WO2010105034A2

WO2010105034A2 - Physiological monitoring for electronic gaming

Info

Publication number: WO2010105034A2
Application number: PCT/US2010/026950
Authority: WO
Inventors: Yatheendhar D. Manicka; Imad Libbus; Mark J. Bly
Original assignee: Corventis, Inc.
Priority date: 2009-03-11
Filing date: 2010-03-11
Publication date: 2010-09-16
Also published as: WO2010105034A3

Abstract

An adherent device configured to couple to a user of a video game is provided. The adherent device measures user data, such as heart rate, respiration rate, temperature, hydration, activity, and posture, and wirelessly transmits the measured data to the circuitry of the video game. The video game may comprise circuitry configured to alter the gaming experience based on the received user data. The video game may comprise circuitry configured to display an avatar. At least one of the activity or the appearance of the avatar is configured to change in response to the measured user data. The adherent device may also comprise adherent devices with accelerometers and which are coupled to the user's limbs. The adherent devices with accelerometers detect motion of the user's limbs and transmit the motion data to circuitry of the video game. Movements of the avatar can be based on the received motion data.

Description

PHYSIOLOGICAL MONITORING FOR ELECTRONIC GAMING

CROSS-REFERENCES TO RELATED APPLICATIONS [0001] The present application claims the benefit under 35 USC 119(e) of US Provisional Application No. 61/159,356 filed March 11, 2009; the full disclosure of which is incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION [0002] 1. Field of the Invention. The present invention relates generally to human machine interfaces, and more specifically to video games. Although specific embodiments make reference to video game interfaces, embodiments of the present invention can be used with many human to machine interfaces, for example human to electronic machine interfaces such as human to computer interfaces. [0003] Video games represent a significant portion of the entertainment industry and are enjoyed by millions of people worldwide.

[0004] Many video games are controlled by user input through a controller device. In video games played through a personal computer, commands to the game are often inputted by pressing buttons on a keyboard and/or by movement of a computer mouse or joystick. In games played through a video game console, at least one controller device may be coupled to the console. A user may press buttons and/or move a directional pad or joystick to cause in-game events such as a character or avatar action or movement. Feedback from in-game events may be provided to the user by sounds and images on the display. Additionally, specific video game controllers for specific video games may be provided, e.g., a racing wheel or a guitar with pressable buttons.

[0005] Work in relation to embodiments of the present invention suggests that current video game controllers may be less than ideal in at least some instances. Because such video game controls are finger activated, repeated and continued playing of such games may cause the user to incur repetitive strain injuries in at least some instances. Also, finger-activated controls can provide a limited degree of user input for a video game, such that at least some controllers may provide the player with a much less interactive and much less immersive experience than would be ideal in at least some instances. Additionally, such finger activated video game controllers may not be intuitive for the user in at least some instances. For example, a complex video game may have a multitude of in-game commands that may be inputted by pressing different buttons and different combinations of buttons, in at least some instances at very specific sequences and with specific timings. Users, such as small children and the elderly, may encounter difficulty in learning to input such button combinations.

[0006] For at least the above reasons, more easily usable and more intuitive human machine interfaces for video games are needed. Desirably, such human machine interfaces may be able to allow physiological variables to be provided to a gaming system, leading to a more interactive and immersive video gaming experience. Desirably, such human machine interfaces may also minimize the chance of the user incurring repetitive strain injuries.

[0007] 2. Background Art. The following references may describe background art: 2008/0318681; 2007/0207858; 2007/0149282; 2003/0100367; 6,450,820; 5,860,860; 5,772,508; 5,362,069; and 5,001,632.

BRIEF SUMMARY OF THE INVENTION [0008] Embodiments of the present invention provide an adherent device configured to couple to a user of a video game and measure user data. In many embodiments, the videogame comprises circuitry configured to display an avatar comprising a graphical image of the user, and at least one of the activity or the appearance of the avatar is configured to change in response to the measured user data, such that the physiologic data from the user can enhance the experience of the user. The adherent device may comprise adherent devices coupled to the limbs of the user with accelerometers, such that the motion of the user can couple to the video game. The adherent device can allow control of the videogame with movements that can be simple for a user to execute with his or her own body that may minimize, even avoid, the pressing buttons to control the video game. This can enhance the user's experience as the device can be comfortable and present life like motion of the avatar. As the devices can be adhered to the user more accurate information can be obtained and the user can be stimulated with the adherent device. The devices adhered to the user can be used with additional devices, for example a known hand held Nintendo Wii™ device, such that the virtually gaming can be extended to comprise user limb motion and device motion for a virtual gaming experience. The user may play another remote user, and one or more of the adherent devices may stimulate the user in response to an action of the remote second user. For example, the hand held device and adherent device measurements can be combined for virtual sword fighting, for example light saber fighting, and the avatars of the user and the remote second user are shown on each user's display, such that the user is stimulated with a vibration in response to a second user's light sword striking his wrist.

[0009] In a first aspect, embodiments of the invention provide an apparatus to couple a user to a video game. The apparatus comprises at least one adherent device configured to adhere to a skin of the user. The adherent device comprises circuitry configured to measure user data and transmit wirelessly the user data to circuitry of the videogame.

[0010] In many embodiments, the at least one adherent device comprises a support with an adhesive configured to adhere to the skin. The support is configured to adhere continuously to the user for at least about one week. [0011] In many embodiments, the at least one adherent device comprises a consumer device having a reusable and rechargeable electronics module. The electronics module is configured to connect to a replaceable adherent base support configured to adhere to the skin of the user. The at least one adherent device may comprise a plurality of replaceable adherent bases configured to connect to the rechargeable electronics module. [0012] In many embodiments, the at least one adherent device is configured to adhere to the user's chest to measure at least one of a heart rate of the user, a respiratory rate of the user, an activity of the user or a posture of the user.

[0013] In many embodiments, the videogame comprises videogame circuitry and a console configured to couple to a display. The videogame circuitry is substantially contained within the console and configured to receive the physiological user data with wireless communication with the at least one adherent device. The electronics circuitry may comprise at least one peripheral receiver coupled to the console and may be configured to receive the user data from the at least one adherent device. [0014] In many embodiments, the videogame circuitry is configured to display an avatar of the user to the user. The avatar may be configured to at least one of sweat or shake in response to at least one of a heart rate, a respiration rate or a temperature of the user.

[0015] In many embodiments, the video game circuitry is configured to alter the user's experience in response to the physiological variables. For example, in some embodiments, the videogame circuitry is configured to display a shooting game with a weapon. The videogame circuitry may be configured to move the weapon in response to at least one of the user's heart rate or the user's respiratory rate so as to shake in response to at least one of a higher heart rate or a higher respiratory rate. [0016] In some embodiments, the circuitry of the at least one adherent device is configured to determine a fatigue amount of the user and adjust the capabilities of an avatar of the user in response to the fatigue amount of the user. The circuitry of the at least one adherent device may be configured to combine at least two of a heart rate, a respiratory rate, a temperature or a hydration of the user to determine the fatigue amount of the user. The at least one adherent device may be configured to combine the at least two of the heart rate, the respiratory rate, the temperature or the hydration of the user with at least one of a multiplication, a division , a subtraction, an addition, a look up table, an index, a weighted combination or a tiered combination. The at least one adherent device may be configured to determine at least one of movement or position of the device adhered to user, and the circuitry of the videogame may be configured to display avatar movement in response to the at least one of the movement or the position of the at least one device adhered to the user. The at least one adherent device may be configured to decrease an amount of movement transmitted to the videogame circuitry in response to an increase in the fatigue amount.

[0017] In many embodiments, the videogame circuitry is configured to display a heart rate and a respiratory rate on a display visible to the user.

[0018] In many embodiments, the videogame circuitry is configured to display at least one of gaming, training, exercise or simulation images.

[0019] In another aspect, embodiments of the invention provide a video game system for a user having a skin. The system comprises videogame circuitry and at least one adherent device. The videogame circuitry is configured for the user to play a video game. The at least one adherent device is configured to adhere to the skin of the user to measure user data. The videogame circuitry is configured adjust the videogame in response to the user data.

[0020] In many embodiments, the at least one adherent device comprises a support with an adhesive to adhere to the skin. The support is configured to adhere to the user for at least about one week.

[0021] In many embodiments, the at least one adherent device comprises wireless communication circuitry supported with the support and a processor supported with the support. The processor is configured to measure the user data and to transmit the user data to the videogame circuitry. [0022] In many embodiments, the at least one adherent device comprise at least one of accelerometer circuitry to measure acceleration of the user, electrocardiogram circuitry to measure an electrocardiogram of the user, respiration circuitry to measure a respiration of the user, or hydration circuitry to measure a hydration of the user.

[0023] In some embodiments, the at least one adherent device comprises the accelerometer circuitry to measure acceleration of the user, and the accelerometer circuitry comprises a 3D accelerometer sensitive to gravity along each axis to determine at least one of an orientation, a position or a motion of the user.

[0024] In some embodiments, the at least one adherent device may comprise at least two adherent devices configured to adhere to each of at least two limbs of the user. The video game circuitry may be configured to show at least two limbs of an avatar corresponding to the at least two limbs of the user. The video game circuitry may be configured to position each of the at least two limbs of the avatar of the user in response to at least one of an orientation, a position or a motion of each of the at least two limbs of the user.

[0025] The video game circuitry may be configured to position the at least two limbs of the avatar in response to the orientation of the at least two limbs of the user. The video game circuitry may be configured to display second at least two limbs of a second avatar of a second user remote from the first user. The video game circuitry may be configured to transmit data corresponding to the position of the at least two limbs of the avatar to second video game circuitry of the second user. The video game circuitry may be configured to receive data corresponding to the positions of the second at least two limbs of the second avatar. [0026] The at least two adherent devices may comprise at least four adherent devices configured to adhere to each at least four limbs of the user, the video game circuitry may be configured to show at least four limbs of the avatar of the user to the user, and the video game circuitry may be configured to move the at least four limbs of the avatar of the user in response to the at least one of the orientation or the movement of the at least four limbs of the user. The at least four limbs of the user may comprise at least two arms of the user, and the at least four limbs of the avatar may comprise at least two arms of the avatar. Alternatively or in combination, the at least four limbs of the user may comprise at least two legs of the user, and the at least four limbs of the avatar may comprise at least two legs of the avatar. [0027] The at least one adherent device may comprise an adherent device configured to adhere to a thorax of the user and the videogame circuitry may be configured to show an orientation of a thorax of an avatar of the user in response to the orientation of the thorax of the user. The adherent device configured to adhere to the thorax may comprises the electrocardiogram circuitry, which may be configured to measure an electrocardiogram comprising a heart rate of the user and which may be coupled to at least two electrodes configured to measure an electrocardiogram signal from the user. The adherent device configured to adhere to the thorax may comprise the respiration circuitry, which may comprise at least one of impedance circuitry or a mechanical sensor to measure the respiration of the user. The respiration circuitry may comprise the impedance circuitry, which may be coupled to at least two electrodes to measure an electrocardiogram of the user. The respiration circuitry may comprise the mechanical sensor, which may be configured to measure a strain signal in response to respiration of the user. The adherent device configured to adhere to the thorax may comprise the hydration circuitry, which may comprise impedance circuitry.

[0028] In many embodiments, the at least one adherent device is configured to stimulate the user in response to an action of a second user at a remote location. The at least one adherent device may be configured to stimulate the user with at least one of a sound, a vibration or a shock.

[0029] In another aspect, embodiments of the invention provide a method of playing a video game. The method comprises adhering at least one adherent device configured to adhere to a skin of a user. The adherent device measures user data when adhered to the user and transmits wirelessly the user data to circuitry of the videogame. BRIEF DESCRIPTION OF THE DRAWINGS

[0030] Figure IA shows a user and a gaming system comprising an adherent device, according to embodiments of the present invention; [0031] Figure IAl shows an adherent device and an accelerometer device simultaneously coupled to the user, according to embodiments of the present invention;

[0032] Figure 1A2 shows the user as in Figs. IA and IAl playing a video game with a remote user, in accordance with the gaming system as in Fig. IA and Fig. IAl;

[0033] Figure 1A3 shows the remote user playing the video game playing the user as in Fig. IA to 1A2;

[0034] Figure 1 A4 shows images of the videogame on the display of the system as in Fig. IA to Fig. 1 A3, in which the user strikes the wrist of the remote user with a virtual sword shown on the display;

[0035] Figure IB shows a bottom view of an adherent device as in Figure IA comprising an adherent patch configured to adhere to a torso of the user;

[0036] Figure IBl shows a bottom view of an adherent device as in Figure IA comprising an adherent patch configured to adhere to a limb of the user;

[0037] Figure 1C shows a top view of the adherent patch, as in Figure IB; [0038] Figure ICl shows a top view of the adherent patch, as in Figure IBl; [0039] Figure ID shows a printed circuit boards and electronic components over the adherent patch, as in Figure 1C;

[0040] Figure IDl shows a printed circuit boards and electronic components over the adherent patch, as in Figure ICl;

[0041] Figure 1D2 shows an equivalent circuit that can be used to determine optimal frequencies for determining user hydration, according to embodiments of the present invention;

[0042] Figure 1D3 shows adherent devices as in Figs. IA- ID positioned on a user to determine orientation of the adherent patch on the user, according to embodiments of the present invention; [0043] Figure 1D4 shows vectors from a 3D accelerometer to determine orientation of the measurement axis of the patch adhered on the user, according to embodiments of the present invention;

[0044] Figure IE shows batteries positioned over the printed circuit board and electronic components as in Figure ID;

[0045] Figure IEl shows batteries positioned over the printed circuit board and electronic components as in Figure IDl;

[0046] Figure IF shows a top view of an electronics housing and a breathable cover over the batteries, electronic components and printed circuit board as in Figure IE; [0047] Figure IFl shows a top view of an electronics housing and a breathable cover over the batteries, electronic components and printed circuit board as in Figure IEl;

[0048] Figure IG shows a side view of the adherent device as in Figures IA to IF; [0049] Figure IGl shows a side view of the adherent device as in IFl;

[0050] Figure IH shown a bottom isometric view of the adherent device as in Figures IA to IG;

[0051] Figure IHl shown a bottom isometric view of the adherent device as in Figure IGl;

[0052] Figures II and IJ show a side cross-sectional view and an exploded view, respectively, of the adherent device as in Figures IA to IH;

[0053] Figures 111 and Ul show a side cross-sectional view and an exploded view, respectively, of the adherent device as in Figure IHl ;

[0054] Figures 112 and 1J2 show a side cross-sectional view and an exploded view, respectively, of embodiments of the adherent device with a temperature sensor affixed to the gel cover;

[0055] Figures 2A to 2C show a system to monitor a user for an extended period comprising a reusable electronic component and a plurality of disposable patch components, according to embodiments of the present invention;

[0056] Figure 2D shows a method of using the system as in Figures 2A to 2C; [0057] Figures 3A to 3D show a method of gaming a user for an extended period with adherent patches alternatively adhered to opposing sides of at least one of the torso or limbs, according to embodiments;

[0058] Figure 4A shows measurement signals, according to embodiments of the present invention;

[0059] Figure 4Al shows accelerometer signals for orientations for an accelerometer of adherent device on the user, for example a limb such as the left arm of the user;

[0060] Figure 4A2 shows orientation of the limb of the user that can be determined in response to signals as in Fig. 4Al; and [0061] Figure 4B shows a method of gaming a user, according to embodiments of the present invention.

