Direct patterning of organic conductors on knitted textiles for long-term electrocardiography

Poly(benzodifurandione) Coated Silk Yarn for Thermoelectric Textiles

Thermoelectric textile devices represent an intriguing avenue for powering wearable electronics. The lack of air-stable n-type polymers has, until now, prevented the development of n-type multifilament yarns, which are needed for textile manufacturing. Here, the thermomechanical properties of the recently reported n-type polymer poly(benzodifurandione) (PBFDO) are explored and its suitability as a yarn coating material is assessed. The outstanding robustness of the polymer facilitates the coating of silk yarn that, as a result, displays an effective bulk conductivity of 13 S cm-1, with a projected half-life of 3.2 ± 0.7 years at ambient conditions. Moreover, the n-type PBFDO coated silk yarn with a Young's modulus of E = 0.6 GPa and a strain at break of εbreak = 14% can be machine washed, with only a threefold decrease in conductivity after seven washing cycles. PBFDO and poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) coated silk yarns are used to fabricate two out-of-plane thermoelectric textile devices: a thermoelectric button and a larger thermopile with 16 legs. Excellent air stability is paired with an open-circuit voltage of 17 mV and a maximum output power of 0.67 µW for a temperature difference of 70 K. Evidently, PBFDO coated multifilament silk yarn is a promising component for the realization of air stable thermoelectric textile devices.

Permeable Bioelectronics toward Biointegrated Systems

Bioelectronics integrates electronics with biological organs, sustaining the natural functions of the organs. Organs dynamically interact with the external environment, managing internal equilibrium and responding to external stimuli. These interactions are crucial for maintaining homeostasis. Additionally, biological organs possess a soft and stretchable nature; encountering objects with differing properties can disrupt their function. Therefore, when electronic devices come into contact with biological objects, the permeability of these devices, enabling interactions and substance exchanges with the external environment, and the mechanical compliance are crucial for maintaining the inherent functionality of biological organs. This review discusses recent advancements in soft and permeable bioelectronics, emphasizing materials, structures, and a wide range of applications. The review also addresses current challenges and potential solutions, providing insights into the integration of electronics with biological organs.

Wearable EMG Measurement Device Using Polyurethane Foam for Motion Artifact Suppression

We propose the use of a specially designed polyurethane foam with a plateau region in its mechanical characteristics-where stress remains nearly constant during deformation-between the electromyography (EMG) electrode and clothing to suppress motion artifacts in EMG measurement. Wearable EMG devices are receiving attention for monitoring muscle weakening due to aging. However, daily EMG measurement has been challenging due to motion artifacts caused by changes in the contact pressure between the bioelectrode and the skin. Therefore, this study aims to measure EMG signals in daily movement environments by controlling the contact pressure using polyurethane foam between the bioelectrode on the clothing and the skin. Through mechanical calculations and finite element method simulations of the polyurethane foam's effect, we clarified that the characteristics of the polyurethane foam significantly influence contact pressure control and that the contact pressure is adjustable through the polyurethane foam thickness. The optimization of the design successfully controlled the contact pressure between the bioelectrode and skin from 1.0 kPa to 2.0 kPa, effectively suppressing the motion artifact in EMG measurement.

Porous Conductive Textiles for Wearable Electronics

Over the years, researchers have made significant strides in the development of novel flexible/stretchable and conductive materials, enabling the creation of cutting-edge electronic devices for wearable applications. Among these, porous conductive textiles (PCTs) have emerged as an ideal material platform for wearable electronics, owing to their light weight, flexibility, permeability, and wearing comfort. This Review aims to present a comprehensive overview of the progress and state of the art of utilizing PCTs for the design and fabrication of a wide variety of wearable electronic devices and their integrated wearable systems. To begin with, we elucidate how PCTs revolutionize the form factors of wearable electronics. We then discuss the preparation strategies of PCTs, in terms of the raw materials, fabrication processes, and key properties. Afterward, we provide detailed illustrations of how PCTs are used as basic building blocks to design and fabricate a wide variety of intrinsically flexible or stretchable devices, including sensors, actuators, therapeutic devices, energy-harvesting and storage devices, and displays. We further describe the techniques and strategies for wearable electronic systems either by hybridizing conventional off-the-shelf rigid electronic components with PCTs or by integrating multiple fibrous devices made of PCTs. Subsequently, we highlight some important wearable application scenarios in healthcare, sports and training, converging technologies, and professional specialists. At the end of the Review, we discuss the challenges and perspectives on future research directions and give overall conclusions. As the demand for more personalized and interconnected devices continues to grow, PCT-based wearables hold immense potential to redefine the landscape of wearable technology and reshape the way we live, work, and play.

Advances in Printed Electronic Textiles

Electronic textiles (e-textiles) have emerged as a revolutionary solution for personalized healthcare, enabling the continuous collection and communication of diverse physiological parameters when seamlessly integrated with the human body. Among various methods employed to create wearable e-textiles, printing offers unparalleled flexibility and comfort, seamlessly integrating wearables into garments. This has spurred growing research interest in printed e-textiles, due to their vast design versatility, material options, fabrication techniques, and wide-ranging applications. Here, a comprehensive overview of the crucial considerations in fabricating printed e-textiles is provided, encompassing the selection of conductive materials and substrates, as well as the essential pre- and post-treatments involved. Furthermore, the diverse printing techniques and the specific requirements are discussed, highlighting the advantages and limitations of each method. Additionally, the multitude of wearable applications made possible by printed e-textiles is explored, such as their integration as various sensors, supercapacitors, and heated garments. Finally, a forward-looking perspective is provided, discussing future prospects and emerging trends in the realm of printed wearable e-textiles. As advancements in materials science, printing technologies, and design innovation continue to unfold, the transformative potential of printed e-textiles in healthcare and beyond is poised to revolutionize the way wearable technology interacts and benefits.

Advances in the Use of Conducting Polymers for Healthcare Monitoring

Conducting polymers (CPs) are an innovative class of materials recognized for their high flexibility and biocompatibility, making them an ideal choice for health monitoring applications that require flexibility. They are active in their design. Advances in fabrication technology allow the incorporation of CPs at various levels, by combining diverse CPs monomers with metal particles, 2D materials, carbon nanomaterials, and copolymers through the process of polymerization and mixing. This method produces materials with unique physicochemical properties and is highly customizable. In particular, the development of CPs with expanded surface area and high conductivity has significantly improved the performance of the sensors, providing high sensitivity and flexibility and expanding the range of available options. However, due to the morphological diversity of new materials and thus the variety of characteristics that can be synthesized by combining CPs and other types of functionalities, choosing the right combination for a sensor application is difficult but becomes important. This review focuses on classifying the role of CP and highlights recent advances in sensor design, especially in the field of healthcare monitoring. It also synthesizes the sensing mechanisms and evaluates the performance of CPs on electrochemical surfaces and in the sensor design. Furthermore, the applications that can be revolutionized by CPs will be discussed in detail.

Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging

BACKGROUND

Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo.

METHODS

CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests.

RESULTS

77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively).

CONCLUSION

Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification.

CLINICAL TRIAL REGISTRATION

Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.

The Influence of the Washing Process on the Impedance of Textronic Radio Frequency Identification Transponder Antennas

Antennas dedicated to RFID systems created on textile substrates should maintain strictly defined parameters. During washing, the materials from which such antennas are made are exposed to mechanical and chemical exposure-degradation of the parameters characterizing those materials may occur, which in turn may lead to a change in the parameters of the antenna. For research purposes, four groups of model dipole antennas (sewn with two types of conductive threads on two fabrics) were created and then they were subjected to several washing processes. After each stage of the experiment, the impedance parameters of the demonstration antennas were measured using indirect measurements. Based on the obtained results, it was found that these parameters change their values during washing, and that this is influenced by a number of factors, e.g., shrinkage of the substrate fabric.

Electronic textiles: New age of wearable technology for healthcare and fitness solutions

Sedentary lifestyles and evolving work environments have created challenges for global health and cause huge burdens on healthcare and fitness systems. Physical immobility and functional losses due to aging are two main reasons for noncommunicable disease mortality. Smart electronic textiles (e-textiles) have attracted considerable attention because of their potential uses in health monitoring, rehabilitation, and training assessment applications. Interactive textiles integrated with electronic devices and algorithms can be used to gather, process, and digitize data on human body motion in real time for purposes such as electrotherapy, improving blood circulation, and promoting wound healing. This review summarizes research advances on e-textiles designed for wearable healthcare and fitness systems. The significance of e-textiles, key applications, and future demand expectations are addressed in this review. Various health conditions and fitness problems and possible solutions involving the use of multifunctional interactive garments are discussed. A brief discussion of essential materials and basic procedures used to fabricate wearable e-textiles are included. Finally, the current challenges, possible solutions, opportunities, and future perspectives in the area of smart textiles are discussed.

Recent Progress of Biomaterials-Based Epidermal Electronics for Healthcare Monitoring and Human-Machine Interaction

Epidermal electronics offer an important platform for various on-skin applications including electrophysiological signals monitoring and human-machine interactions (HMI), due to their unique advantages of intrinsic softness and conformal interfaces with skin. The widely used nondegradable synthetic materials may produce massive electronic waste to the ecosystem and bring safety issues to human skin. However, biomaterials extracted from nature are promising to act as a substitute material for the construction of epidermal electronics, owing to their diverse characteristics of biocompatibility, biodegradability, sustainability, low cost and natural abundance. Therefore, the development of natural biomaterials holds great prospects for advancement of high-performance sustainable epidermal electronics. Here, we review the recent development on different types of biomaterials including proteins and polysaccharides for multifunctional epidermal electronics. Subsequently, the applications of biomaterials-based epidermal electronics in electrophysiological monitoring and HMI are discussed, respectively. Finally, the development situation and future prospects of biomaterials-based epidermal electronics are summarized. We expect that this review can provide some inspirations for the development of future, sustainable, biomaterials-based epidermal electronics.

Tailoring inkjet-printed PEDOT:PSS composition toward green, wearable device fabrication

Inkjet printing remains one of the most cost-efficient techniques for device prototyping and manufacturing, offering considerable freedom of digital design, non-contact, and additive fabrication. When developing novel wearable devices, a balanced approach is required between functional, user-safe materials and scalable manufacturing processes. Here, we propose a tailor-made ink formulation, based on non-hazardous materials, to develop green electronic devices aimed at interfacing with humans. We demonstrate that developed ink exhibits high-resolution inkjet printability, in line with theoretical prediction, on multiple wearable substrates. The ink's chemical composition ensures the pattern's enhanced electrical properties, mechanical flexibility, and stability in water. The cytocompatibility evaluations show no noxious effects from printed films in contact with human mesenchymal stem cells. Finally, we fabricated a printed wearable touch sensor on a non-woven fabric substrate, capable of tracking human steps. This is a step toward the development of green wearable electronics manufacturing, demonstrating a viable combination of materials and processes for biocompatible devices.

Recent Advances and Challenges Toward Application of Fibers and Textiles in Integrated Photovoltaic Energy Storage Devices

Flexible microelectronic devices have seen an increasing trend toward development of miniaturized, portable, and integrated devices as wearable electronics which have the requirement for being light weight, small in dimension, and suppleness. Traditional three-dimensional (3D) and two-dimensional (2D) electronics gadgets fail to effectively comply with these necessities owing to their stiffness and large weights. Investigations have come up with a new family of one-dimensional (1D) flexible and fiber-based electronic devices (FBEDs) comprising power storage, energy-scavenging, implantable sensing, and flexible displays gadgets. However, development and manufacturing are still a challenge owing to their small radius, flexibility, low weight, weave ability and integration in textile electronics. This paper will provide a detailed review on the importance of substrates in electronic devices, intrinsic property requirements, fabrication classification and applications in energy harvesting, energy storage and other flexible electronic devices. Fiber- and textile-based electronic devices for bulk/scalable fabrications, encapsulation, and testing are reviewed and presented future research ideas to enhance the commercialization of these fiber-based electronics devices.

Single-arm diagnostic electrocardiography with printed graphene on wearable textiles

Stimulated by the COVID-19 outbreak, the global healthcare industry better acknowledges the necessity of innovating novel methods for remote healthcare monitoring and treating patients outside clinics. Here we report the development of two different types of graphene textile electrodes differentiated by the employed fabrication techniques (i.e., dip-coating and spray printing) and successful demonstration of ergonomic and truly wearable, single-arm diagnostic electrocardiography (SADE) using only 3 electrodes positioned on only 1 arm. The performance of the printed graphene e-textile wearable systems were benchmarked against the "gold standard" silver/silver chloride (Ag/AgCl) "wet" electrodes; achieving excellent correlation up to ∼ 96% and ∼ 98% in ECG recordings (15 s duration) acquired with graphene textiles fabricated by dip-coating and spray printing techniques, respectively. In addition, we successfully implemented automatic detection of heartrate of 8 volunteers (mean value: 74.4 bpm) during 5 min of static and dynamic daily activities and benchmarked their recordings with a standard fingertip photoplethysmography (PPG) device. Heart rate variability (HRV) was calculated, and the root means successive square difference (rMMSD) metric was 30 ms during 5 min of recording. Other cardiac parameters such as R-R interval, QRS complex duration, S-T segment duration, and T-wave duration were also detected and compared to typical chest ECG values.

