Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs).

BACKGROUND: The aging of the population and the progressive increase of life expectancy in developed countries is leading to a high incidence of age-related cerebrovascular diseases, which affect people's motor and cognitive capabilities and might result in the loss of arm and hand functions. Such conditions have a detrimental impact on people's quality of life. Assistive robots have been developed to help people with motor or cognitive disabilities to perform activities of daily living (ADLs) independently. Most of the robotic systems for assisting on ADLs proposed in the state of the art are mainly external manipulators and exoskeletal devices. The main objective of this study is to compare the performance of an hybrid EEG/EOG interface to perform ADLs when the user is controlling an exoskeleton rather than using an external manipulator. METHODS: Ten impaired participants (5 males and 5 females, mean age 52 ± 16 years) were instructed to use both systems to perform a drinking task and a pouring task comprising multiple subtasks. For each device, two modes of operation were studied: synchronous mode (the user received a visual cue indicating the sub-tasks to be performed at each time) and asynchronous mode (the user started and finished each of the sub-tasks independently). Fluent control was assumed when the time for successful initializations ranged below 3 s and a reliable control in case it remained below 5 s. NASA-TLX questionnaire was used to evaluate the task workload. For the trials involving the use of the exoskeleton, a custom Likert-Scale questionnaire was used to evaluate the user's experience in terms of perceived comfort, safety, and reliability. RESULTS: All participants were able to control both systems fluently and reliably. However, results suggest better performances of the exoskeleton over the external manipulator (75% successful initializations remain below 3 s in case of the exoskeleton and bellow 5s in case of the external manipulator). CONCLUSIONS: Although the results of our study in terms of fluency and reliability of EEG control suggest better performances of the exoskeleton over the external manipulator, such results cannot be considered conclusive, due to the heterogeneity of the population under test and the relatively limited number of participants.

Patients' physiological reactions to competitive rehabilitation therapies assisted by robotic devices.

BACKGROUND: The aging of the population and the progressive increase in life expectancy in developed countries is leading to a high incidence of cerebrovascular diseases. Several studies have demonstrated that robot-assisted rehabilitation therapies combined with serious games can improve rehabilitation outcomes. Social interaction in the form of multiplayer games has been highlighted as a potential element to increase patient's motivation and exercise intensity, which professionals have described as one of the determining factors in maximizing rehabilitation outcomes. Despite this, it has not been widely studied. Physiological measures have been proven as an objective tool to evaluate patients' experience in robot-assisted rehabilitation environments. However, they have not been used to evaluate patients' experience in multiplayer robot-assisted rehabilitation therapies. The main objective of this study is to analyze whether the interpersonal interaction inherent in a competitive game mode affects the patients' physiological responses in robot-assisted rehabilitation environments. METHODS: A total of 14 patients participated in this study. The results of a competitive game mode were compared with a single-player game mode with different difficulty levels. Exercise intensity and performance were measured through parameters extracted from the game and the information provided by the robotic rehabilitation platforms. The physiological response of patients in each game mode was measured by the heart rate (HR) and the galvanic skin response (GSR). Patients were asked to fill out the IMI and the overall experience questionnaire. RESULTS: The exercise intensity results show that high-difficulty single-player game mode is similar in terms of intensity level to a competitive game mode, based on velocity values, reaction time and questionnaire results. However, the results of the physiological responses of the patients measured by GSR and HR are lower in the case of the competitive mode compared to the high-difficulty single-player game mode, obtaining results similar to those obtained in the low-difficulty single-player game mode. CONCLUSIONS: Patients find the competitive game mode the most fun, which is also the mode they report experiencing the most effort and stress level. However, this subjective evaluation is not in line with the results of physiological responses. This study concludes that interpersonal interaction inherent to a competitive game mode influences patients' physiological responses. This could mean that social interaction is an important factor to consider when interpreting the results obtained from physiological measurements.

Differences in Physiological Reactions Due to a Competitive Rehabilitation Game Modality.

