Flexible and Washable Poly(3,4-ethylenedioxythiophene): Polystyrene Sulfonate/Polyvinyl Alcohol Fabric Dry Electrode for Long-Term Electroencephalography Signals Measurement

Recent advancements in smart textiles have facilitated their extensive application in wearable health monitoring, particularly in brain activity measurement. This study introduces a flexible and washable fabric dry electroencephalography (EEG) electrode designed for brain activity measurement. The fabric dry electrode is constructed from electrically conductive polyester fabric with a resistivity of 0.09 Ω·cm, achieved by applying a PEDOT: PSS/PVA conductive paste coating on the textile substrate. A comparative analysis of the tensile properties between the conductive and untreated polyester fabric was conducted. The SEM images demonstrated that the PEDOT: PSS/PVA conductive polymer composite resulted in a uniform coating on the fabric surface. When enveloped in elastic foam, the fabric dry electrode maintained a low and stable electrode-skin contact impedance during prolonged EEG monitoring. Additionally, the short circuit noise level of the fabric dry electrode exhibited superior performance compared to both Ag/AgCl wet and finger dry electrode. The EEG signals acquired from the fabric dry electrode were comparable to those recorded by the Ag/AgCl wet electrode. Moreover, the fabric electrode effectively captured clear and reliable EEG signals, even after undergoing 10 washing cycles. The fabric dry electrode indicates good sweat resistance and biocompatibility during prolonged monitoring.

Efficacy of Various Dry Electrode-Based ECG Sensors: A Review

Long-term electrocardiogram (ECG) monitoring is crucial for detecting and diagnosing cardiovascular diseases (CVDs). Monitoring cardiac health and activities using efficient, noninvasive, and cost-effective techniques such as ECG can be vital for the early detection of different CVDs. Wet electrode-based traditional ECG techniques come with unavoidable limitations of the altered quality of ECG signals caused by gel volatilization and unwanted noise followed by dermatitis. The limitation related to the wet electrodes for long-term ECG monitoring in static and dynamic postures reminds us of the urgency of a suitable substitute. Dry electrodes promise long-term ECG monitoring with the potential for significant noise reduction. This review discusses traditional and alternative techniques to record ECG in terms of meeting the efficient detection of CVDs by conducting a detailed analysis of different types of dry electrodes along with materials (substrate, support, matrix, and conductive part) used for fabrication, followed by the number of human subjects they have been used for validation. The degradation of these electrodes has also been discussed briefly. This review finds a need for more validation on a sufficient number of subjects and the issue of cost and noise hindering the commercialization of these dry electrodes.

Stretchable Ag/AgCl Nanowire Dry Electrodes for High-Quality Multimodal Bioelectronic Sensing

Bioelectrical signal measurements play a crucial role in clinical diagnosis and continuous health monitoring. Conventional wet electrodes, however, present limitations as they are conductive gel for skin irritation and/or have inflexibility. Here, we developed a cost-effective and user-friendly stretchable dry electrode constructed with a flexible network of Ag/AgCl nanowires embedded in polydimethylsiloxane (PDMS). We compared the performance of the stretched Ag/AgCl nanowire electrode with commonly used commercial wet electrodes to measure electrocardiogram (ECG), electromyogram (EMG), and electroencephalogram (EEG) signals. All the signal-to-noise ratios (SNRs) of the as-fabricated or stretched (50% tensile strain) Ag/AgCl nanowire electrodes are higher than that measured by commercial wet electrodes as well as other dry electrodes. The evaluation of ECG signal quality through waveform segmentation, the signal quality index (SQI), and heart rate variability (HRV) reveal that both the as-fabricated and stretched Ag/AgCl nanowire electrode produce high-quality signals similar to those obtained from commercial wet electrodes. The stretchable electrode exhibits high sensitivity and dependability in measuring EMG and EEG data, successfully capturing EMG signals associated with muscle activity and clearly recording α-waves in EEG signals during eye closure. Our stretchable dry electrode shows enhanced comfort, high sensitivity, and convenience for curved surface biosignal monitoring in clinical contexts.

Skin sensing and wearable technology as tools to measure atopic dermatitis severity

Wearable medical technology encompasses a range of electronic devices that act as biosensors. Atopic dermatitis (AD) is the commonest inflammatory skin disease and represents an important area of need in which to leverage the power of wearable biosensor technology, especially as the impact of COVID-19 increases the likelihood of virtual consultations becoming an integrated part of clinical practice. The aim of this review is to systematically define the published evidence for the utility of wearable biosensors in assessment and management of atopic dermatitis (AD). A systematic literature search was conducted for publications from 1995 onwards for 'sensor' OR 'sensing' OR 'biosensor' OR 'biomarker'. Results were combined ('AND') with a search for 'wearable' OR 'actigraphy' OR 'Internet of things' OR 'microneedle' OR 'patch' OR 'e-textile' OR 'smart textile' and atopic dermatitis (MESH terms). Fifty seven abstracts were identified from the database search of which 39 were selected for detailed review. Broadly, wearable sensing systems in atopic dermatitis were split into three categories: wearable biosensor modules (actigraphy and smartwatches), clothing and integrated fabrics placed onto the epidermis and intradermal or subcutaneous sensors. The best evidence for correlation with AD disease severity was with actigraphy measurements of itch. However, newer approaches including sensing skin barrier function, inflammation and small molecule analysis as well as employing artificial intelligence offer more potential for advanced disease monitoring. Skin diseases, specifically AD, stand to benefit greatly from wearable technology, because of the ease of direct contact to the skin, the high prevalence of the disease and the large unmet need for better disease control in this group. However, important emphasis must be placed on validating the correlation of data from such technology with patient-reported outcomes. Wearable biosensors offer a huge potential to deliver better diagnostics, monitoring and treatment outcomes for patients.