DETAILED DESCRIPTION OF THE INVENTION [0062] Embodiments of the present invention provide an adherent device for gaming physiological variables that interfaces with electronic game consoles for providing a more interactive gaming experience, for example with wireless transmission to the gaming console. In addition to entertainment, video games, the human machine interfaces described herein, may be used in many additional applications including robotic surgery, military and other training or simulation, and the remote control of military equipment, such as unmanned flight drones, and many additional applications.

[0063] The adherent device adhered to a location on the user may comprise a product having a reusable, rechargeable electronic module that connects to a replaceable adherent base, for example a consumer product having a single reusable, rechargeable electronic module that connects to a replaceable adherent base. A plurality of consumable adherent bases can be provided to the user. The device can be adhered to the customers chest, and can monitor the following physiological variables: heart rate with ECG circuitry; respiratory rate with impedance circuitry; activity and posture with an accelerometer. The physiological data can be wirelessly transmitted to an electronic game console, or a peripheral receiver, which can alter the gaming experience based on the physiological variables. For example, in a shooting game, the weapon movement and accuracy can dependent upon the gamer's heart rate and respiratory rate, so as to shake with higher heart rate. These variables may be used to determine fatigue, and adjust the capabilities of the avatar accordingly. The device may be used in exer-gaming, in which the movement and position of the device translate into avatar movement, and the heart rate and respiratory rate information can be used to manage the user's workout. The adherent devices described herein can be used in a variety of human/electronic interface settings, including gaming and also in training or simulation settings, for example military training with combat and flight simulators.

[0064] The adherent device comprises a support, for example a patch that may comprise breathable tape, and the support can be configured to adhere to the user and support the electronics and sensors on the user. The support can be porous and breathable so as to allow water vapor transmission. The support can also stretch with skin of the user, so as to improve user comfort and extend the time that the support can be adhered to the user.

[0065] In many embodiments, an adherent device comprises an adhesive patch with at least two electrodes and an accelerometer. The accelerometer can be used to determine an orientation of the at least two measurement electrodes on a user, for example a measurement axis defined by the at least two electrodes. This use of the accelerometer and the at least two measurement electrodes can be particularly advantageous with user gaming for an extended period, for example when it is desirable to detect subtle changes in user physiology and the adherent patch with electrodes is replaced. By determining the orientation of the electrodes of the patch on the user, physiologic measurements with the at least two electrodes can be adjusted and/or corrected in response to the orientation of the patch on the user. In many embodiments, the accelerometer may be oriented with respect to an electrode measurement axis in a predetermined configuration, which can facilitate determination of the electrode measurement axis in response to the accelerometer signal. In many embodiments, the adherent patch and/or electrodes are replaced with a second adherent patch and/or electrodes, and the orientation of the second adherent patch and/or electrodes determined with the accelerometer or a second accelerometer. The determined orientation of the second patch and/or electrodes on the user can be used to correct measurements made with the second adherent patch and/or electrodes, such that errors associated with the alignment of the first and second patch on the user can be minimized, even inhibited. [0066] In many embodiments, the adherent devices described herein may be used for 90 day gaming, or more, and may comprise completely disposable components and/or reusable components, and can provide reliable data acquisition and transfer. In many embodiments, the patch is configured for user comfort, such that the adherent patch can be worn and/or tolerated by the user for extended periods, for example 90 days or more. The patch may be worn continuously for at least seven days, for example 14 days, and then replaced with another patch. In many embodiments, the adherent patch comprises a tape, which comprises a material, preferably breathable, with an adhesive, such that trauma to the user skin can be minimized while the patch is worn for the extended period. The printed circuit board may comprise a flex printed circuit board that can flex with the user to provide improved user comfort.

[0067] Figure IA shows a user P, for example a player, and a gaming system 10. User P comprises a midline M, a first side Sl, for example a right side, and a second side S2, for example a left side. Gaming system 10 comprises an adherent device 100. Adherent device 100 can be adhered to a user P at many locations, for example thorax T of user P. In many embodiments, the adherent device may adhere to one side of the user, from which side data can be collected. Work in relation with embodiments of the present invention suggests that location on a side of the user can provide comfort for the user while the device is adhered to the user.

[0068] At least one adherent device, for example adherent device 100, can be aligned and/or oriented with respect to axes of user P. Orientation of adherent device 100 can comprise orientation of device 100 with a user coordinate system IOOP aligned with axes of the user. User P comprises a horizontal axis Px that extends laterally from one side of the user to the other, for example from side S 1 to side S 1 across midline M. User P comprises an anterior posterior axis Py that extends from the front, or anterior, of the user to the back, or posterior of the user. User P comprises a vertical axis Pz that extends vertically along the user, for example vertically along the midline of the user from the feet of the user toward the head of the user. In many embodiments, horizontal axis Px, anterior posterior axis Py and vertical axis Pz may comprise a right handed triple of orthogonal coordinate references.

[0069] Adherent device 100 may comprise a 3D coordinate reference system 112XYZ. Device 100 may comprise an X-axis 112X for alignment with horizontal axis Px of the user, a Y-axis for alignment with anterior posterior axis Py of the user and a Z axis for alignment with vertical axis Pz of the user. Coordinate reference system 112XYZ may comprise X-axis 112X, Y-axis 112Y and Z-axis 112Z. Coordinate reference system 112XYZ may comprise a right handed triple, although other non-orthogonal and orthogonal reference systems may be used. [0070] Adherent device 100 may comprise indicia for alignment with an axis of the user. The indicia can be used to align at least one axis of device 100 with at least one axis of the user. The indicia can be positioned on at least one of the adherent patch, a cover, or an electronics module. The indicia can be visible to the user and/or a care provider to adhere device 100 to the user in alignment with at least one axis of the user. A vertical line along Z-axis 112Z can indicate vertical axis 112Z to the user and/or care provider, and a horizontal line along X-axis 112X can indicate horizontal X-axis 112X to the user and/or care provider. A name, logo and/or trademark can be visible the outside of device 100 to indicate that device 100 correctly oriented, and arrows can also be used, for example a vertical arrow pointing up and a horizontal arrow pointing to the right.

[0071] The at least one adherent device of system 10 may comprise an adherent device adhered to a limb of the user. For example, the at least one adherent device may be adhered to the wrist of the user. The adherent devices can also be adhered to each limb of the user simultaneously, so as to obtain differential measurements to determine an orientation of the torso of the user and each of the limbs. Adherent device IOOWI is shown adhered to an upper limb of the user on a right wrist of the user P, for example on the inner side of the wrist of the user. Adherent device 100W2 is shown adhered to an opposing upper limb of the user on a left wrist of the user P, for example on the outer side of the left wrist of the user. Adherent device 100Al is shown adhered to a lower limb of the user on a right ankle of the user P, for example on the outer side of the right ankle of the user. Adherent device 100A2 is shown adhered to a lower opposing limb of the user on a left ankle of the user P, for example on the outer side of the left ankle of the user. Each of adherent devices 100Wl, 100W2, 100Al and 100 A2 may comprise many components similar to device 100, for example alignment indicia, adhesive, and electrical components such as and wireless transmission circuitry and a 3D accelerometer that can be aligned with the axes of the user.

[0072] The orientation of the accelerometers on the user can also be determined in many ways, for example when the user walks such that the orientation of the accelerometers on the user can be determined. Alternatively or in combination, the user can be asked to stand with his or her arms by his side to determine the orientation of the accelerometers on the user. [0073] Gaming system 10 includes components to transmit data to server, for example a remote server 106. Remote server 106 can be located in a different building from the user, for example in the same town as the user, and can be located as far from the user as a separate continent from the user, for example the user located on a first continent and the remote server located on a second continent. Adherent device 100 can communicate wirelessly to video game console 102, for example with a single wireless hop from the adherent device on the user to the video game console. Video game console 102 may comprise a gateway and can communicate with remote server 106 in many ways, for example with an internet connection and/or with a cellular connection. Video game console 102 comprises video game circuitry, programs and software to run a video game program for the user. Video game console 102 is configured to couple to a display 109 visible to the user. The display 109 can show the video game to the user and may comprise many known display devices such as a flat screen TV, a plasma TV, a high definition display, a computer display, display of a hand held personal digital assistant. In many embodiments, gaming system 10 comprises a distributed processing system with at least one processor comprising a tangible medium of device 100, at least one processor 102P of video game console 102, and at least one processor 106P at remote server 106, each of which processors can be in electronic communication with the other processors. At least one processor 102P comprises a tangible medium 102T, and at least one processor 106P comprises a tangible medium 106T.

[0074] Remote processor 106P may comprise a backend server located at the remote server. Remote server 106 can be in communication with a first remote video game console 108 A with a two way communication system 107 A, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. First remote video game console 108 A can be in communication with user P through the communication system. First remote video game console can be coupled to a first remote display 109A visible to the first remote user. The remote video game console 108A may comprise components similar to video game console 102. Remote server 106 can be in communication with a second remote video game console 108B with a two way communication system 107B, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. Second remote video game console 108B can be in communication with user P through the communication system. Second remote video game console can be coupled to a first remote display 109B visible to the second remote user. The second remote video game console 108B may comprise components similar to video game console 102. Remote server 106 can be in communication with a third remote video game console 108C with a two way communication system 107C, such as the Internet, an intranet, phone lines, wireless and/or satellite phone. Third remote video game console 108C can be in communication with user P through the communication system. Third remote video game console can be coupled to a third remote display 109C visible to the third remote user. The third remote video game console 108C may comprise components similar to video game console 102. [0075] Video game console 102 can be configured in many ways to collect data from the plurality of devices adhered to the user. For example, each of the adherent devices can pair with video game console 102, such that video game console 102 may receive data directly from each of the video game consoles. The video game console 102 may comprise a smart gateway that can combine the data from each adherent device for transmission to the remote site, for example by combining data from the devices based on a time stamp by the processor of the adherent device when the data is acquired on the adherent device, so as to generate a data frame for transmission to the remote site. Alternatively or in combination, one of the adherent devices may comprise a communication hub that communicates directly with the other adherent devices to receive user data directly from the other adherent devices and then subsequently transmit the data received from the other adherent devices to the video game console.

[0076] In many embodiments, the adherent device may continuously monitor physiological parameters, communicate wirelessly with a remote server, and provide alerts when necessary. The system may comprise an adherent patch, which attaches to the user's thorax and contains sensing electrodes, battery, memory, logic, and wireless communication capabilities. In some embodiments, the patch can communicate with the remote server, via the video game console in the user's home. In some embodiments, remote server 106 receives the user data and applies a user evaluation algorithm, for example an algorithm to determine an amount of fatigue of the user. The user evaluation algorithm, for example an algorithm to determine an amount of fatigue of the user may also be applied at the gateway, for example with the processor of the gateway device. When a flag is raised, the server may communicate with the another user.

[0077] The adherent device may be affixed and/or adhered to the body in many ways. For example, with at least one of the following: an adhesive tape, a constant-force spring, suspenders around shoulders, a pre-shaped electronics module to shape fabric to a thorax. Patch and/or device replacement may occur with a keyed patch (e.g. two-part patch), an outline or anatomical mark, a low-adhesive guide (place guide | remove old patch | place new patch | remove guide), or a keyed attachment for chatter reduction. The patch and/or device may comprise an adhesiveless embodiment (e.g. chest strap), and/or a low-irritation adhesive for sensitive skin. The adherent patch and/or device can comprise many shapes, for example at least one of a dogbone, an hourglass, an oblong, a circular or an oval shape.

[0078] In many embodiments, the adherent device may comprise a reusable electronics module with replaceable patches, and each of the replaceable patches may include a battery. The module may collect cumulative data for approximately 90 days and/or the entire adherent component (electronics + patch) may be disposable. In a completely disposable embodiment, a "baton" mechanism may be used for data transfer and retention, for example baton transfer may include baseline information. In some embodiments, the device may have a rechargeable module, and may use dual battery and/or electronics modules, wherein one module 101 A can be recharged using a charging station 103 while the other module 10 IB is placed on the adherent patch with connectors. In some embodiments, the video game console 102 may comprise the charging module, data transfer, storage and/or transmission, such that one of the electronics modules can be placed in the video game console for charging and/or data transfer while the other electronics module is worn by the user.

[0079] System 10 can perform the following functions: initiation, programming, measuring, storing, analyzing, communicating, predicting, and displaying. The adherent device may contain a subset of the following physiological sensors: bioimpedance, respiration, respiration rate variability, heart rate (ave, min, max), heart rhythm, hear rate variability (HRV), heart rate turbulence (HRT), heart sounds (e.g. S3), respiratory sounds, blood pressure, activity, posture, wake/sleep, orthopnea, temperature/heat flux, and weight. The activity sensor may comprise one or more of the following: ball switch, accelerometer, minute ventilation, HR, bioimpedance noise, skin temperature/heat flux, BP, muscle noise, posture.

[0080] The adherent device can wirelessly communicate with remote server 106. The communication may occur directly (via a cellular or Wi-Fi network), or indirectly through video game console 102. Video game console 102 may consist of multiple devices, which can communicate wired or wirelessly to relay data to remote server 106.

[0081] In many embodiments, instructions are transmitted from remote site 106 to a processor supported with the adherent patch on the user, and the processor supported with the user can receive updated instructions for the user treatment and/or gaming, for example while worn by the user. [0082] Figure IAl shows at least one adherent device comprising adherent device 100 and a accelerometer device IOOA simultaneously coupled to the user. The system 10 may comprise wireless communication between and/or among devices adhered and/or coupled to the user. Accelerometer device IOOA can be disposed on the user to detect limb movement and/or orientation, for example on the leg, ankle and/or foot of the user. Accelerometer device IOOA can be coupled to the user with a coupling structure in many ways, for example with at least one of adhesive, a collar, a band, breathable adhesive tape or a strap. Accelerometer device IOOA may comprise an accelerometer and/or electromyogram (EMG) circuitry comprising electrodes to detect user leg movement. Adherent device 100 may comprise an accelerometer and/or electromyogram circuitry comprising electrodes to detect user motion, for example motion and/or orientation of the thorax as described above.

[0083] Figure 1A2 shows the user P as in Figs. IA and IAl playing a video game with a remote user. User P is shown in a combat position. The sensors adhered to the skin are configured to measure the orientations of the limbs and thorax of user P. User P also holds a controller device 10OS, for example a sword shaped controller with an accelerometer, configured with wireless communication, which the user P holds and moves as a sword. The controller device can be similar to a known Wii™ device commercially available from Nintendo, and each of the devices including the controller and adherent devices can be in wireless communication with the console and wireless communication circuitry of the console. Many accelerometers can be simultaneously adhered to many locations of the patient, for example to the feet, lower legs, theighs, upper arms, forearms, hands and head, so as to determine the orientation and angles of the joints of the user, such as the ankles, knees, hips, shoulders, elbows, and wrists.

[0084] Figure 1A3 shows the remote user PR playing the video game playing the user as in Fig. IA to 1 A2. The remote user has a remote controller 100SR, for example a sword with an acceleometer and corresponding circuitry, in his hand an has sensors adhered to the limbs and thorax in locations substantially similar to user P. The equirement of remote user IOOSR can be substantially similar to user P.

[0085] Figure 1 A4 shows images of the avatars of the videogame on the display of the system as in Fig. IA to Fig. 1A3, in which the user strikes the wrist of the remote user with a virtual sword shown on a screen of display 109. User P has an avatar IOOPA shown on the display, which may have features similar to a famous movie character, such as a good guy. Remote user PR has a remote avatar IOOPRA shown on the display, which may have features similar to a famous evil movie character, such as a really bad guy.