Interpersonal rehabilitation games, compared to single-player games, enhance motivation and intensity level. Usually, it is complicated to restrict the use of the system to pairs of impaired patients who have a similar skill level. Thus, such games must be dynamically adapted. Difficulty-adaptation algorithms are usually based only on performance parameters. In this way, the patient's condition cannot be considered when adapting the game. Introducing physiological reactions could help to improve decision-making. However, it is difficult to control how social interaction influences physiological reactions, making it difficult to interpret physiological responses. This article aimed to explore the changes in physiological responses due to the social interaction of a competitive game modality. This pilot study involved ten unimpaired participants (five pairs). We defined different therapy sessions: (i) a session without a competitor; (ii) two sessions with a virtual competitor with different difficulty levels; (iii) a competitive game. Results showed a difference in the physiological response in the competitive mode concerning single-player mode only due to the interpersonal game modality. In addition, feedback from participants suggested that it was necessary to keep a certain difficulty level to make the activity more challenging, and therefore be more engaging and rewarding.

Exploring New Potential Applications for Hand Exoskeletons: Power Grip to Assist Human Standing.

Hand exoskeleton potential applications reach further than grasping or assistance during manipulation. In this paper, we present a preliminary study of how this technology can be applied in order to improve performance during standing to help the user to keep balance under perturbations. Non-impaired users wearing a hand exoskeleton gripping a hand rail were pushed by a cable-driven robot, so that their standing equilibrium was perturbed. The center of pressure, surface electromyography, and interaction force data were recorded in order to assess the performance of users and their postural strategy. The results showed that users could keep their balance with the same outcomes using their bare hands and the hand exoskeleton. However, when wearing the exoskeleton, a higher muscular activity was registered in hand flexor muscles. This is also supported by the grasping force, which shows that users stretched their hand more than expected when wearing the hand exoskeleton. This paper concludes that it is possible that the lack of tactile feedback could lead to over compensation in the grasping. Therefore, the next studies will aim to check whether this effect can be reversed by training users to wear the exoskeleton.

User activity recognition system to improve the performance of environmental control interfaces: a pilot study with patients.

BACKGROUND: Assistive technologies aim to increase quality of life, reduce dependence on care giver and on the long term care system. Several studies have demonstrated the effectiveness in the use of assistive technology for environment control and communication systems. The progress of brain-computer interfaces (BCI) research together with exoskeleton enable a person with motor impairment to interact with new elements in the environment. This paper aims to evaluate the environment control interface (ECI) developed under the AIDE project conditions, a multimodal interface able to analyze and extract relevant information from the environments as well as from the identification of residual abilities, behaviors, and intentions of the user. METHODS: This study evaluated the ECI in a simulated scenario using a two screen layout: one with the ECI and the other with a simulated home environment, developed for this purpose. The sensorimotor rhythms and the horizontal oculoversion, acquired through BCI2000, a multipurpose standard BCI platform, were used to online control the ECI after the user training and system calibration. Eight subjects with different neurological diseases and spinal cord injury participated in this study. The subjects performed simulated activities of daily living (ADLs), i.e. actions in the simulated environment as drink, switch on a lamp or raise the bed head, during ten minutes in two different modes, AIDE mode, using a prediction model, to recognize the user intention facilitating the scan, and Manual mode, without a prediction model. RESULTS: The results show that the mean task time spent in the AIDE mode was less than in the Manual, i.e the users were able to perform more tasks in the AIDE mode during the same time. The results showed a statistically significant differences with p<0.001. Regarding the steps, i.e the number of abstraction levels crossed in the ECI to perform an ADL, the users performed one step in the 90% of the tasks using the AIDE mode and three steps, at least, were necessary in the Manual mode. The user's intention prediction was performed through conditional random fields (CRF), with a global accuracy about 87%. CONCLUSIONS: The environment analysis and the identification of the user's behaviors can be used to predict the user intention opening a new paradigm in the design of the ECIs. Although the developed ECI was tested only in a simulated home environment, it can be easily adapted to a real environment increasing the user independence at home.

Electromyography Assessment of the Assistance Provided by an Upper-Limb Exoskeleton in Maintenance Tasks.

In this paper, the analysis of the intensity of muscle activations in different subjects when they perform an industrial task in a repetitive way assisted by a robotic upper-limb exoskeleton is presented. To do that, surface electromyography (EMG) signals were monitored with and without a robotic upper-limb exoskeleton for 10 subjects during a drilling task, a typical tedious maintenance or industrial task. Our results show that wearing the upper-limb exoskeleton substantially reduces muscle activity during a drilling task above head height. Specifically, there is statistically significant differences in the pectoralis major and rhomboids muscles between the groups wearing or not wearing the robotic upper-limb exoskeleton.

