Robotic rehabilitation requires personalized, versatile, and efficient devices to accommodate the diverse needs of patients recovering from motor impairments. In this paper, we focus on hand rehabilitation and analyse a tendon-driven, modular, and adaptable robotic glove actuated by twisted string actuators (TSAs). The proposed solution exploits flexibility in design, allowing customization based on individual patient needs while ensuring effective assistance in hand movements.

Specifically, in this paper we investigate the kinematic relationships between tendon-driven actuators and hand motion. We provide a detailed implementation of multiple functional modules within the glove, designed to accommodate various rehabilitation exercises and adapt to different degrees of motor impairment. In addition, we present experimental tests involving a user to evaluate the system’s performance, usability, and effectiveness in facilitating hand movement. The results provide insights into the potential of TSA-driven robotic gloves for enhancing rehabilitation outcomes through a combination of precise actuation and adaptability to user’s needs.

Industrial upper limb exoskeletons offload the upper limb during overhead tasks to help prevent musculoskeletal disorders to the shoulder. Although numerous studies showed reduced shoulder muscle activity during upper limb exoskeleton use for overhead postures, it remains unknown whether and how upper limb exoskeletons provide support over a large shoulder workspace beyond overhead work. Therefore, this study evaluated the Ottobock Paexo Shoulder over a large shoulder workspace from overhead to hip height with shoulder abduction and adduction. Upper body kinematics, muscle activity, and subjective user feedback were obtained by three-dimensional motion capture, surface EMG, and questionnaires, respectively, and captured while participants performed static and dynamic work tasks with an electric screwdriver. Participants completed these tasks (1) without the exoskeleton, (2) with a disengaged exoskeleton, (3) with moderate exoskeleton support, and (4) with high exoskeleton support. Exoskeleton support reduced deltoid muscle activity (−9 to −24 s%, p ≤ .001) in postures with an abducted shoulder, including nonoverhead postures. Exoskeleton support modestly decreased shoulder flexion (−3 to −5°, p ≤ .001) and increased shoulder abduction (2 to 5°, p ≤ .032), but the movement patterns during the dynamic task were unaffected. Additionally, exoskeleton-related effects increased with increasing support, but the subjective perception of change also increased, and perceived comfort decreased. Our results indicate that the tested exoskeleton provides support beyond overhead work and that there is a trade-off between exoskeleton support and subjective perception. Accordingly, further optimization of user–exoskeleton interaction is warranted for long-term prevention of musculoskeletal disorders in overhead workers.

Occupational shoulder exoskeletons can relieve workers during strenuous overhead work. Passive solutions are lightweight, robust, and cost-effective, but they can also restrict user movement, have limited support, and cannot dynamically adapt to different working conditions. Semi-active and active systems are still mostly the subject of research, and existing systems are heavy or have limited performance and support. Here, we present a lightweight semi-active exoskeleton for shoulder support that incorporates a novel motorized torque adjustment mechanism that varies the effective lever arm with which a spring applies force to the supporting joint. The mechanism is integrated into lateral structures and can be actuated via Bowden cables with motors located on the user’s back. The technical performance of the system was experimentally characterized in terms of its dynamic support torque profiles at six different support levels. Furthermore, adjustment times and energy consumption were investigated. The system showed plateau-like support torque profiles in the intended working range and could be adjusted from nearly 0 Nm up to 12 Nm of maximum support per arm. Adjustment times varied between 0.5 s for the adjustment of 20% of the total adjustment range and 1.0 s for a full activation/deactivation. Adjustments consumed between 0.1 As and 1.9 As of battery charge, allowing long operating times of up to one working day, using only a small 2 Ah battery. As a result, the exoskeleton provides high performance by combining comparatively high support, rapid motorized support adjustment, and low energy consumption in a lightweight design.

