Multifunctional hybrid skin patch for wearable smart healthcare applications

Research Progress and Application of Multimodal Flexible Sensors for Electronic Skin

In recent years, wearable electronic skin has garnered significant attention due to its broad range of applications in various fields, including personal health monitoring, human motion perception, human-computer interaction, and flexible display. The flexible multimodal sensor, as the core component of electronic skin, can mimic the multistimulus sensing ability of human skin, which is highly significant for the development of the next generation of electronic devices. This paper provides a summary of the latest advancements in multimodal sensors that possess two or more response capabilities (such as force, temperature, humidity, etc.) simultaneously. It explores the relationship between materials and multiple sensing capabilities, focusing on both active materials that are the same and different. The paper also discusses the preparation methods, device structures, and sensing properties of these sensors. Furthermore, it introduces the applications of multimodal sensors in human motion and health monitoring, as well as intelligent robots. Finally, the current limitations and future challenges of multimodal sensors will be presented.

LiFT (a Lithium Fiber-Based Test): An At-Home Companion Diagnostics for a Safer Lithium Therapy in Bipolar Disorder

This work presents LiFT (a lithium fiber-based test), a low-cost electrochemical sensor that can measure lithium in human saliva and urine with FDA-required accuracy. Lithium is used for the treatment of bipolar disorder, and has a narrow therapeutic window. Close monitoring of lithium concentration in biofluids and adjustment of drug dosage can minimize the devastating side effects. LiFT is an inexpensive, yet accurate and simple-to-operate lithium sensor for frequent at-home testing for early identification of lithium toxicity. The low cost and high accuracy of LiFT are enabled through an innovative design and the use of ubiquitous materials such as yarn and carbon black for fabrication. LiFT measures Li+ through potentiometric recognition using a lithium selective sensing membrane that is deposited on the ink-coated yarn. A detection limit of 0.97 µM is obtained with a sensitivity of 59.07±1.25 mV/decade for the Li+ sensor in deionized water. Moreover, the sodium correction extended LiFT's linear range in urine and saliva to 0.5 mM. The LiFT platform sends the test results to the patient's smartphone, which subsequently can be shared with the patient's healthcare provider to expedite diagnosis and prevention of acute lithium toxicity.

A Bionic Skin for Health Management: Excellent Breathability, In Situ Sensing, and Big Data Analysis

Developing an intelligent wearable system is of great significance to human health management. An ideal health-monitoring patch should possess key characteristics such as high air permeability, moisture-wicking function, high sensitivity, and a comfortable user experience. However, such a patch that encompasses all these functions is rarely reported. Herein, an intelligent bionic skin patch for health management is developed by integrating bionic structures, nano-welding technology, flexible circuit design, multifunctional sensing functions, and big data analysis using advanced electrospinning technology. By controlling the preparation of nanofibers and constructing bionic secondary structures, the resulting nanofiber membrane closely resembles human skin, exhibiting excellent air/moisture permeability, and one-side sweat-wicking properties. Additionally, the bionic patch is endowed with a high-precision signal acquisition capabilities for sweat metabolites, including glucose, lactic acid, and pH; skin temperature, skin impedance, and electromyographic signals can be precisely measured through the in situ sensing electrodes and flexible circuit design. The achieved intelligent bionic skin patch holds great potential for applications in health management systems and rehabilitation engineering management. The design of the smart bionic patch not only provides high practical value for health management but also has great theoretical value for the development of the new generation of wearable electronic devices.

Screen-printed wearable skin surface pH sensor for real-time monitoring of the buffering capacity of human skin

This study demonstrated for the first time that skin surface pH can be monitored in real-time, using a screen-printed wearable pH sensor, to evaluate the buffering capacity of the human skin. The screen-printed pH sensor was composed of a polyaniline-based pH-sensitive electrode and a nitrocellulose membrane-based liquid junction type of Ag/AgCl reference electrode. This sensor showed a reliable and reversible potentiometric response to pH with long-term potential stability. Intermittent monitoring of the buffering capacity of skin surface pH demonstrated the reliability of the proposed wearable pH sensor, which was comparable to that of a commercially available flat-tip pH sensor. We found that contact of the wearable pH sensor with the subject's skin via aqueous electrolyte solutions was necessary for the sensor to continuously monitor the skin surface pH while sustaining the natural buffer capacity of the human skin surface.

