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Energy sources and their

development for application
in medical devices
Expert Rev. Med. Devices 7(5), 693–709 (2010)

Mahdi Rasouli1 and
Louis Soo Jay Phee†1
1
Robotics Research Centre, School of
Mechanical and Aerospace
Engineering, Nanyang Technological
University, Singapore 639798
†
Author for correspondence:
Tel.: +65 679 049 59
Fax: +65 679 118 59
msjphee@ntu.edu.sg
Electronic medical devices have become an indispensable part of modern healthcare. Currently,
a wide variety of electronic medical devices are being used to monitor physiological parameters
of the body, perform therapy and supplement or even entirely replace complex biological
functions. Cardiac pacemakers, cardioverter-defibrillators and cochlear implants are a few
examples of such medical devices. Proper functionality of these devices relies heavily on the
continuous supply of a sufficient amount of electricity to them. In this sense, a reliable, safe and
convenient method for the provision of energy is very crucial. Various approaches have been
developed to fulfil the divergent and challenging energy requirements of medical devices. In
this article, we present a brief overview of the energy requirements of medical devices and
review the existing and emerging energy sources for application in these devices, particularly
wearable and implantable devices.

Keywords : biofuel cell • electrochemical battery • electrochemical capacitor • energy harvesting • energy source
• fuel cell • medical device • nuclear battery • transcutaneous energy transmission • wireless power transmission

The recent advances in integrated circuit tech-
nology and wireless communication systems
have paved the way for the development of
medical devices that can continuously and less
(or non-) invasively monitor and treat various
physiological conditions. This has resulted
in more effective medical treatments and
enhanced quality of life for the patient and the
disabled. Such medical systems have been inves-
tigated intensively over the past two decades
and become the accepted treatment for a broad
range of ailments, such as cardiac arrhythmia,
hearing loss and diabetes. In recent years, the
number of people seeking such treatments has
increased significantly as a result of longer life
expectancy, higher quality-of-life expecta-
tions and greater awareness of new treatment
alternatives [1] .
Proper functionality of electronic medical
devices relies heavily on the continuous supply
of a sufficient amount of energy to them. In this
sense, an unobtrusive energy source that enables
desired portability and energy autonomy for a
prolonged lifetime is highly desired.
The energy source of a medical device must
have several major specifications, most impor-
tantly reliability and predictability of opera-
tion. The energy source should be capable of
continuously and robustly delivering a suf-
ficient amount of energy to the device. Any
failure or malfunction in the operation of the
device may lead to undesired effects, such as
permanent damage to the body or even death
of the patient.
Safety is another major concern for medical
applications. The energy source should not have
any unwanted effect on the body, it should not
poison or damage body tissues and should not
interfere with vital signals of the body, such as
heart beat. Dissipated heat due to operation of
the device or transmission of energy should not
exceed regulatory standards [2] . The increase
in temperature of the surrounding body tissues
due to the dissipated heat may result in criti-
cal damage to body organs. Special consider-
ations must be taken into account to optimize
the efficiency of energy delivery and minimize
energy dissipations.
High energy-density and power capacity
are among other favorable characteristics that
an energy source must have. Higher energy-
density prolongs the lifetime of the device
and eliminates the burden of replacement or
recharging. In addition to the aforementioned
specifications, implantable energy sources must
be hermetically sealable.

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 Review Rasouli & Phee

The choice of the energy source for medical devices depends Electrochemical batteries
on several factors, such as size, power consumption, lifetime and Electrochemical batteries are energy storage devices that con-
temporal mode of operation (continuous or intermittent) of the vert the chemically stored energy of a material into electricity
device. Table 1 lists some of the existing and emerging medical using oxidation/reduction reactions. Electrochemical batteries
devices and their energy requirements. External medical devices are commonly categorized as primary (single use) or second-
benefit from larger available space, and thus higher energy budget ary (rechargeable). Primary batteries are suitable for low-power
and design flexibility. By contrast, provision of energy to in vivo applications requiring low current drain, intermittent operation
medical devices is very challenging owing to several restrictive or short lifespan; secondary batteries are used in devices with
factors, most importantly limited available space and their inac- high energy consumptions where limited energy of a battery is
cessible location, which renders the replacement or adjustment not sufficient for operation of the device. In these devices, the
of the device impractical. energy is delivered to the system through an external power
Currently, electrochemical batteries (most notably lithium source or harvested from the ambient environment to recharge
batteries) are the dominant source of energy for wearable and the battery.
implantable medical devices. However, the limited energy An electrochemical battery is composed of several electro-
capacity of batteries limits their application in miniature chemical cells that are connected in series and/or in parallel
devices, where it shortens the lifetime and necessitates the to provide the required voltage and capacity, respectively. Each
replacement or recharging of the battery. To overcome this limi- electrochemical cell consists of three main sections: anode, cath-
tation, several alternative energy sources have been investigated, ode and electrolyte (Figure 2) . The electrolyte separates the two
including energy storage supplies with higher energy densities, electrodes and provides the mechanism for the transfer of ions
such as fuel cells, wireless transmission of energy from an active between them. During battery discharge, oxidation at the anode
source and harvesting energy from the ambient environment. results in the generation of electrons and positively charged ions.
In this article, we present a brief overview of the existing and Generated electrons flow through the external circuit toward
emerging energy sources and their development for applica- the cathode, resulting in an electrical current in the external
tion in medical devices, with a special focus on wearable and electric circuit. Positively charged ions move through the electro­
implantable devices. lyte toward the cathode and participate in reduction reactions
occurring at available reaction sites of the cathode. In primary
Energy storage & conversion batteries, these reactions result in inactive reaction sites at the
Local energy storage devices, most notably electrochemical bat- cathode. As discharge proceeds, more and more reaction sites
teries and capacitors, are the most common source of energy for become unavailable until the battery becomes completely dis-
medical devices. This is mainly because of their reliable, safe charged. In secondary batteries, this reaction is reversible and
and robust operation, which is essential for biomedical applica- the battery can be recharged by replacing the electrical load with
tions. Furthermore, the modularity and proper encapsulation and an electrical source.
packaging of these devices make the design of biomedical devices The electrical specifications of a battery mainly depend on its
simpler and more robust. The energy and power densities of some chemistry. Some of common battery chemistries and their speci-
of the existing energy storage devices are plotted in Figure 1. fications are listed in Table 2 . It should be pointed out that each
of these battery technologies has its own
Table 1. Examples of existing and emerging biomedical devices. advantages and disadvantages and may suit
specific applications. For example, zinc–air
Device Power Life-time Energy source Ref. batteries are not hermetically sealable and,
Biomonitoring systems Less than 100 µW NA Primary battery [102] therefore, are not suitable for in vivo medi-
cal applications. These batteries are used
Pacemaker Less than 100 µW 10 years Primary battery [9]
in behind-the-ear hearing aid devices [3] .
Cardioverter-defibrillator Steady state less 10 years Primary battery [9] Currently, lithium batteries are the dom-
than 100 µW inant source of energy for medical devices
Peak: 5–10 W owing to their superior characteristics,
Cochlear processor 200 µW 1 week Rechargeable battery [103] including high energy-density, high open
circuit voltage, reliability, predictability of
Hearing aid 100–2000 µW 1 week Rechargeable battery [104]
operation and hermetic sealing [4] . Several
[105]
battery chemistries based on lithium have
Retinal implant 40–250 mW NA Inductive power
been developed to fulfil the divergent
Neural recorder/ 1–100 mW NA Inductive power [106,107] energy and power requirements of dif-
stimulator ferent applications [4,5] . Lithium–iodine
primary batteries have been widely used
LVAD and TAH 10–100 W NA Inductive power [108]
in cardiac pacemakers since 1972 and
LVAD: Left ventricular assist device; NA: Not available; TAH: Total artificial heart. are still the favorite choice for low-power

