1

An Overview of Artificial Intelligence-based Soft Upper

Limb Exoskeleton for Rehabilitation: A Descriptive
Review
Sanjukta Halder1, Dr. Amit Kumar2
1,2Mechanical department, NIT Patna

Abstract: The upper limb robotic exoskeleton is an electromechanical device which

use to recover a patient’s motor dysfunction in the rehabilitation field. It can provide
repetitive, comprehensive, focused, positive, and precise training to regain the joints
and muscles’ capability. It has been shown that existing robotic exoskeletons are
generally used rigid motors and mechanical structures. Soft robotic devices can be a
correct substitute for rigid ones. Soft exosuits are flexible, portable, comfortable,
user-friendly, low-cost, and travel-friendly. Somehow, they need expertise or
therapist to assist those devices. Also, they cannot be adaptable to different patients
with non-identical physical parameters and various rehabilitation needs. For that
reason, nowadays we need intelligent exoskeletons during rehabilitation which have
to learn from patient’s previous data and act according to it with patient’s intention.
There also has a big gap between theoretical and practical applications for using
those exoskeletons. Most of the intelligent exoskeletons are prototype in manner. To
solve this problem, the robotic exoskeleton should be made both criteria as
ergonomic and portable. The exoskeletons have to the power of decision-making to
avoid the presence of expertise. In this growing field, the present trend is to make
the exoskeleton intelligent and make it more reliable to use in clinical practice.

Keywords: Upper Limb Exoskeleton, AI, Human-Machine interaction, AI-based

exoskeleton, Rehabilitation therapy, daily assistance, Soft exoskeleton, Exosuit,
intelligent devices.

Introduction: Now-a-days stroke is a very
common disorder of blood circulation in
human arteries; It obstructs the flow of the
vessel. Temporary or permanent disability
may occur in adults because of these
conditions [1] [3]. Currently, 60% of stroke
patients are belongs to India in the world as
per India express. Approximately 4000 stroke
cases happen daily in India and not more than
2-3% are treated, among them 50-80% are in
the acute phase and 40-50% are in the chronic
phase. After a stroke, rehabilitation must be
needed, it can prevent the next stroke which
may occur within five years after the first
stroke. Traditional treatments such as
physiotherapy use simple equipment or
monitoring to help patients return to normal
life with some uncertainty, even can be
limited by wheelchairs [4][6]. Expertise gives
an indication that robot-assisted rehabilitation
can improve the motor function of a patient's
limbs with appropriate treatment [7].
A predetermined way can be traced by a
robot, operating different training methods,
such as active, passive, assistive, or resistive
 2

training; for the patient's recovery. The used in rehabilitation and many devices have
rehabilitation robot can record patient data been proposed depending on this topic. There
and estimate exercise capability due to high- are many devices that do not have clinical
level control techniques that can be acceptance due to their poor therapeutic
implemented in a range of methods [8]. In utility, many of them were not transportable,
Addition, the rehabilitation process can be airy and convenient. Low-to-middle-income
more fruitful with virtual reality or other countries cannot adopt exosuits due to high
techniques such as gaming technology [9]. cost whereas stroke happens here more than in
The rehabilitation robots communicate with high-income countries [12]. In this way,
patients directly, thus the robots acquire various strategies with AI have to be applied
patient data easily and protect it with effective to reduce the cost of production.
training. Artificial intelligence (AI) presents
Literature review:
some algorithms which acquired knowledge
from occurrences and forecast exotic I. Recap of Upper-Limb Exoskeletons:
conditions, which increases robot-assisted
An exoskeleton of the upper limb describes as
rehabilitation intelligence [1] [10]. Robots
can analyze native movements and compute the covering of the human arm as shown in
human desires combined with AI. Intelligent figure1. Wearable exoskeleton robots have
systems can acquire knowledge from past
happening processes and robotic models can
adapt gracefully to dynamic and unknown
environments by following these processes
[5] [10].
Exoskeletons start a new period of the modern
neuromuscular rehabilitation process and
research in assistive technology [11]. Most of
the used actuators of exoskeletons were
electrical, and almost all devices were
considered fixed and stiff as per previous
publications, but the soft exoskeleton has
Figure 1: Mechanical structure of an upper limb exoskeleton ; (a)
been developed in the last decade and its Schematic design and DOFs, (b) Back View and (c) Front View
development is gradually increasing day by of the exoskeleton, (d) exoskeleton position when elbow at 90
degrees.
day with further research. Although existing
review articles discuss robotic structure [11], gradually become popular in clinics because
sensing technology [7], control techniques they can support multiple joints and provide
[8], kinematic evaluation [13], patient’s flexible and safe rehabilitation training
engagement [9] and human-robot interaction therapy. Still, exoskeletons have further
methods [10] etc. By doing these studies, the complicated mechanical structures and
benefits and drawbacks of every method are control techniques and most of the
also presented. So, the representative's rehabilitation exoskeletons are in the
investigation left some concerns about AI- prototype stage [4].
based robot-assisted rehabilitation.
Upper limb exoskeletons work parallel to the
The aim of this research is to summarize AI-
human arm and are attached to the human
based soft wearable robotic devices and
upper limb at various joints. By this
assistance with a focus on upper limb
indication, it is clear that robots have to adapt
rehabilitation with intelligence. Over the last
to different arm lengths. Different types of
two decades, robotics technology has been
exoskeletons are present as the figure2 based
 3