Carbon fiber-based multichannel solid-contact potentiometric ion sensors for real-time sweat electrolyte monitoring

Solid-contact ion-selective electrodes (SC-ISEs) feature miniaturization and integration that have gained extensive attention in non-invasive wearable sweat electrolyte sensors. The state-of-the-art wearable SC-ISEs mainly use polyethylene terephthalate, gold and carbon nanotube fibers as flexible substrates but suffer from uncomfortableness, high cost and biotoxicity. Herein, we report carbon fiber-based SC-ISEs to construct a four-channel wearable potentiometric sensor for sweat electrolytes monitoring (Na+/K+/pH/Cl-). The carbon fibers were extracted from commercial cloth, of which the starting point is addressing the cost and reproducibility issues for flexible SC-ISEs. The bare carbon fiber electrodes exhibited reversible voltammetric and stable impedance performances. Further fabricated SC-ISEs based on corresponding ion-selective membranes disclosed Nernstian sensitivity and anti-interface ability toward both ions and organic species in sweat. Significantly, these carbon fiber-based SC-ISEs revealed high reproducibility of standard potentials between normal and bending states. Finally, a textile-based sensor was integrated with a solid-contact reference electrode, which realized on-body sweat electrolytes analysis. The results displayed high accuracy compared with ex-situ tests by ion chromatography. This work highlights carbon fiber-based multichannel wearable potentiometric ion sensors with low cost, biocompatibility and reproducibility.

Measuring the Salt Content of Sweat inside a Sweat-Absorbing Skin Adhesive

Biofluids contain a wealth of different biomarkers, and their concentrations are indicative of the state of the body. As one of those biofluids, sweat is easily accessible, and its composition can, for example, be related to particular diseases or sports performance. Due to the relatively low sweat flow rates, however, adequate sampling is paramount. Here, we aim to explore the potential use of sweat-absorbing skin adhesives as a sweat sampling system for wearable sensors with a simple construction. Upon absorption of sweat, the electrochemical properties of the skin adhesive are determined by the composition of sweat and the amount of sweat within the skin adhesive (i.e., hydration). Through the incorporation of two polarizable electrodes within the skin adhesive, its electrical properties can be monitored using impedance spectroscopy. Here, the double layer capacitance is used as an indicator of hydration, while the conductance depends on both the ion concentration and hydration (the mobility of ions). By evaluating the conductance as a function of hydration, the ion concentration within an electrolyte solution can be estimated. We demonstrate the concept based on a simple model sensor patch, which is exposed to electrolyte solutions containing various concentrations of NaCl and an artificial sweat solution. Finally, we show that ion concentrations in human sweat can be estimated when the model sensor patch is worn during exercise.

Robust, self-adhesive and anti-bacterial silk-based LIG electrodes for electrophysiological monitoring

Flexible wearable electrodes have been extensively used for obtaining electrophysiological signals towards smart health monitoring and disease diagnosis. Here, low-cost, and non-conductive silk fabric (SF) have been processed into highly conductive laser induced graphene (LIG) electrodes while maintaining the original structure of SF. A CO2-pulsed laser was utilized to produce LIG-SF with controlled sheet resistance and mechanical properties. Laser processing of SFs under optimized conditions yielded LIG-SF electrodes with a high degree of homogeneity on both, top and bottom layers. Silk fibroin/Ca2+ adhesive layers effectively promoted the adhesive, anti-bacterial properties and provided a conformal contact of LIG-SF electrodes with human skin. Compared with conventional Ag/AgCl electrodes, LIG-SF electrodes possesses a much lower contact impedance in contact with human skin enabling highly stable electrophysiological signals recording. The applicability of adhesive LIG-SF electrodes to acquire electrocardiogram (ECG) signals was investigated. ECG signals recordings of adhesive LIG-SF electrodes showed excellent performance compared to conventional Ag/AgCl electrodes at intense body movements while running at different speeds for up to 9 km over a duration of 24 h. Therefore, our proposed adhesive LIG-SF electrodes can be applied for long-term personalized healthcare monitoring and sports management applications.