[0086] The virtual scenes displayed on the user display 109 and the remote display are substantially similar with substantially similar positions of the avatars and surroundings. The orientations of limbs and thorax of each of the user and the remote user can be used to determine the orientations of the limbs of the avatars. Adherent device 100, adherent device 100Wl, adherent device 100W2, adherent device 100Al, and adherent device 10OA, each measures a corresponding orientation of limb of the user.

[0087] The limbs of each of the avatars are shown to the user orientations corresponding to the orientations of the sensors. A thorax of avatar PA of user P is shown with an orientation IOOA corresponding to an orientation of the adherent device 100 on the user P. A first limb of avatar PA of user P has an orientation IOOWIA corresponding to adherent device IOOWI on the corresponding limb of the user. A second limb of avatar PA of user P has an orientation 100W2A corresponding to adherent device 100W2 on the corresponding limb of the user. A third limb of avatar PA of user P has an orientation IOOA IA corresponding to adherent device 100Al on the corresponding limb of the user. A fourth limb of avatar PA of user P has an orientation IOOWIA corresponding to adherent device IOOWI on the corresponding limb of the user.

[0088] The avatar PRA of remote user PR may comprise orientations corresponding to the sensors adhered to remote user.

[0089] Goodguy avatar PA strikes bad guy avatar PRA in the wrist, based on the sensor measurements, and may even severe the hand of the bad guy avatar at the wrist. In response to the processor system determining that bad guy avatar has been struck in the wrist by the sword IOOS corresponding to avatar sword 100SA, the remote user PR corresponding to bad guy avatar PRA may receive a stimulus, in response to contact with the sword of good guy avatar PA. Many kinds of stimulation can be used and may include user perceptible delivery of energy to tissue such as with at least one of mechanical motion, mechanical vibration or electricity.

[0090] The avatar and game can be correspondingly updated in response to the contact and stimulation based on the measured orientations of the corresponding devices and limbs of the users. [0091] Figure IB shows a bottom view of adherent device 100 as in Figure IA comprising an adherent patch 110. Adherent patch 110 comprises a first side, or a lower side 11OA, that is oriented toward the skin of the user when placed on the user. In many embodiments, adherent patch 110 comprises a tape HOT which is a material, preferably breathable, with an adhesive 116 A. User side 11OA comprises adhesive 116A to adhere the patch 110 and adherent device 100 to user P. Electrodes 112A, 112B, 1 12C and 112D are affixed to adherent patch 110. In many embodiments, at least four electrodes are attached to the patch, for example six electrodes. In some embodiments the patch comprises two electrodes, for example two electrodes to measure the electrocardiogram (ECG) of the user. Gel 114A, gel 114B, gel 114C and gel 114D can each be positioned over electrodes 112A, 112B, 112C and 112D, respectively, to provide electrical conductivity between the electrodes and the skin of the user. In many embodiments, the electrodes can be affixed to the patch 110, for example with known methods and structures such as rivets, adhesive, stitches, etc. In many embodiments, patch 110 comprises a breathable material to permit air and/or vapor to flow to and from the surface of the skin. [0092] Electrodes 112 A, 112B, 112C and 112D extend substantially along a horizontal measurement axis that corresponds to X axis-112X of the measurement device. Electrodes 112, 112B, 112C and 112D can be affixed to adherent patch 11OA, such that the positions of electrodes 112A, 112B, 112C and 112D comprise predetermined positions on adherent patch 11OA. Z-axis 112Z can extend perpendicular to the electrode measurement axis, for example vertically and perpendicular to X-axis 112 when adhered on the user. X-axis 112X and Z-axis 112Z can extend along an adhesive surface of adherent patch HOA, and a Y-axis 112Y can extend away from the adhesive surface of adherent device 11OA.

[0093] Figure IBl shows a bottom view of adherent device IOOWI as in Figure IA comprising an adherent patch configured to adhere to a limb of the user. Adherent device IOOWI comprises many structures and components similar to adherent device 100, for example adherent patch 110, lower side 11OA, tape 11OT, adhesive 116A. User side 11OA comprises adhesive 116A to adhere the patch 110 and adherent device 100 to user P. Patch IOOWI may comprise circuitry to measure electromyogram signals coupled electrodes and gel pads similar to adherent device 100. [0094] Figure 1C shows a top view of the adherent patch 100, as in Figure IB. Adherent patch 100 comprises a second side, or upper side 11OB. In many embodiments, electrodes 112A, 112B, 112C and 112D extend from lower side HOA through adherent patch 110 to upper side 11OB. An adhesive 116B can be applied to upper side 11OB to adhere structures, for example a breathable cover, to the patch such that the patch can support the electronics and other structures when the patch is adhered to the user. The PCB may comprise completely flex PCB, rigid PCB, rigid PCB combined flex PCB and/or rigid PCB boards connected by cable.

[0095] Figure ICl shows a top view of the adherent patch, as in Figure IBl. Adherent device IOOWI comprises upper side HOB and adhesive 116B to adhere structures to the patch.

[0096] Figure ID shows a printed circuit boards and electronic components over adherent patch 110, as in Figures IA to 1C. In some embodiments, a printed circuit board (PCB), for example flex printed circuit board 120, may be connected to electrodes 112 A, 112B, 112C and 112D with connectors 122A, 122B, 122C and 122D. Flex printed circuit board 120 can include traces 123A, 123B, 123C and 123D that extend to connectors 122A, 122B, 122C and 122D, respectively, on the flex PCB. Connectors 122 A, 122B, 122C and 122D can be positioned on flex printed circuit board 120 in alignment with electrodes 112 A, 112B, 112C and 112D so as to electrically couple the flex PCB with the electrodes. In some embodiments, connectors 122A, 122B, 122C and 122D may comprise insulated wires and/or a film with conductive ink that provide strain relief between the PCB and the electrodes. For example, connectors 122A, 122B, 122C and 122D may comprise a flexible film, such as at least one of known polyester film or known polyurethane file coated with a conductive ink, for example a conductive silver ink. In some embodiments, additional PCB's, for example rigid PCB's 120A, 120B, 120C and 120D, can be connected to flex printed circuit board 120. Electronic components 130 can be connected to flex printed circuit board 120 and/or mounted thereon. In some embodiments, electronic components 130 can be mounted on the additional PCB's.

[0097] Electronic components 130 comprise components to take physiologic measurements, transmit data to remote server 106 and receive commands from remote server 106. In many embodiments, electronics components 130 may comprise known low power circuitry, for example complementary metal oxide semiconductor (CMOS) circuitry components. Electronics components 130 comprise an activity sensor and activity circuitry 134, impedance circuitry 136 and electrocardiogram circuitry, for example ECG circuitry 136. In some embodiments, electronics circuitry 130 may comprise a microphone and microphone circuitry 142 to detect an audio signal from within the user, and the audio signal may comprise a heart sound and/or a respiratory sound, for example an S3 heart sound and a respiratory sound with rales and/or crackles.

[0098] Electronics circuitry 130 may comprise a temperature sensor, for example a thermistor in contact with the skin of the user, and temperature sensor circuitry 144 to measure a temperature of the user, for example a temperature of the skin of the user. A temperature sensor may be used to determine the sleep and wake state of the user. The temperature of the user can decrease as the user goes to sleep and increase when the user wakes up.

[0099] Work in relation to embodiments of the present invention suggests that skin temperature may effect impedance and/or hydration measurements, and that skin temperature measurements may be used to correct impedance and/or hydration measurements. In some embodiments, increase in skin temperature or heat flux can be associated with increased vasodilation near the skin surface, such that measured impedance measurement decreased, even through the hydration of the user in deeper tissues under the skin remains substantially unchanged. Thus, use of the temperature sensor can allow for correction of the hydration signals to more accurately assess the hydration, for example extra cellular hydration, of deeper tissues of the user, for example deeper tissues in the thorax.

[0100] Electronics circuitry 130 may comprise a processor 146. Processor 146 comprises a tangible medium, for example read only memory (ROM), electrically erasable programmable read only memory (EEPROM) and/or random access memory (RAM). Electronic circuitry 130 may comprise real time clock and frequency generator circuitry 148. In some embodiments, processor 136 may comprise the frequency generator and real time clock. The processor can be configured to control a collection and transmission of data from the impedance circuitry electrocardiogram circuitry and the accelerometer. In many embodiments, device 100 comprise a distributed processor system, for example with multiple processors on device 100. [0101] In many embodiments, electronics components 130 comprise wireless communications circuitry 132 to communicate with remote server 106. Printed circuit board 120 may comprise an antenna to facilitate wireless communication. The antenna may be integral with printed circuit board 120 or may be separately coupled thereto. The wireless communication circuitry can be coupled to the impedance circuitry, the electrocardiogram circuitry and the accelerometer to transmit to a remote server with a communication protocol at least one of the hydration signal, the electrocardiogram signal or the inclination signal. In specific embodiments, wireless communication circuitry is configured to transmit the hydration signal, the electrocardiogram signal and the inclination signal to the remote server with a single wireless hop, for example from wireless communication circuitry 132 to video game console 102. The communication protocol comprises at least one of Bluetooth, Zigbee, WiFi, WiMax, IR, amplitude modulation or frequency modulation. In many embodiments, the communications protocol comprises a two way protocol such that the remote server is capable of issuing commands to control data collection.

[0102] Video game console 102 may comprise a data collection system to collect and store data from the wireless transmitter. The data collection system can be configured to communicate periodically with the remote server. The data collection system can transmit data in response to commands from remote server 106 and/or in response to commands from the adherent device.

[0103] Activity sensor and activity circuitry 134 can comprise many known activity sensors and circuitry. In many embodiments, the accelerometer comprises at least one of a piezoelectric accelerometer, capacitive accelerometer or electromechanical accelerometer. The accelerometer may comprise a 3-axis accelerometer to measure at least one of an inclination, a position, an orientation or acceleration of the user in three dimensions. Work in relation to embodiments of the present invention suggests that three dimensional orientation of the user and associated positions, for example sitting, standing, lying down, can be very useful when combined with data from other sensors, for example ECG data and/or bioimpedance data such as at least one of respiration rate data or hydration data.

[0104] Activity sensor 134 may comprise an accelerometer with at least one measurement axis, for example two or more measurement axes. In some embodiments, activity sensor 134 comprises three axis accelerometer 134A. Three axis accelerometer 134 A may comprise an X- axis 134X, a Y-axis 134Y and a Z-axis 134Z with each axis sensitive to gravity such that the orientation of the accelerometer can be determined in relation to gravity. Three axis accelerometer 134A can be aligned with electrodes of adherent patch 11OA. X-axis 134X can be aligned with X-axis 112X of adherent patch 110. Y-axis 134Y can be aligned with Y-axis 112Y of adherent patch 110. Z-axis 134Z can be aligned with Z-axis 112Z of adherent patch 110. Axes of accelerometer 134 A can be aligned with axes of patch 11OA, for example with connectors 122A, 122B, 122C and 122D, such that the axes of the accelerometer are aligned with adherent patch and/or the electrodes in a predetermined configuration. Although the axes of the patch and accelerometer are shown substantially parallel, the axes of the patch can be aligned with the axes of the accelerometer in a non-parallel configuration, for example an oblique configuration with oblique angles between axes of the accelerometer and axes of the adherent patch and/or electrodes. [0105] Impedance circuitry 136 can generate both hydration data and respiration data. In many embodiments, impedance circuitry 136 is electrically connected to electrodes 112A, 112B, 112C and 112D in a four pole configuration, such that electrodes 112A and 112D comprise outer electrodes that are driven with a current and comprise force electrodes that force the current through the tissue. The current delivered between electrodes 112A and 112D generates a measurable voltage between electrodes 112B and 112C, such that electrodes 112B and 112C comprise inner, sense, electrodes that sense and/or measure the voltage in response to the current from the force electrodes. In some embodiments, electrodes 112B and 112C may comprise force electrodes and electrodes 112A and 112B may comprise sense electrodes. The voltage measured by the sense electrodes can be used to measure the impedance of the user and determine the respiration rate and/or hydration of the user.

[0106] The adherent device may comprise circuitry to determine when the device is adhered to the user to monitor user compliance. For example the device may comprise impedance circuitry that can periodically measure impedance and when the impedance is outside a physiological range determine that the device is no longer adhered to the user. The circuitry may comprise a switch to detect tissue contact to the electrodes, for example as described in U.S. App. No.

61/046,196, entitled "Medical Device Automatic Start-Up Upon Contact to User Tissue", filed on April 18, 2008, the full disclosure of which is incorporated herein by reference. When the user removes the adherent device, a signal can be transmitted to the gateway and server and an alert issued to the caregiver if the patch is removed outside a specified time period for replacement of the adherent patch device.

[0107] Figure IDl shows a printed circuit boards and electronic components over adherent patch 100Wl, as in Figure ICl. Similar to adherent device 100, adherent device IOOWI may comprise electronics components such as flex printed circuit board 120, connectors comprising a flexible film, additional PCB's, for example rigid PCB's 120A connected to flex printed circuit board 120. At least some of electronic components 130 can be connected to flex printed circuit board 120 and/or mounted thereon, for example 3D accelerometer and wireless circuitry. [0108] Figure 1D2 shows an equivalent circuit 152 that can be used to determine optimal frequencies for measuring user hydration. Work in relation to embodiments of the present invention indicates that the frequency of the current and/or voltage at the force electrodes can be selected so as to provide impedance signals related to the extracellular and/or intracellular hydration of the user tissue. Equivalent circuit 152 comprises an intracellular resistance 156, or R(ICW) in series with a capacitor 154, and an extracellular resistance 158, or R(ECW). Extracellular resistance 158 is in parallel with intracellular resistance 156 and capacitor 154 related to capacitance of cell membranes. In many embodiments, impedances can be measured and provide useful information over a wide range of frequencies, for example from about 0.5 kHz to about 200 KHz. Work in relation to embodiments of the present invention suggests that extracellular resistance 158 can be significantly related extracellular fluid and to cardiac decompensation, and that extracellular resistance 158 and extracellular fluid can be effectively measured with frequencies in a range from about 0.5 kHz to about 20 kHz, for example from about 1 kHz to about 10 kHz. In some embodiments, a single frequency can be used to determine the extracellular resistance and/or fluid. As sample frequencies increase from about 10 kHz to about 20 kHz, capacitance related to cell membranes decrease the impedance, such that the intracellular fluid contributes to the impedance and/or hydration measurements. Thus, many embodiments of the present invention measure hydration with frequencies from about 0.5 kHz to about 20 kHz to determine user hydration. [0109] In many embodiments, impedance circuitry 136 can be configured to determine respiration of the user. In specific embodiments, the impedance circuitry can measure the hydration at 25 Hz intervals, for example at 25 Hz intervals using impedance measurements with a frequency from about 0.5 kHz to about 20 kHz.

[0110] ECG circuitry 138 can generate electrocardiogram signals and data from two or more of electrodes 112A, 112B, 112C and 112D in many ways. In some embodiments, ECG circuitry

138 is connected to inner electrodes 112B and 122C, which may comprise sense electrodes of the impedance circuitry as described above. In some embodiments, ECG circuitry 138 can be connected to electrodes 112A and 112D so as to increase spacing of the electrodes. The inner electrodes may be positioned near the outer electrodes to increase the voltage of the ECG signal measured by ECG circuitry 138. In many embodiments, the ECG circuitry may measure the

ECG signal from electrodes 112A and 112D when current is not passed through electrodes 112A and 112D, for example with switches. [0111] Figure 1D3 shows an adherent device, for example adherent device 100, positioned on user P to determine orientation of the adherent patch. X-axis 112X of device 100 is inclined at an angle α to horizontal axis Px of user P. Z- axis 112Z of device 100 is inclined at angle α to vertical axis Pz of user P. Y-axis 112Y may be inclined at a second angle, for example β, to anterior posterior axis Py and vertical axis Pz. As the accelerometer of adherent device 100 can be sensitive to gravity, inclination of the patch relative to axis of the user can be measured, for example when the user stands.