Older adults often experience a decline in functional abilities, affecting their independence and mobility at home. Wearable lower-limb exoskeletons (LLEs) have the potential to serve as both assistive devices to support mobility and training tools to enhance physical capabilities. However, active end-user involvement is crucial to ensure LLEs align with users’ needs and preferences. This study employed a co-design methodology to explore home-based LLE requirements from the perspectives of older adults with mobility impairments and physiotherapists. Four older adults with self-reported mobility limitations participated by creating personas to represent different user needs and experiences (i.e., PERCEPT methodology), alongside four experienced physiotherapists who contributed their professional insights. As assistive devices, LLEs were seen as valuable for promoting independence, supporting mobility, and facilitating social participation, with essential activities including shopping, toileting, and outdoor walking. Physiotherapists expressed enthusiasm for integrating LLEs into remote rehabilitation programs, particularly to improve strength, balance, coordination, and walking speed. Key design considerations included a lightweight, discreet device that is easy to don and doff and comfortable for extended wear. Physiotherapists highlighted the potential of digital monitoring to assess physical parameters and personalize therapy. Fatigue emerged as a significant challenge for older adults, reinforcing the need for assistive LLEs to alleviate exhaustion and enhance functional independence. A shortlist of LLE features was drafted and scored, covering activity and design applications. These findings provide valuable insights into the design and usability of home-based LLEs, offering a foundation for developing devices that improve acceptance, usability, and long-term impact on healthy ageing.

Designing optimal assistive wearable devices is a complex task, often addressed using human-in-the-loop optimization and biomechanical modeling approaches. However, as the number of design parameters increases, the growing complexity and dimensionality of the design space make identifying optimal solutions more challenging. Predictive simulation, which models movement without relying on experimental data, provides a powerful tool for anticipating the effects of assistive devices on the human body and guiding the design process. This study aims to introduce a design optimization platform that leverages predictive simulation of movement to identify the optimal parameters for assistive wearable devices. The proposed approach is specifically capable of dealing with the challenges posed by high-dimensional design spaces. The proposed framework employs a two-layered optimization approach, with the inner loop solving the predictive simulation of movement and the outer loop identifying the optimal design parameters of the device. It is utilized for designing a knee exoskeleton with a damper to assist level-ground and downhill gait, achieving a significant reduction in normalized knee load peak value by $ 37\% $ for level-ground and by $ 53\% $ for downhill walking, along with a decrease in the cost of transport. The results indicate that the optimal device applies damping torques to the knee joint during the Stance phase of both movement scenarios, with different optimal damping coefficients. The optimization framework also demonstrates its capability to reliably and efficiently identify the optimal solution. It offers valuable insight for the initial design of assistive wearable devices and supports designers in efficiently determining the optimal parameter set.

Upper-limb occupational exoskeletons reduce injuries during overhead work. Previous studies focused on muscle activation with and without exoskeletons, but their impact on shoulder fatigue remains unclear. Additionally, no studies have explored how exoskeleton support levels affect fatigue. This study investigates the effects of assistive profiles on muscular and cardiovascular fatigue. Electromyographic (EMG) and electrocardiographic signals were collected to compute EMG median frequency (MDF), heart rate (HR), and heart rate variability (HRV). Fatigue was assessed using three MDF and HR metrics: relative change ($ {\mathrm{MDF}}_{\Delta} $,$ {\mathrm{HR}}_{\Delta} $), slope ($ {\mathrm{MDF}}_{\mathrm{slope}} $,$ \mathrm{H}{\mathrm{R}}_{\mathrm{slope}} $), and intercept ($ {\mathrm{MDF}}_{\mathrm{intercept}} $,$ \mathrm{H}{\mathrm{R}}_{\mathrm{intercept}} $) of the linear regression. Results showed$ {\mathrm{MDF}}_{\Delta} $decreased 64% (p = 0.0020) with higher assistance compared to no exoskeleton; $ {\mathrm{HR}}_{\Delta} $ decreased 40% (p < 0.0273) with lower assistance, $ {\mathrm{MDF}}_{\mathrm{slope}} $ decreased up to 67% (p = 0.0039) and $ \mathrm{H}{\mathrm{R}}_{\mathrm{slope}} $ by 43% (p < 0.0098) with higher and medium assistance. HRV metrics included root mean square of successive differences (RMSSD) and low-frequency to high-frequency power ratio (LF/HF). RMSSD indicated parasympathetic dominance, while rising LF/HF ratio suggested physiological strain. Findings support occupational exoskeletons as ergonomic tools for reducing fatigue.