Wearable Liquid Metal Composite with Skin-Adhesive Chitosan-Alginate-Chitosan Hydrogel for Stable Electromyogram Signal Monitoring

In wearable bioelectronics, various studies have focused on enhancing prosthetic control accuracy by improving the quality of physiological signals. The fabrication of conductive composites through the addition of metal fillers is one way to achieve stretchability, conductivity, and biocompatibility. However, it is difficult to measure stable biological signals using these soft electronics during physical activities because of the slipping issues of the devices, which results in the inaccurate placement of the device at the target part of the body. To address these limitations, it is necessary to reduce the stiffness of the conductive materials and enhance the adhesion between the device and the skin. In this study, we measured the electromyography (EMG) signals by applying a three-layered hydrogel structure composed of chitosan-alginate-chitosan (CAC) to a stretchable electrode fabricated using a composite of styrene-ethylene-butylene-styrene and eutectic gallium-indium. We observed stable adhesion of the CAC hydrogel to the skin, which aided in keeping the electrode attached to the skin during the subject movement. Finally, we fabricated a multichannel array of CAC-coated composite electrodes (CACCE) to demonstrate the accurate classification of the EMG signals based on hand movements and channel placement, which was followed by the movement of the robot arm.

Microfluidic-Integrated Multimodal Wearable Hybrid Patch for Wireless and Continuous Physiological Monitoring

Despite extensive advances in wearable monitoring systems, most designs focus on the detection of physical parameters or metabolites and do not consider the integration of microfluidic channels, miniaturization, and multimodality. In this study, a combination of multimodal (biochemical and electrophysiological) biosensing and microfluidic channel-integrated patch-based wireless systems is designed and fabricated using flexible materials for improved wearability, ease of operation, and real-time and continuous monitoring. The reduced graphene oxide-based microfluidic channel-integrated glucose biosensor exhibits a good sensitivity of 19.97 (44.56 without fluidic channels) μA mM-1 cm-2 within physiological levels (10 μM-0.4 mM) with good long-term and bending stability. All the sensors in the patch are initially validated using sauna gown sweat-based on-body and real-time tests with five separate individuals who perspired three times each. Multimodal glucose and electrocardiogram (ECG) sensing, along with their real-time adjustment based on sweat pH and temperature fluctuations, optimize sensing accuracy. Laser-burned hierarchical MXene-polyvinylidene fluoride-based conductive carbon nanofiber-based dry ECG electrodes exhibit low skin contact impedance (40.5 kΩ cm2) and high-quality electrophysiological signals (signal-to-noise ratios = 23.4-32.8 dB). The developed system is utilized to accurately and wirelessly monitor the sweat glucose and ECG of a human subject engaged in physical exercise in real time.

Fluid-based wearable sensors: a turning point in personalized healthcare

Nowadays, it has become very popular to develop wearable devices that can monitor biomarkers to analyze the health status of the human body more comprehensively and accurately. Wearable sensors, specially designed for home care services, show great promise with their ease of use, especially during pandemic periods. Scientists have conducted many innovative studies on new wearable sensors that can noninvasively and simultaneously monitor biochemical indicators in body fluids for disease prediction, diagnosis, and management. Using noninvasive electrochemical sensors, biomarkers can be detected in tears, saliva, perspiration, and skin interstitial fluid (ISF). In this review, biofluids used for noninvasive wearable sensor detection under four main headings, saliva, sweat, tears, and ISF-based wearable sensors, were examined in detail. This report analyzes nearly 50 recent articles from 2017 to 2023. Based on current research, this review also discusses the evolution of wearable sensors, potential implementation challenges, and future prospects.

Evolution of nanostructured skin patches towards multifunctional wearable platforms for biomedical applications

Recent advances in the field of skin patches have promoted the development of wearable and implantable bioelectronics for long-term, continuous healthcare management and targeted therapy. However, the design of electronic skin (e-skin) patches with stretchable components is still challenging and requires an in-depth understanding of the skin-attachable substrate layer, functional biomaterials and advanced self-powered electronics. In this comprehensive review, we present the evolution of skin patches from functional nanostructured materials to multi-functional and stimuli-responsive patches towards flexible substrates and emerging biomaterials for e-skin patches, including the material selection, structure design and promising applications. Stretchable sensors and self-powered e-skin patches are also discussed, ranging from electrical stimulation for clinical procedures to continuous health monitoring and integrated systems for comprehensive healthcare management. Moreover, an integrated energy harvester with bioelectronics enables the fabrication of self-powered electronic skin patches, which can effectively solve the energy supply and overcome the drawbacks induced by bulky battery-driven devices. However, to realize the full potential offered by these advancements, several challenges must be addressed for next-generation e-skin patches. Finally, future opportunities and positive outlooks are presented on the future directions of bioelectronics. It is believed that innovative material design, structure engineering, and in-depth study of fundamental principles can foster the rapid evolution of electronic skin patches, and eventually enable self-powered close-looped bioelectronic systems to benefit mankind.

