Effectiveness and Users’ Perceptions of Upper Extremity Exoskeletons and Robot-Assisted Devices in Children with Physical Disabilities: Systematic Review

Abstract

Aim

Systematically determine the effectiveness and users’ perceptions of upper extremity (UE) exoskeletons and robot-assisted devices for pediatric rehabilitation.

Methods

PubMed/Medline, Web of Science, Scopus, and Cochrane Library were searched for studies with “exoskeletons”/“robot-assisted devices”, children with disabilities, effectiveness data, and English publication. Intervention effectiveness outcomes were classified within components of the International Classification of Functioning, Disability, and Health, Children and Youth Version (ICF-CY). Secondary data (users’ perceptions; implementation setting) were extracted. Risk of bias and methodological quality were assessed. Descriptive analyses were performed.

Results

Seventy-two articles were included. Most evaluated body structure and function and activity outcomes with less emphasis on participation. Most effects across all ICF-CY levels were positive. Devices were primarily evaluated in clinical or laboratory rather than natural environments. Perceptions about device effectiveness were mostly positive, while those about expression, accessibility, and esthetics were mostly negative. A need for increased rigor in research study design was detected.

Conclusions

Across populations, devices, settings, interventions, and dosing schedules, UE exoskeletons and robot-assisted devices may improve function, activity, and perhaps participation for children with physical disabilities. Future work should transition devices into natural environments, design devices and implementation strategies to address users’ negative perceptions, and increase research rigor.

Graphical Abstract

Keywords:

• Disability
• exoskeleton device
• pediatric
• robot-assisted device
• systematic review
• upper extremity

Acknowledgements

The authors would like to thank the research assistants for helping to support data acquisition and management.

Disclosure Statement

The authors report no conflicts of interest, financial or otherwise.

Additional information

Funding

This research was supported by the National Science Foundation (#1722596, Lobo).

Notes on contributors

Bai Li

Bai Li, MS, PhD, is a Design Engineer for ILC Dover Astrospace. She received her PHD in Biomechanics and Movement Science from the University of Delaware (UD), and Master in Fashion and Apparel Studies in UD. During her PHD, she was doing research with Dr. Michele Lobo, and working on an NSF-funded project to develop and evaluate a soft exoskeleton for children with disabilities affecting arm movement.

Andrea B. Cunha

Andrea B. Cunha, PT, PhD, is an Assistant Professor in the Department of Physical Therapy at the Munroe-Meyer Institute, University of Nebraska Medical Center. She has a bachelor's degree, master's degree, and PhD in Physical Therapy. She conducted post-doctoral research in the Move 2 Learn Innovation Lab at the University of Delaware. She has experience in clinical teaching, as a researcher and a clinician in pediatric physical therapy. Her work focus assessing play interventions and family-friendly focus to advance development for infants and children with or at risk for motor delays. She is also interested to test and design low-cost technologies using a user-centered design approach for children with physical disabilities.

Michele A. Lobo

Michele A. Lobo, PT, PhD, is passionate about bringing together experts across disciplines to design interventions, wearable technology, and FUNctional Fashions to maximize participation, play, and learning for people with disabilities. She is co-Director of the Move to Learn Innovation Lab and Director of the Super Suits FUNctional Fashion and Wearable Technology Program at the University of Delaware. Her group has developed and tested a variety of effective activity-based interventions as well as low- and high-tech rehabilitation tools, including the Playskin Lift^TM, the first exoskeletal garment for rehabilitation.