# Lower- Limb Exosuits for Rehabilitation or Assistance of Human Movement: A Systematic Review
## 3 Review
### Clinical Studies  
For the analysis of clinical outcomes, the data extracted from the studies are presented in Table 4. The impairments addressed were mostly stroke (15 studies), followed by osteoarthritis (3) and high-impact trauma (1). Overall, 192 users with stroke, 80 with osteoarthritis and 13 recovering from trauma were enrolled (see Figure 2f,g). Active exosuits were only applied in post-stroke patients, while passive exosuits were applied in all impairment types. The application of exosuits in the reviewed studies was limited to correct and assist the movement of users who were still able to walk. The application in users that are unable to walk, such as in spinal cord injury (SCI), was not considered because of the limited assistive joint torque that exosuits can apply. Given the expected increase in the elderly population [1], degenerative musculoskeletal ailments, such as, for example, osteoarthritis, are going to constitute an important field of application for exosuits. Other possible fields of application could be multiples sclerosis or cerebral palsy. While rigid exoskeletons were already applied in these fields [50; 51], exosuits were not evaluated with users affected by these impairments in the reviewed studies. As exosuits work in close synchronicity with the human body and are worn over large periods of time, they change load distributions on the musculoskeletal system of the user [52]. No long-term studies were found in this review to evaluate the long-term effects of the application of external forces by exosuits on the joints or bones of subjects with a degenerative disease, such as osteoarthritis or osteoporosis. \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multicolumn{1}{c}{**ID**} & \multicolumn{1}{c}{**Impairment**} & \multicolumn{1}{c}{**No. of Patients**} & \multicolumn{1}{c}{**Age (Years)**} & \multicolumn{1}{c}{**Height (m)**} & \multicolumn{1}{c}{**Weight (kg)**} & \multicolumn{1}{c}{**Task**} & \multicolumn{1}{c}{\begin{tabular}{c} **Evaluation Type** \\ \end{tabular} } \\ \hline [PERSON] et al. [29] & Stroke & 44 & 27–72 & 1.60–1.88 & 51.2–113.3 & \begin{tabular}{c} Treatmentwall walk, \\ overground \\ walk \\ \end{tabular} & \begin{tabular}{c} Frequency of \\ adverse events, \\ injuries and \\ device \\ malfunctions, \\ custom \\ questionnaires, \\ walking speed \\ \end{tabular} \\ \hline [PERSON] et al. [28] & Stroke & 6 & \(52\pm 10\) & - & - & \begin{tabular}{c} 10 MWT, 6-min \\ overground \\ walk \\ \end{tabular} & \begin{tabular}{c} Walling speed, \\ distance, \\ indirect \\ calorimetry \\ \end{tabular} \\ \hline [PERSON] et al. [30] & Stroke & 8 & 30–67 & - & - & 10 MWT & Motion capture \\ \hline [PERSON] et al. [8] & Stroke & 9 & 30–67 & - & - & 10 MWT & Motion capture, \\  & & & & & 10 MWT & Capture, \\  & & & & & 10 MWT & Indirect \\ \hline [PERSON] et al. [31] & Stroke & 7 & 30–56 & 1.62–1.86 & 49.4–89.7 & \begin{tabular}{c} 8-min walk on \\ treadmill \\ \end{tabular} & \
\begin{tabular}{c} Motion \\ another, \\ calorimetry, \\ ground \\ reaction force \\ \end{tabular} \\ \hline Boudarhan & Stroke & 12 & \(51\pm 16\) & \(1.71\pm 0.1\) & \(72\pm 14\) & 10 MWT &
\begin{tabular}{c} Motion \\ capture, EMG \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Clinical data extracted from the relevant publications. \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline
To clinically evaluate lower-limb exosuits, various tasks were performed and monitored, including walking, balancing and activities of daily living. Walking was the most common task performed, including walking for several minutes (3 min [40], 5 min [7], 6 min [23; 28] and 8 min walking [31]), walking at self-selected velocity or Froude velocity [27] (selected based on leg length) and walking for a determined distance of 10 m (10 MWT) [8; 28; 30; 32; 33; 35; 38; 39] or 12 m [26]. The 10 MWT was the most common test in 8 of 19 studies.