Development of smart medical textiles for treating breast cancer related lymphoedema

淋巴水肿是软组织的肿胀，由富含蛋白质的液体在细胞外空间积聚引起。它的发生是由于淋巴系统的破坏，通常是一条或多条肢体。目前全球约有1.4亿-2.5亿人患有不同类型的淋巴水肿，据估计，仅在英国每年就有36.5万人受到淋巴水肿的影响。这种慢性病是无法治愈的，然而，有一些治疗方法可以减少相关的疼痛和不适。目前推荐的治疗方法是去充血淋巴疗法。这结合了手动淋巴引流按摩技术和按压绷带，皮肤护理和去充血练习。一旦这些治疗过程停止，患者就会穿上定制的按摩服，每天都穿着。不幸的是，这种解决方案给患者带来了几个问题。首先，压缩服装的大小和外观给他们带来了不便。例如，最近的一项研究报告称，80%的参与者认为压缩治疗干扰了工作和日常活动，因为每天的身体活动有限，很难找到适合压缩的衣服，限制了驾驶能力，无法做家务，以及对他们的心理社会生活的影响。其次，压缩效果是高度可变的，因为工作压力受洗涤和磨损的影响，压力分布根据身体轮廓而变化。第三，由于这种可变的有效性，患者必须定期拜访医疗保健提供者，以监测服装。这对患者和承担这些就诊费用的NHS来说都是额外的负担。因此，需要一种有效的、不显眼的、易于使用的、可在家中使用的治疗淋巴水肿的设备。作为回应，该项目将开发一种突破性的智能医疗纺织品服装(SMTG)，旨在有效地提高患者的生活质量。SMTG将使用电刺激(ES)，以一种不显眼和方便的可穿戴形式来减少肿胀。这项研究建立在先前证明ES可以刺激淋巴循环的工作基础上。为了实现这一目标，该项目有几个关键步骤。首先，我的团队将需要开发具有更高灵活性和可靠性的新印刷电路。我已经使用了一些定制的油墨，成功地在织物上实现了电极和导电轨迹，然而，身体的运动被证明会导致细微的裂缝，导致断路。通过优化印刷参数和油墨配方，我们将开发一种更具弹性的印刷电路，可以在人体的大范围内应用。其次，服装中电极对位置的布局需要细化。我们早期的试点工作只使用了两个电极来证明该系统加速了患者体内的淋巴运动。因此，需要了解电极的位置、尺寸和数量的影响，以便生成可适用于不同患者的设计规则。第三，需要开发一组新的用于印刷电极阵列的刺激参数。这将需要理解控制，即当需要时，通过相同或不同的电极对施加具有正确频率的信号。第四，我们将开发一种集成方法，将印刷电极连接到刺激电路。印刷电极目前使用卡扣连接。此选项提供了一种临时解决方案，并且在紧固件和印刷轨道之间的接合处经常会出现裂缝。最后，我们将评估SMTG的可洗性，并提出一个优化的标准，使电子纺织品能够安全地洗涤。

Lymphoedema is the swelling of soft tissues, caused by the accumulation of protein-rich fluid in extracellular space. It occurs as a result of disruption to the lymphatic system, usually of one or more limbs. Approximately 140-250 million people worldwide are currently suffering from different types of lymphoedema and it was estimated that 365,000 are affected by lymphoedema each year in the U.K alone. There is no cure for this chronic condition however there are treatments designed to reduce related pain and discomfort. The current recommended treatment is decongestive lymphatic therapy. This combines manual lymph drainage massage techniques with compressive bandaging, skin care and decongestive exercises. Once these therapy sessions are stopped the patient is fitted with a custom-made compression garment, which is worn every day. Unfortunately, this solution causes several issues for the patient. Firstly, the size and appearance of compression garments makes them inconvenient. For instance, a recent study reported that 80% of participants feel that compression treatments interfered with work and daily activities because of limited daily physical movement, difficulty in finding clothing that would fit over the compression, restricted ability to drive, being unable to do household work and impacts on their psychosocial life. Second, compression effectiveness is highly variable as the operating pressure is impacted by washing and wear, and pressure distribution changes based on body contours. Third, because of this variable effectiveness, patients must regularly visit healthcare providers to monitor the garments. This is an additional burden on both the patient and the NHS who bear the cost of these visits. There is therefore a need for an effective, unobtrusive, easy-to-use, device for treating lymphoedema that can be used at home. In response, this project will develop a breakthrough smart medical textile garment (SMTG) designed to be effective and improve the quality of life of patients. The SMTG will use electrical stimulation (ES) in an unobtrusive and convenient wearable format to enable swelling reduction. This builds on previous work that has shown that ES can stimulate lymph circulation.To achieve this aim, the project has several key steps. First, my team will need to develop new printed circuits with increased flexibility and reliability. I have used a number of bespoke inks to successfully achieve electrodes and conductive tracks on fabric, however body movement has been shown to cause hairline cracks, resulting in open circuits. By optimising the printing parameters and ink formulation, we will develop a more resilient printed circuit that can be applied over a large area of the body. Second, the layout of the electrode pair positions in the garment needs to be refined. Our early pilot work only uses two electrodes to prove that the system accelerated movement of lymph within the patient's body. The influence of positioning, dimensions and number of electrodes therefore needs to be understood in order to generate a design rule that can be adapted for different patients.Third, a new set of stimulation parameters for an array of printed electrodes will need to be developed. This will require the understanding of control in which the signal with correct frequency is applied when needed through the same or different pairs of electrodes. Fourth, we will develop an integration method to connect printed electrodes to the stimulation circuit. The printed electrodes are currently connected using snap fasteners. This option provides a temporary solution and cracks often happens at the join between the fastener and printed tracks. Finally, we will evaluate the washability of SMTG and propose an optimised standard that would allow the electronic textiles to be washed safely.