Upper-Limb Robotic Exoskeletons for Neuromuscular Rehabilitation: A Systematic Review on Lightweight Architectures and Bio-Cooperative Control
DOI:
https://doi.org/10.61467/2007.1558.2027.v18i1.1543Keywords:
Rehabilitation, Robotics, Rehabilitation robot, Rehabilitación, robótica, robot de rehabilitaciónAbstract
Stroke and neuromuscular trauma constitute a leading global cause of severe long-term upper-limb motor disability. Although rehabilitation robotics has proven effective in inducing activity-dependent cortical neuroplasticity through high-intensity training, a significant translational gap persists between complex laboratory prototypes and commercially accessible home-based systems. To address this, a systematic review was conducted following PRISMA 2020 guidelines, analyzing 45 studies from high-impact databases (2016–2026) focused on mechatronic design and clinical validations. The findings reveal a critical transition from rigid-link anthropomorphic exoskeletons toward cable-driven and soft robotic architectures, successfully reducing arm-coupled inertia to under 1.5 kg and mitigating kinematic misalignment risks at the human-robot interface. However, a severe validation gap persists, with less than 10% of studies evaluating prototypes on actual post-stroke cohorts. Additionally, the high computational cost and noise susceptibility of advanced sEMG-driven Assist-as-Needed (AAN) controllers currently limit their viability for autonomous home use. The review concludes that democratizing robotic telerehabilitation requires prioritizing intrinsic mechanical compliance, affordability, and IoT telemetry over redundant structural complexity, alongside an urgent shift toward multicenter Randomized Controlled Trials (RCTs).
Spanish-language metadata / Metadatos en español
Título en español:
Exoesqueletos robóticos de miembro superior para la rehabilitación neuromuscular: una revisión sistemática sobre arquitecturas ligeras y control biocooperativo
Resumen:
El accidente cerebrovascular y los traumatismos neuromusculares constituyen una de las principales causas a nivel mundial de discapacidad motora grave y prolongada de los miembros superiores. Aunque la robótica de rehabilitación ha demostrado ser eficaz para inducir neuroplasticidad cortical dependiente de la actividad mediante entrenamiento de alta intensidad, persiste una importante brecha traslacional entre los complejos prototipos de laboratorio y los sistemas de uso domiciliario comercialmente accesibles.
Para abordar esta problemática, se realizó una revisión sistemática siguiendo las directrices PRISMA 2020, en la que se analizaron 45 estudios procedentes de bases de datos de alto impacto (2016–2026), centrados en el diseño mecatrónico y las validaciones clínicas. Los hallazgos revelan una transición significativa desde los exoesqueletos antropomórficos de eslabones rígidos hacia arquitecturas robóticas accionadas por cables y estructuras blandas, que han logrado reducir la inercia acoplada al brazo a menos de 1,5 kg y mitigar los riesgos de desalineación cinemática en la interfaz humano-robot.
Sin embargo, persiste una importante brecha de validación, ya que menos del 10 % de los estudios evaluaron los prototipos en cohortes reales de pacientes que habían sufrido un accidente cerebrovascular. Además, el elevado coste computacional y la susceptibilidad al ruido de los controladores avanzados de asistencia según necesidad (Assist-as-Needed, AAN) basados en sEMG limitan actualmente su viabilidad para un uso domiciliario autónomo.
La revisión concluye que la democratización de la telerehabilitación robótica requiere priorizar la conformidad mecánica intrínseca, la asequibilidad y la telemetría mediante Internet de las Cosas (IoT) frente a una complejidad estructural redundante, junto con una transición urgente hacia ensayos controlados aleatorizados (RCT) multicéntricos.
Palabras Claves:
Rehabilitación, robótica, robot de rehabilitación.
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