Optimal design of a wheelchair-mounted robotic arm for activities of daily living

BACKGROUND Tetraplegia, often resulting from cervical spinal cord injury (SCI), may lead to significant motor and sensory loss, severely impacting independence and quality of life. Assistive technologies (ATs), such as wheelchair-mounted robotic arms (WMRAs), offer potential to enhance autonomy in daily living. However, adoption remains limited due to high costs, complex controls, and insufficient end-user involvement. Robust evidence on their real-world effectiveness, particularly post-hospitalisation, is still lacking. OBJECTIVE This study explores the real-life use of a WMRA for individuals with tetraplegia. It aims to evaluate its support in activities of daily living (ADLs), assess usability and satisfaction, and conduct a preliminary health economic analysis comparing cost-effectiveness and quality of life outcomes with standard care. METHODS This study will be conducted in post-hospitalisation settings in Switzerland. Up to 15 participants with upper limb impairments (SCI C0–Th1, AIS A–D) using powered wheelchairs will be recruited. They will use the robotic arm for six consecutive days. An equal number of participants will be recruited for the economic analysis group. A mixed methods approach will combine quantitative data collected via standardised questionnaires (PSSUQ, NASA-TLX, EQ-5D-5L, VAS, aCOMP, CSSRI-EU) at baseline and post-intervention, along with qualitative feedback gathered through an informal questionnaire and semi-structured interviews. Feasibility will be assessed through task performance and health economic analysis. The latter will include quality-adjusted life years (QALY), which quantify quality and length of life, and modelling the Incremental Cost-Effectiveness Ratio (ICER), which compares the cost-effectiveness of the intervention based on cost per QALY gained. RESULTS We expect the robotic system to reduce caregiver time and associated costs, while enhancing autonomy, quality of life, and mental well-being. Potential technical and recruitment challenges have been identified and mitigation strategies planned. By evaluating real-life use of a WMRAs, this study may support the broader adoption of assistive robotic technologies. CONCLUSIONS This research offers key insights into the feasibility, usability, and economic value of robotic assistance for individuals with tetraplegia and will help inform future development and scale-up studies.

This paper focuses on kinematic analysis and evaluation of wheelchair mounted robotic arms (WMRA). It addresses the kinematics of the WMRA with respect to its ability to reach common positions while performing activities of daily living (ADL). A procedure is developed for the kinematic analysis and evaluation of a WMRA. In an effort to evaluate two commercial WMRAs, the procedure for kinematic analysis is applied to each manipulator. Design recommendations and insights with regard to each device are obtained and used to design a new WMRA to overcome the limitations of these devices. This method benefits the researchers by providing a standardized procedure for kinematic analysis of WMRAs that is capable of evaluating independent designs.

Purpose Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs. Methods This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics. Results Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists’ contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers. Conclusion This survey provides novel insight into occupational therapists’ perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs. Implications for rehabilitation Most occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams. WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings. Many barriers remain, impeding occupational therapists’ role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

Electric wheelchair-mounted robotic arms can help patients with disabilities to perform their activities in daily living (ADL). Joysticks or keypads are commonly used as the operating interface of Wheelchair-mounted robotic arms. Under different scenarios, some patients with upper limb disabilities such as finger contracture cannot operate such interfaces smoothly. Recently, manual interfaces for different symptoms to operate the wheelchair-mounted robotic arms are being developed. However, the stop the wheelchairs in an appropriate position for the robotic arm grasping task is still not easy. To reduce the individual’s burden in operating wheelchair in narrow spaces and to ensure that the chair always stops within the working range of a robotic arm, we propose here an operating system for an electric wheelchair that can automatically drive itself to within the working range of a robotic arm by capturing the position of an AR marker via a chair-mounted camera. Meanwhile, the system includes an error correction model to correct the wheelchair’s moving error. Finally, we demonstrate the effectiveness of the proposed system by running the wheelchair and simulating the robotic arm through several courses.

This paper focuses on kinematic analysis, evaluation and design of wheelchair mounted robotic arms (WMRA). It addresses the kinematics of the WMRA with respect to its ability to reach common positions while performing activities of daily living (ADL). A procedure is developed for the kinematic analysis and evaluation of WMRAs. In an effort to evaluate two commercial WMRAs, the procedure for kinematic analysis is applied to each manipulator. Design recommendations and insights with regard to each device are obtained and used to design a new WMRA to overcome the limitations of these devices. This method benefits the researchers by providing a standardized procedure for kinematic analysis of WMRAs that is capable of evaluating independent designs

