# Review of upper-limb occupational exoskeletons: From technology to assessment

Giovanni Brunelli, Océane Dubois, Monica Tiboni, Nathanaël Jarrassé

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Giovanni Brunelli, Océane Dubois, Monica Tiboni, Nathanaël Jarrassé. Review of upper-limb occupational exoskeletons: From technology to assessment. International Journal of Industrial Ergonomics, 2025, 110, pp.103815. 10.1016/j.ergon.2025.103815. hal-05304655

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# Review of Upper-limb Occupational Exoskeletons: from Technology to Assessment

Giovanni Brunelli<sup>a,b,*</sup>, Océane Dubois<sup>a</sup>, Monica Tiboni<sup>b</sup>, Nathanaël Jarrassé<sup>a</sup>

## Abstract

Occupational exoskeletons are emerging as a promising solution to reduce work-related musculoskeletal disorders (MSDs) across various industries. Upper-limb exoskeletons are particularly relevant, given the high prevalence of MSDs associated with repetitive arm motions and overhead tasks. However, evaluating the effectiveness of these devices requires careful analysis of the specific technologies and kinematic designs they incorporate to ensure their safe and effective integration. This paper presents a detailed technological review and analysis of the existing literature, focusing on the diversity of technologies and the need for more comprehensive studies addressing challenges in both laboratory and real-world settings. This study particularly highlights the necessity of assessments that account for the unique characteristics of different exoskeleton technologies, rather than generalizing across them. It also emphasizes the need to examine not only reductions in muscle activity but also the potential for overlooked side effects, long-term impacts, and adaptations across different task types. These factors are crucial, as upper-limb exoskeletons are planned to be deployed for prolonged use in complex industrial environments.

## Keywords:

Occupational exoskeletons, Upper-limb, Musculoskeletal disorders (MSDs), Industrial ergonomics, Review

## 1. Introduction

Work-related Musculoskeletal Disorders (MSDs) represent a significant occupational health concern, particularly in industries requiring repetitive and strenuous tasks such as automotive manufacturing. MSDs are among the leading causes of disability, absenteeism, and productivity loss, with the upper limbs, especially the shoulders, being the most affected [1, 2, 3]. These disorders often stem from repetitive overhead tasks, leading to increased interest in ergonomic interventions to mitigate these risks.

Traditionally, ergonomic tools and practices, including manipulators and industrial robots, have been used to reduce the need of human operators in tedious tasks. However, the rapid advancement of wearable technology has introduced a new solution: occupational exoskeletons. These devices, designed to be worn by workers, offer support to the musculoskeletal system, particularly the upper limbs, by reducing the physical load during demanding tasks [4, 5]. Occupational exoskeletons are increasingly recognized as a potential solution to prevent work-related MSDs, particularly in sectors where workers are exposed to excessive repetitive tasks, non-neutral postures, and heavy lifting [6, 7].

Since MSDs and fatigue frequently impact the lower back and shoulders [8, 9, 10, 11], many exoskeletons are designed to support these areas. This review therefore focuses on these

devices, which are expected to play a key role in reducing injury risks in industrial settings involving repetitive arm movements.

Exoskeletons can be broadly categorized into passive, active, and hybrid (semi-passive) systems, as well as by their kinematic structure. Passive exoskeletons, which rely on mechanical elements like springs or counterbalances to redistribute forces, have gained popularity due to their simplicity and affordability [12]. Active systems, on the other hand, incorporate motors or pneumatic actuators to provide powered assistance, offering more dynamic support but at the cost of increased complexity and weight [13]. Hybrid systems aim to combine the advantages of both but face challenges in adoption due to complexity and cost [14]. Additionally, exoskeletons can be classified based on their kinematic structure: rigid (either anthropomorphic or non-anthropomorphic) and soft. Rigid exoskeletons provide structural support through durable frames, whereas soft exosuits offer flexibility and comfort, being lighter and more adaptable but providing less support and generating less torque. An overview of the existing solutions is reported in Figure 1.

Beyond individual sectors, the development and adoption of occupational exoskeletons are progressing at a global scale. In Europe, initiatives in the automotive and aerospace industries have driven early adoption, supported by EU-funded projects such as Robo-Mate and WearHap, which aim to enhance workplace ergonomics and reduce musculoskeletal risks [7, 17, 6]. North America has seen parallel advancements, with pilot programs in logistics, construction, and defense sectors where reducing physical strain and associated injury costs has been a strong economic motivator [21, 22, 13]. In Asia, particularly Japan and South Korea, exoskeletons start being considered not

<footnote><sup>a</sup>Sorbonne Université, Sorbonne Université, CNRS, Institut des Systèmes Intelligents et de Robotique, ISIR, F-75005 Paris, France</footnote>

<footnote><sup>b</sup>Università degli studi di Brescia, via Branze 38, 25123 Brescia, Italy</footnote>

<footnote>*Corresponding author.</footnote>

<footnote>Email address: g.brunelli011@studenti.unibs.it (Giovanni Brunelli)</footnote>
<figure><img src="image_2.png" /><figcaption>**Figure 1:** Classification of the different types of exoskeletons included in this review. Rigid anthropomorphic exoskeleton: Mate [15], Paexo [12], Maps / Rigid non-anthropomorphic exoskeletons: Fortis [16], RoboMate [17], Muscle Upper / Soft Exoskeletons: Inflatable Shoulder Exo [18], Hapo Front [19], Carry [20]</figcaption></figure>

only in manufacturing but also in healthcare and elderly care, reflecting demographic challenges and workforce sustainability needs [5, 4, 23]. Meanwhile, countries such as China and India are exploring industrial and agricultural applications, where repetitive manual labor remains prevalent and injury prevention carries major socioeconomic implications [24, 20, 18].

This growing global interest underscores that occupational exoskeletons are not confined to specific regions or industries but are increasingly viewed as a universal ergonomic solution. However, the diversity in industrial contexts, workforce demographics, and regulatory frameworks means that their effectiveness and acceptance may vary widely, further highlighting the need for comprehensive, cross-contextual evaluations such as the one presented in this review [25, 26, 27].

Despite the promising potential of those exoskeletons, their widespread adoption in real-world scenarios remains limited. This is due to the lack of clinical proof of their effectiveness, resulting from the diversity in their technological designs, which complicates the standardization of evaluation methods. Most existing studies have focused on the immediate benefits of these devices, such as reducing muscle activity and fatigue during specific tasks [28, 22]. However, there is a growing recognition of the need to assess their long-term effects, including potential side effects, impacts on unsupported body regions, and changes in movement patterns and motor control strategies over prolonged use [5, 29, 30].

Current research is predominantly conducted in controlled

laboratory settings, necessary for initial assessments but insufficient to replicate the complexity of real-world industrial environments and scenarios of use. In actual workplaces, workers perform a range of movements and transitions between tasks, significantly influencing the effectiveness and ergonomics of exoskeletons [26]. The lack of comprehensive in-field studies that evaluate both the intended and unintended consequences of exoskeleton use over long durations highlights a critical gap in the literature [24, 21].

Occupational exoskeletons are the subject of numerous review articles in the literature. Table 1 summarizes the most recent review articles on occupational upper-limb exoskeletons, analyzing their main themes, conclusions, technological focus, and assessment approaches in order to highlight their specific contributions to the state of the art.

A first cluster of works addresses risks, long-term effects, and user well-being. Cardoso[31] demonstrates that the majority of studies are short-term, with discomfort, restricted motion, and limited real-world transferability still unresolved. FlorUnda[27] emphasizes the absence of longitudinal evaluations and cautions against the physiological and ergonomic side effects of protracted use. The imperative need for long-term, field-based assessments is underscored by Moeller et al.[26], who also emphasize the variability between laboratory and workplace findings.

