Mar. 03, 2025
The human hand is an intricate appendage that is vital for interacting with the environment, a fact that is emphasized when dextrous hand function is impaired. Limited hand function significantly impedes the ability of an individual to perform activities of daily living and impacts quality of life. Stroke is one of the leading causes of impaired hand function, with over 80 million stroke survivors globally,1 and nearly 80% experiencing upper limb motor deficits.2 Furthermore, there are an estimated 27 million people living with spinal cord injury,3 with a significant proportion experiencing impaired upper limb function.4 Beyond these clinical populations, numerous peripheral neurological disorders and traumatic injuries can also compromise hand function.
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Powered hand exoskeletons are an emerging technology that have demonstrated promise in alleviating functional challenges associated with hand impairment or weakness.5,6 These systems attach to segments of the hand and actively assist digit flexion and extension to aid in the performance of functional grasping tasks by applying forces to the user's digits. Therefore, they help restore movement by guiding the digits to specific positions or grasping patterns; movement that would typically be challenging or impossible to independently achieve and maintain.
Several hand exoskeleton designs have been described in scientific literature.5'12 However, the majority have not been tested in clinical patient populations or translated beyond the laboratory. Those that have are costly and often operate in a purely therapeutic capacity, being tethered to a computer. To date, the only commercially-available assistive device that allows the user to be untethered and perform day-to-day tasks is the MyoPro Motion (Myomo, Inc.).5,13 This device includes multiple joints (elbow, wrist, and hand) and one grasp pattern (tripod) and is marketed as a powered upper limb orthosis, rather than a dedicated hand exoskeleton. While the MyoPro and other devices are promising, the functional benefits of hand exoskeletons remain largely inaccessible to clinicians and patients. Furthermore, designs for exoskeletons are quite varied and it is not clear which populations would benefit from them. Ideally, a clinically accessible powered hand exoskeleton would adhere to a set of well-defined design specifications derived from the input of end users, specifically patients and clinicians.
The purpose of this pilot study was to define preliminary design requirements for an assistive powered hand exoskeleton that would be acceptable for clinical or long-term use according to patients and clinicians. Requirements were determined by interviewing individuals with hand impairment and clinicians who work with such patients. Further design criteria were gathered by characterizing hand function of three participants with hand impairments. The intent was to provide critical information to developers of these devices with guidance toward which criteria are important to assess in different patient populations.
The objective of this pilot study was to ascertain preliminary end-user design requirements for an assistive powered hand exoskeleton. This was accomplished through interviews with clinicians and individuals with impaired hand function, as well as quantitative data collection with participants with hand impairment.
In the interview sessions, some recurrent responses were observed. For example, responses related to desired grasp patterns and force generation often focused on eating and drinking, highlighting these as important tasks from which design criteria could be drawn for both pinch and power grasp. In addition, most participants agreed on 200'g as an acceptable maximum weight for a wearable hand device, and they preferred being able to continually wear the device for 6'h to a full day, implying requirements for both prolonged comfort and battery life. During open discussion, six of the eight participants with impaired hand function raised the importance of being able to independently don/doff the device. While clinician responses generally aligned with individuals with impaired hand function, the topic of control requires further exploration. Clinicians, who had experience with advanced control strategies, such as myoelectric control in the context of prostheses, had concerns about the reliability of these strategies. They expressed that simpler strategies, such as a push button, should be used, especially when introducing a user to the device. Although we did not specifically ask participants with impaired hand function about control, one individual expressed a desire for intuitive control strategies (controlling the device with their 'mind') and an aversion to simple strategies, such as a push button. This points to a need for further investigation into end-user expectations with respect to potential control strategies and the impact on their willingness to accept a hand exoskeleton. The responses also revealed variability between participants with respect to their tolerance for inconveniences, such as motor noise and bulkiness, suggesting different user needs and expectations.
Detailed hand characterization sessions further confirmed variability between individuals with different diagnostic causes of hand impairment, as the three participants who returned for these sessions had substantially different levels of hand function, resting hand postures, and forces/times required for hand movement. Though it is possible that a robust hand exoskeleton could accommodate a wide variety of individuals with impaired hand function, more specific target groups may need to be identified when developing this technology. A device targeted at slowly opening the hand and helping to shape a functional grasp (as would be required for P07) may find more success without the extra machinery that would be necessary to close P05's hand and vice versa. In addition, designing with modularity or customization options may be advantageous.
