Skin Conformal Polymer Electrodes for Clinical ECG and EEG Recordings

3D printed PEDOT:PSS-based conducting and patternable eutectogel electrodes for machine learning on textiles

The proliferation of medical wearables necessitates the development of novel electrodes for cutaneous electrophysiology. In this work, poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) is combined with a deep eutectic solvent (DES) and polyethylene glycol diacrylate (PEGDA) to develop printable and biocompatible electrodes for long-term cutaneous electrophysiology recordings. The impact of printing parameters on the conducting properties, morphological characteristics, mechanical stability and biocompatibility of the material were investigated. The optimised eutectogel formulations were fabricated in four different patterns -flat, pyramidal, striped and wavy- to explore the influence of electrode geometry on skin conformability and mechanical contact. These electrodes were employed for impedance and forearm EMG measurements. Furthermore, arrays of twenty electrodes were embedded into a textile and used to generate body surface potential maps (BSPMs) of the forearm, where different finger movements were recorded and analysed. Finally, BSPMs for three different letters (B, I, O) in sign-language were recorded and used to train a logistic regressor classifier able to reliably identify each letter. This novel cutaneous electrode fabrication approach offers new opportunities for long-term electrophysiological recordings, online sign-language translation and brain-machine interfaces.

Skin-Integrated Electrodes Based on Room-Temperature Curable, Highly Conductive Silver/Polydimethylsiloxane Composites

The quality of electrophysiological (EP) signals heavily relies on the electrode's contact with the skin. However, motion or exposure to water can easily destabilize this connection. In contrast to traditional methods of attaching electrodes to the skin surface, this study introduces a skin-integration strategy inspired by the skin's intergrown structure. A highly conductive and room-temperature curable composite composed of silver microflakes and polydimethylsiloxane (Ag/PDMS) is applied to the skin. Before curing, the PDMS oil partially diffuse into the stratum corneum (SC) layer of the skin. Upon curing, the composite solidifies into an electrode that seamlessly integrated with the skin, resembling a natural extension. This skin-integration strategy offers several advantages. It minimizes motion artifacts resulting from relative electrode-skin displacement, significantly reduces interface impedance (67% of commercial Ag/AgCl gel electrodes at 100 Hz) and withstands water flushes due to its hydrophobic nature. These advantages pave the way for promising advancements in EP signal recording, particularly during motion and underwater conditions.

Treefrog-Inspired Flexible Electrode with High Permeability, Stable Adhesion, and Robust Durability

Long-term continuous monitoring (LTCM) of physiological electrical signals is an effective means for detecting several cardiovascular diseases. However, the integrated challenges of stable adhesion, low impedance, and robust durability under different skin conditions significantly hinder the application of flexible electrodes in LTCM. This paper proposes a structured electrode inspired by the treefrog web, comprising dispersed pillars at the bottom and asymmetric cone holes at the top. Attachment structures with a dispersed pillar improve the contact stability (adhesion increases 2.79/13.16 times in dry/wet conditions compared to an electrode without structure). Improved permeable duct structure provides high permeability (12 times compared to cotton). Due to high adhesion and permeability, the electrode's durability is 40 times larger than commercial Ag/AgCl electrodes. The treefrog web-like electrode has great advantages in permeability, adhesion, and durability, resulting in prospects for application in physiological electrical signal detection and a new design idea for LTCM wearable dry electrodes.

Polymer Bioelectronics: A Solution for Both Stimulating and Recording Electrodes

The advent of closed-loop bionics has created a demand for electrode materials that are ideal for both stimulating and recording applications. The growing complexity and diminishing size of implantable devices for neural interfaces have moved beyond what can be achieved with conventional metallic electrode materials. Polymeric electrode materials are a recent development based on polymer composites of organic conductors such as conductive polymers. These materials present exciting new opportunities in the design and fabrication of next-generation electrode arrays which can overcome the electrochemical and mechanical limitations of conventional electrode materials. This review will examine the recent developments in polymeric electrode materials, their application as stimulating and recording electrodes in bionic devices, and their impact on the development of soft, conformal, and high-density neural interfaces.

Materials and Structural Designs toward Motion Artifact-Free Bioelectronics

Bioelectronics encompassing electronic components and circuits for accessing human information play a vital role in real-time and continuous monitoring of biophysiological signals of electrophysiology, mechanical physiology, and electrochemical physiology. However, mechanical noise, particularly motion artifacts, poses a significant challenge in accurately detecting and analyzing target signals. While software-based "postprocessing" methods and signal filtering techniques have been widely employed, challenges such as signal distortion, major requirement of accurate models for classification, power consumption, and data delay inevitably persist. This review presents an overview of noise reduction strategies in bioelectronics, focusing on reducing motion artifacts and improving the signal-to-noise ratio through hardware-based approaches such as "preprocessing". One of the main stress-avoiding strategies is reducing elastic mechanical energies applied to bioelectronics to prevent stress-induced motion artifacts. Various approaches including strain-compliance, strain-resistance, and stress-damping techniques using unique materials and structures have been explored. Future research should optimize materials and structure designs, establish stable processes and measurement methods, and develop techniques for selectively separating and processing overlapping noises. Ultimately, these advancements will contribute to the development of more reliable and effective bioelectronics for healthcare monitoring and diagnostics.

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.

Solvent-Free and Cost-Efficient Fabrication of a High-Performance Nanocomposite Sensor for Recording of Electrophysiological Signals

Carbon nanotube (CNT)-based nanocomposites have found applications in making sensors for various types of physiological sensing. However, the sensors' fabrication process is usually complex, multistep, and requires longtime mixing and hazardous solvents that can be harmful to the environment. Here, we report a flexible dry silver (Ag)/CNT/polydimethylsiloxane (PDMS) nanocomposite-based sensor made by a solvent-free, low-temperature, time-effective, and simple approach for electrophysiological recording. By mechanical compression and thermal treatment of Ag/CNT, a connected conductive network of the fillers was formed, after which the PDMS was added as a polymer matrix. The CNTs make a continuous network for electrons transport, endowing the nanocomposite with high electrical conductivity, mechanical strength, and durability. This process is solvent-free and does not require a high temperature or complex mixing procedure. The sensor shows high flexibility and good conductivity. High-quality electroencephalography (EEG) and electrooculography (EOG) were performed using fabricated dry sensors. Our results show that the Ag/CNT/PDMS sensor has comparable skin-sensor interface impedance with commercial Ag/AgCl-coated dry electrodes, better performance for noninvasive electrophysiological signal recording, and a higher signal-to-noise ratio (SNR) even after 8 months of storage. The SNR of electrophysiological signal recording was measured to be 26.83 dB for our developed sensors versus 25.23 dB for commercial Ag/AgCl-coated dry electrodes. Our process of compress-heating the functional fillers provides a universal approach to fabricate various types of nanocomposites with different nanofillers and desired electrical and mechanical properties.