Wireless CardioS framework for continuous ECG acquisition

A first-level textile-based electrocardiogram (ECG) monitoring system referred to as "CardioS" (cardiac sensor) for continuous health monitoring applications is proposed in this study to address the demand for resource-constrained environments. and the signal quality assessment of a wireless CardioS was studied. The CardioS consists of a Lead-I ECG signal recorded wirelessly using silver-plated nylon woven (Ag-NyW) dry textile electrodes to compare the results of wired wearable Ag-NyW textile electrode-based ECG acquisition system and CardioS. The effect of prolonged usage of Ag-NyW dry electrodes on electrode impedance was tested in the current work. In addition, electrode half-cell potential was measured to validate the range of Ag-NyW dry electrodes for ECG signal acquisition. Further, the quality of signals recorded by the proposed wireless CardioS framework was evaluated and compared with clinical disposable (Ag-AgCl Gel) electrodes. The signal quality was assessed in terms of mean magnitude coherence spectra, signal cross-correlation, signal-to-noise-band ratio (Sband/Nband), crest factor, low and high band powers and power spectral density. The experimental results showed that the impedance was increased by 2.5-54.6% after six weeks of continuous usage. This increased impedance was less than 1 MΩ/cm2, as reported in the literature. The half-cell potential of the Ag-NyW textile electrode obtained was 80 mV, sufficient to acquire the ECG signal from the human body. All the fidelity parameters measured by Ag-NyW textile electrodes were correlated with standard disposable electrodes. The cardiologists validated all the measurements and confirmed that the proposed framework exhibited good performance for ECG signal acquisition from the five healthy subjects. As a result of its low-cost architecture, the proposed CardioS framework can be used in resource-constrained environments for ECG monitoring.

Biocompatible and Long-Term Monitoring Strategies of Wearable, Ingestible and Implantable Biosensors: Reform the Next Generation Healthcare

Sensors enable the detection of physiological indicators and pathological markers to assist in the diagnosis, treatment, and long-term monitoring of diseases, in addition to playing an essential role in the observation and evaluation of physiological activities. The development of modern medical activities cannot be separated from the precise detection, reliable acquisition, and intelligent analysis of human body information. Therefore, sensors have become the core of new-generation health technologies along with the Internet of Things (IoTs) and artificial intelligence (AI). Previous research on the sensing of human information has conferred many superior properties on sensors, of which biocompatibility is one of the most important. Recently, biocompatible biosensors have developed rapidly to provide the possibility for the long-term and in-situ monitoring of physiological information. In this review, we summarize the ideal features and engineering realization strategies of three different types of biocompatible biosensors, including wearable, ingestible, and implantable sensors from the level of sensor designing and application. Additionally, the detection targets of the biosensors are further divided into vital life parameters (e.g., body temperature, heart rate, blood pressure, and respiratory rate), biochemical indicators, as well as physical and physiological parameters based on the clinical needs. In this review, starting from the emerging concept of next-generation diagnostics and healthcare technologies, we discuss how biocompatible sensors revolutionize the state-of-art healthcare system unprecedentedly, as well as the challenges and opportunities faced in the future development of biocompatible health sensors.

Epidermal Wearable Biosensors for Monitoring Biomarkers of Chronic Disease in Sweat

Biological information detection technology is mainly used for the detection of physiological and biochemical parameters closely related to human tissues and organ lesions, such as biomarkers. This technology has important value in the clinical diagnosis and treatment of chronic diseases in their early stages. Wearable biosensors can be integrated with the Internet of Things and Big Data to realize the detection, transmission, storage, and comprehensive analysis of human physiological and biochemical information. This technology has extremely wide applications and considerable market prospects in frontier fields including personal health monitoring, chronic disease diagnosis and management, and home medical care. In this review, we systematically summarized the sweat biomarkers, introduced the sweat extraction and collection methods, and discussed the application and development of epidermal wearable biosensors for monitoring biomarkers in sweat in preclinical research in recent years. In addition, the current challenges and development prospects in this field were discussed.

