Can powered exoskeletons improve gait and balance in multiple sclerosis? A retrospective study.

Multiple sclerosis (MS) is a progressive neurologic disorder that can profoundly influence mobility, independence and quality of life. Gait dysfunction in MS is common, resulting in an increased risk of losing walking ability. Robotic exoskeletons have been developed to offer a new form of locomotor training. The aim of our study was to investigate the effectiveness of the powered exoskeleton (Ekso) in improving gait and balance in patients affected by MS. Twenty patients with MS (mean ± SD: age = 43.7 ± 10.3 years; 66.7% male) were enrolled in this retrospective study. They were divided into two groups, matched for demographic data (age and sex) and medical characteristics (disease duration and Expanded Disability Status Scale), but differing for the type of rehabilitation training performed. Group 1 [experimental group (EG)] received gait training with the Ekso device, whereas group 2 (control group) performed traditional gait training. Although both trainings led to a significant improvement in the ability to walk and balance, only in the EG a significant improvement in walking speed (10 Meter Walk test; P = 0.002), in person's mobility (Timed Up and Go test; P = 0.002), and in the perception of mental well-being (MSQoL-M; P = 0.004), with a good usability and acceptance of the device, was found. Powered exoskeletons could be considered a valuable tool to improve functional outcomes and get the therapeutic goal in patients with MS.

The use of exoskeletons in the occupational context for primary, secondary, and tertiary prevention of work-related musculoskeletal complaints.

OCCUPATIONAL APPLICATIONS This guideline includes 20 recommendations and four key statements that achieved consensus or strong consensus regarding the application of exoskeletons in the workplace for the prevention of musculoskeletal complaints and diseases, the general use and implementation of exoskeletons, and recommendations for risk assessment. The guideline is intended for company physicians, occupational physicians, ergonomists, occupational safety specialists, and employers, and serves as information for all other actors in practical occupational safety. Due to the lack of evidence from the scientific literature, the recommendations and key statements are the result of expert discussions that were conducted at a consensus conference in accordance with the Regulations of the Association of the Scientific Medical Societies in Germany, moderated by an external consultant.

TECHNICAL ABSTRACT Background The prevention of work-related musculoskeletal complaints and diseases has high priority, considering the prevalence of musculoskeletal complaints and diseases and the associated high burden on health care systems, the economy, and the people affected. Purpose: This guideline provided recommendations for potential applications of exoskeletons in the workplace for the primary, secondary, and tertiary prevention of musculoskeletal complaints and diseases, general recommendations on the use and implementation of exoskeletons, and recommendations on risk assessment. Methods: A systematic literature search, a survey among exoskeleton manufacturers and companies using exoskeletons, and expert discussions formed the basis of the formulated recommendations and key statements. For reaching consensus on the recommendations and key statements, we applied the Nominal Group and Delphi Techniques under the supervision of an external, independent moderator. Results: We formulated 20 recommendations and four key statements, all of which reached consensus or strong consensus. Conclusion: No answers could be found in the current scientific literature to the central questions in this guideline about primary, secondary, and tertiary prevention. We outline five main directions for future research on exoskeletons in occupational settings. First, using exoskeletons for prevention should be investigated using randomized controlled trials. Second, the effects of exoskeletons on work-related musculoskeletal stress and strain should be investigated both in the body region intended to be supported by the exoskeleton as well as in other non-supported body regions. Third, the effects of exoskeletons should be investigated in samples varying in age, gender, and health status, as well as during different occupational activities. Fourth, a specific risk assessment tool for exoskeletons in occupational settings should be developed and implemented to meet and evaluate the applicable occupational health and safety standards. Fifth, there is a need to expand upon the very limited social science research on the impacts of exoskeletons on employee professional understanding, social role understanding, or diversity.

Effects of a passive upper extremity exoskeleton for overhead tasks.