A second thematic area concerns technological design, mechanisms, and anatomical specificity. Supriyono[32] re-
views elbow exoskeletons, identifying engineering trade-offs in mechanical and actuation design, while Tian[23] focuses on shoulder exoskeletons, demonstrating their benefits in overhead work but noting limitations in versatility, comfort, and control. Ashta et al.[33] concentrates on passive devices in manufacturing and logistics, underlining their utility for static tasks but also their shortcomings in dynamic applications and adoption challenges.

A third set of reviews pertains to intention prediction and control strategies. Hochreiter[34] emphasizes the technical challenges in robustness and usability, as well as the absence of standardized evaluation and large-scale field validation, in his survey of sensor-based and machine-learning approaches to active exoskeleton control.

A fourth group emphasizes assessment frameworks and methodological consistency. De Bock et al.[35] propose benchmarking approaches to overcome the heterogeneity of protocols, advocating the integration of both objective and subjective measures. Ahmad et al.[25] introduce a Technology Readiness Level (TRL)-based framework, mapping how evaluation priorities evolve from early prototypes to market-ready systems and workplace integration.

Finally, Al-Khiami et al.[25] address the market and adoption perspective by mapping 132 models from 72 companies worldwide. Their findings demonstrate that industrial adoption is dominated by passive exoskeletons and identify voids in under-served sectors, such as construction.

Collectively, these evaluations offer a multifaceted perspective on the current landscape, including technological diversity, anatomical focus, control strategies, methodological standardization, market dynamics, and user-centered risks.

While existing reviews have provided valuable insights into adoption frameworks [25], sustainability aspects [33], benchmarking evidence [35], market dynamics [36], or specific subsets of devices such as shoulder [23] and elbow exoskeletons [32], they often focus on isolated perspectives. For instance, Supriyono et al.[32] provide an in-depth analysis of sensors and actuation technologies across upper-limb exoskeleton designs, highlighting structural diversity for elbow devices, while Tian [23]. However, few works explore in detail the technological diversity and kinematic structures across the broad range of upper-limb exoskeletons, and even fewer address the long-term effects, potential side effects, and overall impact on workers' health and performance in real-world industrial contexts. Compared to the reviews summarized in Table 1, the present work makes a distinctive contribution by bridging two dimensions that are often treated separately: the technological diversity and kinematic structures of upper-limb exoskeletons and their evaluation in terms of human effects. Although most existing reviews have focused on specific aspects, such as long-term risks and side effects ([27, 31, 26]), device typologies and anatomical focus ([32, 23, 33]), intention prediction and control strategies [34], methodological frameworks ([35, 25]), or market trends [36], few have offered an integrated perspective that jointly evaluates how design choices influence user outcomes. This review explicitly connects the analysis of mechanisms, adoption systems, and kinematic compatibility with the assess-

ment of physiological, ergonomic, and experiential effects on workers. By doing so, it not only characterizes the technological diversity of occupational exoskeletons but also evaluates their real-world implications for health, comfort, and performance, thus filling a critical gap in the current literature and offering guidance for both developers.

This paper aims to characterize these gaps by providing a review of upper-limb occupational exoskeletons, with a particular focus on the technological diversity and kinematic structures of these devices. We will also explore the current state of research on their long-term effects, side effects, and overall impact on workers' health and performance in real-world settings. Through this analysis, we seek to contribute to a more nuanced understanding of the benefits and limitations of exoskeletons, ultimately informing their development and integration into industrial practices.

Given the rapid advancements and the increasing number of patents in industrial ergonomics, this review does not claim to be exhaustive in listing all the developed solutions. Instead, it focuses on presenting the state of the art by studying the main features and specific characteristics of available upper-limb exoskeletons. Additionally, this review evaluates the methodologies used to assess these devices, with a focus on secondary outcomes, such as the long-term effects and performance in non-specific tasks. The rest of the paper is structured as follows: first, the research strategy is outlined; next, a comprehensive list of the devices found in the literature is presented, together with the publications about the topic; finally, the adopted solutions and their broader implications are discussed.