Sensing with Thermally Reduced Graphene Oxide under Repeated Large Multi-Directional Strain

This paper presents a recent investigation into the electromechanical behavior of thermally reduced graphene oxide (rGO) as a strain sensor undergoing repeated large mechanical strains up to 20.72%, with electrical signal output measurement in multiple directions relative to the applied strain. Strain is one the most basic and most common stimuli sensed. rGO can be synthesized from abundant materials, can survive exposure to large strains (up to 20.72%), can be synthesized directly on structures with relative ease, and provides high sensitivity, with gauge factors up to 200 regularly reported. In this investigation, a suspension of graphene oxide flakes was deposited onto Polydimethylsiloxane (PDMS) substrates and thermally reduced to create macroscopic rGO-strain sensors. Electrical resistance parallel to the direction of applied tension (x^) demonstrated linear behavior (similar to the piezoresistive behavior of solid materials under strain) up to strains around 7.5%, beyond which nonlinear resistive behavior (similar to percolative electrical behavior) was observed. Cyclic tensile testing results suggested that some residual micro-cracks remained in place after relaxation from the first cycle of tensile loading. A linear fit across the range of strains investigated produced a gauge factor of 91.50(Ω/Ω)/(m/m), though it was observed that the behavior at high strains was clearly nonlinear. Hysteresis testing showed high consistency in the electromechanical response of the sensor between loading and unloading within cycles as well as increased consistency in the pattern of the response between different cycles starting from cycle 2.

High-Fidelity Bioelectrodes with Bidirectional Ion-Electron Transduction Capability by Integrating Multiple Charge-Transfer Processes

Bioelectronics is an exciting field that bridges the gap between physiological activities and external electronic devices, striving for high resolution, high conformability, scalability, and ease of integration. One crucial component in bioelectronics is bioelectrodes, designed to convert neural activity into electronic signals or vice versa. Previously reported bioelectrodes have struggled to meet several essential requirements simultaneously: high-fidelity signal transduction, high charge injection capability, strain resistance, and multifunctionality. This work introduces a novel strategy for fabricating superior bioelectrodes by merging multiple charge-transfer processes. The resulting bioelectrodes offer accurate ion-to-electron transduction for capturing electrophysiological signals, dependable charge injection capability for neuromodulation, consistent electrode potential for artifact rejection and biomolecule sensing, and high transparency for seamless integration with optoelectronics. Furthermore, the bioelectrode can be designed to be strain-insensitive by isolating signal transduction from electron transportation. The innovative concept presented in this work holds great promise for extending to other electrode materials and paves the way for the advancement of multimodal bioelectronics.

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.

Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions

There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.

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.

Roll-to-roll fabrication of silver/silver chloride coated yarns for dry electrodes and applications in biosignal monitoring

This work presents a continuous roll-to-roll electrochemical coating system for producing silver/silver chloride (Ag/AgCl)-coated yarns, and their application in e-textile electrodes for biosignal monitoring. Ag/AgCl is one of the most preferred electrode materials as an interface between the conductive backbone of an electrode and skin. E-textile Ag/AgCl-coated multi-filament nylon yarns offer stable, flexible, and breathable alternatives to standard rigid or flexible film-based Ag/AgCl electrodes. The developed system allows for highly controlled process parameters to achieve stable and uniform AgCl film deposition on Ag-coated nylon yarns. The electrical, electrochemical properties, and morphology of the coated yarns were characterized. Dry electrodes were fabricated and could measure electrocardiogram (ECG) signals with comparable performance to standard gel electrodes. Ag/AgCl e-textile electrodes demonstrated high stability, with low average polarization potential (1.22 mV/min) compared with Ag-coated electrodes (3.79 mV/min), low impedance (below 2 MΩ, 0.1-150 Hz), and are excellent candidates for heart rate detection and monitoring.

The Utility of a Novel Electrocardiogram Patch Using Dry Electrodes Technology for Arrhythmia Detection During Exercise and Prolonged Monitoring: Proof-of-Concept Study

BACKGROUND

Accurate detection of myocardial ischemia and arrhythmias during free-living exercise could play a pivotal role in screening and monitoring for the prevention of exercise-related cardiovascular events in high-risk populations. Although remote electrocardiogram (ECG) solutions are emerging rapidly, existing technology is neither designed nor validated for continuous use during vigorous exercise.

OBJECTIVE

In this proof-of-concept study, we evaluated the usability, signal quality, and accuracy for arrhythmia detection of a single-lead ECG patch platform featuring self-adhesive dry electrode technology in individuals with chronic coronary syndrome. This sensor was evaluated during exercise and for prolonged, continuous monitoring.

METHODS

We recruited a total of 6 consecutive patients with chronic coronary syndrome scheduled for an exercise stress test (EST) as part of routine cardiac follow-up. Traditional 12-lead ECG recording was combined with monitoring with the ECG patch. Following the EST, the participants continuously wore the sensor for 5 days. Intraclass correlation coefficients (ICC) and Wilcoxon signed rank tests were used to assess the utility of detecting arrhythmias with the patch by comparing the evaluations of 2 blinded assessors. Signal quality during EST and prolonged monitoring was evaluated by using a signal quality indicator. Additionally, connection time was calculated for prolonged ECG monitoring. The comfort and usability of the patch were evaluated by a web-based self-assessment questionnaire.