Overhead work is a major cause of upper extremity work-related musculoskeletal disorders (WMSD). In this paper, the potential effects of a Passive Upper-Limb Exoskeleton (PULE) were evaluated in the tasks of overhead works. This proposed PULE has a higher degree of freedom and does not impede the user's upper limb movements. Fifteen male volunteers participated in the study by performing the repeated overhead bolt installation tasks. The electromyographic (EMG) values of anterior deltoid (AD), mid deltoid (MD), descending trapezius (TR), and triceps (TB) of the left and right arms of the participants were measured at three different overhead task heights with Intervention (with/without the PULE). Moreover, the rankings of perceived discomfort (RPD) obtained on the neck, shoulders, upper arms, forearms, upper back, waists, and legs were rated for each participant. The preliminary experiment results show that the initial nEMG of right anterior deltoid (AD) decreased by 38.5%, median nEMG values decreased by 45.1%, and total RPD decreased by 52.4%. The use of the PULE could bring the benefits of less upper extremity muscle contraction and lower RPD compared to the non-use, which may potentially reduce or slow down the level of upper extremity WMSD across the overhead work.

Dropped Head Syndrome Attenuation by Hybrid Assistive Limb: A Preliminary Study of Three Cases on Cervical Alignment during Walking.

Background and Objectives: Dropped head syndrome (DHS) is characterized by apparent neck extensor muscle weakness and difficulty in extending the neck to raise the head against gravity. DHS affects forward vision and eating behavior, and hence impairs quality of life. However, standardized treatment of DHS has not yet been established. The purpose of this preliminary study is to seek for a possibility of effective non-surgical, conservative treatment for DHS, by applying a robotic treatment. Materials and Methods: A wearable exoskeleton type robot suit hybrid assistive limb (HAL) was applied to three patients with DHS. A course of HAL treatment included 10 sessions of gait training using HAL. One session lasted about an hour. Case 1 completed the course twice, the first time in two weeks (one session per day) and second time in 10 months (one session per month). Case 2 and Case 3 completed the course once in 10 weeks (one session per week) and in 6 months (one session per 2.5 weeks), respectively. Immediate and lasting effects of HAL on the reduction of cervical sagittal vertical alignment (SVA) during gait was evaluated using a motion capture system. Results: Case 1 showed improvement of cervical alignment during gait after the HAL courses of both different frequencies. Case 2 did not show improvement of cervical alignment during gait. Case 3 showed improvement of cervical kyphosis but not of cervical sagittal alignment during gait. Conclusions: The results of the preliminary study suggest that gait training using HAL may be an effective option of conservative treatment for a part of DHS patients. They also suggest that a lack of immediate effects on the cervical alignment and a lack of ability to perform compensatory trunk motion may indicate a non-responding patient. Generalization of the results requires further research with more cases.

Reliability of a battery of tests for functional evaluation of trunk exoskeletons.

Recently, several spinal exoskeletons were developed with the aim to assist occupational tasks such as load-handling and work in prolonged static postures. While the biomechanical effects of such devices has been well investigated, only limited feedback to the developers is usually provided regarding the subjective perceptions of the end-users. The aim of this study was to present a novel battery of tests, designed to assess functional performance and subjective outcomes during the use of assistive trunk exoskeletons, and to assess its test-retest reliability. The battery of tests consists of 12 different simple functional tasks. Twenty participants were included in an intra-session reliability test and repeated the tests within 7-10 days to assess inter-session reliability. They were wearing a novel passive spinal exoskeleton during all trials. The outcomes included quantitative and subjective measures, such as performance time and rating of discomfort and perceived task difficulty. The majority of the outcome measures were reliable within session and between sessions (ICC or α > 0.80). Systematic effects were observed in a few tasks, suggesting that familiarization trials will be needed to minimize the learning effects. The novel battery of tests could become an important easy-to-use tool for functional testing of the spinal exoskeletons in addition to more specific biomechanical and physiological testing. Further studies should address the reliability of the present battery of tests for assessing specific populations, such as low back pain patients and explore how to minimize systematic effects that were observed in this study.

The safety and feasibility of a new rehabilitation robotic exoskeleton for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI): an observational study.

