E) at the frontal side of the
clothes were connected to positive and negative terminals
of the TENS device, respectively. In the experiments,
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Figure 5 Materials used for textile
electrodes.
Figure 6 TENS signal generator
prototype.
TENS signals were generated by the electronic device
(labeled D), as shown in Figure 6 and the block diagram in
Figure 7. This battery-powered electronic device was made
to be compact in size and light in weight so that it could be
mounted to the clothes.
Experimental Set-up
Two experiments were carried out to evaluate the
washability and conductivity of the TENS knitwear with
the proposed textile electrode as compared to the original
 Design of Intelligent Garment with Transcutaneous Electrical Nerve Stimulation Function Based L. Li et al.
Figure 7 Circuit block diagram of TENS signal generator.
electrode. The knitwear with the selected electrode was
washed 10 cycles under AATCC Test Method 135-2003.
The DC resistances of the proposed textile electrode and
conductive stitch were measured. Two identical periodic
pulses with voltage of 20 V, frequencies of 15 Hz, 30 Hz, 60
Hz and 120 Hz, and fixed pulse width generated by a TENS
signal generator were applied directly to the original elec-
trode and textile electrode via conductive stitch of the
prototype, respectively. The original electrode consisted of
solid silica gel hydro pad, whereas the textile electrode con-
sisted of textiles and metal button. The output waveforms
were acquired by probes of channel 1 and channel 2 of a
cathode ray oscilloscope (CRO), respectively, as shown in
Figure 8.
Results and Discussion
This work aimed to evaluate the TENS knitwear for
repeated use, washability and conductivity. After testing of
the four types of newly designed electrode, it was found
that the electrodes made of conductive fabric generally
demonstrated satisfactory performances as compared to
the metallic ones. The electrodes made with adhesives
became hardened, which would cause skin irritation. The
Figure 8 Experimental set-up for
comparison between original and
proposed electrodes.
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283 TRJ
second electrodes wrapped in conductive mesh fabric
could not retain water well, since water could easily
evaporate through the conductive mesh. The third and
fourth electrodes with higher water sustainability were
considered to be suitable to be used as textile electrodes.
Since the fourth ones had better skin contact, they were
chosen as the prototype for the experiments.
Washability
The selected textile electrode generally demonstrated
lower effective resistance (221 kΩ) than the original elec-
trode (465 kΩ) for fabric. The conductive fabric of the
electrode and the conductive stitch showed slight changes
in effective resistance from 0.1 Ω to 0.55 Ω and 1.58 Ω/cm
to 1.83 Ω/cm, respectively, after 10 washing cycles. These
subtle changes were insignificant to the overall resistance
of the textile electrode. The proposed electrode had high
laundering ability and was easy to clean. It was capable of
retaining medicine inside for ease of medical treatment
and could be adopted in smart clothing for a long
operation time for clinical use. It was convenient to use
and readily targeted the predefined location of the body
without expert knowledge. In practice, this electrode could
be made even slimmer without affecting its properties.
Conductivity
The waveforms given by a pair of the original electrodes and
proposed electrodes were compared, as shown in Figure 9.
The output signal of the proposed electrode was nearly iden-
tical to the original electrode, without the introduction of
phase distortion, except for a small voltage drop due to the
finite resistance of the conductive stitch (45.6 Ω) where the
TENS signal passed through before appearing at the textile
electrode. By the potential divider rule, most of the applied
TENS signal was dropped across the electrode rather than
the conductive yarn. Therefore, much of the power was
effectively delivered to the target regions of the body. The
similarity in the electrical properties of the proposed and
original electrodes enables it to be a good candidate for tex-
tile electrode in future TENS intelligent knitwear.
TRJ 284 Textile Research Journal 80(3)

Figure 9 Electrode comparison of

proposed electrode (lower trace)
and original electrode (upper trace).
TENS signal with a 20-V pulse
voltage was applied to terminals of
the conductive yarns of the clothing
prototype and original electrode at
frequencies of 15 Hz, 30 Hz, 60 Hz
and 120 Hz, as shown in panels 1, 2,
3 and 4, respectively.