## 2. Materials and Methods

### 2.1. Sources and Keywords

The bibliographic research was conducted with a comprehensive approach to gather relevant studies and patents on upper-limb exoskeletons designed for occupational use. The primary databases used for this search were PubMed and Scopus, selected for their extensive coverage of biomedical and engineering literature. The search specifically targeted studies evaluating exoskeletons developed or utilized in workplace settings, regardless of their operational mode—be it active, passive, or hybrid. Exoskeletons focused primarily on other body parts, such as the back, legs, or hands, were excluded unless they provided dual support for both the upper limbs and other regions like the back or legs. Rehabilitation exoskeletons were also excluded from this review, as the primary interest was on devices intended to assist with occupational tasks rather than therapeutic interventions. Including back-, leg-, or hand-focused exoskeletons would have substantially broadened the scope of this review, shifting it toward a general overview of occupational exoskeletons rather than a targeted analysis of upper-limb devices. Their inclusion would have diluted the depth of discussion on technological diversity and kinematic structures specific to upper-limb applications, which are the central objectives of the present work. To ensure consistency and relevance, only studies published in English were considered.
<table><thead><tr><td>Author (Year)</td><td>Main Themes Reviewed</td><td>Main Conclusions</td><td>Technological Aspects</td><td>Assessment Aspects</td></tr></thead><tbody><tr><td>Flor-Unda (2025)[27]</td><td>Adverse effects due to the prolonged use of upper-limb exoskeletons</td><td><ul><li>Lack of longitudinal studies and real-world evaluations</li><li>Limited transferability of lab results to actual work conditions</li><li>Need for extensive field testing on sustainability, health impact, and workflow integration</li><li>Absence of design/safety standards and effective training programs</li></ul></td><td><strong>Technological diversity</strong><br>NA*<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> Considers risks of prolonged use (muscle overload, fatigue, joint stress, cardiovascular cost)<br><br><strong>Side Effects</strong> In-depth (physiological, psychological, technological/ergonomic)<br><br><strong>Real-World Health Impact</strong> lab vs. field studies, emphasizes workplace risks and standards</td></tr><tr><td>Supriyono (2025)[32]</td><td>Mechanical designs, actuation systems, control approaches, and applications of elbow exoskeletons, with focus on design trends, effectiveness, and research gaps for practical and accessible solutions</td><td><ul><li>Focus mainly on flexion-extension; Limited integration of supination-pronation</li><li>Engineering trade-offs in size, weight, and usability when adding more DoF</li><li>Balance between precision and usability not always achieved</li><li>Technical issues: user intention detection (EMG), power autonomy, sensor stability, actuator efficiency</li><li>High user variability requires adaptable and modular solutions</li></ul></td><td><strong>Technological diversity</strong><br>Classifies elbow exoskeletons by mechanical structure, actuation, sensing<br><br><strong>Kinematic structure</strong><br>Detailed elbow kinematics</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> NA<br><br><strong>Real-World Health Impact</strong> Adoption challenges shortly addressed</td></tr></tbody></table>
<table><thead><tr><td>Author (Year)</td><td>Main Themes Reviewed</td><td>Main Conclusions</td><td>Technological Aspects</td><td>Assessment Aspects</td></tr></thead><tbody><tr><td>Hochreiter (2025)[34]</td><td>Systematic review (2007–2024) on intention prediction methods for active upper-limb exoskeletons in industrial settings, analyzing sensor-based, machine learning, and hybrid approaches, with implications for ergonomics, usability, safety, and real-time control</td><td><ul><li>Lack of standardized evaluation protocols and comprehensive metrics</li><li>Scarcity of real-world industrial validations beyond laboratory settings</li><li>Limited robustness, generalizability, and diversity of participant samples for tests</li><li>Technical challenges in balancing accuracy, response time, and computational cost</li><li>Need for multimodal data fusion and advanced AI-driven adaptive control for scalability and user acceptance</li></ul></td><td><strong>Technological diversity</strong><br>Intention prediction methods, sensors and control strategies<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> Only minor notes on assessment of usability and effectiveness<br><br><strong>Real-World Health Impact</strong> No field studies analyzed</td></tr><tr><td>Cardoso (2024)[31]</td><td>Systematic review (2014–2024) on the use of exoskeletons for the prevention of work-related musculoskeletal disorders (WMSDs) in occupational settings. The authors analyze applications across various industries, evaluating ergonomic outcomes, task performance, and worker well-being</td><td><ul><li>Most studies are lab-based with small samples, short-term studies, lacking large-scale and real-world evaluations</li><li>Research focuses mainly on passive exoskeletons, back/upper-arm support, and overhead/lifting tasks, leaving other devices, body parts, and occupational scenarios underexplored</li><li>Objective measures (EMG, kinematics) dominate, while observational approaches and comprehensive integration of subjective user experience are underused</li><li>Persistent issues of discomfort, task incompatibility, restricted motion, and usability concerns remain insufficiently addressed</li></ul></td><td><strong>Technological diversity</strong><br>Covers active vs. passive and body-region devices<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> Notes discomfort and ergonomic issues<br><br><strong>Real-World Health Impact</strong><br>Study context is analyzed</td></tr></tbody></table>
<table><thead><tr><td>Author (Year)</td><td>Main Themes Reviewed</td><td>Main Conclusions</td><td>Technological Aspects</td><td>Assessment Aspects</td></tr></thead><tbody><tr><td>Ahmad et al. (2024)[25]</td><td>Systematic review and conceptual framework linking exoskeleton adoption to Technology Readiness Levels (TRLs); maps current evidence on ergonomics, usability, productivity, and health outcomes; shows how these dimensions are assessed differently as devices evolve—from laboratory prototypes (focused on ergonomics and basic functionality) to market-ready systems (evaluated in terms of usability, workplace integration, and long-term impact on worker health and productivity)</td><td><ul><li>Exoskeletons reduce muscle activity and WMSD risk, with generally positive user feedback</li><li>Research is concentrated in manufacturing/automotive; other high-risk sectors are underexplored</li><li>Assessments rely mainly on EMG and questionnaires; other metrics are rarely used</li><li>Need for systematic TRL-based evaluation, longer trials, larger samples, and broader device/sector coverage</li></ul></td><td><strong>Technological diversity</strong><br>Covers TRL stages, device typologies<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> It is focused on muscles activations in the supported area, and then user comfort and acceptance, the overall body impact is not considered<br><br><strong>Real-World Health Impact</strong> Includes industrial scenarios and in-depth analysis</td></tr><tr><td>Al-Khiami et al. (2024)[36]</td><td>Overview of the exoskeleton industry, mapping current market dynamics, technological developments, application domains, and adoption trends</td><td><ul><li>132 models from 72 companies worldwide; rapid market growth</li><li>Industrial use dominates, but devices are not sector-specific</li><li>Passive types prevail in industry; active in healthcare</li><li>Construction sector underserved, showing clear gap for tailored solutions</li></ul></td><td><strong>Technological diversity</strong><br>Industry trends and market diversity; covers active vs. passive<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> NA<br><br><strong>Real-World Health Impact</strong> Notes industry adoption impact</td></tr><tr><td>Tian (2024)[23]</td><td>Occupational shoulder exoskeletons for industrial use, analyzing mechanical designs, actuation systems, control strategies, and evaluation methods</td><td><ul><li>Shoulder exoskeletons lower muscle load and WRMSD risk in overhead work</li><li>Market devices are mainly passive/rigid; soft and active types still face weight, cost, and control issues</li><li>Current assistance is limited to gravity compensation; more versatile support is needed</li><li>Evaluation remains short-term and non-standardized; long-term field studies are lacking</li></ul></td><td><strong>Technological diversity</strong><br>Mechanism design, actuators, control of shoulder devices<br><br><strong>Kinematic structure</strong><br>Analyzed, with a focus on kinematic compatibility</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> Mentions discomfort/fit issues<br><br><strong>Real-World Health Impact</strong> Some real-world assessment noted</td></tr></tbody></table>
<table><thead><tr><td>Author (Year)</td><td>Main Themes Reviewed</td><td>Main Conclusions</td><td>Technological Aspects</td><td>Assessment Aspects</td></tr></thead><tbody><tr><td>Ashta et al. (2023)[33]</td><td>Passive exoskeletons in manufacturing and logistics, assessing their performance across tasks, evaluation methods, efficiency and cost, and proposing a maturity map and future research agenda for industrial adoption</td><td><ul><li>Passive exoskeletons help in static tasks but less in dynamic ones</li><li>Adoption limited by discomfort, fit, and acceptance issues</li><li>Evidence mostly from labs; real-world and long-term data are scarce</li><li>Standardized evaluation and regulation still needed</li></ul></td><td><strong>Technological diversity</strong><br>Focus on passive exoskeletons in manufacturing and logistics<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><strong>Side Effects</strong> Mentions comfort/acceptance<br><strong>Real-World Health Impact</strong> Discusses efficiency and cost in real-world manufacturing and logistics</td></tr><tr><td>De Bock et al. (2022)[35]</td><td>Occupational exoskeletons, classifying assessment types and methods, and proposes a framework to benchmark devices for more consistent, comparable, and user-centered evaluation</td><td><ul><li>Exoskeleton assessment is a dynamic process, evolving from controlled validation to applied field studies</li><li>Heterogeneity of protocols limits comparability across devices and studies</li><li>A benchmarking framework is needed to align methods and improve consistency</li><li>Future research should combine objective and subjective measures and expand field evaluations for real-world relevance</li></ul></td><td><strong>Technological diversity</strong><br>Distinguish between active and passive exoskeletons in the analysis<br><br><strong>Kinematic structure</strong><br>NA</td><td><strong>Long-Term Effects</strong> NA<br><strong>Side Effects</strong> Perceived exertion, discomfort, obstruction, pressure points, workload, usability. The evaluation of side effects relies mainly on subjective measures (questionnaires, scales, self-reports).<br><strong>Real-World Health Impact</strong> Field studies on ergonomics, muscle activity, fatigue, productivity, and acceptance in actual work settings</td></tr></tbody></table>
<table><caption>**Table 1:** Comparative summary of recent review literature on occupational upper-limb exoskeletons.</caption><thead><tr><th>Author (Year)</th><th>Main Themes Reviewed</th><th>Main Conclusions</th><th>Technological Aspects</th><th>Assessment Aspects</th></tr></thead><tbody><tr><td>Moeller et al. (2022)[26]</td><td>Upper-limb exoskeletons for occupational use, analyzing design types, supported tasks, and evaluation methods (objective and subjective) with emphasis on shoulder-support devices</td><td><ul><li>Upper-limb exoskeletons can reduce muscle activity and perceived exertion, mainly in overhead tasks</li><li>Benefits are clearer in lab settings; field results are more variable</li><li>Discomfort, limited motion, and usability issues remain barriers to adoption</li><li>More long-term and real-world studies are needed to confirm health and productivity impacts</li></ul></td><td><strong>Technological diversity</strong><br>Considers a wide variety of upper-limb exoskeletons (active, passive, semi-passive), mostly shoulder-support devices<br><br><strong>Kinematic structure</strong><br>Kinematic outcomes such as joint angles, ROM, posture deviations, and COP (center of pressure) are systematically analyzed</td><td><strong>Long-Term Effects</strong> NA<br><br><strong>Side Effects</strong> Changes in posture and kinematics, perceived exertion and workload, discomfort, pain, and usability issues<br><br><strong>Real-World Health Impact</strong><br>Reduction of muscle activity, productivity and task performance, user acceptance and intention to use</td></tr></tbody></table>
The literature search was conducted between April and May 2024. A combination of keywords was used to identify relevant studies and patents. The search terms included: exoskeleton AND (active OR passive OR work* OR hybrid OR job OR occupation* OR overhead). These terms were selected to encompass a wide range of exoskeleton types and their applications in occupational settings. To broaden the scope and identify additional devices, further research was conducted using online databases and repositories, such as Exoskeleton Report, which specializes in exoskeleton technology and provides detailed insights into various commercially available and protototype devices.