Ultrathin, all-organic, fabric-based ferroelectret loudspeaker for wearable electronics

All-organic, flexible, and body-compatible loudspeakers have become increasingly attractive for wearable electronics. Due to their remarkable piezoelectric response, ferroelectrets are suitable for loudspeakers. Two distinct kinds of ultrathin ferroelectrets, including cellular polypropylene films and expanded polytetrafluoroethylene (ePTFE) films, were combined with three different types of electrodes ((Poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS))-coated fabrics, PEDOT:PSS direct coating, and sputter-coated Au/Pd) for study regarding their frequency-dependent sound intensity and radiation directivity. Among the loudspeakers investigated, the all-fabric loudspeakers with ePTFE ferroelectret and PEDOT:PSS-coated spandex electrodes have a higher frequency dependency. Loudspeakers equipped with PEDOT:PSS-coated spandex electrodes are less angle dependent compared to other loudspeakers evaluated. Moreover, the soft loudspeaker constituted of an all-organic FEP(fluorinated-ethylene-propylene)-ePTFE-based ferroelectret and PEDOT:PSS-coated fabrics presented in this paper is easy to integrate with clothes and has a higher thermal stability. It is naturally compatible with the human body and a competitive candidate for future developments of all-organic loudspeakers for wearable electronic systems.

Development of wearable multi-lead ECG measurement device using cubic flocked electrode

This paper describes the fabrication and fundamental evaluation of the cubic flocked electrode (CFE), which is a dry electrode that is fabricated using electrostatic flocking technology. The development of a wearable multi-lead electrocardiogram (ECG) measurement device using the CFE is also reported. To enable the measurement of ECG signals with sufficient quality for medical applications, the occurrence of motion artifacts (MAs) is the most important problem to be overcome. Therefore, it is necessary to stabilize the contact between the patient's skin and the dry electrode. Because the CFE developed in this work offers both contact stability and flexibility, it is expected to enable ECG measurements with low MA levels. In this study, it is demonstrated that the number of MAs caused by respiration can be reduced when the CFE contact is made at a contact pressure of approximately 500 Pa using MA evaluation equipment that was developed in-house. Additionally, a wearable multi-lead ECG is designed and fabricated based on this contact pressure (500 Pa). The results of the demonstration experiment show that the ECG measurements are successful to the same extent as a conventional medical device.

Design and Manufacturing of Equipment for Investigation of Low Frequency Bioimpedance

The purpose of this study was to highlight a method of making equipment for the investigation of low frequency bioimpedance. A constant current with an average value of I = 100 µA is injected into the human body via means of current injection electrodes, and the biological signal is taken from the electrodes of electric potential charged with the biopotentials generated by the human body. The resulting voltage, ΔU is processed by the electronic conditioning system. The mathematical model of the four-electrode system in contact with the skin, and considering a target organ, was simplified to a single equivalent impedance. The capacitive filter low passes down from the differential input of the first instrumentation amplifier together with the isolated capacitive barrier integrated in the precision isolated secondary amplifier and maintains the biological signal taken from the electrodes charged with the undistorted biopotentials generated by the human body. Mass loops are avoided, and any electric shocks or electrostatic discharges are prevented. In addition, for small amplitudes of the biological signal, electromagnetic interferences of below 100 Hz of the power supply network were eliminated by using an active fourth-order Bessel filtering module. The measurements performed for the low frequency of f = 100 Hz on the volunteers showed for the investigated organs that the bioelectrical resistivities vary from 90 Ωcm up to 450 Ωcm, and that these are in agreement with other published and disseminated results for each body zone.

Ionic-electronic Conductive Fabric Electrodes for Wearable Biopotential Monitoring

This work proposed a low-cost and convenient way to develop textile electrodes with mixed conductive polymer by drop-casting. The effect of a conductivity enhancing agent (i.e., ethylene glycol (EG)) for PEDOT:PSS-coated fabric electrodes was investigated specifically. The results showed that the conductivity of the fabric electrode reached the highest with the addition of 20% EG compared to 0% and 5% EG loadings, which was different from that of thin-film electrodes in previous studies. In addition, the stability of the conductivity to washing was improved with the addition of the crosslinker GOPS and the surfactant DBSA. The signal quality in electrocardiogram recording with the PEDOT:PSS-coated fabric electrodes were comparable to that of commercial wet electrodes and outperformed silver-coated textile electrodes. Clinical Relevance- The dry textile electrodes with high conductivity and biopotential signal quality are of vital importance for wearable health monitoring to enable the early diagnosis and treatment of chronic diseases.

Smart Electronic Textiles for Wearable Sensing and Display

Increasing demand of using everyday clothing in wearable sensing and display has synergistically advanced the field of electronic textiles, or e-textiles. A variety of types of e-textiles have been formed into stretchy fabrics in a manner that can maintain their intrinsic properties of stretchability, breathability, and wearability to fit comfortably across different sizes and shapes of the human body. These unique features have been leveraged to ensure accuracy in capturing physical, chemical, and electrophysiological signals from the skin under ambulatory conditions, while also displaying the sensing data or other immediate information in daily life. Here, we review the emerging trends and recent advances in e-textiles in wearable sensing and display, with a focus on their materials, constructions, and implementations. We also describe perspectives on the remaining challenges of e-textiles to guide future research directions toward wider adoption in practice.

