REVIEW

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Emerging Additive Manufacturing Methods for Wearable

Sensors: Opportunities to Expand Access to Personalized
Health Monitoring
Ziyu Yin, Kaylee M. Clark, and Tyler R. Ray*

medical professional authority, health-

Persistent disparities exist in access to state-of-the-art healthcare care providers can make better-informed
disproportionately affecting underserved and vulnerable populations. decisions, achieve more accurate diag-
Advances in wearable sensors enabled by additive manufacturing (AM) offer noses, and adopt more effective treat-
new opportunities to address such disparities and enhance equitable access ment strategies, which ultimately culmi-
nates in enhanced patient care.[5–10] How-
advanced diagnostic technologies. Additive manufacturing provides a ever, even with the undeniable progress
pathway to rapidly prototype bespoke, multifunctional wearable sensors in improving healthcare quality, persis-
thereby circumventing existing barriers to innovation for resource-limited tent disparities in access to care under-
settings imposed by the need for specialized facilities, technical expertise, and score the necessity for continued efforts
capital-intensive processes. This review examines recent progress in the toward equitable healthcare distribution
and universal access to state-of-the-art
additive manufacture of wearable platforms for physiological health
medical interventions across diverse pop-
monitoring. Supported by an initial overview of relevant techniques, ulations and settings.
representative examples of 3D printed wearable sensors highlight the Healthcare inequity manifests in a
potential for measuring clinically-relevant biophysical and biochemical signals multifaceted manner, encompassing ar-
of interest. The review concludes with a discussion of the promise and utility eas such as advanced technology, vital
of additive manufacturing for wearable sensors, emphasizing opportunities health information, and medical exper-
tise. While progress in healthcare pol-
for expanding access to vital healthcare technology and addressing critical icy and expanding insurance access have
health disparities. improved overall access to care, such
measures are insufficient to bridge the
gap between urban centers and remote
1. Introduction or rural locations, especially for underserved and vulnerable pop-
ulations, such as those based on race/ethnicity, gender and sex-
The continuing evolution of clinical medicine, marked by a shift ual orientation, and individuals with disabilities. The ongoing
from an eminence-based to an evidence-based approach, has COVID-19 pandemic serves as a poignant reminder that the qual-
proven pivotal in enhancing patient health outcomes.[1–4] By plac- ity of available medical interventions is intrinsically linked to
ing rigorously evaluated empirical evidence above reliance upon health outcomes, and the lack of access to best-in-class medi-
cal technology profoundly affects the well-being of vulnerable
Z. Yin, K. M. Clark, T. R. Ray communities.[11]
Department of Mechanical Engineering The recent emergence of a novel class of wearable sensors sig-
University of Hawaiʻi at Mānoa nifies a paradigm shift in physiological monitoring, presenting
Honolulu, HI 96822, USA a powerful opportunity to address some of the prevailing chal-
E-mail: [email protected]
lenges in access to healthcare.[12–14] Leveraging recent advance-
T. R. Ray
ments in material science, chemistry, engineering, and soft, flex-
Department of Cell and Molecular Biology
John. A. Burns School of Medicine ible form factors, these wearable sensing platforms intimately in-
University of Hawaiʻi at Mānoa terface with the curved surfaces of the body to record biophysi-
Honolulu, HI 96813, USA cal and biochemical signals relevant to assessing physiological
health status.[15–19] Conventional clinical approaches to health-
The ORCID identification number(s) for the author(s) of this article
can be found under https://doi.org/10.1002/adsr.202300137
care monitoring predominantly rely upon episodic data collec-
tion in controlled environments using cumbersome, high-cost
© 2023 The Authors. Advanced Sensor Research published by
Wiley-VCH GmbH. This is an open access article under the terms of the monitoring devices.[20] Such methods inherently exhibit limita-
Creative Commons Attribution License, which permits use, distribution tions in capturing a continuous and comprehensive portrait of
and reproduction in any medium, provided the original work is properly the health status of an individual. In contrast, the combination of
cited. multiparameter measurement capabilities, smartphone utiliza-
DOI: 10.1002/adsr.202300137 tion, and low-power wireless communication systems enables