To the best of our knowledge, this is the first time that input from end-users on what would make a successful hand exoskeleton has been reported in the literature. However, other authors have reported limited aspects of design requirements that may be applicable to hand exoskeletons. Hume et al. identified functional requirements for finger RoM during a number of practical activities,16 which were similar to activities in our study (Figure 2). The maximum flexion angles observed by Hume et al. during their functional tasks were 73°, 86°, and 61° for the MCP, PIP, and DIP joints, respectively, and the average functional angles were 61°, 60°, and 39°, indicating that a powered hand exoskeleton would not need to fully flex the fingers to be functional. However, our study also highlighted that some individuals with impaired hand function may not have access to this functional RoM, even in passive motion, due to muscle stiffness or contracture. This must also be considered in hand exoskeleton design so as not to injure wearers by trying to move their fingers past available passive RoM.
With respect to grip force requirements, Smaby et al. documented that for a set of functional activities, 'pinch force requirements ranged from 1.4'N to push a button on a remote to 31.4'N to insert a plug into an outlet.'17 Of the tasks studied by Smaby et al, '9 of 12, including stabbing food with a fork, required less than 10.5'N.' Therefore, 10'N of pinch grip force may be a reasonable goal to aim for in a hand exoskeleton. The grip force results for our study indicate that some individuals with impaired hand function may be able to generate grip force independently, but require help shaping their hand into a functional grasp pattern. Our results also emphasized that consideration should be given to the force required to move the digits and overcome resistance due to muscle stiffness or spasticity (which was up to 10'N in our study), in addition to the force required for a functional grip. Nycz et al. explored the torque required to induce finger extension in individuals with increased flexor tone due to traumatic brain injury.18 Our results suggest that this should be explored in other populations. In our study, moving the finger of the participant with flexor tone (P07-stroke) required a very low force applied over time to prevent a velocity dependent increase in tone, whereas force requirements were higher for the participant with SCI because of muscle stiffness. To gain a full appreciation of motor requirements for a hand exoskeleton, a more rigorous approach, combining force measurement and motion capture and considering moment of inertia effects, should be repeated with multiple patient populations.
We also examined the feasibility of two potential control strategies for a hand exoskeleton; a flex sensor on the wrist and forearm surface EMG. Our BPI participant had separable EMG signals that might be suitable for a dual-site control strategy (i.e. two-state amplitude modulation), whereas the SCI participant might be suitable for a single-site control strategy (i.e. three-state amplitude modulation).15 Our participant with stroke would not be suitable for dual-site EMG control due to co-contraction but may be able to use pattern recognition based on visually distinct patterns of EMG activity between wrist flexion and extension.19 This conclusion is supported by Ryser et al. who were able to achieve classification accuracies of 78.8%'99.2% for three gestures based on surface EMG in three participants post-stroke.20 These findings suggest that myoelectric control of a hand exoskeleton is feasible, although the best control strategy for each patient type may vary.
One limitation of our current study is the small sample size. While our results captured considerable differences between participants, the full range of potential hand exoskeleton users is not represented, and further exploration with a larger sample is required to gain a more complete understanding of end-user needs and expectations.
Scheduling also imposed limitations on the collection of interview data. Six of the interviews were completed individually, while one other interview and the clinician discussion were completed in small groups. Although it was our intention that all interviews be completed in small groups to allow for facilitated discussion among participants, this was not possible, and we recognize that this may have influenced responses between individual and group settings. In addition, no methods were used to confirm the trustworthiness of the qualitative data. A more thorough qualitative methodological approach may allow greater insight into patient experiences and expectations.
Hand measurement (such as surface EMG and force required to assist with finger movement) was assessed in a single arm position (forearm resting on table), which is not reflective of real-world use. These measurements may also be influenced by factors, such as temperature, rest, and medication. It is important to measure hand function characteristics based on the stability of the patient's diagnosis, and future work could explore the repeatability of these measurements. The force measurement method also relied on the experimenter to determine the movement speed and to apply the force normal to the movement direction. Future work could benefit from the development of a methodology that limits these human factors. Despite these limitations, our study provides illuminating data in a relatively unexplored area, highlighting requirements to help shape future hand exoskeleton devices toward clinical success.