RESULTS

A total of 6 male patients with chronic coronary syndrome (mean age 69.8, SD 6.2 years) completed the study protocol. The patch was worn for a mean of 118.3 (SD 5.6) hours. The level of agreement between the patch and 12-lead ECG was excellent for the detection of premature atrial contractions and premature ventricular contractions during the whole test (ICC=0.998, ICC=1.000). No significant differences in the total number of premature atrial contractions and premature ventricular contractions were detected neither during the entire exercise test (P=.79 and P=.18, respectively) nor during the exercise and recovery stages separately (P=.41, P=.66, P=.18, and P=.66). A total of 1 episode of atrial fibrillation was detected by both methods. Total connection time during recording was between 88% and 100% for all participants. There were no reports of skin irritation, erythema, or pain while wearing the patch.

CONCLUSIONS

This proof-of-concept study showed that this innovative ECG patch based on self-adhesive dry electrode technology can potentially be used for arrhythmia detection during vigorous exercise. The results suggest that the wearable patch is also usable for prolonged continuous ECG monitoring in free-living conditions and can therefore be of potential use in cardiac rehabilitation and tele-monitoring for the prevention of exercise-related cardiovascular events. Future efforts will focus on optimizing signal quality over time and conducting a larger-scale validation study focusing on both arrhythmia and ischemia detection.

Washable and Flexible Screen-Printed Ag/AgCl Electrode on Textiles for ECG Monitoring

Electrocardiogram (ECG) electrodes are important sensors for detecting heart disease whose performance determines the validity and accuracy of the collected original ECG signals. Due to the large drawbacks (e.g., allergy, shelf life) of traditional commercial gel electrodes, textile electrodes receive widespread attention for their excellent comfortability and breathability. This work demonstrated a dry electrode for ECG monitoring fabricated by screen printing silver/silver chloride (Ag/AgCl) conductive ink on ordinary polyester fabric. The results show that the screen-printed textile electrodes have good and stable electrical and electrochemical properties and excellent ECG signal acquisition performance. Furthermore, the resistance of the screen-printed textile electrode is maintained within 0.5 Ω/cm after 5000 bending cycles or 20 washing and drying cycles, exhibiting excellent flexibility and durability. This research provides favorable support for the design and preparation of flexible and wearable electrophysiological sensing platforms.

Influence of the Heat Transfer Process on the Electrical and Mechanical Properties of Flexible Silver Conductors on Textiles

With the increase in the popularity of wearable and integrated electronics, a proper way to manufacture electronics on textiles is needed. This study aims to analyze the effect of different parameters of the heat transfer process on the electrical and mechanical properties of flexible electronics made on textiles, presenting it as a viable method of producing such electronics. Wires made from different composites based on silver microparticles and an insulating layer were screen-printed on a release film. Then, they were transferred onto a polyester cloth using heat transfer with different parameters. Research showed that different heat transfer parameters could influence the electrical properties of screen-printed wires, changing their resistance between -15% and +150%, making it imperative to adjust those properties depending on the materials used. Changes in the settings of heat transfer also influence mechanical properties, increasing adhesion between layers at higher temperatures. This study shows the importance of tailoring heat transfer properties and the differences that these properties make.

Signal Quality Analysis for Long-Term ECG Monitoring Using a Health Patch in Cardiac Patients

Cardiovascular diseases (CVD) represent a serious health problem worldwide, of which atrial fibrillation (AF) is one of the most common conditions. Early and timely diagnosis of CVD is essential for successful treatment. When implemented in the healthcare system this can ease the existing socio-economic burden on health institutions and government. Therefore, developing technologies and tools to diagnose CVD in a timely way and detect AF is an important research topic. ECG monitoring patches allowing ambulatory patient monitoring over several days represent a novel technology, while we witness a significant proliferation of ECG monitoring patches on the market and in the research labs, their performance over a long period of time is not fully characterized. This paper analyzes the signal quality of ECG signals obtained using a single-lead ECG patch featuring self-adhesive dry electrode technology collected from six cardiac patients for 5 days. In particular, we provide insights into signal quality degradation over time, while changes in the average ECG quality per day were present, these changes were not statistically significant. It was observed that the quality was higher during the nights, confirming the link with motion artifacts. These results can improve CVD diagnosis and AF detection in real-world 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.

Modeling the Design Characteristics of Woven Textile Electrodes for long-Term ECG Monitoring

An electrocardiograph records the periodic voltage generated by the heart over time. There is growing demand to continuously monitor the ECG for proactive health care and human performance optimization. To meet this demand, new conductive textile electrodes are being developed which offer an attractive alternative to adhesive gel electrodes but they come with their own challenges. The key challenge with textile electrodes is that the relationship between the manufacturing parameters and the ECG measurement is not well understood, making design an iterative process without the ability to prospectively develop woven electrodes with optimized performance. Here we address this challenge by applying the traditional skin-electrode interface circuit model to woven electrodes by constructing a parameterized model of the ECG system. Then the unknown parameters of the system are solved for with an iterative MATLAB optimizer using measured data captured with the woven electrodes. The results of this novel analysis confirm that yarn conductivity and total conductive area reduce skin electrode impedance. The results also indicate that electrode skin pressure and moisture require further investigation. By closing this gap in development, textile electrodes can be better designed and manufactured to meet the demands of long-term ECG capture.

Compensation for Electrode Detachment in Electrical Impedance Tomography with Wearable Textile Electrodes

Electrical impedance tomography (EIT) is a radiation-free and noninvasive medical image reconstruction technique in which a current is injected and the reflected voltage is received through electrodes. EIT electrodes require good connection with the skin for data acquisition and image reconstruction. However, detached electrodes are a common occurrence and cause measurement errors in EIT clinical applications. To address these issues, in this study, we proposed a method for detecting faulty electrodes using the differential voltage value of the detached electrode in an EIT system. Additionally, we proposed the voltage-replace and voltage-shift methods to compensate for invalid data from the faulty electrodes. In this study, we present the simulation, experimental, and in vivo chest results of our proposed methods to verify and evaluate the feasibility of this approach.