## 2.2. Eligibility Criteria

The eligibility criteria for selecting studies on upper-limb exoskeletons in workplace settings are depicted in the accompanying flowchart 3. Studies were included if they focused on exoskeletons designed for or used in occupational environments, provided empirical data on the performance and effects of these devices, and addressed both the technological aspects and ergonomic implications of exoskeleton use. Conversely, studies were excluded if they primarily focused on exoskeletons designed for back, leg, or hand support without upper limb assistance, were centered on rehabilitation or medical applications, or lacked experimental data, relying instead on purely theoretical discussions. This flowchart provides a visual summary of the decision-making process used to determine study eligibility.

<figure><img src="image_3.png" /><figcaption>**Figure 2:** Eligibility criteria for selecting studies on upper-limb exoskeletons in workplace settings</figcaption></figure>

## 2.3. Data Screening

The initial search yielded a large number of studies, which were then screened in two stages:

1. Title and Abstract Screening: This initial screening phase involved a review of titles and abstracts to eliminate irrelevant studies.

2. Full-Text Review: Studies that passed the initial screening were subjected to a full-text review to ensure they met the inclusion criteria and provided sufficient empirical evidence.

The 59 studies that met the inclusion criteria were analyzed to extract key information, including the type of exoskeleton, its kinematic structure, actuation methods, and the specific occupational tasks it was designed to assist with. Particular attention was paid to the methodologies used to evaluate these exoskeletons, the outcomes reported, and any long-term effects or side effects noted.

The overall method and process to include studies in this review can be seen in Figure 3.