Purpose This review examines wheelchair-mounted robotic arms (WMRAs) as an emerging assistive technology that enhances independence and quality of life for individuals with upper- and lower-limb disabilities. By enabling independent performance of activities of daily living (ADLs), WMRAs hold significant promise for disability and rehabilitation. The article aims to critically evaluate the state of the art in WMRA research and development, identifying persistent challenges and highlighting promising innovations. Materials and Methods The review systematically analyzes literature on WMRAs published between 2001 and 2025. The analysis emphasizes design specifications, degrees of freedom, actuation methods, control strategies, and performance evaluations. A comparative synthesis is conducted to assess how existing systems support ADL execution, while also integrating technical considerations with user-centered outcomes. Results and Conclusions The findings indicate that current WMRA designs face significant limitations, including restricted workspace coverage, inadequate gripper dexterity, suboptimal kinematic configurations, limited payload capacity, high cost, and lack of modularity. Safety mechanisms remain underdeveloped, creating barriers to broader adoption. Nevertheless, advancements in AI-driven control systems, modular design strategies, and integration with complementary assistive technologies demonstrate promising progress. The review concludes that WMRAs have substantial potential to improve autonomy and daily functioning for individuals with disabilities. Addressing technical and practical shortcomings is essential to ensure successful real-world deployment. These insights contribute to disability and rehabilitation research, as they highlight pathways to enhance accessibility, safety, and cost-effectiveness in assistive technologies that support independent living.

Wheelchair-mounted robotic arms support people with upper extremity disabilities with various activities of daily living (ADL). However, the associated cost and the power consumption of responsive and adaptive assistive robotic arms contribute to the fact that such systems are in limited use. Neuromorphic spiking neural networks can be used for a real-time machine learning-driven control of robots, providing an energy efficient framework for adaptive control. In this work, we demonstrate a neuromorphic adaptive control of a wheelchair-mounted robotic arm deployed on Intel’s Loihi chip. Our algorithm design uses neuromorphically represented and integrated velocity readings to derive the arm’s current state. The proposed controller provides the robotic arm with adaptive signals, guiding its motion while accounting for kinematic changes in real-time. We pilot-tested the device with an able-bodied participant to evaluate its accuracy while performing ADL-related trajectories. We further demonstrated the capacity of the controller to compensate for unexpected inertia-generating payloads using online learning. Videotaped recordings of ADL tasks performed by the robot were viewed by caregivers; data summarizing their feedback on the user experience and the potential benefit of the system is reported.

There has been significant progress in bringing commercially-viable wheelchair mounted robotic arms (WMRA) into the marketplace in the past 30 years. This paper focuses on kinematic analysis and evaluation of such robotic arms. It addresses the kinematics of the WMRA with respect to its ability to reach common positions while performing activities of daily living (ADL). A procedure is developed for the kinematic analysis and evaluation of a wheelchair mounted robotic arm. In addition to developing the analytical procedure, the manipulator is evaluated, and design recommendations and insights are obtained. Current commercially-available wheelchair mountable robotic manipulators have been designed specifically for use in rehabilitation robotics. In an effort to evaluate two commercial manipulators, the procedure for kinematic analysis is applied to each manipulator. Design recommendations with regard to each device are obtained. This method will benefit the researchers by providing a standardized procedure for kinematic analysis of WMRAs that is capable of evaluating independent designs.

With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required. To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke. We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers. Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. PRIMARY OUTCOMES were performance in activities of daily living (ADL) and functional movement of the upper limb. SECONDARY OUTCOMES were performance in extended ADL and motor impairment of the arm. Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting. We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care. we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)). no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14). There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care.

Children with hemiparesis experience limitations in activities of daily living (ADLs) as a result of upper limb impairments. To address these limitations, we developed a group-based Personalized Upper Limb Intensive Therapy (PULIT) program combining modified constraint-induced movement therapy, bimanual intensive therapy, and exergame-based robotics. To determine the effectiveness of PULIT in helping children with upper limb impairments achieve individually set goals and enable transfer of the attained motor skills into ADLs. Retrospective analysis. Day camp at a pediatric rehabilitation clinic in Switzerland. Twenty-three children with upper limb impairment (unilateral cerebral palsy, n = 16; acquired brain injury, n = 7); 13 boys and 10 girls (M age = 7 yr, 8 mo, SD = 2 yr, 1 mo; Manual Ability Classification System Level I-IV). Thirty hours of PULIT over the course of 8 days. Goal attainment scaling (GAS) was assessed on the first and last day of intervention. The Canadian Occupational Performance Measure (COPM) and dexterity tests, such as the Box and Block Test (BBT), were administered 3 wk before and 3 wk after the intervention. Total goal achievement was 85.7%. GAS, parent- and child-rated COPM Performance and Satisfaction, and the BBT of the affected and dominant upper limb improved significantly. PULIT effectively increases children's dexterity of the impaired and dominant upper limb, improves ADL performance, and achieves individual goals. This retrospective analysis could serve as a basis for a future randomized trial. What This Article Adds: This article informs occupational therapy practitioners about a therapy program that includes conventional and rehabilitation technology interventions and enables children with hemiparesis of the upper limb to improve relevant ADL tasks in 8 days' time.