Active Claw-Shaped Dry Electrodes for EEG Measurement in Hair Areas

EEG, which can provide brain alteration information via recording the electrical activity of neurons in the cerebral cortex, has been widely used in neurophysiology. However, conventional wet electrodes in EEG monitoring typically suffer from inherent limitations, including the requirement of skin pretreatment, the risk of superficial skin infections, and signal performance deterioration that may occur over time due to the air drying of the conductive gel. Although the emergence of dry electrodes has overcome these shortcomings, their electrode-skin contact impedance is significantly high and unstable, especially in hair-covered areas. To address the above problems, an active claw-shaped dry electrode is designed, moving from electrode morphological design, slurry preparation, and coating to active electrode circuit design. The active claw-shaped dry electrode, which consists of a claw-shaped electrode and active electrode circuit, is dedicated to offering a flexible solution for elevating electrode fittings on the scalp in hair-covered areas, reducing electrode-skin contact impedance and thus improving the quality of the acquired EEG signal. The performance of the proposed electrodes was verified by impedance, active electrode circuit, eyes open-closed, steady-state visually evoked potential (SSVEP), and anti-interference tests, based on EEG signal acquisition. Experimental results show that the proposed claw-shaped electrodes (without active circuit) can offer a better fit between the scalp and electrodes, with a low electrode-skin contact impedance (18.62 KΩ@1 Hz in the hairless region and 122.15 KΩ@1 Hz in the hair-covered region). In addition, with the active circuit, the signal-to-noise ratio (SNR) of the acquiring EEG signal was improved and power frequency interference was restrained, therefore, the proposed electrodes can yield an EEG signal quality comparable to wet electrodes.

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

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

The Three-Lead EEG Sensor: Introducing an EEG-Assisted Depression Diagnosis System Based on Ant Lion Optimization

For depression diagnosis, traditional methods such as interviews and clinical scales have been widely leveraged in the past few decades, but they are subjective, time-consuming, and labor-consuming. With the development of affective computing and Artificial Intelligence (AI) technologies, Electroencephalogram (EEG)-based depression detection methods have emerged. However, previous research has virtually neglected practical application scenarios, as most studies have focused on analyzing and modeling EEG data. Furthermore, EEG data is typically obtained from specialized devices that are large, complex to operate, and poorly ubiquitous. To address these challenges, a wearable three-lead EEG sensor with flexible electrodes was developed to obtain prefrontal-lobe EEG data. Experimental measurements show that the EEG sensor achieves promising performance (background noise of no more than 0.91 μVpp, Signal-to-Noise Ratio (SNR) of 26--48 dB, and electrode-skin contact impedance of less than 1 K Ω). In addition, EEG data from 70 depressed patients and 108 healthy controls were collected using the EEG sensor, and the linear and nonlinear features were extracted. The features were then weighted and selected using the Ant Lion Optimization (ALO) algorithm to improve classification performance. The experimental results show that the k-NN classifier achieves a classification accuracy of 90.70%, specificity of 96.53%, and sensitivity of 81.79%, indicating the promising potential of the three-lead EEG sensor combined with the ALO algorithm and the k-NN classifier for EEG-assisted depression diagnosis.

Fabrication and Evaluation of Embroidery-Based Electrode for EMG Smart Wear Using Moss Stitch Technique

Wearable 2.0 research has been conducted on the manufacture of smart fitness wear that collects bio-signals through the wearing of a textile-based electrode. Among them, the electromyography (EMG) suit measures the electrical signals generated by the muscles to check their activity, such as contraction and relaxation. General gel-type electrodes have been reported to cause skin diseases due to an uncomfortable feel and skin irritation when attached to the skin for a long time. Dry electrodes of various materials are being developed to solve this problem. Previous research has reported EMG detectio performance and conducted economic comparisons according to the size and shape of the embroidery electrode. On the other hand, these embroidery electrodes still have foreign body sensations. In this study, a moss sEMG electrode was produced with various shapes (W3 and WF) and loop lengths (1-5 mm). The optimized conditions of the embroidery-based electrodes were derived and analyzed with the tactile comfort factors and sensing performances. As the loop length of the electrode increased, MIU and Qmax increased, but the SMD decreased due to the free movement of the threads constituting the loop. Impedance and sEMG detection performance showed different trends depending on the electrode type.

Flexible Electrodes for Brain-Computer Interface System

Brain-computer interface (BCI) has been the subject of extensive research recently. Governments and companies have substantially invested in relevant research and applications. The restoration of communication and motor function, the treatment of psychological disorders, gaming, and other daily and therapeutic applications all benefit from BCI. The electrodes hold the key to the essential, fundamental BCI precondition of electrical brain activity detection and delivery. However, the traditional rigid electrodes are limited due to their mismatch in Young's modulus, potential damages to the human body, and a decline in signal quality with time. These factors make the development of flexible electrodes vital and urgent. Flexible electrodes made of soft materials have grown in popularity in recent years as an alternative to conventional rigid electrodes because they offer greater conformance, the potential for higher signal-to-noise ratio (SNR) signals, and a wider range of applications. Therefore, the latest classifications and future developmental directions of fabricating these flexible electrodes are explored in this paper to further encourage the speedy advent of flexible electrodes for BCI. In summary, the perspectives and future outlook for this developing discipline are provided.

A Film Electrode upon Nanoarchitectonics of Bacterial Cellulose and Conductive Fabric for Forehead Electroencephalogram Measurement

In this paper, we present a soft and moisturizing film electrode based on bacterial cellulose and Ag/AgCl conductive cloth as a potential replacement for gel electrode patches in electroencephalogram (EEG) recording. The electrode materials are entirely flexible, and the bacterial cellulose membrane facilitates convenient adherence to the skin. EEG signals are transmitted from the skin to the bacterial cellulose first and then transferred to the Ag/AgCl conductive cloth connected to the amplifier. The water in the bacterial cellulose moisturizes the skin continuously, reducing the contact impedance to less than 10 kΩ, which is lower than commercial gel electrode patches. The contact impedance and equivalent circuits indicate that the bacterial cellulose electrode effectively reduces skin impedance. Moreover, the bacterial cellulose electrode exhibits lower noise than the gel electrode patch. The bacterial cellulose electrode has demonstrated success in collecting α rhythms. When recording EEG signals, the bacterial cellulose electrode and gel electrode have an average coherence of 0.86, indicating that they have similar performance across different EEG bands. Compared with current mainstream conductive rubber dry electrodes, gel electrodes, and conductive cloth electrodes, the bacterial cellulose electrode has obvious advantages in terms of contact impedance. The bacterial cellulose electrode does not cause skin discomfort after long-term recording, making it more suitable for applications with strict requirements for skin affinity than gel electrode patches.