STUDY DESIGN: A pre-post observational study. OBJECTIVES: To evaluate the safety and feasibility of a new rehabilitation robotic device for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI). SETTING: Three hospitals in Sichuan Province, China. METHODS: Individuals aged 15-75 years with an SCI between vertebrae six (T6) and lumbar 1 (L1) and complete motor paralysis participated in an exoskeletal-assisted walking (EAW) programme (2 weeks, 5 days/week, 30 min/day). Data were collected pre-, mid- (week 1) and post-intervention (week 2). RESULTS: Twenty-eight individuals (mean age = 41.3, 71% males) participated in the EAW programme. The distance walked during the 6-min walking test (6MWT) increased relative to that at baseline, during week 1 (13.0 ± 5.3 m) and week 2 (16.2 ± 5.3 m) when wearing the exoskeleton. The walking speed during the 10-m walking test (10MWT) increased from 0.039 ± 0.016 to 0.045 ± 0.016 m/s. The Hoffer walking ability grade, the Spinal Cord Independence Measure (SCIM), and the Walking Index for SCI II (WISCI II) changed after 2 weeks of EAW. No improvement in lower extremity motor score (LEMS) was observed. The rates of adverse events and serious adverse events were 21% and 4%, respectively. CONCLUSIONS: The EAW programme with the new robotic exoskeleton provided potential meaningful improvements in mobility for individuals with SCI and had few adverse events.

"Back at the same level as everyone else"-user perspectives on walking with an exoskeleton, a qualitative study.

Study design: Qualitative, in-depth research interviews led by a theme-based interview guide. Objectives: To generate new knowledge regarding user experiences of standing and walking with Ekso™ (Ekso Bionics, Richmond, CA, USA). Setting: In-patient rehabilitation hospital in Norway. Methods: Systematic inductive content analyses were used, utilizing a pattern theory of self as an analytical framework. Results: The participants shared powerful stories, describing largely positive but also challenging emotions and perceptions, related to standing and walking with Ekso™. Four themes emerged: (1) bodily positions, possibilities and feelings, (2) reactivation of loss and hope for the future, (3) to be free and restricted at the same time, and (4) to be controlled and take control. The results indicate that both walking and using a wheelchair involve more than getting from one place to another, as fundamental aspects of being human are touched, involving facilitating a coherent understanding of the self and, on the other hand, leading to an "objectification" of the body. Conclusions: This explorative study points toward contrasts involved when using Ekso™. More studies of lived experiences with walking in Ekso™ are needed, comprising larger samples, variations in participant characteristics and diagnoses as well as contexts.

Design of a Purely Mechanical Sensor-Controller Integrated System for Walking Assistance on an Ankle-Foot Exoskeleton.

Propulsion during push-off (PO) is a key factor to realize human locomotion. Through the detection of real-time gait stage, assistance could be provided to the human body at the proper time. In most cases, ankle-foot exoskeletons consist of electronic sensors, microprocessors, and actuators. Although these three essential elements contribute to fulfilling the function of the detection, control, and energy injection, they result in a huge system that reduces the wearing comfort. To simplify the sensor-controller system and reduce the mass of the exoskeleton, we designed a smart clutch in this paper, which is a sensor-controller integrated system that comprises a sensing part and an executing part. With a spring functioning as an actuator, the whole exoskeleton system is completely made up of mechanical parts and has no external power source. By controlling the engagement of the actuator based on the signal acquired from the sensing part, the proposed clutch enables the ankle-foot exoskeleton (AFE) to provide additional ankle torque during PO, and allows free rotation of the ankle joint during swing phase, thus reducing the metabolic cost of the human body. There are two striking advantages of the designed clutch. On the one hand, the clutch is lightweight and reliable-it resists the possible shock during walking since there is no circuit connection or power in the system. On the other hand, the detection of gait relies on the contact states between human feet and the ground, so the clutch is universal and does not need to be customized for individuals.

Clinical Outcomes with the Intrepid Dynamic Exoskeletal Orthosis: A Retrospective Analysis.

