Technology-supported rehabilitation therapy for neurological patients has gained increasing interest since the last decades. The literature agrees that the goal of robots should be to induce motor plasticity in subjects undergoing rehabilitation treatment by providing the patients with repetitive, intensive, and task-oriented treatment. As a key element, robot controllers should adapt to patients’ status and recovery stage. Thus, the design of effective training modalities and their hardware implementation play a crucial role in robot-assisted rehabilitation and strongly influence the treatment outcome. The objective of this paper is to provide a multi-disciplinary vision of patient-cooperative control strategies for upper-limb rehabilitation exoskeletons to help researchers bridge the gap between human motor control aspects, desired rehabilitation training modalities, and their hardware implementations. To this aim, we propose a three-level classification based on 1) “high-level” training modalities, 2) “low-level” control strategies, and 3) “hardware-level” implementation. Then, we provide examples of literature upper-limb exoskeletons to show how the three levels of implementation have been combined to obtain a given high-level behavior, which is specifically designed to promote motor relearning during the rehabilitation treatment. Finally, we emphasize the need for the development of compliant control strategies, based on the collaboration between the exoskeleton and the wearer, we report the key findings to promote the desired physical human-robot interaction for neurorehabilitation, and we provide insights and suggestions for future works.

In this work, we introduce the Agree exoskeleton, a robotic device designed to assist in upper-limb physical rehabilitation for post-stroke survivors. We detail the exoskeleton design at the mechatronic, actuation, and control levels. The Agree exoskeleton features a lightweight and adaptable mechanical design, which can be used with both the right and left arm, supporting three active degrees-of-freedom at the shoulder and one at the elbow. The device embodies a spring-pulley anti-gravity system to minimize torque requirements and has torque sensors on each joint for safe and smooth interaction with the user. The Agree control system, which employs a loadcell-based impedance control method, offers various modes of human-robot interaction, such as passive-assisted, active-assisted, and active-resistive exercises. Results from our experimental characterization demonstrate that the exoskeleton is capable of both compliant and rigid behavior, providing a wide range of haptic impedance and transparent behavior to both user-generated and therapist-generated forces. Our findings indicate that the Agree exoskeleton may be a viable option for safely assisting patients with neurological conditions.

Objective: Hybrid systems that integrate Functional Electrical Stimulation (FES) and robotic assistance have been proposed in neurorehabilitation to enhance therapeutic benefits. This study focuses on designing a cooperative controller capable of distributing the required torque for movement between robotic actuation and FES, thereby eliminating the need for time-consuming calibration procedures. Methods: The control schema comprises three main blocks: a motion generation block that defines the desired trajectory, a motor control block including both a weight compensation feedforward and a feedback impedance controller, and an FES control block, based on trial-by-trial Iterative Learning Control (ILC), that adjusts the stimulation intensity according to a predefined stimulation waveform. The feedforward motor assistance can be dynamically regulated using an allocation factor. Experiments involving 12 healthy volunteers were conducted using a one-degree-of-freedom elbow testbed. Results: The experimental results showcased the successful integration of Functional Electrical Stimulation (FES) with robotic actuation, ensuring precise trajectory tracking with a Root Mean Square Error (RMSE) below 7°. Notably, allocating more torque to FES led to a 51 $\%$ reduction in motor torque. In conditions where FES operated alone, there was poorer tracking performance with an RMSE of 24° and an early onset of muscle fatigue, as evidenced by a reduced number of achieved repetitions. Furthermore, the hybrid approach enabled 100 fatigue-free elbow flexion repetitions, underscoring the effectiveness of cooperative FES-motor control in extending the benefits of FES-induced exercises. Significance: This study proposes a flexible approach which can be extended to a multi-degree-of-freedom hybrid system. Furthermore, it underscores the significance of employing a straightforward and adaptable methodology with a rapid calibration procedure, making it easily transferable to clinical applications.