Wheelchair Mounted Robotic Arms: Occupational Therapy Perceptions and Practices

As the population aging becomes more severe, the development of Wheelchair Mounted Robotic Arms (WMRA) has gained greater attention. There are remaining issues that haven't been properly tackled, such as human-robot interaction and real-time performance. In this paper, laser pointer is used to facilitate the interaction between human and the WMRA, and an improved target matching method is proposed for laser point detection in home environment. Firstly, the laser point's characteristics are amplified through the use of channel separation technique and reflective materials. Then, the laser point is separated from the image using background difference method. Finally, through ASUS Xtion, the distance between laser point and the centroid coordination of object is calculated, and then Kinova Jaco robotic arm is used for grasping. The experimental result shows that the algorithm can effectively detect laser point in the home environment, and as a human-robot interaction, the robotic arm successfully completes the task of demo grasp.

Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.

Upper extremity functioning is important for achieving independence in activities of daily living (ADL). A better understanding of relationships between different aspects of independence in ADL after spinal cord injury (SCI) and upper extremity functioning is required to guide rehabilitation practices. To determine which aspects of independence in ADL are correlated with upper extremity functioning in individuals with cervical or thoracic SCI. A total of 25 adults (mean age 58.4 years, 72% men) with established cervical or thoracic SCI were recruited. Independence in ADL was assessed by Spinal Cord Independence Measure (SCIM-III) and upper extremity functioning by kinematic measures (movement time, smoothness, and wrist angle during drinking task), grip strength, Upper Extremity Motor and Sensory Score, Box and Block Test (BBT), Action Research Arm Test (ARAT), and Upper Extremity Basic Data Set (ISCI-Hand and ISCI-Shoulder). Spearman correlation coefficients were used for data analyses. The SCIM-self-care subscale, particularly the feeding and dressing items, correlated moderately (r ≥ 0.5) with movement time and smoothness, grip strength, ARAT, BBT, and ISCI-Hand. The SCIM-respiration/sphincter subscale and the SCIM-mobility showed very low and low correlations with upper extremity assessments. However, at item level, respiration and bed/wheelchair mobility showed moderate correlations. Independence in self-care as domain and feeding/dressing, respiration and bed/wheelchair mobility as separate items were dependent on upper extremity functioning in individuals with cervical or thoracic SCI. Movement time and smoothness along with BBT, grip strength, ARAT, and ISCI-Hand can be used as indicators of independence in ADL. These findings can provide guidance to clinical practice in selection of upper extremity assessments in the context for ADL in individuals with SCI.

IntroductionVirtual reality (VR), augmented reality (AR), and mixed reality (MR) are emerging technologies in the field of stroke rehabilitation that have the potential to overcome the limitations of conventional treatment. Enhancing upper limb (UL) function is critical in stroke impairments because the upper limb is involved in the majority of activities of daily living (ADL).MethodsThis study reviewed the use of virtual, augmented and mixed reality (VAMR) methods for improving UL recovery and ADL, and compared the effectiveness of VAMR treatment to conventional rehabilitation therapy. The databases ScienceDirect, PubMed, IEEE Xplore, and Web of Science were examined, and 50 randomized control trials comparing VAMR treatment to standard therapy were determined. The random effect model and fixed effect model are applied based on heterogeneity.ResultsThe most often used outcomes of UL recovery and ADL in stroke rehabilitation were the Fugl-Meyer Assessment for Upper Extremities (FMA-UE), followed by the Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), and the Functional Independence Measure (FIM). According to the meta-analysis, VR, AR, and MR all have a significant positive effect on improving FMA-UE for UL impairment (36 studies, MD = 3.91, 95 percent CI = 1.70–6.12, P = 0.0005) and FIM for ADL (10 studies, MD = 4.25, 95 percent CI = 1.47–7.03, P = 0.003), but not on BBT and WMFT for the UL function tests (16 studies, MD = 2.07, 95 percent CI = − 0.58–4.72, P = 0.13),ConclusionsVAMR therapy was superior to conventional treatment in UL impairment and daily function outcomes, but not UL function measures. Future studies might include further high-quality trials examining the effect of VR, AR, and MR on UL function measures, with an emphasis on subgroup meta-analysis by stroke type and recovery stage.