[0112] ECG circuitry 138 can be coupled to the electrodes in many ways to define an electrocardiogram vector. For example electrode 112A can be coupled to a positive amplifier terminal of ECG circuitry 138 and electrode 112D can be coupled to a negative amplifier terminal of ECG circuitry 138 to define an orientation of an electrocardiogram vector along the electrode measurement axis. To define an electrocardiogram vector with an opposite orientation electrode 112D can be couple to the positive amplifier terminal of ECG circuitry 138 and electrode 112A can be coupled to the negative amplifier terminal of ECG circuitry 138. The ECG circuitry may be coupled to the inner electrodes so as to define an ECG vector along a measurement axis of the inner electrodes.

[0113] Figure 1D4 shows vectors from a 3D accelerometer to determine orientation of the measurement axis of the patch adhered on the user. The orientation can be determined for each patch adhered to the user. A Z- axis vector 112ZV can be measured along vertical axis 112Z with an accelerometer signal from axis 134Z of accelerometer 134A. An X-axis vector 112XV can be measured along horizontal axis 112X with an accelerometer signal from axis 134X of accelerometer 134 A. Inclination angle α can be determined in response to X-axis vector 112XV and Z-axis vector 112ZV, for example with vector addition of X-axis vector 112XV and Z-axis vector 112ZV. An inclination angle β for the patch along the Y and Z axes can be similarly obtained an accelerometer signal from axis 134 Y of accelerometer 134 A and vector 112ZV.

[0114] Figure IE shows batteries 150 positioned over the flex printed circuit board and electronic components as in Figure ID. Batteries 150 may comprise rechargeable batteries that can be removed and/or recharged. In some embodiments, batteries 150 can be removed from the adherent patch and recharged and/or replaced. [0115] Figure IEl shows batteries positioned 150 over the printed circuit board and electronic components as in Figure IDl. [0116] Figure IF shows a top view of a cover 162 over the batteries, electronic components and flex printed circuit board as in Figures IA to IE. In many embodiments, an electronics housing 160 may be disposed under cover 162 to protect the electronic components, and in some embodiments electronics housing 160 may comprise an encapsulant over the electronic components and PCB. In some embodiments, cover 162 can be adhered to adherent patch 110 with an adhesive 164 on an underside of cover 162. In many embodiments, electronics housing 160 may comprise a water proof material, for example a sealant adhesive such as epoxy or silicone coated over the electronics components and/or PCB. In some embodiments, electronics housing 160 may comprise metal and/or plastic. Metal or plastic may be potted with a material such as epoxy or silicone.

[0117] Cover 162 may comprise many known biocompatible cover, casing and/or housing materials, such as elastomers, for example silicone. The elastomer may be fenestrated to improve breathability. In some embodiments, cover 162 may comprise many known breathable materials, for example polyester, polyamide, nylon and/or elastane (Spandex™). The breathable fabric may be coated to make it water resistant, waterproof, and/or to aid in wicking moisture away from the patch.

[0118] Figure IFl shows a top view of electronics housing 160 and breathable cover 162 over the batteries, electronic components and printed circuit board of adherent device lOOWl.

[0119] Figure IG shows a side view of adherent device 100 as in Figures IA to IF. Adherent device 100 comprises a maximum dimension, for example a length 170 from about 4 to 10 inches (from about 100 mm to about 250mm), for example from about 6 to 8 inches (from about

150 mm to about 200 mm). In some embodiments, length 170 may be no more than about 6 inches (no more than about 150 mm). Adherent device 100 comprises a thickness 172.

Thickness 172 may comprise a maximum thickness along a profile of the device. Thickness 172 can be from about 0.2 inches to about 0.6 inches (from about 5 mm to about 15 mm), from about

0.2 inches to about 0.4 inches (from about 5 mm to about 10 mm), for example about 0.3 inches

(about 7.5 mm).

[0120] Figure IGl shows a side view of the adherent device lOOWlas in IFl. Adherent device lOOWl comprises a maximum dimension across comprising a length 170Wl from about 1 to 3 inches (from about 25 mm to about 75 mm), , for example about 2inches (about 50 mm). Adherent device lOOWl comprises a thickness 172Wl. Thickness 172Wl may comprise a maximum thickness along a profile of the device. Thickness 172Wl can be from about 0.1 inches to about 0.5 inches (from about 2.5 mm to about 12 mm), from about 0.2 inches to about 0.4 inches (from about 5 mm to about 10 mm), for example about 0.3 inches (about 7.5 mm).

[0121] Figure IH shown a bottom isometric view of adherent device 100 as in Figures IA to IG. Adherent device 100 comprises a width 174, for example a maximum width along a width profile of adherent device 100. Width 174 can be from about 2 to about 4 inches (from about 50 mm to 100 mm), for example about 3 inches (about 75 mm).

[0122] Figure IHl shown a bottom isometric view of the adherent device as in Figure IGl. Adherent device IOOWI comprises a width 174Wl, for example a maximum width along a width profile of adherent device IOOWI. Width 174Wl can be from about 1 to about 3 inches (from about 25 mm to 75 mm), for example about 2 inches (about 50 mm).

[0123] Figures II and U show a side cross-sectional view and an exploded view, respectively, of adherent device 100 as in Figures IA to IH. Device 100 comprises several layers. Gel 114A, or gel layer, is positioned on electrode 112A to provide electrical conductivity between the electrode and the skin. Electrode 112A may comprise an electrode layer. Adherent patch 110 may comprise a layer of breathable tape 11OT, for example a known breathable tape, such as tricot-knit polyester fabric. An adhesive 116 A, for example a layer of acrylate pressure sensitive adhesive, can be disposed on underside HOA of adherent patch 110.

[0124] Figures 111 and Ul show a side cross-sectional view and an exploded view, respectively, of adherent device IOOWI. Device IOOWI comprises several layers, for example many of the components, structures and layers of adherent device 100. Adherent patch 11OW 1 may comprise a layer of breathable tape 11OT, for example a known breathable tape, such as tricot-knit polyester fabric. An adhesive 116 A, for example a layer of acrylate pressure sensitive adhesive, can be disposed on underside 11OA of adherent patch 110. [0125] Figures 112 and 1J2 show a side cross-sectional view and an exploded view, respectively, of embodiments of the adherent device with a temperature sensor affixed to the gel cover. In these embodiments, gel cover 180 extends over a wider area than in the embodiments shown in Figures II and IJ. Temperature sensor 177 is disposed over a peripheral portion of gel cover 180. Temperature sensor 177 can be affixed to gel cover 180 such that the temperature sensor can move when the gel cover stretches and tape stretch with the skin of the user. Temperature sensor 177 may be coupled to temperature sensor circuitry 144 through a flex connection comprising at least one of wires, shielded wires, non-shielded wires, a flex circuit, or a flex PCB. This coupling of the temperature sensor allows the temperature near the skin to be measured though the breathable tape and the gel cover. The temperature sensor can be affixed to the breathable tape, for example through a cutout in the gel cover with the temperature sensor positioned away from the gel pads. A heat flux sensor can be positioned near the temperature sensor, for example to measure heat flux through to the gel cover, and the heat flux sensor coupled to heat flux circuitry similar to the temperature sensor.

[0126] The adherent device comprises electrodes 112 A 1 , 112B 1 , 112C 1 and 112D 1 configured to couple to tissue through apertures in the breathable tape 11OT. Electrodes 112Al, 112Bl, 112Cl and 112Dl can be fabricated in many ways. For example, electrodes 112Al, 112Bl, 112Cl and 112Dl can be printed on a flexible connector 112F, such as silver ink on polyurethane. Breathable tape HOT comprise apertures 180Al, 180B l, 180Cl and 180Dl. Electrodes 112Al, 112Bl, 112Cl and 112Dl are exposed to the gel through apertures 180Al, 180Bl, 180Cl and 180Dl of breathable tape 11OT. Gel 114A, gel 114B, gel 114C and gel 114D can be positioned over electrodes 112Al, 112Bl, 112Cl and 112Dl and the respective portions of breathable tape 11OT proximate apertures 180Al, 180Bl, 180Cl and 180Dl, so as to couple electrodes 1 12Al, 112B l, 112Cl and 112Dl to the skin of the user. The flexible connector 112F comprising the electrodes can extend from under the gel cover to the printed circuit board to connect to the printed circuit boards and/or components supported thereon. For example, flexible connector 112F may comprise flexible connector 122 A to provide strain relief, as described above.

[0127] In many embodiments, gel 114A, or gel layer, comprises a hydrogel that is positioned on electrode 112A to provide electrical conductivity between the electrode and the skin. In many embodiments, gel 114 A comprises a hydrogel that provides a conductive interface between skin and electrode, so as to reduce impedance between electrode/skin interface. In many embodiments, gel may comprise water, glycerol, and electrolytes, pharmacological agents, such as beta blockers, ace inhibiters, diuretics, steroid for inflammation, antibiotic, antifungal agent. In specific embodiments the gel may comprise cortisone steroid. The gel layer may comprise many shapes, for example, square, circular, oblong, star shaped, many any polygon shapes. In specific embodiments, the gel layer may comprise at least one of a square or circular geometry with a dimension in a range from about .005" to about .100", for example within a range from about .015" - .070", in some embodiments within a range from about .015" - .040", and in specific embodiments within a range from about .020" - .040". In many embodiments, the gel layer of each electrode comprises an exposed surface area to contact the skin within a range from about 100 mm^Λ2 to about 1500mm^Λ2, for example a range from about 250 mm^Λ2 to about 750 mm^Λ2, and in specific embodiments within a range from about 350 mm^Λ2 to about 650 mm^Λ2. Work in relation with embodiments of the present invention suggests that such dimensions and/or exposed surface areas can provide enough gel area for robust skin interface without excessive skin coverage. In many embodiments, the gel may comprise an adhesion to skin, as may be tested with a 1800 degree peel test on stainless steel, of at least about 3 oz/in, for example an adhesion within a range from about 5-10 oz/in.. In many embodiments, a spacing between gels is at least about 5 mm, for example at least about 10mm. Work in relation to embodiments of the present invention suggests that this spacing may inhibit the gels from running together so as to avoid crosstalk between the electrodes. In many embodiments, the gels comprise a water content within a range from about 20% to about 30%, a volume resistivity within a range from about 500 to 2000 ohm-cm, and a pH within a range from about 3 to about 5.

[0128] In many embodiments, the electrodes, for example electrodes 112A to 112D, may comprise an electrode layer. A 0.001" - 0.005" polyester strip with silver ink for traces can extend to silver/silver chloride electrode pads. In many embodiments, the electrodes can provide electrical conduction through hydrogel to skin, and in some embodiments may be coupled directly to the skin. Although at least 4 electrodes are shown, some embodiments comprise at least two electrodes, for example 2 electrodes. In some embodiments, the electrodes may comprise at least one of carbon-filled ABS plastic, silver, nickel, or electrically conductive acrylic tape. In specific embodiments, the electrodes may comprise at least one of carbon-filled ABS plastic, Ag/AgCl. The electrodes may comprise many geometric shapes to contact the skin, for example at least one of square, circular, oblong, star shaped, polygon shaped, or round. In specific embodiments, a dimension across a width of each electrodes is within a range from about 002" to about .050", for example from about .010 to about .040". In many a surface area of the electrode toward the skin of the user is within a range from about 25mm^Λ2 to about 1500mm^Λ2 , for example from about 75 mm^Λ2 to about 150 mm^Λ2. In many embodiments, the electrode comprises a tape that may cover the gel near the skin of the user. In specific embodiments, the two inside electrodes may comprise force, or current electrodes, with a server to server spacing within a range from about 20 to about 50 mm. In specific embodiments, the two outside electrodes may comprise measurement electrodes, for example voltage electrodes, and a server-server spacing between adjacent voltage and current electrodes is within a range from about 15 mm to about 35 mm. Therefore, in many embodiments, a spacing between inner electrodes may be greater than a spacing between an inner electrode and an outer electrode. [0129] In many embodiments, adherent patch 110 may comprise a layer of breathable tape 11OT, for example a known breathable tape, such as tricot-knit polyester fabric. In many embodiments, breathable tape 11OT comprises a backing material, or backing 111, with an adhesive. In many embodiments, the patch adheres to the skin of the user's body, and comprises a breathable material to allow moisture vapor and air to circulate to and from the skin of the user through the tape. In many embodiments, the backing is conformable and/or flexible, such that the device and/or patch does not become detached with body movement. In many embodiments, backing can sufficiently regulate gel moisture in absence of gel cover. In many embodiments, adhesive patch may comprise from 1 to 2 pieces, for example 1 piece. In many embodiments, adherent patch 110 comprises pharmacological agents, such as at least one of beta blockers, ace inhibiters, diuretics, steroid for inflammation, antibiotic, or antifungal agent. In specific embodiments, patch 110 comprises cortisone steroid. Patch 110 may comprise many geometric shapes, for example at least one of oblong, oval, butterfly, dogbone, dumbbell, round, square with rounded corners, rectangular with rounded corners, or a polygon with rounded corners. In specific embodiments, a geometric shape of patch 110 comprises at least one of an oblong, an oval or round. In many embodiments, the geometric shape of the patch comprises a radius on each corner that is no less than about one half a width and/or diameter of tape. Work in relation to embodiments of the present invention suggests that rounding the corner can improve adherence of the patch to the skin for an extended period of time because sharp corners, for example right angle corners, can be easy to peel. In specific embodiments, a thickness of adherent patch 110 is within a range from about 0.001" to about .020", for example within a range from about 0.005" to about 0.010". Work in relation to embodiments of the present invention indicates that these ranges of patch thickness can improve adhesion of the device to the skin of the user for extended periods as a thicker adhesive patch, for example tape, may peel more readily. In many embodiments, length 170 of the patch is within a range from about 2" to about 10", width 174 of the patch is within a range from about 1" to about 5". In specific embodiments, length 170 is within a range from about 4" to about 8" and width 174 is within a range from about 2" to about 4". In many embodiments, an adhesion to the skin, as measured with a 180 degree peel test on stainless steel , can be within a range from about 10 to about 100 oz/in width, for example within a range from about 30 to about 70 oz/in width. Work in relation to embodiments of the present invention suggests that adhesion within these ranges may improve the measurement capabilities of the patch because if the adhesion is too low, patch will not adhere to the skin of the user for a sufficient period of time and if the adhesion is too high, the patch may cause skin irritation upon removal. In many embodiments adherent patch 110 comprises a moisture vapor transmission rate (MVTR, g/m^Λ2/24 hrs) per American Standard for Testing and Materials E-96 (ASTM E-96) is at least about 400, for example at least about 1000. Work in relation to embodiments of the present invention suggest that MVTR values as specified above can provide improved comfort, for example such that in many embodiments skin does not itch. In some embodiments, the breathable tape 11OT of adherent patch 110 may comprise a porosity (sec./lOOcc/in²) within a wide range of values, for example within a range from about 0 to about 200. The porosity of breathable tape 11OT may be within a range from about 0 to about 5. The above amounts of porosity can minimize itching of the user's skin when the patch is positioned on the skin of the user. In many embodiments, the MVTR values above may correspond to a MVTR through both the gel cover and the breathable tape. The above MVTR values may also correspond to an MVTR through the breathable tape, the gel cover and the breathable cover. The MVTR can be selected to minimize user discomfort, for example itching of the user's skin. [0130] In some embodiments, the breathable tape may contain and elute a pharmaceutical agent, such as an antibiotic, anti-inflammatory or antifungal agent, when the adherent device is placed on the user.