Airline Point-of-Care System on Seat Belt for Hybrid Physiological Signal Monitoring

With a focus on disease prevention and health promotion, a reactive and disease-centric healthcare system is revolutionized to a point-of-care model by the application of wearable devices. The convenience and low cost made it possible for long-term monitoring of health problems in long-distance traveling such as flights. While most of the existing health monitoring systems on aircrafts are limited for pilots, point-of-care systems provide choices for passengers to enjoy healthcare at the same level. Here in this paper, an airline point-of-care system containing hybrid electrocardiogram (ECG), breathing, and motion signals detection is proposed. At the same time, we propose the diagnosis of sleep apnea-hypopnea syndrome (SAHS) on flights as an application of this system to satisfy the inevitable demands for sleeping on long-haul flights. The hardware design includes ECG electrodes, flexible piezoelectric belts, and a control box, which enables the system to detect the original data of ECG, breathing, and motion signals. By processing these data with interval extraction-based feature selection method, the signals would be characterized and then provided for the long short-term memory recurrent neural network (LSTM-RNN) to classify the SAHS. Compared with other machine learning methods, our model shows high accuracy up to 84-85% with the lowest overfit problem, which proves its potential application in other related fields.

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.

Recent Advances in Stretchable and Wearable Capacitive Electrophysiological Sensors for Long-Term Health Monitoring

Over the past several years, wearable electrophysiological sensors with stretchability have received significant research attention because of their capability to continuously monitor electrophysiological signals from the human body with minimal body motion artifacts, long-term tracking, and comfort for real-time health monitoring. Among the four different sensors, i.e., piezoresistive, piezoelectric, iontronic, and capacitive, capacitive sensors are the most advantageous owing to their reusability, high durability, device sterilization ability, and minimum leakage currents between the electrode and the body to reduce the health risk arising from any short circuit. This review focuses on the development of wearable, flexible capacitive sensors for monitoring electrophysiological conditions, including the electrode materials and configuration, the sensing mechanisms, and the fabrication strategies. In addition, several design strategies of flexible/stretchable electrodes, body-to-electrode signal transduction, and measurements have been critically evaluated. We have also highlighted the gaps and opportunities needed for enhancing the suitability and practical applicability of wearable capacitive sensors. Finally, the potential applications, research challenges, and future research directions on stretchable and wearable capacitive sensors are outlined in this review.

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.

Design, Fabrication and Performance Assessment of Flexible, Microneedle-Based Electrodes For ECG Signal Monitoring

Microneedle-based electrodes have attracted significant attention for the monitoring of physiological signals, including ECG, EMG, and E OG, as they have the potential to eliminate the skin preparation and stability issues associated with conventional wet gel electrodes. This paper describes the development of a polymeric flexible microneedle electrode (FMNE) that does not require skin abrasion and can be used for long-term ECG monitoring. Fabricated using a combination of epoxy resin microneedles bonded to a flexible substrate, the performance of the FMNE was compared to that of a conventional wet-gel electrode by simultaneously capturing the ECG signal using both electrodes, and estimating the signal-to-noise ratio (SNR) of each. Results show that the flexible electrode can acquire ECG signals in which all the characteristic components of the wave are visible, and that are comparable in quality to those obtained using commercial wet electrodes. Bland-Altman plots were drawn to validate the performance of FMNE, and show that the mean difference ± standard deviation in SNR obtained using wet electrodes and FMNE was [Formula: see text]. Clinical Relevance- These microneedle-based 'dry electrodes' could be used in long-term monitoring of biopotential activity.

A biomimetic skin phantom for characterizing wearable electrodes in the low-frequency regime

Advances in the integration of wearable devices in our daily life have led to the development of new electrode designs for biopotential monitoring. Historically, the development and testing of wearable electrodes for the acquisition of biopotential signals has been empirical, relying on experiments on human volunteers. However, the lack of explicit control on human variables, the intra-, and inter-subject variability complicates the understanding of the performance of these wearable electrodes. Herein, phantom mimicking the electrical properties of the skin in the low-frequency range (1 Hz-1000 Hz), which has the potential to be used as a platform for controlled benchtop experiments for testing electrode functionality, is demonstrated. The fabricated phantom comprises two layers representing the deeper tissues and stratum corneum. The lower layer of the phantom mimicking deeper tissues was realized using polyvinyl alcohol cryogel (PVA-c) prepared with 0.9% W/W saline solution by a freeze-thaw technique. The properties of the upper layer representing the stratum corneum were simulated using a 100μm thick layer fabricated by spin-coating a mixture of polydimethylsiloxane (PDMS), 2.5% W/W carbon black (CB) for conductance, and 40% W/W barium titanate (BaTiO₃) as a dielectric. The hydration of the stratum corneum was modeled in a controlled way by varying porosity of the phantom's upper layer. Impedance spectroscopy measurements were carried out to investigate the electrical performance of the fabricated phantom and validated against the impedance response obtained across a physiological skin impedance range of five human subjects. The results indicated that the Bode plot depicting the impedance response obtained on the phantom was found to lie in the human skin range. Moreover, it was observed that the change of porosity provides control over the hydration and the phantom can be tuned as per the skin ranges among different individuals. Also, the phantom was able to mimic the impact of dry and hydrated skin on a simulated ECG signal in the time domain. The developed skin phantom is affordable, fairly easy to manufacture, stable over time, and can be used as a platform for benchtop testing of new electrode designs.