INTRODUCTION: Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Clinical outcomes were routinely collected on patients fit with IDEOs at the Center for the Intrepid, Brooke Army Medical Center. The purpose of this retrospective study was to analyze the clinical outcomes collection process and the patient outcomes collected as part of routine clinical care. METHODS: The Brooke Army Medical Center IRB approved this study and granted waivers of informed consent and HIPAA authorization. Electronic medical records were reviewed over an 18-month period from July 2014 to January 2016. Records were examined to obtain the date of IDEO delivery, date of outcomes form completion, responses on the forms, and to verify diagnosis or injury. Data gathered included wear time, IDEO comfort, pain with and without the IDEO, Lower Extremity Functional Scale scores with and without the IDEO, and global rating of change questions for everyday activities and high impact activities. Wilcoxon signed-ranked tests were used to compare pain and function with vs. without the IDEO. RESULTS: During the 18-month period, new IDEOs were delivered to 156 unique patients. Outcomes forms were collected as part of routine clinical care from 90 of these 156 patients (58%). An additional nine forms were collected from patients who received their IDEOs prior to July 2014. In all, 99 outcomes forms were collected. Mean follow-up time from IDEO delivery to outcomes form completion was 35 ± 31 days for the original 90 patients. The most common patient diagnoses were fracture, nerve injury, arthritis, and fusion. Responses on the forms indicated that patients were generally comfortable wearing their IDEOs (8.3 ± 1.3 on a 0-10 scale) and wore them most of the day (10.7 ± 3.4 hours per day). Improvement in pain (from 5.2 ± 2.9 to 1.7 ± 1.6 points on a 0-10 scale) and Lower Extremity Functional Scale scores (from 29.7 ± 16.6 to 59.5 ± 13.6 points) with the IDEO were both more than the minimal clinically important difference and were statistically significant (p < 0.001). CONCLUSION: This descriptive retrospective study demonstrated that it was feasible to collect clinical outcomes data which were relevant for characterizing the effects of IDEO use and enabled quantification of improvements in self-reported function and walking pain with the IDEO. Due to the retrospective nature of this study, limitations include missing data and the lack of any performance measures to complement the self-reported data. Clinical outcomes collection continues as a routine part of clinical care and there remains an ongoing aim to collect information on all patients to obtain an accurate assessment of devices and services and ultimately better serve our patients.

Design and Feasibility Study of a Leg-exoskeleton Assistive Wheelchair Robot with Tests on Gluteus Medius Muscles.

The muscles of the lower limbs directly influence leg motion, therefore, lower limb muscle exercise is important for persons living with lower limb disabilities. This paper presents a medical assistive robot with leg exoskeletons for locomotion and leg muscle exercises. It also presents a novel pedal-cycling actuation method with a crank-rocker mechanism. The mechanism is driven by a single motor with a mechanical structure that ensures user safety. A control system is designed based on a master-slave control with sensor fusion method. Here, the intended motion of the user is detected by pedal-based force sensors and is then used in combination with joystick movements as control signals for leg-exoskeleton and wheelchair motions. Experimental data is presented and then analyzed to determine robotic motion characteristics as well as the assistance efficiency with attached electromyogram (EMG) sensors. A typical muscle EMG signal analysis shows that the exercise efficiency for EMG activated amplitudes of the gluteus medius muscles approximates a walking at speed of 3 m/s when cycling at different speeds (i.e., from 16 to 80 r/min) in a wheelchair. As such, the present wheelchair robot is a good candidate for enabling effective gluteus medius muscle exercises for persons living with gluteus medius muscle disabilities.

Robotic exoskeletons for reengaging in everyday activities: promises, pitfalls, and opportunities.

PURPOSE: Media images and marketing materials suggest a future in which individuals with spinal cord injury (SCI) can utilize robotic exoskeletons to reengage in everyday activities, yet these narratives may not align with the current technological realities. The purpose of this paper is to present and describe the current use of robotic exoskeletons in rehabilitation and home settings and discuss the benefits and limitations of the devices. MATERIALS AND METHODS: We provide an overview of the features and limitations of the four robotic exoskeleton products (EKSO Bionics, ReWalk, Rex Bionics, and Indego) that are currently being used in in the United States in rehabilitation settings. We follow by suggesting ways that these devices fall short of fulfilling the promise of reengage in everyday activities in real-world life contexts. RESULTS AND DISCUSSION: Available devices appear to be better suited for rehabilitation settings than for home use. Device weight, the need for upper extremity supports, supervision requirements, and a limited range of movements are all issues that limit functionality and restrict opportunities for using such devices in real-world contexts. Designing the next generation of exoskeletons to be more useful in everyday life will require further collaboration among engineers, clinicians, and patients. Implications for Rehabilitation Exoskeletons offer the promise of allowing individuals with neurological injury to reengage in everyday activities from a standing position. Several exoskeleton devices are currently available for use in the United States. Weight of exoskeleton devices, the need for upper extremity supports, supervision requirements of hone units, and a limited range of movements are issues that restrict opportunities for using such devices in real-world contexts. Further development of exoskeleton technologies is warranted to improve the devices for real-world use.

