Perspectives of users for a future interactive wearable system for upper extremity rehabilitation following stroke: a qualitative study.

BACKGROUND: Wearable sensor technology can facilitate diagnostics and monitoring of people with upper extremity (UE) paresis after stroke. The purpose of this study is to investigate the perspectives of clinicians, people living with stroke, and their caregivers on an interactive wearable system that detects UE movements and provides feedback. METHODS: This qualitative study used semi-structured interviews relating to the perspectives of a future interactive wearable system including a wearable sensor to capture UE movement and a user interface to provide feedback as the means of data collection. Ten rehabilitation therapists, 9 people with stroke, and 2 caregivers participated in this study. RESULTS: Four themes were identified (1) "Everyone is different" highlighted the need for addressing individual user's rehabilitation goal and personal preference; (2) "The wearable system should identify UE and trunk movements" emphasized that in addition to arm, hand, and finger movements, detecting compensatory trunk movements during UE movements is also of interest; (3) "Both quality and amount of movements are necessary to measure" described the parameters related to how well and how much the user is using their affected UE that participants envisioned the system to monitor; (4) "Functional activities should be practiced by the users" outlined UE movements and activities that are of priority in designing the system. CONCLUSIONS: Narratives from clinicians, people with stroke, and their caregivers offer insight into the design of interactive wearable systems. Future studies examining the experience and acceptability of existing wearable systems from end-users are warranted to guide the adoption of this technology.

Novel Flexible Wearable Sensor Materials and Signal Processing for Vital Sign and Human Activity Monitoring.

Advances in flexible electronic materials and smart textile, along with broad availability of smart phones, cloud and wireless systems have empowered the wearable technologies for significant impact on future of digital and personalized healthcare as well as consumer electronics. However, challenges related to lack of accuracy, reliability, high power consumption, rigid or bulky form factor and difficulty in interpretation of data have limited their wide-scale application in these potential areas. As an important solution to these challenges, we present latest advances in novel flexible electronic materials and sensors that enable comfortable and conformable body interaction and potential for invisible integration within daily apparel. Advances in novel flexible materials and sensors are described for wearable monitoring of human vital signs including, body temperature, respiratory rate and heart rate, muscle movements and activity. We then present advances in signal processing focusing on motion and noise artifact removal, data mining and aspects of sensor fusion relevant to future clinical applications of wearable technology.

Screen-Printed Textile-Based Electrochemical Biosensor for Noninvasive Monitoring of Glucose in Sweat.

Wearable sweat biosensors for noninvasive monitoring of health parameters have attracted significant attention. Having these biosensors embedded in textile substrates can provide a convenient experience due to their soft and flexible nature that conforms to the skin, creating good contact for long-term use. These biosensors can be easily integrated with everyday clothing by using textile fabrication processes to enhance affordable and scalable manufacturing. Herein, a flexible electrochemical glucose sensor that can be screen-printed onto a textile substrate has been demonstrated. The screen-printed textile-based glucose biosensor achieved a linear response in the range of 20-1000 µM of glucose concentration and high sensitivity (18.41 µA mM-1 cm-2, R2 = 0.996). In addition, the biosensors show high selectivity toward glucose among other interfering analytes and excellent stability over 30 days of storage. The developed textile-based biosensor can serve as a platform for monitoring bio analytes in sweat, and it is expected to impact the next generation of wearable devices.

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.

Breathable Dry Silver/Silver Chloride Electronic Textile Electrodes for Electrodermal Activity Monitoring.

The focus of this study is to design and integrate silver/silver chloride (Ag/AgCl) electronic textile (e-textile) electrodes into different textile substrates to evaluate their ability to monitor electrodermal activity (EDA). Ag/AgCl e-textiles were stitched into woven textiles of cotton, nylon, and polyester to function as EDA monitoring electrodes. EDA stimulus responses detected by dry e-textile electrodes at various locations on the hand were compared to the EDA signals collected by dry solid Ag/AgCl electrodes. 4-h EDA data with e-textile and clinically conventional rigid electrodes were compared in relation to skin surface temperature. The woven cotton textile substrate with e-textile electrodes (0.12 cm² surface area, 0.40 cm distance) was the optimal material to detect the EDA stimulus responses with the highest average Pearson correlation coefficient of 0.913 ± 0.041 when placed on the distal phalanx of the middle finger. In addition, differences with EDA waveforms recorded on various fingers were observed. Trends of long-term measurements showed that skin surface temperature affected EDA signals recorded by non-breathable electrodes more than when e-textile electrodes were used. The effective design criteria outlined for e-textile electrodes can promote the development of comfortable and unobtrusive EDA monitoring systems, which can help improve our knowledge of the human neurological system.

Effects of Flexible Dry Electrode Design on Electrodermal Activity Stimulus Response Detection.

OBJECTIVE: The focus of this research is to evaluate the effects of design parameters including surface area, distance between and geometry of dry flexible electrodes on electrodermal activity (EDA) stimulus response detection. METHODS: EDA is a result of the autonomic nervous system being stimulated, which causes sweat and changes the electrical characteristics of the skin. Standard silver/silver chloride (Ag/AgCl) EDA electrodes are rigid and lack conformability in contact with skin. In this study, flexible dry Ag/AgCl EDA electrodes were fabricated on a compliant substrate, used to monitor EDA stimulus responses and compared to results simultaneously collected by rigid dry Ag/AgCl electrodes. RESULTS: A repeatable fabrication process for flexible Ag/AgCl electrodes has been established. Surface area, distance between and geometry of electrodes are shown to affect the detectability of the EDA response and the minimum number of sweat glands to be covered by the electrodes has been estimated at 140, or more, in order to maintain functionality. The optimal flexible EDA electrode is a serpentine design with a 0.15 cm2 surface area and a 0.20 cm distance with an average Pearson correlation coefficient of . CONCLUSION: Fabrication of flexible electrodes is described and an understanding of the effects of electrode designs on the EDA stimulus response detection has been established and is potentially related to the coverage of sweat glands. SIGNIFICANCE: This work presents a novel systematic approach to understand the effects of electrode designs on monitoring EDA which is of importance for the design of wearable EDA monitoring devices.