Figure 2: Types and classifications of the upper-limb exoskeleton

on DOFs, Supporting joints, operation modes, freedom (DOFs). Four types of operational
control techniques and applications, etc modes are observed in motor rehabilitation or
neuromotor functioning. They are Active
As per works of literature with figure 3(a), mode, Passive mode, Assistive mode &
most exoskeletons are rigid in nature. The Resistive mode. The active mode [26][28]
hard exoskeletons are structured gives all possible movements of a limb using
mechanically and offer high resistance to a robotic exoskeleton. In passive mode
tension or deformation [13]. The full limb will [16][18], limb movements are monitored
be supported by this type of exoskeleton. It using the exoskeleton. Assistive mode [34] is
provides some mechanical flexibility. Some
partially used to move the limb and resistive
of the reviews are introduced about soft
mode [29] opposes the movement of the limb.
exoskeleton systems but in very small
amounts. These types of exoskeletons are soft Another operating mode is multi-mode [27]
and flexible and made of soft materials. Soft which contributes to mixing modes of
exoskeletons are used to assist the users’ operation. Different types of exoskeletons
movement without any restrictions [16]. utilize different operational modes for
The robotic exoskeletons have many features different types of regaining health conditions.
that highlight their applicability in rehab
properly. Most of the exoskeletons are made
of rigid materials such as metal or carbon fiber
or aluminum alloy. As regards the structural
materials, the review of the physical models is
made by a combination of different materials
[14]. Nowadays cable-driven joints are used to
make the exoskeleton lighter, compact and
portable. Plastic materials are used to reduce
the weight of physical appearances. A very
small amount of research used soft or semi-
hard materials [16]. The distribution of used
materials for upper exosuits are laid out in
figure 3(d). With the growing technology
additive manufacturing or 3D printing
technology is also used for manufacturing Figure 3: The general distribution of physical properties of
exoskeletons [2] [15]. robotics exoskeleton based on (a) exoskeleton types, (b)
degrees of freedom(DOFs), (c) operational modes and (d)
The characters of the exoskeletons depend materials.
upon the type of modes and degrees of
 4

The DOF determines the possible movement flexible soft exoskeleton is also known as an
of a limb over one or different joints. Higher Exosuits. Some components must be rigid,
DOFs require more actuators and are more such as the battery and controller, which are
complex in mechanical design and needed often placed in a bag or separately somewhere
much improvement in control techniques to to reduce weight [17]. That types of exosuits
do the specific task. The design is simple to are great because of their features as they are
use with one DOF [26] [27] [28] [29] [30], light, flexible, and easy to transport and
and the driving mechanism allows accurate install. Patients can use these devices alone
joint mobility but increases the complexity of and carry them around. Therefore, they are
the controller. Approximately 45% of user-friendly and can be used in daily life for
research considered single DOF exosuits improvement easily. Soft exosuits can be used
mostly based on the elbow joint [26] which for the treatment of the upper limb, especially
assists in flexion and extension movements. for the shoulder [17,18,41], wrist [20,23],
The internal and external design of two DOFs elbow [16,21], and finger [19,22] aid.
robots [17] [18] are more complex than
single. Almost 20% of reviewed papers are The shoulder is a vital joint for the upper limb,
based on two DOF as shown in figure 3(b). it is a kind of ball-socket joint. The disabilities
All of those shoulder-elbow models are very of the shoulder can affect the whole upper
common [17]. The robotic structure decides to limb badly. The shoulder joint has three
improve the efficacy of rehabilitation degrees of freedom (DOFs) such as flexion-
guidance according to the patient’s condition. extension in the sagittal plane, abduction-
This study presented 10% of reviews are on adduction in the coronal plane, and medio-
the basis of three DOFs models [34] [38] [39]. lateral rotation in the transverse plane.
In specific, the used exoskeleton in paper [42]
introduced three DOFs at the elbow joint, arm
rotation, and wrist joint. Finally, the most
illuminating work was conducted by
Varghese et al. [41], where a multi-DoFs
shoulder kinematic detection model was
published. The work was established based on
the physical location of one patient and will
be elongated for multiple patients in the
future. The primary aim of exoskeletons is to
bear rehabilitation treatment with a compact,
airy, and high-performance device. The
tendon-routing framework can be extended to
the exosuit's actuator structure and to other
multi-DOF joints such as the hip, wrist, and
ankle.
II. Soft Exoskeleton:

Development of soft exoskeletons has

increased over the past decade, particularly in
lower limb applications. Soft exoskeletons
Figure 4: Examples of soft exoskeletons for
may replace many or all hard exoskeletons in shoulder joints.
the future. Light, thin and flexible materials
are the substitute for hard, heavy, and rigid Thompson et al [18] represent a cable-driven
materials for soft exoskeletons [2]. The soft actuation system for shoulder joints. This

