Capacitive epidermal electronics for electrically safe, long-term electrophysiological measurements

Silicon-based transient electronics: principles, devices and applications

Recent advances in materials science, device designs and advanced fabrication technologies have enabled the rapid development of transient electronics, which represents a class of devices or systems that their functionalities and constitutions can be partially/completely degraded via chemical reaction or physical disintegration over a stable operation. Therefore, numerous potentials, including zero/reduced waste electronics, bioresorbable electronic implants, hardware security, and others, are expected. In particular, transient electronics with biocompatible and bioresorbable properties could completely eliminate the secondary retrieval surgical procedure after their in-body operation, thus offering significant potentials for biomedical applications. In terms of material strategies for the manufacturing of transient electronics, silicon nanomembranes (SiNMs) are of great interest because of their good physical/chemical properties, modest mechanical flexibility (depending on their dimensions), robust and outstanding device performances, and state-of-the-art manufacturing technologies. As a result, continuous efforts have been made to develop silicon-based transient electronics, mainly focusing on designing manufacturing strategies, fabricating various devices with different functionalities, investigating degradation or failure mechanisms, and exploring their applications. In this review, we will summarize the recent progresses of silicon-based transient electronics, with an emphasis on the manufacturing of SiNMs, devices, as well as their applications. After a brief introduction, strategies and basics for utilizing SiNMs for transient electronics will be discussed. Then, various silicon-based transient electronic devices with different functionalities are described. After that, several examples regarding on the applications, with an emphasis on the biomedical engineering, of silicon-based transient electronics are presented. Finally, summary and perspectives on transient electronics are exhibited.

E-Tattoos: Toward Functional but Imperceptible Interfacing with Human Skin

The human body continuously emits physiological and psychological information from head to toe. Wearable electronics capable of noninvasively and accurately digitizing this information without compromising user comfort or mobility have the potential to revolutionize telemedicine, mobile health, and both human-machine or human-metaverse interactions. However, state-of-the-art wearable electronics face limitations regarding wearability and functionality due to the mechanical incompatibility between conventional rigid, planar electronics and soft, curvy human skin surfaces. E-Tattoos, a unique type of wearable electronics, are defined by their ultrathin and skin-soft characteristics, which enable noninvasive and comfortable lamination on human skin surfaces without causing obstruction or even mechanical perception. This review article offers an exhaustive exploration of e-tattoos, accounting for their materials, structures, manufacturing processes, properties, functionalities, applications, and remaining challenges. We begin by summarizing the properties of human skin and their effects on signal transmission across the e-tattoo-skin interface. Following this is a discussion of the materials, structural designs, manufacturing, and skin attachment processes of e-tattoos. We classify e-tattoo functionalities into electrical, mechanical, optical, thermal, and chemical sensing, as well as wound healing and other treatments. After discussing energy harvesting and storage capabilities, we outline strategies for the system integration of wireless e-tattoos. In the end, we offer personal perspectives on the remaining challenges and future opportunities in the field.

Body-temperature softening electronic ink for additive manufacturing of transformative bioelectronics via direct writing

Mechanically transformative electronic systems (TESs) built using gallium have emerged as an innovative class of electronics due to their ability to switch between rigid and flexible states, thus expanding the versatility of electronics. However, the challenges posed by gallium's high surface tension and low viscosity have substantially hindered manufacturability, limiting high-resolution patterning of TESs. To address this challenge, we introduce a stiffness-tunable gallium-copper composite ink capable of direct ink write printing of intricate TES circuits, offering high-resolution (~50 micrometers) patterning, high conductivity, and bidirectional soft-rigid convertibility. These features enable transformative bioelectronics with design complexity akin to traditional printed circuit boards. These TESs maintain rigidity at room temperature for easy handling but soften and conform to curvilinear tissue surfaces at body temperature, adapting to dynamic tissue deformations. The proposed ink with direct ink write printing makes TES manufacturing simple and versatile, opening possibilities in wearables, implantables, consumer electronics, and robotics.

Skin preparation-free, stretchable microneedle adhesive patches for reliable electrophysiological sensing and exoskeleton robot control

High-fidelity and comfortable recording of electrophysiological (EP) signals with on-the-fly setup is essential for health care and human-machine interfaces (HMIs). Microneedle electrodes allow direct access to the epidermis and eliminate time-consuming skin preparation. However, existing microneedle electrodes lack elasticity and reliability required for robust skin interfacing, thereby making long-term, high-quality EP sensing challenging during body movement. Here, we introduce a stretchable microneedle adhesive patch (SNAP) providing excellent skin penetrability and a robust electromechanical skin interface for prolonged and reliable EP monitoring under varying skin conditions. Results demonstrate that the SNAP can substantially reduce skin contact impedance under skin contamination and enhance wearing comfort during motion, outperforming gel and flexible microneedle electrodes. Our wireless SNAP demonstration for exoskeleton robot control shows its potential for highly reliable HMIs, even under time-dynamic skin conditions. We envision that the SNAP will open new opportunities for wearable EP sensing and its real-world applications in HMIs.

Flexible and Stretchable Organic Electrochemical Transistors for Physiological Sensing Devices

Flexible and stretchable bioelectronics provides a biocompatible interface between electronics and biological systems and has received tremendous attention for in situ monitoring of various biological systems. Considerable progress in organic electronics has made organic semiconductors, as well as other organic electronic materials, ideal candidates for developing wearable, implantable, and biocompatible electronic circuits due to their potential mechanical compliance and biocompatibility. Organic electrochemical transistors (OECTs), as an emerging class of organic electronic building blocks, exhibit significant advantages in biological sensing due to the ionic nature at the basis of the switching behavior, low driving voltage (<1 V), and high transconductance (in millisiemens range). During the past few years, significant progress in constructing flexible/stretchable OECTs (FSOECTs) for both biochemical and bioelectrical sensors has been reported. In this regard, to summarize major research accomplishments in this emerging field, this review first discusses structure and critical features of FSOECTs, including working principles, materials, and architectural engineering. Next, a wide spectrum of relevant physiological sensing applications, where FSOECTs are the key components, are summarized. Last, major challenges and opportunities for further advancing FSOECT physiological sensors are discussed.

