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Upper-limb exoskeletons for action control from stroke

Upper limb robots can supplement ARNI training by assisting with intensive, repetitive exercises that might otherwise be too demanding for trainers or therapists to deliver or us stroke survivors to manage to do. The best results are seen clinically when robotic therapy is combined with conventional methods, and different robots are suited for varying needs.

Upper limb exoskeletons provide assistance tailored to the patient’s needs and stage of recovery. They can support full limb movement for those with very limited function, offer support only when needed as motor control improves, gently guide the limb back to the correct path if movement deviates, and even provide resistance for more advanced patients working to regain strength. Robotics can deliver a higher dosage of repetitive, task-oriented exercises and provide consistent, objective data to track progress. They can be broadly categorised into two types based on their function and how they interact with the stroke survivor:

* End-effector devices, which are independent of the patient and attach at a single, distal point, such as the hand… and are effective for training movements in a horizontal plane but are less capable of controlling and isolating the movement of individual joints.

* Exoskeleton devices, however are wearable, powered devices resemble and attach directly to the human arm, with their joints aligned to mimic human joints, which allows for assisted movement of specific joints in the hand, wrist, elbow, and shoulder. Upper limb exoskeletons operate in several modes to help with different stages of recovery:

  • Assistive mode: For patients with very little to no movement, the exoskeleton fully supports the limb and helps the patient perform the desired motion.
  • Assist-as-needed (AAN) mode: As the patient recovers some motor function, the device detects their initial movement intention and provides support only when needed to complete the task.
  • Corrective mode: This mode provides force to gently guide the limb back toward the correct trajectory if the patient’s movement deviates from the desired path.
  • Resistive mode: For patients with significant motor recovery, the exoskeleton can provide resistance to help them regain strength and better control their movements.

Integrating exoskeletons into stroke rehabilitation offers several advantages. They enable high-intensity, repetitive, and task-specific training crucial for motor relearning, which is difficult to achieve manually. Many systems also enhance patient engagement through virtual reality and gamification. Exoskeletons provide objective data on performance and range of motion, helping therapists track progress and customize treatment. Some portable devices also allow for easier access to rehabilitation at home.

Despite their potential, challenges remain. Exoskeletons can be costly and are not always readily available. Proper fitting is also essential for comfort and effectiveness due to the potential for misalignment with human joints. While exoskeletons can improve upper limb function, transferring these gains to daily activities and maintaining them long-term is an area that requires further research and optimization.


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