Portable exoskeletons for upper limb rehabilitation: A systematic review.

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.