694 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices Review

applications where currents in the range 1.0E+07

of a few microamperes are needed  [6] .
Lithium–thionyl chloride (SoCl 2 ) and 1.0E+06
lithium/carbon fluoride (CFx) batteries

Specific power (W/kg)

target medium-rate applications, such as 1.0E+05 Capacitors
neurostimulators and drug delivery sys-
tems that demand for currents in the range 1.0E+04
of a few milliamperes  [7] . Lithium–silver
1.0E+03
vanadium oxide (SVO), lithium–manga- Electrochemical
nese dioxide (MnO2) and lithium–SVO- capacitors
1.0E+02
CFx batteries are suitable for high-rate Batteries
Fuel cells
applications, such as cardioverter-defi-
1.0E+01
brillators [8,9] . Rechargeable lithium-ion
batteries have been utilized in applica- 1.0E+00
tions with high energy demands where the 0.01 0.1 1 10 100 1000
limited energy of primary batteries is not Specific energy (Wh/kg)
sufficient for operation of the device. Left
ventricular assist devices (LVADs) and Figure 1. Ragone plot of various energy storage devices.
total artificial hearts are two examples of Adapted from [98] .
such implantable medical devices [4] .
Thin-film solid-state batteries [10] and flexible batteries [11] are Application of nanomaterials to improve the energy density, rate
two promising emerging technologies for application in medical capacity and cycling performance of electrochemical batteries has
devices. Thin-film solid-state batteries offer excellent cycling per- received considerable attention over the past few years [16] . High
formance, safety, reliability, low self-discharge and compatibility capacity electrodes, such as the Si anode [17,18] and the LiFePO4
with integrated circuit technology [12] . The latter provides the cathode [19], are being developed for high-energy and high-rate appli-
opportunity for integration of batteries with other circuit elements, cations. An exhaustive review of recent developments in battery
resulting in more compact and customized devices. Furthermore, technologies are presented in [20,21] .
this technology opens up the door for fabrication of ultraminia- In addition to developments in general-purpose batteries, appli-
turized microbatteries (with footprints of less than 1 mm2) for cation-specific batteries targeting medical devices have also been
implantable medical devices [13] . To fully benefit from the advan- reported [22,23] . Heller et al. proposed two potentially implantable
tages of thin-film batteries, it is necessary to improve their low-rate miniature batteries that comprise subcutaneously implantable
capacity. 3D battery structures have proved promising to overcome electrodes and utilize the subcutaneous interstitial fluid as their
this limitation [14,15] . electrolyte [23] . The proposed battery structures obviate the need
for a protecting case, and thus provide the
opportunity for significant miniaturization.
The first battery comprised of a Zn anode
and a biocompatible hydrogel-shielded
Ag/AgCl cathode, and could achieve a
projected energy density of 500 Wh/l, a
power density of 50 W/l and a lifetime of
1 month in subcutaneous fluid. The sec-
ond battery, utilizing the same anode and a
bilirubin oxidase O2 cathode, could achieve
projected energy density of 5000 Wh/l, a
power density of 10 W/l and a lifetime of
2 weeks in pH 7.4 saline buffer.

Micro fuel cells/biofuel cells

Fuel cells convert the electrochemical
energy of a fuel into electricity using cata-
lytic oxidation/reduction reactions [24,25] .
As is illustrated in Figure 3, an electrical cur-
rent is generated through oxidation of a fuel
in the anode and reduction of an oxidizing
Figure 2. Operational principle of a typical lithium-ion battery.
material, most commonly oxygen, in the

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 Review Rasouli & Phee

Table 2. Common battery chemistries.

Battery technology Anode Cathode Voltage Energy density Specific energy
(V) (Wh/l) (Wh/Kg)
Primary Zn/air Zn O2 1.5 1270–1560 370–490
Zn/Ag2O Zn Ag2O 1.5 207–543 56–137
Li/SO2 Li SO2 3.0 313–498 160–307
Li/SOCl2 Li SOCl2 3.6 715–1100 380–537
Li/MnO2 Li MnO2 3.0 371–789 129–343
Li/I2 Li I2 (P2VP) 2.8 820–1030 220–280
Secondary Zn/Ag2O Zn AgO 1.5 180 105
Zn/MnO2 Zn MnO2 1.5 210–458 50–150
Nickel metal hydride MH NiOOH 1.2 53–360 40–100
Lithium ion C LiCoO2 4.0 200–450 60–200
Lithium polymer C LiFePO4 3.6 160–217 74–180
Adapted from [109].

