Task-Dependent Effectiveness of a Quasi-Direct-Drive Upper-Limb Exoskeleton: Shoulder Muscle Offloading Versus Metabolic Cost in Overhead Work.

Work-related shoulder disorders during overhead assembly represent a persistent occupational challenge. We evaluated a quasi-direct-drive (QDD) active upper-limb exoskeleton during simulated overhead work, providing simultaneous metabolic, electromyographic, and kinematic assessment of QDD actuation under static and dynamic conditions. Seven healthy males completed within-subject comparisons of without-exoskeleton (WO) and with-exoskeleton (WE) conditions during dynamic screwing (5 min) and static holding (2.5 min, 3 kg). During static holding, the exoskeleton achieved substantial shoulder offloading (Upper Trapezius: -68.2%, 6/6 participants, p = 0.031, d = 3.61; Anterior Deltoid: -43.6%) and improved postural stability (32-41% variability reduction). However, metabolic cost increased during both static (+57.2%) and dynamic (+30.6%) tasks, while movement smoothness degraded. These findings extend prior task-dependent exoskeleton observations to QDD actuation, revealing that intrinsic backdrivability does not eliminate whole-body energy penalties from device mass. The exoskeleton exhibits task-dependent effectiveness: potentially suitable for prolonged static overhead holding but not currently recommended for dynamic assembly without mass reduction and control refinement.