Challenges and Potential Solutions for 100% Recycling of Medical Textiles

Medical textiles are all fiber-based products and structures which are utilized for emergency treatment, clinical, surgical and hygienic purposes. It is an exceptionally particular and bio viable specialized material, utilized for clinical and cleanliness applications. Volumes of clinical waste being created in excess of 60 million tons yearly around the world. According to the current investigation reports and information, the worldwide clinical waste administration market was esteemed at USD 11.77 billion in the year 2018 and will reach at 17.89 billion by the year 2026 at a compound annual growth rate (CAGR) of 5.3%. Over the world, out of the measure of waste created by medical care activities, about 85% is general waste and staying 15% is viewed as unsafe material that might be irresistible, poisonous or radioactive. The following particular reasons are very harmful for the environment in the upcoming future. The waste management policy of medical textile is a vital fact for the world. The potential and effectual solution is recycling of these medical wastes. Current solutions for 100% recycling of medical textiles are chemical treatment, incineration, and autoclaving. But the most innovative solution of medical textiles is molecular tagging/tagging of fibers. Medical textile market is producing state-of-the-art polymeric textile implantable devices that are redefining traditional materials and methods of surgery. Developing polymer innovation has yielded a wide scope of uses of implantable clinical material or biotextiles. Due to world Covid-19 pandemic situation, the requirement of medical textiles already has been increased almost double from last year. It has been observed that the market value of medical textiles will be in optimum position. In the year 2019, the global market worth of medical textiles was US$ 17.5 billion. In the present world, the current medical textiles like implantable and non-implantable categories are not applying for recycling process or end used of their life cycle. In this paper, we will discuss about potential solutions for recycling medical textiles like—by using conductive polymers, maintaining ε-Poly-lysine, non-fibrous biomass, bioactive fibers, etc. But there are still some challenges for recycling like—maintain 100% polymeric bonds, bacterial effect, flexibility and sustainability for clinical performance after recycling the specific product. In this paper, we are presenting the scientific methods, mechanisms, and procedures that used to overcome the aforementioned challenges in the recycling methods.

Washable, Sewable, All-Carbon Electrodes and Signal Wires for Electronic Clothing

Smart wearable electronic accessories (e.g., watches) have found wide adoption; conversely, progress in electronic textiles has been slow due to the difficulty of embedding rigid electronic materials into flexible fabrics. Electronic clothing requires fibers that are conductive, robust, biocompatible, and can be produced on a large scale. Here, we create sewable electrodes and signal transmission wires from neat carbon nanotube threads (CNTT). These threads are soft like standard sewing thread, but they have metal-level conductivity and low interfacial impedance with skin. Electrocardiograms (EKGs) obtained by CNTT electrodes were comparable (P > 0.05) to signals obtained with commercial electrodes. CNTT can also be used as transmission wires to carry signals to other parts of a garment. Finally, the textiles can be machine-washed and stretched repeatedly without signal degradation. These results demonstrate promise for textile sensors and electronic fabric with the feel of standard clothing that can be incorporated with traditional clothing manufacturing techniques.

Evaluation of dry textile electrodes for long-term electrocardiographic monitoring

Background

Continuous long-term electrocardiography monitoring has been increasingly recognized for early diagnosis and management of different types of cardiovascular diseases. To find an alternative to Ag/AgCl gel electrodes that are improper for this application scenario, many efforts have been undertaken to develop novel flexible dry textile electrodes integrated into the everyday garments. With significant progresses made to address the potential issues (e.g., low signal-to-noise ratio, high skin–electrode impedance, motion artifact, and low durability), the lack of standard evaluation procedure hinders the further development of dry electrodes (mainly the design and optimization).

Results

A standard testing procedure and framework for skin–electrode impedance measurement is demonstrated for the development of novel dry textile electrodes. Different representative electrode materials have been screen-printed on textile substrates. To verify the performance of dry textile electrodes, impedance measurements are conducted on an agar skin model using a universal setup with consistent frequency and pressure. In addition, they are demonstrated for ECG signals acquisition, in comparison to those obtained using conventional gel electrodes.

Conclusions

Dry textile electrodes demonstrated similar impedance when in raised or flat structures. The tested pressure variations had an insignificant impact on electrode impedance. Looking at the effect of impedance on ECG signals, a noticeable effect on ECG signal performance metrics was not observed. Therefore, it is suggested that impedance alone is possibly not the primary indicator of signal quality. As well, the developed methods can also serve as useful guidelines for future textile dry-electrode design and testing for practical ECG monitoring applications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12938-021-00905-4.

Nanomaterials-patterned flexible electrodes for wearable health monitoring: a review

ABSTRACT

Electrodes fabricated on a flexible substrate are a revolutionary development in wearable health monitoring due to their lightweight, breathability, comfort, and flexibility to conform to the curvilinear body shape. Different metallic thin-film and plastic-based substrates lack comfort for long-term monitoring applications. However, the insulating nature of different polymer, fiber, and textile substrates requires the deposition of conductive materials to render interactive functionality to substrates. Besides, the high porosity and flexibility of fiber and textile substrates pose a great challenge for the homogenous deposition of active materials. Printing is an excellent process to produce a flexible conductive textile electrode for wearable health monitoring applications due to its low cost and scalability. This article critically reviews the current state of the art of different textile architectures as a substrate for the deposition of conductive nanomaterials. Furthermore, recent progress in various printing processes of nanomaterials, challenges of printing nanomaterials on textiles, and their health monitoring applications are described systematically.

Wearable Smart Textiles for Long-Term Electrocardiography Monitoring-A Review

The continuous and long-term measurement and monitoring of physiological signals such as electrocardiography (ECG) are very important for the early detection and treatment of heart disorders at an early stage prior to a serious condition occurring. The increasing demand for the continuous monitoring of the ECG signal needs the rapid development of wearable electronic technology. During wearable ECG monitoring, the electrodes are the main components that affect the signal quality and comfort of the user. This review assesses the application of textile electrodes for ECG monitoring from the fundamentals to the latest developments and prospects for their future fate. The fabrication techniques of textile electrodes and their performance in terms of skin–electrode contact impedance, motion artifacts and signal quality are also reviewed and discussed. Textile electrodes can be fabricated by integrating thin metal fiber during the manufacturing stage of textile products or by coating textiles with conductive materials like metal inks, carbon materials, or conductive polymers. The review also discusses how textile electrodes for ECG function via direct skin contact or via a non-contact capacitive coupling. Finally, the current intensive and promising research towards finding textile-based ECG electrodes with better comfort and signal quality in the fields of textile, material, medical and electrical engineering are presented as a perspective.