A hybridized nano-porous carbon reinforced 3D graphene-based epidermal patch for precise sweat glucose and lactate analysis

Wearable electrochemical biosensors for perspiration analysis offer a promising non-invasive biomarker monitoring method. Herein, a functionalized hybridized nanoporous carbon (H-NPC)-encapsulated flexible 3D porous graphene-based epidermal patch was firstly fabricated for monitoring sweat glucose, lactate, pH, and temperature using simple, cost-effective, laser-engraved, and spray-coating techniques. The fabricated H-NPC-modified electrode significantly increased electrochemical surface area and electrocatalytic activity. Within the physiological sweat range (0-1.5 mM), the second-generation glucose sensor exhibited an excellent sensitivity of 82.7 μAmM-1cm-2 with 0.025 μM LOD. Moreover, the lactate biosensor exhibited an extraordinary linear range (0-56 mM) response owing to the incorporation of an outer diffusion limiting layer (DLL) that controls the lactate flux reaching the enzyme with comparable sensitivity (204 nAmM-1cm-2) and LOD (4 μM). Finally, we employed an analytical correction approach incorporating pH and temperature adjustments during on-body tests. In addition to connecting various carbon-based materials to limitless metal-organic frameworks as a transduction material, our research also paves the way for enabling these sensors to operate on pH and T correction independently while delivering accurate results.

A Comprehensive Review of the Recent Developments in Wearable Sweat-Sensing Devices

Sweat analysis offers non-invasive real-time on-body measurement for wearable sensors. However, there are still gaps in current developed sweat-sensing devices (SSDs) regarding the concerns of mixing fresh and old sweat and real-time measurement, which are the requirements to ensure accurate the measurement of wearable devices. This review paper discusses these limitations by aiding model designs, features, performance, and the device operation for exploring the SSDs used in different sweat collection tools, focusing on continuous and non-continuous flow sweat analysis. In addition, the paper also comprehensively presents various sweat biomarkers that have been explored by earlier works in order to broaden the use of non-invasive sweat samples in healthcare and related applications. This work also discusses the target analyte's response mechanism for different sweat compositions, categories of sweat collection devices, and recent advances in SSDs regarding optimal design, functionality, and performance.

A Focused Review on the Flexible Wearable Sensors for Sports: From Kinematics to Physiologies

As an important branch of wearable electronics, highly flexible and wearable sensors are gaining huge attention due to their emerging applications. In recent years, the participation of wearable devices in sports has revolutionized the way to capture the kinematical and physiological status of athletes. This review focuses on the rapid development of flexible and wearable sensor technologies for sports. We identify and discuss the indicators that reveal the performance and physical condition of players. The kinematical indicators are mentioned according to the relevant body parts, and the physiological indicators are classified into vital signs and metabolisms. Additionally, the available wearable devices and their significant applications in monitoring these kinematical and physiological parameters are described with emphasis. The potential challenges and prospects for the future developments of wearable sensors in sports are discussed comprehensively. This review paper will assist both athletic individuals and researchers to have a comprehensive glimpse of the wearable techniques applied in different sports.

Point-of-care biochemical assays using electrochemical technologies: approaches, applications, and opportunities

Against the backdrop of hidden symptoms of diseases and limited medical resources of their investigation, in vitro diagnosis has become a popular mode of real-time healthcare monitoring. Electrochemical biosensors have considerable potential for use in wearable products since they can consistently monitor the physiological information of the patient. This review classifies and briefly compares commonly available electrochemical biosensors and the techniques of detection used. Following this, the authors focus on recent studies and applications of various types of sensors based on a variety of methods to detect common compounds and cancer biomarkers in humans. The primary gaps in research are discussed and strategies for improvement are proposed along the dimensions of hardware and software. The work here provides new guidelines for advanced research on and a wider scope of applications of electrochemical biosensors to in vitro diagnosis.

An Auto Adjustable Transimpedance Readout System for Wearable Healthcare Devices

The objective of this work was to design a versatile readout circuit for patch-type wearable devices consisting of a Transimpedance Amplifier (TIA). The TIA performs Current to Voltage (I–V) conversion, the most widely used technique for amperometry and impedance measurement for various types of electrochemical sensors. The proposed readout circuit employs a digitally controllable feedback resistor (Rf) technique in the TIA to improve accuracy, which can be utilized in a variety of electrochemical sensors within a current range of 0.1 µA–100 µA. It is designed to accommodate multiple sensors simultaneously to track multiple target analytes for high accuracy and versatile usage. The readout circuit consists of low power operational amplifier (op–amp) and digital circuit blocks, is designed and fabricated with Magna 0.18 µm Complementary Metal Oxide Semiconductor (CMOS) technology, which provides low power consumption and a high degree of integration. The design has a small size of 0.282 mm2 and low power consumption of 0.38 mW with a 3.3 V power supply, which are desirable factors in wearable device applications.