{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T11:06:22Z","timestamp":1769598382950,"version":"3.49.0"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2018,5,23]],"date-time":"2018-05-23T00:00:00Z","timestamp":1527033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2018,5,23]],"date-time":"2018-05-23T00:00:00Z","timestamp":1527033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digital Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Peripheral nerves are often vulnerable to damage during surgeries, with risks of significant pain, loss of motor function, and reduced quality of life for the patient. Intraoperative methods for monitoring nerve activity are effective, but conventional systems rely on bench-top data acquisition tools with hard\u2013wired connections to electrode leads that must be placed percutaneously inside target muscle tissue. These approaches are time and skill intensive and therefore costly to an extent that precludes their use in many important scenarios. Here we report a soft, skin-mounted monitoring system that measures, stores, and wirelessly transmits electrical signals and physical movement associated with muscle activity, continuously and in real-time during neurosurgical procedures on the peripheral, spinal, and cranial nerves. Surface electromyography and motion measurements can be performed non-invasively in this manner on nearly any muscle location, thereby offering many important advantages in usability and cost, with signal fidelity that matches that of the current clinical standard of care for decision making. These results could significantly improve accessibility of intraoperative monitoring across a broad range of neurosurgical procedures, with associated enhancements in patient outcomes.<\/jats:p>","DOI":"10.1038\/s41746-018-0023-7","type":"journal-article","created":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T08:59:12Z","timestamp":1525942752000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Intraoperative monitoring of neuromuscular function with soft, skin-mounted wireless devices"],"prefix":"10.1038","volume":"1","author":[{"given":"Yuhao","family":"Liu","sequence":"first","affiliation":[]},{"given":"Limei","family":"Tian","sequence":"additional","affiliation":[]},{"given":"Milan S.","family":"Raj","sequence":"additional","affiliation":[]},{"given":"Matthew","family":"Cotton","sequence":"additional","affiliation":[]},{"given":"Yinji","family":"Ma","sequence":"additional","affiliation":[]},{"given":"Siyi","family":"Ma","sequence":"additional","affiliation":[]},{"given":"Bryan","family":"McGrane","sequence":"additional","affiliation":[]},{"given":"Arjun V.","family":"Pendharkar","sequence":"additional","affiliation":[]},{"given":"Nader","family":"Dahaleh","sequence":"additional","affiliation":[]},{"given":"Lloyd","family":"Olson","sequence":"additional","affiliation":[]},{"given":"Haiwen","family":"Luan","sequence":"additional","affiliation":[]},{"given":"Orin","family":"Block","sequence":"additional","affiliation":[]},{"given":"Brandon","family":"Suleski","sequence":"additional","affiliation":[]},{"given":"Yadong","family":"Zhou","sequence":"additional","affiliation":[]},{"given":"Chandrasekaran","family":"Jayaraman","sequence":"additional","affiliation":[]},{"given":"Tyler","family":"Koski","sequence":"additional","affiliation":[]},{"given":"A. J.","family":"Aranyosi","sequence":"additional","affiliation":[]},{"given":"John A.","family":"Wright","sequence":"additional","affiliation":[]},{"given":"Arun","family":"Jayaraman","sequence":"additional","affiliation":[]},{"given":"Yonggang","family":"Huang","sequence":"additional","affiliation":[]},{"given":"Roozbeh","family":"Ghaffari","sequence":"additional","affiliation":[]},{"given":"Michel","family":"Kliot","sequence":"additional","affiliation":[]},{"given":"John A.","family":"Rogers","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2018,5,23]]},"reference":[{"key":"23_CR1","first-page":"198","volume":"87","author":"NG Simon","year":"2015","unstructured":"Simon, N. G., Spinner, R. J., Kline, D. G. & Kliot, M. Advances in the neurological and neurosurgical management of peripheral nerve trauma. J. Neurol. Neurosurg. Psychiatry  87, 198\u2013208 (2015).","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"23_CR2","unstructured":"Dyck, P. J. Peripheral Neuropathy (Elsevier Inc., Philadelphia, PA, USA, 2005)."},{"key":"23_CR3","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1097\/BOT.0000000000000525","volume":"30","author":"R Kakazu","year":"2016","unstructured":"Kakazu, R., Dailey, S. K., Schroeder, A. J., Wyrick, J. D. & Archdeacon, M. T. Iatrogenic radial nerve palsy after humeral shaft nonunion repair: more common than you think. J. Orthop. Trauma 30, 256 (2016).","journal-title":"J. Orthop. Trauma"},{"key":"23_CR4","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1007\/s00276-016-1781-z","volume":"39","author":"G Koch","year":"2016","unstructured":"Koch, G. et al Anatomical risk evaluation of iatrogenic injury to the infrapatellar branch of the saphenousnerve during medial meniscus arthroscopic surgery. Surg. Radiol. Anat. 39, 611 (2016).","journal-title":"Surg. Radiol. Anat."