Adhesive Wearable Sensors for Electroencephalography from Hairy Scalp

Electroencephalography has garnered interest for applications in mobile healthcare, human-machine interfaces, and Internet of Things. Conventional electroencephalography relies on wet and dry electrodes. Despite favorable interface impedance of wet electrodes and skin, the application of a large amount of gel at their interface with skin limits the electroencephalography spatial resolution, increases the risk of shorting between electrodes, and makes them unsuited for long-term mobile recording. In contrast, dry electrodes are better suited for long-term recordings but susceptible to motion artifacts. In addition, both wet and dry electrodes are non-adhesive to the hairy scalp and mechanical support, or chemical adhesives are used to hold them in place. Herein, a conical microstructure array (CMSA) based sensor made of carbon nanotube-polydimethylsiloxane composite is reported. The CMSA sensor is fabricated using the innovative, cost-effective, and scalable method of viscosity-controlled dip-pull process. The sensor adheres to the hairy scalp by generating negative pressure in its conical microstructures when it is pressed against scalp. Aided by the application of a trace amount of gel, CMSA sensor establishes good electrical contact with the skin, enabling its applications in mobile electroencephalography over extended periods. Notably, the signal quality of CMSA sensors is comparable to that of medical-grade wet gel electrodes.

Facile Transfer of Spray-Coated Ultrathin AgNWs Composite onto the Skin for Electrophysiological Sensors

Disposable wearable sensors that ultrathin and conformable to the skin are of significant interest as affordable and easy-to-use devices for short-term recording. This study presents a facile and low-cost method for transferring spray-coated silver nanowire (AgNW) composite films onto human skin using glossy paper (GP) and liquid bandages (LB). Due to the moderately hydrophobic and rough surface of the GP, the ultrathin AgNWs composite film (~200 nm) was easily transferred onto human skin. The AgNW composite films conformally attached to the skin when applied with a LB, resulting in the stable and continuous recording of wearable electrophysiological signals, including electromyogram (EMG), electrocardiogram (ECG), and electrooculogram (EOG). The volatile LB, deposited on the skin via spray coating, promoted rapid adhesion of the transferred AgNW composite films, ensuring stability to the AgNWs in external environments. The AgNWs composite supported with the LB film exhibited high water vapor breathability (~28 gm-2h-1), which can avoid the accumulation of sweat at the skin-sensor interface. This approach facilitates the creation of rapid, low-cost, and disposable tattoo-like sensors that are practical for extended use.

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.

Advances in Electrode Materials for Scalp, Forehead, and Ear EEG: A Mini-Review

Electroencephalogram (EEG) records the electrical activity of neurons in the cerebral cortex and is used extensively to diagnose, treat, and monitor psychiatric and neurological conditions. Reliable contact between the skin and the electrodes is essential for achieving consistency and for obtaining electroencephalographic information. There has been an increasing demand for effective equipment and electrodes to overcome the time-consuming and cumbersome application of traditional systems. Recently, ear-centered EEG has met with growing interest since it can provide good signal quality due to the proximity of the ear to the brain. In addition, it can facilitate mobile and unobtrusive usage due to its smaller size and ease of use, since it can be used without interfering with the patient's daily activities. The purpose of this mini-review is to first introduce the broad range of electrodes used in conventional (scalp) EEG and subsequently discuss the state-of-the-art literature about around- and in-the-ear EEG.

Aerogel-Based Biomaterials for Biomedical Applications: From Fabrication Methods to Disease-Targeting Applications

Aerogel-based biomaterials are increasingly being considered for biomedical applications due to their unique properties such as high porosity, hierarchical porous network, and large specific pore surface area. Depending on the pore size of the aerogel, biological effects such as cell adhesion, fluid absorption, oxygen permeability, and metabolite exchange can be altered. Based on the diverse potential of aerogels in biomedical applications, this paper provides a comprehensive review of fabrication processes including sol-gel, aging, drying, and self-assembly along with the materials that can be used to form aerogels. In addition to the technology utilizing aerogel itself, it also provides insight into the applicability of aerogel based on additive manufacturing technology. To this end, how microfluidic-based technologies and 3D printing can be combined with aerogel-based materials for biomedical applications is discussed. Furthermore, previously reported examples of aerogels for regenerative medicine and biomedical applications are thoroughly reviewed. A wide range of applications with aerogels including wound healing, drug delivery, tissue engineering, and diagnostics are demonstrated. Finally, the prospects for aerogel-based biomedical applications are presented. The understanding of the fabrication, modification, and applicability of aerogels through this study is expected to shed light on the biomedical utilization of aerogels.

Soft, adhesive and conductive composite for electroencephalogram signal quality improvement

Since electroencephalogram (EEG) is a very small electrical signal from the brain, it is very vulnerable to external noise or motion artifact, making it difficult to measure. Therefore, despite the excellent convenience of dry electrodes, wet electrodes have been used. To solve this problem, self-adhesive and conductive composites using carbon nanotubes (CNTs) in adhesive polydimethylsiloxane (aPDMS), which can have the advantages of both dry and wet electrodes, have been developed by mixing them uniformly with methyl group-terminated PDMS. The CNT/aPDMS composite has a low Young's modulus, penetrates the skin well, has a high contact area, and excellent adhesion and conductivity, so the signal quality is enhanced. As a result of the EEG measurement test, although it was a dry electrode, results comparable to those of a wet electrode were obtained in terms of impedance and motion noise. It also shows excellent biocompatibility in a human fibroblast cell test and a week-long skin reaction test, so it can measure EEG with high signal quality for a long period of time.

Hairy-Skin-Adaptive Viscoelastic Dry Electrodes for Long-Term Electrophysiological Monitoring

Long-term epidermal electrophysiological (EP) monitoring is crucial for disease diagnosis and human-machine synergy. The human skin is covered with hair that grows at an average rate of 0.3 mm per day. This impedes a stable contact between the skin and dry epidermal electrodes, resulting in motion artifacts during ultralong-term EP monitoring. Therefore, accurate and high-quality EP signal detection remains challenging. To address this issue, a new solution-the hairy-skin-adaptive viscoelastic dry electrode (VDE) is reported. This innovative technology is capable of bypassing hair and filling into the skin wrinkles, leading to long-lasting and stable interface impedance. The VDE maintains a stable interface impedance for a remarkable period of 48 days and 100 cycles. The VDE is highly effective in shielding against hair disturbances in electrocardiography (ECG) monitoring, even during intense chest expansion, and in electromyography (EMG) monitoring during large strain. Furthermore, the VDE is easily attachable to the skull without requiring any electroencephalogram (EEG) cap or bandage, making it an ideal solution for EEG monitoring. This work represents a substantial breakthrough in the field of EP monitoring, providing a solution for the previously challenging issue of monitoring human EP signals on hairy skin.