cathode. A membrane separates the electrodes and facilitates the
transfer of ions to complete the electrical circuit. Fuel cells differ
from batteries in that the fuel is not an integrated part of the trans-
duction mechanism and is supplied externally. Liquid fuels have
higher energy densities compared with battery materials (Figure 4) .
Considering the size of the conversion cell, a practical energy
density four- to five-times higher than that of batteries seems
feasible for portable applications. The higher energy density of
fuel cells, as well as the possibility of instantaneous replacement
of the fuel, makes fuel cells an appealing alternative for portable
and wearable medical devices.
Biofuel cells follow the same mechanism and structure as
fuel cells, except they replace the precious metal catalysts with
biocatalysts, such as microorganisms or enzymes [26,27] . Biofuel
e- e-
Fuel
(H2)
Cathode
cells are generally classified as microbial [28] or enzymatic fuel
cells  [29] . Microbial fuel cells utilize living microorganisms to
oxidize the fuel substrates, whereas enzymatic fuel cells employ
isolated enzymes. Microbial fuel cells offer the advantages of long-
term stability and fuel efficiency, but they suffer from low power
density. This is mainly because of the slow process of electron
transfer across the cell membrane. The application of isolated
enzymes eliminates this problem and increases the selectivity and
specificity of the electrode for biofuels. However, it results in
short lifetime and low conversion efficiency due to incomplete
oxidation of the biofuel.
Although portable medical devices may also benefit from higher
energy density and instantaneous recharging capability of tradi-
tional fuel cells, the most appealing medical application of fuel
cells lies in utilization of endogenous substrates and oxygen from
a patient’s body for powering implantable medical devices. The
ubiquitous availability of glucose and oxygen in body fluids (e.g.,
blood and interstitial fluid) allows the continuous production of
electricity [30] .
The research on implantable glucose fuel cells dates back to the
late 1960s and has focused mostly on enzymatic biofuel cells and
Oxidant
abiotically catalyzed fuel cells, which are based on nonbiological
(O2) catalysts, such as noble metals or activated carbon [30] . Microbial
fuel cells did not receive considerable attention for implantable
applications owing to their low power and energy densities and

safety concerns [30] .

H+
Anode

In general, enzymatic glucose fuel cells offer the highest output

current and power density compared with other types. Moreover,
they provide the opportunity for extreme miniaturization by
Electrolyte obviating the need for a separating membrane [31] . Heller et al.
(for exchange of ions) reported the development of a miniature membraneless enzy-
Excess Water
fuel/reaction (H2O) matic glucose-O2 biofuel cell [31] . The cell comprised a wired
byproducts glucose oxidase-coated anode and a wired bilirubun oxidase-
coated cathode (each 7 µm in diameter and 2 cm in length),
Figure 3. Operational principle of a solid-oxide fuel cell.
and produced 430 µW/cm 2 at 0.52 V and 37°C. Considering

696 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices Review

the 1-week lifetime of the cell, the power

capacity of the developed biofuel cell is
9000
1000-fold higher than Zn–air batteries,
with similar dimensions and lifetime. 8000
The proposed biofuel cell is an appealing
alternative for disposable applications, 7000

Energy density (Wh/l)

especially for glucose monitoring systems. 6000
Despite their favorable characteristics of
high energy-density and fuel selectivity, 5000
enzymatic biofuel cells suffer from several
4000
major drawbacks that limit their application.
Instability and denaturization of enzymes is 3000
the most important problem of enzymatic
2000
biofuel cells, and impedes their application
in long-life implantable devices [30] . 1000
Abiotically catalyzed fuel cells suggest
a good alternative for long-life implant- 0

NiMH

Li ion

Li ion polymer

NaBH4/H2O (40%)

Methanol

Butane

Iso-octane
able devices. They have the advantages
of long-term stability, sterilizability and
bio­compatibility [30] . Kerzenmacher et al.
reported the development and long-term
characterization of an abiotically catalyzed
glucose fuel cell in physiological glucose
solution. They observed a decrease in Figure 4. Comparison of energy density of fuel cells and batteries.
the maximum power density from 3.3 to Reprinted with permission from [25] .
1.0 µW/cm over a period of 224 days [32] .
2

Recent advancements in micro fuel cells and implantable carbon) [36] . Pseudocapacitors use fast and reversible surface or
fuel cells are reviewed in [24] and [30,33] , respectively. Although near-surface reactions for charge storage, and can achieve higher
implantable fuel cells have proven feasible, several issues remain to charge/discharge rates compared with EDLCs [37] . Hybrid capaci-
be addressed for consideration of applications in medical devices, tors, combining a capacitive or pseudocapacitive electrode with a
most importantly, the long-term in vivo performance of these battery electrode, have also been developed [37] . These capacitors
devices and their safety. benefit from both capacitor and battery properties. These develop-
ments, combined with superior characteristics of nanostructured
Capacitors/supercapacitors electrodes, have brought the energy density of electrochemical
Capacitors are high-power energy storage devices, in which the capacitors closer to that of batteries [38] . A good review of these
energy is stored in the electric field between a pair of oppositely technologies is provided in [39] .
charged electrodes. Compared with batteries and fuel cells,
capacitors offer higher power capacity, higher charge/discharge Nuclear batteries
rates and excellent cycling performance of over 100,000-times. Nuclear batteries are fuel-based energy-storage devices that con-
However, they suffer from low energy-densities as the energy vert the radiative energy of a radioisotope material into electric-
is not stored in the bulk of the material. Capacitors usually ity. Radioisotope materials lose energy through the emission
compliment batteries or fuel cells for high-power applications. of energetic particles, such as a and b particles. The energy
An implantable cardioverter-defibrillator is an example of such carried by these particles can be converted into electricity using
applications, whereas a capacitor is used to gradually accumu- a transduction mechanism, such as thermoelectric generators
late energy from a battery and then discharge it to a load in for the conversion of generated heat [40] or electronic devices
burst [34] . for the collection of electron/hole pairs generated by incident
The supercapacitor (also termed ultracapacitor or electro- particles [41] .
chemical capacitor) is an emerging technology that enhances the Nuclear power sources were introduced into the medical indus-
energy density upon capacitors. Supercapacitors are categorized try in the early 1970s for application in early pacemakers [42] .
as electrochemical double-layer capacitors (EDLCs) or pseudo­ Plutonium 238 was used to generate heat via emission of a particles.
capacitors (also called redox supercapacitors) [35] . EDLCs achieve The heat was then converted into electricity using a thermopile.
high capacitances by storing the charge in the ultrathin electro- Unique characteristics of nuclear batteries, including high
chemical double layer at the electrode–electrolyte interface, and energy density and outstanding reliability, made them an appeal-
increasing the effective surface area of the electrode via applica- ing alternative for implantable applications. However, the tox-
tion of high-surface-area materials (most commonly, activated icity and excessively long half-time of the fuel, necessitating

