Scalable Manufacturing of Solderable and Stretchable Physiologic Sensing Systems

Design and Development of Transient Sensing Devices for Healthcare Applications

With the ever-growing requirements in the healthcare sector aimed at personalized diagnostics and treatment, continuous and real-time monitoring of relevant parameters is gaining significant traction. In many applications, health status monitoring may be carried out by dedicated wearable or implantable sensing devices only within a defined period and followed by sensor removal without additional risks for the patient. At the same time, disposal of the increasing number of conventional portable electronic devices with short life cycles raises serious environmental concerns due to the dangerous accumulation of electronic and chemical waste. An attractive solution to address these complex and contradictory demands is offered by biodegradable sensing devices. Such devices may be able to perform required tests within a programmed period and then disappear by safe resorption in the body or harmless degradation in the environment. This work critically assesses the design and development concepts related to biodegradable and bioresorbable sensors for healthcare applications. Different aspects are comprehensively addressed, from fundamental material properties and sensing principles to application-tailored designs, fabrication techniques, and device implementations. The emerging approaches spanning the last 5 years are emphasized and a broad insight into the most important challenges and future perspectives of biodegradable sensors in healthcare are provided.

Soft Sensors and Actuators for Wearable Human-Machine Interfaces

Haptic human-machine interfaces (HHMIs) combine tactile sensation and haptic feedback to allow humans to interact closely with machines and robots, providing immersive experiences and convenient lifestyles. Significant progress has been made in developing wearable sensors that accurately detect physical and electrophysiological stimuli with improved softness, functionality, reliability, and selectivity. In addition, soft actuating systems have been developed to provide high-quality haptic feedback by precisely controlling force, displacement, frequency, and spatial resolution. In this Review, we discuss the latest technological advances of soft sensors and actuators for the demonstration of wearable HHMIs. We particularly focus on highlighting material and structural approaches that enable desired sensing and feedback properties necessary for effective wearable HHMIs. Furthermore, promising practical applications of current HHMI technology in various areas such as the metaverse, robotics, and user-interactive devices are discussed in detail. Finally, this Review further concludes by discussing the outlook for next-generation HHMI technology.

Intrinsically Stretchable Conductive Self-Healable Organogels for Strain, Pressure, Temperature, and Humidity Sensing

Intrinsically stretchable conductive self-healable organogels containing poly(lipoic acid), Al3+ ion, tannic acid, and reduced graphene oxide are produced in this report. These noncovalent networks interlocked through physical (hydrogen and coordination) bonds offered high stretchabilities and mechanical strengths as well as fast self-healing behaviors. The optimum organogel-based sensor showed outstanding pressure sensitivities (0.94 kPa-1 up to 10 and 1.07 kPa-1 for 10-50 kPa) and high strain responses (corresponding gauge factors of 1.1 and 0.4 for 0-50 and 50-100% stretching ratios). This organogel also revealed high stabilities at ambient atmosphere due to the presence of binary solvents of dimethyl sulfoxide and glycerol. Additionally, this stretchable thermistor displayed remarkable two-stage sensitivities of -2.6 and -0.4%/°C ranging over 0-30 and 30-80 °C, respectively. Besides, the signal variations of water droplet addition and removal with different temperatures were recorded by the organogel sensor to elucidate the practical applicabilities as a temperature sensor. Moreover, the organogel was utilized to demonstrate humidity sensing, where individual sensitivities of 0.89 and 0.55 were obtained in the respective relative humidity ranges of 10-30 and 40-90%. In the meanwhile, the sensor device illustrated distinct humidity signals during respiration monitoring of nose and mouth breathing detection. Accordingly, these quad-functional sensor applications in strain, pressure, temperature, and humidity detection enable this gel to act as a promising material for future multifunctional flexible electronics.

Soft Wireless Headband Bioelectronics and Electrooculography for Persistent Human-Machine Interfaces

Recent advances in wearable technologies have enabled ways for people to interact with external devices, known as human-machine interfaces (HMIs). Among them, electrooculography (EOG), measured by wearable devices, is used for eye movement-enabled HMI. Most prior studies have utilized conventional gel electrodes for EOG recording. However, the gel is problematic due to skin irritation, while separate bulky electronics cause motion artifacts. Here, we introduce a low-profile, headband-type, soft wearable electronic system with embedded stretchable electrodes, and a flexible wireless circuit to detect EOG signals for persistent HMIs. The headband with dry electrodes is printed with flexible thermoplastic polyurethane. Nanomembrane electrodes are prepared by thin-film deposition and laser cutting techniques. A set of signal processing data from dry electrodes demonstrate successful real-time classification of eye motions, including blink, up, down, left, and right. Our study shows that the convolutional neural network performs exceptionally well compared to other machine learning methods, showing 98.3% accuracy with six classes: the highest performance till date in EOG classification with only four electrodes. Collectively, the real-time demonstration of continuous wireless control of a two-wheeled radio-controlled car captures the potential of the bioelectronic system and the algorithm for targeting various HMI and virtual reality applications.

