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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 

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. 

Abstract Durable and conductive interfaces that enable chronic and high‐resolution recording of neural activity are essential for understanding and treating neurodegenerative disorders. These chronic implants require long‐term stability and small contact areas. Consequently, they are often coated with a blend of conductive polymers and are crosslinked to enhance durability despite the potentially deleterious effect of crosslinking on the mechanical and electrical properties. Here the grafting of the poly(3,4 ethylenedioxythiophene) scaffold, poly(styrenesulfonate)‐b‐poly(poly(ethylene glycol) methyl ether methacrylate block copolymer brush to gold, in a controlled and tunable manner, by surface‐initiated atom‐transfer radical polymerization (SI‐ATRP) is described. This “block‐brush” provides high volumetric capacitance (120 F cm^─3), strong adhesion to the metal (4 h ultrasonication), improved surface hydrophilicity, and stability against 10 000 charge–discharge voltage sweeps on a multiarray neural electrode. In addition, the block‐brush film showed 33% improved stability against current pulsing. This approach can open numerous avenues for exploring specialized polymer brushes for bioelectronics research and application. 

Abstract In this work, a portable venturi tube capable of measuring bidirectional respiratory flow is developed and correlated the measurements to pulmonary function. Pressure signals are transduced using flexible and compressible capacitive foam sensors embedded into the wall of the device. In this configuration, the sensors are able to provide differential pressure readings, from which the airflow rate passing through the tube could be extrapolated. Utilizing the venturi effect, the geometry of the spirometer tube is designed through finite element analysis to measure respiratory airflow during inhalation and exhalation. The device tube is 3D‐printed and used to measure tidal breathing and deep breathing, along with peak expiratory flow rates, on a healthy individual. This spirometer design allows for easy‐to‐use point‐of‐care diagnoses and has the potential to improve the care of respiratory illnesses. 

Abstract Epidermal sensors for remote healthcare and performance monitoring require the ability to operate under the effects of bodily motion, heat, and perspiration. Here, the use of purpose‐synthesized polymer‐based dry electrodes and graphene‐based strain gauges to obtain measurements of swallowed volume under typical conditions of exercise is evaluated. The electrodes, composed of the common conductive polymer poly(3,4 ethylenedioxythiophene) (PEDOT) electrostatically bound to poly(styrenesulfonate)‐b‐poly(poly(ethylene glycol) methyl ether acrylate) (PSS‐b‐PPEGMEA), collect surface electromyography (sEMG) signals on the submental muscle group, under the chin. Simultaneously, the deformation of the surface of the skin is measured using strain gauges comprising single‐layer graphene supporting subcontinuous coverage of gold and a highly plasticized composite containing PEDOT:PSS. Together, these materials permit high stretchability, high resolution, and resistance to sweat. A custom printed circuit board (PCB) allows this multicomponent system to acquire strain and sEMG data wirelessly. This sensor platform is tested on the swallowing activity of a cohort of 10 subjects while walking or cycling on a stationary bike. Using a machine learning (ML) model, it is possible to predict swallowed volume with absolute errors of 36% for walking and 43% for cycling. 

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.