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.

Preliminary Analysis of a Wireless and Wearable Electronic-Textile EASI-Based Electrocardiogram

Background: With cardiovascular disease continuing to be the leading cause of death and the primary reason for hospitalization worldwide, there is an increased burden on healthcare facilities. Electronic-textile (e-textile)-based cardiac monitoring offers a viable option to allow cardiac rehabilitation programs to be conducted outside of the hospital.

Objectives: This study aimed to determine whether signals produced by an e-textile ECG monitor with textile electrodes in an EASI configuration are of sufficient quality to be used for cardiac monitoring. Specific objectives were to investigate the effect of the textile electrode characteristics, placement, and condition on signal quality, and finally to compare results to a reference ECG obtained from a current clinical standard the Holter monitor.

Methods: ECGs during different body movements (yawning, deep-breathing, coughing, sideways, and up movement) and activities of daily living (sitting, sitting/standing from a chair, and climbing stairs) were collected from a baseline standard of normal healthy adult male using a novel e-textile ECG and a reference Holter monitor. Each movement or activity was recorded for 5 min with 2-min intervals between each recording. Three different textile area electrodes (40, 60, and 70 mm²) and electrode thicknesses (3, 5, and 10 mm) were considered in the experiment. The effect of electrode placement within the EASI configuration was also studied. Different signal quality parameters, including signal to noise ratio, approximate entropy, baseline power signal quality index, and QRS duration and QT intervals, were used to evaluate the accuracy and reliability of the textile-based ECG monitor.

Results: The overall signal quality from the 70 mm² textile electrodes was higher compared to the smaller area electrodes. Results showed that the ECGs from 3 and 5 mm textile electrodes showed good quality. Regarding location, placing the “A” and “I” electrodes on the left and right anterior axillary points, respectively, showed higher signal quality compared to the standard EASI electrode placement. Wet textile electrodes showed better signal quality compared to their dry counterparts. When compared to the traditional Holter monitor, there was no significant difference in signal quality, which indicated textile monitoring was as good as current clinical standards (non-inferior).

Conclusion: The e-textile EASI ECG monitor could be a viable option for real-time monitoring of cardiac activities. A clinical trial in a larger sample is recommended to validate the results in a clinical population.

Applying Noncontact Sensing Technology in the Customized Product Design of Smart Clothes Based on Anthropometry

Electrocardiograms (ECGs) provide important information for diagnosing cardiovascular diseases. In clinical practice, the conventional Ag/AgCl electrode is generally used; however, it is not suitable for long-term ECG measurement because of the risk of allergic reactions on the skin and the dying issue of electrolytic gels. In previous studies, several dry electrodes have been proposed to address these issues. However, most dry electrodes, which are the mode of conductive materials, have to contact the skin well and are easily affected by motion artifacts in daily life. In the smart clothes developed in this study, a noncontact electrode was used to assess the biopotential across the clothes to prevent skin irritation and discomfort. Moreover, a three-dimensional parametric model based on anthropometric data was built, and the technique of customized product design was introduced into the smart clothes development process to reduce the influence of motion artifacts. The experimental results show that the proposed smart clothes can maintain a good ECG signal quality stably under motion from different activities.

Dry Wearable Textile Electrodes for Portable Electrical Impedance Tomography

Electrical impedance tomography (EIT), a noninvasive and radiation-free medical imaging technique, has been used for continuous real-time regional lung aeration. However, adhesive electrodes could cause discomfort and increase the risk of skin injury during prolonged measurement. Additionally, the conductive gel between the electrodes and skin could evaporate in long-term usage and deteriorate the signal quality. To address these issues, in this work, textile electrodes integrated with a clothing belt are proposed to achieve EIT lung imaging along with a custom portable EIT system. The simulation and experimental results have verified the validity of the proposed portable EIT system. Furthermore, the imaging results of using the proposed textile electrodes were compared with commercial electrocardiogram electrodes to evaluate their performance.

Performance Analysis of Data Fusion Methods Applied to Epileptic Seizure Recognition

Epilepsy is a chronic neurological disorder that is caused by unprovoked recurrent seizures. The most commonly used tool for the diagnosis of epilepsy is the electroencephalogram (EEG) whereby the electrical activity of the brain is measured. In order to prevent potential risks, the patients have to be monitored as to detect an epileptic episode early on and to provide prevention measures. Many different research studies have used a combination of time and frequency features for the automatic recognition of epileptic seizures. In this paper, two fusion methods are compared. The first is based on an ensemble method and the second uses the Choquet fuzzy integral method. In particular, three different machine learning approaches namely RNN, ML and DNN are used as inputs for the ensemble method and the Choquet fuzzy integral fusion method. Evaluation measures such as confusion matrix, AUC and accuracy are compared as well as MSE and RMSE are provided. The results show that the Choquet fuzzy integral fusion method outperforms the ensemble method as well as other state-of-the-art classification methods.

Effects of ECG Data Length on Heart Rate Variability among Young Healthy Adults

The relationship between the robustness of HRV derived by linear and nonlinear methods to the required minimum data lengths has yet to be well understood. The normal electrocardiography (ECG) data of 14 healthy volunteers were applied to 34 HRV measures using various data lengths, and compared with the most prolonged (2000 R peaks or 750 s) by using the Mann-Whitney U test, to determine the 0.05 level of significance. We found that SDNN, RMSSD, pNN50, normalized LF, the ratio of LF and HF, and SD1 of the Poincaré plot could be adequately computed by small data size (60-100 R peaks). In addition, parameters of RQA did not show any significant differences among 60 and 750 s. However, longer data length (1000 R peaks) is recommended to calculate most other measures. The DFA and Lyapunov exponent might require an even longer data length to show robust results. Conclusions: Our work suggests the optimal minimum data sizes for different HRV measures which can potentially improve the efficiency and save the time and effort for both patients and medical care providers.