Wearable respiratory sensors for COVID-19 monitoring

Since its outbreak in 2019, COVID-19 becomes a pandemic, severely burdening the public healthcare systems and causing an economic burden. Thus, societies around the world are prioritizing a return to normal. However, fighting the recession could rekindle the pandemic owing to the lightning-fast transmission rate of SARS-CoV-2. Furthermore, many of those who are infected remain asymptomatic for several days, leading to the increased possibility of unintended transmission of the virus. Thus, developing rigorous and universal testing technologies to continuously detect COVID-19 for entire populations remains a critical challenge that needs to be overcome. Wearable respiratory sensors can monitor biomechanical signals such as the abnormities in respiratory rate and cough frequency caused by COVID-19, as well as biochemical signals such as viral biomarkers from exhaled breaths. The point-of-care system enabled by advanced respiratory sensors is expected to promote better control of the pandemic by providing an accessible, continuous, widespread, noninvasive, and reliable solution for COVID-19 diagnosis, monitoring, and management.

Strain-Driven Auto-Detachable Patterning of Flexible Electrodes

Flexible electrodes that are multilayer, multimaterial, and conformal are pivotal for multifunctional wearable electronics. Traditional electronic circuits manufacturing requires substrate-supported transfer printing, which limits their multilayer integrity and device conformability on arbitrary surfaces. Herein, a "shrinkage-assisted patterning by evaporation" (SHAPE) method is reported, by employing evaporation-induced interfacial strain mismatch, to fabricate auto-detachable, freestanding, and patternable electrodes. The SHAPE method utilizes vacuum-filtration of polyaniline/bacterial cellulose (PANI/BC) ink through a masked filtration membrane to print high-resolution, patterned, and multilayer electrodes. The strong interlayer hydrogen bonding ensures robust multilayer integrity, while the controllable evaporative shrinking property of PANI/BC induces mismatch between the strains of the electrode and filtration membrane at the interface and thus autodetachment of electrodes. Notably, a 500-layer substrateless micro-supercapacitor fabricated using the SHAPE method exhibits an energy density of 350 mWh cm^-2 at a power density of 40 mW cm^-2 , 100 times higher than reported substrate-confined counterparts. Moreover, a digital circuit fabricated using the SHAPE method functions stably on a deformed glove, highlighting the broad wearable applications of the SHAPE method.

Soft Wireless Bioelectronics Designed for Real-Time, Continuous Health Monitoring of Farmworkers

Hotter summers caused by global warming and increased workload and duration are endangering the health of farmworkers, a high-risk population for heat-related illness (HRI), and deaths. Although prior studies using wearable sensors show the feasibility of employing field-collected data for HRI monitoring, existing devices still have limitations, such as data loss from motion artifacts, device discomfort from rigid electronics, difficulties with administering ingestible sensors, and low temporal resolution. Here, this paper introduces a wireless, wearable bioelectronic system with functionalities for continuous monitoring of skin temperature, electrocardiograms (ECG), heart rates (HR), and activities, configured in a single integrated package. Advanced nanomanufacturing based on laser machining allows rapid device fabrication and direct incorporation of sensors with a highly breathable substrate, allowing for managing excessive sweating and multimodal stresses. To validate the device's performance in agricultural settings, the device is applied to multiple farmworkers at various operations, including fernery, nursery, and crop. The accurate data recording, including high-fidelity ECG (signal-to-noise ratio: >20 dB), accurate HR (r = 0.89, r² = 0.65 in linear correlation), and reliable temperature/activity, confirms the device's capability for multiparameter health monitoring of farmworkers.

Respiratory Monitoring by Ultrafast Humidity Sensors with Nanomaterials: A Review

Respiratory monitoring is a fundamental method to understand the physiological and psychological relationships between respiration and the human body. In this review, we overview recent developments on ultrafast humidity sensors with functional nanomaterials for monitoring human respiration. Key advances in design and materials have resulted in humidity sensors with response and recovery times reaching 8 ms. In addition, these sensors are particularly beneficial for respiratory monitoring by being portable and noninvasive. We systematically classify the reported sensors according to four types of output signals: impedance, light, frequency, and voltage. Design strategies for preparing ultrafast humidity sensors using nanomaterials are discussed with regard to physical parameters such as the nanomaterial film thickness, porosity, and hydrophilicity. We also summarize other applications that require ultrafast humidity sensors for physiological studies. This review provides key guidelines and directions for preparing and applying such sensors in practical applications.