A Review of Skin-Wearable Sensors for Non-Invasive Health Monitoring Applications

The early detection of fatal diseases is crucial for medical diagnostics and treatment, both of which benefit the individual and society. Portable devices, such as thermometers and blood pressure monitors, and large instruments, such as computed tomography (CT) and X-ray scanners, have already been implemented to collect health-related information. However, collecting health information using conventional medical equipment at home or in a hospital can be inefficient and can potentially affect the timeliness of treatment. Therefore, on-time vital signal collection via healthcare monitoring has received increasing attention. As the largest organ of the human body, skin delivers significant signals reflecting our health condition; thus, receiving vital signals directly from the skin offers the opportunity for accessible and versatile non-invasive monitoring. In particular, emerging flexible and stretchable electronics demonstrate the capability of skin-like devices for on-time and continuous long-term health monitoring. Compared to traditional electronic devices, this type of device has better mechanical properties, such as skin conformal attachment, and maintains compatible detectability. This review divides the health information that can be obtained from skin using the sensor aspect's input energy forms into five categories: thermoelectrical signals, neural electrical signals, photoelectrical signals, electrochemical signals, and mechanical pressure signals. We then summarize current skin-wearable health monitoring devices and provide outlooks on future development.

Printed dry electrode for neuromuscular electrical stimulation (NMES) for e-textile

Muscle atrophy is a well-known consequence of immobilization and critical illness, leading to prolonged rehabilitation and increased mortality. In this study, we develop a solution to preserve muscle mass using customized biocompatible neuromuscular electrical stimulation (NMES) device. Commercially available NMES solutions with gel-based electrodes often lead to skin irritation. We demonstrate the printing of conducting electrodes on a compressive stocking textile that can be used for more than seven days without observing any inflammation. This solution consists of a dry and biocompatible electrode directly integrated into the textile with good mechanical compatibility with skin (Young's modulus of 0.39 MPa). The surface roughness of the underlying substrate plays a significant role in obtaining good print quality. Electrochemical Impedance Spectroscopy (EIS) analysis showed that the printed electrode showed better performance than the commercial ones based on a matched interfacial performance and improved series resistance. Furthermore, we investigated our NMES solution in a hospital setting to evaluate its effectiveness on muscle atrophy, with promising results.

Wet-Adhesive Multifunctional Hydrogel with Anti-swelling and a Skin-Seamless Interface for Underwater Electrophysiological Monitoring and Communication

A stable and seamless adhesion between the human skin and the hydrogel-based electronic skin is necessary for accurate sensing and human health monitoring in aquatic environments. Despite achieving significant progress in this field, it remains a great challenge to design skin-interfaced conductive hydrogels with high electrical conductivity, stablility, and seamless underwater adhesion to skin. Herein, a skin-inspired conductive multifunctional hydrogel is proposed, which has a wet-adhesive/hydrophilic and a non-adhesive/hydrophobic bilayer structure. The hydrogel shows high stretchability (∼2400%) and an ultra-low modulus (4.5 kPa), which facilitate the conformal and seamless attachment of the hydrogel to the skin with reduced motion artifacts. Owing to synergistic physical and chemical interactions, this hydrogel can achieve reliable underwater adhesion and display remarkable underwater adhesion strength (388.1 kPa) to porcine skin. In addition, MXene has been employed to obtain high electrical conductivity, create a route for stable electron transport, and reinforce mechanical properties. The hydrogel also possesses self-healing ability, a low swelling ratio (∼3.8%), biocompatibility, and specific adhesion to biological tissues in water. Facilitated with these advantages, the hydrogel-based electrodes achieve reliable electrophysiological signal detection in both air and wet conditions and demonstrate a higher signal-to-noise ratio (28.3 dB) than that of commercial Ag/AgCl gel electrodes (18.5 dB). Also, the hydrogel can be utilized as a strain sensor with high sensitivity for underwater communication. This multifunctional hydrogel improves the stability of the skin-hydrogel interface in aquatic environments and is expected to be promising for the next-generation bio-integrated electronics.

End-User Assessment of an Innovative Clothing-Based Sensor Developed for Pressure Injury Prevention: A Mixed-Method Study

This study aimed to evaluate a clothing prototype that incorporates sensors for the evaluation of pressure, temperature, and humidity for the prevention of pressure injuries, namely regarding physical and comfort requirements. A mixed-method approach was used with concurrent quantitative and qualitative data triangulation. A structured questionnaire was applied before a focus group of experts to evaluate the sensor prototypes. Data were analyzed using descriptive and inferential statistics and the discourse of the collective subject, followed by method integration and meta-inferences. Nine nurses, experts in this topic, aged 32.66 ± 6.28 years and with a time of profession of 10.88 ± 6.19 years, participated in the study. Prototype A presented low evaluation in stiffness (1.56 ± 1.01) and roughness (2.11 ± 1.17). Prototype B showed smaller values in dimension (2.77 ± 0.83) and stiffness (3.00 ± 1.22). Embroidery was assessed as inadequate in terms of stiffness (1.88 ± 1.05) and roughness (2.44 ± 1.01). The results from the questionnaires and focus groups' show low adequacy as to stiffness, roughness, and comfort. The participants highlighted the need for improvements regarding stiffness and comfort, suggesting new proposals for the development of sensors for clothing. The main conclusions are that Prototype A presented the lowest average scores relative to rigidity (1.56 ± 1.01), considered inadequate. This dimension of Prototype B was evaluated as slightly adequate (2.77 ± 0.83). The rigidity (1.88 ± 1.05) of Prototype A + B + embroidery was evaluated as inadequate. The prototype revealed clothing sensors with low adequacy regarding the physical requirements, such as stiffness or roughness. Improvements are needed regarding the stiffness and roughness for the safety and comfort characteristics of the device evaluated.

Biomedical Silicones: Leveraging Additive Strategies to Propel Modern Utility

Silicones have a long history of use in biomedical devices, with unique properties stemming from the siloxane (Si-O-Si) backbone that feature a high degree of flexibility and chemical stability. However, surface, rheological, mechanical, and electrical properties of silicones can limit their utility. Successful modification of silicones to address these limitations could lead to superior and new biomedical devices. Toward improving such properties, recent additive strategies have been leveraged to modify biomedical silicones and are highlighted herein.