Asymmetric Dual Arm Approach For Post Stroke Recovery Of Motor Functions Utilizing The EXO-UL8 Exoskeleton System: A Pilot Study.

In a dual arm therapeutic regime aiming to rehabilitate motor functions post stroke, both the affected arm (paretic) and the unaffected (non-paretic) arm are involved. In this context, the leading idea is that motor functions of the affected arm during a reaching task may be improved if the unaffected arm has already reached the target. As part of this pilot study, one chronic post-stroke patient with weakness and spasticity on his right arm conducted reaching tasks to virtual targets arranged in a $5\times 3$ matrix located parallel to his frontal plane, in two different configurations: (1) affected arm only (without assistance from the exoskeleton); (2) unaffected arm first followed by the affected arm (2a) without, and (2b) with assistance. A force field attracting the wrist of the affected arm to the target was used in the assistive mode. The data post-processing and analysis included task completion time, reachable task space, joint range of motion, human-robot interaction force/torque and power exchange at multiple sensors along the arm - visualized in a series of interaction maps. The data validated the robotic system's basic functionality in facilitating post-stroke unilateral and asymmetric bilateral training. Future work would be expanded to clinical trials with more subjects to be recruited and additional features to be implemented.

Design and Pilot Evaluation of a Reconfigurable Spinal Exoskeleton.

Low back pain is a leading cause of disability, and there is a tremendous need for nonsurgical, nonpharmaceutical interventions to manage it. Versatile spinal exoskeletons have been proposed as a method of supporting or augmenting the wearer, but experimental data from human subjects are limited, and the effects of such exoskeletons remain poorly understood. We thus present a prototype of a reconfigurable spinal exoskeleton that features easily adjustable resistance and compression at multiple spinal levels, allowing us to study the effect of different exoskeleton configurations on the body. In a pilot evaluation with a single subject, both thoracic and abdominal compression were found to affect trunk angle, low back moment and the electromyogram of the erector spinae, though different exoskeleton configurations had different effects during different tasks. This supports the premise that intelligent mechanical adjustments of a spinal exoskeleton are necessary for optimal support or augmentation of the wearer, though the results need to be examined in a larger, varied sample of subjects.

Effects of Exoskeleton Training Intervention on Net Loading Force in Chronic Spinal Cord Injury.

The goal of this study was to understand the rehabilitative effects of longitudinal overground exoskeleton training $( >100$ hours) on gait mechanics, especially foot loading, for gains in walking speed in an individual with chronic motorincomplete SCI. Biomechanical measures included: normalized plantar loading forces, walking speed and bilateral weight transfer ratio during walking in the EksoGT $^{\mathrm{ TM}}$ exoskeleton. Longitudinal training with a robotic exoskeleton yielded improvements in clinical outcomes (AIS classification, ISNCSCI motor scores and 10MWT) and provided functional gains in terms of biomechanical outcomes (plantar forces, weight transfer point) to increase overall walking speed.

A Velocity-Based Flow Field Control Approach for Reshaping Movement of Stroke-Impaired Individuals with a Lower-Limb Exoskeleton.

This paper describes a controller for guiding and assisting leg movement during walking with a lower limb exoskeleton with actuated hip and knee joints. The primary novel aspect of the controller is that it employs a virtual flow field to influence movement during swing, rather than a more typical potential-energy-based field. The controller was tested on a single stroke subject. The stroke subject's leg kinematics demonstrate that the controller is capable of appropriately influencing leg kinematics during overground walking.

Repeatability of EMG activity during exoskeleton assisted walking in children with cerebral palsy: implications for real time adaptable control.