Detection of the Complete ECG Waveform with Woven Textile Electrodes

Wearable physiological monitoring systems are becoming increasingly prevalent in the push toward autonomous health monitoring and offer new modalities for playful and purposeful interaction within human computer interaction (HCI). Sensing systems that can be integrated into garments and, therefore, daily activities offer promising pathways toward ubiquitous integration. The electrocardiogram (ECG) signal is commonly monitored in healthcare and is increasingly utilized as a method of determining emotional and psychological state; however, the complete ECG waveform with the P, Q, R, S, and T peaks is not commonly used, due to the challenges associated with collecting the full waveform with wearable systems. We present woven textile electrodes as an option for garment-integrated ECG monitoring systems that are capable of capturing the complete ECG waveform. In this work, we present the changes in the peak detection performance caused by different sizes, patterns, and thread types with data from 10 human participants. These testing results provide empirically-derived guidelines for future woven textile electrodes, present a path forward for assessing design decisions, and highlight the importance of testing novel wearable sensor systems with more than a single individual.

Anytime ECG Monitoring through the Use of a Low-Cost, User-Friendly, Wearable Device

Every year cardiovascular diseases kill the highest number of people worldwide. Among these, pathologies characterized by sporadic symptoms, such as atrial fibrillation, are difficult to be detected as state-of-the-art solutions, e.g., 12-leads electrocardiogram (ECG) or Holter devices, often fail to tackle these kinds of pathologies. Many portable devices have already been proposed, both in literature and in the market. Unfortunately, they all miss relevant features: they are either not wearable or wireless and their usage over a long-term period is often unsuitable. In addition, the quality of recordings is another key factor to perform reliable diagnosis. The ECG WATCH is a device designed for targeting all these issues. It is inexpensive, wearable (size of a watch), and can be used without the need for any medical expertise about positioning or usage. It is non-invasive, it records single-lead ECG in just 10 s, anytime, anywhere, without the need to physically travel to hospitals or cardiologists. It can acquire any of the three peripheral leads; results can be shared with physicians by simply tapping a smartphone app. The ECG WATCH quality has been tested on 30 people and has successfully compared with an electrocardiograph and an ECG simulator, both certified. The app embeds an algorithm for automatically detecting atrial fibrillation, which has been successfully tested with an official ECG simulator on different severity of atrial fibrillation. In this sense, the ECG WATCH is a promising device for anytime cardiac health monitoring.

Fiber‐Shaped Electronic Devices

Textile electronics embedded in clothing represent an exciting new frontier for modern healthcare and communication systems. Fundamental to the development of these textile electronics is the development of the fibers forming the cloths into electronic devices. An electronic fiber must undergo diverse scrutiny for its selection for a multifunctional textile, viz., from the material selection to the device architecture, from the wearability to mechanical stresses, and from the environmental compatibility to the end‐use management. Herein, the performance requirements of fiber‐shaped electronics are reviewed considering the characteristics of single electronic fibers and their assemblies in smart clothing. Broadly, this article includes i) processing strategies of electronic fibers with required properties from precursor to material, ii) the state‐of‐art of current fiber‐shaped electronics emphasizing light‐emitting devices, solar cells, sensors, nanogenerators, supercapacitors storage, and chromatic devices, iii) mechanisms involved in the operation of the above devices, iv) limitations of the current materials and device manufacturing techniques to achieve the target performance, and v) the knowledge gap that must be minimized prior to their deployment. Lessons learned from this review with regard to the challenges and prospects for developing fiber‐shaped electronic components are presented as directions for future research on wearable electronics.

Human Body-Electrode Interfaces for Wide-Frequency Sensing and Communication: A Review

Several on-body sensing and communication applications use electrodes in contact with the human body. Body-electrode interfaces in these cases act as a transducer, converting ionic current in the body to electronic current in the sensing and communication circuits and vice versa. An ideal body-electrode interface should have the characteristics of an electrical short, i.e., the transfer of ionic currents and electronic currents across the interface should happen without any hindrance. However, practical body-electrode interfaces often have definite impedances and potentials that hinder the free flow of currents, affecting the application's performance. Minimizing the impact of body-electrode interfaces on the application's performance requires one to understand the physics of such interfaces, how it distorts the signals passing through it, and how the interface-induced signal degradations affect the applications. Our work deals with reviewing these elements in the context of biopotential sensing and human body communication.

Signal Quality Assessment of a Novel ECG Electrode for Motion Artifact Reduction

BACKGROUND

The presence of noise is problematic in the analysis and interpretation of the ECG, especially in ambulatory monitoring. Restricting the analysis to high-quality signal segments only comes with the risk of excluding significant arrhythmia episodes. Therefore, the development of novel electrode technology, robust to noise, continues to be warranted.

METHODS

The signal quality of a novel wet ECG electrode (Piotrode) is assessed and compared to a commercially available, commonly used electrode (Ambu). The assessment involves indices of QRS detection and atrial fibrillation detection performance, as well as signal quality indices (ensemble standard deviation and time-frequency repeatability), computed from ECGs recorded simultaneously from 20 healthy subjects performing everyday activities.

RESULTS

The QRS detection performance using the Piotrode was considerably better than when using the Ambu, especially for running but also for lighter activities. The two signal quality indices demonstrated similar trends: the gap in quality became increasingly larger as the subjects became increasingly more active.