Soft Fiber Electronics Based on Semiconducting Polymer

Fibers, originating from nature and mastered by human, have woven their way throughout the entire history of human civilization. Recent developments in semiconducting polymer materials have further endowed fibers and textiles with various electronic functions, which are attractive in applications such as information interfacing, personalized medicine, and clean energy. Owing to their ability to be easily integrated into daily life, soft fiber electronics based on semiconducting polymers have gained popularity recently for wearable and implantable applications. Herein, we present a review of the previous and current progress in semiconducting polymer-based fiber electronics, particularly focusing on smart-wearable and implantable areas. First, we provide a brief overview of semiconducting polymers from the viewpoint of materials based on the basic concepts and functionality requirements of different devices. Then we analyze the existing applications and associated devices such as information interfaces, healthcare and medicine, and energy conversion and storage. The working principle and performance of semiconducting polymer-based fiber devices are summarized. Furthermore, we focus on the fabrication techniques of fiber devices. Based on the continuous fabrication of one-dimensional fiber and yarn, we introduce two- and three-dimensional fabric fabricating methods. Finally, we review challenges and relevant perspectives and potential solutions to address the related problems.

Wearable System Based on Ultra-Thin Parylene C Tattoo Electrodes for EEG Recording

In an increasingly interconnected world, where electronic devices permeate every aspect of our lives, wearable systems aimed at monitoring physiological signals are rapidly taking over the sport and fitness domain, as well as biomedical fields such as rehabilitation and prosthetics. With the intent of providing a novel approach to the field, in this paper we discuss the development of a wearable system for the acquisition of EEG signals based on a portable, low-power custom PCB specifically designed to be used in combination with non-conventional ultra-conformable and imperceptible Parylene-C tattoo electrodes. The proposed system has been tested in a standard rest-state experiment, and its performance in terms of discrimination of two different states has been compared to that of a commercial wearable device for EEG signal acquisition (i.e., the Muse headset), showing comparable results. This first preliminary validation demonstrates the possibility of conveniently employing ultra-conformable tattoo-electrodes integrated portable systems for the unobtrusive acquisition of brain activity.

Biomimetic Patch with Wicking-Breathable and Multi-mechanism Adhesion for Bioelectrical Signal Monitoring

Wearable bioelectrical monitoring devices can provide long-term human health information such as electrocardiogram and other physiological signals. It is a crucial part of the remote medical system. These can provide prediction for the diagnosis and treatment of cardiovascular disease and access to timely treatment. However, the patch comfort of the wearable monitoring devices in long-term contact with the skin have been a technical bottleneck of the hardware. In this study, the biomimetic patch with wicking-breathable and multi-mechanism adhesion performance to achieve adaptability and comfortability to human skin has been reported. The patch was designed based on a conical through-hole and hexagonal microgroove to directionally transport sweat from skin to air which gives the patch the breathable performance. The breathable and drainage capability of the biomimetic patch was experimentally verified by analyzing the conical through-hole and hexagonal microgroove with the structural mechanism of wicking. Multi-mechanism adhesion of the Ag/Ni microneedle array and PDMS-t adhesion material ensures the stability of patch signal acquisition. This study provides a new way for enhancing the breathability and adaptability of the patch to realize accurate bioelectrical signal monitoring under sweat conditions on human skin.

Hybrid 1D/2D nanocarbon-based conducting polymer nanocomposites for high-performance wearable electrodes

A low interfacial contact resistance is a challenge in polymer nanocomposites based on conductive nanomaterials for high-performance wearable electrode applications. Herein, a polydimethylsiloxane (PDMS)-based flexible nanocomposite incorporating high-conductivity 1D single-walled carbon nanotubes (SWCNTs) and 2D reduced graphene oxide (r-GO) was developed for high-performance electrocardiogram (ECG) wearable electrodes. A PDMS-SWCNT (P-SW; type I) nanocomposite containing only SWCNTs (2 wt%), exhibited rough and non-uniform surface morphology owing to the strong bundling effect of as-grown SWCNTs and randomly entangled aggregate structures and because of inefficient vacuum degassing (i.e., R _P-SW = 1871 Ω). In contrast, owing to the hybrid structure of the SWCNTs (1 wt%) and r-GO (1 wt%), the PDMS-SWCNTs/r-GO (P-SW/r-GO; type II) nanocomposite exhibited uniform surface characteristics and low contact resistance (i.e., R _P-SW/r-GO = 63 Ω) through the formation of hybrid and long conducting pathways. The optimized nanocomposite (P-SW/r-GO/f; type III) possessed a fabric-assisted structure that enabled tunable and efficient vacuum degassing and curing conditions. Additionally, a long and wide conducting pathway was formed through more uniform and dense interconnected structures, and the contact resistance was drastically reduced (i.e., R _P-SW/r-GO/f = 15 Ω). The performance of the electrodes fabricated using the optimized nanocomposites was the same or higher than that of commercial Ag/AgCl gel electrodes during real-time measurement for ECG Bluetooth monitoring. The developed high-performance hybrid conducting polymer electrodes are expected to contribute significantly to the expansion of the application scope of wearable electronic devices and wireless personal health monitoring systems.

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

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

Textile-Integrated Liquid Metal Electrodes for Electrophysiological Monitoring

Next generation textile-based wearable sensing systems will require flexibility and strength to maintain capabilities over a wide range of deformations. However, current material sets used for textile-based skin contacting electrodes lack these key properties, which hinder applications such as electrophysiological sensing. In this work, a facile spray coating approach to integrate liquid metal nanoparticle systems into textile form factors for conformal, flexible, and robust electrodes is presented. The liquid metal system employs functionalized liquid metal nanoparticles that provide a simple "peel-off to activate" means of imparting conductivity. The spray coating approach combined with the functionalized liquid metal system enables the creation of long-term reusable textile-integrated liquid metal electrodes (TILEs). Although the TILEs are dry electrodes by nature, they show equal skin-electrode impedances and sensing capabilities with improved wearability compared to commercial wet electrodes. Biocompatibility of TILEs in an in vivo skin environment is demonstrated, while providing improved sensing performance compared to previously reported textile-based dry electrodes. The "spray on dry-behave like wet" characteristics of TILEs opens opportunities for textile-based wearable health monitoring, haptics, and augmented/virtual reality applications that require the use of flexible and conformable dry electrodes.