Fundamentals of Skin Bioimpedances

The bioimpedances of tissues beyond the stratum corneum, which is the outermost layer of skin, contain crucial clinical information. Nevertheless, bioimpedance measurements of both the viable skin and the adipose tissue are not widely used, mainly because of the complex multilayered skin structure and the electrically insulating nature of the stratum corneum. Here, a theoretical framework is established for analyzing the impedances of multilayered tissues and, in particular, of skin. Then, strategies are determined for the system-level design of electrodes and electronics, which minimize 4-wire (or tetrapolar) measurement errors even in the presence of a top insulating tissue, thus enabling non-invasive characterizations of tissues beyond the stratum corneum. As an example, non-invasive measurements of bioimpedances of living tissues are demonstrated in the presence of parasitic impedances which are much (e.g., up to 350 times) higher than the bioimpedances of the living tissues beyond the stratum corneum, independently on extreme variations of the barrier (tape stripping) or of the skin-electrode contact impedances (sweat). The results can advance the development of bioimpedance systems for the characterization of viable skin and adipose tissues in several applications, including transdermal drug delivery and the assessment of skin cancer, obesity, dehydration, type 2 diabetes mellitus, cardiovascular risk, and multipotent adult stem cells.

Wearable bioelectronics fabricated in situ on skins

In recent years, wearable bioelectronics has rapidly expanded for diagnosing, monitoring, and treating various pathological conditions from the skin surface. Although the devices are typically prefabricated as soft patches for general usage, there is a growing need for devices that are customized in situ to provide accurate data and precise treatment. In this perspective, the state-of-the-art in situ fabricated wearable bioelectronics are summarized, focusing primarily on Drawn-on-Skin (DoS) bioelectronics and other in situ fabrication methods. The advantages and limitations of these technologies are evaluated and potential future directions are suggested for the widespread adoption of these technologies in everyday life.

Wireless, AI-enabled wearable thermal comfort sensor for energy-efficient, human-in-the-loop control of indoor temperature

The conventional heating, ventilation, and air conditioning (HVAC) systems are based on a set-point control approach that only considers the temperature of the environment without reflecting the thermophysiological status of the occupant. This approach not only fails to fully satisfy individual thermal preferences, but it also makes an HVAC operation energy-inefficient. One possible solution is to control the indoor thermal condition based on an accurate prediction of the occupant's thermal comfort to prevent any unnecessary energy consumption. Here, we present an artificial intelligence (AI) wearable sensor-based human-in-the-loop HVAC control system that is operated on a real-time basis reflecting the thermophysiological condition of the occupant to automatically improve their thermal comfort while reducing the energy consumption of the building. The wristband-type, AI-based, three-point wearable temperature sensor offers excellent thermal comfort prediction accuracy (93.9%), enabling a human-centric HVAC control operation. A proof-of-concept demonstration of closed human-in-the-loop HVAC control using the AI-enabled wearable sensor system confirms both the accuracy of the thermal comfort prediction and the energy-efficiency of this approach, demonstrating its potential as a new solution that improves the occupant's thermal comfort and provides building energy savings.

Highly Conductive and Compliant Silver Nanowire Nanocomposites by Direct Spray Deposition

The silver nanowire (Ag NW)/elastomer nanocomposite represents a prototypical form of a compliant conductor for flexible and stretchable electronic devices. The widespread implementations are currently hindered by the complicated procedures to effectively disperse Ag NWs into elastomer matrices. In this study, we report a facile and scalable coating process to create Ag NW nanocomposites on various flexible/stretchable substrates. As-synthesized Ag NWs from the high-yield polyol-reduction approach are homogeneously dispersed into a variety of dilute elastomer solutions, thereby enabling direct spray deposition into highly compliant conductors. The as-prepared nanocomposite exhibits excellent conductivity (∼11,000 S/cm) and high deformability to 100% strain. The stable electrical properties are largely retained under repetitive mechanical manipulations including stretching, bending, and folding. The patterned features of conductive nanocomposites are conveniently accessed using shadow masks or selective laser ablation. The practical suitability is demonstrated by the successful implementations of a stretchable sensing patch and a flexible light-emitting diode display.

A photoacoustic patch for three-dimensional imaging of hemoglobin and core temperature

Electronic patches, based on various mechanisms, allow continuous and noninvasive monitoring of biomolecules on the skin surface. However, to date, such devices are unable to sense biomolecules in deep tissues, which have a stronger and faster correlation with the human physiological status than those on the skin surface. Here, we demonstrate a photoacoustic patch for three-dimensional (3D) mapping of hemoglobin in deep tissues. This photoacoustic patch integrates an array of ultrasonic transducers and vertical-cavity surface-emitting laser (VCSEL) diodes on a common soft substrate. The high-power VCSEL diodes can generate laser pulses that penetrate >2 cm into biological tissues and activate hemoglobin molecules to generate acoustic waves, which can be collected by the transducers for 3D imaging of the hemoglobin with a high spatial resolution. Additionally, the photoacoustic signal amplitude and temperature have a linear relationship, which allows 3D mapping of core temperatures with high accuracy and fast response. With access to biomolecules in deep tissues, this technology adds unprecedented capabilities to wearable electronics and thus holds significant implications for various applications in both basic research and clinical practice.

Ultra-Thin Flexible Encapsulating Materials for Soft Bio-Integrated Electronics

Recently, bioelectronic devices extensively researched and developed through the convergence of flexible biocompatible materials and electronics design that enables  more precise diagnostics and therapeutics in human health care and opens up the potential to expand into various fields, such as clinical medicine and biomedical research. To establish an accurate and stable bidirectional bio-interface, protection against the external environment and high mechanical deformation is essential for wearable bioelectronic devices. In the case of implantable bioelectronics, special encapsulation materials and optimized mechanical designs and configurations that provide electronic stability and functionality are required for accommodating various organ properties, lifespans, and functions in the biofluid environment. Here, this study introduces recent developments of ultra-thin encapsulations with novel materials that can preserve or even improve the electrical performance of wearable and implantable bio-integrated electronics by supporting safety and stability for protection from destruction and contamination as well as optimizing the use of bioelectronic systems in physiological environments. In addition, a summary of the materials, methods, and characteristics of the most widely used encapsulation technologies is introduced, thereby providing a strategic selection of appropriate choices of recently developed flexible bioelectronics.