Comparison of silver-plated nylon (Ag/PA66) e-textile and Ag/AgCl electrodes for bioelectrical impedance analysis (BIA)

Recently, researchers have adapted Bioelectrical Impedance Analysis (BIA) as a new approach to objectively monitor wounds. They have indicated various BIA parameters associated to specific wound types can be linked to wound healing through trend analysis relative to time. However, these studies are conducted using wet electrodes which have been identified as possessing several shortcomings, such as unstable measurements. Thus, the adaption of e-textile electrodes has become an area of interest in measuring biosignals. E-textile electrodes are known to possess a significantly large polarization impedance (Z_p) that potentially influences these biosignal measurements. In this study we aim to identify the suitability of e-textile electrodes to monitor wounds using BIA methodologies. By adapting suggested methodologies conducted in-vivo from previous studies, we used an ex-vivo model to observe the behaviour of e-textile electrodes relative to time. This was compared to common clinical wet electrodes, specifically Ag/AgCl. The objective of this study was to identify the BIA parameters that can be used to monitor wounds with e-textile electrodes. By analysing the BIA parameters relative to time, we observed the influence ofZ_pon these parameters.

Smart Textiles and Sensorized Garments for Physiological Monitoring: A Review of Available Solutions and Techniques

Several wearable devices for physiological and activity monitoring are found on the market, but most of them only allow spot measurements. However, the continuous detection of physiological parameters without any constriction in time or space would be useful in several fields such as healthcare, fitness, and work. This can be achieved with the application of textile technologies for sensorized garments, where the sensors are completely embedded in the fabric. The complete integration of sensors in the fabric leads to several manufacturing techniques that allow dealing with both the technological challenges entailed by the physiological parameters under investigation, and the basic requirements of a garment such as perspiration, washability, and comfort. This review is intended to provide a detailed description of the textile technologies in terms of materials and manufacturing processes employed in the production of sensorized fabrics. The focus is pointed at the technical challenges and the advanced solutions introduced with respect to conventional sensors for recording different physiological parameters, and some interesting textile implementations for the acquisition of biopotentials, respiratory parameters, temperature and sweat are proposed. In the last section, an overview of the main garments on the market is depicted, also exploring some relevant projects under development.

Electronic-components less fully textile multiple resonant combiners for body-centric near field communication

Smart and e-textiles have nowadays an important increasing place in the garment industry. The rise of embedded telecommunications, especially smartphones in our pocket, enables us to provide a power source and a wireless link for smart textiles. The main issue is to develop garments able to receive power from smartphones and communicate with them without flexibility and comfort constraints bound to embedded solid-state electronic components. Consequently, this article aims to develop a fully textile NFC combiner to transfer data and power between a smartphone and sensors without any electronic components. It precisely describes textile NFC multiple combiners composed of textile NFC antennas linked by two-wire transmission lines. Also, theoretical analysis, simulations, and experiments have been conducted to adapt the resonant frequency of such structures to the NFC technology (13.56 MHz). Finally, our article generalizes textile NFC combiner resonant frequency equations for multiple combiners with any number of antennas.

Recent Trends, Construction and Applications of Smart Textiles and Clothing for Monitoring of Health Activity: A Comprehensive Multidisciplinary Review

In the area of biomedical signal monitoring, wearable electronics represents a dynamically growing field with a significant impact on the market of commercial products of biomedical signal monitoring and acquisition, as well as consumer electronic for vital functions monitoring. Since the electrodes are perceived as one of the most important part of the biomedical signal monitoring, they have been one of the most frequent subjects in the research community. Electronic textile (e-textile), also called smart textile represents a modern trend in the wearable electronics, integrating of functional materials with common clothing with the goal to realize the devices, which include sensors, antennas, energy harvesters and advanced textiles for self-cooling and heating. The area of textile electrodes and e-textile is perceived as a multidisciplinary field, integrating material engineering, chemistry, and biomedical engineering. In this review, we provide a comprehensive view on this area. This multidisciplinary review integrates the e-textile characteristics, materials and manufacturing of the textile electrodes, noise influence on the e-textiles performance, and mainly applications of the textile electrodes for biomedical signal monitoring and acquisition, including pressure sensors, electrocardiography, electromyography, electroencephalography and electrooculography monitoring.

Techniques and Processes for the Realization of Electrically Conducting Textile Materials from Intrinsically Conducting Polymers and Their Application Potential

This review will give an overview on functional conducting polymers, while focusing on the integration of intrinsically conducting, i.e., self-conducting, polymers for creating electrically conducting textile materials. Thus, different conduction mechanisms as well as achievable electrical properties will be introduced. First, essential polymers will be described individually, and secondly, techniques and processes for the realization of electrically conducting textile products in addition to their application potential will be presented.

Electrical Characterization of a Double-Layered Conductive Pattern with Different Crack Configurations for Durable E-Textiles

For the conductive patterns of electronic textiles (e-textiles), it is still challenging to maintain low electrical resistance, even under large or cyclic tensile deformation. This study investigated a double-layered pattern with different crack configurations as a possible solution. Patterns with single crack growth exhibit a low initial resistance and resistance change rate. In contrast, patterns with multiple crack growth maintain their conductivity under deformation, where electrical failure occurs in those with single crack growth. We considered that a double-layered structure could combine the electrical characteristics of patterns with single and multiple crack growths. In this study, each layer was theoretically designed to control the crack configuration. Then, meandering copper patterns, silver ink patterns, and their double layers were fabricated on textiles as patterns with single and multiple crack growths and double-layered patterns, respectively. Their resistance changes under the single (large) and cyclic tensile deformations were characterized. The results confirmed that the double-layered patterns maintained the lowest resistance at the high elongation rate and cycle. The resistance change rates of the meandering copper and silver ink patterns were constant, and changed monotonically against the elongation rate/cycle, respectively. In contrast, the change rate of the double-layered patterns varied considerably when electrical failure occurred in the copper layer. The change rate after the failure was much higher than that before the failure, and on the same order as that of the silver ink patterns.

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.

Challenges in Design and Fabrication of Flexible/Stretchable Carbon- and Textile-Based Wearable Sensors for Health Monitoring: A Critical Review

To demonstrate the wearable flexible/stretchable health-monitoring sensor, it is necessary to develop advanced functional materials and fabrication technologies. Among the various developed materials and fabrication processes for wearable sensors, carbon-based materials and textile-based configurations are considered as promising approaches due to their outstanding characteristics such as high conductivity, lightweight, high mechanical properties, wearability, and biocompatibility. Despite these advantages, in order to realize practical wearable applications, electrical and mechanical performances such as sensitivity, stability, and long-term use are still not satisfied. Accordingly, in this review, we describe recent advances in process technologies to fabricate advanced carbon-based materials and textile-based sensors, followed by their applications such as human activity and electrophysiological sensors. Furthermore, we discuss the remaining challenges for both carbon- and textile-based wearable sensors and then suggest effective strategies to realize the wearable sensors in health monitoring.