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wearable systems to extend clinical-grade health monitoring be- while others center on additive manufacturing in the con-
yond the confines of traditional clinical settings.[21–23] text of methods,[38] materials,[32] general applications,[35,36,54,55]
The widespread adoption of wearable sensors with clinical- and challenges.[56,57] By comparison, this review examines the
grade monitoring capabilities would have profound impact for relatively uncharted intersection of wearable sensors and 3D
transcending geographic, economic, and resource constraints, al- printing techniques, emphasizing sensors and devices primar-
leviating disparities in access to cutting-edge healthcare, and uti- ily fabricated through additive manufacturing. Specifically, this
lizing real-time health insights to enable proactive interventions manuscript contextualizes the current state, benefits, challenges,
during periods of healthy living and early onset of disease.[24–27] and opportunities within the field of additive manufacturing for
However, access to these devices remains a considerable barrier enhancing access to diagnostic technologies through the fabri-
for low-resource settings, such as remote and rural locations, due cation of wearable sensing platforms. The introductory section
to capital-intensive fabrication methods and the need for exten- highlights additive manufacturing processes relevant to wearable
sive training for personnel. The necessity for specialized tools to sensing platforms and the considerations for successfully apply-
fabricate new sensing materials, device form factors, and gen- ing each fabrication method. The sections that follow highlight
eral sensing platforms constrains place-specific innovation.[28,29] representative examples of wearable sensing platforms fabricated
Prototyping these platforms requires complex, time-consuming, via additive manufacturing categorized by the primary biophys-
and expensive fabrication methods, specialized facilities (e.g., ical and biochemical signals of interest. The review concludes
cleanroom), and highly-skilled technicians.[30] Low-cost fabrica- with a discussion of the overall promise and utility of AM for
tion methods (e.g., screen printing) for flexible electronics of- wearable sensor fabrication with a particular emphasis on the op-
fer strategies to reduce costs but present additional challenges portunities for expanding access to vital cutting-edge healthcare
on account of resolution, materials libraries, and often inferior technology.
performance in comparison to established electronic fabrication
methods.[31] Broadening equitable access to both best-in-class 2. Overview of Additive Manufacturing Methods
medical care and the tools for innovation requires the advent of
advanced manufacturing techniques amenable to smaller proto- Additive manufacturing broadly encompasses seven distinct
typing methods. printing methodologies: material extrusion, vat photopolymer-
Additive manufacturing (AM), commonly referred to as 3D ization, material jetting, binder jetting, powder bed fusion, sheet
printing, represents a groundbreaking manufacturing approach lamination, and directed energy deposition.[55,58] Each of these
that provides unparalleled opportunities for generating be- processes occupies a specialized niche for specific applications,
spoke physical objects characterized by precisely tailored geome- with material extrusion and vat photopolymerization favored for
tries, properties, and functionalities uniquely suited to a given consumer-based rapid prototyping (e.g., consumer 3D printers).
application.[32,33] AM describes a process by which digital models Binder jetting, powder bed fusion, and directed energy depo-
created using computer-aided design (CAD) software are trans- sition are commonly employed in aerospace, medical, and de-
formed into physical objects by a 3D printer that constructs a se- fense sectors for fabricating intricate metal components.[32,59–61]
ries of 2D cross-sections in a layer-by-layer manner.[34] AM has Although AM holds transformative potential for the creation of
emerged as a particularly promising solution to address existing wearable devices with unprecedented levels of design freedom
barriers to prototyping wearable platforms and democratize ac- and customization capabilities, at present only a select subset
cess to state-of-the-art healthcare technology.[35,36] The potential of these printing methods is compatible with the processing re-
of AM technology lies in the capacity for rapidly producing in- quirements of wearable sensors.
tricate, customizable structures from an expansive library of ma- Wearable platforms deploy a diverse array of sensing
terials, thereby streamlining the prototyping process to expedite technologies to measure the wide spectrum of biophysical
the development of application-specific wearable sensors.[37] AM and biochemical signals critical for monitoring the health
also reduces the reliance on specialized facilities and skilled tech- of an individual.[62–77] The performance of a given wear-
nicians thereby lowering the barriers of entry for developing and able device depends upon numerous parameters interwoven
producing wearable platforms.[38] Democratizing wearable sen- within the mechanical, electrical, and functional properties of
sor prototyping and manufacturing processes through AM not the sensor. Designing a high-performance wearable sensor—
only fosters innovation by enabling the creation of platforms to characterized by high sensitivity, selectivity, and stability—
address location-specific needs but also offers a pathway toward necessitates careful optimization of the means of biorecognition
broader access to advanced healthcare technology.[39] (e.g., enzyme/substrate,[78–80] antibody/antigen,[81,82] functional
This review explores the latest advancements in the additive materials/biomarkers[83,84] ), method of signal transduction (e.g.,
manufacture of wearable sensing platforms, an emerging appli- optical,[85] electrochemical[86,87] ), and approach for transmitting
cation area undergoing rapid, continuous technological progres- the signal to the user. The device form factor (e.g., thickness, cur-
sion across printing methods, materials chemistry, and poten- vature, geometry) is equally critical as it governs the degree of
tial applications. Drawing parallels with the transformational im- conformity with the human body.[88] Traditional approaches for
pact of 3D printing on lab-on-chip diagnostics, which revolution- device prototyping introduce additional design considerations.
ized the field through low-cost prototyping and widespread in- When compounded with the requisite material and operational
novation, we envision similar potential for wearable sensors. A requirements for ensuring unobtrusive wear, the result is often a
wide range of recent reviews survey wearable sensor progress in constrictive design space.
terms of form factors,[40–42] sensing approaches,[43–45] fabrication Selecting an appropriate additive manufacturing method ne-
methods,[46–48] material systems,[49–51] and applications,[4,52,53] cessitates a comprehensive evaluation of these factors to ensure

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process compatibility and performance optimization, given the