Flexible hybrid integration enabled on-skin electronics for wireless monitoring of electrophysiology and motion

On-skin electronics are promising in human motion and vital sign monitoring, disease diagnosis and treatment. On-skin systems are soft and stretchable, and can maintain electrical performances during bending, stretching or twisting, etc. However, current integrated circuit based fabrication processes are not compatible with stretchable substrate, and recently proposed flexible hybrid integration methods typically involve complicated fabrication processes or structural design, and do not support high integration density. Herein, we report a series of flexible hybrid integration strategies which endow the on-skin electronics with advantages of high integration density of electric components, facile fabrications, high stretchability and reliability. Proposed strategies include: 1. High I/O density with highly stretchable and conductive composite materials as interconnects; 2. Multi-layer structures enabled by stretchable and conductive via-holes; 3. High reliability approach for chip attachment onto stretchable substrate; 4. Design and fabrication of strain separation structure. Based on these methods, an on-skin flexible hybrid electronic system (FHES) is fabricated to collect electrocardiogram (ECG) and acceleration data, wirelessly transmit and display the data in real time on a mobile phone application through Bluetooth communication. We also verify the accuracy and stability of the FHES through the measurements of ECG and acceleration data from human skin under various conditions. The flexible hybrid integration schemes proposed can be adopted for the development of a variety of on-skin systems for biomedical applications.

Stretchable anisotropic conductive film (S-ACF) for electrical interfacing in high-resolution stretchable circuits

In stretchable electronics, high-resolution stretchable interfacing at a mild temperature is considered as a great challenge and has not been achieved yet. This study presents a stretchable anisotropic conductive film (S-ACF) that can electrically connect high-resolution stretchable circuit lines to other electrodes whether they are rigid, flexible, or stretchable. The key concepts of this study are (i) high-resolution (~50 μm) but low-contact resistance (0.2 ohm in 0.25 mm²) interfacing by periodically embedding conductive microparticles in thermoplastic film, (ii) low-temperature interfacing through the formation of chemical bonds between the S-ACF and the substrates, (iii) economical interfacing by selectively patterning the S-ACF, and (iv) direct interfacing of chips by using the adhesion of the thermoplastic matrix. We integrate light-emitting diodes on the patterned S-ACF and demonstrate stable light operation at large biaxial areal stretching (ε_xy = 70%).

Stretchable, Rehealable, Recyclable, and Reconfigurable Integrated Strain Sensor for Joint Motion and Respiration Monitoring

Cutting-edge technologies of stretchable, skin-mountable, and wearable electronics have attracted tremendous attention recently due to their very wide applications and promising performances. One direction of particular interest is to investigate novel properties in stretchable electronics by exploring multifunctional materials. Here, we report an integrated strain sensing system that is highly stretchable, rehealable, fully recyclable, and reconfigurable. This system consists of dynamic covalent thermoset polyimine as the moldable substrate and encapsulation, eutectic liquid metal alloy as the strain sensing unit and interconnects, and off-the-shelf chip components for measuring and magnifying functions. The device can be attached on different parts of the human body for accurately monitoring joint motion and respiration. Such a strain sensing system provides a reliable, economical, and ecofriendly solution to wearable technologies, with wide applications in health care, prosthetics, robotics, and biomedical devices.

Instant, multiscale dry transfer printing by atomic diffusion control at heterogeneous interfaces

Transfer printing is a technique that integrates heterogeneous materials by readily retrieving functional elements from a grown substrate and subsequently printing them onto a specific target site. These strategies are broadly exploited to construct heterogeneously integrated electronic devices. A typical wet transfer printing method exhibits limitations related to unwanted displacement and shape distortion of the device due to uncontrollable fluid movement and slow chemical diffusion. In this study, a dry transfer printing technique that allows reliable and instant release of devices by exploiting the thermal expansion mismatch between adjacent materials is demonstrated, and computational studies are conducted to investigate the fundamental mechanisms of the dry transfer printing process. Extensive exemplary demonstrations of multiscale, sequential wet-dry, circuit-level, and biological topography-based transfer printing demonstrate the potential of this technique for many other emerging applications in modern electronics that have not been achieved through conventional wet transfer printing over the past few decades.

Layer-Scale and Chip-Scale Transfer Techniques for Functional Devices and Systems: A Review

Hetero-integration of functional semiconductor layers and devices has received strong research interest from both academia and industry. While conventional techniques such as pick-and-place and wafer bonding can partially address this challenge, a variety of new layer transfer and chip-scale transfer technologies have been developed. In this review, we summarize such transfer techniques for heterogeneous integration of ultrathin semiconductor layers or chips to a receiving substrate for many applications, such as microdisplays and flexible electronics. We showed that a wide range of materials, devices, and systems with expanded functionalities and improved performance can be demonstrated by using these technologies. Finally, we give a detailed analysis of the advantages and disadvantages of these techniques, and discuss the future research directions of layer transfer and chip transfer techniques.

