Understanding limited adoption of powered hand and wrist exoskeletons : a scoping review of devices and technology readiness

Tools

Galbert, Angel and Buis, Arjan (2025) Understanding limited adoption of powered hand and wrist exoskeletons : a scoping review of devices and technology readiness. In: CDT Prosthetics and Orthotics Conference 2025, 2025-11-13 - 2025-11-14, Royal Armouries Museum.

[thumbnail of Galbert-etal-CDT-POC-2025-Understanding-Limited-Adoption-of-Powered-Hand-and-Wrist-Exoskeletons]
Preview
 Text. Filename: Galbert-etal-CDT-POC-2025-Understanding-Limited-Adoption-of-Powered-Hand-and-Wrist-Exoskeletons.pdf
Accepted Author Manuscript
License: Creative Commons Attribution 4.0 logo
Download (618kB)| Preview

Abstract

1. Background Upper limb impairments significantly limit activities of daily living (ADLs) and reduce quality of life [1]. Portable, powered hand and wrist exoskeletons have the potential to improve function, yet adoption is limited, and saturated with variations in design, inconsistent evaluation, and limited real-world validation [2]. 2. Aim To understand their low adoption, a synthesise focusing on users, device characteristics, validation methods, and technology readiness levels (TRLs) was conducted. 3. Method Following PRISMA-ScR guidelines [3], MEDLINE, EMBASE, Scopus, Web of Science, and NHS Knowledge Network were searched (inception–2023). Inclusion criteria required portable, powered devices supporting hand and/or wrist movement in ADLs. Data on target population of the device, device design, actuation, user control, outcome measurement tools, and TRL were extracted and analysed using descriptive statistics. 4. Results From 5,588 records, 135 studies (1995-2023) describing 121 devices and involving 1,310 participants (39% female) were included. Stroke (46%) and spinal cord injury (28%) were the main conditions studied. Common actuation methods included electrical stimulation (26%), bar linkage (15%), and pneumatics (15%), with mean degrees of freedom (DoF) of 3.6 for hands and 2.8 for wrists. Electromyography and joint movement detection each represented 30% of control methods. Outcome measures were diverse, with 226 unique metrics; only 8% used in ≥10 studies. Clinical validation was reported in 44% of studies; 69% of devices were ≤TRL 6, while few reached TRL 9 (devices ready for market) at 20%. Reporting of weight, DoF, comorbidities and alternative control methods was inconsistent. 5. Discussion and Conclusion The existing literature on hand and wrist exoskeletons, while promising, lacks consistency in reporting, and minimal patient-reported outcomes. This hinders the clinical translation and adoption of these devices [4]. Establishing standard protocols for technical and clinical evaluation is essential for robust, user-centred research and future prescription. This will ultimately be placing the user's needs and experiences at the heart of future innovation. References [1] R. D. Rondinelli, W. Dunn, K. M. Hassanein, C. A. Keesling, S. C. Meredith, T. L. Schulz, et al., "A simulation of hand impairments: Effects on upper extremity function and implications toward medical impairment rating and disability determination," Archives of Physical Medicine and Rehabilitation, vol. 78, no. 12, pp. 1358–1363, Dec. 1997, doi: 10.1016/S0003-9993(97)90310-5. [2] A. Galbert and A. Buis, “Active, actuated, and assistive: A scoping review of exoskeletons for the hands and wrists,” Can. Prosthet. Orthot. J., vol. 7, no. 1, Art. No. 9, Nov. 8, 2024, doi: 10.33137/cpoj.v7i1.43827 [3] A. C. Tricco et al., "PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation," Annals of Internal Medicine, vol. 169, no. 7, pp. 467–473, Oct. 2018, doi: 10.7326/M18-0850. [4] A. Galbert and A. Buis, “Exploring factors for prescription and validation of actuated upper limb devices: A cross-sectional survey of allied health professionals,” Can. Prosthet. Orthot. J., vol. 7, no. 1, Art. no. 4, 2024, doi: 10.33137/cpoj.v7i1.43790. Word Count 300 Acknowledgments We would like to acknowledge the funding and support from the University of Strathclyde and the UK Engineering and Physical Sciences Research Council (EP /S02249X) for the Centre of Doctoral Training in Prosthetics and Orthotics. Conflict of Interest Disclosure The authors declare no conflict of interest.

ORCID iDs

Galbert, Angel ORCID logoORCID: https://orcid.org/0000-0003-1180-5691 and Buis, Arjan ORCID logoORCID: https://orcid.org/0000-0003-3947-293X;
CORE (COnnecting REpositories)