inherent limitations in printable materials, printer resolution,
and process parameters. Material advances address some of these
challenges via the expanding library of printable materials suit-
able for constructing device components[89–94] (e.g., circuit traces,
physical structure), such as the development of printable stretch-
able conductive inks[95] and biocompatible hydrogels.[96,97] Con-
current innovations in printer hardware and printing techniques,
such as multi-material printing and high-resolution stereolithog-
raphy, provide strategies for overcoming process limitations en-
abling feature resolutions of printed components to rival those
fabricated via traditional manufacturing methods.[3,55,98–100] Ma-
terial extrusion, material jetting, and vat photopolymerization
represent the predominant additive manufacturing technolo-
gies of interest for wearable platforms and support novel de-
vice architectures unattainable through conventional manufac-
turing. Moreover, these printing approaches offer distinct ad-
vantages and opportunities for prototyping advanced wearable
devices in resource-constrained environments, which is critical
for addressing fundamental challenges inherent in lab-at-home
applications.[32,38]
Material extrusion is a versatile additive manufacturing tech-
nique deployed widely in most consumer-grade 3D printers.
Here, material extruded through a nozzle in a layer-by-layer man-
ner forms complex 3D architectures.[101] Within this category are
two sub-classifications: fused deposition modeling (FDM) and di-
rect ink writing (DIW). FDM employs heated thermoplastic fila-
ments (primarily polylactic acid (PLA), polyethylene terephtha-
late (PET), and acrylonitrile butadiene styrene (ABS)), which so-
lidify by cooling after deposition to form the desired net structure
(Figure 1A).[39,102] Strengths of FDM printing include compat-
ibility with various thermoplastics, cost-effectiveness, and ease
of use; however, limitations arise from low print resolution and
anisotropic mechanical properties.[59] Conversely, DIW leverages
viscoelastic inks that solidify through mechanisms such as sol-
vent evaporation or chemical cross-linking, which in turn enables
finer printed resolutions, expanded material versatility, and the
capacity for embedding functional materials. The primary appeal
of utilizing DIW for wearable sensors resides in its capacity to
print a diverse array of materials, provided they can form self-
supporting extruded layers that maintain shape fidelity. The ca-
pability spans polymers, conductive carbon, metals, biomateri-
als, and other custom inks.[103] However, challenges in the DIW
printing processes include specialized ink requirements, process
drift during extended printing durations, and maintaining struc-
tural integrity of the part during printing.[103–105] Both FDM and
DIW techniques have garnered substantial attention in wearable Figure 1. Schematic illustrations of the primary additive manufacturing
sensor development with recent reports demonstrating creation techniques utilized for fabricating wearable devices: A) fused deposition
of customizable device architectures with integrated functional modeling (FDM) printer, B) material jetting, C) aerosol jet printing (AJP),
materials using minimal hardware requirements.[33,55,57,106] and D) vat photopolymerization.
Material jetting is a similarly attractive AM method for fab-
ricating wearable sensors owing to the capability to simultane-
ously incorporate multiple materials during printing.[107] Here, printhead and are subsequently cured in a layer-by-layer man-
it is crucial to distinguish material jetting from inkjet printing. ner, resulting in a solid 3D object (Figure 1B).[108] This technique
Inkjet printing, while employing a similar jetting mechanism, offers exceptional printed resolution, rapid printing times, and
does not constitute a 3D printing process. Rather the inkjet print- multi-material capabilities, rendering it well suited for complex
ing process typically coats a 2D planar substrate with a single structures.[109] However, material jetting is constrained by ma-
layer of ink.[34] In contrast, material jetting (i.e., polyjet) describes terial property requirements to support deposition and requires
a process by which droplets of photopolymer resin jet from a extensive post-processing steps to yield a final product.

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Aerosol jet printing (AJP) represents an emerging additive portunities afforded by the rapid, on-demand, facile manufacture
manufacturing technique akin to traditional material jetting yet of intricate, sophisticated, and highly customized sensors elim-
with unique operating principles that are particularly attractive inates traditional cost barriers to device innovation.[32,33,58,59] In
for wearable sensor fabrication.[110,111] Central to the AJP process the sections that follow, we highlight recent progress in deploy-
is the transformation of liquid ink into aerosol droplets, which ing AM to fabricate wearable sensing platforms. We restrict the
are then focused and deposited onto a substrate via a gas-assisted scope of our focus to exemplars that utilize AM techniques pro-
stream (Figure 1C).[112] This technique exhibits broad compatibil- duce a finished, working component, such as a functional sens-
ity with a diverse array of inks, including nanoparticle-based and ing module[73,74,76,86,96,120] or the structural/defining elements of
conductive formulations, enabling the creation of intricate pat- a wearable platform[30,72,75] (e.g., microfluidic channels), in con-
terns and fine features suitable for high-quality electronics.[113] trast to supporting (i.e., soft lithographic molds) or cosmetic
AJP is broadly deployed in the manufacture of printed hybrid elements[77,87] (e.g., nonactive wristbands/straps).
electronics owing to low-temperature processing requirements
and broad adaptability to various substrates.[114] However, AJP 3. Additive Manufacture of Wearable Platforms for
is constrained by extended printing times and complex hard- Biophysical Monitoring
ware requirements, which hinder efficacy in specific manufac-
turing contexts. Nevertheless, AJP holds immense, albeit under- Monitoring biophysical signals arising from the natural physio-
explored, potential for fabricating novel device architectures and logical processes of the body is a fundamental component of as-
enhancing the functionality of wearable platforms beyond tradi- sessing the health and wellness status of an individual.[12,21,25,40,69]
tional manufacturing approaches. Parameters such as heart rate and core body temperature serve
Vat photopolymerization describes a process by which con- as quantitative indices reflective of cardiac, neurological, and
trolled light exposure—predominantly within the ultraviolet respiratory health to enable clinicians to evaluate the physio-
spectrum—selectively cures photosensitive resins in a layer- logical condition of a patient and develop suitable therapeutic
by-layer manner to form intricate structures characterized by strategies.[78,106,121–125] However, current methodologies require
high resolution and exceptional surface finish.[34] This AM pro- trained personnel to use expensive, cumbersome equipment via
cess enables the creation of components with elaborate, de- wired interfaces that restrict patient movement to record these
tailed geometries that cannot be fabricated via alternative AM physiological signals.
methodologies.[115] Vat polymerization resins employ a range A paradigm shift catalyzed by the advent of a consumer-
of photosensitive polymers, including numerous biocompati- centered wellness culture has created a rich ecosystem of
ble materials (e.g., N,N-dimethylaminobenzoic acid ethyl ester, wearable technologies for biophysical data capture.[70,92,126–128]
poly(𝜖-caprolactone), poly(ethylene glycol)) that are aptly suited These platforms—spanning numerous form factors (e.g.,
for wearable sensors.[34,116] The primary subcategories of vat pho- smartwatches,[129] rings,[130] patches,[131] and bands/straps[132] )—
topolymerization include stereolithography (SLA), digital light support a comfortable, user-friendly mode of data collection.
processing (DLP), and continuous liquid interface production Yet the applicability of these existing wearable technologies in a
(CLIP).[117] Whereas SLA, the most established and perhaps the clinical setting remains restricted due to inherent limitations in
most well-known, utilizes laser illumination for selective resin measurement capabilities, accuracy, and reliability. Addressing
curing through tracing,[115] DLP uses a digital projector to simul- the inherent measurement challenges of collecting the full
taneously expose an entire resin layer in (Figure 1D), thereby spectrum of biophysical signals fundamental to critical care
accelerating the printing process.[32] CLIP is a relatively recent from a wearable platform requires the development of novel
entrant whereby an oxygen-permeable window facilitates a con- device architectures and form factors. Moreover, such efforts
tinuous printing process that accelerates printing speed while demand additional innovations in fabrication methods to sup-
preserving resolution and optimal surface finish.[118] Vat pho- port sustainability across the device lifecycle and facilitate the
topolymerization processes present certain drawbacks that re- creation of bespoke, patient-specific device form factors required
strict broad adoption (as compared to FDM-based printers), par- for personalized medical care. Recent efforts[32,64] to leverage
ticularly in relation to wearable devices. While the assortment advances in additive manufacturing to support sophisticated
of biocompatible resins has expanded, the availability of flexible biophysical measurement capabilities in platforms relevant for
resins appropriate for skin-interfaced wearable devices remains clinical applications underscore the vast potential for innovation
comparatively limited. Moreover, the mechanical attributes of in addressing these critical areas.
cured photopolymer resins may not entirely fulfill the exigencies Most instances of additively manufactured wearable sensors
of wearable devices, and post-processing requirements can prove for biophysical monitoring utilize material extrusion-based print-
labor-intensive. However, vat photopolymerization offers com- ers, a selection largely driven by the technological maturity, broad
pelling capabilities for fabricating the advanced, high-resolution library of printable materials, the relatively minimal hardware
structures required for many wearable sensing applications; par- requirements of this class of AM processes. In simplest form,
ticularly with regards to fluid-based systems (i.e., epidermal FDM printers can reduce the complexity of a sensor manufac-
microfluidics[119] ). turing process by enabling fabrication of a relatively simple yet
The emergence and rapid maturation of these AM processes architecturally intricate component of a device. For example, one
for producing hybrid/flexible electronic systems and objects with demonstration (Figure 2A) utilizes the FDM printing process to
high-resolution, multiscale features (micro-to-macroscale) has fabricate an wearable ear sensor for the non-invasive measure-
sparked the beginnings of a paradigm shift in our conception ment of core body temperature,[133] a key vital sign for assess-
of the limits of what is possible for wearable platforms. The op- ing health state.[134–136] The use of a stretchable polyurethane