model presented a nested linear and pennant
architecture by using fiber-reinforced
elastomeric perimeter with the same
manufacturing factors for increasing shoulder
flexion. It estimated forces for low
displacements up to 200 kPa pressure,
whereas SAMPER-ESCUDERO et al [17]
designed a wearable exosuit made of elastic
fabric that supports shoulder and elbow
stretch. This soft prototype can support the
elbow fully and the shoulder partially up to
100 degrees. These two types of soft
exoskeletons are used for shoulder flexion as
shown in figure-4.
The wrist joint is a complicated joint that
bridges the gap between the hand and the
forearm. It has three degrees of freedom -
flexion-extension, radioulnar-deviation, and
rotation. In a paper, Benjamin et al [19] spoke
for a 3D-printed soft robotic wrist device for
rehabilitation with the mobility of two DOF.
By using this at least 70% recovery is possible
with sufficient torque and bending. They have
adopted a folding-based design fabrication
process that can be accepted in other
applications and Yuejun Xu [23] designed an
assistive and portable soft robot and simulated
it for wrist dysfunction. This robotic device
used soft actuator, elastomeric chambers, and
shell reinforcement plates for inducing
specific bending under pneumatic pressure.
Figure 5: Examples of soft robotic aided devices for wrist (A)
and Elbow (B) rehabilitation.
5
Elbow joint is a kind of hinge joint between
the arm and forearm of a human body. It
possesses two degrees of freedom as flexion-
extension and supination- pronation to the
forearm. For the aiding of elbow, Chiaradia et
al [16] proposed a refined design of the
exosuit of which a smooth control
architecture represented motion-intention
detection with gravity compensation. It has
been shown that the device relieves 77% of a
user's sustaining moment to move a light
weight with a reduction in muscle effort of
64.5%. In Oguntosinet et al [21]
representation, he revealed a prototype of an
inexpensive, airy, and wearable soft robotic-
aided device that could assist a patient with
elbow motion therapies after a stroke occurs.
Finger joint dysfunction is a very crucial
problem due to its most complicated
anatomical nature. The fingers have 21
degrees of freedom (DOFs), including 5DOFs
for the thumb and the remaining four fingers
with 4 DOFs each for the index, middle, ring,
and little fingers.
Figure 6: Examples of soft exosuits for finger rehabilitation.
Suresh Gobee et al [20] proposed a portable
soft robot assistive device for finger
rehabilitation. It utilized electromyography
(EMG) signals to catch patients’ muscular
signals, amplified those signals, and
simulated solenoid valves for controlling
pneumatic actuators attached to the wearable
gloves. Yet Zhang et al [22] demonstrated a
conformal mechanism of a multi-material
pneumatic soft finger that was optimized to

obtain its maximum bending deflection and
also modified for artificial hand gripper,
rehabilitation and other practical applications.
Some exosuits are used for only one reason as
shoulder flexion or elbow flexion or wrist
bend and some exosuits are applied for
various reasons as Escudero et al [17]
presented a prototype for both shoulder and
elbow flexion, Chingyi Nam, et al. [25]
elaborated lightweight, ergonomic and low
power-demanding soft wearable robot for the
blooming system can aid the elbow, wrist, and
fingers to fulfil the following arm reaching in
a logical order and withdrawing through
EMG signals. These and many other reviews
show that soft exoskeletons are user-friendly,
low-cost, portable, lightweight, and ready to
move anywhere. Mainly soft exosuits are
made up of fabric or textile or elastomer that
bundle up around a user’s limbs and act
aligned to the limb [24].
III. Exoskeletons and AI control techniques:
AI is a technique to mimic human
intelligence. A machine can perform different
functions such as planning, learning, and
solving problems with artificial intelligence.
AI is a wide concept that usually requires
humans to carry out tasks performed by a
machine. Machine learning algorithm (MLA)
is the subset of AI which adopt and learn data
iteratively by statistical models and draw
useful hypothesis without human feedback.
Figure 7: Different techniques of AI used for robotic device
control.
6
Finally, Deep Learning is a special category
of MLA which uses artificial neural networks
to copy like the human brain. The evolution
of AI techniques is shown in Figure 7.
Advanced data acquisition, processing and
control techniques based on AI are much
more feasible in modern times that can be
more cost-effective than classic methods
applied in biomechatronic systems including
robotic exoskeletons. [1] [2]. Artificial neural
networks (ANN), adaptive algorithms, fuzzy
logic, and other mixed techniques are mostly
used for exoskeleton purposes. These
techniques are commonly used to detect
patterns or analyze motion patterns. Figure 8
illustrates the use of multiple AI-based data
processing and control techniques according
to the distribution of literature references.
Figure 8: General distribution of control techniques for
soft exoskeletons.
The development and application of
artificial intelligence (AI) techniques in this
field have become a current trend in late
2015 and will change this field with further
research in the future. The literature shows
that among AI processes that have been used
in rehabilitation, 40% focus on artificial
neural networks, 20% on adaptive
algorithms, and 40% on other mixed
techniques. Also, it was observed that only
16% of the articles concentrated on
neuromotor rehabilitation.
 7

No Ref Authors’ Yea Used AI Scope of Results Clinicall

No Name r Technique movement y Tested
1 26 Tageldee 2016 Fuzzy Elbow [1 DOF] Torque No
n et.al. interfacingc Estimation
ontroller
2 27 Sangha 2016 Neural Wrist [1 dof] Motor Recovery No
et.al. Network
3 28 Siddiqi et 2016 SVM with Thumb [1] Angle No
al Puk Kernel Estimation
4 29 Yu Lei et 2016 ELM Wrist [1] A potential Yes
al. algorithms approach to the
with SVM remote
quantitive
rehabilitation
5 30 Rethlep 2017 NARX Elbow [1] Joint Angle No
et.al. MLPNN velocity
estimation
6 34 Xin Li 2017 TDRNN Wrist[2] & Angle Yes
et.al. Hand[1] Estimation
7 39 Zhang 2018 BP Neural elbow & Wrist Angle No
Network [3] Estimation
8 38 Peng Xia 2018 CNN neural 3 DOF Improvement of No
et.al Network limb movement