Soft Nanomembrane Sensors and Flexible Hybrid Bioelectronics for Wireless Quantification of Blepharospasm

Blepharospasm (BL) is characterized by involuntary closures of the eyelids due to spasms of the orbicularis oculi muscle. The gold standard for clinical evaluation of BL involves visual inspection for manual rating scales. This approach is highly subjective and error prone. Unfortunately, there are currently no simple quantitative systems for accurate and objective diagnostics of BL. Here, we introduce a soft, flexible hybrid bioelectronic system that offers highly conformal, gentle lamination on the skin, while enabling wireless, quantitative detection of electrophysiological signals. Computational and experimental studies of soft materials and flexible mechanics provide a set of key fundamental design factors for a low-profile bioelectronic system. The nanomembrane soft electrodes, mounted around the eyes, are capable of accurately measuring clinical symptoms, including the frequency of blinking, the duration of eye closures during spasms, as well as combinations of blinking and spasms. The use of a deep-learning, convolutional neural network, with the bioelectronics offers objective, real-time classification of key pathological features in BL. The wearable bioelectronics outperform the conventional manual clinical rating, as shown by a pilot study with 13 patients. In vivo demonstration of the bioelectronics with these patients indicates the device as an easy-to-use solution for objective quantification of BL.

Heterogeneous integration of rigid, soft, and liquid materials for self-healable, recyclable, and reconfigurable wearable electronics

Wearable electronics can be integrated with the human body for monitoring physical activities and health conditions, for human-computer interfaces, and for virtual/augmented reality. We here report a multifunctional wearable electronic system that combines advances in materials, chemistry, and mechanics to enable superior stretchability, self-healability, recyclability, and reconfigurability. This electronic system heterogeneously integrates rigid, soft, and liquid materials through a low-cost fabrication method. The properties reported in this wearable electronic system can find applications in many areas, including health care, robotics, and prosthetics, and can benefit the well-being, economy, and sustainability of our society.

Devising Materials Manufacturing Toward Lab-to-Fab Translation of Flexible Electronics

Flexible electronics have witnessed exciting progress in academia over the past decade, but most of the research outcomes have yet to be translated into products or gain much market share. For mass production and commercialization, industrial adoption of newly developed functional materials and fabrication techniques is a prerequisite. However, due to the disparate features of academic laboratories and industrial plants, translating materials and manufacturing technologies from labs to fabs is notoriously difficult. Therefore, herein, key challenges in the materials manufacturing of flexible electronics are identified and discussed for its lab-to-fab translation, along the four stages in product manufacturing: design, materials supply, processing, and integration. Perspectives on industry-oriented strategies to overcome some of these obstacles are also proposed. Priorities for action are outlined, including standardization, iteration between basic and applied research, and adoption of smart manufacturing. With concerted efforts from academia and industry, flexible electronics will bring a bigger impact to society as promised.

Stretchable respiration sensors: Advanced designs and multifunctional platforms for wearable physiological monitoring

Respiration signals are a vital sign of life. Monitoring human breath provides critical information for health assessment, diagnosis, and treatment for respiratory diseases such as asthma, chronic bronchitis, and emphysema. Stretchable and wearable respiration sensors have recently attracted considerable interest toward monitoring physiological signals in the era of real time and portable healthcare systems. This review provides a snapshot on the recent development of stretchable sensors and wearable technologies for respiration monitoring. The article offers the fundamental guideline on the sensing mechanisms and design concepts of stretchable sensors for detecting vital breath signals such as temperature, humidity, airflow, stress and strain. A highlight on the recent progress in the integration of variable sensing components outlines feasible pathways towards multifunctional and multimodal sensor platforms. Structural designs of nanomaterials and platforms for stretchable respiration sensors are reviewed.