# 3. Results

The two tables (2, 3) provide a comprehensive overview of upper-limb exoskeletons used in occupational settings, focusing on different aspects of analysis. Table 2 details the technical specifications of the exoskeletons, including power source, kinematic structure, attachment points, supported body parts, primary tasks, weight, and peak torque. This table allows for a comparison of the mechanical and functional attributes of each device, highlighting their intended applications and physical characteristics. The table 3 shifts the focus to the evaluation of these devices in terms of their effects on users. It includes information on the studies conducted, the evaluation of side effects, the presence or absence of after-effects, long-term evaluations, and unassisted body areas. This table emphasizes the types of research carried out on these exoskeletons.
<figure><img src="image_4.png" /><figcaption>**Figure 3:** Flowchart of the method used to include articles in the review</figcaption></figure>
<table><thead><tr><td>Device Name (Company / Team)</td><td>Power Source</td><td>Kinematics Structure</td><td>Attachment Port</td><td>Supported Body Part</td><td>Main Task</td><td>Weight</td><td>Peak Force/Torque</td></tr></thead><tbody><tr><td>Agadexo Shoulder (AGADE SR)</td><td>Hybrid</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders, Back</td><td>Pick and carry, Overhead works</td><td>6 Kg</td><td>8 Kg x arm</td></tr><tr><td>Airframe (LEVITATE TECH)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.27 Kg</td><td>-</td></tr><tr><td>Ant-A1 (LUBAN EXO)</td><td>Active</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders, Back</td><td>Heavy lifting</td><td>5.2 Kg</td><td>30 Nm</td></tr><tr><td>Armor-Man (TILTAMAX)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Hands, Arms</td><td>Shoulders</td><td>Tool holding (Camera)</td><td>25 Kg</td><td>-</td></tr><tr><td>Bes-Ultra (ULS ROBOTICS)</td><td>Active</td><td>Rigid, anthropomorphic</td><td>Upper-arms, legs</td><td>Shoulders, Back, Knees</td><td>Pick and carry, Overhead works</td><td>25 Kg</td><td>-</td></tr><tr><td>Besk G (CYBER HUMAN)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>3 kg</td><td>12 Kg</td></tr><tr><td>Carry (Nassour et al.)</td><td>Active</td><td>Soft</td><td>Upper-arms, forearms, hands</td><td>Arms</td><td>Carrying</td><td>-</td><td>-</td></tr><tr><td>CDYS (CRIMSON DYNAMICS)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.6 kg</td><td>-</td></tr><tr><td>DeltaSuit (AUXIVO)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>1.8 Kg</td><td>6.6 Nm</td></tr><tr><td>Enforcer (EXOMED)</td><td>Active</td><td>Fixed structure</td><td>Hands</td><td>Shoulders, Back</td><td>Tool holding</td><td>23.5 Kg</td><td>120 Kg</td></tr><tr><td>Ecura Arms (ERCURA)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2 Kg</td><td>16 Nm</td></tr><tr><td>Evo (EKSO BIONICS)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Tool holding, Overhead works</td><td>3.4 Kg</td><td>6.8 Nm</td></tr><tr><td>Exo Vest (EKSO BIONICS)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms, forearms</td><td>Shoulders</td><td>Overhead works</td><td>4.3 Kg</td><td>-</td></tr><tr><td>Exo-01 (HILTI)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2 Kg</td><td>-</td></tr><tr><td>Exo-S (HILTI)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.3 Kg</td><td>-</td></tr><tr><td>Exhaus (lifter) (EXHAUSS)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Hands</td><td>Arms</td><td>Heavy lifting</td><td>5.8 Kg</td><td>25 Kg</td></tr><tr><td>Exhaus (worker) (EXHAUSS)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Hands</td><td>Shoulders, Arms</td><td>Repetitive tasks</td><td>8.9 Kg</td><td>25 Kg</td></tr><tr><td>Exhaus (reliever) (EXHAUSS)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>7.9 Kg</td><td>25 Kg</td></tr><tr><td>Exy One (EXY)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>3.55 Kg</td><td>8 Kg x arm</td></tr><tr><td>Fawcett Exovest (THE TIFFEN COMPANY)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Hands</td><td>Shoulders, Arms</td><td>Tool holding (Camera)</td><td>4.85 Kg</td><td>-</td></tr><tr><td>Fortis (LOCKHEED MARTIN)</td><td>Passive</td><td>Fixed structure</td><td>Hands</td><td>Shoulders, Back</td><td>Tool holding</td><td>-</td><td>23 Kg</td></tr></tbody></table>
<table><thead><tr><th>Device Name<br>(Company / Team)</th><th>Power<br>Source</th><th>Kinematics<br>Structure</th><th>Attachment Port</th><th>Supported Body<br>Part</th><th>Main Task</th><th>Weight</th><th>Peak<br>Torque</th></tr></thead><tbody><tr><td>Hapo Front<br>(ERGOSANTE')</td><td>Passive</td><td>Soft</td><td>Upper-arms,<br>forearms</td><td>Shoulders</td><td>Repetitive tasks,<br>Arms extended</td><td>1.3 Kg</td><td>6 Kg</td></tr><tr><td>Hapo Up<br>(ERGOSANTE')</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>1.67 Kg</td><td>3.8 Kg x<br>arm</td></tr><tr><td>Holdupper (EXOMED)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Elbow, forearms</td><td>Shoulders</td><td>Overhead works</td><td>4.8 Kg</td><td>8 Kg x arm</td></tr><tr><td>Hust-Ev (Du et al.)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>1.3 Kg</td><td>-</td></tr><tr><td>H-pulse (IUVO)</td><td>Hybrid</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>5 Kg</td><td>6 Nm</td></tr><tr><td>H-Vex (HYUNDAI)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.5 Kg</td><td>5.5 Kg</td></tr><tr><td>Light (HTM)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms,<br>forearms</td><td>Arms</td><td>Tool Handling</td><td>2.9 Kg</td><td>6 Kg</td></tr><tr><td>MAPS_E (ULS<br>ROBOTICS)</td><td>Active</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>6.5 Kg</td><td>20 Kg</td></tr><tr><td>Mate (COMAU (IUVO))</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>4 Kg</td><td>5.46 Kg x<br>arm</td></tr><tr><td>Mate-XT (COMAU<br>(IUVO))</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>3 Kg</td><td>5.5 Kg x<br>arm</td></tr><tr><td>MuscleSuit<br>(INNOPHYS)</td><td>Active</td><td>Rigid, non-<br>anthropomorphic</td><td>Hands</td><td>Shoulders, Back</td><td>Heavy lifting,<br>Pick and carry</td><td>8.1 Kg</td><td>35.7 Kg,<br>140 Nm</td></tr><tr><td>Lucy 2.0 (PROJECT<br>SMARTASSIST)</td><td>Active</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>-</td><td>-</td></tr><tr><td>Ottobock Shoulder<br>(OTTOBOCK)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>-</td><td>-</td></tr><tr><td>Paexo Shoulder<br>(OTTOBOCK)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>1.9 Kg</td><td>11.7 N</td></tr><tr><td>OmniSuit (AUXIVO)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms, legs</td><td>Shoulders, Back</td><td>Overhead works,<br>Heavy lifting</td><td>2.7 Kg</td><td>-</td></tr><tr><td>Plum' (HTM)</td><td>Passive</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Arms</td><td>Overhead works</td><td>1.5 Kg</td><td>6 Kg</td></tr><tr><td>Robo-Mate (passive)<br>(EUROPEAN<br>PROJECT)</td><td>Passive</td><td>Rigid, non-<br>anthropomorphic</td><td>Arms</td><td>Shoulders, Arms</td><td>Medium / heavy<br>loads handling</td><td>3.7 Kg</td><td>7.5 Kg x<br>arm</td></tr><tr><td>Robo-Mate (active)<br>(EUROPEAN<br>PROJECT)</td><td>Active</td><td>Rigid, non-<br>anthropomorphic</td><td>Arms</td><td>Shoulders, Arms</td><td>Pick and place<br>tasks</td><td>2.3 Kg</td><td>7.5 Kg x<br>arm</td></tr><tr><td>S700 (EXOIQ)</td><td>Active</td><td>Rigid,<br>anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>6.5 Kg</td><td>5 Kg</td></tr></tbody></table>
<table><caption>**Table 2:** Detailed technical specifications of upper-limb occupational exoskeletons used in industrial applications, including power source, kinematic structure, attachment ports, supported body parts, primary tasks, weight, and peak torque. *NA = Not Addressed</caption><thead><tr><td>Device Name (Company / Team)</td><td>Power Source</td><td>Kinematics Structure</td><td>Attachment Port</td><td>Supported Body Part</td><td>Main Task</td><td>Weight</td><td>Peak Torque</td></tr></thead><tbody><tr><td>Shiva Exo (ERGOSANTE')</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms, forearms, thighs</td><td>Shoulders, Back</td><td>Pick and carry, Overhead works</td><td>6.85 Kg</td><td>7.5 Kg x arm</td></tr><tr><td>ShoulderX (SUITX)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>3.2 Kg</td><td>5.4 Kg</td></tr><tr><td>Skelex 360 (SKELEX)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.3 Kg</td><td>4 Kg</td></tr><tr><td>Stuttgart exo jacket (FRAUNHOFER INSTITUTE)</td><td>Active</td><td>Rigid, anthropomorphic</td><td>Upper-arms, forearms</td><td>Shoulders, Arms</td><td>Overhead works</td><td>-</td><td>40 Nm</td></tr><tr><td>Task AR 3.0 (DAYDO CO., LTD)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms, neck</td><td>Shoulders, Neck</td><td>Overhead works</td><td>1.7 Kg</td><td>3.0 Kg</td></tr><tr><td>Titan Arms PUCE4 (HYETONE EXOSKELETON)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2.8 Kg</td><td>7 Kg</td></tr><tr><td>Uplift (MAWASHI)</td><td>Passive</td><td>Rigid, anthropomorphic</td><td>Upper-arms, forearms, legs</td><td>Shoulders, Back, Knees</td><td>Pick and carry, Overhead works</td><td>-</td><td>-</td></tr><tr><td>X-Arm (EXORISE)</td><td>Passive</td><td>Fixed structure</td><td>Hands</td><td>Shoulders, Back</td><td>Tool holding</td><td>17 Kg</td><td>40 Kg</td></tr><tr><td>X-Rise (EXORISE)</td><td>Passive</td><td>Rigid, non-anthropomorphic</td><td>Upper-arms</td><td>Shoulders</td><td>Overhead works</td><td>2-3 Kg</td><td>6 Kg</td></tr></tbody></table>