9 36 Yudha P 2019 Reinforcem Shoulder[1],Elb Enhance the No

Pane ent learning ow[1], Base[1], control
et.al. based Wrist[3] performance
compensati
on

10 33 Yan 2019 LSTM Shoulder Joint Angle No

Chen Neural estimation
et.al. Network
11 32 Siqi Cai 2019 SVM 5 Standard Self- No
et.al. Machine Upper limb Rehabilitation
ML Method Motion (ReRobot)

12 41 Varghese 2019 ANN Shoulder (Multi- Bio-Inspired No

et al DOF) Kinematic
Sensing Suit

13 43 Zhu et al. 2021 CNN- Multi movement Predicts the No

LSTM (Upper and human
LowerLimb both knee/ankle joint
movement) trajectory
14 31 Hussain 2022 NARX-NN Elbow (2) Predicts the No
et al. Wrist (2) torques during
different eating
activities.

Some of published AI-based robotic devices
for exoskeletons are closely observed from
this growing field and based on those some
used techniques such as fuzzy logic, and
neural networks, etc are discussed in the table
as Tageldeen et.al. [26] in 2016 made a fuzzy
logic technique to estimate joint (elbow)
torque from relevant sEMG signals for
accurate control of exoskeleton. A compact
wearable robotic Orthosis is developed by
Sangha et.al.[22] for Wrist Assistance with
the help of neural network; where Siddiqi et
al [ 28] used support vector machine (SVM)
technique with puk kernel for thumb angle
estimation with an average accuracy of
86.5%. Yu Lei et al. [24] proposed a fugl-
meyer evaluation model using machine
learning algorithm and RRelief algorithm
implemented to discover the optimal feature
subset.
The research is growing in the rehabilitation
field with artificial intelligence every day
because upper limb disorders harm our daily
routine. No doubt eating activity is one of
them. To eliminate that type of problem
Hussain et al. [31] build a 4 DOFs dynamic
model for predicting torque during eating
activity process by using Nonlinear Auto-
Regressive network with exogenous input
Neural Network (NARX-NN).
We can see many types of AI techniques are
used to control the exoskeletons. Among
those traditional AI techniques make easy
paths for these robot-aided devices. From this
table, it can be understood that AI is suitable
for quantitative patient feedback by pre-
processing, monitoring progress, and tracking
outcomes in the retrieval process. Some of
them are clinically tested, and most of them
are in the prototype phase. In context, AI
cannot bind patients to a predetermined
motion and motivate patients with great
accuracy and reliability with their own
intention. Most of the AI-based exoskeletons
are not clinically tested, they need more
8
observations over it and will make them
usable.
IV. Intelligent soft exosuits:
An intelligent soft rehabilitation
exoskeleton is a combination of bionic
structure design and artificial intelligence
control algorithm. We can see from this
research that intelligent soft-exoskeleton or
exosuits is good for rehabilitation because of
their lightweight, portable, low-cost, user-
friendly, and travel-friendly nature with the
user’s intention. Artificial intelligence makes
the exoskeleton more intelligent and
ergonomic. In 2019, Varghese et al. [41]
presented a kinematic perception outfit for the
complex joint of shoulder joint. This
prototype proposed bio-inspired cable-driven
architecture which is trained by a mapping
based on ANN transfer sensor data to joint
angles but it does not friendly with
nonlinearity as friction, hysteresis, creep etc.
Hence the existing exoskeletons
cannot provide rehabilitation training without
any therapist due to low intelligence. Since
limb movements are uncertain, it is important
to recognize and analyze motor intentions and
provide proper training accordingly. Artificial
intelligence can control training by detecting
motion intention by physiological cues and
predict patient’s movements including the
ability of users. An intelligent controller is
able to build their reference trajectory from
the patient's state or learn to adjust the control
criteria. Qingcong et. al. [44] represent a
neuro-fuzzy adaptive controller which is drew
on radial basis function neural network
(RBFNN) for trajectory tracking. Therefore,
intelligent or adaptive controllers are more
suitable for rehabilitation training. Some
basic technologies are discussed below:

i. Actuation Process and Power
Transmission:
According to research status, the most used
the following actuation systems are cable-
driven modules, pneumatic actuators, shape
memory alloy-based actuators, and passive
actuators. The cable-driven actuator uses
cables and sheaths to transfer the power [46],
where sheaths are usually installed on the
surface of the body and follow the
correspondence path from the prime mover to
the anchor joint. In a pneumatic actuator, the
volume or shape is changed according to the
adjusting internal pressure and executes such
actions as elongation, bending, or shortening
[47]. But most of the pneumatic actuator-
driven exosuits need external connections for
heavy air sources, thatswhy they are not
unportable. Shape memory alloy-based
actuator is very popular as they are
lightweight, produce noiseless actuation [48].
Copaci et.al. [49] represent an exoskeleton
using a nonconventional actuation system
based on Bowden cable, Teflon sheath, and
SMA wire for elbow flexion. Passive
actuators mainly consist of spring and elastic
fabric, where quasi-passive actuators are
using spring, elastic fabric and quasi-passive
elements such as variable dampers or
electromagnetic clutch [50].
ii. Control techniques:
A powered exosuit must detect the user's
motion and provide information for human-
robot interactions that are controlled by an
appropriate control algorithm. The adaptive
controller can adjust some control parameters
to accommodate dynamic changes in human-
machine interaction. An adaptive [51]
proposed auxiliary controller with inverse
dynamic model attempted to provide
feedforward support for online learning.
Some extra torque can be added to the human
joint to reduce the gravity load in a limb by
using the gravity compensation control
algorithm [52]. Backlash compensation
9
control methods are mostly applied to cable-
driven exosuits to improve motion control
performance. Transmission is delayed by
friction between wire and sheath. To solve
this problem some researchers established a
backlash observing controller and non-linear
adaptive controller with hysteresis model
[53]. Another most popular control system is
bio-signal-based control. This control method
is processed with motion intention by the help
of physiological signals such as EMG, ECG,
EOG etc. A neural network controller is
developed to enhance torque estimation by
the combination of feedback signals, SEMG,
IMU, force sensor and motor encoder, etc.
[54]. A Kalman filter is used to identify joint
torque, a NN module to perceive the user’s
intent and PID controller for hybrid position
or torque feedback to achieve motion
guidance.
Finally, a set of soft wearable robots has been
designed for specific functional requirements
to support various human joints. In order to
improve human-machine compatibility and
assistive performance, related researchers
have been trying to create different methods
by accumulating rich technological
achievements in various processes. The
resulting prototypes can contribute
exceptionally well to many aspects of people's
daily lives.
Discussion:
The role of human upper limbs is very
important for performing personal activities
in daily life. A patient's daily activities can be
greatly affected due to improper functioning
of this organ due to neurological disorders or
surgery. The design of the exoskeleton still
requires many adaptations, such as moving
towards flexible, adaptable, wearable, and
lightweight structures, as some devices still
do not fully meet these criteria. Wire-actuated
and soft-structured exoskeletons are also
preferred in rehabilitation processes because
they are more friendly to everyday life due to
their lightness and performance as Thompson

et al [18] represent a cable-driven soft
actuation system for shoulder and elbow
joints for increasing muscle strength to
working labour. This technology can be
brought into the rehabilitation process with
some modifications. Benjamin’s 3D-printed
soft robotics wrist sleeve is capable of 70%
recovery and supports the fabrication process
of fold-based designs which may be able to
adapt in other applications. In Nam et al. [25]
paper said a lightweight, ergonomic and low
power-demanding soft wearable robot for
assisting elbow, wrist, and fingers by using
surface EMG signals.
The incorporation of different modes of
operation of the exoskeleton has been shown
to improve patient’s motor recovery. In the
paper of sangha et. al. [27] represents a multi-
mode orthosis for wrist rehabilitation. They
used passive, active, resistive and active
assistive modes for motor recovery with the
help of neural networks. Resistance mode
helped users reach full motion with current
muscle tone or unable to reach full range and
active assistive mode was used to assist the
user in reducing muscle abnormalities and
increasing interaction. The results displayed
that the robotic orthosis was capable to done
jobs successfully under any functional
parameters. Now the continued development
of new devices is suggested multi-mode
approaches.
Future research is trending toward creating
exoskeletons that actively learn from input
experiences and automatically adapt to the
environment or user as artificial intelligence
provides the basis for developing more
reliable systems. A variety of AI techniques
are incorporated into the study to find possible
solutions among which artificial neural
networks are popular. Since ANN has strong
non-linear properties, it shows a large effect
on continuous motion estimation results.
ANN makes robots movement smoother and
10
safer. As chiaradia [16] represents a smooth
control exosuits for elbow which detect
motion intention by using gravity
compensation.Some studies have also
become home base for self-rehabilitation after
the Covid pandemic [36].
Almost all enlisted robotics exoskeletons are
capable of muscle power strength but are not
intelligent enough to function alone. Yet
existing intelligent soft exoskeletons are not
suitable for clinical use due to some of their
shortcomings, with some exceptions. The
literature appears that there is a need to
develop integration methods for intelligent
systems and specialized hardware that cover
user needs in a global, comprehensive way.
Conclusion:
The soft exoskeleton is currently a boon for
everyday life. It protects our organs from
damage. A variety of exosuits have been
presented, each of them a new concept and
attitude to the device, which has been in the
form of prototypes, early clinical studies, and
sometimes extensive clinical and commercial
research to solve movement disorders and
rehabilitation problems. These concepts
require more extensive clinical trials to
become a complete and efficient plan. For
this, related researchers are trying to develop
different types of algorithms to achieve
different soft upper limb exosuits.
The present scenario of upper limb
rehabilitation systems shows that
transportable robotic exoskeletons composed
of intelligent control and information
processing systems can play an important role
in bridging the gap between prototype and
clinical acceptance. Additionally,
exoskeleton capabilities can be greatly
enhanced by improving materials and
incorporating a better mechanical design, and
improving motion sensing techniques.
 11