Recent Advances in Stretchable and Wearable Capacitive Electrophysiological Sensors for Long-Term Health Monitoring

Over the past several years, wearable electrophysiological sensors with stretchability have received significant research attention because of their capability to continuously monitor electrophysiological signals from the human body with minimal body motion artifacts, long-term tracking, and comfort for real-time health monitoring. Among the four different sensors, i.e., piezoresistive, piezoelectric, iontronic, and capacitive, capacitive sensors are the most advantageous owing to their reusability, high durability, device sterilization ability, and minimum leakage currents between the electrode and the body to reduce the health risk arising from any short circuit. This review focuses on the development of wearable, flexible capacitive sensors for monitoring electrophysiological conditions, including the electrode materials and configuration, the sensing mechanisms, and the fabrication strategies. In addition, several design strategies of flexible/stretchable electrodes, body-to-electrode signal transduction, and measurements have been critically evaluated. We have also highlighted the gaps and opportunities needed for enhancing the suitability and practical applicability of wearable capacitive sensors. Finally, the potential applications, research challenges, and future research directions on stretchable and wearable capacitive sensors are outlined in this review.

Rapid meniscus-guided printing of stable semi-solid-state liquid metal microgranular-particle for soft electronics

Liquid metal is being regarded as a promising material for soft electronics owing to its distinct combination of high electrical conductivity comparable to that of metals and exceptional deformability derived from its liquid state. However, the applicability of liquid metal is still limited due to the difficulty in simultaneously achieving its mechanical stability and initial conductivity. Furthermore, reliable and rapid patterning of stable liquid metal directly on various soft substrates at high-resolution remains a formidable challenge. In this work, meniscus-guided printing of ink containing polyelectrolyte-attached liquid metal microgranular-particle in an aqueous solvent to generate semi-solid-state liquid metal is presented. Liquid metal microgranular-particle printed in the evaporative regime is mechanically stable, initially conductive, and patternable down to 50 μm on various substrates. Demonstrations of the ultrastretchable (~500% strain) electrical circuit, customized e-skin, and zero-waste ECG sensor validate the simplicity, versatility, and reliability of this manufacturing strategy, enabling broad utility in the development of advanced soft electronics.

In this article, meniscus-guided printing of polyelectrolyte-attached liquid metal particles to simultaneously achieve mechanical stability and initial electrical conductivity at high resolution is introduced.

Skin bioelectronics towards long-term, continuous health monitoring

Skin bioelectronics are considered as an ideal platform for personalised healthcare because of their unique characteristics, such as thinness, light weight, good biocompatibility, excellent mechanical robustness, and great skin conformability. Recent advances in skin-interfaced bioelectronics have promoted various applications in healthcare and precision medicine. Particularly, skin bioelectronics for long-term, continuous health monitoring offer powerful analysis of a broad spectrum of health statuses, providing a route to early disease diagnosis and treatment. In this review, we discuss (1) representative healthcare sensing devices, (2) material and structure selection, device properties, and wireless technologies of skin bioelectronics towards long-term, continuous health monitoring, (3) healthcare applications: acquisition and analysis of electrophysiological, biophysical, and biochemical signals, and comprehensive monitoring, and (4) rational guidelines for the design of future skin bioelectronics for long-term, continuous health monitoring. Long-term, continuous health monitoring of advanced skin bioelectronics will open unprecedented opportunities for timely disease prevention, screening, diagnosis, and treatment, demonstrating great promise to revolutionise traditional medical practices.

Flexible Electronics and Devices as Human-Machine Interfaces for Medical Robotics

Medical robots are invaluable players in non-pharmaceutical treatment of disabilities. Particularly, using prosthetic and rehabilitation devices with human-machine interfaces can greatly improve the quality of life for impaired patients. In recent years, flexible electronic interfaces and soft robotics have attracted tremendous attention in this field due to their high biocompatibility, functionality, conformability, and low-cost. Flexible human-machine interfaces on soft robotics will make a promising alternative to conventional rigid devices, which can potentially revolutionize the paradigm and future direction of medical robotics in terms of rehabilitation feedback and user experience. In this review, the fundamental components of the materials, structures, and mechanisms in flexible human-machine interfaces are summarized by recent and renowned applications in five primary areas: physical and chemical sensing, physiological recording, information processing and communication, soft robotic actuation, and feedback stimulation. This review further concludes by discussing the outlook and current challenges of these technologies as a human-machine interface in medical robotics.

Breathable, Self-Adhesive Dry Electrodes for Stable Electrophysiological Signal Monitoring During Exercise

On-skin electrodes with high air permeability, low thickness, low elastic modulus, and high adhesion are essential for biomedical signal recordings, which provide data for sports management and biomedical applications. However, nanothickness electrodes interacting with the skin by van der Waals force can be interfered with by sweating, and elastomers with high adhesion prepared by modification are not satisfactory in terms of air permeability. Here, a dry electrode with high stretchability (598%), low elastic modulus (5 MPa), high air permeability (726 g m^-2 d^-1), and high adhesion (6.33 kPa) was fabricated by semi-embedding Ag nanowires into nonyl and glycerol-modified polyvinyl alcohol. Furthermore, a small amount of 40 wt % ethanol was sprayed on the skin to facilitate microdissolution of the substrate and form immediate conformability with skin texture. The dry electrodes can record high-quality electrocardiogram and electromyogram signals through a robust contact with the skin under skin deformation, with a water stream, or after running for 1 h. The film can also be served as the substrate for self-adhesive strain sensors to monitor motion with higher quality than nonadhesive polydimethylsilane-based sensors.