Resistance Reduction of Conductive Patterns Printed on Textile by Curing Shrinkage of Passivation Layers

Directly printing conductive ink on textiles is simple and compatible with the conventional electronics manufacturing process. However, the conductive patterns thus formed often show high initial resistance and significant resistance increase due to tensile deformation. Achieving conductive patterns with low initial resistance and reduced deformation-induced resistance increase is a significant challenge in the field of electronic textiles (e-textiles). In this study, the passivation layers printed on conductive patterns, which are necessary for practical use, were examined as a possible solution. Specifically, the reduction of the initial resistance and deformation-induced resistance increase, caused by the curing shrinkage of passivation layers, were theoretically and experimentally investigated. In the theoretical analysis, to clarify the mechanism of the reduction of deformation-induced resistance increase, crack propagation in conductive patterns was analyzed. In the experiments, conductive patterns with and without shrinking passivation layers (polydimethylsiloxane) cured at temperatures of 20–120 °C were prepared, and the initial resistances and resistance increases due to cyclic tensile and washing in each case were compared. As a result, the initial resistance was reduced further by the formation of shrinking passivation layers cured at higher temperatures, and reduced to 0.45 times when the curing temperature was 120 °C. The cyclic tensile and washing tests confirmed a 0.48 and a 0.011 times reduction of resistance change rate after the 100th elongation cycle (10% in elongation rate) and the 10th washing cycle, respectively, by comparing the samples with and without shrinking passivation layers cured at 120 °C.

Fabric Vest Socket with Embroidered Electrodes for Control of Myoelectric Prosthesis

Myoelectric prostheses assist users to live their daily lives. However, the majority of users are primarily confined to forearm amputees because the surface electromyography (sEMG) that understands the motion intents should be acquired from a residual limb for control of the myoelectric prosthesis. This study proposes a novel fabric vest socket that includes embroidered electrodes suitable for a high-level upper amputee, especially for shoulder disarticulation. The fabric vest socket consists of rigid support and a fabric vest with embroidered electrodes. Several experiments were conducted to verify the practicality of the developed vest socket with embroidered electrodes. The sEMG signals were measured using commercial Ag/AgCl electrodes for a comparison to verify the performance of the embroidered electrodes in terms of signal amplitudes, the skin-electrode impedance, and signal-to-noise ratio (SNR). These results showed that the embroidered electrodes were as effective as the commercial electrodes. Then, posture classification was carried out by able-bodied subjects for the usability of the developed vest socket. The average classification accuracy for each subject reached 97.92%, and for all the subjects it was 93.2%. In other words, the fabric vest socket with the embroidered electrodes could measure sEMG signals with high accuracy. Therefore, it is expected that it can be readily worn by high-level amputees to control their myoelectric prostheses, as well as it is cost effective for fabrication as compared with the traditional socket.

Electronic Component Mounting for Durable E-Textiles: Direct Soldering of Components onto Textile-Based Deeply Permeated Conductive Patterns

For the improvement of the performance and function of electronic textiles (e-textiles), methods for electronic component mounting of textile circuits with electrical and mechanical durability are necessary. This manuscript presents a component mounting method for durable e-textiles, with a simpler implementation and increased compatibility with conventional electronics manufacturing processes. In this process, conductive patterns are directly formed on a textile by the printing of conductive ink with deep permeation and, then, components are directly soldered on the patterns. The stiffness of patterns is enhanced by the deep permeation, and the enhancement prevents electrical and mechanical breakages due to the stress concentration between the pattern and solder. This allows components to be directly mounting on textile circuits with electrical and mechanical durability. In this study, a chip resistor was soldered on printed patterns with different permeation depths, and the durability of the samples were evaluated by measuring the variation in resistance based on cyclic tensile tests and shear tests. The experiments confirmed that the durability was improved by the deep permeation, and that the samples with solder and deep permeation exhibited superior durability as compared with the samples based on commercially available elastic conductive adhesives for component mounting. In addition, a radio circuit was fabricated on a textile to demonstrate that various types of components can be mounted based on the proposed methods.

Smart Textile-Integrated Microelectronic Systems for Wearable Applications

The programmable nature of smart textiles makes them an indispensable part of an emerging new technology field. Smart textile-integrated microelectronic systems (STIMES), which combine microelectronics and technology such as artificial intelligence and augmented or virtual reality, have been intensively explored. A vast range of research activities have been reported. Many promising applications in healthcare, the internet of things (IoT), smart city management, robotics, etc., have been demonstrated around the world. A timely overview and comprehensive review of progress of this field in the last five years are provided. Several main aspects are covered: functional materials, major fabrication processes of smart textile components, functional devices, system architectures and heterogeneous integration, wearable applications in human and nonhuman-related areas, and the safety and security of STIMES. The major types of textile-integrated nonconventional functional devices are discussed in detail: sensors, actuators, displays, antennas, energy harvesters and their hybrids, batteries and supercapacitors, circuit boards, and memory devices.

Recent Advances in 1D Stretchable Electrodes and Devices for Textile and Wearable Electronics: Materials, Fabrications, and Applications

Research on wearable electronic devices that can be directly integrated into daily textiles or clothes has been explosively grown holding great potential for various practical wearable applications. These wearable electronic devices strongly demand 1D electronic devices that are light-weight, weavable, highly flexible, stretchable, and adaptable to comport to frequent deformations during usage in daily life. To this end, the development of 1D electrodes with high stretchability and electrical performance is fundamentally essential. Herein, the recent process of 1D stretchable electrodes for wearable and textile electronics is described, focusing on representative conductive materials, fabrication techniques for 1D stretchable electrodes with high performance, and designs and applications of various 1D stretchable electronic devices. To conclude, discussions are presented regarding limitations and perspectives of current materials and devices in terms of performance and scientific understanding that should be considered for further advances.