Physiological Responses During Hybrid BNCI Control of an Upper-Limb Exoskeleton.

When combined with assistive robotic devices, such as wearable robotics, brain/neural-computer interfaces (BNCI) have the potential to restore the capabilities of handicapped people to carry out activities of daily living. To improve applicability of such systems, workload and stress should be reduced to a minimal level. Here, we investigated the user's physiological reactions during the exhaustive use of the interfaces of a hybrid control interface. Eleven BNCI-naive healthy volunteers participated in the experiments. All participants sat in a comfortable chair in front of a desk and wore a whole-arm exoskeleton as well as wearable devices for monitoring physiological, electroencephalographic (EEG) and electrooculographic (EoG) signals. The experimental protocol consisted of three phases: (i) Set-up, calibration and BNCI training; (ii) Familiarization phase; and (iii) Experimental phase during which each subject had to perform EEG and EoG tasks. After completing each task, the NASA-TLX questionnaire and self-assessment manikin (SAM) were completed by the user. We found significant differences (p-value < 0.05) in heart rate variability (HRV) and skin conductance level (SCL) between participants during the use of the two different biosignal modalities (EEG, EoG) of the BNCI. This indicates that EEG control is associated with a higher level of stress (associated with a decrease in HRV) and mental work load (associated with a higher level of SCL) when compared to EoG control. In addition, HRV and SCL modulations correlated with the subject's workload perception and emotional responses assessed through NASA-TLX questionnaires and SAM.

Human arm joints reconstruction algorithm in rehabilitation therapies assisted by end-effector robotic devices.

BACKGROUND: End-effector robots are commonly used in robot-assisted neuro-rehabilitation therapies for upper limbs where the patient's hand can be easily attached to a splint. Nevertheless, they are not able to estimate and control the kinematic configuration of the upper limb during the therapy. However, the Range of Motion (ROM) together with the clinical assessment scales offers a comprehensive assessment to the therapist. Our aim is to present a robust and stable kinematic reconstruction algorithm to accurately measure the upper limb joints using only an accelerometer placed onto the upper arm. METHODS: The proposed algorithm is based on the inverse of the augmented Jaciobian as the algorithm (Papaleo, et al., Med Biol Eng Comput 53(9):815-28, 2015). However, the estimation of the elbow joint location is performed through the computation of the rotation measured by the accelerometer during the arm movement, making the algorithm more robust against shoulder movements. Furthermore, we present a method to compute the initial configuration of the upper limb necessary to start the integration method, a protocol to manually measure the upper arm and forearm lengths, and a shoulder position estimation. An optoelectronic system was used to test the accuracy of the proposed algorithm whilst healthy subjects were performing upper limb movements holding the end effector of the seven Degrees of Freedom (DoF) robot. In addition, the previous and the proposed algorithms were studied during a neuro-rehabilitation therapy assisted by the 'PUPArm' planar robot with three post-stroke patients. RESULTS: The proposed algorithm reports a Root Mean Square Error (RMSE) of 2.13cm in the elbow joint location and 1.89cm in the wrist joint location with high correlation. These errors lead to a RMSE about 3.5 degrees (mean of the seven joints) with high correlation in all the joints with respect to the real upper limb acquired through the optoelectronic system. Then, the estimation of the upper limb joints through both algorithms reveal an instability on the previous when shoulder movement appear due to the inevitable trunk compensation in post-stroke patients. CONCLUSIONS: The proposed algorithm is able to accurately estimate the human upper limb joints during a neuro-rehabilitation therapy assisted by end-effector robots. In addition, the implemented protocol can be followed in a clinical environment without optoelectronic systems using only one accelerometer attached in the upper arm. Thus, the ROM can be perfectly determined and could become an objective assessment parameter for a comprehensive assessment.

Intelligent Multimodal Framework for Human Assistive Robotics Based on Computer Vision Algorithms.

Assistive technologies help all persons with disabilities to improve their accessibility in all aspects of their life. The AIDE European project contributes to the improvement of current assistive technologies by developing and testing a modular and adaptive multimodal interface customizable to the individual needs of people with disabilities. This paper describes the computer vision algorithms part of the multimodal interface developed inside the AIDE European project. The main contribution of this computer vision part is the integration with the robotic system and with the other sensory systems (electrooculography (EOG) and electroencephalography (EEG)). The technical achievements solved herein are the algorithm for the selection of objects using the gaze, and especially the state-of-the-art algorithm for the efficient detection and pose estimation of textureless objects. These algorithms were tested in real conditions, and were thoroughly evaluated both qualitatively and quantitatively. The experimental results of the object selection algorithm were excellent (object selection over 90%) in less than 12 s. The detection and pose estimation algorithms evaluated using the LINEMOD database were similar to the state-of-the-art method, and were the most computationally efficient.