NiO-Based Electronic Flexible Devices

Personal, portable, and wearable electronics have become items of extensive use in daily life. Their fabrication requires flexible electronic components with high storage capability or with continuous power supplies (such as solar cells). In addition, formerly rigid tools such as electrochromic windows find new utilizations if they are fabricated with flexible characteristics. Flexibility and performances are determined by the material composition and fabrication procedures. In this regard, low-cost, easy-to-handle materials and processes are an asset in the overall production processes and items fruition. In the present mini-review, the most recent approaches are described in the production of flexible electronic devices based on NiO as low-cost material enhancing the overall performances. In particular, flexible NiO-based all-solid-state supercapacitors, electrodes electrochromic devices, temperature devices, and ReRAM are discussed, thus showing the potential of NiO as material for future developments in opto-electronic devices.

Recent Progress in Materials Chemistry to Advance Flexible Bioelectronics in Medicine

Designing bioelectronic devices that seamlessly integrate with the human body is a technological pursuit of great importance. Bioelectronic medical devices that reliably and chronically interface with the body can advance neuroscience, health monitoring, diagnostics, and therapeutics. Recent major efforts focus on investigating strategies to fabricate flexible, stretchable, and soft electronic devices, and advances in materials chemistry have emerged as fundamental to the creation of the next generation of bioelectronics. This review summarizes contemporary advances and forthcoming technical challenges related to three principal components of bioelectronic devices: i) substrates and structural materials, ii) barrier and encapsulation materials, and iii) conductive materials. Through notable illustrations from the literature, integration and device fabrication strategies and associated challenges for each material class are highlighted.

Nanolignin filled conductive hydrogel with improved mechanical, anti-freezing, UV-shielding and transparent properties for strain sensing application

Herein, we innovatively synthesized an ionic conductive PVA/LNP hydrogel with integrated excellent mechanical, anti-freezing, moisturizing, transparent and UV-shielding performances via incorporating nanolignin (also called lignin nanoparticle, LNP) and aluminum chloride (AlCl₃) into polyvinyl alcohol (PVA) matrix containing ethylene glycol/water (EG/H₂O) binary solvent. The rigid porous network structure was well constructed by the hydrogen bond interactions among the evenly distributed LNP and PVA chains, thus providing abundant ion transport channels, which attributed to the outstanding ionic conductivity (up to 1.35 × 10^-2 S/m, at -24 °C) with improved mechanical strength and flexibility. The tensile strength and elongation at break of PVA/LNP hydrogel were greatly increased from 574.6 kPa and 363.7% to 1241.4 kPa and 589% at the addition of 0.35% LNP, respectively. In addition, the UV-resistance ability was 95% at 365 nm, while the transparency was 74% at 550 nm. The binary solvent of EG and H₂O ensured long-term moisturizing capability (10 days) of the hydrogel at 35 °C and 60 RH%, as well as possessing superior anti-freezing performance over the temperature range of -62.6 to 24 °C. As a result, the fabricated PVA/LNP hydrogel was successfully used as strain sensor for detecting diverse human motions and electrophysiological signals.

Smart Chemical Engineering-Based Lightweight and Miniaturized Attachable Systems for Advanced Drug Delivery and Diagnostics

Smart attachable systems have attracted much attention owing to their capabilities in terms of body performance evaluation, disease diagnostics, and drug delivery. Recent advances in chemical and engineering techniques provide many opportunities to improve device fabrication and applications owing to the advantages of being lightweight and easy to control as well as their battery absence and functional diversity. This review highlights the latest developments in the field of chemical engineering-based lightweight and miniaturized attachable systems, which are mainly inspired by the natural world. Their applications for real-time monitoring, point-of-care sampling, biomarker detection, and controlled release are discussed thoroughly with respect to specific products/prototypes. The perspectives of the field, including persistence guarantee, burden reduction, and personality improvement, are also discussed. It is believed that chemical engineering-based lightweight and miniaturized attachable systems have good potential in both clinical and industrial fields, indicating a large potential to improve human lives in the near future.

Computational design and optimization of electro-physiological sensors

Electro-physiological sensing devices are becoming increasingly common in diverse applications. However, designing such sensors in compact form factors and for high-quality signal acquisition is a challenging task even for experts, is typically done using heuristics, and requires extensive training. Our work proposes a computational approach for designing multi-modal electro-physiological sensors. By employing an optimization-based approach alongside an integrated predictive model for multiple modalities, compact sensors can be created which offer an optimal trade-off between high signal quality and small device size. The task is assisted by a graphical tool that allows to easily specify design preferences and to visually analyze the generated designs in real-time, enabling designer-in-the-loop optimization. Experimental results show high quantitative agreement between the prediction of the optimizer and experimentally collected physiological data. They demonstrate that generated designs can achieve an optimal balance between the size of the sensor and its signal acquisition capability, outperforming expert generated solutions.

Though skin-conformable electro-physiological sensors are attractive for epidermal electronics, their optimal design remains a challenge. Here, the authors report a computational design approach for realizing multi-modal electro-physiological sensors that optimizes electrode layout design.

Human Body-Electrode Interfaces for Wide-Frequency Sensing and Communication: A Review

Several on-body sensing and communication applications use electrodes in contact with the human body. Body-electrode interfaces in these cases act as a transducer, converting ionic current in the body to electronic current in the sensing and communication circuits and vice versa. An ideal body-electrode interface should have the characteristics of an electrical short, i.e., the transfer of ionic currents and electronic currents across the interface should happen without any hindrance. However, practical body-electrode interfaces often have definite impedances and potentials that hinder the free flow of currents, affecting the application's performance. Minimizing the impact of body-electrode interfaces on the application's performance requires one to understand the physics of such interfaces, how it distorts the signals passing through it, and how the interface-induced signal degradations affect the applications. Our work deals with reviewing these elements in the context of biopotential sensing and human body communication.

