{"title":"Advancing Gait Rehabilitation: A Systematic Review of Robotic Exoskeletons for Cerebral Palsy.","authors":"Amna Riaz Khawaja, Prashant K Jamwal, Dilnoza Karibzhanova, Akim Kapsalyamov, Sunil Agrawal","doi":"10.1017/wtc.2025.10027","DOIUrl":"10.1017/wtc.2025.10027","url":null,"abstract":"<p><p>Individuals with cerebral palsy (CP) experience significant impairments in lower limb mobility, which severely limit their daily activities and overall quality of life. Robotic exoskeletons have emerged as a cutting-edge solution to assist in the rehabilitation of individuals with CP by improving their motor functions. This systematic review, conducted following PRISMA guidelines, critically evaluates lower limb robotic exoskeletons specifically designed for individuals with CP, focusing on their design, rehabilitation interfaces, and clinical effectiveness. The review includes research papers published between 2010 and 2024, analyzing 30 lower limb exoskeletons reported in 57 papers. We analyze each exoskeleton, focusing on its technological features, user experience, and clinical outcomes. Notably, we identify a trend in which researchers are increasingly adapting exoskeleton functions to the specific needs of individual users, facilitating personalized rehabilitation approaches. Additionally, we highlight critical gaps in current research, such as the lack of sufficient long-term evaluations and studies assessing sustained therapeutic impacts. While ease of use remains crucial for these devices, there is a pressing need for user-friendly designs that promote prolonged engagement and adherence to therapy. This comprehensive review of existing gait rehabilitation exoskeleton technologies aimed to inform future design and application, ultimately contributing to the development of devices that better address the needs of individuals with CP and enhance their motor functions and quality of life.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e46"},"PeriodicalIF":2.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-09-03eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10025
Leon Lauret, Brent James Raiteri, Paolo Tecchio, Daniel Hahn
{"title":"A passive upper limb exoskeleton effectively reduces shoulder muscle activity over a large shoulder workspace.","authors":"Leon Lauret, Brent James Raiteri, Paolo Tecchio, Daniel Hahn","doi":"10.1017/wtc.2025.10025","DOIUrl":"10.1017/wtc.2025.10025","url":null,"abstract":"<p><p>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 <i>Ottobock Paexo Shoulder</i> 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%, <i>p</i> ≤ .001) in postures with an abducted shoulder, including nonoverhead postures. Exoskeleton support modestly decreased shoulder flexion (-3 to -5°, <i>p</i> ≤ .001) and increased shoulder abduction (2 to 5°, <i>p</i> ≤ .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.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e45"},"PeriodicalIF":2.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-26eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.9
Mohamed Abdelhady, Thomas C Bulea
{"title":"Gaussian regressor-based adaptive control of exoskeleton joints in the presence of system uncertainty.","authors":"Mohamed Abdelhady, Thomas C Bulea","doi":"10.1017/wtc.2025.9","DOIUrl":"10.1017/wtc.2025.9","url":null,"abstract":"<p><p>System uncertainty remains a challenge for effective control of lower extremity exoskeletons, particularly in clinical populations. Adaptive control offers a potential solution by accounting for unknown system characteristics in real time. Here, we introduce the use of Gaussian-based adaptive control (GBAC) in a two-degree-of-freedom (DOF) exoskeleton for an angular position tracking task in the presence of system uncertainty. The mathematical derivation of the implicitly non-Lyapunov adaptation law is presented using Lagrangian mechanics, including a Gaussian kernel regressor and its stable convergence. We then evaluate GBAC performance in a 2-DOF simulation compared with a previously developed robust adaptive backstepping algorithm, Lyapunov-stable Slotine-Li control, and a proportional-integral-derivative (PID) controller. We additionally complete 1-DOF simulations to evaluate the effects of external disturbance and parameter uncertainty on controller performance. Finally, we evaluate GBAC experimentally in our existing 1-DOF knee exoskeleton along with Slotine-Li and PID controllers. The simulation results demonstrate the improved tracking performance and faster convergence of GBAC, especially in the presence of an external disturbance and uncertainty introduced by extra segment length and mass. The experimental results demonstrate similar performance, wherein GBAC and Slotine-Li provide stable tracking in the presence of unmodeled system dynamics; however, convergence time was faster and tracking error was lower for GBAC. Collectively, these results demonstrate that GBAC is an effective adaptive controller in the presence of system uncertainty and therefore warrants further development and investigation for use in flexible joint exoskeleton systems, particularly those designed for pediatric and/or clinical populations that have inherently high uncertainty.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e44"},"PeriodicalIF":2.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-26eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10022
Sung-Jin Park, Seongok Chae, Hyung-Soon Park