Metallic Nanoislands on Graphene for Biomechanical Sensing

This minireview describes a nanomaterial-based multimodal sensor for performing biomechanical measurements. The sensor consists of ultrathin metallic films on single-layer graphene. This composite material exhibits physical properties that neither material possesses alone. For example, the metal, deposited by evaporation at low (≤10 nm) nominal thicknesses, renders the film highly sensitive to mechanical stimuli, which can be detected using electrical (i.e., resistance) and optical (i.e., plasmonic) modalities. The electrical modality, in particular, is capable of resolving deformations as small as 0.0001% engineering strain, or 1 ppm. The electrical and optical responses of the composite films can be tailored by controlling the morphology of the metallic film. This morphology (granular or island-like when deposited onto the graphene) can be tuned using the conditions of deposition, the identity of the substrate beneath the graphene, or even the replacement of the graphene for hexagonal boron nitride (hBN). This material responds to forces produced by a range of physiological structures, from the contractions of heart muscle cells, to the beating of the heart through the skin, to stretching of the skin due to the expansion of the lungs and movement of limbs. Here, we provide an update on recent applications of this material in fields ranging from cardiovascular medicine (by measuring the contractions of 2D monolayers of cardiomyocytes), regenerative medicine (optical measurements of the forces produced by myoblasts), speech pathology and physical therapy (measuring swallowing function in head and neck cancer survivors), lab-on-a-chip devices (using deformation of sidewalls of microfluidic channels to detect transiting objects), and sleep medicine (measuring pulse and respiration with a wearable, unobtrusive device). We also discuss the mechanisms by which these films detect strain.

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.

Respiratory rate on exercise measured by nanoparticle-based humidity sensor

In this study, we show the measurement of respiratory rate on exercise using a nanoparticle-based humidity sensor. A portable respiratory rate sensor is comprised of a colloidal silica nanoparticle-based humidity sensor chip. The impedance of the silica nanoparticle film is dependent on humidity and it is used for the detection of humid exhaled air. The respiratory rate sensor can be attached on an oxygen mask and the sensor signal is remotely monitored via Bluetooth. We show that the sensor follows a respiratory rate up to 60 bpm. We compare the sensor signal with that of a conventional respiratory measurement unit, which monitors a respiratory volume. The nanoparticle-based sensor can monitor a respiratory rate of an exercising person on a treadmill. The sensor operates stably for almost one year.

Advanced Soft Materials, Sensor Integrations, and Applications of Wearable Flexible Hybrid Electronics in Healthcare, Energy, and Environment

Recent advances in soft materials and system integration technologies have provided a unique opportunity to design various types of wearable flexible hybrid electronics (WFHE) for advanced human healthcare and human-machine interfaces. The hybrid integration of soft and biocompatible materials with miniaturized wireless wearable systems is undoubtedly an attractive prospect in the sense that the successful device performance requires high degrees of mechanical flexibility, sensing capability, and user-friendly simplicity. Here, the most up-to-date materials, sensors, and system-packaging technologies to develop advanced WFHE are provided. Details of mechanical, electrical, physicochemical, and biocompatible properties are discussed with integrated sensor applications in healthcare, energy, and environment. In addition, limitations of the current materials are discussed, as well as key challenges and the future direction of WFHE. Collectively, an all-inclusive review of the newly developed WFHE along with a summary of imperative requirements of material properties, sensor capabilities, electronics performance, and skin integrations is provided.

Influence of Flexibility of the Interconnects on the Dynamic Bending Reliability of Flexible Hybrid Electronics

The growing interest towards thinner and conformable electronic systems has attracted significant attention towards flexible hybrid electronics (FHE). Thin chip-foil packages fabricated by integrating ultra-thin monocrystalline silicon integrated circuits (ICs) on/in flexible foils have the potential to deliver high performance electrical functionalities at very low power requirements while being mechanically flexible. However, only very limited information is available regarding the fatigue or dynamic bending reliability of such chip-foil packages. This paper reports a series of experiments where the influence of the type of metal constituting the interconnects on the foil substrates on their dynamic bending reliability has been analyzed. The test results show that chip-foil packages with interconnects fabricated from a highly flexible metal like gold endure the repeated bending tests better than chip-foil packages with stiffer interconnects fabricated from copper or aluminum. We conclude that further analysis work in this field will lead to new technical concepts and designs for reliable foil based electronics.

Soft Materials, Stretchable Mechanics, and Optimized Designs for Body-Wearable Compliant Antennas

Among the various methods to develop flexible wearable antennas, a serpentine, mesh structure has been a great interest because of its mechanical reliability upon applied strain. However, there is still a significant lack of design guidelines for the open-mesh concept that account for both material and electromagnetic (EM) properties of antennas. In this work, we introduce a comprehensive study of materials, mechanics, fabrication, and system integration for the development of stretchable dipole and patch antennas that have networks of two-dimensional serpentine patterns. A set of computational modeling and experimental validation of open-mesh structures provides the key design guidelines to offer the maximum mechanical stretchability and minimum effective moduli of wearable antennas. Integration of the thin-film antenna traces with various substrates captures the versatility of the deterministic fabrication and material transfer printing methods. The influence of antenna stretching on the EM properties, including return loss, electric and magnetic fields, and far-field radiation patterns, is investigated. EM characterization with mechanical stretching results in different properties of fabricated antennas. The simulation study of specific absorption rates shows a potential for safe applications of dipole and patch stretchable antennas on the human skin.