References: techniques on robot-assisted upper-limb

rehabilitation”. Advanced Robot.
1. Manuel Andrés Vélez-Guerrero, Mauro Volume 32, Issue 24,2018.
Callejas-Cuervo and Stefano Mazzoleni 9. David D. Luxton and Laurel D. Riek;
; “Artificial Intelligence-Based “Artificial Intelligence and Robotics in
Wearable Robotic Exoskeletons for Rehabilitation”; Chapter 30; Handbook
Upper Limb Rehabilitation: A Review”; of Rehabilitation Psychology, 2019.
MDPI; : 18 March 2021. 10. Qingsong Ai, Zemin Liu, Wei Meng,
2. Elena Bardi, Marta Gandolla, Francesco Quan Liu, and Sheng Q. Xie; “Machine
Braghin, Ferruccio Resta, Alessandra L. Learning in Robot-Assisted Upper Limb
G. Pedrocchi and Emilia Ambrosini; Rehabilitation: A Focused
“Upper limb soft robotic wearable Review”; IEEE Transactions on
devices: a systematic review”; Journal Cognitive and Developmental
of NeuroEngineering and Systems (Early Access); 19th July,2021.
Rehabilitation,2022. 11. Muhammad Ahsan Gull, Shaoping Bai
3. Chen, T.; Keravnou-Papailiou, E.; and Thomas Bak,” A Review on Design
Antoniou, G. “Medical analytics for of Upper Limb Exoskeletons”;
healthcare intelligence—Recent MDPI,2020.
advances and future directions”. Artif. 12. Andrea Demofonti, Giorgio Carpino,
Intell. Med. 2021. Loredana Zollo, Michelle J. Johnson,
4. Md Rasedul Islam*, Christopher “Affordable Robotics for Upper Limb
Spiewak, Mohammad Habibur Rahman Stroke Rehabilitation in Developing
and Raouf Fareh; “A Brief Review on Countries: A Systematic Review”; IEEE
Robotic Exoskeletons for Upper Transactions on Medical Robotics and
Extremity Rehabilitation to Find the Bionics , Volume: 3, Issue: 1, Feb.
Gap between Research Porotype and 2021.
Commercial Type”; Adv Robot Autom, 13. Zaira Pineda-Rico, Jose Alfonso
an open access journal Volume 6 Issue 3 Sanchez de Lucio, Francisco Javier
1000177 ISSN: 2168-9695;2017. Martinez Lopez, Pedro Cruz; “Design of
5. Alan Francisco Pérez Vidal, Jesse Yoe an exoskeleton for upper limb robot-
Rumbo Morales, Gerardo Ortiz Torres, assisted rehabilitation based on co-
Felipe de Jesús Sorcia Vázquez, Alan simulation”; Journal of
Cruz Rojas, Jorge Aurelio Brizuela Vibroengineering, Vol 18, Issue 5, Aug
Mendoza and Julio César Rodríguez 2016.
Cerda; “Soft Exoskeletons: 14. Manuel Andres Velez-Guerrero, Mauro
Development, Requirements, and Callejaw-Cuervo and Stefano
Challenges of the Last Decade”; MDPI, Mazzoleni ;“Design, Development,
journal,actuators, July 2021. and Testing of an Intelligent
6. Mekki, M.; Delgado, A.D.; Fry, A.; Wearable Robotic Exoskeleton
Putrino, D.; Huang, V. Robotic
Prototype for Upper Limb
Rehabilitation and Spinal Cord Injury: A
Narrative Review. Neurotherapeutics Rehabilitation”; Journal of
2018. Sensors,MDPI,10 Aug,2021.
7. De la Tejera, J.A.; Bustamante-Bello, 15. Emanuele Palazzi, Luca Luzi, Eldison
R.; Ramirez-Mendoza, R.A.; Izquierdo- Dimo, Matteo Meneghetti, Rudy
Reyes, J. “Systematic review of Vicario, Rafael Ferro Luzia, Rocco
exoskeletons towards a general Vertechy and Andrea Calanca ; “An
categorization model proposal”. Affordable Upper-Limb Exoskeleton
Applied Science Journal, 2021. Concept for Rehabilitation
8. Miao, Q.; Zhang, M.; Cao, J.; Xie, S.Q. Applications”; Journal Of
“Reviewing high-level control Technologies,MDPI, 2022.

