Abstract

Wearable robotic upper limb orthoses (ULO) are promising tools to assist or enhance the upper-limb function of their users. While the functionality of these devices has continuously increased, the robust and reliable detection of the user's intention to control the available degrees of freedom remains a major challenge and a barrier for acceptance. As the information interface between device and user, the intention detection strategy (IDS) has a crucial impact on the usability of the overall device. Yet, this aspect and the impact it has on the device usability is only rarely evaluated with respect to the context of use of ULO. A scoping literature review was conducted to identify non-invasive IDS applied to ULO that have been evaluated with human participants, with a specific focus on evaluation methods and findings related to functionality and usability and their appropriateness for specific contexts of use in daily life. A total of 93 studies were identified, describing 29 different IDS that are summarized and classified according to a four-level classification scheme. The predominant user input signal associated with the described IDS was electromyography (35.6%), followed by manual triggers such as buttons, touchscreens or joysticks (16.7%), as well as isometric force generated by residual movement in upper-limb segments (15.1%). We identify and discuss the strengths and weaknesses of IDS with respect to specific contexts of use and highlight a trade-off between performance and complexity in selecting an optimal IDS. Investigating evaluation practices to study the usability of IDS, the included studies revealed that, primarily, objective and quantitative usability attributes related to effectiveness or efficiency were assessed. Further, it underlined the lack of a systematic way to determine whether the usability of an IDS is sufficiently high to be appropriate for use in daily life applications. This work highlights the importance of a user- and application-specific selection and evaluation of non-invasive IDS for ULO. For technology developers in the field, it further provides recommendations on the selection process of IDS as well as to the design of corresponding evaluation protocols.

Highlights

  • Our upper limbs are essential for numerous tasks in our daily lives, allowing us to interact physically and socially with our environment

  • We hypothesize that the intention detection strategy (IDS) as the interface between users and their upper limb orthoses (ULO) plays an essential role in the usability of the overall device perceived by the user

  • We aim to provide technology developers with an evidence-based overview of the key aspects to consider for the selection of appropriate non-invasive IDS for ULO applications

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Summary

Introduction

Our upper limbs are essential for numerous tasks in our daily lives, allowing us to interact physically and socially with our environment. Robotic wearable orthoses for the upper limbs, i.e., for the shoulder, elbow, wrist, hand or fingers, emerged as tools to compensate for functional impairments and aim to improve quality of life of their users. The potential of wearable upper-limb orthoses (ULO), in this context often called “exoskeletons,” has further been exploited for people with impairments and to complement or augment upper limb function of non-impaired users, e.g., by enhancing their strength or endurance in specific tasks in their work environment (Bergamasco and Herr, 2016; Thalman and Artemiadis, 2020). The usability of a device describes how well it can be used by a specific user and context of use (ISO 9241-11, 2018). The question of whether a person is able and willing to use a specific IDS highly depends on the person’s residual sensorimotor capabilities and the tasks for which the device is intended. Research papers describing the development or application of IDS for ULO rarely cover all these decisive factors

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