Estimation of Human Arm Joints Using Two Wireless Sensors in Robotic Rehabilitation Tasks.

This paper presents a novel kinematic reconstruction of the human arm chain with five degrees of freedom and the estimation of the shoulder location during rehabilitation therapy assisted by end-effector robotic devices. This algorithm is based on the pseudoinverse of the Jacobian through the acceleration of the upper arm, measured using an accelerometer, and the orientation of the shoulder, estimated with a magnetic angular rate and gravity (MARG) device. The results show a high accuracy in terms of arm joints and shoulder movement with respect to the real arm measured through an optoelectronic system. Furthermore, the range of motion (ROM) of 50 healthy subjects is studied from two different trials, one trying to avoid shoulder movements and the second one forcing them. Moreover, the shoulder movement in the second trial is also estimated accurately. Besides the fact that the posture of the patient can be corrected during the exercise, the therapist could use the presented algorithm as an objective assessment tool. In conclusion, the joints' estimation enables a better adjustment of the therapy, taking into account the needs of the patient, and consequently, the arm motion improves faster.

Estimating vertical ground reaction forces during gait from lower limb kinematics and vertical acceleration using wearable inertial sensors.

One of the most important forces generated during gait is the vertical ground reaction force (vGRF). This force can be measured using force plates, but these can limit the scope of gait analysis. This paper presents a method to estimate the vGRF using inertial measurement units (IMU) and machine learning techniques. Four wearable IMUs were used to obtain flexion/extension angles of the hip, knee, and ankle joints, and an IMU placed over the C7 vertebra to measure vertical acceleration. We trained and compared the performance of two machine learning algorithms: feedforward neural networks (FNN) and random forest (RF). We investigated the importance of the inputs introduced into the models and analyzed in detail the contribution of lower limb kinematics and vertical acceleration to model performance. The results suggest that the inclusion of vertical acceleration increases the root mean square error in the FNN, while the RF appears to decrease it. We also analyzed the ability of the models to construct the force signal, with particular emphasis on the magnitude and timing of the vGRF peaks. Using the proposed method, we concluded that FNN and RF models can estimate the vGRF with high accuracy.

Influence of Robotic Therapy on Severe Stroke Patients.

Robotic rehabilitation has emerged as a promising approach to enhance motor recovery after stroke, but there is limited knowledge about its efficacy in individuals who have experienced severe stroke. The study presented in this paper aims to analyze the effect of robotic therapy on the recovery of patients with severe stroke when combined with conventional rehabilitation therapies, and we want to observe whether there is a relationship between the clinical assessment provided by the therapist and the data recorded by the robotic device. Participants were divided into an experimental group and a control group, both receiving 15 sessions of conventional therapy in three consecutive weeks, but the experimental group underwent three out of five sessions per week with a robotic device. Both groups were evaluated using clinical scales, and in addition the experimental group was evaluated using an assessment game incorporated in the robotic device that provides session data such as the level of assistance needed by each user to complete the activity, or the score obtained in the game. These preliminary results showed that patients who received robot-assisted therapy had better motor function recovery compared to those who only received conventional therapy. In addition, it is also observed that the robot assistance needed by patients in the experimental group decreased as the sessions progressed, suggesting that robot-assisted therapy could be an effective tool for severe stroke patients.

Distributed smart device for monitoring, control and management of electric loads in domotic environments.

This paper presents a microdevice for monitoring, control and management of electric loads at home. The key idea is to compact the electronic design as much as possible in order to install it inside a Schuko socket. Moreover, the electronic Schuko socket (electronic microdevice + Schuko socket) has the feature of communicating with a central unit and with other microdevices over the existing powerlines. Using the existing power lines, the proposed device can be installed in new buildings or in old ones. The main use of this device is to monitor, control and manage electric loads to save energy and prevent accidents produced by different kind of devices (e.g., iron) used in domestic tasks. The developed smart device is based on a single phase multifunction energy meter manufactured by Analog Devices (ADE7753) to measure the consumption of electrical energy and then to transmit it using a serial interface. To provide current measurement information to the ADE7753, an ultra flat SMD open loop integrated circuit current transducer based on the Hall effect principle manufactured by Lem (FHS-40P/SP600) has been used. Moreover, each smart device has a PL-3120 smart transceiver manufactured by LonWorks to execute the user's program, to communicate with the ADE7753 via serial interface and to transmit information to the central unit via powerline communication. Experimental results show the exactitude of the measurements made using the developed smart device.