Adjusting the assistive torque of upper limb occupational exoskeletons is essential to optimize their effectiveness and user acceptance in companies. This adjustment enables a balance to be struck between the expected benefits and potential undesirable effects associated with their use, particularly for the shoulder joint, which is sensitive to the balance of forces. Despite this, no study has yet evaluated these assistive torques in static and dynamic conditions representative of work situations. The aim of this article is therefore to evaluate these assistive torques under these two conditions, using an isokinetic dynamometer. Angular velocities ranging from 0 to 240°/s and four levels of assistance were investigated. The results showed that the maximum assistive torques in flexion (energy restitution phase) were lower than those in extension (tensioning phase) by 20 to 36% and were median in static conditions. It was also observed that the level of assistance and the exoskeleton opening angles had a strong impact on the assistive torques, unlike the angular velocity in dynamic conditions, which had a minimal effect. Quantifying these assistive torques is crucial for assessing their biomechanical impact and adjusting the exoskeleton’s assistance to the operator and the task performed.

Compliant and safe human–robot interaction is an important requirement in lower limb exoskeleton design. Motivated by this need, this paper presents the design of a compatible lower limb exoskeleton with variable stiffness actuation and anthropomorphic joint mechanisms, for walking assistance and gait rehabilitation. A novel variable stiffness actuator (VSA) based on a guide-bar mechanism was designed, to provide force and impedance controllability. By changing the crank length of the mechanism, the stiffness of the actuator is adjusted in a wide range (from 0 to 1301 Nm/rad), at fast speed (about 2582 Nm/rad/s), and with low-energy cost. These features make it possible for online stiffness adjustment during one gait cycle, to change the human–robot coupling behavior and improve the performance of the exoskeleton. An anthropomorphic hip joint mechanism was designed based on a parallelogram linkage and a passive joint compensation approach, which absorbs misalignment and improves kinematic compatibility between the human and the exoskeleton joint. Furthermore, a torque control-based multimode control strategy, which consists of passive mode, active mode, and hybrid mode, was developed for different disease stages. Finally, the torque control performance of the actuator was verified by benchtop test, and experimental validations of the exoskeleton with a human subject were carried out, which demonstrate that compliant human–robot interaction was achieved, and stiffness variation benefits for control performance improvement when the control mode changes.

Pouch-type actuators have recently garnered significant interest and are increasingly utilized in diverse fields, including soft wearable robotics and prosthetics. This is largely due to their lightweight, high output force, and low cost. However, the inherent hysteresis behavior markedly affects the stability and force control of pouch-type driven systems. This study proposes a modified generalized Prandtl–Ishlinskii (MGPI) model, which includes generalized play operators, the tangent envelope function, and one-sided dead-zone operators, to describe the asymmetric and non-convex hysteresis characteristics of pouch-type actuators. Compared to a classical Prandtl–Ishlinskii (PI) model incorporating one-sided dead-zone functions, the MGPI model exhibits smaller relative errors at six different air pressures, demonstrating its capability to accurately describe asymmetric and non-convex hysteresis curves. Subsequently, the MGPI hysteresis model is integrated with displacement sensing technology to establish a load compensation control system for maintaining human posture. Four healthy subjects are recruited to conduct a 1 kg load compensation test, achieving efficiencies of 85.84%, 84.92%, 83.63%, and 68.86%, respectively.