Stretchable Sponge Electrodes for Long-Term and Motion-Artifact-Tolerant Recording of High-Quality Electrophysiologic Signals

Soft electronic devices and sensors have shown great potential for wearable and ambulatory electrophysiologic signal monitoring applications due to their light weight, ability to conform to human skin, and improved wearing comfort, and they may replace the conventional rigid electrodes and bulky recording devices widely used nowadays in clinical settings. Herein, we report an elastomeric sponge electrode that offers greatly reduced electrode-skin contact impedance, an improved signal-to-noise ratio (SNR), and is ideally suited for long-term and motion-artifact-tolerant recording of high-quality biopotential signals. The sponge electrode utilizes a porous polydimethylsiloxane sponge made from a sacrificial template of sugar cubes, and it is subsequently coated with a poly(3,4-ethylenedioxythiophene) polystyrenesulfonate (PEDOT:PSS) conductive polymer using a simple dip-coating process. The sponge electrode contains numerous micropores that greatly increase the skin-electrode contact area and help lower the contact impedance by a factor of 5.25 or 6.7 compared to planar PEDOT:PSS electrodes or gold-standard Ag/AgCl electrodes, respectively. The lowering of contact impedance resulted in high-quality electrocardiogram (ECG) and electromyogram (EMG) recordings with improved SNR. Furthermore, the porous structure also allows the sponge electrode to hold significantly more conductive gel compared to conventional planar electrodes, thereby allowing them to be used for long recording sessions with minimal signal degradation. The conductive gel absorbed into the micropores also serves as a buffer layer to help mitigate motion artifacts, which is crucial for recording on ambulatory patients. Lastly, to demonstrate its feasibility and potential for clinical usage, we have shown that the sponge electrode can be used to monitor uterine contraction activities from a patient in labor. With its low-cost fabrication, softness, and ability to record high SNR biopotential signals, the sponge electrode is a promising platform for long-term wearable health monitoring applications.

Ordered Nanopillar Arrays of Low Dynamic Noise Dry Bioelectrodes for Electrocardiogram Surface Monitoring

Flexible bioelectric dry electrodes are an important part of long-term medical healthcare monitoring systems. In this study, a new method is proposed for the preparation of dry electrodes with micronanopillar arrays structured by designing dimensionally tunable anodized aluminum oxide (AAO) templates, by which polyaniline/thermoplastic polyurethane single-layer micronanopillar array structured dry electrodes (PANI/TPU-SE) and polyaniline/thermoplastic polyurethane double-layer micronanopillar array structured dry electrodes (PANI/TPU-DE) are prepared. Compared with the planar structure, the micronanopillar array structure can reduce the contact gap between the electrode and skin and increase the contact area, thus exhibiting lower contact impedance and higher signal quality. At 0.1 Hz, the impedances of the wet electrode, PANI/TPU-DE300, PANI/TPU-SE10, and planar structure electrodes are 269.5 kΩ, 375.5 kΩ, 398.1 kΩ, and 2.257 MΩ, respectively, and the impedance value for PANI/TPU-DE300 is smaller than that for PANI/TPU-SE10 and closer to that for the wet electrode. In addition, because the surface of the micronanostructure can conform to the human skin, about 210.7% increase in the peel strength of double-layer structure electrodes compared to flat structure electrodes, it shows a low baseline drift in the dynamic ECG measurement, and the signal-to-noise ratio in the walking state can reach 21.33 ± 5.4775 dB. Therefore, the prepared bioelectric dry electrode has a wide application prospect in the fields of wearable medical monitoring.

Blended Polymer Dry Electrodes for Reliable Electrocardiogram and Electromyogram Measurements and Their Eco-Friendly Disposal Led by Degradability in Hot Water

To increase the human lifespan, healthcare monitoring devices that diagnose diseases and check body conditions have attracted considerable interest. Commercial AgCl-based wet electrodes with the advantages of high conductivity and strong adaptability to human skin are considered the most frequently used electrode material for healthcare monitoring. However, commercial AgCl-based wet electrodes, when exposed for a long period, cause an evaporation of organic solvents, which could reduce the signal-to-noise ratio of biosignals and stimulate human skin. In this context, we demonstrate a dry electrode for a poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS)-based blended polymer electrode using a combination of PEDOT:PSS, waterborne polyurethane (WPU) and ethylene glycol (EG) that could be reused for a long period of time to detect electrocardiography (ECG) and electromyography (EMG). Both ECG and EMG are reliably detected by the wireless real-time monitoring system. In particular, the proposed dry electrode detects biosignals without deterioration for over 2 weeks. Additionally, a double layer of a polyimide (PI) substrate and fluorinated polymer CYTOP induces the strong waterproof characteristics of external liquids for the proposed dry electrodes, having a low surface energy of 14.49 mN/m. In addition, the proposed electrode has excellent degradability in water; it dissolves in hot water at 60 °C.

Development and Characterization of Embroidery-Based Textile Electrodes for Surface EMG Detection

The interest in wearable devices has expanded to measurement devices for building IoT-based mobile healthcare systems and sensing bio-signal data through clothing. Surface electromyography, called sEMG, is one of the most popular bio-signals that can be applied to health monitoring systems. In general, gel-based (Ag/AgCl) electrodes are mainly used, but there are problems, such as skin irritation due to long-time wearing, deterioration of adhesion to the skin due to moisture or sweat, and low applicability to clothes. Hence, research on dry electrodes as a replacement is increasing. Accordingly, in this study, a textile-based electrode was produced with a range of electrode shapes, and areas were embroidered with conductive yarn using an embroidery technique in the clothing manufacturing process. The electrode was applied to EMG smart clothing for fitness, and the EMG signal detection performance was analyzed. The electrode shape was manufactured using the circle and wave type. The wave-type electrode was more morphologically stable than the circle-type electrode by up to 30% strain, and the electrode shape was maintained as the embroidered area increased. Skin-electrode impedance analysis confirmed that the embroidered area with conductive yarn affected the skin contact area, and the impedance decreased with increasing area. For sEMG performance analysis, the rectus femoris was selected as a target muscle, and the sEMG parameters were analyzed. The wave-type sample showed higher EMG signal strength than the circle-type. In particular, the electrode with three lines showed better performance than the fill-type electrode. These performances operated without noise, even with a commercial device. Therefore, it is expected to be applicable to the manufacture of electromyography smart clothing based on embroidered electrodes in the future.