{"title":"The effect of body-conforming passive wearable device with knee flexion taping on dynamic knee stability.","authors":"Sung-Jin Park, Seongok Chae, Hyung-Soon Park","doi":"10.1017/wtc.2025.10022","DOIUrl":"10.1017/wtc.2025.10022","url":null,"abstract":"<p><p>Passive wearable devices are widely used for fitness and have also become fashionable. There is increasing interest in adding functionality, such as knee stability, to these compact devices, which are more convenient for daily wear than separate devices like braces or exoskeletons. This study designed and assessed flexion taping passive wearable devices (FTPW). The design emphasized providing adequate flexion moment capacity and controlling varus/valgus movement to prevent knee injuries. In this research, 20 healthy women performed single leg drop (SLD) and step-up (SU) tests with and without muscle fatigue. Knee joint angle, muscle activation, metabolic cost, and blood flow were measured across FTPW, passive wearable devices without flexion taping (PW), and control shorts (Ctrl). In the SLD test after muscle fatigue, FTPW produced a significantly larger knee flexion angle during landing. In the SU test, before and after fatigue, knee varus angle was notably higher with FTPW. Additionally, FTPW showed reduced knee flexor fatigue, indicated by smaller median frequency shifts, and improved blood flow compared to PW. No significant differences in respiratory exchange ratio were detected among the three conditions. Overall, FTPW demonstrated strong potential to enhance knee kinematics, muscle activation, and blood flow, pointing to benefits for both performance improvement and injury prevention. By delivering focused support in a compact format, FTPW may serve as an innovative passive wearable solution that supports daily movement, comfort, and daily activities. This emphasizes the device's promise as an alternative to bulkier knee aids, merging style and functionality effectively.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e43"},"PeriodicalIF":2.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-11eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10004
Roberto Paolini, Fangqi Liu, Alessia Scarpelli, Andrea Demofonti, Francesca Cordella, Dai Jiang, Andreas Demosthenous, Loredana Zollo
{"title":"A novel portable device and validation procedure for transcutaneous electrical nerve stimulation.","authors":"Roberto Paolini, Fangqi Liu, Alessia Scarpelli, Andrea Demofonti, Francesca Cordella, Dai Jiang, Andreas Demosthenous, Loredana Zollo","doi":"10.1017/wtc.2025.10004","DOIUrl":"10.1017/wtc.2025.10004","url":null,"abstract":"<p><p>The adoption of upper limb myoelectric prosthesis is limited by the lack of closed control loop systems. Although the efferent control has already been integrated into these devices, the sensory feedback restoration in the afferent channel still remains an open challenge. Transcutaneous electrical nerve stimulation (TENS) is a promising method for generating somatotopic sensory feedback, allowing the closure of the control loop system. The application of this technique is limited by cumbersome and grid-powered electrical stimulators, making them unsuitable for everyday life, whereas most portable stimulators available on the market are designed for other purposes (e.g., muscular stimulation or pain therapy) and present limited stimulation wave customization. The stimulation devices employed in the literature often produce not fully suitable stimulation parameters and are frequently validated through procedures that do not fully clarify their practical application for sensory feedback restoration. The research aims to present a novel wearable TENS stimulation device (46 g, 62 × 49 × 20 mm) suitable for sensory feedback application. The validation was achieved through a benchtop test and a preliminary analysis on 10 healthy participants comparing the qualities, intensities, and stimulated areas of the sensations elicited by the proposed device and a reference stimulator. The proposed device is capable of delivering charge-balanced stimulation waves over skin-like resistive load and eliciting tingling and vibration sensations with similar intensities compared to the adopted reference.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e40"},"PeriodicalIF":2.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-11eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10024
Adrian Esser, Fabian Müller, Julia Manczurowsky, Christopher J Hasson, Tim Unger, Chris Easthope Awai, Peter Wolf, Robert Riener
{"title":"Impact of a shoulder exosuit on range of motion, endurance, and task execution in users with neurological impairments.","authors":"Adrian Esser, Fabian Müller, Julia Manczurowsky, Christopher J Hasson, Tim Unger, Chris Easthope Awai, Peter Wolf, Robert Riener","doi":"10.1017/wtc.2025.10024","DOIUrl":"10.1017/wtc.2025.10024","url":null,"abstract":"<p><p>The Myoshirt, an active exosuit, provides gravity compensation for the shoulders. This study evaluated the impact of the Myoshirt on range of motion (ROM), endurance, and activities of daily living (ADLs) performance through tests involving nine participants with varying levels of arm impairments and diverse pathologies. Optical motion capture was used to quantify ROM of the shoulder and elbow joints during isolated movements and functional tasks. Endurance was quantified through a timed isometric shoulder flexion task, and a battery of ADL tasks was used to measure the perceived support of the exosuit, along with changes in movement quality. Feedback and usability insights were gathered with surveys. The Myoshirt did not significantly improve ROM during isolated movements (shoulder flexion, shoulder abduction, and elbow flexion/extension), but during the reaching phase of a functional drinking task elbow extension increased significantly by 13.5% (t = 7.52, p = .002). Participants could also keep their arms elevated 78.7% longer (t = 1.942, p = .047). Patients also reported less perceived difficulty with ADLs while using the device, and a therapist reported improved execution quality. Participants who self-reported severe impairment levels tended to derive greater benefits compared to those with milder impairments. These findings highlight the potential of the Myoshirt as an assistive device, particularly for individuals with severe impairments, while emphasizing the need for further refinement.