},{"key":"23_CR5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/JSA.0000000000000084","volume":"23","author":"AE Weber","year":"2015","unstructured":"Weber, A. E., Harris, J. D. & Nho, S. J. Complications in hip arthroscopy: a systematic review and strategies for prevention. Sports Med. Arthrosc. 23, 187 (2015).","journal-title":"Sports Med. Arthrosc."},{"key":"23_CR6","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.ejso.2013.06.004","volume":"39","author":"W Kneist","year":"2013","unstructured":"Kneist, W., Kauff, D., Juhre, V., Hoffmann, K. & Lang, H. Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME?: results of a case-control study. Eur. J. Surg. Oncol. 39, 994 (2013).","journal-title":"Eur. J. Surg. Oncol."},{"key":"23_CR7","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1002\/jcu.22354","volume":"44","author":"CR Falyar","year":"2016","unstructured":"Falyar, C. R., Shaffer, K. M. & Perera, R. A. Localization of the brachial plexus: sonography versus anatomic landmarks. J. Clin. Ultrasound 44, 411 (2016).","journal-title":"J. Clin. Ultrasound"},{"key":"23_CR8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/BRS.0000000000001662","volume":"42","author":"RM Ajiboye","year":"2017","unstructured":"Ajiboye, R. M. et al. Routine use of intraoperative neuromonitoring during ACDFs for the treatment of spondylotic myelopathy and radiculopathy is questionable: a review of 15,395 cases. Spine  42, 14 (2017).","journal-title":"Spine"},{"key":"23_CR9","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1002\/ca.22254","volume":"27","author":"A Mian","year":"2014","unstructured":"Mian, A. et al. Brachial plexus anesthesia: a review of the relevant anatomy, complications, and anatomical variations. Clin. Anat. 27, 210 (2014).","journal-title":"Clin. Anat."},{"key":"23_CR10","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.clinph.2007.09.135","volume":"119","author":"V Deletis","year":"2008","unstructured":"Deletis, V. & Sala, F. Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin. Neurophysiol. 119, 248 (2008).","journal-title":"Clin. Neurophysiol."},{"key":"23_CR11","doi-asserted-by":"crossref","unstructured":"Koht, A., Sloan, T.B., Toleikis, J.R. Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals (Springer, New York, NY, USA, 2012).","DOI":"10.1007\/978-1-4614-0308-1"},{"key":"23_CR12","unstructured":"M\u00f8ller, A. R. Intraoperative Neurophysiological Monitoring (Springer, Totowa, NJ, USA, 2006)."},{"key":"23_CR13","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/01.sla.0000132260.34503.02","volume":"240","author":"M Hermann","year":"2004","unstructured":"Hermann, M., Hellebart, C. & Freissmuth, M. Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann. Surg. 240, 9 (2004).","journal-title":"Ann. Surg."},{"key":"23_CR14","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1109\/MCOM.2006.1632650","volume":"44","author":"D Cypher","year":"2006","unstructured":"Cypher, D., Chevrollier, N., Montavont, N. & Golmie, N. Prevailing over wires in healthcare environments: benefits and challenges. IEEE Commun. Mag. 44, 56 (2006).","journal-title":"IEEE Commun. Mag."},{"key":"23_CR15","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1002\/mus.10315","volume":"27","author":"A Al-Shekhlee","year":"2003","unstructured":"Al-Shekhlee, A., Shapiro, B. E. & Preston, D. C. Iatrogenic complications and risks of nerve conduction studies and needle electromyography. Muscle Nerve 27, 517 (2003).","journal-title":"Muscle Nerve"},{"key":"23_CR16","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1002\/mus.21111","volume":"38","author":"SL Lynch","year":"2008","unstructured":"Lynch, S. L., Boon, A. J., Smith, J., Harper, C. M. & Tanaka, E. M. Complications of needle electromyography: hematoma risk and correlation with anticoagulation and antiplatelet therapy. Muscle Nerve 38, 1225 (2008).","journal-title":"Muscle Nerve"},{"key":"23_CR17","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1601185","volume":"2","author":"Y Liu","year":"2016","unstructured":"Liu, Y. et al. Epidermal mechano-acoustic sensing electronics for cardiovascular diagnostics and human-machine interfaces. Sci. Adv. 2, e1601185 (2016).","journal-title":"Sci. Adv."},{"key":"23_CR18","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1126\/science.1250169","volume":"344","author":"S Xu","year":"2014","unstructured":"Xu, S. et al. Soft microfluidic assemblies of sensors, circuits, and radios for the skin. Science 344, 70 (2014).","journal-title":"Science"},{"key":"23_CR19","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1126\/science.1206157","volume":"333","author":"DH Kim","year":"2011","unstructured":"Kim, D.