<table><thead><tr><th>Device Name<br>(Company / Team)</th><th>Publications</th><th>Main<br>Measurement</th><th>Complementary Measurement</th><th>Residual<br>Effects</th><th>Long-<br>Term<br>Effects</th><th>Not<br>Supported<br>Body Area</th></tr></thead><tbody><tr><td>Agadexo Shoulder<br>(AGADE SR)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Airframe (LEVITATE<br>TECH)</td><td>[37, 38, 39, 40,<br>41, 24, 42, 43,<br>44, 45]</td><td>Muscles activity via<br>EMG<br>[37, 38, 39, 24],<br>Muscles activity via<br>TSI [44],<br>Kinematics via<br>MoCap [24, 45]</td><td>Subjective perception (RPD)<br>[37, 38, 41, 44]; Heart rate [39],<br>Task time, Task precision [43, 45]</td><td>-</td><td>-</td><td>Lower<br>Limbs [37],<br>Back [37,<br>38, 24, 44]</td></tr><tr><td>Ant-A1 (LUBAN EXO)<br>Armor-Man<br>(TILTAMAX)<br>Bes-Ultra (ULS<br>ROBOTICS)<br>Besk G (CYBER<br>HUMAN)</td><td>-<br>-<br>-<br>-</td><td>-<br>-<br>-<br>-</td><td>-<br>-<br>-<br>-</td><td>-<br>-<br>-<br>-</td><td>-<br>-<br>-<br>-</td><td>-</td></tr><tr><td>Carry (Nassour et al.)</td><td>[20]</td><td>Muscles activity via<br>EMG</td><td>Oxygen consumption</td><td>-</td><td>-</td><td>-</td></tr><tr><td>CDYS (CRIMSON<br>DYNAMICS)</td><td>[46]</td><td>-</td><td>Subjective perception (RPE,<br>VAS)</td><td>-</td><td>-</td><td>-</td></tr><tr><td>DeltaSuit (AUXIVO)</td><td>[47]</td><td>Muscles activity via<br>EMG</td><td>Subjective perceptions (RPD,<br>RPE), Heart rate</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Enforcer (EXOMED)<br>Ercura Arms (ERCURA)</td><td>-<br>-</td><td>-<br>-</td><td>-<br>-</td><td>-<br>-</td><td>-<br>-</td><td>-</td></tr><tr><td>Evo (EKSO BIONICS)</td><td>[48, 49]</td><td>Kinematics via<br>IMU [48]<br>Muscles activity via<br>TSI [44],<br>Kinematics via<br>IMU [50]</td><td>Heart rate, Task time [48], Task<br>precision [49]</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Exo Vest (EKSO<br>BIONICS)</td><td>[50, 44, 51, 21,<br>52]</td><td>Muscles activity via<br>TSI [44],<br>Kinematics via<br>IMU [50]</td><td>Subjective perception (RPD)<br>[44], Heart rate [52]</td><td>-</td><td>Subjective<br>perception<br>[51, 21]</td><td>Back [44]</td></tr><tr><td>Exo-01 (HILTI)<br>Exo-S (HILTI)<br>Exhaus (lifter)<br>(EXHAUSS)</td><td>[48]</td><td>Kinematics via IMU</td><td>Heart rate, Task time</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Exhaus (worker)<br>(EXHAUSS)</td><td>[53]</td><td>Muscles activity via<br>EMG, Kinematics<br>via IMU</td><td>Postural balance, Heart rate,<br>Subjective perception (RPE),<br>Task time</td><td>-</td><td>-</td><td>Lower limb</td></tr><tr><td>Exhaus (reliever)<br>(EXHAUSS)</td><td>[54]</td><td>Muscles activity via<br>EMG</td><td>Postural balance</td><td>-</td><td>-</td><td>Back</td></tr><tr><td>Exy One (EXY)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<table><thead><tr><th>Device Name<br>(Company / Team)</th><th>Publications</th><th>Main<br>Measurement</th><th>Complementary Measurement</th><th>Residual<br>Effects</th><th>Long-<br>Term<br>Effects</th><th>Not<br>Supported<br>Body Area</th></tr></thead><tbody><tr><td>Fawcett Exovest (THE<br>TIFFEN COMPANY)</td><td>[55, 56]</td><td>Muscles activity via<br>EMG [55, 56]</td><td>Subjective perception (MAF,<br>RPD) [55, 56]</td><td>-</td><td>-</td><td>Back<br>[55, 56]</td></tr><tr><td>Fortis (LOCKHEED<br>MARTIN)</td><td>[55]</td><td>Muscles activity via<br>EMG</td><td>Subjective perception (MAF,<br>RPD)</td><td>-</td><td>-</td><td>Back</td></tr><tr><td>Hapo Front<br>(ERGOSANTE')</td><td>[19]</td><td>Muscles activity via<br>EMG</td><td>Subjective perception (RPE,<br>RPD), Postural balance</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Hapo Up<br>(ERGOSANTE')</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Holdupper (EXOMED)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Hust-Ev (Du et al.)</td><td>[57]</td><td>Muscles activity via<br>EMG, Kinematics<br>via MoCap</td><td>Task precision</td><td>-</td><td>-</td><td>Lower<br>Limbs,<br>Back</td></tr><tr><td>H-pulse (IUVO)</td><td>[14]</td><td>Muscles activity via<br>EMG</td><td>Subjective perceptions (NASA,<br>RPE), Heart rate</td><td>-</td><td>-</td><td>-</td></tr><tr><td>H-Vex (HYUNDAI)</td><td>[37]</td><td>Muscles activity via<br>EMG</td><td>Subjective perception (RPD)</td><td>-</td><td>-</td><td>Lower<br>Limbs,<br>Back</td></tr><tr><td>Light (HTM)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Maps_E (ULS<br>ROBOTICS)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Mate (COMAU (IUVO))</td><td>[50, 58, 15, 59]</td><td>Muscles activity via<br>EMG [59, 15],<br>Kinematics via<br>IMU [50]</td><td>Subjective perceptions (LPE)<br>[15], Limb vibration [59]</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Mate-XT (COMAU<br>(IUVO))</td><td>[30]</td><td>Muscles activity via<br>EMG, Kinematics<br>via IMU</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>MuscleSuit<br>(INNOPHYS)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Lucy 2.0 (PROJECT<br>SMARTASSIST)</td><td>[60]</td><td>Muscles activity via<br>EMG</td><td>Subjective perception (RPE)</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Ottobock Shoulder<br>(OTTOBOCK)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<table><thead><tr><th>Device Name (Company / Team)</th><th>Publications</th><th>Main Measurement</th><th>Complementary Measurement</th><th>Residual Effects</th><th>Long-Term Effects</th><th>Not Supported Body Area</th></tr></thead><tbody><tr><td>Paexo Shoulder (OTTOBOCK)</td><td>[61, 62, 63, 64, 59, 12, 22, 50]</td><td>Muscles activity via EMG [62, 12, 59, 22], Muscles activity via FMG [62], Kinematics via IMU [61, 12, 50], Joint forces via Simulation [63, 64]</td><td>Subjective perceptions (RPE, RPD) [12], Ground Reaction [61, 12], Heart rate, Oxygen consumption [12, 22]</td><td>-</td><td>-</td><td>Back [63, 64, 22], Abdomen [22], Whole body kinematics [61, 12]</td></tr><tr><td>OmniSuit (AUXIVO) Plum' (HTM) Robo-Mate (passive) (EUROPEAN PROJECT) Robo-Mate (active) (EUROPEAN PROJECT) S700 (EXOIQ) Shiva Exo (ERGOSANTE')</td><td>[65]<br>-<br>[17, 7, 66, 67, 68, 69]</td><td>-<br>-<br>Muscles activity via EMG [69]</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>ShoulderX (SUITX)</td><td>[44, 55, 70, 59]</td><td>Muscles activity via EMG [55, 70, 59], Muscles activity via TSI [44]</td><td>Subjective perception (RPE) [69]</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Skelex 360 (SKELEX)</td><td>[71, 72, 73, 46]</td><td>Muscles activity via EMG [71]</td><td>Subjective perception (RPD) [44], Subjective perceptions (MAF, RPD) [55], Limb vibration [59]<br>Subjective perception (RPE, RPD) [71]; Heart rate, Subjective perceptions (RPE) [72], Subjective perceptions (RPE, VAS) [46], Subjective perceptions (UA, IU) [73]</td><td>-</td><td>-</td><td>Back [44, 55]</td></tr><tr><td>Stuttgart exo jacket (FRAUNHOFER INSTITUTE) Task AR 3.0 (DAYDO CO., LTD) Titan Arms PUCE4 (HYETONE EXOSKELETON) Uplift (MAWASHI) X-Arm (EXORISE)</td><td>[74]<br>-<br>-<br>-<br>-</td><td>Kinematics via MoCap</td><td>-</td><td>-</td><td>-</td><td>Whole body kinematics</td></tr></tbody></table>
<table><caption>**Table 3:** Overview of studies conducted on the effect of upper-limb occupational exoskeletons, focusing on the aspects analyzed, such as muscle activity, side effects, after-effects, and long-term evaluations. This table outlines which specific areas have been studied for each device, including evaluations of unsupported body parts, and whether long-term effects were considered. (Abbreviations: UA = User Acceptance; IU = Intention of Use; VAS = Visual Analog Scale; RPE = Rate of Perceived Effort; RPD = Rate of Perceived Discomfort; TSI = Tissue Saturation Index; MAF = Maximum Acceptable Frequency; FMG = Force Myograph; LPE = Local Perceived Exertion; TAM = Technology Acceptance Model)</caption><thead><tr><td>Device Name (Company / Team)</td><td>Publications</td><td>Main Measurement</td><td>Complementary Measurement</td><td>Residual Effects</td><td>Long-Term Effects</td><td>Not Supported Body Area</td></tr></thead><tbody><tr><td>X-Rise (EXORISE)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<figure><img src="image_5.png" /><figcaption>**Figure 4:** Number of publications per year</figcaption></figure>

