Development of Washable Silver Printed Textile Electrodes for Long-Term ECG Monitoring

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.

Recent Advances and Challenges in Textile Electrodes for Wearable Biopotential Signal Monitoring: A Comprehensive Review

The technology of wearable medical equipment has advanced to the point where it is now possible to monitor the electrocardiogram and electromyogram comfortably at home. The transition from wet Ag/AgCl electrodes to various types of gel-free dry electrodes has made it possible to continuously and accurately monitor the biopotential signals. Fabrics or textiles, which were once meant to protect the human body, have undergone significant development and are now employed as intelligent textile materials for healthcare monitoring. The conductive textile electrodes provide the benefit of being breathable and comfortable. In recent years, there has been a significant advancement in the fabrication of wearable conductive textile electrodes for monitoring biopotential signals. This review paper provides a comprehensive overview of the advances in wearable conductive textile electrodes for biopotential signal monitoring. The paper covers various aspects of the technology, including the electrode design, various manufacturing techniques utilised to fabricate wearable smart fabrics, and performance characteristics. The advantages and limitations of various types of textile electrodes are discussed, and key challenges and future research directions are identified. This will allow them to be used to their fullest potential for signal gathering during physical activities such as running, swimming, and other exercises while being linked into wireless portable health monitoring systems.

Evaluation of Novel Embroidered Textile-Electrodes Made from Hybrid Polyamide Conductive Threads for Surface EMG Sensing

Recently, there has been an increase in the number of reports on textile-based dry electrodes that can detect biopotentials without the need for electrolytic gels. However, these textile electrodes have a higher electrode skin interface impedance due to the improper contact between the skin and the electrode, diminishing the reliability and repeatability of the sensor. To facilitate improved skin-electrode contact, the effects of load and holding contact pressure were monitored for an embroidered textile electrode composed of multifilament hybrid thread for its application as a surface electromyography (sEMG) sensor. The effect of the textile's inter-electrode distance and double layering of embroidery that increases the density of the conductive threads were studied. Electrodes embroidered onto an elastic strap were wrapped around the forearm with a hook and loop fastener and tested for their performance. Time domain features such as the Root Mean Square (RMS), Average Rectified Value (ARV), and Signal to Noise Ratio (SNR) were quantitatively monitored in relation to the contact pressure and load. Experiments were performed in triplicates, and the sEMG signal characteristics were observed for various loads (0, 2, 4, and 6 kg) and holding contact pressures (5, 10, and 20 mmHg). sEMG signals recorded with textile electrodes were comparable in amplitude to those recorded using typical Ag/AgCl electrodes (28.45 dB recorded), while the signal-to-noise ratios were, 11.77, 19.60, 19.91, and 20.93 dB for the different loads, and 21.33, 23.34, and 17.45 dB for different holding pressures. The signal quality increased as the elastic strap was tightened further, but a pressure higher than 20 mmHg is not recommended because of the discomfort experienced by the subjects during data collection.

Self-Healing, Reconfigurable, Thermal-Switching, Transformative Electronics for Health Monitoring

Soft, deformable electronic devices provide the means to monitor physiological information and health conditions for disease diagnostics. However, their practical utility is limited due to the lack of intrinsical thermal switching for mechanically transformative adaptability and self-healing capability against mechanical damages. Here, the design concepts, materials and physics, manufacturing approaches, and application opportunities of self-healing, reconfigurable, thermal-switching device platforms based on hyperbranched polymers and biphasic liquid metal are reported. The former provides excellent self-healing performance and unique tunable stiffness and adhesion regulated by temperature for the on-skin switch, whereas the latter results in liquid metal circuits with extreme stretchability (>900%) and high conductivity (3.40 × 104  S cm-1 ), as well as simple recycling capability. Triggered by the increased temperature from the skin surface, a multifunctional device platform can conveniently conform and strongly adhere to the hierarchically textured skin surface for non-invasive, continuous, comfortable health monitoring. Additionally, the self-healing and adhesive characteristics allow multiple multifunctional circuit components to assemble and completely wrap on 3D curvilinear surfaces. Together, the design, manufacturing, and proof-of-concept demonstration of the self-healing, transformative, and self-assembled electronics open up new opportunities for robust soft deformable devices, smart robotics, prosthetics, and Internet-of-Things, and human-machine interfaces on irregular surfaces.