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e42"},"PeriodicalIF":2.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Energy conservation-based on-line tuning of an analytical model for accurate estimation of multi-joint stiffness with joint modular soft actuators.","authors":"Fuko Matsunaga, Taichi Kurayama, Ming-Ta Ke, Ya-Hsin Hsueh, Shao Ying Huang, Jose Gomez-Tames, Wenwei Yu","doi":"10.1017/wtc.2025.10023","DOIUrl":"10.1017/wtc.2025.10023","url":null,"abstract":"<p><p>Accurate estimation of finger joint stiffness is important in assessing the hand condition of stroke patients and developing effective rehabilitation plans. Recent technological advances have enabled the efficient performance of hand therapy and assessment by estimating joint stiffness using soft actuators. While joint modular soft actuators have enabled cost-effective and personalized stiffness estimation, existing approaches face limitations. A corrective approach based on an analytical model suffers from actuator-finger and inter-actuator interactions, particularly in multi-joint systems. In contrast, a data-driven approach struggles with generalization due to limited availability of labeled data. In this study, we proposed a method for energy conservation-based online tuning of the analytical model using an artificial neural network (ANN) to address these challenges. By analyzing each term in the analytical model, we identified causes of estimation error and introduced correction parameters that satisfy energy balance within the actuator-finger complex. The ANN enhances the analytical model's adaptability to measurement data, thereby improving estimation accuracy. The results show that our method outperforms the conventional corrective approach and exhibits better generalization potential than the purely data-driven approach. In addition, the method also proved effective in estimating stiffness in human subjects, where errors tend to be larger than in prototype experiments. This study is an essential step toward the realization of personalized rehabilitation.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e41"},"PeriodicalIF":2.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-08eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10013
Rajan Prasad, Marwan El-Rich, Mohammad I Awad, Kinda Khalaf
{"title":"Simulation of stroke gait impairment correction using cable-driven lower limb rehabilitation exoskeleton (C-LREX).","authors":"Rajan Prasad, Marwan El-Rich, Mohammad I Awad, Kinda Khalaf","doi":"10.1017/wtc.2025.10013","DOIUrl":"10.1017/wtc.2025.10013","url":null,"abstract":"<p><p>Cable-driven exoskeletons have recently shown great promise in the rehabilitation of stroke survivors. Numerical modeling/simulation provides a cost- and time-effective approach to fine-tuning design parameters of the exoskeletons, hence reducing the need for expensive and time-consuming experimental trials. This study investigated using a cable-driven lower limb rehabilitation exoskeleton (C-LREX) to correct stroke-impaired gait and track reference healthy trajectories. The impact of different levels of impairment and subject anthropometry variation on the model's performance was studied. The C-LREX model was successful in assisting the impaired limb to track the reference trajectory in all impaired gait patterns, except for higher impairment levels (>20° range of motion deviation at the hip joint). Subject anthropometry variation did not affect trajectory tracking when the cable routing was scaled to fit the user's anthropometry. This study confirmed that the C-LREX model could simulate various impaired lower limb gait patterns in the sagittal plane and determine the cable tension requirements needed to correct the impairment. Future work includes expanding the framework to incorporate frontal plane motion and to validate C-LREX performance in assisting biplanar impaired motion.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e39"},"PeriodicalIF":2.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wearable technologiesPub Date : 2025-08-07eCollection Date: 2025-01-01DOI: 10.1017/wtc.2025.10018
James Greig, Mhairi McInnes, Edward K Chadwick, Maria Elena Giannaccini
{"title":"Decoupled, wearable soft robotic rehabilitation device for the upper limb.","authors":"James Greig, Mhairi McInnes, Edward K Chadwick, Maria Elena Giannaccini","doi":"10.1017/wtc.2025.10018","DOIUrl":"10.1017/wtc.2025.10018","url":null,"abstract":"<p><p>Lightweight, adjustable, and affordable devices are needed to enable the next generation of effective, wearable adjuncts for rehabilitation. Used at home or in a rehabilitation setting, these devices have the potential to reduce compound pressures on hospitals and social care systems. Despite recent developments in soft wearable robots, many of these devices restrict the range of motion and lack quantitative assessment of moment transfer to the wearer. The decoupled design of our wearable device for upper-limb rehabilitation successfully delivers almost the full range of motion to the user, with a mean maximum flexion angle of 149° (SD = 8.5). In this article, for the first time, we show that in tests involving a wide range of participants, 82% of the moment produced by the actuator is applied to the wearer. This testing of elbow flexion moment transfer supports the effectiveness of the device. This research is a step toward effective pneumatic soft robotic wearable devices that are adaptable to a wide range of users - a necessary prerequisite for their widespread adoption in health care.</p>","PeriodicalId":75318,"journal":{"name":"Wearable technologies","volume":"6 ","pages":"e38"},"PeriodicalIF":2.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}