# 4. Discussion

Research on exoskeletons has seen significant growth in re-
cent years, as shown in Figure 4, with the number of published
studies increasing dramatically since 2018. These findings are
consistent with those of Moeller et al. [26], who reported that
32 out of 35 studies published between 2014 and 2022 appeared
in the last four years. This trend is also reflected in review arti-
cles such as De Bock et al. [35] and Ahmad et al. [25], which
mapped an accelerating evidence base. This surge in research
interest parallels the expansion of the exoskeleton market. The
global exoskeleton market size is projected to grow at a Com-
pound Annual Growth Rate (CAGR) of 16.6% from 2024 to
2030, driven by innovations in powered exoskeleton technolo-
gies and their increasing adoption across various sectors, in-
cluding manufacturing and construction [75].

## 4.1. Technical Specifications

This first part of the discussion will focus on technical and
design specifications of the exoskeletons presented in Table 2.

### 4.1.1. Passive Exoskeleton Predominance

<figure><img src="image_6.png" /><figcaption>**Figure 5:** Actuation technology based distribution</figcaption></figure>

The majority of industrial exoskeletons are passive (Figure 5,
created from data in Table 2), a trend consistent with prior ob-
servations [7]. This predominance is also confirmed in multiple
empirical studies evaluating devices such as the Airframe [37]-
[45], Paexo Shoulder [12, 22, 50, 61, 62, 63, 64], and Mate
[15, 59], all of which showed measurable reductions in muscle
activity or perceived exertion. Passive exoskeletons function
without external power, instead storing and releasing mechan-
ical energy as needed. This dominance likely reflects industry
priorities, as passive designs offer operational efficiency, relia-
bility, and ease of use in real-world settings. Supporting this,
most field evaluations have focused on passive upper-limb ex-
oskeletons [15, 43, 46, 48], suggesting their current superiority
for industrial applications.

Historically, exoskeleton development emphasized active
systems [76], particularly following successes in medical re-
habilitation. A notable example is the Lokomat exoskeleton
[77], developed in 1994 for gait rehabilitation. The initial ap-
peal of active systems stemmed from their capacity for tailored
assistance and energy injection, properties that seemed transfer-
able to industrial tasks like repetitive overhead work. However,
practical implementation revealed significant limitations: active
exoskeletons introduce maintenance burdens, safety risks, de-
sign complexity, and weight penalties, while requiring continu-
ous power [78]. These challenges have driven the shift toward
passive designs [79], which better align with industrial needs.

### 4.1.2. Anthropomorphic Predominance

<figure><img src="image_7.png" /><figcaption>**Figure 6:** Kinematics structure based distribution</figcaption></figure>

A significant proportion of industrial exoskeletons employ
anthropomorphic designs that closely replicate human arm
biomechanics (Figure 6). This design paradigm strategi-
cally aligns the exoskeleton's rotational axes with the user's
anatomical joint centers, thereby preserving natural kinematic
chains[80]. Such biomechanical congruence serves multiple
critical functions: it enhances user comfort by distributing me-
chanical loads according to natural movement patterns, main-
tains the user's native task space, and prevents disruptions in
inter-joint coordination. Studies comparing anthropomorphic
and non-anthropomorphic structures support this: for example,
the Exhaus Reliever [54] induced back strain despite shoulder
relief, while Skelex 360 [71, 72, 73, 74] was reported to reduce perceived exertion but showed variability depending on task.

Complementing this anthropomorphic approach is a clear design trend toward minimizing the number of attachment points to the body. Recent exoskeletons typically interface with users at only essential anatomical locations, a strategy that yields three primary benefits: (1) reduced soft-tissue discomfort and thermal accumulation, (2) diminished risk of inducing unnatural movement patterns, and (3) preserved biomechanical integrity of unsupported body segments. This minimal-contact philosophy is particularly advantageous in industrial environments where workers must transition between diverse tasks requiring varied postures and movement patterns.

However, the convergence of these two design principles, anthropomorphic kinematics and minimal attachment points, has led to a notable specialization in joint-specific support. Analysis of current industrial exoskeletons reveals a predominance of single-joint assistance systems, with particular emphasis on shoulder joint support (as evidenced by upper-arm attachment predominance in Table 2). While this focused approach simplifies mechanical design and control requirements, it introduces potential ergonomic trade-offs. The selective support of individual joints may create functional asymmetries in multiarticular tasks, where unsupported joints must compensate for the assisted motion.

### 4.1.3. Supported Body Area

Most exoskeletons are designed to be attached to the upper arms, providing stable support for the shoulders during overhead tasks and repetitive motions without significantly limiting mobility. This attachment point is effective for general support, but may lack the precision needed for tasks requiring fine motor control which most of the case is done with the elbow, and then the wrist following the natural proximal-to-distal sequence of the upper-limb motion [81]. To address this, some exoskeletons extend their support to the forearms, such as the Holdupper and ShoulderX, which provide additional stability for tasks requiring extended arm positioning or precision, especially when using tools. However, while this dual support enhances stability, it can sometimes restrict natural arm movement, which may be a limitation for tasks requiring a high degree of flexibility and Range Of Motion (ROM). This trade-off between support and mobility must be carefully considered when selecting or designing exoskeletons for specific industrial applications. For tasks involving direct manipulation of tools or objects, endpoint-based exoskeletons also sometimes named supernumerary limbs (SNL), are particularly used. These devices attach directly to the tool or object being handled, reducing strain on smaller joints and muscles, such as those in the hands and wrists. This design is exemplified by the Armor Man exoskeleton, which is used for tasks like camera holding in filming. However, due to their weight, that is generally heavier (see Figure 8), and to the asymmetry they're generating, field evaluations of devices show to overall increase muscle activity [82] with, for example, devices like the Fawcett Exovest[56], Fortis [55] which demonstrated that endpoint-based support can

increase muscular load in the back and reduce usability in dynamic tasks.

Full-body exoskeletons, which provide support to the shoulders, back, and legs, are rare in industrial contexts but offer comprehensive assistance for tasks that involve a wide range of motion. For example the Uplift or the Bes-Ultra exoskeletons were designed both to pick, carry and overhead work. The Omnisuit by AUXIVO [65] is also one example, designed to reduce workload and fatigue across the shoulder and the back regions. This modularity in the supported tasks and goals enhances the versatility of exoskeleton systems, making them adaptable to various industrial needs while maintaining targeted support.

### 4.1.4. Main Tasks

Overhead work remains the most common application for industrial exoskeletons, with devices like the Airframe [37, 39], Paexo Shoulder [22], and Mate-XT [44, 55, 70] specifically designed to reduce shoulder strain during repetitive tasks. These exoskeletons are often lightweight and passive, which is advantageous for prolonged use as they do not add significant weight to the user. Evidence from studies on those devices consistently shows reduced deltoid activation during overhead tasks, but at the cost of restricted ROM or compensatory effort in other muscles.

For tasks involving heavier loads, such as tool holding, exoskeletons like the Enforcer and X-Arm use active or fixed structures to provide robust support. However, these designs come with a trade-off, as the increased support often results in reduced flexibility and greater weight. This highlights the ongoing challenge of balancing support with mobility, particularly in tasks that require a blend of strength and precision. Devices designed for heavy lifting, like the Fortis and Muscle Upper, often utilize both passive and active systems to manage substantial weights while minimizing user strain. These exoskeletons must be carefully designed to ensure they meet the specific demands of their intended tasks without introducing new ergonomic challenges.

The mass of the tool or object being handled can significantly influence the effectiveness of an exoskeleton, as reported in various studies [56, 69, 83]. This consideration is critical when designing or selecting exoskeletons for specific industrial applications, as the device must be capable of accommodating the varying weights and dynamics of the tools used.

### 4.1.5. Variability in Weight and Torque Capability

There is a wide range of weight and torque capacities among industrial exoskeletons, from around 3 to 40kg, reflecting the diversity of tasks they are designed to support (Figure 7). Exoskeletons intended for heavy lifting typically have higher torque capacities but may also be heavier, which can affect user fatigue and overall comfort. Conversely, exoskeletons designed for overhead work prioritize lightweight designs to minimize user fatigue, often at the expense of torque capacity.

This variability underscores the importance of selecting exoskeletons based on the specific requirements of the task and the working environment. Passive exoskeletons, in particular, tend to prioritize lightweight construction to enhance us-
<figure><img src="image_8.png" /><figcaption>**Figure 7:** Distribution of Peak Torque in different devices</figcaption></figure>

ability and reduce fatigue, while active exoskeletons are more performance-oriented, offering higher torque capacities at the cost of increased weight and complexity (Figure 8). This trade-off must be carefully managed to ensure that the exoskeleton provides the necessary support without compromising the user's ability to perform their tasks effectively. For instance, Kim et al. [83] found that tool mass strongly influenced the benefits of passive vests, while Alabdulkarim & Nussbaum [55] demonstrated that heavier devices such as the Fawcett Exovest reduced performance under drilling tasks.