16. Domenico Chiaradia, Michele
Xiloyannis, Chris W. Antuvan, Antonio
Frisoli, Lorenzo Masia; “Design and
Embedded Control of a Soft Elbow
Exosuit”; 8 IEEE International
Conference on Soft Robotics
(RoboSoft); Italy, April 24-28, 2018.
17. Jose Luis Samper-Escudero, Antonio
Gimenez-Fernandez, Miguel Ángel
Sanchez-Uran, and Manuel Ferre; “A
Cable-Driven Exosuit for Upper Limb
Flexion Based on Fibres Compliance”;
IEEEAccess, August 21, 2020.
18. Nicholas Thompson, Ayush Sinha and
Girish Krishnan; “Characterizing
Architectures of Soft Pneumatic
Actuators for a Cable-Driven Shoulder
Exoskeleton”; International Conference
on Robotics and Automation (ICRA),
Canada, May 20-24, 2019.
19. Suresh Gobee, Vickneswari Durairajah,
Naqibullah Mohammadullah; “Portable
Soft-exoskeleton for Finger
Rehabilitation”; Association for
Computing Machinery(ACM Digital
Library); , Bangkok, Thailand ,
September 14–16, 2017.
20. Benjamin W.K. Ang, Chen-Hua Yeow;
“Design and Characterization of a 3D
Printed Soft Robotic Wrist Sleeve with
2 DoF for Stroke Rehabilitation”; IEEE
International Conference on Soft
Robotics (RoboSoft), , Korea, April 14-
18, 2019.
21. Victoria Oguntosin, William S. Harwin,
Sadao Kawamura, Slawomir J. Nasuto
and Yoshikatsu Hayashi; ”Development
of a Wearable Assistive Soft Robotic
Device for Elbow Rehabilitation”; IEEE
International Conference on
Rehabilitation Robotics (ICORR),2015.
22. Hongying Zhang, A. Senthil Kumar,
Feifei Chen, Jerry Y. H. Fuh, and
Michael Yu Wang;” Topology
Optimized Multimaterial Soft Fingers
for Applications on Grippers,
Rehabilitation and Artificial Hands”;
IEEE/ASME TRANSACTIONS ON
MECHATRONICS,2018.
23. Yuejun Xu; “Design and Simulation of
a Soft Robotic Device for Wrist
12
Rehabilitation”; International
Conference on Advanced Electronic
Materials, Computers and Software
Engineering (AEMCSE); 24-26 April
2020.
24. Michele Xiloyannis , Domenico
Chiaradia, Antonio Frisoli and Lorenzo
Masia; “Physiological and kinematic
effects of a soft exosuit on arm
movements”; Journal of
NeuroEngineering and
Rehabilitation,2019.
25. Chingyi Nam, Wei Rong, Waiming Li,
Chingyee Cheung, Wingkit Ngai,
Tszching Cheung, Mankit Pang, Li Li,
Junyan Hu, Honwah Wai, and Xiaoling
Hu; “An Exoneuromusculoskeleton for
Self-Help Upper Limb Rehabilitation
After Stroke”; SOFT ROBOTICS
Volume 00, Number 00, 2020.
26. Momen Kamal Tageldeen, N.
Perumal2*, I. Elamvazuthi3 and 4 T.
Ganesan ;“Design and Control of an
Upper Arm Exoskeleton using Fuzzy
Logic Techniques”; IEEE;2016.
27. Sohail Sangha, Ahmed M. Elnady,
Student Member, IEEE, and Carlo
Menon, Member, IEEE; “A Compact
Robotic Orthosis for Wrist Assistance”;
6th IEEE RAS/EMBS International
Conference on Biomedical Robotics and
Biomechatronics (BioRob) June 26-29,
2016.
28. Abdul Rahman Siddiqi, Shahrul Naim
Sidek, Aida Khorshidtalab; “Signal
Processing of EMG Signal for
Continuous Thumb-Angle Estimation”;
978-1-4799-1762-4/15/$31.00 ©2015
IEEE, 2015.
29. Lei Yua,b,∗, Daxi Xiong a, Liquan Guo
a, Jiping Wang a; ” A remote
quantitative Fugl-Meyer assessment
framework for stroke patients based on
wearable sensor networks”; computer
methods and programs in biomedicine
128 ( 2 0 1 6 ) 100–11.
30. Retheep Raj, K S Sivanandan; “Elbow
joint angle and elbow movement
velocity estimation using NARX-
multiple layer perceptron neural
network model with surface EMG time