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 Review Rasouli & Phee

tight regulatory controls to avoid loss of any such devices, were
two major concerns that limited their application in medical
devices [42] .
Energy harvesting
Harvesting energy from the ambient sources is an appealing
alternative for powering medical devices. It provides the device
with virtually unlimited energy, and thus prolonged lifetime.
This is particularly important for implantable medical devices
where it can extend the lifetime of the device and obviate the
burdensome replacement or recharging of the batteries. However,
harvesting useful amounts of energy from the ambient environ-
ment is very challenging. The amount of available energy is
usually variable, intermittent and unpredictable. As a result,
special voltage-regulating and power-management circuits are
usually needed.
Table  3 lists some of the possible energy sources for harvest-
ing and their specifications. Among the listed energy sources,
human-based energy sources (thermoelectric and motion-driven)
are appealing alternatives for medical applications owing to their
abundance and the inherent vicinity of the energy source to the
device. However, special consideration should be taken to avoid
disturbing the physiological activity of the user or the metabolic
rate of the body.
Thermoelectric generator
Thermoelectric generators are solid-state devices that directly
convert the thermal energy of temperature gradients into electri-
cal energy [43] . High reliability, durability, compactness and the
absence of any moving part make thermoelectric generators an
appealing alternative for medical applications. The human body
is an abundant source of thermal energy, which can be utilized
for the generation of electricity [44,45] .
Thermoelectric generators are based on the Seebeck effect,
discovered by Tomas Seebeck in 1821 [46] . The Seebeck effect
states that an electrical voltage is generated across a metal or
semi­c onductor material when it is exposed to a temperature
gradient  [46] . Mobile charge carriers (electrons or holes) at the
hot side of the material have higher thermal energy than the car-
riers at the cold side and diffuse to the cold side of the material
as heat flows [43] . The resulting voltage (V) at the open circuit
condition is proportional to the temperature difference and can
be expressed as: V = S.DT, where DT is the temperature difference
between the hot and cold surfaces, and S is the proportionality
coefficient, termed Seebeck coefficient.
A typical thermoelectric generator, comprising of alternating
n-type and p-type doped semiconductor materials, is depicted
in Figure 5 [47] . In this configuration, n- and p-type legs are con-
nected thermally in parallel and electrically in series to enhance
the output voltage and conversion efficiency. The negative charge
carriers (electrons) from the n-type material produce a current
from the cold to the hot side, whereas the positive charge carriers
(holes) from the p-type electrode generate an electrical current
from the hot to the cold surface. The generated open circuit
voltage is expressed as: V = n.(Sp –Sn).DT, where n is the num-
ber of thermocouples (pairs of n- and p-type legs) connected
in series, DT is the temperature difference between the hot and
cold surfaces, and Sn and Sp are Seebeck coefficients of n- and
p-type legs, respectively. n- and p-type legs, commonly made of
doped bismuth telluride semiconductor, have Seebeck coefficients
between 100 and 300 µV/K [43] . To achieve voltage levels of a few
volts, a large number of these thermoelectric devices are usually
connected in series.
Wearable thermoelectric generators are commercially available
today. Seiko’s Thermic wristwatch (producing 22 µW of electrical
power and 300 mV open circuit voltage at 1.5 K temperature drop
across the device [48]) and Applied Digital Solutions’ Thermo life®
(generating 10 µA at 3 V and 6 V open circuit at 5 K tempera-
ture difference [49]) are two commercial examples that use body
heat to generate electrical energy. The feasibility of thermoelec-
tric harvesting for body-worn medical devices has been recently
demonstrated for a pulse oximeter (62 µW power consumption),
a two-channel EEG system (0.8 mW power consumption) and
an ECG system (0.6 mW power consumption) [50] .

Table 3. Energy harvesting sources and their characteristics.

Energy source Performance Remarks Ref.
Ambient light 100 µW/cm (indoor)
2
Ambient solar energy: [49,110]
100 mW/cm2 (outdoor) 1 mW/cm2 (indoor)
500 mW/cm2 (outdoor)
Ambient radiofrequency Less than 1 µW/cm2 Power density from telecommunication towers and other [74]
radiations sources in urban areas can be as high as 3 µW/cm2, but it is
commonly 2–3 orders of magnitude lower
Thermoelectric 30 µW/cm2 Quoted for Thermo life generator at 5°C [49]
temperature difference
Vibrational 4 µW/cm3 (human motion, Hz) Predicted power density for a vibrational microgenerator [111]
800 µW/cm3 (industrial, KHz) with volume of 1 cm3
Biomechanical energy 4.8 W (knee-brace) Potential available power from heel strike was estimated to [49]
of the body 0.8 W (heel strike) be 7 W
(direct force) Knee-brace harvester extracts energy from negative work [67]
of muscles