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Figure 2. A) 3D printed “earable” core body temperature device. Adapted with permission.[133] Copyright 2017, American Chemical Society. B) 3D printed
wearable pressure sensor. Adapted with permission.[137] Copyright 2019, Wiley-VCH. C) 3D printed wearable tactile sensor. Adapted with permission.[106]
Copyright 2021, Wiley-VCH. D) Representative image of a patient specific 3D printed wearable pulse oximeter. Adapted with permission.[151] Copyright
2020, Wiley-VCH. E) 3D printed self-powered pressure sensor. Adapted with permission.[154] Copyright 2023, Elsevier B.V. F) 3D printed wearable strain
sensor for human/machine interfacing. Adapted with permission.[162] Copyright 2023, Springer Nature.

filament to form the structural components of the device facil- tilayer pressure sensor.[139] Here, PVA serves as a sacrificial scaf-
itates a comfortable and seamless fit within the ear canal, per- fold for printed layers of a carbon black-infiltrated TPU filament
sonalized to accommodate size and shape variations among pa- that, when dissolved, enables the compression of the printed con-
tients. Additionally, liquid metal (Galinstan) microchannels were ductive layers.
embedded in the device, rather than less compatible traditional Rapid innovation within the FDM printing ecosystem has
metal wiring, to provide circuit functionality for a wireless modu- broadened the portfolio of printable materials well beyond the
lar communication system. In another example (Figure 2B),[137] a common thermoplastics used in most applications. Recent ef-
dual-nozzle FDM printing process enables fabrication of a wear- forts seek to enable printing soft, lightweight materials that are
able sensor for recording heel pressure. Here, a multi-nozzle con- both non-toxic and biocompatible, which would further expand
figuration expands the capabilities of FDM printers to print in- the opportunities of using FDM-based printing processes for fab-
tricate objects with high fidelity (via removable support materi- ricating wearable platforms. However, the growing ubiquity of
als) or cosmetic features (i.e., multiple colors). In this demon- FDM printing comes with an unfortunate corollary—a sharp in-
stration a water-soluble support material (PVA) serves as a sac- crease in plastic waste. This issue can be viewed as a microcosm
rificial layer to facilitate creation of a microbump array (PLA) of a more expansive challenge within the wearable domain as
with integrated microchannels. Encapsulation of the printed de- many embodiments are single use. As a consequence, it is crit-
vice within a stretchable elastomer (Dragon Skin 10) prior to re- ical to evaluate the environmental footprint of a wearable plat-
moval of the PVA by water infiltration forms sealed channels form throughout the device lifecycle to mitigate any potential eco-
designed to contain a conductive liquid metal (Galinstan). The logical impact. In this context, it is of particular interest to uti-
integration of the 3D printed microbump array enhances the lize materials that are not just recyclable but also biodegradable
performance of the pressure sensor in a manner comparable within a reasonable timeframe and with negligible processing
to other microbump arrays fabricated using more conventional requirements. For example, a recent report[140] details a new dy-
cleanroom-based approaches.[138] Other reports detail the similar namically covalent cross-linked thermoset elastomer for use with
use of a dual nozzle printer to create a soft, compressible, mul- FDM printers. Demonstrations of using this material to fabricate