The global exoskeleton market size is estimated to grow from USD 2.20 billion in to USD 20.30 billion by , representing a CAGR of 22.4% during the forecast period till .
Over the years, the healthcare burden due to neurological disorders, including multiple sclerosis and strokes, has increased significantly with the growing prevalence of such disorders. As per the estimates of World Health Organization (WHO), approximately 1.8 million individuals, worldwide, currently suffer from multiple sclerosis, whereas over 12.2 million patients experience stroke, every year. These statistics are anticipated to increase further with the rise in the geriatric population.
Neurological disorders often lead to muscle weakness, which affects mobility, whether in localized muscle groups (such as hemiplegia, paraplegia, or quadriplegia) or the entire body. Unfortunately, there is no cure for neuromotor impairment; however, the use of assistive ambulatory devices, such as wheelchairs, crutches, and walkers can enhance independence and comfort for patients. Though these assistive devices are widely popular, they provide short-term relief rather than a transformative solution. Moreover, improper handling or prolonged use of these devices can lead to physical fatigue, discomfort and even injuries, thereby decreasing the quality of life (QoL); in fact, about 50% of the manual wheelchair users are reported to have a shoulder injury at some point in their lives. Over the years, exoskeletons have emerged as a partial alternative or a companion rehabilitation device that allow individuals with spinal cord injury and related injuries to walk freely in hospital and at home compared to the conventional ambulatory options . A medical exoskeleton is a wearable electromechanical device designed to help patients with mobility issues, that are either partially or completely paralyzed, in restoring movements of upper extremity or lower extremity. Leveraging neuroplasticity, the medical exoskeleton equipped with sensors, motors, actuators, power sources and control strategies enable recovery of fundamental movements and speed up recovery from injuries, such as acquired brain injury (ABI) or spinal cord injury (SCI). Apart from patients, healthcare providers, such as nurses and surgeons, also suffer from a range of musculoskeletal disorders due to the physically demanding nature of their roles in the healthcare sector. Medical exoskeleton can assist caregivers with tasks such as lifting and moving patients, negotiating obstacles, and standing for extended periods of time.
Beyond the healthcare industry, exoskeleton technology is serving to augment the performance as well as prevent work-related accidents of workers employed in a wide range of industries, such as construction, logistics, vehicle factory, aircraft manufacture, shipyard, automotive / metal mechanics industry, foundry, aeronautics, maintenance, and other factory works. According to the estimates of International Labor Organization(ILO), over 2.3 million workers die every year to work-related accidents or diseases. With such a staggering number of accidents each year, the adoption of industrial exoskeleton assisting workers in physical strenuous tasks of lifting of loads or overhead work, has potential to not only improve workplace safety but also increase employee turnover, improve productivity, and save costs.
Despite their widespread benefits, several factors, including the cost barriers and lack of awareness limit the adoption of these devices amongst users. In order to ensure wider acceptance, exoskeleton companies are focusing their R&D efforts to lower the cost of exoskeleton, as well as integrating technologies such as cloud computing, deep learning, smart sensors and artificial intelligence in their exoskeleton portfolio. As the exoskeleton technology advances and the cost of exoskeletons decreases, and the stakeholders recognize the positive return on investment (ROI) on exoskeleton products (owing to higher benefit-cost ratio), the adoption of this nascent exoskeleton technology across various industries is poised to grow, ultimately driving the growth of the global exoskeleton market during the forecast period.
The Global Exoskeleton Market, Till : Focus on Industrial Exoskeleton, Military Exoskeleton and Medical Exoskeleton Market: Distribution by Body Part Covered (Upper Body, Lower Body and Full Body), Mode of Operation (Powered Exoskeleton, Passive Exoskeleton and Hybrid Exoskeleton), Form of Exoskeleton (Rigid and Soft), Mobility (Fixed / Supported and Mobile), End Users (Patients, Healthcare Providers, Industry Workers, Military Personnel and Others) and Geography (North America, Europe, Asia-Pacific, and Rest of the World) report features an extensive study of the current market landscape, market size and future opportunities associated with this industry, during the given forecast period. The market research report highlights the efforts of several stakeholders engaged in this emerging and rapidly evolving segment of the medical device industry. Key takeaways from the study of the global exoskeleton market are briefly discussed below.
