Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

Active movement-assistive devices aim to increase the quality of life for patients with neuromusculoskeletal disorders. This technology requires interaction between the user and the device through a control interface that detects the user’s movement intention. Researchers have explored a wide variety of invasive and non-invasive control interfaces. To summarize the wide spectrum of strategies, this paper presents a comprehensive review focused on non-invasive control interfaces used to operate active movement-assistive devices. A novel systematic classification method is proposed to categorize the control interfaces based on: (I) the source of the physiological signal, (II) the physiological phenomena responsible for generating the signal, and (III) the sensors used to measure the physiological signal. The proposed classification method can successfully categorize all the existing control interfaces providing a comprehensive overview of the state of the art. Each sensing modality is briefly described in the body of the paper following the same structure used in the classification method. Furthermore, we discuss several design considerations, challenges, and future directions of non-invasive control interfaces for active movement-assistive devices.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-168) contains supplementary material, which is available to authorized users.

While there is an extensive number of studies on the development and evaluation of electromyography (EMG)- and force-based control interfaces for assistive devices, no studies have focused on testing these control strategies for the specific case of adults with Duchenne muscular dystrophy (DMD). This paper presents a feasibility study on the use of EMG and force as control interfaces for the operation of active arm supports for men with DMD. We have built an experimental active elbow support, with a threefold objective: 1) to investigate whether adult men with DMD could use EMG- and force-based control interfaces; 2) to evaluate their performance during a discrete position-tracking task; and 3) to examine users' acceptance of the control methods. The system was tested in three adults with DMD (21-22 years). Although none of the three participants had performed any voluntary movements with their arms for the past 3-5 years, all of them were 100% successful in performing the series of tracking tasks using both control interfaces (mean task completion time EMG: [Formula: see text] , force: [Formula: see text] ). While movements with the force-based control were considerably smoother in Subject 3 and faster in Subject 1, EMG based-control was perceived as less fatiguing by all three subjects. Both EMG- and force-based interfaces are feasible solutions for the control of active elbow supports in adults with DMD and should be considered for further investigations on multi-DOF control.