Wearable and Implantable Soft Bioelectronics: Device Designs and Material Strategies

High-performance wearable and implantable devices capable of recording physiological signals and delivering appropriate therapeutics in real time are playing a pivotal role in revolutionizing personalized healthcare. However, the mechanical and biochemical mismatches between rigid, inorganic devices and soft, organic human tissues cause significant trouble, including skin irritation, tissue damage, compromised signal-to-noise ratios, and limited service time. As a result, profuse research efforts have been devoted to overcoming these issues by using flexible and stretchable device designs and soft materials. Here, we summarize recent representative research and technological advances for soft bioelectronics, including conformable and stretchable device designs, various types of soft electronic materials, and surface coating and treatment methods. We also highlight applications of these strategies to emerging soft wearable and implantable devices. We conclude with some current limitations and offer future prospects of this booming field.

Noninvasive Human-Prosthesis Interfaces for Locomotion Intent Recognition: A Review

The lower-limb robotic prostheses can provide assistance for amputees' daily activities by restoring the biomechanical functions of missing limb(s). To set proper control strategies and develop the corresponding controller for robotic prosthesis, a prosthesis user's intent must be acquired in time, which is still a major challenge and has attracted intensive attentions. This work focuses on the robotic prosthesis user's locomotion intent recognition based on the noninvasive sensing methods from the recognition task perspective (locomotion mode recognition, gait event detection, and continuous gait phase estimation) and reviews the state-of-the-art intent recognition techniques in a lower-limb prosthesis scope. The current research status, including recognition approach, progress, challenges, and future prospects in the human's intent recognition, has been reviewed. In particular for the recognition approach, the paper analyzes the recent studies and discusses the role of each element in locomotion intent recognition. This work summarizes the existing research results and problems and contributes a general framework for the intent recognition based on lower-limb prosthesis.

Biocompatible, Transparent, and High-Areal-Coverage Kirigami PEDOT:PSS Electrodes for Electrooculography-Derived Human-Machine Interactions

Electronic skin sensors prepared from biocompatible and biodegradable polymeric materials significantly benefit the research and scientific community, as they can reduce the amount of effort required for e-waste management by deteriorating or dissolving into the environment without pollution. Herein, we report the use of polylactic acid (PLA)-a promising plant-based bioplastic-and highly transparent, conductive, biocompatible, and flexible poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) materials to fabricate kirigami-based stretchable on-skin electrophysiological sensors via a low-cost and rapid laser cutting technique. The sensor stack with PEDOT:PSS and PLA layers exhibited high transparency (>85%) in the wavelength range of 400-700 nm and stay attached conformally to the skin for several hours without adverse effects. The Y-shaped kirigami motifs inspired by the microcracked gold film endowed the sensor with attributes such as high areal coverage (∼85%), breathability (∼40 g m^-2 h^-1), and multidirectional stretchability. The sensor has been successfully applied to monitor electrophysiological signals and demonstrated with an eye movement-supported communication interface for controlling home electronic appliances.

Materials, Devices, and Systems of On-Skin Electrodes for Electrophysiological Monitoring and Human-Machine Interfaces

On-skin electrodes function as an ideal platform for collecting high-quality electrophysiological (EP) signals due to their unique characteristics, such as stretchability, conformal interfaces with skin, biocompatibility, and wearable comfort. The past decade has witnessed great advancements in performance optimization and function extension of on-skin electrodes. With continuous development and great promise for practical applications, on-skin electrodes are playing an increasingly important role in EP monitoring and human-machine interfaces (HMI). In this review, the latest progress in the development of on-skin electrodes and their integrated system is summarized. Desirable features of on-skin electrodes are briefly discussed from the perspective of performances. Then, recent advances in the development of electrode materials, followed by the analysis of strategies and methods to enhance adhesion and breathability of on-skin electrodes are examined. In addition, representative integrated electrode systems and practical applications of on-skin electrodes in healthcare monitoring and HMI are introduced in detail. It is concluded with the discussion of key challenges and opportunities for on-skin electrodes and their integrated systems.

Textile sensors platform for the selective and simultaneous detection of chloride ion and pH in sweat

The development of wearable sensors, in particular fully-textile ones, is one of the most interesting open challenges in bioelectronics. Several and significant steps forward have been taken in the last decade in order to achieve a compact, lightweight, cost-effective, and easy to wear platform for healthcare and sport activities real-time monitoring. We have developed a fully textile, multi-thread biosensing platform that can detect different bioanalytes simultaneously without interference, and, as an example, we propose it for testing chloride ions (Cl^-) concentration and pH level. The textile sensors are simple threads, based on natural and synthetic fibers, coated with the conducting polymer poly(3,4-ethylenedioxythiophene):poly(styrene-sulfonate) (PEDOT:PSS) and properly functionalized with either a nano-composite material or a chemical sensitive dye to obtain Cl^- and pH selective sensing functionality, respectively. The single-thread sensors show excellent sensitivity, reproducibility, selectivity, long term stability and the ability to work with small volumes of solution. The performance of the developed textile devices is demonstrated both in buffer solution and in artificial human perspiration to perform on-demand and point-of-care epidermal fluids analysis. The possibility to easily knit or sew the thread sensors into fabrics opens up a new vision for a textile wearable multi-sensing platform achievable in the near future.

Wearable Circuits Sintered at Room Temperature Directly on the Skin Surface for Health Monitoring

A soft body area sensor network presents a promising direction in wearable devices to integrate on-body sensors for physiological signal monitoring and flexible printed circuit boards (FPCBs) for signal conditioning/readout and wireless transmission. However, its realization currently relies on various sophisticated fabrication approaches such as lithography or direct printing on a carrier substrate before attaching to the body. Here, we report a universal fabrication scheme to enable printing and room-temperature sintering of the metal nanoparticle on paper/fabric for FPCBs and directly on the human skin for on-body sensors with a novel sintering aid layer. Consisting of polyvinyl alcohol (PVA) paste and nanoadditives in the water, the sintering aid layer reduces the sintering temperature. Together with the significantly decreased surface roughness, it allows for the integration of a submicron-thick conductive pattern with enhanced electromechanical performance. Various on-body sensors integrated with an FPCB to detect health conditions illustrate a system-level example.