698 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices Review

Yang et al. investigated the feasibility of

the application of thermoelectric genera-
Heat absorbed
tors for implantable medical devices [51] .
In their study, theoretical interpretations
and numerical simulations were performed
to evaluate temperature differences estab-
Substrates
lished across a thermoelectric generator
positioned in the body, and proof-of-con-
cept in vitro and in vivo experiments were
carried out. They reported the generation
of output voltages of 5 mV and 25 mV from
Thermoelectric + current
temperature differences of 1.3 K and 5.5 K, Metal
elements External
respectively, across a thermoelectric gen- interconnects
erator implanted in a rabbit in the state of electrical
connection
general anesthesia.
Despite their favorable characteristics, Heat rejected
thermoelectric generators suffer from low
conversion efficiencies, especially at low
temperature differences. The efforts to
improve efficiency of thermoelectric genera-
tors are currently focused on design optimi-
Heat absorption
zations and improving thermal properties
of the materials. It was found that supper-
lattices [52] and nano­materials  [53] could
Heat flow h+ p
greatly enhance the conversion efficiency.
Development of new fabrication techniques e- n
for improved specifications and lower costs
is another major area of research that has
received considerable attention. Of particu-
lar interest is the development of Si-based
Heat rejection
thermoelectric generators that are compat-
ible with integrated circuit technology [54] .
An exhaustive review of thermoelectric
generators and their recent advancement is
presented in [55] . Figure 5. Schematic of a thermoelectric generator.
Reprinted with permission from Macmillan Publishers Ltd: Nature Materials [47] , © 2008.
Motion-driven energy harvesters
The human body is an abundant source of biomechanical energy respect to the coil results in a change of the magnetic flux in the
that can be converted into electrical energy using a conversion coil and, thus, induces an electrical voltage in the coil.
mechanism [56] . These include the energy of respiration, muscle Piezoelectric transduction is based on the ability of piezo­electric
stretching, joint rotations, body weight during walking, the materials to produce an electrical voltage when subjected to a
hydraulic energy of blood flow, heart beats and contractions of mechanical deformation. A typical structure for piezoelectric
blood vessels, to name a few. Considerable caution must be exer- generators is illustrated in Figure 7. In this configuration, defor-
cised so that harvesting energy from the body does not expose mation of the structure due to external forces produces tensile
any extra loads to the body. Extraction of an excessive amount strain on one side and compressive strain in the other, and thus
of energy may exhaust the muscles, increase the metabolic rate results in positive and negative voltages across the beam. Using
of the body and bring about undesired effects. this mechanism, an alternating current (AC) output voltage is
To convert the mechanical energy of motion into electrical generated when the mass oscillates.
energy a transduction mechanism is needed. Electromagnetic [57] , Electrostatic generators are mechanically variable capacitors
piezoelectric [58] and electrostatic [59] are the most commonly with movable electrodes. Relative displacement of the electrodes
applied transduction mechanisms. However, other mechanisms, changes the capacitance of the system and thus also changes the
such as magnetoelectric [60] , have been also developed. stored electrical energy (Figure 8) . The excess energy of the capaci-
Electromagnetic generators are based on the magnetic induc- tor can be extracted to energize an electrical circuit. In contrast to
tion principle and deploy a movable permanent magnet or coil other methods, this mechanism demands a precharged capacitor,
(Figure 6) . Relative displacement of the permanent magnet with and thus a prestored energy source.

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 Review Rasouli & Phee

F F
generator that could produce 250  mW
[64,65] . Although the developed devices

Magnetic Eccentric were capable of producing electricity, they

S Magnet magnetic S suffered from several drawbacks, includ-
rotor
N T rotor N
N ing bulky volume, heavy weight, fragile
N
Coils structure and a noticeable effect on the
S S Coils user’s gait (particularly in the case of the
Coils electromagnetic generator).
Donelan et al. developed a novel bio­
Figure 6. Three different types of electromagnetic generators. (A) Rotational mechanical energy harvester for generat-
device driven by continuous rotational power; (B) linear oscillatory device driven in ing electricity from walking by using a
resonance by forced vibration; and (C) hybrid device that converts linear vibrations into
rotational motion.
knee-brace (F igur e  13) [66,67] . The system
Reproduced with permission from [99] , © 1969 IEEE. was based on the concept of regenerative
braking; absorbing energy from muscles
Magnetorestrictive generators rely on the Villari effect for while performing negative work. This mechanism avoids put-
transduction of vibrational motions [61] . The Villari effect states ting extra load on muscles while they are doing positive work,
that an induced strain in a magnetorestrictive material changes and thus does not increase the metabolic rate excessively.
its magnetization. In magnetorestrictive generators, alternating Moreover, it assists the muscles in performing negative work.
tensile and compressive strains in a magnetorestrictive material The developed system generated 4.8 ± 0.8 W of electricity with
results in a varying magnetic field that is converted into electricity a 5 ± 21-W increase in metabolic cost.
by using a pick-up coil (Figure 9) . Lewandowski et al. proposed a stimulated muscle-driven piezo-
Hybrid systems utilizing a combination of the aforementioned electric generator for application in implantable and prosthetic
techniques have also been developed to increase the energy devices (Figure 14) [68] . A piezoelectric generator was connected in
conversion efficiency (Figure 10) . Challa et al. proposed a piezo- series with a muscle-tendon to convert the tensile force of stimu-
electric beam that could resonate in a coil structure to simul- lated muscle contractions into electricity. Software simulations
taneously benefit from both piezoelectric and electromagnetic predicted a possible output power of 690 mW for such a generator,
transductions [62] . with an estimated stimulating power of 46 mW. The feasibility
In general, motion-driven generators fall into two categories: of the proposed concept was demonstrated acutely with rabbit
inertial (vibrational) or force-driven. Vibrational harvesters uti- quadriceps [69] .
lize the inertial energy of a proof mass for the generation of elec- Several other approaches for harvesting human-based energies
trical energy, while force-driven generators are based on the direct for wearable and implantable medical devices have been inves-
application of a mechanical force onto a transducer. tigated. These include, but are not limited to, harvesters for the
Seiko’s Kinetic® wristwatch is a good example of inertial har- utilization of pressure fluctuations of blood vessels [70] , piezo­
vesters (Figure 11) . It consists of an oscillating weight connected electric nanogenerators for harvesting ambient environment vibra-
to a small magnetic generator and can produce an average of tions [71] and flexible nanogenerators for the generation of power
5–10 µW when worn and 1 mW when forcibly shaken [56] . Goto from muscle movements [72] . A review of the recent developments
et al. studied the feasibility of using Seiko wristwatch’s vibrational in energy harvesting technologies is presented in [73,74] .
generator for implantable medical devices [63] . In their study, the The research on motion-driven harvesters, especially vibra-
generator was placed on the right ventricular wall of a dog’s heart tional harvesters, has been largely focused on the development
and produced 80 mJ of energy after recti-
fication and storage in a capacitor over a
30-min period for a heart rate of 200 beats
per minute.
Force-driven generators have also
been investigated for powering medical Mass
devices. In contrast to inertial harvest- Strain
ers, these devices can benefit from slow 3 Strain
and long-range motions of the body.
Paradiso et al. investigated the feasibility Voltage
of harvesting energy from human walking 2
Vertical
using three types of shoe-mounted har- 1 displacement
vesters: a piezoelectric bender placed in
the sole generated 2 mW; a unimorph that
could bend under heel strike and generate Figure 7. Operational principle of a piezoelectric generator.
8 mW (Figure 12) ; and an electromagnetic Reprinted with permission from [100] .

