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Abstract Swallowing is an ensemble of voluntary and autonomic processes key to maintaining our body’s homeostatic balance. Abnormal swallowing (dysphagia) can cause dehydration, malnutrition, aspiration pneumonia, weight loss, anxiety, or even mortality—especially in older adults—by airway obstruction. To prevent or mitigate these outcomes, it is imperative to regularly assess swallowing ability in those who are at risk of developing dysphagia and those already diagnosed with it. However, current diagnostic tools such as endoscopy, manometry, and videofluoroscopy require access to clinical experts to interpret the results. These results are often sampled from a limited examination timeframe of swallowing activity in a controlled environment. Additionally, there is some risk of periprocedural complications associated with these methods. In contrast, the field of epidermal sensors is finding non-invasive and minimally obtrusive ways to examine swallowing function and dysfunction. In this review, we summarize the current state of wearable devices that are aimed at monitoring swallowing function and detecting its abnormalities. We pay particular attention to the materials and design parameters that enable their operation. We examine a compilation of both proof-of-concept studies (which focus mainly on the engineering of the device) and studies whose aims are biomedical (which may involve larger cohorts of subjects, including patients). Furthermore, we briefly discuss the methods of signal acquisition and device assessment in relevant wearable sensors. Finally, we examine the need to increase adherence and engagement of patients with such devices and discuss enhancements to the design of such epidermal sensors that may encourage greater enthusiasm for at-home and long-term monitoring. 

Electrotactile stimulus is a form of sensory substitution in which an electrical signal is perceived as a mechanical sensation. The electrotactile effect could, in principle, recapitulate a range of tactile experience by selective activation of nerve endings. However, the method has been plagued by inconsistency, galvanic reactions, pain and desensitization, and unwanted stimulation of nontactile nerves. Here, we describe how a soft conductive block copolymer, a stretchable layout, and concentric electrodes, along with psychophysical thresholding, can circumvent these shortcomings. These purpose-designed materials, device layouts, and calibration techniques make it possible to generate accurate and reproducible sensations across a cohort of 10 human participants and to do so at ultralow currents (≥6 microamperes) without pain or desensitization. This material, form factor, and psychophysical approach could be useful for haptic devices and as a tool for activation of the peripheral nervous system. 

BackgroundFrequent sensor-assisted monitoring of changes in swallowing function may help improve detection of radiation-associated dysphagia before it becomes permanent. While our group has prototyped an epidermal strain/surface electromyography sensor that can detect minute changes in swallowing muscle movement, it is unknown whether patients with head and neck cancer would be willing to wear such a device at home after radiation for several months. ObjectiveWe iteratively assessed patients’ design preferences and perceived barriers to long-term use of the prototype sensor. MethodsIn study 1 (questionnaire only), survivors of pharyngeal cancer who were 3-5 years post treatment and part of a larger prospective study were asked their design preferences for a hypothetical throat sensor and rated their willingness to use the sensor at home during the first year after radiation. In studies 2 and 3 (iterative user testing), patients with and survivors of head and neck cancer attending visits at MD Anderson’s Head and Neck Cancer Center were recruited for two rounds of on-throat testing with prototype sensors while completing a series of swallowing tasks. Afterward, participants were asked about their willingness to use the sensor during the first year post radiation. In study 2, patients also rated the sensor’s ease of use and comfort, whereas in study 3, preferences were elicited regarding haptic feedback. ResultsThe majority of respondents in study 1 (116/138, 84%) were willing to wear the sensor 9 months after radiation, and participant willingness rates were similar in studies 2 (10/14, 71.4%) and 3 (12/14, 85.7%). The most prevalent reasons for participants’ unwillingness to wear the sensor were 9 months being excessive, unwanted increase in responsibility, and feeling self-conscious. Across all three studies, the sensor’s ability to detect developing dysphagia increased willingness the most compared to its appearance and ability to increase adherence to preventive speech pathology exercises. Direct haptic signaling was also rated highly, especially to indicate correct sensor placement and swallowing exercise performance. ConclusionsPatients and survivors were receptive to the idea of wearing a personalized risk sensor for an extended period during the first year after radiation, although this may have been limited to well-educated non-Hispanic participants. A significant minority of patients expressed concern with various aspects of the sensor’s burden and its appearance. Trial RegistrationClinicalTrials.gov NCT03010150; https://clinicaltrials.gov/study/NCT03010150 

Polymeric arrays of microrelief structures have a range of potential applications. For example, to influence wettability, to act as biologically inspired adhesives, to resist biofouling, and to play a role in the “feel” of an object during tactile interaction. Here, we investigate the damage to micropillar arrays comprising pillars of different modulus, spacing, diameter, and aspect ratio due to the sliding of a silicone cast of a human finger. The goal is to determine the effect of these parameters on the types of damage observed, including adhesive failure and ploughing of material from the finger onto the array. Our experiments point to four principal conclusions [1]. Aspect ratio is the dominant parameter in determining survivability through its effect on the bending stiffness of micropillars [2]. All else equal, micropillars with larger diameter are less susceptible to breakage and collapse [3]. The spacing of pillars in the array largely determines which type of adhesive failure occurs in non-surviving arrays [4]. Elastic modulus plays an important role in survivability. Clear evidence of elastic recovery was seen in the more flexible polymer and this recovery led to more instances of pristine survivability where the stiffer polymer tended to ablate PDMS. We developed a simple model to describe the observed bending of micropillars, based on the quasi-static mechanics of beam-columns, that indicated they experience forces ranging from 10 −4 –10 −7 N to deflect into adhesive contact. Taken together, results obtained using our framework should inform design considerations for microstructures intended to be handled by human users.