-H. et al. Epidermal electronics. Science 333, 838 (2011).","journal-title":"Science"},{"key":"23_CR20","doi-asserted-by":"publisher","first-page":"3698","DOI":"10.1002\/adfm.201501086","volume":"25","author":"CH Lee","year":"2015","unstructured":"Lee, C. H. et al. Soft core\/shell packages for stretchable electronics. Adv. Funct. Mater. 25, 3698 (2015).","journal-title":"Adv. Funct. Mater."},{"key":"23_CR21","unstructured":"A. Documentation. ABAQUS analysis user\u2019s manual. Materials. Other plasticity models. Simulia 113, 23.3.1 (2010)."},{"key":"23_CR22","unstructured":"Riley, W. F. Mechanics of Materials (John Wiley & Sons, Inc., Indianapolis, IN, USA, 2006)."},{"key":"23_CR23","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1152\/jn.00009.2006","volume":"96","author":"CJ De Luca","year":"2006","unstructured":"De Luca, C. J., Adam, A., Wotiz, R., Gilmore, L. D. & Nawab, S. H. Decomposition of surface EMG signals. J. Neurophysiol. 96, 1646 (2006).","journal-title":"J. Neurophysiol."},{"key":"23_CR24","first-page":"293","volume":"19","author":"R Merletti","year":"1992","unstructured":"Merletti, R., Knaflitz, M. & De Luca, C. J. Electrically evoked myoelectric signals. Crit. Rev. Biomed. Eng. 19, 293 (1992).","journal-title":"Crit. Rev. Biomed. Eng."},{"key":"23_CR25","doi-asserted-by":"crossref","unstructured":"Rattay, F., Electrical Nerve Stimulation (Springer, Wien, 1990).","DOI":"10.1007\/978-3-7091-3271-5"},{"key":"23_CR26","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1109\/TBME.1983.325041","volume":"30","author":"PH Gorman","year":"1983","unstructured":"Gorman, P. H. & Mortimer, J. T. The effect of stimulus parameters on the recruitment characteristics of direct nerve stimulation. IEEE Trans. Biomed. Eng. 30, 407\u2013414 (1983).","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"23_CR27","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/EJA.0b013e328360bd85","volume":"30","author":"C Keyl","year":"2013","unstructured":"Keyl, C., Held, T., Albiez, G., Schmack, A. & Wiesenack, C. Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene: a prospective parallel cohort study. Eur. J. Anaesthesiol. 30, 435 (2013).","journal-title":"Eur. J. Anaesthesiol."},{"key":"23_CR28","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1177\/000348940211100909","volume":"111","author":"KP Tschopp","year":"2002","unstructured":"Tschopp, K. P. & Gottardo, C. Comparison of various methods of electromyographic monitoring of the recurrent laryngeal nerve in thyroid surgery. Ann. Otol. Rhinol. Laryngol. 111, 811 (2002).","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"23_CR29","doi-asserted-by":"publisher","first-page":"i98","DOI":"10.1093\/bja\/aet055","volume":"110","author":"F Radtke","year":"2013","unstructured":"Radtke, F. et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br. J. Anaesth. 110, i98 (2013).","journal-title":"Br. J. Anaesth."},{"key":"23_CR30","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1302\/0301-620X.94B2.28019","volume":"94","author":"M Sutter","year":"2012","unstructured":"Sutter, M. et al. Use of multimodal intra-operative monitoring in averting nerve injury during complex hip surgery. J. Bone Joint Surg. Br. 94, 179 (2012).","journal-title":"J. Bone Joint Surg. Br."},{"key":"23_CR31","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1007\/s40140-016-0155-8","volume":"6","author":"SR Thilen","year":"2016","unstructured":"Thilen, S. R. & Bhananker, S. M. Qualitative neuromuscular monitoring: how to optimize the use of a peripheral nerve stimulator to reduce the risk of residual neuromuscular blockade. Curr. Anesthesiol. Rep. 6, 164 (2016).","journal-title":"Curr. Anesthesiol. Rep."},{"key":"23_CR32","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1038\/nature12314","volume":"499","author":"M Kaltenbrunner","year":"2013","unstructured":"Kaltenbrunner, M. et al. An ultra-lightweight design for imperceptible plastic electronics. Nature 499, 458 (2013).","journal-title":"Nature"},{"key":"23_CR33","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1500701","volume":"1","author":"RC Webb","year":"2015","unstructured":"Webb, R. C. et al. Epidermal devices for noninvasive, precise, and continuous mapping of macrovascular and microvascular blood flow. Sci. Adv. 1, e1500701 (2015).","journal-title":"Sci. Adv."},{"key":"23_CR34","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms5496","volume":"5","author":"C Dagdeviren","year":"2014","unstructured":"Dagdeviren, C. et al. Conformable amplified lead zirconate titanate sensors with enhanced piezoelectric response for cutaneous pressure monitoring. Nat. Commun. 