## 4.2. Experimental evaluation

In these paragraphs, the results obtained from Table 3 will be discussed.

### 4.2.1. Principal Measurements: EMG and Kinematics

Most studies on industrial exoskeletons evaluate their effect using muscles activity measured via Electromyography (EMG) (Figure 9). As exoskeletons are usually used with the aim of reducing fatigue, EMG is typically used to evaluate the decrease in the activity of key muscles involved in shoulder, arm, and upper body movements (Airframe [37, 38, 39, 24], Carry [20], DeltaSuit [47], ExoVest [44], Exhaus [53, 54], Fawcette Exovest [55, 56], Fortis [84], Happ Front [19], Hust-Ev [57] ect.), such as the Anterior and Medial Deltoid, Posterior Deltoid, Upper Trapezius, Latissimus Dorsi, Erector Spinae, Pectoralis Major, Biceps Brachii, and Triceps Brachii [85]. This measurement is critical for understanding how exoskeletons reduce muscle strain during physically demanding tasks. For example, studies on devices such as the Paexo Shoulder and the Mate (Comau) exoskeletons have used EMG to demonstrate significant reductions in muscle activity during overhead work [12, 15]. Similarly, the Airframe [37, 38, 39] and Skelex 360 [71, 72] have repeatedly shown deltoid and trapezius relief, while Hust-Ev [57] provided EMG evidence of improved endurance in overhead precision tasks. However, focusing solely

on EMG without considering other aspects may limit the understanding of an exoskeleton's overall impact.

In addition to EMG, many studies complement their evaluations with kinematic measurements, such as Range of Motion (ROM) [50, 12], joint angle trajectories [74], and the speed of body segments. These parameters help to understand how exoskeletons influence movement and motor control during use. For instance, research on the Paexo Shoulder and Mate XT exoskeletons has shown some restriction in ROM, particularly in extreme postures like shoulder abduction and elbow flexion [22, 50].

### 4.2.2. Complementary Measurement: Heart Rate, and Subjective Metrics

Subjective parameters, including Ratings of Perceived Exertion (RPE) and Ratings of Perceived Discomfort (RPD), are also vital to understanding user experience. These metrics provide insights into comfort and ease of use, critical factors for adoption in industrial settings [26]. Devices like the Airframe and Exo Vest have been evaluated using both RPE and RPD to assess how the user perceives the exertion and discomfort during tasks [37, 38].

Other measurements include heart rate [39, 47, 14], energy expenditure [12, 22, 20], and task performance metrics such as time taken to complete tasks [12, 53] or postural balance [53] (Figure 10), which give a broader perspective on the physiological effects of exoskeleton use [43, 44].

### 4.2.3. Residual and Long-Term Effects

Despite the numerous metrics used to evaluate exoskeletons effect while the user wears it, a critical gap remains: long-term effects and residual effects of exoskeleton use are still under-researched. Most studies, such as those on the Paexo Shoulder, focus on short-term use. However, it has been shown that exoskeletons can still alter motor control even once removes [29].
<figure><img src="image_9.png" /><figcaption>**Figure 8:** Distribution of Weight in different devices</figcaption></figure>

<figure><img src="image_10.png" /><figcaption>**Figure 9:** Distribution of main measurements in exoskeleton studies</figcaption></figure>

<figure><img src="image_11.png" /><figcaption>**Figure 10:** Distribution of complementary measurements in exoskeleton studies</figcaption></figure>

Moreover, current studies only evaluate the impact of the devices on directly supported body areas, like the muscles of the shoulder and the arm. However, residual effects such as changes

in posture or movement habits [86] that could persist after removing the exoskeleton are rarely considered, even though they are critical for understanding the prolonged impact of these devices [63, 64]. In this review, apart from [51] and [21] who conducted studies over respectively 1 year and 18 months, no other studies have worked on long term impact of exoskeletons. However, these two studies focuses on qualitative questionnaires, lacking some quantitative metrics to fully assess exoskeletons' impact.

Research is needed to assess whether exoskeletons could inadvertently cause long-term musculoskeletal issues due to compensatory movements or altered motor control. [27] emphasized that such long-term and residual effects are rarely studied systematically, and Moeller et al. [26] highlighted the lack of transferability from laboratory to field. For example, Van En gelhoven et al. [70] observed increased activation in the Triceps Brachii during overhead work, suggesting a redistribution of muscular effort, which could pose risks for other muscle groups in the long run.

### 4.2.4. *Effect on unsupported body areas*

Finally, a major missing topic in exoskeleton research is the indirect effect of those on unsupported body areas. This review analyzed 49 exoskeletons, yet only 11 were assessed for effects beyond the directly supported area (primarily the shoulder). Of these 11, nine focused solely on the back—a region adjacent to the supported area. Just two exoskeletons were evaluated for their impact on whole-body kinematics while worn: the Stuttgart Exo-Jacket [74] and the Paexo Shoulder [61, 12]). Nevertheless, this topic is critical as, for example, studies on the Paexo Shoulder and Airframe showed that while these devices offload shoulder muscles, they provide little to no support for the lower back or legs, potentially leading to overuse or strain in these areas during extended use [22, 37]. The Exhaus Reliever [54] and Fawcett Exovest [55, 56] similarly increased load transfer to the back, underscoring the risk of secondary
<figure><img src="image_12.png" /><figcaption>**Figure 11:** Distribution of unsupported body areas considered in exoskeleton studies</figcaption></figure>

strain. This limitation is significant, as prolonged compensatory movement patterns could result in discomfort or injury in unsupported areas.

## 5. Limitations and Future Scope

Despite advancements in design, particularly in aligning exoskeletons with natural biomechanics, significant research gaps remain. One of the most striking omissions in current studies is the evaluation of post-effects of exoskeleton use, such as residual impacts that persist after the device is removed. This aspect has been largely overlooked, despite its importance in understanding long-term safety and ensuring that exoskeletons do not introduce new risks with prolonged use.

Additionally, much of the existing research has been conducted in controlled laboratory settings, which fail to fully capture the complexity of real-world industrial environments. Factors such as task variability, work transitions, and long-duration usage significantly influence device effectiveness but are underexplored. Addressing these limitations requires long-term field studies, particularly for active exoskeletons, to assess their performance in dynamic work scenarios and across diverse industrial sectors.

Looking ahead, future research should also explore the integration of intelligent control strategies, such as adaptive or AI-driven assistance, to improve user-device interaction and reduce cognitive load. Advances in lightweight materials, wearable sensing, and personalized fitting strategies could further enhance usability and worker acceptance. Finally, the development of regulatory standards and unified evaluation frameworks at both national and international levels will be critical to ensuring safe, consistent, and sustainable adoption of exoskeletons across industries worldwide.

## 6. Conclusion

The development of occupational exoskeletons, particularly upper-limb devices, shows considerable potential for reducing

work-related musculoskeletal disorders (MSDs) across industries. However, evaluating these devices must go beyond immediate reductions in muscle activity, as such outcomes provide only a partial picture of efficacy. Distinct technological approaches—passive, active, or hybrid—offer different advantages and limitations, underscoring the importance of matching device design to specific tasks and environments.

A key takeaway is the current dominance of passive exoskeletons in industrial applications due to their simplicity and reliability, whereas active systems face challenges in real-world deployment. Ensuring safe, effective, and sustainable integration of exoskeletons into industrial practice will require not only technical refinement but also comprehensive evaluation strategies that account for both user experience and long-term occupational outcomes.

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