Room temperature readily self-healing polymer via rationally designing molecular chain and crosslinking bond for flexible electrical sensor

Mechanically tough polymers with excellent room temperature self-healing capacity have aroused strong interest in soft electronics, electronic skins and flexible energy storage devices. However, achieving such polymers remains a challenge due to tardy diffusion dynamics. Herein, a robust and readily self-healing polymer, which is synthesized by one-pot polymerization among 2,4'-tolylene diisocyanate, isophorone diisocyanate, and poly(oxy-1,4-butanediyl), is achieved through reasonably tuning the hardness of the molecular segment and the strength of the dynamic crosslinking bond. The poly(oxy-1,4-butanediyl) that act as a soft segment can effectively avoid the microphase separation, enabling rapid chain mobility of the polymer at the room temperature. Furthermore, the dual H-bonding from 2,4'-tolylene diisocyanate segment acting as a relatively strong crosslinking bond contributes to high mechanical strength, while the weaker single H-bonding from isophorone diisocyanate segment can efficiently dissipate strain energy by bond rupture, endowing the polymer with rapid room temperature self-healing ability. Featuring state-of-the-art of robust stress strength (≈1.3 MPa), high self-healing efficiency (97% within 6 h), and large tensile strain (≈2100%), the resulting polymers are used for the fabrication of stretchable and self-healable electrical sensor, which can be employed to monitor a variety of physiological activities in real time. The described strategy is promising and universal for healable materials, displaying great potential for developing soft electronics.

All-in-One, Wireless, Stretchable Hybrid Electronics for Smart, Connected, and Ambulatory Physiological Monitoring

Commercially available health monitors rely on rigid electronic housing coupled with aggressive adhesives and conductive gels, causing discomfort and inducing skin damage. Also, research-level skin-wearable devices, while excelling in some aspects, fall short as concept-only presentations due to the fundamental challenges of active wireless communication and integration as a single device platform. Here, an all-in-one, wireless, stretchable hybrid electronics with key capabilities for real-time physiological monitoring, automatic detection of signal abnormality via deep-learning, and a long-range wireless connectivity (up to 15 m) is introduced. The strategic integration of thin-film electronic layers with hyperelastic elastomers allows the overall device to adhere and deform naturally with the human body while maintaining the functionalities of the on-board electronics. The stretchable electrodes with optimized structures for intimate skin contact are capable of generating clinical-grade electrocardiograms and accurate analysis of heart and respiratory rates while the motion sensor assesses physical activities. Implementation of convolutional neural networks for real-time physiological classifications demonstrates the feasibility of multifaceted analysis with a high clinical relevance. Finally, in vivo demonstrations with animals and human subjects in various scenarios reveal the versatility of the device as both a health monitor and a viable research tool.

Bioelectronics for mapping gut activity

Gastric peristalsis is initiated and coordinated by an underlying bioelectrical activity, termed slow waves. High-resolution (HR) mapping of the slow waves has become a fundamental tool for accurately defining electrophysiological properties in gastroenterology, including dysrhythmias in gastric disorders such as gastroparesis and functional dyspepsia. Currently, HR mapping is achieved via acquisition of slow waves taken directly from the serosa of fasted subjects undergoing invasive abdominal surgery. Recently, a minimally invasive retractable catheter and electrode has been developed for HR mapping that can only be used in short-term studies in subjects undergoing laparoscopy. Noninvasive mapping has also emerged from multichannel cutaneous electrogastrography; however, it lacks sufficient resolution and is prone to artifacts. Bioelectronics that can map slow waves in conscious subjects, postprandially and long-term, are in high demand. Due to the low signal-to-noise ratio of cutaneous electrogastrography, electrodes for HR mapping of gut activity have to acquire slow waves directly from the gut; hence, development of novel device implantation methods has inevitably accompanied development of the devices themselves. Initial efforts that have paved the way toward achieving these goals have included development of miniature wireless systems with a limited number of acquisition channels using commercially available off-the-shelf electronic components, flexible HR electrodes, and endoscopic methods for minimally invasive device implantation. To further increase the spatial resolution of HR mapping, and to minimize the size and power consumption of the implant for long-term studies, application-specific integrated circuitry, wireless power transfer, and stretchable electronics technologies have had to be integrated into a single system.