Paper-Based Flexible Electrode Using Chemically-Modified Graphene and Functionalized Multiwalled Carbon Nanotube Composites for Electrophysiological Signal Sensing

Flexible paper-based physiological sensor electrodes were developed using chemically-modified graphene (CG) and carboxylic-functionalized multiwalled carbon nanotube composites (f@MWCNTs). A solvothermal process with additional treatment was conducted to synthesize CG and f@MWCNTs to make CG-f@MWCNT composites. The composite was sonicated in an appropriate solvent to make a uniform suspension, and then it was drop cast on a nylon membrane in a vacuum filter. A number of batches (0%~35% f@MWCNTs) were prepared to investigate the performance of the physical characteristics. The 25% f@MWCNT-loaded composite showed the best adhesion on the paper substrate. The surface topography and chemical bonding of the proposed CG-f@MWCNT electrodes were characterized by scanning electron microscopy (SEM) and Raman spectroscopy, respectively. The average sheet resistance of the 25% CG-f@MWCNT electrode was determined to be 75 Ω/□, and it showed a skin contact impedance of 45.12 kΩ at 100 Hz. Electrocardiogram (ECG) signals were recorded from the chest and fingertips of healthy adults using the proposed electrodes. The CG-f@MWCNT electrodes demonstrated comfortability and a high sensitivity for electrocardiogram signal detection.

Stretchable Conductive Adhesives with Superior Electrical Stability as Printable Interconnects in Washable Textile Electronics

As practical interest in stretchable electronics increases for future applications in wearables, healthcare, and robotics, the demand for electrical interconnects with high electrical conductivity, durability, printability, and adhesion is growing. Despite the high electrical conductivity and stretchability of most previous interconnects, they lack stable conductivity against strain and adhesion to stretchable substrates, leading to a limitation for their practical applications. Herein, we propose a stretchable conductive adhesive consisting of silver particles with carbon nanotube as an auxiliary filler in silicone adhesives. The conductive adhesive exhibits a high initial conductivity of 6450 S cm^-1. They show little change in conductivity over 3000 stretching cycles at 50% strain, currently the highest stability reported for elastic conductors. Based on strong adhesion to stretchable substrates, the gel-free, dry adhesives printed on an elastic bandage for electrocardiography monitoring exhibit an extremely stable performance upon movement of the subject, even after several cycles of detachment-reattachment and machine washing.

Development of an sEMG sensor composed of two-layered conductive silicone with different carbon concentrations

To achieve robust sEMG measurements in an EMG prosthetic system, this study proposes a surface electromyogram (sEMG) sensor with a novel electrode structure composed of two-layered conductive silicone with different carbon concentrations. We hypothesized there is an optimal carbon concentration for achieving a large sEMG amplitude with robustness to external perturbation, and we empirically determined this optimal concentration. We produced fourteen sets of electrodes, with the weight ratio of carbon to silicone ranging from 1.7% to 4.0%. Using these electrodes, the user sEMG and electrical properties of the electrodes were measured. An external perturbation was applied on one side of the electrode to introduce a condition of unbalanced contact to the sEMG sensor. We defined an index of robustness for the sEMG sensor based on the signal-to-noise ratio in the balanced and unbalanced contact conditions. Based on the results of the robustness index, two optimal carbon concentrations, at weight ratios of 2.0%–2.1% and 2.6%–2.7%, were observed. Moreover, the double-peak property was correlated to the capacitance. Our results clearly demonstrate an optimal carbon concentration for robust sEMG measurements, and suggest that the robust measurement of sEMG is supported by the capacitance component of the sensor system.

Graphene and Poly(3,4-ethylene dioxythiophene):Poly(4-styrenesulfonate) on Nonwoven Fabric as a Room Temperature Metal and Its Application as Dry Electrodes for Electrocardiography

Highly conductive, metal-like poly(ethylene terephthalate) (PET) nonwoven fabric was prepared by coating poly(3,4-ethylenedioxythiophene):poly(4-styrenesulfonate) (PEDOT:PSS) containing dimethyl sulfoxide (DMSO) onto PET nonwoven fabric previously coated with graphene/graphite. The sheet resistance of the original nonwoven fabric decreases from >80 MΩ□^-1 to 1.1 Ω□^-1 after coating with 10.7 wt % graphene and 5.48 wt % PEDOT:PSS with a maximum current at breakdown of 4 A. This sheet resistance is lower than previously reported sheet resistances of fabrics coated with graphene films, PEDOT:PSS films, or PEDOT:PSS coated fabrics from the literature. The effect of temperature on the resistance of graphene/PEDOT:PSS coated fabric has revealed that the resistance decreases with increasing temperature, analogous to semiconductors, with a clear semiconductor-metal transition occurring at 290 K. Finally, a coating of 18 wt % graphene/graphite and 2.5 wt % PEDOT:PSS (R_s = 5.5 Ω□^-1) screen printed on the nonwoven fabric was shown to function as an electrode for electrocardiography without any hydrogel and with dry skin conditions. This composite coating finds application in wearable electronics for military and consumer sectors.

Ambulatory cardiac bio-signals: From mirage to clinical reality through a decade of progress

BACKGROUND

Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly.

OBJECTIVES

The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis.

RESULTS

Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance.

CONCLUSIONS

Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.

Mechanically Flexible Conductors for Stretchable and Wearable E-Skin and E-Textile Devices

Considerable progress in materials development and device integration for mechanically bendable and stretchable optoelectronics will broaden the application of "Internet-of-Things" concepts to a myriad of new applications. When addressing the needs associated with the human body, such as the detection of mechanical functions, monitoring of health parameters, and integration with human tissues, optoelectronic devices, interconnects/circuits enabling their functions, and the core passive components from which the whole system is built must sustain different degrees of mechanical stresses. Herein, the basic characteristics and performance of several of these devices are reported, particularly focusing on the conducting element constituting them. Among these devices, strain sensors of different types, energy storage elements, and power/energy storage and generators are included. Specifically, the advances during the past 3 years are reported, wherein mechanically flexible conducting elements are fabricated from (0D, 1D, and 2D) conducting nanomaterials from metals (e.g., Au nanoparticles, Ag flakes, Cu nanowires), carbon nanotubes/nanofibers, 2D conductors (e.g., graphene, MoS₂ ), metal oxides (e.g., Zn nanorods), and conducting polymers (e.g., poly(3,4-ethylenedioxythiophene):poly(4-styrene sulfonate), polyaniline) in combination with passive fibrotic and elastomeric materials enabling, after integration, the so-called electronic skins and electronic textiles.