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wearable capacitive pressure sensors and other electronics under- Although material extrusion-based printing is inherently lim-
scores the potential such materials hold in this capacity. ited in resolution, vat photopolymerization methods excel in
These considerations—encompassing the necessity for non- fabricating highly complex, high-resolution architectures ideal
toxic, biocompatible materials and solutions to mitigate envi- for on-body sensing.[156,157] Yet, the comparatively high modulus
ronmental impact—highlight the continual need for material of resin-based objects has historically restricted conformal skin
innovation. However, emerging materials often lack compati- interfacing. Recent innovations in both materials and printing
bility with a given printing technology. For example, gel-type processes[158] offer strategies for addressing this inherent stiff-
biopolymers[141] such as hydrogels exhibit properties highly rel- ness mismatch. For example, one recent work[159] demonstrates
evant for wearable platforms including a low Young’s modu- the rapid fabrication (<30 s) of a multifunctional movement sen-
lus, biocompatibility, and straightforward pathway for the in- sor comprised of a 3D printed solid-state low-modulus conduc-
tegration of functional particles. As hydrogels lack compati- tive ionogel by a DLP-based process. In a similar manner,[160] op-
bility with FDM printers research efforts must leverage DIW timization of a photocurable ionic liquid/acrylate resin formula-
systems designed for viscous inks and external solidification. tion enables fabrication of a porous, flexible ionogel sensor tai-
Recent work shows the use of a thermo-reversible material, lored for human motion monitoring. Tuning the resin material
termed eutectogel, that exhibits ionic-electronic conduction en- properties and sensor geometry (i.e., lattice structure) increases
ables printing stretchable conformal electrodes for electrophys- sensor sensitivity while reducing hysteresis, allowing long-term
ical signal monitoring.[142] Another report[143] details a con- acquisition of high-fidelity signals. The addition of functional
ductive, self-healing hydrogel facilitates printing a self-adhesive materials to a resin (e.g., graphene) can impart new proper-
wearable strain sensor for activity monitoring. The wide vis- ties (i.e., conductivity); however, uniform dispersion is critical.
cosity range accessible by DIW allows incorporating functional Other work[161] fabricated electrophysiological sensors by lever-
additives, such as nanomaterials, into inks to modify sen- aging DLP printing and a customized graphene-based resin that
sor performance.[144] In one demonstration,[145] DIW printing incorporated an amphiphilic dispersant reduce particle aggrega-
with a graphene nanoplatelet/PDMS ink enables fabrication tion resulting in a material with enhanced conductivity and flexi-
of a skin-mounted resistive temperature sensor with a honey- bility. Additional innovative approaches lie in the advancement of
comb structure that strain-isolates the active sensing element printing techniques themselves, as with the recently reported[162]
to reduce motion-induced noise artifacts. Additional sensor so- single-vat single-cure grayscale DLP method that leverages mod-
phistication is possible through a multimaterial DIW process ulated light intensity to dictate local transitions from soft, stretch-
whereby layers of distinct materials are printed sequentially. One able organogels to rigid thermosets within a single printed layer
demonstration[106] (Figure 2C) leverages a layer stack compris- (Figure 2F).
ing thin conductive layers and microstructured dielectric layers While such advances in resin formulations, functional com-
to enhance sensing performance of an all-printed tactile pres- posites, and printing techniques expand the opportunities for
sure sensor. Structured air voids introduced by printing the di- using vat photopolymerization to fabricate wearable sensors, ad-
electric layers in a woodpile structure (via a rectilinear infill ditional innovations in multimaterial printing and performance
pattern) increase sensor compressibility and thus overall sensi- optimization are critical to fully realize the promise of this man-
tivity. Resolution limitations remain a key challenge for DIW- ufacturing approach.
based printers arising from materials deposition and form hold- Other additive manufacturing approaches demonstrate
ing constraints.[146,147] Recent examples demonstrate the use of emerging potential for wearable physiological sensors. For ex-
optimized ink formulations to obtain printed soft electrodes[148] ample, powder bed 3D printing enables fabrication of scaffolds
and piezoresistive sensors[128] with feature sizes on the order of that can be injected with functional materials, such as SWCNT-
50 𝜇m. Emerging DIW techniques, such as freeform reversible coated elastomers, to produce inexpensive electrophysiological
embedding of suspended hydrogels (FRESH),[149,150] can fur- sensors.[125] This approach, in combination with high-resolution
ther enhance printer resolution or expand material compatibility. 3D body scans, enables a workflow to produce personalized,
For example, one recent demonstration[151] (Figure 2D) utilizes highly conformal sensors on demand. Material jetting is another
FRESH-based printing to fabricate pulse oximeter cuffs from emerging alternative technique that offers superior fabrication
PDMS with 50 𝜇m feature resolution. speed but deployment has been hindered by a limited library
Alternatively, DIW has been employed for other compo- of printable materials suitable for wearable sensors. Recent
nents necessary to embody a fully integrated wearable system. work[163] highlights efforts to address these challenges demon-
For example, the creation of wearable piezoelectric[152,153] and strating the fabrication of flexible piezoresistive sensors at 5x the
triboelectric[154,155] nanogenerators (PENG and TENG) enables speed of a similar extrusion-based process. Similarly, crosstalk
fabrication of self-powered wearable platforms to eliminate the between sensing nodes was eliminated in a wearable fingertip
requirement of a battery. A recent report details a power-efficient pressure sensors by leveraging the precise control and resolution
TENG that combines 3D printed MXene ink with DIW technol- of aerosol jet printing to improve spatial distribution.[164] While
ogy to produce a self-powered, battery-free, and wireless system extrusion and vat-photopolymerization-based printing meth-
that facilitates the direct transmission of pressure sensor data to ods currently dominate the field, the rapid pace of innovation
a smartphone (Figure 2E).[154] Ongoing advances in printer capa- continues to expand the suite of available fabrication methods
bilities via such techniques will continue expanding material ex- for producing wearable biophysical sensors with each offering
trusion methods for sensors and devices with personalized form distinct advantages in terms of resolution, customization, and
factors. material versatility.