Background: Appropriate training modalities for post-stroke upper-limb rehabilitation are key features for effective recovery after the acute event. This study presents a cooperative control framework that promotes compliant motion and implements a variety of high-level rehabilitation modalities with a unified low-level explicit impedance control law. The core idea is that we can change the haptic behavior perceived by a human when interacting with the rehabilitation robot by tuning three impedance control parameters.Methods: The presented control law is based on an impedance controller with direct torque measurement, provided with positive-feedback compensation terms for disturbances rejection and gravity compensation. We developed an elbow flexion-extension experimental setup as a platform to validate the performance of the proposed controller to promote the desired high-level behavior. The controller was first characterized through experimental trials regarding joint transparency, torque, and impedance tracking accuracy. Then, to validate if the controller could effectively render different physical human-robot interaction according to the selected rehabilitation modalities, we conducted tests on 14 healthy volunteers and measured their muscular voluntary effort through surface electromyography (sEMG). The experiments consisted of one degree-of-freedom elbow flexion/extension movements, executed under six high-level modalities, characterized by different levels of (i) corrective assistance, (ii) weight counterbalance assistance, and (iii) resistance.Results: The unified controller demonstrated suitability to promote good transparency and render both compliant and stiff behavior at the joint. We demonstrated through electromyographic monitoring that a proper combination of stiffness, damping, and weight assistance could induce different user participation levels, render different physical human-robot interaction, and potentially promote different rehabilitation training modalities.Conclusion: We proved that the proposed control framework could render a wide variety of physical human-robot interaction, helping the user to accomplish the task while exploiting physiological muscular activation patterns. The reported results confirmed that the control scheme could induce different levels of the subject's participation, potentially applicable to the clinical practice to adapt the rehabilitation treatment to the subject's progress. Further investigation is needed to validate the presented approach to neurological patients.

Robotic manipulation in unstructured, human-centric environments poses a dual challenge: achieving the precision need for delicate free-space operation while ensuring safety during unexpected contact events. Traditional wrists struggle to balance these demands, often relying on complex control schemes or complicated mechanical designs to mitigate potential damage from force overload. In response, we present BiFlex, a flexible robotic wrist that uses a soft buckling honeycomb structure to provide a natural bimodal stiffness response. The higher stiffness mode enables precise household object manipulation, while the lower stiffness mode provides the compliance needed to adapt to external forces. We design BiFlex to maintain a fingertip deflection of less than 1 cm while supporting loads up to 500 g and create a BiFlex wrist for many grippers, including Panda, Robotiq, and BaRiFlex. We validate BiFlex under several real-world experimental evaluations, including surface wiping, precise pick-and-place, and grasping under environmental constraints. We demonstrate that BiFlex simplifies control while maintaining precise object manipulation and enhanced safety in real-world applications.

Robot-assisted therapy has long promised to advance stroke rehabilitation by delivering intensive and personalized training, yet its clinical impact remains limited. Closing the sensorimotor loop with brain–computer interfaces offers a better strategy than passive mobilization, directly linking user intent to robotic assistance and potentially driving neuroplasticity. However, a brain-computer interface requires subject-specific calibration that is time-consuming and often impractical. Moreover, brain decoding remains error-prone due to variability of neural signals, thus resulting in unintended robot actions that could reduce engagement during closed-loop control. Here, we demonstrate that a decoder trained on an expert subject can be transferred to naïve users for online control of a rehabilitation exoskeleton in a rest-versus-reaching paradigm, a functional task with clinical relevance. We then characterize error-related potentials arising from expectation mismatches between brain commands and robot actions during closed-loop control. Finally, we show that these mismatches can be reliably decoded in a subject-independent framework (mean area under the receiver operating characteristic curve: 0.77), a crucial step toward rehabilitation scenarios where collecting subject-specific error-related potential data is challenging. Our findings highlight the potential for integrating real-time error-detection to enhance human–robot interaction by correcting unintended robot behaviors, which could significantly improve rehabilitation outcomes where accurate and contingent feedback is essential.