Quantitative Muscle Fatigue Estimation with High SNR Flexible Skin Electrode

In recent years, surface electromyography (sEMG) has been commonly used to diagnose neuromuscular abnormalities. Since sEMG measures electrical signals from various tangled muscle nerves, a high signal-to-noise ratio (SNR) is required to estimate the condition accurately. Previously, Ag/AgCl electrodes were widely used for sEMG measurements, but noble metals are more advantageous for long-term and continuous measurement. In this study, we improved the SNR of bioelectrical signals by increasing the surface area of a flexible skin-electrode made of noble metal. The electrode surface area was increased by 1.38 times with electroplating, and the SNR of sEMG was improved by 1.63 times. Utilizing the sEMG signals with high SNR, we propose a new muscle fatigue estimation algorithm for monitoring the muscle condition in real-time.

Electrothermal soft manipulator enabling safe transport and handling of thin cell/tissue sheets and bioelectronic devices

"Living" cell sheets or bioelectronic chips have great potentials to improve the quality of diagnostics and therapies. However, handling these thin and delicate materials remains a grand challenge because the external force applied for gripping and releasing can easily deform or damage the materials. This study presents a soft manipulator that can manipulate and transport cell/tissue sheets and ultrathin wearable biosensing devices seamlessly by recapitulating how a cephalopod's suction cup works. The soft manipulator consists of an ultrafast thermo-responsive, microchanneled hydrogel layer with tissue-like softness and an electric heater layer. The electric current to the manipulator drives microchannels of the gel to shrink/expand and results in a pressure change through the microchannels. The manipulator can lift/detach an object within 10 s and can be used repeatedly over 50 times. This soft manipulator would be highly useful for safe and reliable assembly and implantation of therapeutic cell/tissue sheets and biosensing devices.

Skin-conformable printed supercapacitors and their performance in wear

Wearable sensors and electronic systems are of great interest these days, but their viability depends on the availability of compatible energy storage solutions. Such sensors can either be integrated into clothing or attached directly to the skin, each case presenting a different set of requirements for the devices. In this work, we examine the performance of printed supercapacitors while attached to the skin. The devices are manufactured from benign materials, such as water, carbon and sodium chloride, and worn on the forearm or chest for 24 h for durability testing. The supercapacitors exhibit excellent mechanical durability and stay well attached under all test conditions. Electrically, the supercapacitors exhibit reliable capacitive function throughout the test period; other key parameters such as equivalent series resistance and leakage current are affected but to a minimal extent. The movement and deformation of the supercapacitor show good compatibility with the skin, as shown by the Digital Image Correlation full field strain measurements on and around the capacitor. The supercapacitors deform with the skin and do not hinder normal movement or function.

Ultra-conformal drawn-on-skin electronics for multifunctional motion artifact-free sensing and point-of-care treatment

An accurate extraction of physiological and physical signals from human skin is crucial for health monitoring, disease prevention, and treatment. Recent advances in wearable bioelectronics directly embedded to the epidermal surface are a promising solution for future epidermal sensing. However, the existing wearable bioelectronics are susceptible to motion artifacts as they lack proper adhesion and conformal interfacing with the skin during motion. Here, we present ultra-conformal, customizable, and deformable drawn-on-skin electronics, which is robust to motion due to strong adhesion and ultra-conformality of the electronic inks drawn directly on skin. Electronic inks, including conductors, semiconductors, and dielectrics, are drawn on-demand in a freeform manner to develop devices, such as transistors, strain sensors, temperature sensors, heaters, skin hydration sensors, and electrophysiological sensors. Electrophysiological signal monitoring during motion shows drawn-on-skin electronics' immunity to motion artifacts. Additionally, electrical stimulation based on drawn-on-skin electronics demonstrates accelerated healing of skin wounds.

Advances in Sweat Wearables: Sample Extraction, Real-Time Biosensing, and Flexible Platforms

Wearable biosensors for sweat-based analysis are gaining wide attention due to their potential use in personal health monitoring. Flexible wearable devices enable sweat analysis at the molecular level, facilitating noninvasive monitoring of physiological states via real-time monitoring of chemical biomarkers. Advances in sweat extraction technology, real-time biosensors, stretchable materials, device integration, and wireless digital technologies have led to the development of wearable sweat-biosensing devices that are light, flexible, comfortable, aesthetic, affordable, and informative. Herein, we summarize recent advances of sweat wearables from the aspects of sweat extraction, fabrication of stretchable biomaterials, and design of biosensing modules to enable continuous biochemical monitoring, which are essential for a biosensing device. Key chemical components of sweat, sweat capture methodologies, and considerations of flexible substrates for integrating real-time biosensors with electronics to bring innovations in the art of wearables are elaborated. The strategies and challenges involved in improving the wearable biosensing performance and the perspectives for designing sweat-based wearable biosensing devices are discussed.

Recent Advances in Flexible and Stretchable Sensing Systems: From the Perspective of System Integration

Biological signals generated during various biological processes are critically important for providing insight into the human physiological status. Recently, there have been many great efforts in developing flexible and stretchable sensing systems to provide biological signal monitoring platforms with intimate integration with biological surfaces. Here, this review summarizes the recent advances in flexible and stretchable sensing systems from the perspective of electronic system integration. A comprehensive general sensing system architecture is described, which consists of sensors, sensor interface circuits, memories, and digital processing units. The subsequent content focuses on the integration requirements and highlights some advanced progress for each component. Next, representative examples of flexible and stretchable sensing systems for electrophysiological, physical, and chemical information monitoring are introduced. This review concludes with an outlook on the remaining challenges and opportunities for future fully flexible or stretchable sensing systems.

Skin-interfaced sensors in digital medicine: from materials to applications

The recent advances in skin-interfaced wearable sensors have enabled tremendous potential towards personalized medicine and digital health. Compared with traditional healthcare, wearable sensors could perform continuous and non-invasive data collection from the human body and provide an insight into both fitness monitoring and medical diagnostics. In this review, we summarize the latest progress of skin-interfaced wearable sensors along with their integrated systems. We first introduce the strategies of materials selection and structure design that can be accommodated for intimate contact with human skin. Current development of physical and biochemical sensors is then classified and discussed with an emphasis on their sensing mechanisms. System-level integration including power supply, wireless communication and data analysis are also briefly discussed. We conclude with an outlook of this field and identify the key challenges and opportunities for future wearable devices and systems.