Wearable and Flexible Textile Electrodes for Biopotential Signal Monitoring: A review

Wearable electronics is a rapidly growing field that recently started to introduce successful commercial products into the consumer electronics market. Employment of biopotential signals in wearable systems as either biofeedbacks or control commands are expected to revolutionize many technologies including point of care health monitoring systems, rehabilitation devices, human–computer/machine interfaces (HCI/HMIs), and brain–computer interfaces (BCIs). Since electrodes are regarded as a decisive part of such products, they have been studied for almost a decade now, resulting in the emergence of textile electrodes. This study presents a systematic review of wearable textile electrodes in physiological signal monitoring, with discussions on the manufacturing of conductive textiles, metrics to assess their performance as electrodes, and an investigation of their application in the acquisition of critical biopotential signals for routine monitoring, assessment, and exploitation of cardiac (electrocardiography, ECG), neural (electroencephalography, EEG), muscular (electromyography, EMG), and ocular (electrooculography, EOG) functions.

Relationship between Contact Pressure and Motion Artifacts in ECG Measurement with Electrostatic Flocked Electrodes Fabricated on Textile

To develop a wearable multi-lead electrocardiogram (ECG) measuring system, we fabricated the electrodes and wires by using electrostatic flocking technology on a textile. By using this technology, it was possible to fabricate many electrodes and wires, simultaneously. Also the flocked electrodes and wires had stretchability and washing resistance properties. To use dry electrodes, it is important to reduce the influence of motion artifacts (MAs). The results of the experiment with the skin phantom revealed that the contact pressure between the skin and the electrode is an important factor in MA reduction. Then, we conducted experiments with a human body to determine the relationship between the contact pressure and the MAs. Under the pressures of 200 Pa and 500 Pa, MAs were observed. Meanwhile, under the pressures of 1000 Pa, 2000Pa and 4000 Pa, the ECG signals under rest and deep breathing conditions were able to be measured without MAs. Considering the comfortability, the contact pressure from 1000 Pa to 2000 is preferable. Finally, we fabricated the wearable ECG measuring system and succeeded in measuring 18-lead ECG signals. The measured ECG waveform is in good agreement with the ECG waveform measured by a commercial system.

Electrical performance of PEDOT:PSS-based textile electrodes for wearable ECG monitoring: a comparative study

Background

Wearable textile electrodes for the detection of biopotentials are a promising tool for the monitoring and early diagnosis of chronic diseases. We present a comparative study of the electrical characteristics of four textile electrodes manufactured from common fabrics treated with a conductive polymer, a commercial fabric, and disposable Ag/AgCl electrodes. These characteristics will allow identifying the performance of the materials when used as ECG electrodes. The electrodes were subjected to different electrical tests, and complemented with conductivity calculations and microscopic images to determine their feasibility in the detection of ECG signals.

Methods

We evaluated four electrical characteristics: contact impedance, electrode polarization, noise, and long-term performance. We analyzed PEDOT:PSS treated fabrics based on cotton, cotton–polyester, lycra and polyester; also a commercial fabric made of silver-plated nylon Shielde® Med-Tex P130, and commercial Ag/AgCl electrodes. We calculated conductivity from the surface resistance and, analyzed their surface at a microscopic level. Rwizard was used in the statistical analysis.

Results

The results showed that textile electrodes treated with PEDOT:PSS are suitable for the detection of ECG signals. The error detecting features of the ECG signal was lower than 2% and the electrodes kept working properly after 36 h of continuous use. Even though the contact impedance and the polarization level in textile electrodes were greater than in commercial electrodes, these parameters did not affect the acquisition of the ECG signals. Fabrics conductivity calculations were consistent to the contact impedance.

Single-Wall Carbon Nanotube-Coated Cotton Yarn for Electrocardiography Transmission

We fabricated a type of conductive fabric, specifically single-wall carbon nanotube-coated cotton yarns (SWNT-CYs), for electrocardiography (ECG) signal transmission utilizing a "dipping and drying" method. The conductive cotton yarns were prepared by dipping cotton yarns in SWNTs (single-wall carbon nanotubes) solutions and then drying them at room temperature-a simple process that shows consistency in successfully coating cotton yarns with conductive carbon nanotubes (CNTs). The influence of fabrication conditions on the conductivity properties of SWNT-CYs was investigated. The results demonstrate that our conductive yarns can transmit weak bio-electrical (i.e., ECG) signals without significant attenuation and distortion. Our conductive cotton yarns, which combine the flexibility of conventional fabrics and the good conductivity of SWNTs, are promising materials for wearable electronics and sensor applications in the future.

Ultraconformable Temporary Tattoo Electrodes for Electrophysiology

Electrically interfacing the skin for monitoring personal health condition is the basis of skin-contact electrophysiology. In the clinical practice the use of stiff and bulky pregelled or dry electrodes, in contrast to the soft body tissues, imposes severe restrictions to user comfort and mobility while limiting clinical applications. Here, in this work dry, unperceivable temporary tattoo electrodes are presented. Customized single or multielectrode arrays are readily fabricated by inkjet printing of conducting polymer onto commercial decal transfer paper, which allows for easy transfer on the user's skin. Conformal adhesion to the skin is provided thanks to their ultralow thickness (<1 µm). Tattoo electrode-skin contact impedance is characterized on short- (1 h) and long-term (48 h) and compared with standard pregelled and dry electrodes. The viability in electrophysiology is validated by surface electromyography and electrocardiography recordings on various locations on limbs and face. A novel concept of tattoo as perforable skin-contact electrode, through which hairs can grow, is demonstrated, thus permitting to envision very long-term recordings on areas with high hair density. The proposed materials and patterning strategy make this technology amenable for large-scale production of low-cost sensing devices.

Washable and Reliable Textile Electrodes Embedded into Underwear Fabric for Electrocardiography (ECG) Monitoring

A medical quality electrocardiogram (ECG) signal is necessary for permanent monitoring, and an accurate heart examination can be obtained from instrumented underwear only if it is equipped with high-quality, flexible, textile-based electrodes guaranteeing low contact resistance with the skin. The main objective of this article is to develop reliable and washable ECG monitoring underwear able to record and wirelessly send an ECG signal in real time to a smart phone and further to a cloud. The article focuses on textile electrode design and production guaranteeing optimal contact impedance. Therefore, different types of textile fabrics were coated with modified poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) in order to develop and manufacture reliable and washable textile electrodes assembled to female underwear (bras), by sewing using commercially available conductive yarns. Washability tests of connected underwear containing textile electrodes and conductive threads were carried out up to 50 washing cycles. The influence of standardized washing cycles on the quality of ECG signals and the electrical properties of the textile electrodes were investigated and characterized.