Robust and cooperative image-based visual servoing system using a redundant architecture.

The reliability and robustness of image-based visual servoing systems is still unsolved by the moment. In order to address this issue, a redundant and cooperative 2D visual servoing system based on the information provided by two cameras in eye-in-hand/eye-to-hand configurations is proposed. Its control law has been defined to assure that the whole system is stable if each subsystem is stable and to allow avoiding typical problems of image-based visual servoing systems like task singularities, features extraction errors, disappearance of image features, local minima, etc. Experimental results with an industrial robot manipulator based on Schunk modular motors to demonstrate the stability, performance and robustness of the proposed system are presented.

Development of a single actuator exoskeleton for wrist and forearm rehabilitation.

Recent estimations state that the absolute number of strokes will increase in the future. For this reason, novel rehabilitation therapies, such as robot-assisted therapy, are essential to speed up patient recovery. This paper describes the design, development, and control aspects of a light-exoskeleton addressing forearm and wrist motions using one actuator. Besides, usability pilot study results are presented.

Movement-Related EEG Oscillations of Contralesional Hemisphere Discloses Compensation Mechanisms of Severely Affected Motor Chronic Stroke Patients.

Conventional rehabilitation strategies for stroke survivors become difficult when voluntary movements are severely disturbed. Combining passive limb mobilization, robotic devices and EEG-based brain-computer interfaces (BCI) systems might improve treatment and clinical follow-up of these patients, but detailed knowledge of neurophysiological mechanisms involved in functional recovery, which might help for tailoring stroke treatment strategies, is lacking. Movement-related EEG changes (EEG event-related desynchronization (ERD) in [Formula: see text] and [Formula: see text] bands, an indicator of motor cortex activation traditionally used for BCI systems), were evaluated in a group of 23 paralyzed chronic stroke patients in two unilateral motor tasks alternating paretic and healthy hands ((i) passive movement, using a hand exoskeleton, and (ii) voluntary movement), and compared to nine healthy subjects. In tasks using unaffected hand, we observed an increase of contralesional hemisphere activation for stroke patients group. Unexpectedly, when using paralyzed hand, motor cortex activation was reduced or absent in severely affected group of patients, while patients with moderate motor deficit showed an activation greater than control group. Cortical activation was reduced or absent in damaged hemisphere of all the patients in both tasks. Significant differences related to severity of motor deficit were found in the time course of [Formula: see text]-[Formula: see text] bands power ratio in EEG of contralesional hemisphere while moving affected hand. These findings suggest the presence of different compensation mechanisms in contralesional hemisphere of stroke patients related to the grade of motor disability, that might turn quantitative EEG during a movement task, obtained from a BCI system controlling a robotic device included in a rehabilitation task, into a valuable tool for monitoring clinical progression, evaluating recovery, and tailoring treatment of stroke patients.

Physiological reactions in single-player and competitive arm rehabilitation games.

This study aims to explore the relationship between the stress level and the exercise intensity performing a rehabilitation task, aided by an upper limb rehabilitation robot, in a game in single-player mode and competitive mode. The stress level has been estimated by means of the Galvanic Skin Response(GSR). The results prove that to employ a social game mode like the competitive one, makes possible to increase the intensity level increasing the stress level to a lesser extent than in single-player modes.

Synchronization of Slow Cortical Rhythms During Motor Imagery-Based Brain-Machine Interface Control.