700 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices
Direction
of motion
In-plane overlap varying
Direction
of motion
In-plane gap closing
Direction
of motion
Out-of-plane gap closing
Figure 8. Three different topologies for micromachined
electrostatic converters. (A) In-plane gap closing type:
capacitance changes by changing gap between fingers;
(B) in-plane gap varying type: capacitance changes by changing
overlap area of fingers; (C) out-of-plane gap closing type:
capacitance changes by changing gap between two large plates.
Adapted from [100] .
of new harvesting mechanisms, and less attention has been paid
to regulation and management of the harvested energy. Variable
and usually small output energy levels associated with these
mechanisms make the design of power management circuits a
challenging task that needs to be further investigated.
www.expert-reviews.com
Review
Wireless power transmission
The limited available space and stringent energy constraints of
some implantable medical devices render the application of on-
board energy supplies or energy harvesters impractical. LVADs
and neural stimulators are examples of such medical devices. The
short lifetime of batteries demands costly and inconvenient surgi-
cal procedures to recharge or replace them. Harvesting energy
from the ambient environment to power the device is not a practi-
cal approach either. Existing energy harvesters are still immature
and can only provide very low power densities in the range of
microwatts. Transfer of energy through the skin is the practical
method for these applications. Percutaneous wires were deployed
to deliver electrical energy from an external wearable battery pack
to LVADs and total artificial hearts [75] . However, application of
percutaneous wires has several major drawbacks. Potential risk of
infection is among the most important problems of percutaneous
links [76] . Furthermore, a tethered connection affects the mobil-
ity of the patient, decreases their quality of life and brings along
esthetic concerns. A wireless energy delivery mechanism through
the skin, often referred to as trans­cutaneous energy transmis-
sion, is very desirable as it obviates the need for wire leads that
penetrate the skin. Acoustic and nonionizing electromagnetic
waves have been successfully applied to transfer energy through
the tissue. Here, we briefly review each of these methods and their
development for the provision of power to implantable medical
devices. In this context, we address the optical waves in a separate
section from other electromagnetic waves owing to their different
interaction with body tissue.
Electromagnetic energy
Electromagnetic waves carry energy as they propagate through
space. Various approaches have been investigated to apply this
phenomenon to transfer energy to implantable medical devices
wirelessly (Figure 15) . Some of these mechanisms are discussed in
the following sections. It should be pointed out that all of these
mechanisms may act simultaneously, although one of them is
usually dominant [77] .
Radiative transmission
Figure 15A illustrates the principle of radiative energy transmission.
A transmitting antenna radiates energy into a medium, part of
which will be picked up by a receiving antenna that is located
in the far field of the transmitter. Choice of the transmission
frequency and antenna design is determined mainly by the appli-
cation. The highest transmission efficiency is usually achieved
when dimensions of the antenna properly match the wavelength
of the electromagnetic field.
Considering the dimensions of typical biomedical implants, an
efficient antenna for radiative power reception becomes feasible
only in the GHz range. However, the absorption by body tissues,
and subsequent attenuation of electromagnetic waves, is very high
at these frequencies [2] . For example, the penetration depth of
muscle tissue is only 3 cm at 1 GHz, while it is approximately 7 cm
at 100 MHz [2] . Transmission of significant amounts of energy at
these frequencies is prohibited by health and safety regulations [2] .
701
 Review Rasouli & Phee
Base
Pick-up coil
MsM laminate
Copper layer
Figure 9. Schematic of a magnetostrictive generator.
MsM: Magnetostrictive material.
Reprinted with permission from IOP Publishing Ltd [61] .
These frequencies are usually used for data communication owing
to their higher bandwidth requirement and lower energy level.
Conductive/capacitive coupling
Electrical power can be transferred wirelessly to a remote load
over a conductive or capacitive medium. A conceptual schematic
of this mechanism is depicted in Figure 15B. As illustrated, an elec-
trical voltage can be induced in the remote load through the
medium. The distance between the transmitting and receiving
parts is assumed to be short compared with the wavelength of the
source. Longer distances of the receiver can be considered under
a far field approximation and radiative transmission.
In the case of medical implants, receiving electrodes are
implanted in the body and transmitting electrodes are mounted
on the skin. To achieve an acceptable level of power, the receiv-
ing electrodes should have a large surface area and high imped-
ance compared with the body tissue. Any air gap between the
Piezoelectric cantilever beam
+ suitable for applications with low power requirements. Ferrite
–
Magnet
+
Coil
- and a ferrite-core internal coil [79] . The proposed configuration
Figure 10. Schematic of a coupled
piezoelectric–electromagnetic energy harvester.
Reprinted with permission from IOP Publishing Ltd [62] .
702
transmitting electrodes and the skin
should also be avoided as it results in poor
transmission [77] . In case an air gap exists,
most of the voltage will drop over the air
gap owing to its higher impedance com-
pared with body tissue. Passage of gener-
ated currents through the tissue is a serious
safety concern and limits the application
of this mechanism for transcutaneous
power transmission [77] .
Inductive coupling/resonant coupling
Inductive coupling is the most com-
mon method for wireless transmission
of power to medical implants. It offers
a relatively safe and efficient mechanism
for transmission of energy using near-
field electromagnetic waves – which is the
preferred method for implantable appli-
cations owing to the lower absorption
rate by body tissue at lower frequencies.
This method has been successfully used
to power implantable medical devices,
including cochlear implants, LVADs, total artificial hearts and
neural implants.
Inductive coupling is based on the principle of electromagnetic
induction in conductors. In this method, an alternating current
in a transmitting coil generates an alternating magnetic field,
which passes through and couples with a secondary receiving coil
(Figure 15C) . The generated alternating magnetic field induces an
electromotive force (EMF) in the receiving coil that can be used
to power the implanted load, either directly or after rectification
and regulation.
The efficiency of the transmission link depends on geometri-
cal factors and material properties of the coupling medium,
and is expressed by a coupling factor (k), which ranges from 0
to 1. A coupling factor of 1 represents perfect coupling where
all the generated magnetic flux penetrates the receiver coil,
while a coupling factor of 0 expresses a system in which the
transmitter and receiver coils are independent of each other.
Coupling efficiency can be enhanced by careful design of coils
and the use of magnetic flux guides. Air-core coils are usually
lighter and provide better fitting for implantable or wearable
applications. However, they have lower efficiencies and are only
cores are usually used in applications with high power require-
ments, such as artificial hearts and LVADs [78] . Okamoto et al.
proposed a transcutaneous power transmission mechanism for
biventricular assist devices based on an air-core external coil
could provide high transmission efficiency and stable opera-
tion, while eliminating the cosmetic problem of the external
coupling method. The system could achieve a maximum power
transmission of 60 W and maximum transmission efficiency
of 87.3%.
Expert Rev. Med. Devices 7(5), (2010)
 Energy sources & their development for application in medical devices
Oscillating
weight
Oscillating
weight gear
Transmission gear
Stator Rotor
Coil
Figure 11. The Seiko Kinetic® watch.
Courtesy of Seiko Watch Corporation.
The coupling efficiency is not fixed and may change owing to
body motions. This is especially important for medical devices that
are implanted in soft tissues, such as retinal prosthesis and LVADs.
It is estimated that the coupling coefficient may vary between 0.1
and 0.3 for an artificial heart [80] , and between 0.08 and 0.24 for
a retinal prosthesis [81] . The load may also vary depending on the
operation mode of the device. For example, neural stimulators
may consume relatively high amounts of power when they are in
stimulation mode, while they need only a negligible amount of
power in their standby state. Coupling and loading variations result
in poor transfer efficiency, and excess or insufficient amounts of
power transmitted. The excess transmitted power results in heat
generation, while insufficient power may deteriorate or even stop
the operation of the device. This is especially important in battery-
free systems. To overcome this problem, closed loop operation con-
trol should be implemented to regulate the transmitted power [82] .
Adaptive control using back-telemetry from the receiver can be
used to maintain the optimal operation of the device and increase
the efficiency [83] . Regulating transmitter voltage amplitude [82] or
frequency [84,85] has been shown to be effective for this purpose.
The optimized power on the load is achieved when the imped-
ance of the load and receiving circuit are matched and the circuit
operates at its resonance frequency. To increase the efficiency, both
transmitter and receiver can be tuned into the same resonance
frequency to achieve resonant coupling [84,85] . Resonant coupling
can enhance the transmission efficiency, even at low coupling effi-
ciencies and over longer distances [86] . However, implementation
of this mechanism for medical implants is not straightforward
owing to possible variations in load or circuit parameters. An
adaptive control mechanism to adjust the resonant frequency of
the transmitter can help to overcome this problem [84,85] .
Inductive powering of freely moving in vivo medical devices, such
as ingestible capsules, is very challenging owing to the unpredict-
able orientation and distance of the receiver [87] . Misalignment of
transmitting and receiving coils can significantly decrease the trans-
mission efficiency or even result in zero output power. To enhance
the efficiency and avoid zero-crossing in output power, multiple
primary or secondary coils can be used. These configurations have
been investigated by Lenaerts and Puers [77] . The authors concluded
that multiple secondary coils offer superior characteristics compared
www.expert-reviews.com
Review
with other configurations. The implemented system could provide
up to 400 mW of power to a self-propelled and steerable endoscopic
capsule [88] .
Magnetoelectric conversion
Magnetoelectric materials can generate an AC output voltage
when they are exposed to a varying magnetic field [89] . This
phenomenon offers an interesting alternative for wireless power
transmission (Figure 15D) . Compared with inductive coupling,
magneto­electric generators can provide higher output voltages
without suffering from joule loss. Recently, hybrid structures
of piezoelectric and magnetorestrictive materials have received
considerable attention for wireless power transmission. The
alternating magnetic field induces structural changes in the
magnetostrictive material, and subsequently in the piezoelectric
material, resulting in an AC output voltage over the piezoelectric
material [90] .
Magnetic gearing
Suzuki et al. proposed the application of magnetic gearing for
wireless transfer of power to medical implants [91] . In this method
a rotating external magnetic field is used to rotate an in vivo per-
manent magnet to operate a microgenerator. High ratio gears
were used to increase the rotation speed of the internal magnet
and thus the generated voltage. Figures 16A & B depict two imple-
mentations of this mechanism with power outputs of 11 mW and
1.9 W, respectively. This method suffers from several major draw-
backs. Application of moving mechanical parts and permanent
magnets can deteriorate the performance of the device over time
and reduces the reliability. Moreover, the effect of permanently
implanted magnets and exposure of the body to high magnetic
fields need to be investigated further.
Optical energy
The application of optical waves to power medical implants has
also been proposed. In contrast to electromagnetic waves, opti-
cal waves do not interfere with nearby communication systems
Insole
PZT PZT unimorph
dimorph PVDF
stave
Metal
midplate PZT unimorph
Sole
Figure 12. Shoe-mounted piezoelectric energy harvester.
P2T: Lead zirconate titanate; PVDF: Polyvinylidene fluoride.
Reprinted with permission from [65] , © 2001 IEEE.
703
 Review Rasouli & Phee

