Current Trends and Challenges in Pediatric Access to Sensorless and Sensor-Based Upper Limb Exoskeletons

Abstract

Sensorless and sensor-based upper limb exoskeletons that enhance or support daily motor function are limited for children. This review presents the different needs in pediatrics and the latest trends when developing an upper limb exoskeleton and discusses future prospects to improve accessibility. First, the principal diagnoses in pediatrics and their respective challenge are presented. A total of 14 upper limb exoskeletons aimed for pediatric use were identified in the literature. The exoskeletons were then classified as sensorless or sensor-based, and categorized with respect to the application domain, the motorization solution, the targeted population(s), and the supported movement(s). The relative absence of upper limb exoskeleton in pediatrics is mainly due to the additional complexity required in order to adapt to children’s growth and answer their specific needs and usage. This review highlights that research should focus on sensor-based exoskeletons, which would benefit the majority of children by allowing easier adjustment to the children’s needs. Sensor-based exoskeletons are often the best solution for children to improve their participation in activities of daily living and limit cognitive, social, and motor impairments during their development.

Intelligent Robotics in Pediatric Cooperative Neurorehabilitation: A Review

“…Exoskeletons hold great promise in assistive robotics since they can provide embodied sensing and actuation that supports natural movements. For example, lower limb multijoint exoskeletons were shown to improve ankle-knee moving dynamics [55][56][57], and higher limb exoskeletons were shown to improve arm-shoulder and elbow movements in children with CP [58,59]. Advances in AI contribute to powering the performance of assistive robots and the range of applications they can support [60].…”

From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy

“…Similarly, early interventions such as the GAME intervention [492,494], the Supporting Play Exploration and Early Development Intervention (SPEEDI [550]), and the Sitting Together and Reaching to Play intervention (START-Play [551,552]) have been shown to improve children's sensorimotor and motor skills. Furthermore, early interventions involving wearable technologies, such as "sticky mittens" [442,553] or exoskeletons [327,531,[554][555][556] might help children with CP who struggle with low muscle tone. The "sticky mittens" may allow a higher level of object engagement and more sophisticated object exploration in the absence of fine-motor movements in the affected hand; the experience of "grasping" a toy with the assistance of Velcro may reinforce the action and allow children to observe the consequences of their own actions [442].…”

Identification of Users’ Needs for Pediatric Upper Extremity Exoskeletons

“…[1][2][3][4][5] UE exoskeletons are devices designed to be worn to provide external support to enhance range of motion, reduce energy expenditure, assist weight-bearing activities, and improve the functional performance of daily tasks. 8,9 They may be made of soft or hard materials and incorporate passive mechanisms, such as elastic bands or springs, or powered mechanisms, such as motors or pumps, to provide movement support. 5 Examples of the UE exoskeletons currently available to children include the A Pediatric Whole Hand Exoskeleton, Playskin Lift, and Wilmington Robotic Exoskeleton.…”

“…Several researchers have begun to evaluate the impact of exoskeletons for UE rehabilitation in recent years 1-5. UE exoskeletons are devices designed to be worn to provide external support to enhance range of motion, reduce energy expenditure, assist weight-bearing activities, and improve the functional performance of daily tasks 8,9. They may be made of soft or hard materials and incorporate passive mechanisms, such as elastic bands or springs, or powered mechanisms, such as motors or pumps, to provide movement support 5.…”