High-Performance Flexible Microneedle Array as a Low-Impedance Surface Biopotential Dry Electrode for Wearable Electrophysiological Recording and Polysomnography

Polyimide-based flexible microneedle array (PI-MNA) electrodes realize high electrical/mechanical performance and are compatible with wearable wireless recording systems. The normalized electrode-skin interface impedance (EII) of the PI-MNA electrodes reaches 0.98 kΩ cm² at 1 kHz and 1.50 kΩ cm² at 10 Hz, approximately 1/250 of clinical standard electrodes. This is the first report on the clinical study of microneedle electrodes. The PI-MNA electrodes are applied to clinical long-term continuous monitoring for polysomnography. Microneedle array (MNA) electrodes are an effective solution to achieve high-quality surface biopotential recording without the coordination of conductive gel and are thus very suitable for long-term wearable applications. Existing schemes are limited by flexibility, biosafety, and manufacturing costs, which create large barriers for wider applications. Here, we present a novel flexible MNA electrode that can simultaneously achieve flexibility of the substrate to fit a curved body surface, robustness of microneedles to penetrate the skin without fracture, and a simplified process to allow mass production. The compatibility with wearable wireless systems and the short preparation time of the electrodes significantly improves the comfort and convenience of electrophysiological recording. The normalized electrode-skin contact impedance reaches 0.98 kΩ cm² at 1 kHz and 1.50 kΩ cm² at 10 Hz, a record low value compared to previous reports and approximately 1/250 of the standard electrodes. The morphology, biosafety, and electrical/mechanical properties are fully characterized, and wearable recordings with a high signal-to-noise ratio and low motion artifacts are realized. The first reported clinical study of microneedle electrodes for surface electrophysiological monitoring was conducted in tens of healthy and sleep-disordered subjects with 44 nights of recording (over 8 h per night), providing substantial evidence that the electrodes can be leveraged to substitute for clinical standard electrodes.

Design of hydrogel-based wearable EEG electrodes for medical applications

The electroencephalogram (EEG) is considered to be a promising method for studying brain disorders. Because of its non-invasive nature, subjects take a lower risk compared to some other invasive methods, while the systems record the brain signal. With the technological advancement of neural and material engineering, we are in the process of achieving continuous monitoring of neural activity through wearable EEG. In this article, we first give a brief introduction to EEG bands, circuits, wired/wireless EEG systems, and analysis algorithms. Then, we review the most recent advances in the interfaces used for EEG recordings, focusing on hydrogel-based EEG electrodes. Specifically, the advances for important figures of merit for EEG electrodes are reviewed. Finally, we summarize the potential medical application of wearable EEG systems.

Graphene-Based Flexible Electrode for Electrocardiogram Signal Monitoring

With the rapidly aging society and increased concern for personal cardiovascular health, novel, flexible electrodes suitable for electrocardiogram (ECG) signal monitoring are in demand. Based on the excellent electrical and mechanical properties of graphene and the rapid development of graphene device fabrication technologies, graphene-based ECG electrodes have recently attracted much attention, and many flexible graphene electrodes with excellent performance have been developed. To understand the current research progress of graphene-based ECG electrodes and help researchers clarify current development conditions and directions, we systematically review the recent advances in graphene-based flexible ECG electrodes. Graphene electrodes are classified as bionic, fabric-based, biodegradable, laser-induced/scribed, modified-graphene, sponge-like, invasive, etc., based on their design concept, structural characteristics, preparation methods, and material properties. Moreover, some categories are further divided into dry or wet electrodes. Then, their performance, including electrode–skin impedance, signal-to-noise ratio, skin compatibility, and stability, is analyzed. Finally, we discuss possible development directions of graphene ECG electrodes and share our views.

Highly Conformal Polymers for Ambulatory Electrophysiological Sensing

Stable ambulatory electrophysiological sensing is widely utilized for smart e-healthcare monitoring, clinical diagnosis of cardiovascular diseases, treatment of neurological diseases, and intelligent human-machine interaction. As the favorable signal interaction platform of electrophysiological sensing, the conformal property of on-skin electrodes is an extremely crucial factor that can affect the stability of long-term ambulatory electrophysiological sensing. From the perspective of materials, to realize conformal contact between electrodes and skin for stable sensing, highly conformal polymers are strongly demanding and attracting ever-growing attention. In this review, we focused on the recent progress of highly conformal polymers for ambulatory electrophysiological sensing, including their synthetic methods, conformal property, and potential applications. Specifically, three main types of highly conformal polymers for stable long-term electrophysiological signals monitoring were proposed, including nature silk fibroin based conformal polymers, marine mussels bio-inspired conformal polymers, and other conformal polymers such as zwitterionic polymers and polyacrylamide. Furthermore, the future challenges and opportunities of preparing highly conformal polymers for on-skin electrodes were also highlighted. This article is protected by copyright. All rights reserved.

Air-Permeable Waterproofing Electrocardiogram Patch to Monitor Full-Day Activities for Multiple Days

On-skin healthcare patch-type devices have great technological challenges in monitoring full-day activities and wearing for multiple days without detachment. These challenges can be overcome when the sensor is air permeable but waterproof. This study presents a light-weight, highly stable, and stretchable Au electrode that is fabricated by sputtering on an imidized nanofiber mat. The contact surface of the electrode is hydro-wetting and the outer surface of the electrode is hydrophobic, so the porous electrode simultaneously has excellent sweat permeability and waterproofing capabilities. The electrode is applied to the electrocardiogram sensor for monitoring the cardiac signals for five consecutive days without detaching while doing various full-day activities such as relaxing, exercising, showering, and sleeping. This study suggests a modular setup of the electrodes and the cardiac signal processing unit for activating the device when cardiac monitoring is required.

Fructus Xanthii-Inspired Low Dynamic Noise Dry Bioelectrodes for Surface Monitoring of ECG

The microstructured surfaces of bioelectrical dry electrodes are important aspects of dry electrode design. However, traditional surfaces for microstructured bioelectrical dry electrodes are costly to produce and require complex fabrication methods. In this study, a novel stacked-template method is proposed for the first time, rapidly producing microstructured dry electrodes at a low cost and with a large surface area. Three types of microstructured Ag/AgCl thermoplastic polyurethane (TPU) electrodes with a Fructus xanthii-inspired barb structure (FXbs) are prepared using this method; then, the dynamic friction, hair interference resistance, electrochemical, and electrocardiogram (ECG) signal acquisition performance of the electrodes are tested, and the dynamic noise characteristics of the electrodes are comprehensively evaluated with simulated instruments. Compared to the plate structure, the dynamic friction coefficient of the FXbs electrode improved by about 38.8%, exhibiting strong hair interference resistance. In addition, the FXbs electrode exhibits low dynamic noise and comparable performance to the wet electrode, in terms of signal acquisition, when it is tested using simulated instruments. Therefore, the prepared FXbs electrode increases the friction coefficient between the electrode and the skin, which effectively resolves issues related to dynamic noise in bioelectrical signals, making it suitable for dynamic measurements.