The objectives of this case series study were to test whether an elastic back exosuit could increase a wearer’s endurance when lifting heavy objects and to assess whether lifting more cancels out the exosuit’s risk reduction benefits. We found that 88% of participants increased their lifting repetitions while wearing an exosuit, with endurance increases ranging from 28 to 75%. We then used these empirical data with an ergonomic assessment model based on fatigue failure principles to estimate the effects on cumulative back damage (an indicator of low back disorder risk) when an exosuit is worn and more lifts are performed. Participants exhibited 27–93% lower cumulative back damage when wearing an exosuit. These results confirmed that wearing an exosuit increased participants’ lifting capacity without canceling out injury risk reduction benefits. Back exosuits may make it possible to simultaneously boost productivity and reduce musculoskeletal disorder risks, which is relevant to workers in civilian and defense sectors.

This work introduces a real-time intention decoding algorithm grounded in muscle synergies (Syn-ID). The algorithm detects the electromyographic (EMG) onset and infers the direction of the movement during reaching tasks to control a powered shoulder–elbow exoskeleton. Features related to muscle synergies are used in a Gaussian Mixture Model and probability accumulation-based logic to infer the user’s movement direction. The performance of the algorithm was verified by a feasibility study including eight healthy participants. The experiments comprised a transparent session, during which the exoskeleton did not provide any assistance, and an assistive session in which the Syn-ID strategy was employed. Participants were asked to reach eight targets equally spaced on a circumference of 25 cm radius (adjusted chance level: 18.1%). The results showed an average accuracy of 48.7% after 0.6 s from the EMG onset. Most of the confusion of the estimate was found along directions adjacent to the actual one (type 1 error: 33.4%). Effects of the assistance were observed in a statistically significant reduction in the activation of Posterior Deltoid and Triceps Brachii. The final positions of the movements during the assistive session were on average 1.42 cm far from the expected ones, both when the directions were estimated correctly and when type 1 errors occurred. Therefore, combining accurate estimates with type 1 errors, we computed a modified accuracy of 82.10±6.34%. Results were benchmarked with respect to a purely kinematics-based approach. The Syn-ID showed better performance in the first portion of the movement (0.14 s after EMG onset).

This paper introduces a lower limb exoskeleton for gait rehabilitation, which has been designed to be adjustable to a wide range of patients by incorporating an extension mechanism and series elastic actuators (SEAs). This configuration adapts better to the user’s anatomy and the natural movements of the user’s joints. However, the inclusion of SEAs increases actuator mass and size, while also introducing nonlinearities and changes in the dynamic response of the exoskeletons. To address the challenges related to the human–exoskeleton dynamic interaction, a nonsingular terminal sliding mode control that integrates an adaptive parameter adjustment strategy is proposed, offering a practical solution for trajectory tracking with uncertain exoskeleton dynamics. Simulation results demonstrate the algorithm’s ability to estimate unknown parameters. Experimental tests analyze the performance of the controller against uncertainties and external disturbances.

The authors seek to design a lower limb exoskeleton to augment human finned swimming; however, data associated with human finned swimming previously did not exist, particularly data that characterizes the active joint torque requirements for human-scale finned swimming motion and the corresponding thrust generation. Since these data are not directly measurable nor easily computed in human subject experiments, the authors instead employed a human-scale robotic platform to characterize the relationship between joint torque, speed, power, and thrust production during flutter kick swimming, specifically at the hip joints. Among the useful insights from this study: (1) the underwater environment can be accurately modeled as a simple viscous load as seen by the hip joints, where viscous coefficient depends on the type of fin; (2) accordingly, for a given fin, movement at any amplitude and frequency is invariant when motion is normalized by amplitude; velocity and torque by the product of amplitude and frequency; and power and thrust by the square of the product of amplitude and frequency; (3) the power-specific thrust is invariant, regardless of fin type, amplitude of motion, and frequency of motion; and 4) the phasing between right and left legs does not have a significant effect on thrust generation (i.e., kicking in-phase and kicking in opposition behave similarly). The authors hope this data will be useful to other researchers interested in developing lower limb exoskeletons to augment underwater human finned swimming.