Expert commentary
Generator Bushings Axis of Significant miniaturization of electronic
rotation Potentiometer devices has paved the way for the develop-
Bearing ment of miniature and light-weight medical
Input shaft
devices that can monitor and treat various
Towards medical conditions continuously. Although
thigh
Roller clutch the processing capability of current elec-
Towards
tronic systems could bring forth more
Chassis advanced and functional medical devices,
shank
Gear train Shaft
connector the full potential of these technologies
remains unattainable owing to the stringent
Angle feedback energy constraints.
Computer
Input One-way control The advancement in battery technol-
shaft clutch ogy is very slow and far behind that of
Rg
RL Output
microelectronic technologies. Thin-film
Potentio- E(t) solid-state battery technology is an emerg-
meter Transmission ing technology that enhances the energy
Generator
density, safety and cycling performance
of electrochemical batteries. Furthermore,
Figure 13. Knee-brace biomechanical energy harvester. it provides the opportunity for miniatur-
Reprinted from [67] with permission from the American Association for the Advancement ization and integration of batteries with
of Science. other microelectronic technologies, and
thus the development of novel microscale

and environmental electromagnetic fields. A transcutaneous

power transmission based on infrared photodiodes was reported
by Goto et al. [92] . The developed system, comprising of an array Bone
of commercial silicon diodes embedded under the skin (area of
ve
2.1 cm 2 ), could successfully charge a lithium battery in 17 min Ner
to power up a pacemaker for 24 h. A modified system to increase
the possible implantation depth is reported in [93] , where an
Muscle

optical fiber is used for transporting light from the region just
under the skin to a desired location of the body without any Stimulator
significant losses.