Medical exoskeleton has emerged as a popular rehabilitation tool, transforming the field of robotics. Medical exoskeletons have the ability to restore movement in individuals with motor impairments, as well as augment performance in able bodied users. The device uses sensors and actuation technologies (motors, pneumatics, levers, or hydraulics) to restore locomotion of the upper extremity and / or lower extremity. Beyond healthcare purposes, industrial exoskeleton provides postural support, improved productivity, and reduces work-related injuries. The adoption of industrial exoskeleton has demonstrated positive outcomes in several scenarios; for example, the implementation of Ekso Bionics eksoVest at Ford Motor Company led to an 83% reduction in worker injuries and a 17% increase in Boeing's airline production capacity.
The current market landscape features the presence of over 95 companies, which design, develop and commercialize medical exoskeleton for patients, healthcare providers and researchers. Further, over 55% of the medical exoskeleton are powered exoskeleton, followed by passive exoskeleton which do not require any kind of electric source. Some examples of players engaged in manufacturing passive exoskeleton include (in alphabetical order) Archelis, Hocoma, Newndra Innovations, Mebster, Ossur and PolySpine.
The current market landscape features the presence of close to 100 non-medical exoskeleton companies engaged in manufacturing exoskeletons for industrial workers, military purposes, daily life activities, sports and agriculture. It is worth mentioning that there has been a substantial rise in the number of non-medical exoskeleton companies over the past decade, indicating significant start-up activity in the exoskeleton market. Further, a significant proportion of the non-medical exoskeleton companies (73%) offer support to industrial workers employed in different sectors; notable examples of players engaged in manufacturing non-medical exoskeletons include (in alphabetical order) Bionic Power, CYBERDYNE, Ekso Bionics, LG Electronics, Ottobock and Xeno Dynamics.
Recent advancements in exoskeleton technology with the integration of modern tools, have paved way for remarkable innovations in the exoskeleton space. This can be attributed to the incorporation of games, virtual reality (VR) and augmented reality (AR) technologies in these devices for effective rehabilitation. Several exoskeleton companies are slowly transitioning from bulky and high-cost exoskeletons to light weight and affordable exosuits with human-like anthropomorphic designs. For instance, Hilti Bionic Arm, an industrial exoskeleton, weighs only 5 pounds and is developed for assisting workers in carrying out overhead tasks conveniently.
Another notable example is MyoSwiss powered exoskeleton, designed for tasks, such as gait training and daily life support. The exosuit comprises three layers, namely a garment layer, a ligament layer, and a power layer. The garment layer serves as intermediary between Myosuit and the wearer, effectively distributing the forces throughout the body. Few exoskeleton companies have developed / are currently developing exoskeleton models which can be controlled by paralyzed patients through their thoughts. For instance, in , NeuroSolutions received FDA breakthrough designation for their exoskeleton IpsiHand System, which translates the neural signals automatically and assists the required movement. Some exoskeletons, such as HaptX Gloves and DextaRobotics Dexmo Gloves, offer haptic feedback, enhancing the user's tactile sensations and proprioception. Beyond these features, software advancements, such as artificial intelligence powered variable assist control feature ensures that the rehabilitation exoskeletons provide additional power only when needed, thereby optimizing its assistance capabilities. For instance, B-Temia introduced the Keeogo exoskeleton which is AI Integrated, allowing it to automatically adapt to the user's movement and dynamically adjust its output to perform daily life activities.
Smart factories are integrating exoskeletons with the help of the Industrial Internet of Things (IIoT) to enhance worker safety and productivity. These IIoT-enabled exoskeletons provide real-time data on worker's movements, enable remote monitoring, enable predictive maintenance, offer customization for user comfort, trigger safety alerts, manage workforce allocation, and optimize energy efficiency. This integration improves both workplace safety and operational efficiency in modern manufacturing environments.