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4. Additive Manufacture of Wearable Platforms for

Biochemical Monitoring
A comprehensive assessment of physiological health status
requires measurement of a broad spectrum of biochemical
analytes. These targets include nutrients and metabolites—
encompassing vitamins, minerals, amino acids, glucose, and
lactate—alongside pH, various electrolyte ions (specifically,
sodium, potassium, calcium, and chloride ions), and disease-
associated biomarkers (e.g., cytokines).[6,16,23,67,122,165] Blood-
based analysis represents the traditional pathway such biochem-
ical monitoring; however, invasive sampling procedures, associ-
ated discomfort for the patient, and a requirement for sophisti-
cated, high-cost equipment for analysis present considerable lim-
itations for continuous health monitoring beyond specific, well-
established use cases (e.g., diabetes).
Wearable sensing platforms offer significant promise for
mitigating such challenges by utilizing a wide range of
non-invasively sampled biofluids—including sweat,[12,26,30,166–168]
saliva,[169] tear,[170] and interstitial fluids[171] —to monitor bio-
chemical markers indicative of health status. By potentially re-
solving the discomfort and inconvenience of traditional blood-
based analysis, these platforms offer a pathway for real-time,
continuous, long-term biochemical health monitoring. As with
biophysical sensors, advanced manufacturing techniques en-
abling rapid fabrication of customized, patient-specific devices
would enable new opportunities within the context of developing
personalized therapeutic interventions for an individual. When
considering technologies within this context, additive manufac-
turing emerges as a powerful approach. Examples of fully 3D
printed wearable devices incorporating all essential components
of wearable chemical sensors remain rare, which is largely at-
tributed to the complex nature of such devices. Successful ef-
forts must leverage the unique strengths of various 3D print-
ing techniques for fabricating individual components (e.g., mi-
crofluidic networks,[172–174] electrical circuits,[140,175,176] sensing
modules[79,177–180] ) and subsequently integrating these disparate
elements into a single, unified platform. In the following discus-
sion, we focus on exemplars of 3D printed wearable biochemical
sensors with demonstrated on-body measurement capabilities to
emphasize the rapidly increasing sophistication of such sensing
platforms.
As with biophysical sensing platforms, material extrusion-
based 3D printing offers a broadly accessible pathway for fab-
ricating wearable biochemical sensors via additive manufactur-
ing. Realizing such sensing platforms requires printing key func-
tional components including substrates, electrodes, sensors, and
fluid routing elements as an integrated system. For example,
one recent report[130] (Figure 3A) details using a dual extrusion
FDM printer to fabricate an electrochemical ring for noninvasive
monitoring of sweat glucose concentration. Dual extrusion en-
ables layer-by-layer printing of the flexible, nonconductive ring
structure and carbon composite electrodes as a single mono- Figure 3. A) 3D printed electrochemical ring (e-ring). Adapted with
lithic unit. Other demonstrations include fabricating epidermal permission.[130] Copyright 2021, American Chemical Society. B) 3D
sweat platforms with integrated sensors[30,181] and finger-based printed wearable, multifunctional wound dressing. Adapted with
electrochemical sensors for detecting sedation drugs in alcoholic permission.[183] Copyright 2017, Wiley-VCH. C) 3D printed wearable
beverages.[175] Leveraging emerging extrusion techniques (e.g., sweat lactate sensors. Adapted with permission.[166] Copyright 2022, El-
FRESH) offers additional design capabilities as demonstrated sevier B.V. D) 3D printed epidermal microfluidic device for sweat analysis.
Adapted with permission.[119] Copyright 2023, American Association for
by the fabrication of a silk-based wearable sensing platform[182] the Advancement of Science.