Traction of the head-neck is important in the treatment of patients suffering from neck pain due to degeneration of the intervertebral discs. Conventional neck traction is provided manually by experienced physical therapists who maintain a desired orientation of the head-neck relative to the trunk while applying the traction. It is postulated that innovative designs of neck exoskeletons can provide the same function both flexibly and accurately. This article presents a novel architecture of a parallel mechanism whose base sits on the human shoulders with 4 parallel chains, each chain having a revolute-revolute-universal-revolute (RRUR) structure, while the end-effector is connected rigidly to the human head. Each chain has five degrees-of-freedom (DOF) and applies a constraint on the motion of the end-effector. As a result, this parallel mechanism allows two DOFs to the end-effector. These are (i) forward flexion or lateral bending of the head and (ii) vertical translation. An important motivation for the current design with RRUR structure is to characterize the range of forward flexion/lateral bending of the head-neck with this structure and the vertical translation to the end-effector. A physical prototype was constructed and tested to evaluate the performance of this mechanism in hardware for the proposed application.

The paper presents a hybrid user-centred/simulation approach to populate the design specification. It presents an application in the field of exoskeleton design, with the final goal to support workers to carry out their professional tasks. More than 100 professionals (mostly health workers) participated in the survey. The qualitative requirements were extracted are then tested in simulation environments. The approach proved to generate meaningful results for product concept generation. Beyond the expectations, the simulation also showed more adequate product architectures.

Low-back pain is a common occupational hazard for industrial workers. Several studies show the advantages of using rigid and soft back-support passive exoskeletons and exosuits (exos) to reduce the low-back loading and risk of injury. However, benefits of using these exos have been shown to be task-specific. Therefore, in this study, we developed a benchmarking approach to assess exos for an industrial workplace at Hankamp Gears B.V. We assessed two rigid (Laevo Flex, Paexo back) and two soft (Auxivo Liftsuit 1.0, and Darwing Hakobelude) exos for tasks resembling the workplace. We measured the assistive moment provided by each exo and their respective influence on muscle activity as well as the user’s perception of comfort and exertion. Ten participants performed four lifting tasks (Static hold, Asymmetric, Squat, and Stoop), while their electromyography and subjective measures were collected. The two rigid exos provided the largest assistance during the Dynamic tasks. Reductions in erector spinae activity were seen to be task-specific, with larger reductions for the two rigid exos. Overall, Laevo Flex offered a good balance between assistive moments, reductions in muscle activity, as well as user comfort and reductions in perceived exertion. Thus, we recommend benchmarking exos for intended use in the industrial workplace. This will hopefully result in a better adoption of the back-support exoskeletons in the workplace and help reduce low-back pain.

This paper presents the design and validation of a wearable shoulder exoskeleton robot intended to serve as a platform for assistive controllers that can mitigate the risk of musculoskeletal disorders seen in workers. The design features a four-bar mechanism that moves the exoskeleton’s center of mass from the upper shoulders to the user’s torso, dual-purpose gravity compensation mechanism located inside the four-bar’s linkages that supports the full gravitational loading from the exoskeleton with partial user’s arm weight compensation, and a novel 6 degree-of-freedom (DoF) compliant misalignment compensation mechanism located between the end effector and the user’s arm to allow shoulder translation while maintaining control of the arm’s direction. Simulations show the four-bar design lowers the center of mass by $ 11 $ cm and the kinematic chain can follow the motion of common upper arm trajectories. Experimental tests show the gravity compensation mechanism compensates gravitational loading within $ \pm 0.5 $ Nm over the range of shoulder motion and the misalignment compensation mechanism has the desired 6 DoF stiffness characteristics and range of motion to adjust for shoulder center translation. Finally, a workspace admittance controller was implemented and evaluated showing the system is capable of accurately reproducing simulated impedance behavior with transparent low-impedance human operation.