Characterization and Validation of Flexible Dry Electrodes for Wearable Integration

When long-term biosignal monitoring is required via surface electrodes, the use of conventional silver/silver chloride (Ag/AgCl) gelled electrodes may not be the best solution, as the gel in the electrodes tends to dry out over time. In this work, the electrical behaviour and performance of dry electrodes for biopotential monitoring was assessed. Three materials were investigated and compared against the gold-standard Ag/AgCl gelled electrodes. To characterize their electrical behaviour, the impedance response over the frequency was evaluated, as well as its signal to noise ratio. The electrodes' performance was evaluated by integrating them in a proven electrocardiogram (ECG) acquisition setup where an ECG signal was acquired simultaneously with a set of dry electrodes and a set of standard Ag/AgCl gelled electrodes as reference. The obtained results were morphologically compared using the Normalised Root Mean Squared Error (nRMSE) and the Cosine Similarity (CS). The findings of this work suggest that the use of dry electrodes for biopotential monitoring is a suitable replacement for the conventional Ag/AgCl gelled electrodes. The signal obtained with dry electrodes is comparable to the one obtained with the gold standard, with the advantage that these do not require the use of gel and can be easily integrated into fabric to facilitate their use in long-term monitoring scenarios.

Fully Screen-Printed PI/PEG Blends Enabled Patternable Electrodes for Scalable Manufacturing of Skin-Conformal, Stretchable, Wearable Electronics

Recent advances in soft materials and nano-microfabrication have enabled the development of flexible wearable electronics. At the same time, printing technologies have been demonstrated to be efficient and compatible with polymeric materials for manufacturing wearable electronics. However, wearable device manufacturing still counts on a costly, complex, multistep, and error-prone cleanroom process. Here, we present fully screen-printable, skin-conformal electrodes for low-cost and scalable manufacturing of wearable electronics. The screen printing of the polyimide (PI) layer enables facile, low-cost, scalable, high-throughput manufacturing. PI mixed with poly(ethylene glycol) exhibits a shear-thinning behavior, significantly improving the printability of PI. The premixed Ag/AgCl ink is then used for conductive layer printing. The serpentine pattern of the screen-printed electrode accommodates natural deformation under stretching (30%) and bending conditions (180°), which are verified by computational and experimental studies. Real-time wireless electrocardiogram monitoring is also successfully demonstrated using the printed electrodes with a flexible printed circuit. The algorithm developed in this study can calculate accurate heart rates, respiratory rates, and heart rate variability metrics for arrhythmia detection.

Towards Estimating Arterial Diameter Using Bioimpedance Spectroscopy: A Computational Simulation and Tissue Phantom Analysis

This paper improves the accuracy of quantification in the arterial diameter-dependent impedance variance by altering the electrode configuration. The finite element analysis was implemented with a 3D human wrist fragment using ANSYS Electronics Desktop, containing fat, muscle, and a blood-filled radial artery. Then, the skin layer and bones were stepwise added, helping to understand the dielectric response of multi-tissues and blood flow from 1 kHz to 1 MHz, the current distribution throughout the wrist, and the optimisation of electrode configurations for arterial pulse sensing. Moreover, a low-cost wrist phantom was fabricated, containing two components: the surrounding tissue simulant (20 wt % gelatine power and 0.017 M sodium chloride (NaCl) solution) and the blood simulant (0.08 M NaCl solution). The blood-filled artery was constricted using a desktop injection pump, and the impedance change was measured by the Multi-frequency Impedance Analyser (MFIA). The simulation revealed the promising capabilities of band electrodes to generate a more uniform current distribution than the traditional spot electrodes. Both simulation and phantom experimental results indicated that a longer spacing between current-carrying (CC) electrodes with shorter spacing between pick-up (PU) electrodes in the middle could sense a more uniform electric field, engendering a more accurate arterial diameter estimation. This work provided an improved electrode configuration for more accurate arterial diameter estimation from the numerical simulation and tissue phantom perspectives.