Flexible Hybrid Electronics for Digital Healthcare

Recent advances in material innovation and structural design provide routes to flexible hybrid electronics that can combine the high-performance electrical properties of conventional wafer-based electronics with the ability to be stretched, bent, and twisted to arbitrary shapes, revolutionizing the transformation of traditional healthcare to digital healthcare. Here, material innovation and structural design for the preparation of flexible hybrid electronics are reviewed, a brief chronology of these advances is given, and biomedical applications in bioelectrical monitoring and stimulation, optical monitoring and treatment, acoustic imitation and monitoring, bionic touch, and body-fluid testing are described. In conclusion, some remarks on the challenges for future research of flexible hybrid electronics are presented.

Recent Developments of Flexible and Stretchable Electrochemical Biosensors

The skyrocketing popularity of health monitoring has spurred increasing interest in wearable electrochemical biosensors. Compared with the traditionally rigid and bulky electrochemical biosensors, flexible and stretchable devices render a unique capability to conform to the complex, hierarchically textured surfaces of the human body. With a recognition element (e.g., enzymes, antibodies, nucleic acids, ions) to selectively react with the target analyte, wearable electrochemical biosensors can convert the types and concentrations of chemical changes in the body into electrical signals for easy readout. Initial exploration of wearable electrochemical biosensors integrates electrodes on textile and flexible thin-film substrate materials. A stretchable property is needed for the thin-film device to form an intimate contact with the textured skin surface and to deform with various natural skin motions. Thus, stretchable materials and structures have been exploited to ensure the effective function of a wearable electrochemical biosensor. In this mini-review, we summarize the recent development of flexible and stretchable electrochemical biosensors, including their principles, representative application scenarios (e.g., saliva, tear, sweat, and interstitial fluid), and materials and structures. While great strides have been made in the wearable electrochemical biosensors, challenges still exist, which represents a small fraction of opportunities for the future development of this burgeoning field.

Intrinsically Stretchable Organic-Tribotronic-Transistor for Tactile Sensing

Stretchable electronics are of great significance for the development of the next-generation smart interactive systems. Here, we propose an intrinsically stretchable organic tribotronic transistor (SOTT) without a top gate electrode, which is composed of a stretchable substrate, silver nanowire electrodes, semiconductor blends, and a nonpolar elastomer dielectric. The drain-source current of the SOTT can be modulated by external contact electrification with the dielectric layer. Under 0-50% stretching both parallel and perpendicular to the channel directions, the SOTT retains great output performance. After being stretched to 50% for thousands of cycles, the SOTT can survive with excellent stability. Moreover, the SOTT can be conformably attached to the human hand, which can be used for tactile signal perception in human-machine interaction and for controlling smart home devices and robots. This work has realized a stretchable tribotronic transistor as the tactile sensor for smart interaction, which has extended the application of tribotronics in the human-machine interface, wearable electronics, and robotics.

Flexible Ultrasonic Transducer Array with Bulk PZT for Adjuvant Treatment of Bone Injury

Flexible electronic devices are developing rapidly, especially in medical applications. This paper reports an arrayed flexible piezoelectric micromachined ultrasonic transducer (FPMUT) with a sandwich structure for adjuvant treatment of bone injury. To make the device conformable and stretchable for attaching to the skin surface, the flexible substrate of polydimethylsiloxane (PDMS) was combined with the flexible metal line interconnection between the bulk lead zirconate titanate (PZT) arrays. Simulations and experiments were carried out to verify the resonant frequency and tensile property of the reported FPMUT device. The device had a resonant frequency of 321.15 KHz and a maximum sound pressure level (SPL) of 180.19 dB at the distance of 5 cm in water. In addition, detailed experiments were carried out to test its acoustic performance with different pork tissues, and the results indicated good ultrasound penetration. These findings confirm that the FPMUT shows unique advantages for adjuvant treatment of bone injury.

Ultra-Low Power Wearable Infant Sleep Position Sensor

Numerous wearable sensors have been developed for a variety of needs in medical/healthcare/wellness/sports applications, but there are still doubts about their usefulness due to uncomfortable fit or frequent battery charging. Because the size or capacity of battery is the major factor affecting the convenience of wearable sensors, power consumption must be reduced. We developed a method that can significantly reduce the power consumption by introducing a signal repeater and a special switch that provides power only when needed. Antenna radiation characteristics are an important factor in wireless wearable sensors, but soft material encapsulation for comfortable fit results in poor wireless performance. We improved the antenna radiation characteristics by a local encapsulation patterning. In particular, ultra-low power operation enables the use of paper battery to achieve a very thin and flexible form factor. Also, we verified the human body safety through specific absorption rate simulations. With these methods, we demonstrated a wearable infant sleep position sensor. Infants are unable to call for help in unsafe situations, and it is not easy for caregivers to observe them all the time. Our wearable sensor detects infants’ sleep positions in real time and automatically alerts the caregivers when needed.

A 3D Microscaffold Cochlear Electrode Array for Steroid Elution

In cochlear implants, the electrode insertion trauma during surgery can cause damage residual hearing. Preserving the residual hearing is an important challenge and the localized administration of drugs, such as steroids, is one of the most promising ways, but remains a challenge. Here, a microscaffold cochlear electrode array (MiSCEA) consisting of a microfabricated flexible electrode array and a 3D microscaffold for steroid reservoir is reported. The MiSCEA without loaded drug is tested by measuring the electrically evoked auditory brainstem response of the cochlea in guinea pigs (n = 4). The scaffold is then coated with steroid (dexamethasone) encapsulated in polylactic-co-glycolic acid and the continuous release of the steroid into artificial perilymph during six weeks is monitored. The steroid-containing scaffolds are then implanted into guinea pigs (n = 4) and threshold shifts are analyzed for four weeks by measuring the acoustically evoked auditory brainstem response. The threshold shifts tend to be lower in the group implanted with the steroid-containing MiSCEAs. The feasibility of 3D MiSCEA opens up the development of potential next-generation cochlear electrode with improved steroid release dynamics into cochlea.