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with an integrated microfluidic network via use of a sacrifi- miniaturized sensor systems in a manner similar to material ex-
cial support structure. Another study utilized high-throughput trusion or vat photopolymerization methods.
DIW-based 3D printing technology to fabricate a multifunc-
tional dressing that detects bacterial infection through printed 5. Pathway toward Fully 3D Printed Multimodal
colorimetric pH sensing fibers and releases antibiotic agents at Wearable Platforms
wound sites to manage chronic and acute injuries caused by
trauma, surgery, or diabetes (Figure 3B).[183] In aggregate, these Although a rapidly evolving field, there exist relatively few exam-
demonstrations exemplify the potential for fabricating person- ples of additively manufactured integrated systems that support
alized, scalable biochemical sensing platforms in a straightfor- multimodal collection of biophysical and biochemical signals.
ward, user-customizable manner via additive manufacturing. Material extrusion techniques (e.g., FDM, DIW) appear most
While extrusion-based techniques offer readily accessible path- promising and prevalent among the few published examples.
ways to fabricate wearable biochemical sensors, vat photopoly- For example, one recent work[123] utilized FDM to 3D print elec-
merization methods (e.g., SLA, DLP) provide additional ad- tronic eyeglasses capable of continuous physiological monitoring
vantages in terms of resolution, feature size, and device so- including electrophysiological signals, ultraviolet light detection,
phistication. Most demonstrations utilize vat photopolymeriza- and motion tracking with wireless data transmission (Figure 5A).
tion techniques to fabricate structural housings for sensing Another recent work[190] utilized FDM-based 3D printing to cre-
components.[184] One example[166] (Figure 3C) utilizes a high- ate a conformal, adhesive-free mesh platform capable of contin-
resolution SLA printing process to fabricate a case with inte- uous, wireless, and battery-free multimodal sensing (Figure 5B).
grated fluidic network to route sweat from the epidermis to Such systems highlight the tremendous potential for fabricat-
sensing zones for the simultaneous monitoring of sweat rate ing fully integrated wearable systems via additive manufacturing;
and lactate concentration. By comparison, one recent work[119] however, significant challenges restrict continued progress.
(Figure 3D) highlights the potential for vat photopolymerization Material availability represents a fundamental challenge as
to create functional epidermal microfluidic platforms for sweat sensor functionality depends intrinsically on the library of print-
analysis. Here, high-resolution DLP printing enables fabrication able materials. AM process-specific requirements, such as the
of epifluidic devices with complex, 3D microfluidic network ge- glass transition temperature for FDM printable materials or
ometries and integrated colorimetric sensors. the viscosity of ink for AJP, can be incompatible with fabrica-
Although these demonstrations highlight the limited number tion of a particular sensor type. For instance, biological materi-
of examples of resin-printed noninvasive sensing platforms, als frequently act as biorecognition components (e.g., antibod-
there exists a substantial body of work[48,185,186] highlighting ies, enzymes) and may impose additional printing considera-
the utility of vat photopolymerization for fabricating minimally tions (e.g., temperature, shear rate) to avoid degrading functional
invasive microneedle-based sensing platforms. While a broader performance.[195] Other difficulties center on manufacturing fac-
discussion of such minimally invasive sensors is beyond the tors including part production throughput or unit expense. Com-
scope of this work, microneedles require small, sharp geome- pared to conventional high-volume fabrication methods such as
tries that are challenging to fabricate without a reliance upon roll-to-roll processing and injection molding, additive manufac-
cleanroom-based processes.[171] The use of high-resolution SLA turing is inherently a batch technique with objects generated ei-
printing enables fabrication of hollow microneedle arrays[187] ther individually or in small batches. While objects made through
that support collection and analysis of glucose and lactate in conventional pathways exhibit limited variation between parts
interstitial fluid (Figure 4A) or microneedle patches[186] that (functionally indistinguishable), additive manufacturing process
integrate with electrochemical sensors for the continuous moni- variability arising from printer hardware (e.g., wear on drive com-
toring of apomorphine levels for Parkinson’s disease (Figure 4B). ponents), material (e.g., voids in FDM filament, localized hetero-
These examples highlight the transformative capabilities of vat geneity in resin composition), environment (e.g., temperature,
photopolymerization, and additive manufacturing in general, for humidity), or operator handling (e.g., user-specific variations in
facilitating complex, integrated biochemical sensing platforms post-processing) yield parts that are fundamentally unique.[196]
(Figure 4C).[188] The presence of weak interlayer bonds or residual stresses intro-
Other additive manufacturing approaches, such as material duced during printing further necessitate post-processing to en-
jetting, demonstrate emerging potential for producing wearable sure a functional end product. Absent real-time process monitor-
biochemical sensors. For example, aerosol jet printing offers ing innovations, the inherent variability in AM currently restricts
unique capabilities for non-contact, high-resolution printing of potential applications to non-critical roles (e.g., cosmetic rather
flexible electronics that would otherwise be challenging to pro- than structural). Emerging machine learning and AI-based pro-
duce using other AM methods.[111–113] With few processing lim- cess monitoring represent promising methods for addressing
itations beyond aerosolizability, AJP printable inks include all such challenges through the rapid detection of print defects dur-
materials necessary for fabricating functional sensors (e.g., con- ing fabrication.[197] For wearable platforms, such variability man-
ductive, insulating, dielectric, and sensing materials)[189] as high- dates extensive sensor quality control to ensure reliable, repeat-
lighted by a recent demonstration of a wearable electrochemical able, uniform performance.
biosensor for continuous noninvasive monitoring of sweat lac- Hybrid manufacturing paradigms integrating AM with con-
tate levels.[111] While these few examples highlight promising ca- ventional subtractive, or mass production techniques offer
pabilities for manufacturing wearable biochemical sensors, con- strategies to address some of these challenges.[36] Recent process
tinued improvements in resolution, scalability, and integration innovations enabling printing systems with high-speed, multi-
are required to enable practical manufacturing of sophisticated, nozzle arrays can substantially reduce manufacturing time,

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Figure 4. A) 3D printed hollow microneedle arrays for the collection and analysis of interstitial fluid. Adapted with permission.[187] Copyright 2023,
Elsevier B.V. B) 3D printed wearable electrochemical microneedle sensing patch for continuously monitoring apomorphine levels in interstitial fluid.
Adapted with permission.[186] Copyright 2021 Elsevier B.V. C) Aptamer-functionalized microneedles for pharmacokinetic measurements in interstitial
fluid. Adapted with permission.[188] Copyright 2024, Elsevier B.V.

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Figure 5. (A) 3D printed wearable smart E-glasses. Adapted with permission.[123] Copyright 2020, American Chemical Society. B) 3D printed wearable
biosymbiotic device for multi-site, long-distance, wireless, and battery-free measurement of physiological signals. Adapted with permission.[190] Copy-
right 2021, American Association for the Advancement of Science. C) 3D printed colorimetric UV sensors. Adapted with permission.[191] Copyright
2023, Wiley-VCH. D) A multi-material 3D printed device containing conductive parts. Adapted with permission.[192] Copyright 2023, The Royal Society
of Chemistry. E) 3D printed soft, wearable braille display. Adapted with permission.[193] Copyright 2023, Elsevier B.V. F) Epifluidic elastic electronic skin
(e3 -skin) with multimodal physiochemical sensing, energy management, and machine learning capabilities. Adapted with permission.[194] Copyright
2023, American Association for the Advancement of Science.

