Journal of experimental orthopaedics · 2025
Portable exoskeletons for upper limb rehabilitation: A systematic review.
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Carnevale Arianna, Nicodemi Guido, Pisani Matteo Giuseppe, Lalli Alberto, di Luzio Francesco Scotto, D'Hooghe Pieter, Zollo Loredana, Schena Emiliano, Longo Umile Giuseppe
Аннотация
PURPOSE: This systematic review evaluates the efficacy and feasibility of portable exoskeletons for upper limb rehabilitation in patients post-stroke and with postoperative neurological complications. It focuses on motor function, range of motion (ROM), spasticity reduction and improvements in daily living activities.
METHODS: Following PRISMA guidelines [12], PubMed, Cochrane, and Scopus databases were searched up to October 2024 using combinations of keywords and MeSH terms such as "exoskeleton devices" and "shoulder rehabilitation." Included studies (January 2008-October 2023) assessed portable exoskeletons for upper limb function in patients with chronic stroke or postoperative neurological complications. Excluded were studies on non-portable robots, animal studies, protocols, those without quantitative outcomes, and those not involving human patients. The Joanna Briggs Institute (JBI) Critical Appraisal tool, and the Risk Of Bias 2 (ROB2) tool assessed study bias.
RESULTS: Five selected studies included 70 patients. Evaluated exoskeletons included the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER), Wilmington Robotic Exoskeleton (WREX), Hybrid Exoskeleton Upper Limb 30A (HEXO-UR30A), and Hybrid Assistive Limb (HAL). These devices demonstrated significant improvements in motor function, ROM, spasticity reduction, and kinematic parameters. High adherence and absence of severe adverse events supported feasibility.
CONCLUSION: Portable exoskeletons are promising tools for upper limb rehabilitation post-stroke and after neurological surgery. They enhance motor recovery and functional outcomes. However, moderate risk of bias, small sample sizes, and limited data in orthopedic contexts-especially comparisons with conventional rehabilitation-underscore the need for further high-quality RCTs.
LEVEL OF EVIDENCE: Level IV.
METHODS: Following PRISMA guidelines [12], PubMed, Cochrane, and Scopus databases were searched up to October 2024 using combinations of keywords and MeSH terms such as "exoskeleton devices" and "shoulder rehabilitation." Included studies (January 2008-October 2023) assessed portable exoskeletons for upper limb function in patients with chronic stroke or postoperative neurological complications. Excluded were studies on non-portable robots, animal studies, protocols, those without quantitative outcomes, and those not involving human patients. The Joanna Briggs Institute (JBI) Critical Appraisal tool, and the Risk Of Bias 2 (ROB2) tool assessed study bias.
RESULTS: Five selected studies included 70 patients. Evaluated exoskeletons included the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER), Wilmington Robotic Exoskeleton (WREX), Hybrid Exoskeleton Upper Limb 30A (HEXO-UR30A), and Hybrid Assistive Limb (HAL). These devices demonstrated significant improvements in motor function, ROM, spasticity reduction, and kinematic parameters. High adherence and absence of severe adverse events supported feasibility.
CONCLUSION: Portable exoskeletons are promising tools for upper limb rehabilitation post-stroke and after neurological surgery. They enhance motor recovery and functional outcomes. However, moderate risk of bias, small sample sizes, and limited data in orthopedic contexts-especially comparisons with conventional rehabilitation-underscore the need for further high-quality RCTs.
LEVEL OF EVIDENCE: Level IV.