CONCLUSIONS

The novel wet ECG electrode produces signals with less motion artifacts, thereby offering the potential to reduce the review burden, and accordingly the cost, associated with ambulatory monitoring.

INTEGRATED DESIGN OF PHYSIOLOGICAL MULTI-PARAMETER SENSORS ON A SMART GARMENT BY ULTRA-ELASTIC E-TEXTILE

The performance of electronic textile (E-textile)-based wearable sensors is largely determined by the wire and electrode contacting stability to the body, which is a multi-discipline challenge for smart garment designs. In this paper, an integrated design of wearable sensors on a smart garment is presented to concurrently measure the multi-channel electrocardiogram, respiration, and temperature signals in different regions of the body. Sensors in separative probe-controller schemes are introduced with full-textile designs of the electrodes and signal transmission wires. An ultra-elastic structure of E-textile wire is proposed with excellent electrical stability, high stretch ratio, and low tension under body dynamics. A complete garment integration solution of the probes, wires, and the sensors is presented. The design is evaluated by comparing the signal quality in static and moderate body movements, which shows clinical level comparable precision and stability. The proposed design may constitute a general solution of distributed noninvasive physiological multi-parameter detection and monitoring applications.

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.

A Novel Wearable Flexible Dry Electrode Based on Cowhide for ECG Measurement

The electrocardiogram (ECG) electrode, as a sensor, is an important part of the wearable ECG monitoring device. Natural leather is rarely used as the electrode substrate. In this paper, wearable flexible silver electrodes based on cowhide were prepared by sputtering and brush-painting. A signal generator, oscilloscope, impedance test instrument, and ECG monitor were used to build the test platform evaluating the performance of electrodes with six subjects. The lossless waveform transmission can be achieved with our electrodes. Therefore, the Pearson’s correlation coefficient calculated with input waveform and output waveform of the electrodes based on the top grain layer (GLE) and the split layer (SLE) of cowhide were 0.997 and 0.998 at 0.1 Hz respectively. The skin electrode impedance (Z) was tested, and the parameters of the equivalent circuit model of the skin electrode interface were calculated by a fitting method, indicating that the Z of the prepared electrodes was comparable with the standard gel electrode when the skin is moist enough. The signal-to-noise ratio of the ECG of the GLE and the SLE were 1.148 and 1.205 times that of the standard electrode in the standing posture, which meant the ECG measured by our electrodes was basically consistent with that measured by the standard electrode.

Materials, Devices, and Systems of On-Skin Electrodes for Electrophysiological Monitoring and Human-Machine Interfaces

On-skin electrodes function as an ideal platform for collecting high-quality electrophysiological (EP) signals due to their unique characteristics, such as stretchability, conformal interfaces with skin, biocompatibility, and wearable comfort. The past decade has witnessed great advancements in performance optimization and function extension of on-skin electrodes. With continuous development and great promise for practical applications, on-skin electrodes are playing an increasingly important role in EP monitoring and human-machine interfaces (HMI). In this review, the latest progress in the development of on-skin electrodes and their integrated system is summarized. Desirable features of on-skin electrodes are briefly discussed from the perspective of performances. Then, recent advances in the development of electrode materials, followed by the analysis of strategies and methods to enhance adhesion and breathability of on-skin electrodes are examined. In addition, representative integrated electrode systems and practical applications of on-skin electrodes in healthcare monitoring and HMI are introduced in detail. It is concluded with the discussion of key challenges and opportunities for on-skin electrodes and their integrated systems.

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.

Preparation and characterization of a novel sprayable hydrogel for skin preparation to record ECG and other biopotentials

Wet electrodes are widely used to perform biopotential measurements from the body, such as electroencephalogram, electrocardiogram, and electromyogram. These electrodes have certain disadvantages, including bacterial growth, irritation in long-term recordings, infection to patients' skin caused by skin preparation techniques, and unpleasant feeling caused after their removal. Thus, a sprayable hydrogel (SH) was designed to avoid these problems. Five electrode configurations, namely, Zipprep™, wet Ag/AgCl, wipes, dry Ag/AgCl, and SH, were tested using an impedance analyzer. Measurements were obtained by placing each of the electrode systems on the forearm of five subjects, which comprised one Caucasian, two Indians, one Syrian, and one Cypriot aging between 23 and 60 years for 10 min. Impedance versus time and reactance versus resistance performance plots were compared and assessed. The performance of the SH sprayed under dry electrodes had lower impedance values compared with those of the dry Ag/AgCl and wipes. As a result, the SH electrode configuration can be used as an electrode set-up for acquiring and recording various physiological signals.

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

Long-term electrocardiography (ECG) monitoring is very essential for the early detection and treatment of cardiovascular disorders. However, commercially used silver/silver chloride (Ag/AgCl) electrodes have drawbacks, and these become more obvious during long-term signal monitoring, making them inconvenient for this use. In this study, we developed silver printed textile electrodes from knitted cotton and polyester fabric for ECG monitoring. The surface resistance of printed electrodes was 1.64 Ω/sq for cotton and 1.78 Ω/sq for polyester electrodes. The ECG detection performance of the electrodes was studied by placing three electrodes around the wrist where the electrodes were embedded on an elastic strap with Velcro. The ECG signals collected using textile electrodes had a comparable waveform to those acquired using standard Ag/AgCl electrodes with a signal to noise ratio (SNR) of 33.10, 30.17, and 33.52 dB for signals collected from cotton, polyester, and Ag/AgCl electrodes, respectively. The signal quality increased as the tightness of the elastic strap increased. Signals acquired at 15 mmHg pressure level with the textile electrodes provided a similar quality to those acquired using standard electrodes. Interestingly, the textile electrodes gave acceptable signal quality even after ten washing cycles.