5, 4496 (2014).","journal-title":"Nat. Commun."},{"key":"23_CR35","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms2832","volume":"4","author":"G Schwartz","year":"2013","unstructured":"Schwartz, G. et al. Flexible polymer transistors with high pressure sensitivity for application in electronic skin and health monitoring. Nat. Commun. 4, 1859 (2013).","journal-title":"Nat. Commun."},{"key":"23_CR36","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1038\/nmat3755","volume":"12","author":"RC Webb","year":"2013","unstructured":"Webb, R. C. et al. Ultrathin conformal devices for precise and continuous thermal characterization of human skin. Nat. Mater. 12, 938 (2013).","journal-title":"Nat. Mater."},{"key":"23_CR37","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/smll.201400483","volume":"10","author":"X Huang","year":"2014","unstructured":"Huang, X. et al. Stretchable, wireless sensors and functional substrates for epidermal characterization of sweat. Small  10, 3083 (2014).","journal-title":"Small"},{"key":"23_CR38","doi-asserted-by":"publisher","first-page":"17014","DOI":"10.1038\/micronano.2017.14","volume":"3","author":"S Krishnan","year":"2017","unstructured":"Krishnan, S. et al. Multimodal epidermal devices for hydration monitoring. Microsyst. Nanoeng. 3, 17014 (2017).","journal-title":"Microsyst. Nanoeng."},{"key":"23_CR39","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1038\/nmat4289","volume":"14","author":"C Dagdeviren","year":"2015","unstructured":"Dagdeviren, C. et al. Conformal piezoelectric systems for clinical and experimental characterization of soft tissue biomechanics. Nat. Mater. 14, 728 (2015).","journal-title":"Nat. Mater."},{"key":"23_CR40","doi-asserted-by":"publisher","first-page":"3846","DOI":"10.1002\/adfm.201303886","volume":"24","author":"X Huang","year":"2014","unstructured":"Huang, X. et al. Materials and designs for wireless epidermal sensors of hydration and strain. Adv. Funct. Mater. 24, 3846 (2014).","journal-title":"Adv. Funct. Mater."},{"key":"23_CR41","doi-asserted-by":"publisher","first-page":"6954","DOI":"10.1002\/adma.201502535","volume":"27","author":"CM Boutry","year":"2015","unstructured":"Boutry, C. M. et al. A sensitive and biodegradable pressure sensor array for cardiovascular monitoring. Adv. Mater. 27, 6954 (2015).","journal-title":"Adv. Mater."},{"key":"23_CR42","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1038\/nature20118","volume":"539","author":"M Capogrosso","year":"2016","unstructured":"Capogrosso, M. et al. A brain\u2013spine interface alleviating gait deficits after spinal cord injury in primates. Nature 539, 284 (2016).","journal-title":"Nature"},{"key":"23_CR43","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1038\/nature16521","volume":"529","author":"W Gao","year":"2016","unstructured":"Gao, W. et al. Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis. Nature 529, 509 (2016).","journal-title":"Nature"},{"key":"23_CR44","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1038\/nn.3905","volume":"18","author":"D Khodagholy","year":"2015","unstructured":"Khodagholy, D. et al. NeuroGrid: recording action potentials from the surface of the brain. Nat. Neurosci. 18, 310 (2015).","journal-title":"Nat. Neurosci."},{"key":"23_CR45","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms6745","volume":"5","author":"CM Lochner","year":"2014","unstructured":"Lochner, C. M., Khan, Y., Pierre, A. & Arias, A. C. All-organic optoelectronic sensor for pulse oximetry. Nat. Commun. 5, 5745 (2014).","journal-title":"Nat. Commun."},{"key":"23_CR46","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1501856","volume":"2","author":"T Yokota","year":"2016","unstructured":"Yokota, T. et al. Ultraflexible organic photonic skin. Sci. Adv. 2, e1501856 (2016).","journal-title":"Sci. Adv."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0023-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0023-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0023-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T12:38:10Z","timestamp":1671626290000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0023-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,23]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["23"],"URL":"https:\/\/doi.org\/10.1038\/s41746-018-0023-7","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,23]]},"assertion":[{"value":"26 October 2017","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2018","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2018","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2018","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"J.A.R. and R.G. hold equity in the company MC10 that makes related wearable devices for medical applications. The remaining authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"19"}}