[0131] In many embodiments, tape 11OT of adherent patch 110 may comprise backing material, or backing 111, such as a fabric configured to provide properties of patch 110 as described above. In many embodiments backing 111 provides structure to breathable tape 11OT, and many functional properties of breathable tape 11OT as described above. In many embodiments, backing 111 comprises at least one of polyester, polyurethane, rayon, nylone, breathable plastic film; woven, nonwoven, spunlace, knit, film, or foam. In specific embodiments, backing 111 may comprise polyester tricot knit fabric. In many embodiments, backing 111 comprises a thickness within a range from about 0.0005" to about 0.020", for example within a range from about 0.005" to about 0.010". [0132] In many embodiments, an adhesive 116A, for example breathable tape adhesive comprising a layer of acrylate pressure sensitive adhesive, can be disposed on underside 11OA of patch 110. In many embodiments, adhesive 116A adheres adherent patch 110 comprising backing 111 to the skin of the user, so as not to interfere with the functionality of breathable tape, for example water vapor transmission as described above. In many embodiments, adhesive 116A comprises at least one of acrylate, silicone, synthetic rubber, synthetic resin, hydrocolloid adhesive, pressure sensitive adhesive (PSA), or acrylate pressure sensitive adhesive. In many embodiments, adhesive 116A comprises a thickness from about 0.0005" to about 0.005", in specific embodiments no more than about 0.003". Work in relation to embodiments of the present invention suggests that these thicknesses can allow the tape to breathe and/or transmit moisture, so as to provide user comfort.

[0133] A gel cover 180, or gel cover layer, for example a polyurethane non-woven tape, can be positioned over patch 110 comprising the breathable tape. A PCB layer, for example flex printed circuit board 120, or flex PCB layer, can be positioned over gel cover 180 with electronic components 130 connected and/or mounted to flex printed circuit board 120, for example mounted on flex PCB so as to comprise an electronics layer disposed on the flex PCB layer. In many embodiments, the adherent device may comprise a segmented inner component, for example the PCB may be segmented to provide at least some flexibility. In many embodiments, the electronics layer may be encapsulated in electronics housing 160 which may comprise a waterproof material, for example silicone or epoxy. In many embodiments, the electrodes are connected to the PCB with a flex connection, for example trace 123 A of flex printed circuit board 120, so as to provide strain relive between the electrodes 112A, 112B, 112C and 112D and the PCB.

[0134] Gel cover 180 can inhibit flow of gel 114A and liquid. In many embodiments, gel cover 180 can inhibit gel 114A from seeping through breathable tape 11OT to maintain gel integrity over time. Gel cover 180 can also keep external moisture from penetrating into gel 114A. For example gel cover 180 can keep liquid water from penetrating though the gel cover into gel 114A, while allowing moisture vapor from the gel, for example moisture vapor from the skin, to transmit through the gel cover. The gel cover may comprise a porosity at least 200 sec./lOOcc/in , and this porosity can ensure that there is a certain amount of protection from external moisture for the hydrogel. [0135] In many embodiments, the gel cover can regulate moisture of the gel near the electrodes so as to keeps excessive moisture, for example from a user shower, from penetrating gels near the electrodes. In many embodiments, the gel cover may avoid release of excessive moisture form the gel, for example toward the electronics and/or PCB modules. Gel cover 180 may comprise at least one of a polyurethane, polyethylene, polyolefin, rayon, PVC, silicone, non- woven material, foam, or a film. In many embodiments gel cover 180 may comprise an adhesive, for example a acrylate pressure sensitive adhesive, to adhere the gel cover to adherent patch 110. In specific embodiments gel cover 180 may comprise a polyurethane film with acrylate pressure sensitive adhesive. In many embodiments, a geometric shape of gel cover 180 comprises at least one of oblong, oval, butterfly, dogbone, dumbbell, round, square, rectangular with rounded corners, or polygonal with rounded corners. In specific embodiments, a geometric shape of gel cover 180 comprises at least one of oblong, oval, or round. In many embodiments, a thickness of gel cover is within a range from about 0.0005" to about 0.020", for example within a range from about 0.0005 to about 0.010". In many embodiments, gel cover 180 can extend outward from about 0-20 mm from an edge of gels, for example from about 5-15 mm outward from an edge of the gels.

[0136] In many embodiments, the breathable tape of adherent patch 110 comprises a first mesh with a first porosity and gel cover 180 comprises a breathable tape with a second porosity, in which the second porosity is less than the first porosity to inhibit flow of the gel through the breathable tape.

[0137] In many embodiments, device 100 includes a printed circuitry, for example a printed circuitry board (PCB) module that includes at least one PCB with electronics component mounted thereon on and the battery, as described above. In many embodiments, the PCB module comprises two rigid PCB modules with associated components mounted therein, and the two rigid PCB modules are connected by flex circuit, for example a flex PCB. In specific embodiments, the PCB module comprises a known rigid FR4 type PCB and a flex PCB comprising known polyimide type PCB. In specific embodiments, the PCB module comprises a rigid PCB with flex interconnects to allow the device to flex with user movement. The geometry of flex PCB module may comprise many shapes, for example at least one of oblong, oval, butterfly, dogbone, dumbbell, round, square, rectangular with rounded corners, or polygon with rounded corners. In specific embodiments the geometric shape of the flex PCB module comprises at least one of dogbone or dumbbell. The PCB module may comprise a PCB layer with flex PCB 120 can be positioned over gel cover 180 and electronic components 130 connected and/or mounted to flex PCB 120 so as to comprise an electronics layer disposed on the flex PCB. In many embodiments, the adherent device may comprise a segmented inner component, for example the PCB, for limited flexibility. The printed circuit may comprise polyester film with silver traces printed thereon.

[0138] In many embodiments, the electronics layer may be encapsulated in electronics housing 160. Electronics housing 160 may comprise an encapsulant, such as a dip coating, which may comprise a waterproof material, for example silicone and/or epoxy. In many embodiments, the PCB encapsulant protects the PCB and/or electronic components from moisture and/or mechanical forces. The encapsulant may comprise silicone, epoxy, other adhesives and/or sealants. In some embodiments, the electronics housing may comprising metal and/or plastic housing and potted with aforementioned sealants and/or adhesives.

[0139] In many embodiments, the electrodes are connected to the PCB with a flex connection, for example trace 123 A of flex PCB 120, so as to provide strain relive between the electrodes 112 A, 112B, 1 12C and 112D and the PCB. In such embodiments, motion of the electrodes relative to the electronics modules, for example rigid PCB's 120A, 120B, 120C and 120D with the electronic components mounted thereon, does not compromise integrity of the electrode/hydrogel/skin contact. In some embodiments, the electrodes can be connected to the PCB and/or electronics module with a flex PCB 120, such that the electrodes and adherent patch can move independently from the PCB module. In many embodiments, the flex connection comprises at least one of wires, shielded wires, non-shielded wires, a flex circuit, or a flex PCB. In specific embodiments, the flex connection may comprise insulated, non-shielded wires with loops to allow independent motion of the PCB module relative to the electrodes.

[0140] In specific embodiments, cover 162 comprises at least one of polyester, 5-25% elastane/spandex, polyamide fabric; silicone, a polyester knit, a polyester knit without elastane, or a thermoplastic elastomer. In many embodiments cover 162 comprises at least 400% elongation. In specific embodiments, cover 162 comprises at least one of a polyester knit with 10-20% spandex or a woven polyamide with 10-20% spandex. In many embodiments, cover 162 comprises a water repellent coating and/or layer on outside, for example a hydrophobic coating, and a hydrophilic coating on inside to wick moisture from body. In many embodiments the water repellent coating on the outside comprises a stain resistant coating. Work in relation to embodiments of the present invention suggests that these coatings can be important to keep excessive moisture from the gels near the electrodes and to remove moisture from body so as to provide user comfort.

[0141] In many embodiments, cover 162 can encase the flex PCB and/or electronics and can be adhered to at least one of the electronics, the flex PCB or adherent patch 110, so as to protect at least the electronics components and the PCB. Cover 162 can attach to adherent patch 110 with adhesive 116B. Cover 162 can comprise many known biocompatible cover materials, for example silicone. Cover 162 can comprise an outer polymer cover to provide smooth contour without limiting flexibility. In many embodiments, cover 162 may comprise a breathable fabric. Cover 162 may comprise many known breathable fabrics, for example breathable fabrics as described above. In some embodiments, the breathable cover may comprise a breathable water resistant cover. In some embodiments, the breathable fabric may comprise polyester, nylon, polyamide, and/or elastane (Spandex™) to allow the breathable fabric to stretch with body movement. In some embodiments, the breathable tape may contain and elute a pharmaceutical agent, such as an antibiotic, anti-inflammatory or antifungal agent, when the adherent device is placed on the user.

[0142] The breathable cover 162 and adherent patch 110 comprise breathable tape can be configured to couple continuously for at least one week the at least one electrode to the skin so as to measure breathing of the user. The breathable tape may comprise the stretchable breathable material with the adhesive and the breathable cover may comprises a stretchable breathable material connected to the breathable tape, as described above, such that both the adherent patch and cover can stretch with the skin of the user. The breathable cover may also comprise a water resistant material. Arrows 182 show stretching of adherent patch 110, and the stretching of adherent patch can be at least two dimensional along the surface of the skin of the user. As noted above, connectors 122A, 122B, 122C and 122D between PCB 130 and electrodes 112A, 112B, 112C and 112D may comprise insulated wires that provide strain relief between the PCB and the electrodes, such that the electrodes can move with the adherent patch as the adherent patch comprising breathable tape stretches. Arrows 184 show stretching of cover 162, and the stretching of the cover can be at least two dimensional along the surface of the skin of the user. [0143] Cover 162 can be attached to adherent patch 110 with adhesive 116B such that cover 162 stretches and/or retracts when adherent patch 110 stretches and/or retracts with the skin of the user. For example, cover 162 and adherent patch 110 can stretch in two dimensions along length 170 and width 174 with the skin of the user, and stretching along length 170 can increase spacing between electrodes. Stretching of the cover and adherent patch 110, for example in two dimensions, can extend the time the patch is adhered to the skin as the patch can move with the skin such that the patch remains adhered to the skin. Electronics housing 160 can be smooth and allow breathable cover 162 to slide over electronics housing 160, such that motion and/or stretching of cover 162 is slidably coupled with housing 160. The printed circuit board can be slidably coupled with adherent patch 110 that comprises breathable tape 11OT, such that the breathable tape can stretch with the skin of the user when the breathable tape is adhered to the skin of the user, for example along two dimensions comprising length 170 and width 174.

[0144] The stretching of the adherent device 100 along length 170 and width 174 can be characterized with a composite modulus of elasticity determined by stretching of cover 162, adherent patch 110 comprising breathable tape HOT and gel cover 180. For the composite modulus of the composite fabric cover-breathable tape-gel cover structure that surrounds the electronics, the composite modulus may comprise no more than about IMPa, for example no more than about 0.3MPa at strain of no more than about 5%. These values apply to any transverse direction against the skin.

[0145] The stretching of the adherent device 100 along length 170 and width 174, may also be described with a composite stretching elongation of cover 162, adherent patch 110 comprising breathable tape breathable tape 11OT and gel cover 180. The composite stretching elongation may comprise a percentage of at least about 10% when 3 kg load is a applied, for example at least about 100% when the 3 kg load applied. These percentages apply to any transverse direction against the skin.

[0146] The printed circuit board may be adhered to the adherent patch 110 comprising breathable tape 11OT at a central portion, for example a single central location, such that adherent patch 110 can stretch around this central region. The central portion can be sized such that the adherence of the printed circuit board to the breathable tape does not have a substantial effect of the modulus of the composite modulus for the fabric cover, breathable tape and gel cover, as described above. For example, the central portion adhered to the patch may be less than about 100 mm², for example with dimensions of approximately 10 mm by 10 mm (about 0.5" by 0.5"). Such a central region may comprise no more than about 10% of the area of patch 110, such that patch 110 can stretch with the skin of the user along length 170 and width 174 when the patch is adhered to the user.

[0147] The cover material may comprise a material with a low recovery, which can minimize retraction of the breathable tape from the pulling by the cover. Suitable cover materials with a low recovery include at least one of polyester or nylon, for example polyester or nylon with a loose knit. The recovery of the cover material may be within a range from about 0% recovery to about 25% recovery. Recovery can refer to the percentage of retraction the cover material that occurs after the material has been stretched from a first length to a second length. For example, with 25% recovery, a cover that is stretched from a 4 inch length to a 5 inch length will retract by 25% to a final length of 4.75 inches.

[0148] Electronics components 130 can be affixed to printed circuit board 120, for example with solder, and the electronics housing can be affixed over the PCB and electronics components, for example with dip coating, such that electronics components 130, printed circuit board 120 and electronics housing 160 are coupled together. Electronics components 130, printed circuit board 120, and electronics housing 160 are disposed between the stretchable breathable material of adherent patch 110 and the stretchable breathable material of cover 160 so as to allow the adherent patch 110 and cover 160 to stretch together while electronics components 130, printed circuit board 120, and electronics housing 160 do not stretch substantially, if at all. This decoupling of electronics housing 160, printed circuit board 120 and electronic components 130 can allow the adherent patch 110 comprising breathable tape to move with the skin of the user, such that the adherent patch can remain adhered to the skin for an extended time of at least one week, for example two or more weeks.

[0149] An air gap 169 may extend from adherent patch 110 to the electronics module and/or PCB, so as to provide user comfort. Air gap 169 allows adherent patch 110 and breathable tape HOT to remain supple and move, for example bend, with the skin of the user with minimal flexing and/or bending of printed circuit board 120 and electronic components 130, as indicated by arrows 186. Printed circuit board 120 and electronics components 130 that are separated from the breathable tape HOT with air gap 169 can allow the skin to release moisture as water vapor through the breathable tape, gel cover, and breathable cover. This release of moisture from the skin through the air gap can minimize, and even avoid, excess moisture, for example when the user sweats and/or showers. [0150] The breathable tape of adherent patch 110 may comprise a first mesh with a first porosity and gel cover 180 may comprise a breathable tape with a second porosity, in which the second porosity is less than the first porosity to minimize, and even inhibit, flow of the gel through the breathable tape. The gel cover may comprise a polyurethane film with the second porosity.

[0151] Cover 162 may comprise many shapes. In many embodiments, a geometry of cover 162 comprises at least one of oblong, oval, butterfly, dogbone, dumbbell, round, square, rectangular with rounded corners, or polygonal with rounded corners. In specific embodiments, the geometric of cover 162 comprises at least one of an oblong, an oval or a round shape. [0152] Cover 162 may comprise many thicknesses and/or weights. In many embodiments, cover 162 comprises a fabric weight: within a range from about 100 to about 200 g/m^Λ2, for example a fabric weight within a range from about 130 to about 170 g/m^Λ2.

[0153] In many embodiments, cover 162 can attach the PCB module to adherent patch 110 with cover 162, so as to avoid interaction of adherent patch HOC with the PCB having the electronics mounted therein. Cover 162 can be attached to breathable tape 11OT and/or electronics housing 160 comprising over the encapsulated PCB. In many embodiments, adhesive 116B attaches cover 162 to adherent patch 1 10. In many embodiments, cover 162 attaches to adherent patch 110 with adhesive 116B, and cover 162 is adhered to the PCB module with an adhesive 161 on the upper surface of the electronics housing. Thus, the PCB module can be suspended above the adherent patch via connection to cover 162, for example with a gap 169 between the PCB module and adherent patch. In many embodiments, gap 169 permits air and/or water vapor to flow between the adherent patch and cover, for example through adherent patch 110 and cover 162, so as to provide user comfort.