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.

Measuring Biosignals with Single Circuit Boards

To measure biosignals constantly, using textile-integrated or even textile-based electrodes and miniaturized electronics, is ideal to provide maximum comfort for patients or athletes during monitoring. While in former times, this was usually solved by integrating specialized electronics into garments, either connected to a handheld computer or including a wireless data transfer option, nowadays increasingly smaller single circuit boards are available, e.g., single-board computers such as Raspberry Pi or microcontrollers such as Arduino, in various shapes and dimensions. This review gives an overview of studies found in the recent scientific literature, reporting measurements of biosignals such as ECG, EMG, sweat and other health-related parameters by single circuit boards, showing new possibilities offered by Arduino, Raspberry Pi etc. in the mobile long-term acquisition of biosignals. The review concentrates on the electronics, not on textile electrodes about which several review papers are available.

Smart E-Textile Systems: A Review for Healthcare Applications

E-textiles is a new hybrid field developed with the help of the integration of electronic components into our daily usage of textile products. These wearable e-textiles provide user-defined applications as well as normal textile clothing. The medical field is one of the major leading areas where these new hybrid products are being implemented, and relatively mature products can be observed in the laboratory as well as in commercial markets. These products are developed for continuous patient monitoring in large-scale hospital centers as well as for customized patient requirements. Meanwhile, these products are also being used for complex medical treatments and the replacement of conventional methods. This review manuscript contains a basic overview of e-textile systems, their components, applications, and usages in the field of medical innovations. E-textile systems, integrated into customized products for medical needs, are discussed with their proposed properties and limitations. Finally, some recommendations to enhance the e-textile system’s integration into the medical field are argued.

Validating Poly(3,4-ethylene dioxythiophene) Polystyrene Sulfonate-Based Textile Electroencephalography Electrodes by a Textile-Based Head Phantom

It is important to go through a validation process when developing new electroencephalography (EEG) electrodes, but it is impossible to keep the human mind constant, making the process difficult. It is also very difficult to identify noise and signals as the input signal is unknown. In this work, we have validated textile-based EEG electrodes constructed from a poly(3,4-ethylene dioxythiophene) polystyrene sulfonate:/polydimethylsiloxane coated cotton fabric using a textile-based head phantom. The performance of the textile-based electrode has also been compared against a commercial dry electrode. The textile electrodes collected a signal to a smaller skin-to-electrode impedance (-18.9%) and a higher signal-to-noise ratio (+3.45%) than Ag/AgCl dry electrodes. From an EEGLAB, it was observed that the inter-trial coherence and event-related spectral perturbation graphs of the textile-based electrodes were identical to the Ag/AgCl electrodes. Thus, these textile-based electrodes can be a potential alternative to monitor brain activity.

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.

Integration of Conductive Materials with Textile Structures, an Overview

In the last three decades, the development of new kinds of textiles, so-called smart and interactive textiles, has continued unabated. Smart textile materials and their applications are set to drastically boom as the demand for these textiles has been increasing by the emergence of new fibers, new fabrics, and innovative processing technologies. Moreover, people are eagerly demanding washable, flexible, lightweight, and robust e-textiles. These features depend on the properties of the starting material, the post-treatment, and the integration techniques. In this work, a comprehensive review has been conducted on the integration techniques of conductive materials in and onto a textile structure. The review showed that an e-textile can be developed by applying a conductive component on the surface of a textile substrate via plating, printing, coating, and other surface techniques, or by producing a textile substrate from metals and inherently conductive polymers via the creation of fibers and construction of yarns and fabrics with these. In addition, conductive filament fibers or yarns can be also integrated into conventional textile substrates during the fabrication like braiding, weaving, and knitting or as a post-fabrication of the textile fabric via embroidering. Additionally, layer-by-layer 3D printing of the entire smart textile components is possible, and the concept of 4D could play a significant role in advancing the status of smart textiles to a new level.