Design Considerations for 3D Printed, Soft, Multimaterial Resistive Sensors for Soft Robotics

Sensor design for soft robots is a challenging problem because of the wide range of design parameters (e.g., geometry, material, actuation type, etc.) critical to their function. While conventional rigid sensors work effectively for soft robotics in specific situations, sensors that are directly integrated into the bodies of soft robots could help improve both their exteroceptive and interoceptive capabilities. To address this challenge, we designed sensors that can be co-fabricated with soft robot bodies using commercial 3D printers, without additional modification. We describe an approach to the design and fabrication of compliant, resistive soft sensors using a Connex3 Objet350 multimaterial printer and investigated an analytical comparison to sensors of similar geometries. The sensors consist of layers of commercial photopolymers with varying conductivities. We characterized the conductivity of TangoPlus, TangoBlackPlus, VeroClear, and Support705 materials under various conditions and demonstrate applications in which we can take advantage of these embedded sensors.

Combining High Sensitivity and Dynamic Range: Wearable Thin-Film Composite Strain Sensors of Graphene, Ultrathin Palladium, and PEDOT:PSS

Wearable mechanical sensors have the potential to transform healthcare by enabling patient monitoring outside of the clinic. A critical challenge in the development of mechanical-e.g., strain-sensors is the combination of sensitivity, dynamic range, and robustness. This work describes a highly sensitive and robust wearable strain sensor composed of three layered materials: graphene, an ultrathin film of palladium, and highly plasticized PEDOT:PSS. The role of the graphene is to provide a conductive, manipulable substrate for the deposition of palladium. When deposited at low nominal thicknesses (~8 nm) palladium forms a rough, granular film which is highly piezoresistive (i.e., the resistance increases with strain with high sensitivity). The dynamic range of these graphene/palladium films, however, is poor, and can only be extended to ~10% before failure. This fragility renders the films incompatible with wearable applications on stretchable substrates. To improve the working range of graphene/palladium strain sensors, a layer of highly plasticized PEDOT:PSS is used as a stretchable conductive binder. That is, the conductive polymer provides an alternative pathway for electrical conduction upon cracking of the palladium film and the graphene. The result was a strain sensor that possessed good sensitivity at low strains (0.001% engineering strain) but with a working range up to 86%. The piezoresistive performance can be optimized in a wearable device by sandwiching the conductive composite between a soft PDMS layer in contact with the skin and a harder layer at the air interface. When attached to the skin of the torso, the patch-like strain sensors were capable of detecting heartbeat (small strain) and respiration (large strain) simultaneously. This demonstration highlights the ability of the sensor to measure low and high strains in a single interpolated signal, which could be useful in monitoring, for example, obstructive sleep apnea with an unobtrusive device.

High-density surface electromyography: A visualization method of laryngeal muscle activity

OBJECTIVES/HYPOTHESIS

Laryngeal muscle activation is a complex and dynamic process. Current evaluation methods include needle and surface electromyography (sEMG). Limitations of needle electromyography include patient discomfort, interpretive complexity, and limited duration of recording. sEMG demonstrates interpretive challenges given loss of spatial selectivity. Application of high-density sEMG (HD sEMG) arrays were evaluated for potential to compensate for spatial selectivity loss while retaining benefits of noninvasive monitoring.

STUDY DESIGN

Basic science.

METHODS

Ten adults performed phonatory tasks while a 20-channel array recorded spatiotemporal data of the anterior neck. Data were processed to provide average spectral power of each electrode. Comparison was made between rest, low-, and high-pitch phonation. Two-dimensional (2D) spectral energy maps were created to evaluate use in gross identification of muscle location.

RESULTS

Three phonatory tasks yielded spectral power measures across the HD sEMG array. Each electrode within the array demonstrated unique power values across all subjects (P < .001). Comparison of each electrode to itself across phonatory tasks yielded differences in all subjects during rest versus low versus high, rest versus low, and rest versus high and in 9/10 subjects (P < .001) for low versus high phonation. Symmetry of HD sEMG signal was noted. Review of 2D coronal energy maps allowed for gross identification of cricothyroid muscle amidst anterior strap musculature.

CONCLUSIONS

HD sEMG can be used to identify differences in anterior neck muscle activity between rest, low-, and high-pitch phonation. HD sEMG of the anterior neck holds potential to enhance diagnostic and therapeutic monitoring for pathologies of laryngeal function.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:2347-2353, 2019.

Reducing Structural Defects and Oxygen-Containing Functional Groups in GO-Hybridized CNTs Aerogels: Simultaneously Improve the Electrical and Mechanical Properties To Enhance Pressure Sensitivity

Three-dimensional graphene oxide-carbon nanotube (GO-CNT, abbreviated as GCNT) aerogels can find wide applications in various fields. Especially, low-density GCNT aerogels featuring both high conductivity and superelasticity are essential requirements for the construction of highly sensitive pressure sensor. However, simultaneous improvement on the electrical and mechanical properties of low-density GCNT is still a great challenge owing to their disordered microstructure, severe structural defects and massive oxygen-containing functional groups. Here, a structurally ordered and less defective GCNT aerogel featuring both high conductivity and superelasticity has been fabricated through alkali induced self-assembly of GO liquid crystals (GO LCs) and CNTs. Our methodology relies on the double roles of KOH solution as dispersant for CNTs and an inducer for the self-assembly of GO LCs nanosheets. The less-defective CNTs acting as reinforcement material contributes to the robust structure networks, leading to the significantly improved conductivity (2.4 S m^-1) and elasticity (14.3 kPa) of GCNT. Benefiting from these outstanding properties of GCNT aerogels, the assembled pressure sensor exhibits an ultrahigh sensitivity of 1.22 kPa^-1, rapid response time of 28 ms and excellent cycling stability, which enables it as a high-performance sensing platform to monitor various human motions in real time.