[0154] In many embodiments, adhesive 116B is configured such that adherent patch 110 and cover 162 can be breathable from the skin to above cover 162 and so as to allow moisture vapor and air to travel from the skin to outside cover 162. In many embodiments, adhesive 116B is applied in a pattern on adherent patch 110 such that the patch and cover can be flexible so as to avoid detachment with body movement. Adhesive 116B can be applied to upper side 11OB of patch 110 and comprise many shapes, for example a continuous ring, dots, dashes around the perimeter of adherent patch 110 and cover 162. Adhesive 116B may comprise at least one of acrylate, silicone, synthetic rubber, synthetic resin, pressure sensitive adhesive (PSA), or acrylate pressure sensitive adhesive. Adhesive 16B may comprise a thickness within a range from about 0.0005" to about 0.005", for example within a range from about .001 - .005". In many embodiments, adhesive 116B comprises a width near the edge of patch 110 and/or cover 162 within a range from about 2 to about 15 mm , for example from about 3 to about 7 near the periphery. In many embodiments with such widths and/or thickness near the edge of the patch and/or cover, the tissue adhesion may be at least about 30 oz/in, for example at least about 40 oz/in, such that the cover remains attached to the adhesive patch when the user moves.

[0155] In many embodiments, the cover is adhered to adherent patch 110 comprising breathable tape 11OT at least about 1 mm away from an outer edge of adherent patch 110. This positioning protects the adherent patch comprising breathable tape HOT from peeling away from the skin and minimizes edge peeling, for example because the edge of the patch can be thinner. In some embodiments, the edge of the cover may be adhered at the edge of the adherent patch, such that the cover can be slightly thicker at the edge of the patch which may, in some instances, facilitate peeling of the breathable tape from the skin of the user. [0156] Gap 169 extend from adherent patch 110 to the electronics module and/or PCB a distance within a range from about 0.25 mm to about 4 mm, for example within a range from about 0.5 mm to about 2 mm.

[0157] In many embodiments, the adherent device comprises a patch component and at least one electronics module. The patch component may comprise adherent patch 110 comprising the breathable tape with adhesive coating 116A, at least one electrode, for example electrode 114A and gel 114. The at least one electronics module can be separable from the patch component. In many embodiments, the at least one electronics module comprises the flex printed circuit board 120, electronic components 130, electronics housing 160 and cover 162, such that the flex printed circuit board, electronic components, electronics housing and cover are reusable and/or removable for recharging and data transfer, for example as described above. In many embodiments, adhesive 116B is coated on upper side 11OA of adherent patch HOB, such that the electronics module can be adhered to and/or separated from the adhesive component. In specific embodiments, the electronic module can be adhered to the patch component with a releasable connection, for example with Velcro™, a known hook and loop connection, and/or snap directly to the electrodes. Two electronics modules can be provided, such that one electronics module can be worn by the user while the other is charged, as described above. Many patch components can be provided for gaming over the extended period. For example, about 12 patches can be used to monitor the user for at least 90 days with at least one electronics module, for example with two reusable electronics modules.

[0158] In many embodiments, the adherent device comprises a patch component and at least one electronics module. The patch component may comprise adherent patch 110 comprising the breathable tape with adhesive coating 116A, at least one electrode, for example electrode 114 A and gel 114. The at least one electronics module can be separable from the patch component. In many embodiments, the at least one electronics module comprises the flex printed circuit board 120, electronic components 130, electronics housing 160 and cover 162, such that the flex printed circuit board, electronic components, electronics housing and cover are reusable and/or removable for recharging and data transfer, for example as described above. In many embodiments, adhesive 116B is coated on upper side 11OA of adherent patch 11OB, such that the electronics module can be adhered to and/or separated from the adhesive component. In specific embodiments, the electronic module can be adhered to the patch component with a releasable connection, for example with Velcro™, a known hook and loop connection, and/or snap directly to the electrodes. Two electronics modules can be provided, such that one electronics module can be worn by the user while the other is charged, as described above. Gaming with multiple adherent patches for an extended period is described in U.S. Pat. App. No. 60/972,537 ^', the full disclosure of which has been previously incorporated herein by reference. Many patch components can be provided for gaming over the extended period. For example, about 12 patches can be used to monitor the user for at least 90 days with at least one electronics module, for example with two reusable electronics modules.

[0159] At least one electrode 112A can extend through at least one aperture 180A in the breathable tape 110 and gel cover 180. [0160] In some embodiments, the adhesive patch may comprise a medicated patch that releases a medicament, such as antibiotic, beta-blocker, ACE inhibitor, diuretic, or steroid to reduce skin irritation. The adhesive patch may comprise a thin, flexible, breathable patch with a polymer grid for stiffening. This grid may be anisotropic, may use electronic components to act as a stiffener, may use electronics-enhanced adhesive elution, and may use an alternating elution of adhesive and steroid. [0161] Figures 2A to 2C show a schematic illustration of a system 200 to monitor a user for an extended period.

[0162] Figure 2A shows a schematic illustration of system 200 comprising a reusable electronics module 210 and a plurality of disposable patch components. Figure 2B shows a schematic illustration of a side cross-sectional view of reusable electronics module 210. System 200 may comprise a first disposable patch component 220A, a second disposable patch component 220B, a third disposable patch component 220C and a fourth disposable patch component 220D. Although four patch components a shown the plurality may comprise as few as two patch component and as many as three or more patch components, for example 25 patch components.

[0163] Reusable electronics module 210 may comprise a connector 219 adapted to connect to each of the disposable patch components, sequentially, for example one disposable patch component at a time. Connector 219 can be formed in many ways, and may comprise known connectors as described above, for example a snap. In some embodiments, the connectors on the electronics module and adhesive component can be disposed at several locations on the reusable electronics module and disposable patch component, for example near each electrode, such that each electrode can couple directly to a corresponding location on the flex PCB of the reusable electronics component.

[0164] Reusable electronics module 210 may comprise additional reusable electronics modules, for example two or more rechargeable electronics modules each with a 3D accelerometer, such that the first module comprising a first 3D accelerometer can be recharged while the second module comprising a second 3D accelerometer is worn by the user. The second module can be recharged and connected to a third adhesive patch when the first adhesive patch is removed from the user. The second module comprising the second accelerometer can be removably coupled to the adhesive patch such that the second accelerometer can be recharged and connected to a fourth adhesive patch when the second adhesive patch is removed from the user.

[0165] Reusable electronics module 210 may comprises many of the structures described above that may comprise the electronics module. In many embodiments, reusable electronics module 210 comprises a PCB, for example a flex PCB 212, electronics components 214, batteries 216, and a cover 217, for example as described above. In some embodiments, reusable electronics module 210 may comprise an electronics housing over the electronics components and/or PCB as described above. The electronics components may comprise circuitry and/or sensors for measuring ECG signals, hydration impedance signals, respiration impedance signals and accelerometer signals, for example as described above. [0166] Electronics components 214 may comprise an accelerometer 214A. Accelerometer 214A may comprise a three axis accelerometer, for example as described above. Accelerometer 214A may comprise an X-axis 234X, a Y-axis 234Y and a Z-axis 234Z with each axis sensitive to gravity such that the orientation of the accelerometer, for example 3D orientation, can be determined in relation to gravity, as described above. Alignment of the accelerometer, for example the axes of the accelerometer 214A, can be aligned with the axes of the adherent patches using the connectors. For example connector 219 can connect with at least one of connector 229 A, connector 229B, connector 229C and connector 229D to align the respective patch with accelerometer 214A.

[0167] First disposable patch component 220A comprises a connector 229A to mate with connector 219 on reusable electronics module 210 such that the first disposable patch component 220A is aligned with the reusable electronics module with a predetermined orientation. First disposable patch component 220A comprises a first axis 220AX substantially aligned with electrodes 222A. A second axis 220AZ corresponds to vertical on the user when first disposable patch component 220A is adhered to the user. Connector 229A is configured to mate with connector 219 such that axis 234X is aligned with first axis 220AX and axis 234Z is aligned with axis 220AZ.

[0168] Second disposable patch component 220B comprises a connector 229B to mate with connector 219 on reusable electronics module 210 such that the second disposable patch component 220B is aligned with the reusable electronics module with the predetermined orientation similar to first disposable patch component 220A. Second disposable patch component 220B comprises a first axis 220BX substantially aligned with electrodes 222B. A second axis 220BZ corresponds to vertical on the user when second disposable patch component 220B is adhered to the user. Connector 229B is configured to mate with connector 219 such that axis 234X is aligned with first axis 220BX and axis 234Z is aligned with axis 220BZ. [0169] Third disposable patch component 220C comprises a connector 229C to mate with connector 219 on reusable electronics module 210 such that the third disposable patch component 220C is aligned with the reusable electronics module with the predetermined orientation similar to second disposable patch component 220B. Third disposable patch component 220C comprises a first axis 220CX substantially aligned with electrodes 222C. A second axis 220CZ corresponds to vertical on the user when second disposable patch component 220C is adhered to the user. Connector 229C is configured to mate with connector 219 such that axis 234X is aligned with first axis 220CX and axis 234Z is aligned with axis 220CZ.

[0170] Fourth disposable patch component 220D comprises a connector 229D to mate with connector 219 on reusable electronics module 210 such that the fourth disposable patch component 220D is aligned with the reusable electronics module with the predetermined orientation similar to third disposable patch component 220C. Fourth disposable patch component 220D comprises a first axis 220DX substantially aligned with electrodes 222D. A second axis 220DZ corresponds to vertical on the user when second disposable patch component 220D is adhered to the user. Connector 229D is configured to mate with connector 219 such that axis 234X is aligned with first axis 220DX and axis 234Z is aligned with axis 220DZ. [0171] Figure 2C shows a schematic illustration first disposable patch component 220A of the plurality of disposable patch components that is similar to the other disposable patch components, for example second disposable patch component 220B, third disposable patch component 220C and fourth disposable patch component 220C. The disposable patch component comprises a breathable tape 221 A, an adhesive 226A on an underside of breathable tape 227A to adhere to the skin of the user, and at least four electrodes 222A. The at least four electrodes 224A are configured to couple to the skin of a user, for example with a gel 226A, in some embodiments the electrodes may extend through the breathable tape to couple directly to the skin of the user with aid form the gel. In some embodiments, the at least four electrodes may be indirectly coupled to the skin through a gel and/or the breathable tape, for example as described above. A connector 229A on the upper side of the disposable adhesive component can be configured for attachment to connector 219 on reusable electronics module 210 so as to electrically couple the electrodes with the electronics module. The upper side of the disposable patch component may comprise an adhesive 224A to connect the disposable patch component to the reusable electronics module. The reusable electronics module can be adhered to the patch component with many additional known ways to adhere components, for example with Velcro™ comprising hooks and loops, snaps, a snap fit, a lock and key mechanisms, magnets, detents and the like. [0172] Figure 2D shows a method 250 of using system 200, as in Figures 2A to 2C. A step 252 adheres electronics module 210 to first disposable adherent patch component 220A of the plurality of adherent patch components and adheres the first disposable patch component to the skin of the user, for example with the first adherent patch component adhered to the reusable electronics module. The orientation on the user of first disposable patch component 220A is determined with the accelerometer, for example as described above, when the first disposable patch component is adhered to the user. User measurements can be taken with the electronics module and/or adjusted in response to the orientation of the first patch on the user. A step 254 removes the first disposable adherent patch from the user and separates first disposable adherent patch component 220A from reusable electronics module 210.

[0173] A step 256 adheres electronics module 210 to second disposable adherent patch component 220B and adheres the second disposable patch component to the skin of the user, for example with the second adherent patch component adhered to the reusable electronics module. The orientation on the user of second disposable patch component 220B is determined with the accelerometer, for example as described above, when the second disposable patch component is adhered to the user. User measurements can be taken with the electronics module and/or adjusted in response to the orientation of the second patch on the user. A step 258 removes the second disposable adherent patch from the user and separates second disposable adherent patch component 220B from reusable electronics module 210. [0174] A step 260 adheres electronics module 210 to third disposable adherent patch component 220C and adheres the third disposable patch component to the skin of the user, for example with the third adherent patch component adhered to the reusable electronics module. The orientation on the user of third disposable patch component 220C is determined with the accelerometer, for example as described above, when the third disposable patch component is adhered to the user. User measurements can be taken with the electronics module and/or adjusted in response to the orientation of the third patch on the user. A step 262 removes the third disposable adherent patch from the user and separates third disposable adherent patch component 220C from reusable electronics module 210.

[0175] A step 264 adheres electronics module 210 to fourth disposable adherent patch component 220D and adheres the fourth disposable patch component to the skin of the user, for example with the third adherent patch component adhered to the reusable electronics module. The orientation on the user of fourth disposable patch component 220D is determined with the accelerometer, for example as described above, when the fourth disposable patch component is adhered to the user. User measurements can be taken with the electronics module and/or adjusted in response to the orientation of the fourth patch on the user. A step 268 removes the fourth disposable adherent patch from the user and separates fourth disposable adherent patch component 220D from reusable electronics module 210.

[0176] In many embodiments, physiologic signals, for example ECG, hydration impedance, respiration impedance and accelerometer impedance are measured when the adherent patch component is adhered to the user, for example when any of the first, second, third or fourth disposable adherent patches is adhered to the user.

[0177] Figures 3A to 3D show a method 300 of gaming a user for an extended period with adherent patches alternatively adhered to opposing sides of at least one of the torso or limbs. The adherent patches can be alternatively adhered to a opposite sides of at least one of a torso or a limb of the user, for example right side 302 and a left side 304 of the torso of the user. For example, the patch may be placed on the torso. The patches adhered to the limbs can similarly be alternated among limbs, for example in embodiments where the device is adhered to one limb at a time of the user. Also, when patches are simultaneously adhered to each limb, the patches can be alternately placed on opposing sides of the limb, for example on an inner side of the wrist and an outer side of the wrist. Patches can also be alternatively placed on an inner side of the leg and an outer side of the leg.

[0178] Work in relation to embodiments of the present invention suggests that repeated positioning of a patch at the same location can irritate the skin and may cause user discomfort. This can be minimized, even avoided, by alternating the patch placement between left and right sides of the user, often a front left and a front right side of the user where the user can reach easily to replace the patch. In some embodiments, the patch location can be alternated on the same side of the user, for example higher and/or lower on the same side of the user without substantial overlap to allow the skin to recover and/or heal. In many embodiments, the patch can be symmetrically positioned on an opposite side of the limb or torso such that signals may be similar to a previous position of the patch symmetrically disposed on an opposite side. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that any differences between the signals may be assumed to be related to placement of the patch, and these differences can be removed with signal processing. The orientation of the patches can also be determined and corrected.

[0179] A step 310 adheres adherent patch devices to the user at first locations. First adherent patch devices, for example patch device 312, are adhered to the skin, for example at a first location 314 on a first side 302 of the torso of the user, for a first period of time, for example about 1 week. Additional first patch devices adhered at the first locations can include patch device 312Wl adhered to the right wrist at location 314Wl, patch device 312W2 adhered to the left wrist at location 314W2, patch device 312Al adhered to the right ankle at location 314Al, patch device 312A2 adhered to the left ankle at location 314A2. In many embodiments each patch device adhered to the torso comprises at least four electrodes configured to measure an ECG signal and impedance, for example impedance to determine respiration. In many embodiments, the user comprises a midline 306, with first side, for example right side 302, and second side, for example left side 304, symmetrically disposed about the midline. When the adherent patch device 312 is position at first location 314 on the first side of the torso of the user, the accelerometer signals are measured to determine the orientation of the patch and the electrodes of the patch are coupled to the skin of the user to measure the ECG signal and impedance signals. The accelerometer signals can similarly be measured for each of patch device 312Wl, patch device 312W2, patch device 312Al and patch device 312A2.