Integration of biological systems with electronic-mechanical assemblies

Biological systems continuously interact with the surrounding environment because they are dynamically evolving. The interaction is achieved through mechanical, electrical, chemical, biological, thermal, optical, or a synergistic combination of these cues. To provide a fundamental understanding of the interaction, recent efforts that integrate biological systems with the electronic-mechanical assemblies create unique opportunities for simultaneous monitoring and eliciting the responses to the biological system. Recent innovations in materials, fabrication processes, and device integration approaches have created the enablers to yield bio-integrated devices to interface with the biological system, ranging from cells and tissues to organs and living individual. In this short review, we will provide a brief overview of the recent development on the integration of the biological systems with electronic-mechanical assemblies across multiple scales, with applications ranging from healthcare monitoring to therapeutic options such as drug delivery and rehabilitation therapies. STATEMENT OF SIGNIFICANCE: An overview of the recent progress on the integration of the biological system with both electronic and mechanical assemblies is discussed. The integration creates the unique opportunity to simultaneously monitor and elicit the responses to the biological system, which provides a fundamental understanding of the interaction between the biological system and the electronic-mechanical assemblies. Recent innovations in materials, fabrication processes, and device integration approaches have created the enablers to yield bio-integrated devices to interface with the biological system, ranging from cells and tissues to organs and living individual.

Recoverable Electrical Breakdown Strength and Dielectric Constant in Ultralow-k Nanolattice Capacitors

The dielectric reliability of low-k materials during mechanical deformation attracts tremendous attention, owing to the increasing demand for thin electronics to meet the ever-shrinking form factor of consumer products. However, the strong coupling between dielectric/electric and mechanical properties limits the use of low-k dielectrics in industrial applications. We report the leakage current and dielectric properties of a nanolattice capacitor during compressive stress cycling. Electrical breakdown measurements during the stress cycling, combined with a theoretical model and in situ mechanical experiments, provide insights to key breakdown mechanisms. Electrical breakdown occurs at nearly 50% strain, featuring a switch-like binary character, correlated with a transition from beam bending and buckling to collapse. Breakdown strength appears to recover after each cycle, concomitant with nanolattice's shape recovery. The compressive displacement at breakdown decreases with cycling due to permanently buckled beams, transforming the conduction mechanism from Schottky to Poole-Frankel emission. Remarkably, our capacitor with 99% porosity, k ∼ 1.09, is operative up to 200 V, whereas devices with 17% porous alumina films breakdown upon biasing based on a percolation model. Similarly with electrical breakdown, the dielectric constant of the capacitor is recoverable with five strain cycles and is stable under 25% compression. These outstanding capabilities of the nanolattice are essential for revolutionizing future flexible electronics.

Soft Bioelectronic Stickers: Selection and Evaluation of Skin-Interfacing Electrodes

Surface biopotentials collected from the human epidermis contain important information about human physiology, such as muscular, heart, and brain activities. However, commercially available wearable biomonitoring devices are generally composed of rigid hardware incompatible with the mechanical compliance of soft human tissues. Thin-film stretchable e-skin circuits that can interface the human skin represent an excellent alternative for long-term wearable biomonitoring. Here, a series of soft and stretchable electrodes are evaluated for their applicability in biopotential sensing. This includes conductive composites made of polydimethylsiloxane (PDMS) as a base substrate and conductive particles, i.e., carbon (cPDMS), silver (AgPDMS), anisotropic z-axis conductors made with silver-coated nickel particles (zPDMS), as well as a combination of a conductive tough hydrogel with PDMS, and finally ultrathin tattoo-like adhesive poly(vinyl alcohol)-coated films with stretchable biphasic Ag-EGaIn electrodes. These electrodes are compared between themselves and against the gold-standard Ag/AgCl and stainless steel electrodes, in order to assess relative performance in signal-to-noise ratio (SNR) during electrocardiography, and electrode-skin impedance for a range of frequencies. Results show a direct relation between conformity of the electrode-skin interface and the SNR value. An all-integrated biomonitoring patch with embedded processing and communication electronics, hydrogel electrodes, and a multilayer liquid metal circuit is presented for electromyography.

Flexible electronic/optoelectronic microsystems with scalable designs for chronic biointegration

Flexible biocompatible electronic systems that leverage key materials and manufacturing techniques associated with the consumer electronics industry have potential for broad applications in biomedicine and biological research. This study reports scalable approaches to technologies of this type, where thin microscale device components integrate onto flexible polymer substrates in interconnected arrays to provide multimodal, high performance operational capabilities as intimately coupled biointerfaces. Specificially, the material options and engineering schemes summarized here serve as foundations for diverse, heterogeneously integrated systems. Scaled examples incorporate >32,000 silicon microdie and inorganic microscale light-emitting diodes derived from wafer sources distributed at variable pitch spacings and fill factors across large areas on polymer films, at full organ-scale dimensions such as human brain, over ∼150 cm² In vitro studies and accelerated testing in simulated biofluids, together with theoretical simulations of underlying processes, yield quantitative insights into the key materials aspects. The results suggest an ability of these systems to operate in a biologically safe, stable fashion with projected lifetimes of several decades without leakage currents or reductions in performance. The versatility of these combined concepts suggests applicability to many classes of biointegrated semiconductor devices.

Wearable Sensors for Biochemical Sweat Analysis

Sweat is a largely unexplored biofluid that contains many important biomarkers ranging from electrolytes and metabolites to proteins, cytokines, antigens, and exogenous drugs. The eccrine and apocrine glands produce and excrete sweat through microscale pores on the epidermal surface, offering a noninvasive means for capturing and probing biomarkers that reflect hydration state, fatigue, nutrition, and physiological changes. Recent advances in skin-interfaced wearable sensors capable of real-time in situ sweat collection and analytics provide capabilities for continuous biochemical monitoring in an ambulatory mode of operation. This review presents a broad overview of sweat-based biochemical sensor technologies with an emphasis on enabling materials, designs, and target analytes of interest. The article concludes with a summary of challenges and opportunities for researchers and clinicians in this swiftly growing field.