The way for exoskeletons to become the standard of care is fraught with several challenges. Various industry and non-industry stakeholders are implementing novel initiatives in order to accelerate the adoption of these devices, such as providing financing and reimbursement options, as well as diverse purchasing choices, such as outright product purchase, leasing, or subscription models. In addition, a rise in government initiatives and policies have also forged exoskeleton companies to propel the growth of the exoskeleton market. For instance, ReWalk Robotics collaborated with the Department of Veterans Affairs to establish a national policy aimed at offering exoskeletons to all eligible veterans with spinal cord injuries. Exoskeleton companies have been actively seeking support for their research and development endeavors through various government funding initiatives, including programs, such as the Mind, Machine and Motor Nexus (M3X) program and MSDs Pilot Grant 1.0. Moreover, startups in this field are harnessing the power of online crowdfunding platforms, such as Kickstarter, wherein they rely on contributions and pre-orders from individual backers to help them transition from prototype stages to market-ready products. These exoskeleton companies are also emphasizing on increasing awareness within the exoskeleton community. This is evident from their participation in conferences, such as ExoBerlin, WearRAcon, and ErgoX, as well as competitive events, including the CYBATHLON Exoskeleton Race and the Exo Games. This proactive approach not only allows them to showcase their technological advancements but also extends their product reach on a global scale.
The exoskeleton industry faces a multitude of challenges that must be addressed for the widespread acceptance of exoskeleton technology. Currently, exoskeletons are not considered the standard of care in rehabilitation and face competition from conventional orthotic and prosthetic devices. Further, regulatory bodies, such as the FDA, often rely on industry standards to evaluate and approve exoskeletons, which are considered Class II medical devices. A lack of standards can lead to inconsistencies in regulatory processes, making it more difficult for manufacturers to obtain approvals for their products, which can hinder market entry. Moreover, securing adequate insurance coverage or reimbursement from third-party payors is a challenge, particularly if these products are deemed investigational. As a result, healthcare providers are cautious about adopting new products due to liability and reimbursement concerns. Additionally, design-related challenges persist, with current exoskeletons, including limited range of motion, heavy weight, causing discomfort to the users' bodies. These factors inhibit their adoption and usability. Additionally, navigation through uneven surfaces remains a hurdle, and twisting motions are yet to be developed in prototypes. A comprehensive solution to these design-related challenges necessitates a multidisciplinary approach, featuring expertise in fields such as biomechanics, robotics, materials science and human computer interaction.
Robotic or powered exoskeleton have emerged as a breakthrough device for rehabilitation of individuals with mobility impairments. Currently, ~60% of the medical exoskeleton can translate the user's body movements to activate motors to move the patients' limbs through a predetermined pattern. It augments the human capabilities in rehabilitation centers and home settings allowing the subject to not only receive rehabilitation in a hospital setting but also to continue their recovery process in the community and at home. Further, the use of powered exoskeleton mitigates the risks of cardiovascular and metabolic disorders, which are associated with inactive or sedentary lifestyle. With an increase in number of patients with spinal cord injuries and strokes, which require more assistance, the powered exoskeleton is anticipated to drive the market growth for exoskeleton market during the forecast period.
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The majority of the exoskeleton companies are headquartered in North America, followed by those based in Europe. Consequently, nearly 30% of the global market for exoskeletons is anticipated to be captured by exoskeleton companies based in North America, in . According to data from the Centers for Disease Control and Prevention (CDC), it is estimated that approximately 61 million people in the United States live with various forms of impairment, and among these individuals, mobility disabilities constitute a significant portion, accounting for 13.7% of the disabled population. As per the projections of the United States Census Bureau (USCB), the US population aged 65 and older is expected to more than double by the year . This demographic shift has the potential to significantly increase the demand for medical exoskeletons throughout the nation. Further, the exoskeleton market in Asia-Pacific is expected to grow at a relatively high CAGR of 26.4% during the forecast period till .
Starting in January , ReWalk Personal Exoskeleton platform by ReWalk Robotics is being classified within the Medicare brace benefit category.
