Angel Galbert, Arjan Buis

ACTIVE, ACTUATED, AND ASSISTIVE: A SCOPING REVIEW OF EXOSKELETONS FOR THE HANDS AND WRISTS

Introduction

Active, actuated, and assistive: a scoping review of exoskeletons for the hands and wrists. Explore a scoping review of active, actuated, and assistive exoskeletons for hands & wrists. Learn about their design, control, validation, and limitations in rehabilitation for upper limb impairments.

Abstract

BACKGROUND: Assistive technology is often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force to the joints of users with muscle weakness. Actuated devices allow dynamic movement compared to splints, therefore improving the ability to complete activities of daily living. However, these devices are not often prescribed and are underrepresented in research and clinical settings. OBJECTIVE: This review examined the existing literature on devices developed to support hand and wrist functionality in daily activities. Focusing on active, powered, and actuated devices, to gain a clearer understanding of the current limitations in their design and prescription. METHODOLOGY: The scoping review was conducted using the PRISMA-ScR guidelines. A systematic search was done on MEDLINE, EMBASE, Scopus, Web of Science, and NHS the Knowledge Network from inception to May 2023. Articles were included if the device was portable; supported the hands and wrist actively using an actuator; and could be used for assistive living during or post-rehabilitation period. FINDINGS: A total of 135 studies were included in the analysis of which 34 were clinical trials. The design and control methods of 121 devices were analyzed. Electrical stimulation and direct mechanical transmission were popular actuation methods. Electromyography (EMG) and joint movement detection were highly used control methods to translate user intentions to device actuation. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often not conducted in operational environments with 69% at technology readiness levels ≤ 6, indicating that further development and testing is required. CONCLUSION: The existing literature on hand and wrist exoskeletons presents large variations in validation methods and technical requirements for user-specific characteristics. This suggests a need for well-defined testing protocols and refined reporting of device designs. This would improve the significance of clinical outcomes and new assistive technology. Layman's Abstract Assistive devices are often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force for users with muscle weakness. Unlike splints, these devices do not constrict movement, therefore improving the ability to complete activities of daily living. However, these devices are rarely prescribed or presented in research and clinical settings. This review examines the current literature concerning powered devices that aid the hands and wrists to investigate who uses them, how they are designed and how they are validated. The scoping review was conducted using a validated guideline. A systematic search was done on 5 databases up to May 2023. Articles were included if the device was portable; supported the hands and wrist using motors; and could be used for everyday tasks. A total of 135 studies were included in the analysis, of which 34 were clinical trials. The design and method of device function of 121 devices were analysed. Muscle and joint movement detection were highly used to control device movement. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often conducted in research and clinical environments (69%) rather than at home settings. In conclusion, existing literature on hand and wrist exoskeletons presents large variations in design, control methods and validation practices. This suggests a need for well-defined testing protocols. This would improve the significance of clinical outcomes of new assistive technology. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43827/33279 How To Cite: Galbert A, Buis A. Active, actuated, and assistive: A scoping review of exoskeletons for the hands and wrists. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.9. https://doi.org/10.33137/cpoj.v7i1.43827 Corresponding Author: Professor Arjan Buis, PhDDepartment of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland.E-Mail: arjan.buis@strath.ac.ukORCID ID: https://orcid.org/0000-0003-3947-293X

Review

This comprehensive scoping review, "ACTIVE, ACTUATED, AND ASSISTIVE: A SCOPING REVIEW OF EXOSKELETONS FOR THE HANDS AND WRISTS," effectively addresses a critical gap in the literature concerning powered assistive devices for upper limb impairments. The authors highlight the paradox that despite their potential, these dynamic, movement-enabling devices are underrepresented in both research and clinical prescription. Utilizing a robust methodology aligned with PRISMA-ScR guidelines, the systematic search across five major databases up to May 2023 yielded a substantial body of work, including 135 studies and analyses of 121 distinct devices. The review commendably identifies common actuation methods, such as electrical stimulation and direct mechanical transmission, and prevalent control mechanisms like electromyography and joint movement detection, providing a valuable snapshot of current technological approaches. However, the review critically exposes significant limitations within the current landscape of hand and wrist exoskeleton research. A key finding reveals large variations in validation methods and technical requirements across studies, with only 44% of reported validation methods being clinically validated. Furthermore, the analysis indicates a concerning lack of real-world applicability, as 69% of studies were found to be at Technology Readiness Levels (TRL) of 6 or below. This suggests that the majority of devices are not being tested in operational environments, thereby hindering their progression towards practical clinical integration and user-centric application in daily living. These findings collectively underscore the fragmented nature of the field and the hurdles preventing wider adoption of these potentially transformative technologies. In conclusion, this scoping review provides an invaluable service to the field by meticulously mapping the current state of active, actuated, and assistive hand and wrist exoskeletons and, more importantly, by identifying the systemic challenges impeding their development and implementation. The authors' call for well-defined testing protocols and refined reporting of device designs is not merely a suggestion but a critical necessity. Adopting standardized approaches to validation and clearly articulating technical specifications will be paramount to improving the significance of clinical outcomes and accelerating the translation of innovative assistive technology from research labs into effective, widely prescribed solutions for individuals with upper limb impairments. This review serves as a crucial roadmap for future research and development, guiding efforts towards more rigorous, clinically relevant, and user-focused advancements.

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