Modulation of sensorimotor rhythm (SMR) power, a rhythmic brain oscillation physiologically linked to motor imagery, is a popular Brain-Machine Interface (BMI) paradigm, but its interplay with slower cortical rhythms, also involved in movement preparation and cognitive processing, is not entirely understood. In this study, we evaluated the changes in phase and power of slow cortical activity in delta and theta bands, during a motor imagery task controlled by an SMR-based BMI system. In Experiment I, EEG of 20 right-handed healthy volunteers was recorded performing a motor-imagery task using an SMR-based BMI controlling a visual animation, and during task-free intervals. In Experiment II, 10 subjects were evaluated along five daily sessions, while BMI-controlling same visual animation, a buzzer, and a robotic hand exoskeleton. In both experiments, feedback received from the controlled device was proportional to SMR power (11-14 Hz) detected by a real-time EEG-based system. Synchronization of slow EEG frequencies along the trials was evaluated using inter-trial-phase coherence (ITPC). Results: cortical oscillations of EEG in delta and theta frequencies synchronized at the onset and at the end of both active and task-free trials; ITPC was significantly modulated by feedback sensory modality received during the tasks; and ITPC synchronization progressively increased along the training. These findings suggest that phase-locking of slow rhythms and resetting by sensory afferences might be a functionally relevant mechanism in cortical control of motor function. We propose that analysis of phase synchronization of slow cortical rhythms might also improve identification of temporal edges in BMI tasks and might help to develop physiological markers for identification of context task switching and practice-related changes in brain function, with potentially important implications for design and monitoring of motor imagery-based BMI systems, an emerging tool in neurorehabilitation of stroke.

A four-state Markov model of sleep-wakefulness dynamics along light/dark cycle in mice.

Behavioral states alternate between wakefulness (wk), rapid eye movement (rem) and non-rem (nrem) sleep at time scale of hours i.e., light and dark cycle rhythms and from several tens of minutes to seconds (i.e., brief awakenings during sleep). Using statistical analysis of bout duration, Markov chains of sleep-wk dynamics and quantitative EEG analysis, we evaluated the influence of light/dark (ld) changes on brain function along the sleep-wk cycle. Bout duration (bd) histograms and Kaplan-Meier (km) survival curves of wk showed a bimodal statistical distribution, suggesting that two types of wk do exist: brief-wk (wkb) and long-wk (wkl). Light changes modulated specifically wkl bouts, increasing its duration during active/dark period. In contrast, wkb, nrem and rem bd histograms and km curves did not change significantly along ld cycle. Hippocampal eeg of both types of wk were different: in comparison wkb showed a lower spectral power in fast gamma and fast theta bands and less emg tone. After fitting a four-states Markov chain to mice hypnograms, moreover in states transition probabilities matrix was found that: in dark/active period, state-maintenance probability of wkl increased, and probability of wkl to nrem transition decreased; the opposite was found in light period, favoring the hypothesis of the participation of brief wk into nrem-rem intrinsic sleep cycle, and the role of wkl in SWS homeostasis. In conclusion, we propose an extended Markov model of sleep using four stages (wkl, nrem, rem, wkb) as a fully adequate model accounting for both modulation of sleep-wake dynamics based on the differential regulation of long-wk (high gamma/theta) epochs during dark and light phases.

Learning by Demonstration for Motion Planning of Upper-Limb Exoskeletons.

The reference joint position of upper-limb exoskeletons is typically obtained by means of Cartesian motion planners and inverse kinematics algorithms with the inverse Jacobian; this approach allows exploiting the available Degrees of Freedom (i.e. DoFs) of the robot kinematic chain to achieve the desired end-effector pose; however, if used to operate non-redundant exoskeletons, it does not ensure that anthropomorphic criteria are satisfied in the whole human-robot workspace. This paper proposes a motion planning system, based on Learning by Demonstration, for upper-limb exoskeletons that allow successfully assisting patients during Activities of Daily Living (ADLs) in unstructured environment, while ensuring that anthropomorphic criteria are satisfied in the whole human-robot workspace. The motion planning system combines Learning by Demonstration with the computation of Dynamic Motion Primitives and machine learning techniques to construct task- and patient-specific joint trajectories based on the learnt trajectories. System validation was carried out in simulation and in a real setting with a 4-DoF upper-limb exoskeleton, a 5-DoF wrist-hand exoskeleton and four patients with Limb Girdle Muscular Dystrophy. Validation was addressed to (i) compare the performance of the proposed motion planning with traditional methods; (ii) assess the generalization capabilities of the proposed method with respect to the environment variability. Three ADLs were chosen to validate the system: drinking, pouring and lifting a light sphere. The achieved results showed a 100% success rate in the task fulfillment, with a high level of generalization with respect to the environment variability. Moreover, an anthropomorphic configuration of the exoskeleton is always ensured.