Ultrasonic energy
Similar to optical waves, ultrasonic waves offer the advantages
Tendon

of lower interference with nearby electromagnetic fields and

communication devices. Ultrasonic waves induce vibration in
the tissue. The kinetic energy of the generated vibration can
attachment

be converted into electrical energy using a proper transducer,

Energy
Tendon

such as piezoelectric transducers [94] . Suzuki et al. reported a storage circuitry

hybrid magnetic/ultrasonic system for transmission of energy to
implanted medical devices [95] . Wang et al. have also proposed
a novel piezoelectric nanogenerator that can convert vibrational
energy into electrical energy [96] . Piezoelectric
Despite their advantages, ultrasonic power transmission suf- generator
fers from several major drawbacks that limit its application for
in vivo medical devices. The ultrasonic power transmission is very
sensitive to the contact between the transmitter and the tissue, Bone attachment
Application load
as well as mutual orientation and distance of the transmitter and Bone
the receiver  [97] . Any misalignment of the transmitter and the
receiver, or impedance mismatch between the transmitter and
the tissue at their contact point, may reduce the transmission Figure 14. Muscle-driven active energy harvester.
efficiency significantly. Reprinted with permission from [68] .

704 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices
Zremote
Magnetic field
Zremote
Figure 15. Principles of electromagnetic wireless power transmission. (A) radiative, (B) conductive/capacitive, (C) inductive and
(D) magnetoelectric.
Adapted from [77] .
medical devices. Application of nanostructured materials is
another important approach that has proved promising for
improving characteristics of batteries. Although these advance-
ments enhance specifications of batteries, they do not overcome
the limited power capacity and energy density of electrochemi-
cal batteries. Electrochemical capacitors may compliment or
replace batteries for high-power applications. However, they
do not overcome the limited energy capacity of batteries. This
is particularly undesired for in vivo medical applications where
a limited energy budget shortens the lifetime of the device,
and demands inconvenient and costly surgical procedures for
replacement of batteries.
Micro fuel cells, providing energy densities four- to five-times
higher than that of batteries, are very appealing for portable
medical applications. Although fuel cells do not overcome the
recharging requirement of batteries, they replace it with a less
frequent and faster refueling process. Implantable fuel cells,
www.expert-reviews.com
Review
Equipotential surfaces
Conduction/
displacement
Zremote
current
Magnetic field
Zremote
such as a glucose fuel cell, eliminate the need for external refu-
eling by tapping into the internal reservoirs of the body, and
thus provide the device with a theoretically unlimited amount
of energy.
Harvesting energy from the ambient environment, especially from
the human body or activities, is another interesting alternative for
powering medical devices. Owing to the intermittent and unpredict-
able nature of the harvested energy, this technique is most useful
in conjunction with secondary batteries. Although proven feasible,
energy harvesting technologies are still immature and need to be
further investigated. Several major issues, such as output regulation
and integration with other system elements, need to be addressed.
Currently, in vivo medical devices with high energy consump-
tions or ultrasmall scales are powered through transcutaneous
energy transmission, most commonly inductive coupling. Using
this method, continuous, intermittent and on-demand power-
ing of implantable medical devices is achievable. However, this
705
 Review Rasouli & Phee

Outside

Outside

N
N
N S
S S

Working
N

circuit
S N
S
S N
Rotor 1 Rotor 2 Rotor 1
SN Inside
Coil
Inside Rotor 3 IMD

Figure 16. Schematics of implantable microgenerators based on magnetic coupling.

Reprinted with permission from [101] , © 2002 IEEE.

method requires an additional infrastructure, which is usually
mounted on the body. This may reduce the mobility and quality
of life of the patient.
Considering advantages and disadvantages of each of the exist-
ing approaches, hybrid energy supplies, combining two or more
energy sources, suggest a practical solution to overcome limita-
tions of each technology and enhance the performance and life-
time of the system. Electrochemical capacitors can be used to
provide instantaneous peak power, while electrochemical batteries
can handle moderate power and energy requirements. Fuel cells
and nuclear batteries may be utilized to supply high energy densi-
ties at low average power. Wireless power transmission and energy
harvesting can be deployed to replenish an otherwise exhaustible
reservoir of energy and extend the lifetime of the device.
Five-year view
The progress toward unobtrusive energy sources for medical appli-
cations is focused mainly on miniaturization and enhancement
of electrochemical batteries and fuel cells, as wells as the develop-
ment of new technologies for harvesting energy from the ambient
environment. Nanostructured materials are expected to play a key
role in improving the energy storage capability of electrochemical
batteries and capacitors. Thin-film batteries are envisaged to be
applied widely in implantable medical devices in the near future.
They provide the opportunity for development of microscale medi-
cal devices with integrated energy storages or hybrid energy supplies
with the capability of being replenished. Micro fuel cells may soon
enter the market of portable and wearable medical devices, and
replace batteries in some applications. Implantable fuel cells, case-
less batteries and energy harvesters, although proven feasible, need
to be further investigated before application in practical systems.
Financial & competing interests disclosure
This study was funded by Singapore’s Agency for Science, Technology and
Research (A*STAR) under grant number 082-140-0036 (M47050060).
The authors have no other relevant affiliations or financial involvement with
any organization or entity with a financial interest in or financial conflict
with the subject matter or materials discussed in the manuscript apart from
those disclosed.
No writing assistance was utilized in the production of this manuscript.

Key issues
• An unobtrusive energy source that enables desired portability and energy autonomy is crucial for medical applications.
• The energy source of a medical device must have several major specifications, most importantly safety, reliability, predictability of
operation and high energy-density.
• Limited energy capacity of electrochemical batteries restricts the operational lifetime of medical devices. This is particularly undesirable
for implanted medical devices where replacement or recharging of batteries demands expensive and inconvenient surgical procedures.
• Energy harvesting is an emerging technology that has the potential to overcome the limited energy capacity of batteries and provide
the device with an extended lifetime.
• The high energy-density of micro fuel cells makes them a promising alternative for external medical devices. Fuel cells replace the
recharging requirement of batteries with a less-frequent and faster refueling process.
• Implantable fuel cells have the potential to extend the lifetime of implantable medical devices by utilizing endogenous substrates and
oxygen from the body for generation of energy.
• Inductive coupling can be used to power implanted devices continuously, intermittently or on demand.
• Hybrid energy supplies have the potential to overcome the limitations of each of the available technologies and to enhance the
performance and lifetime of medical devices.

706 Expert Rev. Med. Devices 7(5), (2010)

 Energy sources & their development for application in medical devices
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