The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO’s healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson’s Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso^®, HAL^®, Stride Management Assist^®, Honda Walking Assist^®, Lokomat^®, Walkbot^®, Healbot^®, Keeogo Rehab^®, EX1^®, overground wearable exoskeletons, Eksoband^®, powered ankle–foot orthoses, HAL^® lumbar type, Human Body Posturizer^®, Gait Enhancing and Motivation System^®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.

Older adults often experience a decline in functional abilities, affecting their independence and mobility at home. Wearable lower-limb exoskeletons (LLEs) have the potential to serve as both assistive devices to support mobility and training tools to enhance physical capabilities. However, active end-user involvement is crucial to ensure LLEs align with users’ needs and preferences. This study employed a co-design methodology to explore home-based LLE requirements from the perspectives of older adults with mobility impairments and physiotherapists. Four older adults with self-reported mobility limitations participated by creating personas to represent different user needs and experiences (i.e., PERCEPT methodology), alongside four experienced physiotherapists who contributed their professional insights. As assistive devices, LLEs were seen as valuable for promoting independence, supporting mobility, and facilitating social participation, with essential activities including shopping, toileting, and outdoor walking. Physiotherapists expressed enthusiasm for integrating LLEs into remote rehabilitation programs, particularly to improve strength, balance, coordination, and walking speed. Key design considerations included a lightweight, discreet device that is easy to don and doff and comfortable for extended wear. Physiotherapists highlighted the potential of digital monitoring to assess physical parameters and personalize therapy. Fatigue emerged as a significant challenge for older adults, reinforcing the need for assistive LLEs to alleviate exhaustion and enhance functional independence. A shortlist of LLE features was drafted and scored, covering activity and design applications. These findings provide valuable insights into the design and usability of home-based LLEs, offering a foundation for developing devices that improve acceptance, usability, and long-term impact on healthy ageing.

Assistive lower-limb exoskeletons (LLEs) have been recognized as promising tools for enhancing physical capacity in stroke survivors. Involving end-users in the early development stages is essential to ensure these technologies meet user needs. Co-design approaches, which actively engage end-users, support this goal. This study aims to (1) evaluate the impact of fatigue on daily living, (2) identify activities that could benefit from LLE assistance, (3) outline design and usability requirements for home-based LLEs, and (4) define physical parameters LLEs should monitor and assess. Discussions were structured using the PERCEPT co-design methodology and thematically analyzed. Four chronic stroke survivors participated in three focus group sessions, each lasting approximately 2 hours. Fatigue was identified as a significant factor in daily life, underscoring the importance of assistive technologies, such as LLEs, to help mitigate exhaustion. Participants recognized LLEs as valuable tools for enhancing physical performance, with benefits for muscle strength, balance, fatigue management, coordination, and general mobility. Design considerations included system modularity, battery efficiency, ease of donning and doffing, and practical needs for daily use. Our findings offer valuable insights into stroke survivors' design and usability concerns regarding LLEs and provide a foundation for advancing the development and adoption of new assistive technologies.

Background: Hospitalized older adults often spend prolonged periods of time bedridden, leading to decreased muscle strength and function. To tackle this, rehabilitation aims to keep patients active and train affected muscles. Exergames have proven to be effective in the rehabilitation of different patient populations and offer a motivating solution to combat inactivity associated with hospitalization. Furthermore, blood flow restriction (BFR) is effective in therapy for weakened patients, so combining BFR and exergames might be promising. Objective: As part of an iterative process of user-centered development, this mixed method study investigates the acceptability and feasibility of the Ghostly game as a stand-alone added therapy or combined with BFR in strength training of hospitalized older adults. Methods: A mixed methods study was conducted on 15 hospitalized older adults. Participants were randomized into 3 groups and received daily interventions from the moment they were included in the geriatric ward, until discharge from the hospital. The Ghostly group received daily conventional therapy with the Ghostly game as added therapy, the Ghostly + BFR group received daily conventional therapy with Ghostly in combination with BFR as added therapy and last, the control group received daily conventional therapy with dose-matched isometric exercises as added therapy. The primary outcome, user experience, was assessed before discharge from the hospital using the Usefulness, Satisfaction, and Ease of Use questionnaire and through expert observations. Clinical outcomes such as muscle strength, muscle architecture, and segmental body composition were assessed at baseline and before discharge from the hospital to test the feasibility of the research protocol in preparation for future randomized controlled trials. Results: A total of 15 hospitalized older adults (11 female participants, 73.33%) were included in this study with an average age of 84.53 (range: 78‐94) years. Participants received an average of 3.47 (range: 3‐5) intervention sessions after transferring to the geriatric ward of the hospital. Results on user experience revealed high scores on all subcategories of the Usefulness, Satisfaction, and Ease of Use questionnaire (usefulness: 78.93%, ease of use: 82.99%, ease of learning: 85.36%, and satisfaction: 87.55%). Furthermore, expert observations identified issues with color contrast, reaction time speed, and the need to tailor the game to accommodate the diverse requirements of different patient populations. All outcomes and procedures were found feasible for a future randomized controlled trial. Conclusions: This mixed methods study combines the innovative aspects of an electromyography-driven exergame with strength training principles of BFR and reveals the acceptability and feasibility of the Ghostly game as a stand-alone added therapy modality for strength training in hospitalized older adults and in combination with BFR. Future improvements of the exergame could focus on addressing expert-identified issues, including optimizing color contrast, adjusting reaction time speeds, and tailoring the game to meet the needs of different patient populations.

「福祉科技與服務管理學刊」創辦於2012年12月，由中華福祉科技與服務管理學會發行，旨在提供老人福祉科技(gerontechnology)及高齡者照護服務與管理之相關學者、產業界和從業人員，以中文發表研發成果或實務經驗之平台，期能促進跨領域知識交流與傳播，提升整體研究水平與相關產業發展，進而為高齡化社會衍生之各種問題提出具體解決方案，提升高齡者之生活品質。