In-ear EEG wearables for brain activity assessment and cognitive rehabilitation: the emerging role of multimodal...

This literature review critically examines the design, validation, and application of non-invasive in-ear electroencephalography (ear-EEG) systems as emerging wearable platforms for long-term neurophysiological monitoring and intervention. Following PRISMA guidelines, studies published between 2010 and 2025 were systematically selected from four major databases and organized into four thematic domains: in-ear wearable system design and validation, multimodal sensing and stimulation, embedded intelligence, and brain-state monitoring and rehabilitation. The review focuses exclusively on wearable, ear-centered EEG technologies, explicitly excluding cochlear implants and other invasive or behind-the-ear systems. We analyze key engineering challenges unique to ear-EEG, including electrode placement constraints, mechanical-electrical coupling, motion robustness, power efficiency, and long-term wearability. The review highlights a growing transition toward compact, wireless ear-EEG systems with on-device signal processing and embedded machine learning, enabling real-time brain-state estimation under ambulatory conditions. Multimodal integration, combining ear-EEG with complementary sensors such as EOG, inertial units, and cardiovascular signals is shown to improve artifact awareness, contextual interpretation, and closed-loop capability. Beyond summarizing existing technologies, this review identifies critical gaps limiting clinical translation, including the lack of standardized validation protocols, limited embedded autonomy, and underexplored closed-loop neurofeedback and neuromodulation architectures. By synthesizing advances across hardware design, signal processing, and intelligent system integration, this work provides a systems-level roadmap for the future development of wearable, intelligent, and clinically robust ear-EEG platforms for mental health, neurorehabilitation, and continuous brain monitoring.