Wearables and the medical revolution

Wearable sensors are already impacting healthcare and medicine by enabling health monitoring outside of the clinic and prediction of health events. This paper reviews current and prospective wearable technologies and their progress toward clinical application. We describe technologies underlying common, commercially available wearable sensors and early-stage devices and outline research, when available, to support the use of these devices in healthcare. We cover applications in the following health areas: metabolic, cardiovascular and gastrointestinal monitoring; sleep, neurology, movement disorders and mental health; maternal, pre- and neo-natal care; and pulmonary health and environmental exposures. Finally, we discuss challenges associated with the adoption of wearable sensors in the current healthcare ecosystem and discuss areas for future research and development.

Iono-Elastomer-Based Wearable Strain Sensor with Real-Time Thermomechanical Dual Response

An ultrastretchable iono-elastomer with resistance sensitive to both elongation strain and temperature has been developed by hierarchical self-assembly of an end functionalized triblock copolymer in a protic ionic liquid (ethylammonium nitrate) followed by cross-linking. Small-angle X-ray scattering experiments in situ with uniaxial elongation reveal a nanoscale microstructural transition of the hierarchically self-assembled cross-linked micelles that is responsible for the material's remarkable mechanical and ionic conductivity responses. The results show that the intermicelle distance extends along the deformation direction while the micelles organize into a long-range ordered face-centered-cubic structure during the uniaxial elongation. Besides good cyclability and resistance to selected physical damage, the iono-elastomer simultaneously achieves an unprecedented combination of high stretchability (340%), highly linear resistance vs elongation strain ( R² = 0.998), and large temperature gauge factor (Δ R/ R = 3.24%/°C@30 °C). Human subject testing demonstrates that the iono-elastomer-based wearable thermomechanical sensor is able to effectively and accurately register both body motion and skin temperature simultaneously.

Artifact Rejection Methodology Enables Continuous, Noninvasive Measurement of Gastric Myoelectric Activity in Ambulatory Subjects

The increasing prevalence of functional and motility gastrointestinal (GI) disorders is at odds with bottlenecks in their diagnosis, treatment, and follow-up. Lack of noninvasive approaches means that only specialized centers can perform objective assessment procedures. Abnormal GI muscular activity, which is coordinated by electrical slow-waves, may play a key role in symptoms. As such, the electrogastrogram (EGG), a noninvasive means to continuously monitor gastric electrical activity, can be used to inform diagnoses over broader populations. However, it is seldom used due to technical issues: inconsistent results from single-channel measurements and signal artifacts that make interpretation difficult and limit prolonged monitoring. Here, we overcome these limitations with a wearable multi-channel system and artifact removal signal processing methods. Our approach yields an increase of 0.56 in the mean correlation coefficient between EGG and the clinical "gold standard", gastric manometry, across 11 subjects (p < 0.001). We also demonstrate this system's usage for ambulatory monitoring, which reveals myoelectric dynamics in response to meals akin to gastric emptying patterns and circadian-related oscillations. Our approach is noninvasive, easy to administer, and has promise to widen the scope of populations with GI disorders for which clinicians can screen patients, diagnose disorders, and refine treatments objectively.

Soft Material-Enabled, Flexible Hybrid Electronics for Medicine, Healthcare, and Human-Machine Interfaces

Flexible hybrid electronics (FHE), designed in wearable and implantable configurations, have enormous applications in advanced healthcare, rapid disease diagnostics, and persistent human-machine interfaces. Soft, contoured geometries and time-dynamic deformation of the targeted tissues require high flexibility and stretchability of the integrated bioelectronics. Recent progress in developing and engineering soft materials has provided a unique opportunity to design various types of mechanically compliant and deformable systems. Here, we summarize the required properties of soft materials and their characteristics for configuring sensing and substrate components in wearable and implantable devices and systems. Details of functionality and sensitivity of the recently developed FHE are discussed with the application areas in medicine, healthcare, and machine interactions. This review concludes with a discussion on limitations of current materials, key requirements for next generation materials, and new application areas.