Woven electrocardiogram (ECG) electrodes for health monitoring in operational environments

Electrical signals produced within the human body can reveal information about a wide variety of physiological processes including physical activity, cardiac health, and psychological state. The industry standard for physiological signal detection is the use of adhesive electrodes that stick onto the skin. These electrodes can irritate the skin over long periods of time and are not reusable, making them a challenge for use in operational environments. Further, these electrodes often require gel to improve signal transduction, leading to changes in signal quality as these gels dry over time. Wearable sensors for operational environments should be comfortable, unobtrusive, and non-stigmatizing while maintaining signal quality high enough to allow the detection of health states. Here, we present the development and test of a set of woven textile electrodes of 8 different sizes for chest-mounted, 3-lead electrocardiogram (ECG) monitoring. Ten male subjects were tested with each of the woven electrode sizes and with one set of adhesive electrodes. A derived performance metric and signal-to-noise ratio were calculated for each set of electrodes for comparison between them. The smallest sized electrodes were found to be least effective, while the 6^th of the 8 sizes were found to be most effective.

Wearable Circuits Sintered at Room Temperature Directly on the Skin Surface for Health Monitoring

A soft body area sensor network presents a promising direction in wearable devices to integrate on-body sensors for physiological signal monitoring and flexible printed circuit boards (FPCBs) for signal conditioning/readout and wireless transmission. However, its realization currently relies on various sophisticated fabrication approaches such as lithography or direct printing on a carrier substrate before attaching to the body. Here, we report a universal fabrication scheme to enable printing and room-temperature sintering of the metal nanoparticle on paper/fabric for FPCBs and directly on the human skin for on-body sensors with a novel sintering aid layer. Consisting of polyvinyl alcohol (PVA) paste and nanoadditives in the water, the sintering aid layer reduces the sintering temperature. Together with the significantly decreased surface roughness, it allows for the integration of a submicron-thick conductive pattern with enhanced electromechanical performance. Various on-body sensors integrated with an FPCB to detect health conditions illustrate a system-level example.

A Compliant Ionic Adhesive Electrode with Ultralow Bioelectronic Impedance

Simultaneous implementation of high signal-to-noise ratio (SNR) but low crosstalk is of great importance for weak surface electromyography (sEMG) signals when precisely driving a prosthesis to perform sophisticated activities. However, due to gaps with the curved skin during muscle contraction, many electrodes have poor compliance with skin and suffer from high bioelectrical impedance. This causes serious noise and error in the signals, especially the signals from low-level muscle contractions. Here, the design of a compliant electrode based on an adhesive hydrogel, alginate-polyacrylamide (Alg-PAAm) is reported, which eliminates those large gaps through the strong electrostatic interaction and abundant hydrogen bond with the skin. The obtained compliant electrode, having an ultralow bioelectrical impedance of ≈20 kΩ, can monitor even 2.1% maximal voluntary contraction (MVC) of muscle. Furthermore, benefiting from the high SNR of >5:1 at low-level MVC, the crosstalk from irrelevant muscle is minimized through reducing the electrode size. Finally, a prosthesis is successfully demonstrated to precisely grasp a needle based on a 9 mm² Alg-PAAm compliant electrode. The strategy to design such compliant electrodes provides the potential for improving the quality of dynamically weak sEMG signals to precisely control prosthesis in performing purposefully dexterous activity.

Wearable Active Electrode for sEMG Monitoring Using Two-Channel Brass Dry Electrodes with Reduced Electronics

Gel-based electrodes are employed to record sEMG signals for prolonged periods. These signals are used for the control of myoelectric prostheses, clinical analysis, or sports medicine. However, when the gel dries, the electrode-skin impedance increases considerably. Using dry active electrodes (AEs) to compensate variations of impedance is an alternative for long-term recording. This work describes the optimization of the electronic design of a conventional AE by removing the impedance coupling stage and two filters. The proposed work consisted of 5 stages: electrodes, amplification (X250), 2.2 Vdc offset, low-pass filter, and ADC with USART communication. The device did not need the use of electrolytic gel. The measurements of CMRR (96 dB), amplitude of the output sEMG signal (∼1.6 Vp-p), and system bandwidth (15-450 Hz) were performed in order to confirm the reliability of the device as an sEMG signal acquisition system. The SNR values from seven movements performed by eleven volunteers were compared in order to measure the repeatability of the measurements (average 30.32 dB for a wrist flexion). The SNR for wrist flexion measured with the proposed and the commercial system was compared; the values were 49 dB and 60 dB, respectively.

Dry Electrodes for Human Bioelectrical Signal Monitoring

Bioelectrical or electrophysiological signals generated by living cells or tissues during daily physiological activities are closely related to the state of the body and organ functions, and therefore are widely used in clinical diagnosis, health monitoring, intelligent control and human-computer interaction. Ag/AgCl electrodes with wet conductive gels are widely used to pick up these bioelectrical signals using electrodes and record them in the form of electroencephalograms, electrocardiograms, electromyography, electrooculograms, etc. However, the inconvenience, instability and infection problems resulting from the use of gel with Ag/AgCl wet electrodes can't meet the needs of long-term signal acquisition, especially in wearable applications. Hence, focus has shifted toward the study of dry electrodes that can work without gels or adhesives. In this paper, a retrospective overview of the development of dry electrodes used for monitoring bioelectrical signals is provided, including the sensing principles, material selection, device preparation, and measurement performance. In addition, the challenges regarding the limitations of materials, fabrication technologies and wearable performance of dry electrodes are discussed. Finally, the development obstacles and application advantages of different dry electrodes are analyzed to make a comparison and reveal research directions for future studies.