Effective solutions for gait rehabilitation in children with cerebral palsy (CP) remain elusive. Wearable robotic exoskeletons offer the potential to greatly increase the dosage and intensity of gait training in this population, which may improve outcomes. We recently reported that a robotic exoskeleton significantly improved knee extension in children with crouch gait from CP. Longitudinal studies are necessary to fully understand long term biomechanical effects of exoskeleton gait training. Given that children's gait can change both as they develop and throughout their therapy, advanced control strategies which can adapt assistance over time may be beneficial. But, stride-to-stride variability makes it difficult to ascertain the effects of exoskeleton assistance and therefore complicates implementation of adaptable control algorithms. Here, we examine the use of the variance ratio (VR), a previously published measure, to assess the effect of exoskeleton assistance on knee extensor and flexor EMG variability in children with CP. Our results show that VR was significantly increased ($p<0.001)$ compared to baseline during walking with exoskeleton assistance. After five practice sessions, we found that VR was reduced though still greater than baseline levels. Given its sensitivity to exoskeleton assistance and ease of computation, VR may be a useful measure in the future for evaluating stride-to-stride variability in real time to inform algorithmic decision making for autonomous adaptable control.

Experience of Robotic Exoskeleton Use at Four Spinal Cord Injury Model Systems Centers.

BACKGROUND AND PURPOSE: Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility. METHODS: We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. RESULTS: Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. DISCUSSION AND CONCLUSIONS: Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231).

A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation.

BACKGROUND: The use of robotic trainers has increased with the aim of improving gait function in patients with limitations. Nevertheless, there is an absence of studies that deeply describe detailed guidelines of how to correctly implement robot-based treatments for gait rehabilitation. This contribution proposes an accurate robot-based training program for gait rehabilitation of pediatric population with Cerebral Palsy (CP). METHODS: The program is focused on the achievement of some specifications defined by the International Classification of Functioning, Disability and Health framework, Children and Youth version (ICF-CY). It is framed on 16 non-consecutive sessions where motor control, strength and power exercises of lower limbs are performed in parallel with a postural control strategy. A clinical evaluation with four pediatric patients with CP using the CPWalker robotic platform is presented. RESULTS: The preliminary evaluation with patients with CP shows improvements in several aspects as strength (74.03 ± 40.20%), mean velocity (21.46 ± 33.79%), step length (17.95 ± 20.45%) or gait performance (e.g. 66 ± 63.54% in Gross Motor Function Measure-88 items, E and D dimensions). CONCLUSIONS: The improvements achieved in the short term show the importance of working strength and power functions meanwhile over-ground training with postural control. This research could serve as preliminary support for future clinical implementations in any robotic device. TRIAL REGISTRATION: The study was carried out with the number R-0032/12 from Local Ethical Committee of the Hospital Infantil Niño Jesús. Public trial registered on March 23, 2017: ISRCTN18254257 .

Design-validation of a hand exoskeleton using musculoskeletal modeling.

Exoskeletons are progressively reaching homes and workplaces, allowing interaction with virtual environments, remote control of robots, or assisting human operators in carrying heavy loads. Their design is however still a challenge as these robots, being mechanically linked to the operators who wear them, have to meet ergonomic constraints besides usual robotic requirements in terms of workspace, speed, or efforts. They have in particular to fit the anthropometry and mobility of their users. This traditionally results in numerous prototypes which are progressively fitted to each individual person. In this paper, we propose instead to validate the design of a hand exoskeleton in a fully digital environment, without the need for a physical prototype. The purpose of this study is thus to examine whether finger kinematics are altered when using a given hand exoskeleton. Therefore, user specific musculoskeletal models were created and driven by a motion capture system to evaluate the fingers' joint kinematics when performing two industrial related tasks. The kinematic chain of the exoskeleton was added to the musculoskeletal models and its compliance with the hand movements was evaluated. Our results show that the proposed exoskeleton design does not influence fingers' joints angles, the coefficient of determination between the model with and without exoskeleton being consistently high (R2¯=0.93) and the nRMSE consistently low (nRMSE¯ = 5.42°). These results are promising and this approach combining musculoskeletal and robotic modeling driven by motion capture data could be a key factor in the ergonomics validation of the design of orthotic devices and exoskeletons prior to manufacturing.