Soft Bioelectronics Based on Nanomaterials

Recent advances in nanostructured materials and unconventional device designs have transformed the bioelectronics from a rigid and bulky form into a soft and ultrathin form and brought enormous advantages to the bioelectronics. For example, mechanical deformability of the soft bioelectronics and thus its conformal contact onto soft curved organs such as brain, heart, and skin have allowed researchers to measure high-quality biosignals, deliver real-time feedback treatments, and lower long-term side-effects in vivo. Here, we review various materials, fabrication methods, and device strategies for flexible and stretchable electronics, especially focusing on soft biointegrated electronics using nanomaterials and their composites. First, we summarize top-down material processing and bottom-up synthesis methods of various nanomaterials. Next, we discuss state-of-the-art technologies for intrinsically stretchable nanocomposites composed of nanostructured materials incorporated in elastomers or hydrogels. We also briefly discuss unconventional device design strategies for soft bioelectronics. Then individual device components for soft bioelectronics, such as biosensing, data storage, display, therapeutic stimulation, and power supply devices, are introduced. Afterward, representative application examples of the soft bioelectronics are described. A brief summary with a discussion on remaining challenges concludes the review.

Emergence of flexible technology in developing advanced systems for post-stroke rehabilitation: a comprehensive review

OBJECTIVE

Stroke is one of the most common neural disorders, which causes physical disabilities and motor impairments among its survivors. Several technologies have been developed for providing stroke rehabilitation and to assist the survivors in performing their daily life activities. Currently, the use of flexible technology (FT) for stroke rehabilitation systems is on a rise that allows the development of more compact and lightweight wearable systems, which stroke survivors can easily use for long-term activities.

APPROACH

For stroke applications, FT mainly includes the "flexible/stretchable electronics", "e-textile (electronic textile)" and "soft robotics". Thus, a thorough literature review has been performed to report the practical implementation of FT for post-stroke application.

MAIN RESULTS

In this review, the highlights of the advancement of FT in stroke rehabilitation systems are dealt with. Such systems mainly involve the "biosignal acquisition unit", "rehabilitation devices" and "assistive systems". In terms of biosignals acquisition, electroencephalography (EEG) and electromyography (EMG) are comprehensively described. For rehabilitation/assistive systems, the application of functional electrical stimulation (FES) and robotics units (exoskeleton, orthosis, etc.) have been explained.

SIGNIFICANCE

This is the first review article that compiles the different studies regarding flexible technology based post-stroke systems. Furthermore, the technological advantages, limitations, and possible future implications are also discussed to help improve and advance the flexible systems for the betterment of the stroke community.

Wireless Soft Scalp Electronics and Virtual Reality System for Motor Imagery-Based Brain-Machine Interfaces

Motor imagery offers an excellent opportunity as a stimulus-free paradigm for brain-machine interfaces. Conventional electroencephalography (EEG) for motor imagery requires a hair cap with multiple wired electrodes and messy gels, causing motion artifacts. Here, a wireless scalp electronic system with virtual reality for real-time, continuous classification of motor imagery brain signals is introduced. This low-profile, portable system integrates imperceptible microneedle electrodes and soft wireless circuits. Virtual reality addresses subject variance in detectable EEG response to motor imagery by providing clear, consistent visuals and instant biofeedback. The wearable soft system offers advantageous contact surface area and reduced electrode impedance density, resulting in significantly enhanced EEG signals and classification accuracy. The combination with convolutional neural network-machine learning provides a real-time, continuous motor imagery-based brain-machine interface. With four human subjects, the scalp electronic system offers a high classification accuracy (93.22 ± 1.33% for four classes), allowing wireless, real-time control of a virtual reality game.

Mind the gap: State-of-the-art technologies and applications for EEG-based brain-computer interfaces

Brain-computer interfaces (BCIs) provide bidirectional communication between the brain and output devices that translate user intent into function. Among the different brain imaging techniques used to operate BCIs, electroencephalography (EEG) constitutes the preferred method of choice, owing to its relative low cost, ease of use, high temporal resolution, and noninvasiveness. In recent years, significant progress in wearable technologies and computational intelligence has greatly enhanced the performance and capabilities of EEG-based BCIs (eBCIs) and propelled their migration out of the laboratory and into real-world environments. This rapid translation constitutes a paradigm shift in human-machine interaction that will deeply transform different industries in the near future, including healthcare and wellbeing, entertainment, security, education, and marketing. In this contribution, the state-of-the-art in wearable biosensing is reviewed, focusing on the development of novel electrode interfaces for long term and noninvasive EEG monitoring. Commercially available EEG platforms are surveyed, and a comparative analysis is presented based on the benefits and limitations they provide for eBCI development. Emerging applications in neuroscientific research and future trends related to the widespread implementation of eBCIs for medical and nonmedical uses are discussed. Finally, a commentary on the ethical, social, and legal concerns associated with this increasingly ubiquitous technology is provided, as well as general recommendations to address key issues related to mainstream consumer adoption.

Flexible Electrodes for In Vivo and In Vitro Electrophysiological Signal Recording

A variety of electrophysiological signals (electrocardiography, electromyography, electroencephalography, etc.) are generated during the physiological activities of human bodies, which can be collected by electrodes and thus provide critical insights into health status or facilitate fundamental scientific research. The long-term stable and high-quality recording of electrophysiological signals is the premise for their further applications, leading to demands for flexible electrodes with similar mechanical modulus and minimized irritation to human bodies. This review summarizes the latest advances in flexible electrodes for the acquisition of various electrophysiological signals. First, the concept of electrophysiological signals and the characteristics of different subcategory signals are introduced. Second, the invasive and noninvasive methods are reviewed for electrophysiological signal recording with a highlight on the design of flexible electrodes, followed by a discussion on their material selection. Subsequently, the applications of the electrophysiological signal acquisition in pathological diagnosis and restoration of body functions are discussed, showing the advantages of flexible electrodes. Finally, the main challenges and opportunities in this field are discussed. It is believed that the further exploration of materials for flexible electrodes and the combination of multidisciplinary technologies will boost the applications of flexible electrodes for medical diagnosis and human-machine interface.

Multifunctional and Ultrathin Electronic Tattoo for On-Skin Diagnostic and Therapeutic Applications

Epidermal electronic systems for detecting electrophysiological signals, sensing, therapy, and drug delivery are at the frontier in man-machine interfacing for healthcare. However, it is still a challenge to develop multifunctional bioapplications with minimal invasiveness, biocompatibility, and stable electrical performance under various mechanical deformations of biological tissues. In this study, a natural silk protein with carbon nanotubes (CNTs) is utilized to realize an epidermal electronic tattoo (E-tattoo) system for multifunctional applications that address these challenging issues through dispersing highly conductive CNTs onto the biocompatible silk nanofibrous networks with porous nature to construct skin-adhesive ultrathin electronic patches. Individual components that incorporate electrically and optically active heaters, a temperature sensor (temperature coefficient of resistance of 5.2 × 10^-3  °C^-1 ), a stimulator for drug delivery (>500 µm penetration depth in skin), and real-time electrophysiological signal detectors are described. This strategy of E-tattoos integrated onto human skin can open a new route to a next-generation electronic platform for wearable and epidermal bioapplications.