[0180] A step 320 removes the first patch devices and adheres second patch devices for a second period of time, for example about 1 week. For example patch 312 can be removed and a second adherent patch 322 adhered at a second location 324 on a second side 206 of the user. In many embodiments, second location 324 can be symmetrically disposed opposite first location 314 of the torso or limb, for example across midline 304, so as to minimize changes in the sequential impedance signals measured from the second side and first side. When adherent patch 322 is position at second location 324 on the second side of the torso of the user, the orientation of the patch can be measured with the accelerometer and the electrodes of the patch are coupled to the skin of the user to measure the ECG signal and impedance signals. In many embodiments, while adherent patch 322 is positioned at second location 324, skin at first location 314 can heal and recover from adherent coverage of the first patch. In many embodiments, second location 324 is symmetrically disposed opposite first location 314 across midline 304, for example so as to minimize changes in the impedance signals measured between the first side and second side. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that any differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the user.

[0181] Each of the patches adhered to the limbs can be removed and replaced similarly to the devices adhered to the torso. For example, patch device 312W2 can be removed and a second adherent patch device 322W2 adhered at a second location 324W2 on a second side of the limb of the user. In many embodiments, the second location can be symmetrically disposed opposite the first location of the limb, so as to minimize changes in the sequential signals measured from the second side and first side of the limb. When adherent patch 322W2 is position at second location 324W2 on the second side of the limb of the user, the orientation of the patch can be measured with the accelerometer and the electrodes of the patch, if present, can be coupled to the skin of the user to measure the EMG signals. In many embodiments, while adherent patch device 322W2 is positioned at second location 324W2, skin at first location 314W2 can heal and recover from adherent coverage of the first patch device. In many embodiments, the duration between removal of one patch from the limb and placement of the other patch on the limb can be short, such that differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the user, for example when the user comprises detectable position such as standing or walking. [0182] Additional patches on additional limbs of the user can be removed and replaced, such that the user can be monitored for an extended period of at least 90 days with devices adhered substantially continuously and simultaneously to each limb and the thorax of the user. Additional removal and replacement are described with respect to the torso and one limb, and adherent devices can be similarly removed and replaced from each limb of the user, for example both arms and both legs of the user.

[0183] A step 330 removes second patch devices, for example second patch 322, and adheres a third patches, for example third adherent patch 332 at a third location 334, on the first sides, for example right side 302, of the user for a third period of time, for example about 1 week. In many embodiments, third location 334 can be symmetrically disposed opposite second location 324 across midline 304, for example so as to minimize changes in the sequential impedance signals measured from the third side and second side. In many embodiments, third location 334 substantially overlaps with first location 314, so as to minimize differences in measurements between the first adherent patch and third adherent patch that may be due to patch location. When adherent patch device 332 is positioned at third location 334 on the first side of the user, the orientation of the patch is measured with the accelerometer. The electrodes of the patch, if present, are coupled to the skin of the user to measure the EMG signals. In many embodiments, while adherent patch device 332 is positioned at third location 334, skin at second location 324 can heal and recover from adherent coverage of the second patch. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the user.

[0184] Each of the patches adhered to the limbs can be removed and replaced similarly to the devices adhered to the torso. For example, patch device 322W2 can be removed and a third adherent patch device 332W2 adhered at a third location 334W2 on the first side of the limb of the user.

[0185] A step 340 removes third patch devices, for example third patch device 332 and adheres fourth patch devices, for example a fourth adherent patch 342 at a fourth location 344, on the second sides, for example left side 306 of the torso, of the user for a fourth period of time, for example about 1 week. In many embodiments, fourth location 344 can be symmetrically disposed opposite third location 334 across midline 304, for example so as to minimize changes in the sequential impedance signal measured from the fourth side and third side. In many embodiments, fourth location 344 substantially overlaps with second location 324, so as to minimize differences in measurements between the second adherent patch and fourth adherent patch that may be due to patch location. When adherent patch 342 is positioned at fourth location 344 on the second side of the user, the orientation of patch is measured with the accelerometer and the electrodes of the patch are coupled to the skin of the user to measure the ECG signal and impedance signals. In many embodiments, while adherent patch 342 is positioned at fourth location 324, skin at third location 334 can heal and recover from adherent coverage of the third patch. In many embodiments, the duration between removal of one patch and placement of the other patch can be short, such that differences between the signals may be determined to be related to orientation of the patch, and these differences can be corrected in response to the measured orientation of the patch on the user. [0186] Each of the patches adhered to the limbs can be removed and replaced similarly to the devices adhered to the torso. For example, patch device 332W2 can be removed and a fourth adherent patch device 342W2 adhered at a fourth location 344W2 on the second side of the limb of the user. [0187] The accelerometer signal measured to determine the orientation of the user for each of adherent patch devices. For example adherent patch device 312, adherent patch 322, adherent patch 332 or adherent patch 342 can be measured with a reusable accelerometer of a reusable electronics module, for example as described above, or measured with a disposable accelerometer affixed to each patch and disposed of with the patch after the patch is removed from the user.

[0188] It should be appreciated that the specific steps illustrated in Figures 3A to 3D provide a particular method of gaming a user for an extended period, according to an embodiment of the present invention. Other sequences of steps may also be performed according to alternative embodiments. For example, alternative embodiments of the present invention may perform the steps outlined above in a different order. Moreover, the individual steps illustrated in Figures 3A to 3D may include multiple sub-steps that may be performed in various sequences as appropriate to the individual step. Furthermore, additional steps may be added or removed depending on the particular applications. One of ordinary skill in the art would recognize many variations, modifications, and alternatives. [0189] Figure 4A shows measurement signals, according to embodiments of the present invention. Such signals comprise user data can be measured with a plurality of accelerometers adhered to the user as described herein. Each of the measurement signals can be digitized with a processor supported with the adhesive of the respective adherent patch device, and the data can be time stamped such that the data can be combined, for example with at least one the gateway or the server.

[0190] The device adhered to the thorax can measure accelerometers signals, an electrocardiogram, respiration and temperatures. The accelerometer adhered to the thorax generates 3 accelerometer signals with each signal corresponding to one axis of the accelerometer. Signal TX corresponds to the X axis of the thorax accelerometer. Signal TY corresponds to the Y axis of the thorax accelerometer. Signal TZ corresponds to the Z axis of the thorax accelerometer. Signal ECG corresponds to the electrocardiogram signal of the user measured from the thorax adherent device and comprises heart rate user data. A heart rate of user may increase from a low heart rate LOW H.R. to a greater, increasing heart rate INC. H.R. Signal Resp. corresponds to the respiration of the user measured from the thorax adherent device, which can be measured in many ways, for example with impedance, as described above. A respiration rate of the user may increase from a low respiration rate LOW RESP. to a greater, increasing respiration rate INC. RESP. Signal Temp, corresponds to the body temperature of the user and can be measured with a temperature sensor and heat flux sensor coupled to the user with the adherent patch device. A body temperature of the user may increase from a lower body temperature LOW TEMP, to a greater, increasing body temperature INC. TEMP. [0191] In many embodiments, the measurement signals are received by the gaming console and the gaming experience can be altered based on the measurement signals and/or changes in the measurement signals. For example, in an exercise game or in exer-gaming as described herein, the gaming console may modify the intensity of an exercise program based on the measurement signals. For example, if the heart rate, respiration rate, and/or body temperature is deemed too high or too low, the intensity of the exercise program may be respectively decreased or increased. For example, in a shooting game as described herein, the stability and/or accuracy may be decreased in response to a greater heart rate, respiration rate, body temperature, and/or body movement.

[0192] The signals from the accelerometers on the limbs can be stored separately initial on each processor and combined with the user data from the adherent patch device adhered to the thorax. Signal LA corresponds to the accelerometer signals for the left arm, which signals comprise an X axis accelerometer signal LAX, a Y axis accelerometer signal LAY, and a Z axis accelerometer signal LAZ. Signal RA corresponds to the accelerometer signals for the right arm, which comprise an X axis accelerometer signal RAX, a Y axis accelerometer signal RAY, and a Z axis accelerometer signal RAZ. Signal LL corresponds to the accelerometer signals for the left leg, which comprise an X axis accelerometer signal LLX, a Y axis accelerometer signal LLY, and a Z axis accelerometer signal LLZ. Signal RL corresponds to the accelerometer signals for the right leg, which comprise an X axis accelerometer signal RLX, a Y axis accelerometer signal RLY, and a Z axis accelerometer signal RLZ. As shown in Fig. 4a, a more active right leg can register as a more active signal RL. [0193] Fig. 4Al shows accelerometer signals for orientations of an accelerometer of adherent device on the left arm of the user, the accelerometer axes. The signals comprise signals X axis accelerometer signal LAX, Y axis accelerometer signal LAY, and Z axis accelerometer signal LAZ. The signals can be low pass filtered to determine the orientation and high pass filtered to detect user movement. The low pass filter can pass frequencies below about 2 Hz, for example below one Hz, and the high pass filter can pass frequencies above about 1 Hz, for example above about 2 Hz. Signal LAZ shows an intensity of about Ig at time 0, corresponding to the Z- axis 112Z aligned with vertical, and X-axis 112X and Y-axis 112Y align with horizontal. For example, the user may be standing and have his left arm raised above his or her head vertically, such that the Z axis of the accelerometer is aligned with vertical. Rotation of the accelerometer, for example about X-axis 112X results in a change in the Y-axis 112Y and Z- axis 112Z signals, for example as shown at a time of about 4 seconds. Such rotation can occur when the standing user lowers his or her left arm by his side. For times greater than about 6 seconds, the accelerometer is inverted, and Z-axis 112Z points downward, similar to the users arm pointing downward.

[0194] Fig. 4A2 shows orientation of the limb of the user that can be determined in response to signals as in Fig. 4Al. The signals from all 3-axes can be used to determine the orientation of the accelerometer. For example, LAZO corresponds to the orientation of the Z-axis. LAXO corresponds to the orientation of the X-axis, and LAYO corresponds to the orientation of the Y- axis.

[0195] The signals for each accelerometer can be used to determine the orientation of body part to which the accelerometer is coupled, for example the orientation of the limb to which the accelerometer is coupled. Differential orientation signals can be measured to determine the orientation of the limbs of the user relative to the thorax, which can be used to determine the orientations of the limbs of the avatar relative to the thorax of the avatar.

[0196] Figure 4B shows a method 400 of gaming a user. A step 405 adheres first adherent patch devices to the user, for example a plurality of adherent patch devices as described above. The first adherent patch devices may comprise a first patches that are separable from electronics modules, as described above. The first adherent patch devices may comprise first patches of first devices with the electronics modules fixed to the adherent patch devices, for example disposable electronics with disposable patches. [0197] A step 410A measures first accelerometer signals along a first axes, for example X-axes of 3D accelerometers responsive to gravity as described above. A step 410B measures first accelerometer signals along a second axes, for example Y-axes of 3D accelerometers as described above. A step 410C measures first accelerometer signals along third axes, for example Z-axes of 3D accelerometers as described above. Measurements of the accelerometer signals with step 410A, step 410B and step 410C, which may comprise sub-steps, can be performed with the user in a known and/or determined position. The user may be asked to stand and/or sit upright in a chair and the first signals measured to determine alignment of the accelerometers on the user. In some embodiments, the 3D accelerometer signals can be analyzed to determine that the user is standing, walking and the first signals determined from a plurality of measurements to indicate that the user is upright for the measurement of the first signals.

[0198] A step 415 determines orientation of the first patch devices on the user. The accelerometers can be coupled to the patches with a pre-determined orientation, for example with connectors as described above, such that the 3D orientation of each of the patch can be determined from: the accelerometer signal, the orientation of the 3D accelerometer on the adherent patch, and the orientation of the user.

[0199] A step 420 measures a first ECG signal. The first ECG signal can be measured with the electrodes attached to the user when the patch comprises the first orientation. The ECG signal can be measured with electronics components and electrodes, as described above. [0200] A step 425 determines a first orientation of an electrode measurement axis on the user, for example on the thorax of the user. The electrode measurement axis may correspond to one of the measurement axes of the 3D accelerometer, for example an X-axis of the accelerometer as described above. However, the orientation of the electrode measurement axis can be aligned in relation to the axes of the accelerometer in many ways, for example at oblique angles, such that the alignment of the accelerometer with the electrode measurement axis is known and the signal from the accelerometer can be used to determine the alignment of the electrode measurement axis.

[0201] A step 430 determines a first orientation of the ECG vector. The orientation of the ECG vector can be determined in response to the polarity of the measurement electrodes and orientation of the electrode measurement axis, as described above. [0202] A step 435 rotates a first ECG vector. The first ECG vector orientation of the ECG vector can be used to rotate the ECG vector onto a desired axis, for example an X-axis of the user in response to the first orientation of the ECG vector and the accelero meter signal. For example, if the first measurement axis of the first ECG vector is rotated five degrees based on the accelerometer signal, the first ECG vector can be rotated by five degrees so as to align the first ECG vector with the user axis.

[0203] A step 436 measures accelerometer signals with the adherent devices positioned on the user. Each of the adherent devices can measure and store that data with a processor on the adherent device. [0204] A step 437 detects motion above a threshold. For example each of the adherent devices can sample periodically sample the accelerometer for motion along at least one axis above a threshold.

[0205] A step 438 activates additional sensors in response to motion above the threshold. For example, one of the axes on one of the accelerometers can detect acceleration above a threshold. In response to motion above the threshold, the adherent device can transmit a signal, for example a wirelessly transmitted interrupt, to at least one other adherent device to trigger additional data acquisition and storage. The at least one other adherent device may comprise a first low power quiescent configuration that can be changed to a second high power active configuration to acquire additional data. For example, the adherent device on the thorax can acquire ECG and respiration data in response to the wireless interrupt from the sensor on the limb.

[0206] A step 439 measures additional signals, for example at least one of heart rate or respiration from the thorax. The additional signals may comprise accelerometer signals from the additional sensors on the other limbs of the user.

[0207] A step 440 measures a first user temperature. The first temperature of the user can be measured with electronics of the adherent device, as described above.

[0208] A step 445 measures a first user impedance. The first user impedance may comprise a four pole impedance measurement, as described above. The first user impedance can be used to determine respiration of the user and/or hydration of the user.

[0209] A step 455 adheres second patch devices to the user, for example one week after the first patches to replace the first patch devices. The second patch devices may comprise second patch devices connected to reusable electronics modules, for example reusable electronics modules connected to the first patch devices for the first user measurements above. The second patch devices may comprise second patches of second adherent devices comprising second electronics modules in which the second patch devices and second electronics modules comprise disposable second adherent devices and the first adherent patch devices and first electronics modules comprise first disposable adherent devices.

[0210] A step 455A measures second accelerometer signals along first axes, for example x- axes of the accelerometers as described above. The first axes may comprise the first axes of the first accelerometers as described above, for example the X-axes of the accelerometers used to measure the X-axes signals with the first measurements. In some embodiments, the second accelerometer signals along the first axes may comprise X-axes of second accelerometers, for example second disposable electronics modules, aligned with electrode measurement axes as described above.