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increasing throughput and thus decreasing overall unit enable real-time personalized health monitoring. Such concerted
cost.[198–200] Such efforts are essential to enabling new classes innovation efforts will in aggregate establish additive manufac-
of functional printable materials, as diverse analyte detection turing as a transformative approach to the development and man-
necessitates tailoring printed components with included func- ufacture of the next generation of personalized wearable sensors.
tional materials[191] (Figure 5C). Other promising innovations
lie in process advancements that expand the capabilities of
multi-material printing[192] (Figure 5D) that expand the range Acknowledgements
of printable, functional components as well as print processes
The authors acknowledge and thank Roxanne Kate Balanay and Justin
that enable the fabrication of multiscale, microarchitected com-
Yip for contributions in developing the CAD renderings used in Figure 1.
posites with programmed features (e.g., controlling architecture Funding for this work was supported by the National Institute of Gen-
from nanoscale to macroscale).[201,202] Commercial demonstra- eral Medical Sciences of the National Institutes of Health under grant
tions highlight the potential of multi-material printing via the P20GM113134 (T.R.R., K.M.C., Z.Y.), the National Science Foundation un-
production of complete printed circuit boards (PCBs) which in- der grant CMMI 2240170 (T.R.R.), the Office of Naval Research under grant
corporate both insulating and conducting materials, integrated N00014-23-1-2128 (K.M.C., T.R.R.), and by the Air Force Office of Scientific
circuits (ICs), and other electronics within a fully-integrated Research and was accomplished under Grant Number W911NF-23-1-0162
(T.R.R.). The views and conclusions contained in this document are those
package.[203,204] When coupled to process simulations or patient- of the authors and should not be interpreted as representing the official
specific data, the resulting data-driven models can optimize the policies, either expressed or implied, of the Air Force Office of Scientific
print process in a layer-by-layer or voxel-by-voxel manner to pre- Research or the U.S. Government. The U.S. Government is authorized to
cisely control material properties of a highly customized printed reproduce and distribute reprints for Government purposes notwithstand-
object[193] (Figure 5E). For example, a recent report[194] details ing any copyright notation herein.
the use of additive manufacturing to establish a fully integrated
electronic skin (e-skin) platform. E-skin systems are multimodal
platforms that establish a conformal, seamless skin interface to Conflict of Interest
support the active monitoring of relevant physiological health
T.R.R. is an inventor on patents and patent applications related to both epi-
parameters via on-board sensors.[205,206] Figure 5F highlights dermal microfluidics and additive manufacturing. T.R.R. has a consulting
this epifluidic elastic electronic skin (e3 -skin) fabricated almost and advisory relationship with Epicore Biosystems, a company focused on
entirely by DIW, including the biophysical and biochemical sen- the commercialization of epidermal microfluidic platforms.
sors, channels for sweat sampling, and an energy management
system.[194] Moreover, the integration of machine learning algo-
rithms to assess collected data and enable an accurate prediction Author Contributions
of behavioral responses indicative of impairments following
alcohol consumption. Collectively, such innovations will permit The manuscript was written through contributions of all authors. Con-
ceptualization: Z.Y. and T.R.R.; Visualization: Z.Y., K.M.C., and T.R.R.;
additive manufacturing of not just individual sensors, but fully- Writing—original draft: Z.Y. and K.M.C.; Writing—review & editing: K.M.C.
integrated wearable systems combining microfluidics, flexible and T.R.R.
electronics, and sophisticated sensing modules in a unified
platform with performance indistinguishable from platforms
created via conventional manufacturing methods. Keywords
3D printing, additive manufacturing, healthcare devices, personalized
6. Outlook medicine, wearable sensors
Realizing the full potential of additive manufacturing for produc-
ing fully integrated, customized wearable systems will require Received: September 4, 2023
Revised: December 7, 2023
sustained collaborative efforts across a diverse array of fields Published online:
spanning academia, industry, and medicine. Substantial innova-
tion in printable materials is essential to expand the library of
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Ziyu Yin holds a B.S. in food science and engineering from Hunan University of Chinese Medicine
and completed her Ph.D. in nanoscience at the University of North Carolina at Greensboro in May
2021. Her research centers on nanomaterials and nanoscience, specifically in electrochemical sensing
and correlated electron transfer within structural frameworks. Her goal is to incorporate advanced
functional materials into wearable sensor platforms for biomarker sensing systems.

Kaylee M. Clark received her B.S. in chemistry from Clemson University and her Ph.D. in analytical
chemistry from Colorado State University in 2022. She is currently a postdoctoral researcher at Univer-
sity of Hawaiʻi at Mānoa. Her research efforts have broadly focused on the development of low-cost
electrochemical sensors and fluidic devices for bioanalytical applications.

Tyler R. Ray is an assistant professor of mechanical engineering at the University of Hawaii at Manoa.
He received a B.S. (2008) and M.S. (2010) in mechanical engineering from the University of South Car-
olina, and a Ph.D. (2015) in mechanical engineering from the University of California, Santa Barbara.
His research interests are at the intersection of 3D printing functional materials, lab-on-chip diag-
nostics, and wearable sensing. He has received several awards for this work including the National
Science Foundation Faculty Early Career (CAREER) Award.

Adv. Sensor Res. 2023, 2300137 2300137 (15 of 15) © 2023 The Authors. Advanced Sensor Research published by Wiley-VCH GmbH