Effect of Increasing the Number of Textile For the same applied voltage, the power dissipation is
Electrode Pairs proportional to the number of electrodes used, given by
equations (2) and (3). The total available power, Pa, and
The number of textile electrode pairs is not limited to six in power efficiency, η, to the treatment region of the human
which the clothing prototype was designed, and depends body are given as follows:
on the size of electrodes and wiring routing in the fabric.
The equivalent resistance, Req, of N electrode pairs of a 2
parallel resistive system is governed by the following ⎛R ⎞
equation: N V a ⎜ -----s⎟ 2
⎝ R⎠ NV a R s
P a = ------------------------------ = ------------------------------------
-
2
(4)
Rs ( Rl + Rp + Rs )
N
1- 1
-------
R eq
= ∑ ----R-
i=1
i
(1)
P
η = -----a- (5)
PT
where Ri is the total equivalent resistance including human
skin of each electrode pair i = 1, 2, ..., N. Assuming for the
same skin, electrode and wiring resistance for each pair, where R = Rl + Rp + Rs, and Rl, Rp and Rs are the effective
i.e. R = R1 = R2 = … RN, equation (1) becomes: resistance of the conductive stitch, textile electrode and
skin, respectively. The lower the resistance of the
conductive yarn and textile electrode, the more available
R
R eq = ---- (2) power was delivered to the treatment region by an
N
electrode pair. For the same skin resistance, the proposed
electrodes gave higher power efficiency than the original
The total equivalent resistance is decreased as the number electrodes.
of electrode pairs increases. Higher current is drawn for
the same supply voltage, Va. The total power consumption,
PT, is given by the following formula: Corner Effect of Conductive Wire (Conductive
Knitted Stitches Versus Conductive Threads
V
2
Sewn on the Fabric)
P T = -------a- (3)
R eq Turnings inevitably exist in routing conductive yarn in the
fabric. A sharp corner turning by the sewing of conductive
threads on fabric can cause significant resistance change.

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 Design of Intelligent Garment with Transcutaneous Electrical Nerve Stimulation Function Based L. Li et al.
Figure 10 Design of turning routing with intarsia knitting
technique.
However, this resistance change did not occur in the
designed knitting fabric. For the same distance A and B, as
shown in Figure 10, resistances of 4.21 Ω and 4.60 Ω were
obtained, respectively. This increased resistance was due to
the corner effect which retarded the flow of the electron,
thus increasing its effective resistance.
Further Improvement to Garment Design
and Functionality
With reference to the Worth Global Style Network, one
leading global service website analyzed that one of the rea-
sons for this retail market’s slow growth is due to consump-
tion factors such as acceptance of wearable technology and
consumers may consider products of ‘technical’ rather than
‘fashion’ interest [12]. Therefore, from the experimental
results, knitwear can satisfy the basic functions, as shown in
Figure 11. With the incorporation of garment design skills,
Figure 11 Prototype of garment with TENS function.
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285 TRJ
Figure 12 New intarsia pattern design for routing hiding
based on the garment prototype.
the previously mentioned problems can be readily solved
and the esthetics are further improved by hiding the con-
ductive yarn using the knitting technique of the intarsia
pattern. The routing of the connecting wires can be hid-
den beneath the fabric, as shown in Figure 12. The dark
green color is the conductive yarn knitted into knitwear as
conductive wire. After the pattern redesign, the wires
were totally dissolved into the pattern of the clothes. The
white circle dot is the metallic dual-lock for connecting the
conductive yarn and the electrodes and TENS device. The
black mesh pocket for the battery holder could be replaced
by a knitted pocket, knitted by the same yarn of the knit-
wear. The TENS generator could be sealed by silicon and
hid inside the pocket so that the batteries could be removed
during washing.
One of the possible future developments of this TENS
knitwear is to focus on the selectable treatment of group
points including neck pain, shoulder pain, low back pain,
etc. The treating points could be grouped or controlled
individually by textile switches according to the acupunc-
ture point theory to treat different positional pains.
Conclusions
A new design method has been proposed for the intelligent
garment design, which represents an integration of medi-
cine, garment design and wearable electronic technique for
the improvement of TENS medical knitwear. It has been
found that the knitted fabric design has gained promising
applications compared with the only style design, while
intelligent garment design has the potential for growth in
both research laboratory and industrial environments, espe-
TRJ 286 Textile Research Journal 80(3)
cially in healthcare due to the high flexibility in its design
approach.
This is the first time electronic wearable garment tech-
nology combined with physical therapy and traditional
Chinese acupuncture has been used. It could greatly
improve daily pain management, not only facilitating new
therapeutic methods, but also enhancing the lifestyle of
patients who wear the clothing. It can be repeatedly used,
laundered and is flexible. In our future research, massage
and therapy for shoulder pain, neck pain, low back pain,
etc., will be studied by applying TENS through controlling
different switches and groups of switches in different posi-
tions. The performance of pain relief knitwear may be more
successful than the existing TENS garment. This research
could provide a design methodology for future research and
development for other symptoms or disease treatments.
Acknowledgements
We would like to express our thanks to the Center for Inte-
grative Digital Health (CIDH) of The Hong Kong Poly-
technic University for its support and patience throughout
the whole period of the experiments.
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