[0211] A step 455B measures second accelerometer signal along second axes of the second accelerometers, for example Y-axes.

[0212] A step 455C measures a second accelerometer signal along third axes, for example Z- axes.

[0213] A step 446 stores user data in a circular buffer on each device. For example, the processor each of the adherent device can store data to a RAM memory of the processor. [0214] A step 447 time stamps the data stored on each adherent device. For example, the processor on each adherent device can time stamp the data stored in RAM. The gateway may transmit a time signal that is received by each adherent device such that the time stamps on each adherent device can be synchronized.

[0215] A step 448 pairs each adherent device with the gateway. The pairing can be sequential or simultaneous.

[0216] A step 449 transmits data from each adherent device to the gateway.

[0217] A step 450 receives, stores and combines data with the gateway. For example, the gateway can receive data sequentially from each adherent device and combine the data based on time stamp information for transmission to the server. [0218] A step 451 transmits combined data from the gateway to the remote server. The gateway may transmit frames of combined data. Alternatively or in combination, the remote server may combine the data based on time stamp information.

[0219] A step 452A high pass filters the accelerometer signals. The high pass filter may comprise an analog filter, a digital filter. The high pass filter data can be used to determine an amount of fatigue of the user. The high pass filter data can be generated with a Fourier transform, and/or other known transforms and filters. The high pass filter data, for example above about 1 Hz, as described above, can be used to determine an amount of fatigue of the user.

[0220] A step 452B low pass filters the accelerometer data, for example with a cutoff frequency of about 1 Hz. The low pass filter data can be used to determine the orientation of each limb.

[0221] A step 453 determines the orientation of each limb of the user and the torso in response to the low pass filtered accelerometer data.

[0222] A step 460 determines orientations of the second patches on the user. The accelerometers can be coupled to the second patches with a pre-determined orientation, for example with connectors as described above, such that the orientations of the second patches can be determined from: the second accelerometer signals, the pre-determined orientations of the 3D accelerometers on the adherent patches, and the orientation of the user.

[0223] A step 465 measures a second ECG signal. The second ECG signal can be measured with the electrodes attached to the user when the second patch comprises the second orientation, for example after the first patch has been removed and the second patch has been positioned on the user as described above. The ECG signal can be measured with electronics components and electrodes, as described above.

[0224] A step 470 determines a second orientation of the electrode measurement axis on the user. The second orientation of the electrode measurement axis may comprise orientation of an axis of a second set of electrodes, for example a second set of electrodes disposed along an axis of the second patch. The second orientation of the electrode measurement axis may correspond to one of the measurement axes of the 3D accelerometer, for example an X-axis of the accelerometer as described above. However, the second orientation of the electrode measurement axis can be aligned in relation to the axes of the accelerometer in many ways, for example at oblique angles, such that the alignment of the accelerometer with the second electrode measurement axis is known and the signal from the accelerometer can be used to determine the alignment of the electrode measurement axis.

[0225] A step 475 determines a second orientation of the ECG vector. The second orientation of the ECG vector can be determined in response to the polarity of the second measurement electrodes and second orientation of the electrode measurement axis, for example second measurement electrodes on the second adherent patch that extend along the electrode measurement axis of the second adherent patch.

[0226] A step 480 rotates a second ECG vector. The second ECG vector orientation of the second ECG vector can be used to rotate the second ECG vector onto the desired axis, for example the X-axis of the user in response to the first orientation of the ECG vector and the accelerometer signal. For example, if the first measurement axis of the first ECG vector is rotated five degrees from the X-axis based on the accelerometer signal, the first ECG vector can be rotated by five degrees so as to align the first ECG vector with the X-axis of the user, for example the horizontal axis of the user.

[0227] A step 485 measures a second user temperature. The second temperature of the user can be measured with electronics of the adherent device, as described above.

[0228] A step 490 measures a second user impedance. The second user impedance may comprise a four pole impedance measurement, as described above. The second user impedance can be used to determine respiration of the user and/or hydration of the user.

[0229] A step 491 transmits data to the gaming system. The adhered patches and/or the remote server may transmit data to the gaming system. The transmitted data may include ECG, orientation, time stamp, other physiological, or other user data.

[0230] A step 492 modifies the gaming experience. The gaming system may modify the gaming experience based on the transmitted data it receives.

[0231] For example, in a shooting game, weapon movement and accuracy would be dependent on the user's heart rate and respiratory rate, e.g., as the user's heart rate and/or respiratory rate goes up, weapon movement may increase and weapon accuracy may decrease. [0232] A step 493 provides feedback to the user. The adhered patches may include a vibration element which may provide force feedback to the user in response to an in-game event. For example, an adhered patch on the user's arm may vibrate in response to the game avatar being struck in the arm in the game setting. The adhered patches may produce a vibration in response to a physiological data threshold being reached, e.g., the adhered patch may vibrate or vibrate more strongly once the user reaches a certain heart rate or respiration rate. Alternatively or in combination, the adhered patches may provide feedback to the user through other means such as a slight electric shock or a generated sound.

[0233] A step 495 repeats the above steps. The above steps can be repeated to provide longitudinal gaming of the user with differential measurement of user status. The gaming of the user may comprise a comparison of baseline user data with subsequent user date.

[0234] A step 508 measures the orientation and movement data of the patches adhered to a user. A step 512 transmits the measured orientation and movement data to the gaming system. In a step 516, the gaming system receives the transmitted data. A step 520 correlates the received data to in-game avatar orientation and movement.

[0235] In some embodiments, a step 524 further provides the user with a hand-holdable controller. The hand-holdable controller, such as a Nintendo Wii™ Remote, may include an accelerometer to measure and monitor acceleration and orientation. The hand-holdable controller may measure orientation and movement with a step 528. The hand-holdable controller may include pressable buttons to input data and a transmitter to transmit data to the gaming console. The hand-holdable controller transmits the controller data to the gaming system with a step 532. In a step 536, the gaming system receives the transmitted controller data. A step 540 correlates the received controller data to the orientation and movement of an in-game object. For example, the hand held device and adherent device measurements can be combined for virtual sword fighting as described herein with reference to Figures 1 A2, 1A3, and 1A4, for example light saber fighting, and the avatars of the user and a remote second user are shown on each user's display, such that the user is stimulated with a vibration in response to a second user's light sword striking his wrist. [0236] In some embodiments, an exercise routine for a user may be facilitated by the physiological variables measured by the adhered patches. A step 554 compiles the previously measured physiological data, including at least two of a heart rate, a respiratory rate, a temperature, or a hydration of a user. A step 558 displays the physiological data. A step 562 combines the physiological data to determine a fatigue amount or fatigue factor of the user. The fatigue factor may be determined with at least one of a multiplication, a division, a subtraction, an addition, a look up table, an index, a weighted combination, or a tiered combination. A step 570 modifies the capabilities of the in-game avatar based on the determined fatigue factor. The gaming system may also be configured to displayed the avatar as sweating or shaking in response to at least one of the heart rate, respiration rate, or temperature of the user.

[0237] Many of the steps of method 400 can be performed with the processor system, as described above.

[0238] The steps of method 400 may also include steps for gaming a user to provide an exercise game or exer-gaming. [0239] It should be appreciated that the specific steps illustrated in Figure 4B provide a particular method of gaming a user, according to an embodiment of the present invention. Other sequences of steps may also be performed according to alternative embodiments. For example, alternative embodiments of the present invention may perform the steps outlined above in a different order. Moreover, the individual steps illustrated in Figure 4B may include multiple sub-steps that may be performed in various sequences as appropriate to the individual step.

Furthermore, additional steps may be added or removed depending on the particular applications. One of ordinary skill in the art would recognize many variations, modifications, and alternatives, including adapting the method for multiple users for a game with multiple players.

[0240] While the exemplary embodiments have been described in some detail, by way of example and for clarity of understanding, those of skill in the art will recognize that a variety of modifications, adaptations, and changes may be employed. Hence, the scope of the present invention should be limited solely by the appended claims.

Claims

WHAT IS CLAIMED IS:

1. An apparatus to couple a user to a video game, the apparatus comprising: at least one adherent device configured to adhere to a skin of the user, the adherent device comprising circuitry configured to measure user data and transmit wirelessly the user data to circuitry of the videogame.

2. The apparatus of claim 1 wherein the at least one adherent device comprises a support with an adhesive configured to adhere to the skin, the support configured to adhere continuously to the user for at least about one week.

3. The apparatus of claim 1 wherein the at least one adherent device comprises a consumer device having a reusable and rechargeable electronics module, which electronics module is configured to connect to a replaceable adherent base support configured to adhere to the skin of the user.

4. The apparatus of claim 3 wherein the at least one adherent device comprises a plurality of replaceable adherent bases configured to connect to the rechargeable electronics module.

5. The apparatus of claim 1 wherein the at least one adherent device is configured to adhere to the user's chest to measure at least one of a heart rate of the user, a respiratory rate of the user, an activity of the user or a posture of the user.

6. The apparatus of claim 1 wherein the videogame comprises videogame circuitry and a console configured to couple to a display, wherein the videogame circuitry is substantially contained within the console and configured to receive the physiological user data with wireless communication with the at least one adherent device.

7. The apparatus of claim 6 wherein the electronics circuitry comprises at least one peripheral receiver coupled to the console and configured to receive the user data from the at least one adherent device.

8. The apparatus of claim 1 wherein the videogame circuitry is configured to display an avatar of the user to the user.

9. The apparatus of claim 8 wherein the avatar is configured to at least one of sweat or shake in response to at least one of a heart rate, a respiration rate or a temperature of the user.

10. The apparatus of claim 1 wherein the video game circuitry is configured to alter the user's experience in response to the physiological variables.

11. The apparatus of claim 10 wherein videogame circuitry is configured to display a shooting game with a weapon and wherein the videogame circuitry is configured to move the weapon in response to at least one of the user's heart rate or the user's respiratory rate so as to shake in response to at least one of a higher heart rate or a higher respiratory rate.

12. The apparatus of claim 10 wherein the circuitry of the at least one adherent device is configured to determine a fatigue amount of the user and adjust the capabilities of an avatar of the user in response to the fatigue amount of the user.

13. The apparatus of claim 12 wherein the circuitry of the at least one adherent device is configured to combine at least two of a heart rate, a respiratory rate, a temperature or a hydration of the user to determine the fatigue amount of the user.

14. The apparatus of claim 13 wherein the at least one adherent device is configured to combine the at least two of the heart rate, the respiratory rate, the temperature or the hydration of the user with at least one of a multiplication, a division , a subtraction, an addition, a look up table, an index, a weighted combination or a tiered combination.

15. The apparatus of claim 13 wherein the at least one adherent device is configured to determine at least one of movement or position of the device adhered to user and wherein the circuitry of the videogame is configured to display avatar movement in response to the at least one of the movement or the position of the at least one device adhered to the user.

16. The apparatus of claim 15 wherein the at least one adherent device is configured to decrease an amount of movement transmitted to the videogame circuitry in response to an increase in the fatigue amount.

17. The apparatus of claim 1 videogame circuitry is configured to display a heart rate and a respiratory rate on a display visible to the user..

18. The apparatus of claim 1 videogame circuitry is configured to display at least one of gaming, training, exercise or simulation images.

19. A video game system for a user having a skin, the system comprising: videogame circuitry configured for the user to play a video game; and at least one adherent device configured to adhere to the skin of the user to measure user data, wherein the videogame circuitry is configured adjust the videogame in response to the user data.

20. The system of claim 19 wherein the at least one adherent device comprises a support with an adhesive to adhere to the skin, the support configured to adhere to the user for at least about one week.

21. The system of claim 19 the at least one adherent device comprises wireless communication circuitry supported with the support and a processor supported with the support, the processor configured to measure the user data and to transmit the user data to the videogame circuitry.

22. The system of claim 19 wherein the at least one adherent device comprise at least one of accelerometer circuitry to measure acceleration of the user, electrocardiogram circuitry to measure an electrocardiogram of the user, respiration circuitry to measure a respiration of the user, or hydration circuitry to measure a hydration of the user.

23. The system of claim 22 wherein the at least one adherent device comprise the accelerometer circuitry to measure acceleration of the user and wherein the accelerometer circuitry comprises a 3D accelerometer sensitive to gravity along each axis to determine at least one of an orientation, a position or a motion of the user.

24. The system of claim 23 wherein the at least one adherent device comprise at least two adherent devices configured to adhere to each of at least two limbs of the user and wherein videogame circuitry is configured to show at least two limbs of an avatar corresponding to the at least two limbs of the user, and wherein the videogame circuitry is configured to position each of the at least two limbs of the avatar of the user in response to at least one of an orientation, a position or a motion of each of the at least two limbs of the user.

25. The system of claim 24 wherein the videogame circuitry is configured to position the at least two limbs of the avatar in response to the orientation of the at least two limbs of the user.

26. The system of claim 24 wherein videogame circuitry is configured to display second at least two limbs of a second avatar of a second user remote from the first user, and wherein the videogame circuitry is configured to transmit data corresponding to the position of the at least two limbs of the avatar to second videogame circuitry of the second user.

27. The system of claim 26 wherein the videogame circuitry is configured to receive data corresponding to the positions of the second at least two limbs of the second avatar.

28. The system of claim 24 wherein the at least two adherent devices comprise at least four adherent devices configured to adhere to each at least four limbs of the user and wherein the videogame circuitry is configured to show at least four limbs of the avatar of the user to the user, and wherein the videogame circuitry is configured to move the at least four limbs of the avatar of the user in response to the at least one of the orientation or the movement of the at least four limbs of the user.

29. The system of claim 28 wherein the at least four limbs of the user comprise at least two arms of the user and wherein the at least four limbs of the avatar comprise at least two arms of the avatar.

30. The system of claim 28 wherein the at least four limbs of the user comprise at least two legs of the user and wherein the at least four limbs of the avatar comprise at least two legs of the avatar.

31. The system of claim 24 wherein the at least one adherent device comprise an adherent device configured to adhere to a thorax of the user and wherein the videogame circuitry is configured to show an orientation of a thorax of an avatar of the user in response to the orientation of the thorax of the user.

32. The system of claim 31 wherein the adherent device configured to adhere to the thorax comprises the electrocardiogram circuitry and wherein the electrocardiogram circuitry is configured to measure an electrocardiogram comprising a heart rate of the user and wherein the electrocardiogram circuitry is coupled to at least two electrodes configured to measure an electrocardiogram signal from the user.

33. The system of claim 31 wherein the adherent device configured to adhere to the thorax comprises the respiration circuitry and wherein the respiration circuitry comprises at least one of impedance circuitry or a mechanical sensor to measure the respiration of the user.

34. The system of claim 33 wherein the respiration circuitry comprises the impedance circuitry and wherein the impedance circuitry is coupled to at least two electrodes to measure an electrocardiogram of the user.

35. The system of claim 33 wherein the respiration circuitry comprises the mechanical sensor and mechanical sensor is configured to measure a strain signal in response to respiration of the user.

36. The system of claim 31 wherein the adherent device configured to adhere to the thorax comprises the hydration circuitry and wherein the hydration circuitry comprises impedance circuitry.

37. The system of claim 19 wherein the at least one adherent device is configured to stimulate the user in response to an action of a second user at a remote location.

38. The system of claim 37 wherein the at least one adherent device is configured to stimulate the user with at least one of a sound, a vibration or a shock.

39. A method of playing a video game, the method comprising: adhering at least one adherent device configured to adhere to a skin of a user, wherein the adherent device measures user data when adhered to the user and transmits wirelessly the user data to circuitry of the videogame.