Orthotic wrist supports will be beneficial for people with muscular weakness to keep their hand in a neutral rest position and prevent potential wrist contractures. Compensating the weight of the hands is complex since the level of support depends on both wrist and forearm orientations. To explore simplified approaches, two different weight compensation strategies (constant and linear) were compared to the theoretical ideal sinusoidal profile and no compensation in eight healthy subjects using a mechanical wrist support system. All three compensation strategies showed a significant reduction of 47–53% surface electromyography activity in the anti-gravity m. extensor carpi radialis. However, for the higher palmar flexion region, a significant increase of 44–61% in the m. flexor carpi radialis was found for all compensation strategies. No significant differences were observed between the various compensation strategies. Two conclusions can be drawn: (1) a simplified torque profile (e.g., constant or linear) for weight compensation can be considered as equally effective as the theoretically ideal sinusoidal profile and (2) even the theoretically ideal profile provides no perfect support as other factors than weight, such as passive joint impedance, most likely influence the required compensation torque for the wrist joint.

Occupational back-support exoskeletons, categorized as active or passive, hold promise for mitigating work-related musculoskeletal disorders. However, their impact on combined physical and cognitive aspects of industrial work performance remains inadequately understood, especially regarding potential differences between exoskeleton categories. A randomized, counterbalanced cross-over study was conducted, comparing the active CrayX, passive Paexo Back, and a no exoskeleton condition. A 15-min dual task was used to simulate both cognitive and physical aspects of industrial work performance. Cognitive workload parameters included reaction time, accuracy, and subjective measures. Physical workload included movement duration, segmented in three phases: (1) walking to and grabbing the box, (2) picking up, carrying, and putting down the box, and (3) returning to the starting point. Comfort of both devices was also surveyed. The Paexo significantly increased movement duration in the first segment compared to NoExo (Paexo = 1.55 ± 0.19 s; NoExo = 1.32 ± 0.17 s; p < .01). Moreover, both the Paexo and CrayX increased movement duration for the third segment compared to NoExo (CrayX = 1.70 ± 0.27 s; Paexo = 1.74 ± 0.27 s, NoExo = 1.54 ± 0.23 s; p < .01). No significant impact on cognitive outcomes was observed. Movement Time 2 was not significantly affected by both exoskeletons. Results of the first movement segment suggest the Paexo may hinder trunk bending, favoring the active device for dynamic movements. Both devices may have contributed to a higher workload as the movement duration in the third segment increased compared to NoExo.

Lower limb exoskeletons (LLEs) have demonstrated their potential in delivering quantified repetitive gait training for individuals afflicted with gait impairments. A critical concern in robotic gait training pertains to fostering active patient engagement, and a viable solution entails harnessing the patient’s intrinsic effort to govern the control of LLEs. To address these challenges, this study presents an innovative online gait learning approach with an appropriate control strategy for rehabilitation exoskeletons based on dynamic movement primitives (DMP) and an Assist-As-Needed (AAN) control strategy, denoted as DMP-AAN. Specifically tailored for post-stroke patients, this approach aims to acquire the gait trajectory from the unaffected leg and subsequently generate the reference gait trajectory for the affected leg, leveraging the acquired model and the patient’s personal exertion. Compared to conventional AAN methodologies, the proposed DMP-AAN approach exhibits adaptability to diverse scenarios encompassing varying gait patterns. Experimental validation has been performed using the lower limb rehabilitation exoskeleton HemiGo. The findings highlight the ability to generate suitable control efforts for LLEs with reduced human-robot interactive force, thereby enabling highly patient-controlled gait training sessions to be achieved.