domain parameters”; NIH, Pubmed.gov;
2017.
31. Zakia Hussain & Norsinnira Zainul
Azlan; “Estimation of the Torques
Produced by Human Upper Limb during
Eating Activities Using NARXNN”;
Applied Artificial Intelligence, An
International Journal; 16 Feb 2022.
32. Siqi Cai, Yan Chen, Shuangyuan
Huang, Yan Wu, Haiqing Zheng, Xin Li
3 and Longhan Xie1; SVM-Based
Classification of sEMG Signals for
Upper-Limb Self-Rehabilitation
Training; 4th June,2019.
33. Yan Chen, Song Yu, Ke Ma,
Shuangyuan Huang, Guofeng Li, Siqi
Cai, and Longhan Xie; “A Continuous
Estimation Model of Upper Limb Joint
Angles by Using Surface
Electromyography and Deep Learning
Method”; IEEE Access,2019.
34. Xin Li, Qiang Huang, Jinying Zhu,
Wentao Sun and Haotian She; “A Novel
Proportional and Simultaneous Control
Method for Prosthetic Hand” Journal of
Mechanics in Medicine and Biology
Vol. 17, No. 8 ,2017.
35. Manuel Andrés Vélez-Guerrero, Mauro
Callejas-Cuervo and Stefano Mazzoleni
; “Artificial Intelligence-Based
Wearable Robotic Exoskeletons for
Upper Limb Rehabilitation: A Review”;
MDPI;18 March 2021.
36. Yudha P. Pane, Subramanya P.
Nageshrao, Jens Kober, Robert
Babuška; “Reinforcement learning
based compensation methods for robot
manipulators”; Engineering
Applications of Artificial Intelligence
,2019.
37. Kai Zhang, Xiaofeng Chen, Fei Liu,
Haili Tang, Jing Wang, and Weina Wen;
“System Framework of Robotics in
Upper Limb Rehabilitation on
Poststroke Motor Recovery”; Hindawi
Behavioural Neurology Volume 2018.
38. Peng Xia, Jie Hu Ying-hong Peng
;“EMG‐Based Estimation of Limb
Movement Using Deep Learning With
Recurrent Convolutional Neural
Network”; International Center for
13
Artificial Organs and Transplantation and
Wiley Periodicals , Volume 42, Issue 5 ;
May 2018.
39. Lei Zhang;“An upper limb movement
estimation from electromyography by
using BP neural network”; Biomedical
Signal Processing and Control, Volume
49, March 2019.
40. Chloë Nicholson-Smith, Vahid
Mehrabi, S. Farokh Atashzar, and Rajni
V. Patel; “A Multi-Functional Lower-
and Upper-Limb Stroke Rehabilitation
Robot”, IEEE Transactions on Medical
Robotics and Bionics, Vol. 2, No. 4,
November 2020.
41. Rejin John Varghese, Benny P L Lo, and
Guang-Zhong Yang; “Design and
Prototyping of a Bio-inspired Kinematic
Sensing Suit for the Shoulder Joint:
Precursor to a Multi-DoF Shoulder
Exosuit”; IEEE Robotics and
Automation Letters Preprint Vertion.
Dec, 2019.
42. Wang, W.; Li, H.; Xiao, M.; Chu, Y.;
Yuan, X.; Ming, X.; Zhang, B. Design
and verification of a human–robot
interaction system for upper limb
exoskeleton rehabilitation. Medical
Engineering and Physics. volume 79,
2020.
43. Chang Zhu, Quan Liu, Member, IEEE,
Wei Meng, Member, IEEE, Qingsong
Ai, Member, IEEE, Sheng Q Xie, Senior
Member, IEEE; “An Attention-Based
CNN-LSTM Model with Limb Synergy
for Joint Angles Prediction*”; 2021
IEEE/ASME International Conference
on Advanced Intelligent Mechatronics
(AIM)
44. Wu Qingcong, Wang Xingsong, Chen
Bai, Wu Hongtao; “Development of an
RBFN-based neural – fuzzy adaptive
control strategy for an upper limb
rehabilitation exoskeleton”The journal
of Mechatronics, vol 53, August,2018.
45. Michele Xiloyannis, Ryan Alicea,
Anna-Maria Georgarakis, Florian L.
Haufe, Peter Wolf, Lorenzo Masia, and
Robert Riener, “Soft robotic suits: State
of the art, core technologies and open
challenges”; IEEE Transactions on
 14

Robotics, Volume: 38, Issue: 3, June Flexion Movements With an Ergonomic

2022. Reinforced Glove. Front. Robot. AI
46. Asbeck, A.T.; Dyer, R.J.; Larusson, 2020.
A.F.; Walsh, C.J. Biologically-inspired 53. Dinh, B.K.; Xiloyannis, M.; Cappello,
soft exosuit. In Proceedings of the 13th L.; Antuvan, C.W.; Yen, S.-C.; Masia,
IEEE International Conference on L. Adaptive backlash compensation in
Rehabilitation Robotics (ICORR), Univ upper limb soft wearable exoskeletons.
Washington Campus, Seattle, WA, Robot. Auton. Syst. 2017.
USA, 24–26 June 2013. 54. Wu, Q.; Chen, B.; Wu, H. Neural-
47. Sridar, S.; Poddar, S.; Tong, Y.; network-enhanced torque estimation
Polygerinos, P.; Zhang, W. Towards control of a soft wearable exoskeleton
untethered soft pneumatic exosuits for elbow assistance. Journal of
using low-volume inflatable actuator Mechatronics, 2019.
composites and a portable pneumatic
source. IEEE Robot. Autom. Lett. 2020.
48. Dorin-Sabin Copai, Dolores Blanco,
Alejandro Martin-Clemente, Luis
Moreno; “Flexible shape memory alloy
actuators for soft robotics: Modelling
and control”; Sage Journals,
International Journal of Advanced
Robotic System, January,2020.
49. Dorin Copaci, Enrique Cano, Luis
Moreno and Dolores Blanco; “New
Design of a Soft Robotics Wearable
Elbow Exoskeleton based on Shape
Memory alloy wire actuarors”; Hindawi
Applied Bionics and
Biomechanics,2017.
50. Poliero, T.; Di Natali, C.; Sposito, M.;
Ortiz, J.; Graf, E.; Pauli, C.; Bottenberg,
E.; De Eyto, A.; Caldwell, D.G. Soft
Wearable Device for Lower Limb
Assistance: Assessment of an Optimized
Energy Efficient Actuation Prototype. In
Proceedings of the 1st IEEE-RAS
International Conference on Soft
Robotics (RoboSoft), Livorno, Italy,
24–28 April 2018.
51. Wilkening, A.; Stoppler, H.; Ivlev, O.
Adaptive Assistive Control of a Soft
Elbow Trainer with Self-Alignment
using Pneumatic Bending Joint. In
Proceedings of the 14th IEEE/RAS-
EMBS International Conference on
Rehabilitation Robotics (ICORR),
Nanyang Technology University,
Singapore, 11–14 August 2015.
52. Chiaradia, D.; Tiseni, L.; Xiloyannis,
M.; Solazzi, M.; Masia, L.; Frisoli, A.
An Assistive Soft Wrist Exosuit for