In recent years, several partnerships have been inked by industry stakeholders, in order to consolidate their presence in this field. It is worth highlighting that nearly 60% of deals were forged in the last three years (since ). Interestingly, most of the agreements were distribution agreements (26%), followed by product / technology development agreements (15%). In July , Wandercraft entered into an agreement with Brazilian Health authority to provide its two Atalante X exoskeletons at Lucy Montoro, a Brazilian neurological rehabilitation institution to support patient rehabilitation and medical research. Further, in June , Trexo Robotics entered into a commercialization agreement with Keystone Education Group to use their Trexo Robotic Gait Trainer exoskeleton for children with autism spectrum disorder.
The COVID-19 pandemic, which began in , had profound repercussions on the exoskeleton industry. The pandemic made it difficult for exoskeleton companies to introduce and pilot wearable devices, which require training, fitting and face-to-face time with the users. Further, owing to the supply chain disruption during the pandemic, the prices of several specific parts, mainly electronic parts increased. Further, the pandemic led to a shortage of healthcare workers, which made it difficult for hospitals and clinics to implement medical exoskeleton that require trained personnel to operate. Despite the challenging circumstances, several companies demonstrated goodwill by donating their exoskeleton products to frontline workers. For instance, in May , Laevo donated numerous LAEVO V2 exoskeletons to ease the physically demanding tasks of those heavily impacted by COVID-19. These donations primarily targeted individuals working in logistics (such as order pickers), healthcare (including surgeons and nurses), agriculture (such as farmers and seasonal workers), and various other sectors.
Examples of key exoskeleton companies (which have also been captured in this market report, arranged in alphabetical order) include Bionic Yantra, CYBERDYNE, Ekso Bionics, ExoAtlet, Fourier Intelligence, Gloreha, Guangzhou Yikang Medical Equipment, Hexar Humancare, Hocoma, MediTouch, Milebot Robotics, Myomo, Neofect, NextStep Robotics, ReWalk Robotics, Rex Bionics, Roam Robotics, Trexo Robotics, Tyromotion and U&O Technologies. This market report includes an easily searchable excel database of all the exoskeleton companies worldwide.
Although the first concept of exoskeleton was introduced in the 19th century, the development of exoskeletons gained momentum only after , when it got significant attention from researchers from various countries, such as the US, Japan, Israel, France, Switzerland, South Korea, China. Several recent developments have taken place in the field of exoskeleton technology over the past few years. Some of these recent initiatives have been mentioned below. These developments, even if they took place post the release of our market report, substantiate the overall market trends that have been outlined in our analyses.
The market report presents an in-depth analysis of the various exoskeleton companies / organizations that are engaged in this industry, across different segments as defined in the table below:
Key Report Attributes DetailsHistorical Trend
SinceFuture Trend
TillForecast Period
10+ Years
Market Size
$ 2.20 Billion
CAGR
22.4%
Body Part Covered
Mode of Operation
Form
Mobility
End Users
Geography
Key Exoskeleton Companies Profiled
Customization Scope
15% customization availableExcel Data Packs (Complimentary)
The market report presents an in-depth analysis, highlighting the capabilities of various exoskeleton companies, across different geographies. Amongst other elements, the market research report features:
The key objective of this market report is to provide a detailed market forecast analysis in order to estimate the existing market size and future opportunity for exoskeleton companies over the next decade. We have extensively studied the historical market data within this industry, in order to develop a deeper understanding of the evolutionary market trends. Based on multiple parameters, likely estimated revenue of an exoskeleton type and through primary validations, we have provided an informed estimate on the market evolution during the forecast period -. The market report also features the likely distribution of the current and forecasted opportunity within the global exoskeleton market across various segments, such as body part covered (upper extremity, lower extremity and full body), mode of operation (powered exoskeleton, passive exoskeleton and hybrid exoskeleton), form of exoskeleton (rigid and soft), mobility (fixed / supported and mobile), end users (patients, healthcare providers, industry workers, military personnel and others) and geography (North America, Europe, Asia-Pacific, and Rest of the World). In order to account for future uncertainties and to add robustness to our model, we have provided three market forecast scenarios, namely conservative, base and optimistic scenarios, representing different tracks of the industry's market growth.
The opinions and insights presented in the market analysis were influenced by discussions held with stakeholders in the industry. The report features detailed transcripts of interviews held with the following industry stakeholders:
All actual figures have been sourced and analyzed from publicly available information forums and primary research discussions. Financial figures mentioned in this market report are in USD, unless otherwise specified.
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