Soft wearable robots (exosuits), being lightweight, ergonomic and low power-demanding, are attractive for a variety of applications, ranging from strength augmentation in industrial scenarios, to medical assistance for people with motor impairments. Understanding how these devices affect the physiology and mechanics of human movements is fundamental for quantifying their benefits and drawbacks, assessing their suitability for different applications and guiding a continuous design refinement.
We present a novel wearable exosuit for assistance/augmentation of the elbow and introduce a controller that compensates for gravitational forces acting on the limb while allowing the suit to cooperatively move with its wearer. Eight healthy subjects wore the exosuit and performed elbow movements in two conditions: with assistance from the device (powered) and without assistance (unpowered). The test included a dynamic task, to evaluate the impact of the assistance on the kinematics and dynamics of human movement, and an isometric task, to assess its influence on the onset of muscular fatigue.
Powered movements showed a low but significant degradation in accuracy and smoothness when compared to the unpowered ones. The degradation in kinematics was accompanied by an average reduction of 59.20±5.58% (mean ± standard error) of the biological torque and 64.8±7.66% drop in muscular effort when the exosuit assisted its wearer. Furthermore, an analysis of the electromyographic signals of the biceps brachii during the isometric task revealed that the exosuit delays the onset of muscular fatigue.
The study examined the effects of an exosuit on the characteristics of human movements. The suit supports most of the power needed to move and reduces the effort that the subject needs to exert to counteract gravity in a static posture, delaying the onset of muscular fatigue. We interpret the decline in kinematic performance as a technical limitation of the current device. This work suggests that a powered exosuit can be a good candidate for industrial and clinical applications, where task efficiency and hardware transparency are paramount.
In the never-ending quest to push the boundaries of their motor performance, humans have designed a wealth of wearable robotic devices. In one of the earliest recorded attempts to do so, in 1967, Mosher aspired to create a symbiotic unit that would have the “…alacrity of man’s information and control system coupled with the machine’s power and ruggedness” . His design of the Hardiman, although visionary, ran into fundamental technological limitations.
Advances in materials science, electronics and energy storage have since enabled an exponential growth of the field, with state-of-the-art exoskeletons arguably accomplishing Mosher’s vision . Wearable robotic technology has been successful in augmenting human strength during locomotion , reducing the metabolic cost of human walking [4, 5], restoring ambulatory capabilities to paraplegic patients , assisting in rehabilitating stroke patients [7, 8, 9], harvesting energy from human movements  and helping to study fundamental principles underlying human motor control [11, 12].
These feats were achieved with machines made of rigid links of metal and capable of accurately and precisely delivering high forces to their wearer. While this is undeniably an advantage, it comes at a cost: 1) a significant inertia, which affects both the kinematics of human movement and the power requirements of the device; 2) the need for the joints of the robot to be aligned with the biological joints , resulting in increased mechanical complexity and size ; 3) a strong cosmetic impact, shown to be linked with psychological health and well-being .
The recent introduction of soft materials to transmit forces and torques to the human body  has allowed to design wearable robotic devices on the other side of the spectrum: lightweight, low-profile and compliant machines that sacrifice accuracy and magnitude of assistance for the sake of portability and svelteness.
Soft exoskeletons, or exosuits, are clothing-like devices made of fabric or elastomers that wrap around a person’s limb and work in parallel with his/her muscles [17, 18]. Characteristic of exosuits is that they rely on the structural integrity of the human body to transfer reaction forces between body segments, rather than having their own frame, thus acting more like external muscles than an external skeleton. Their intrinsic compliance removes the need for alignment with the joints and their low-profile allows to wear them underneath everyday clothing.
Exosuits actively transmit power to the human body either using cables, moved by electric motors, or soft pneumatic actuators, embedded in the garment. The latter paradigm was probably among the first to be proposed  and has been explored to assist stroke patients during walking , to increase shoulder mobility in subjects with neuromuscular conditions , to help elbow movements  and for rehabilitation purposes to train and aid grasping [23, 24, 25].
Cable-driven exosuits, instead, include a DC motor that transmits power to the suit using Bowden cables. This flexible transmission allows to locate the actuation stage where its additional weight has the least metabolic impact on its wearer. Using this paradigm to provide assistance to the lower limbs has resulted in unprecedented levels of walking economy in healthy subjects  and improved symmetry and efficiency of mobility in stroke patients . Similar principles were used to provide active support to hip and knee extension, reducing activation of the gluteus maximus in sit-to-stand and stand-to-sit transitions .
Cable-driven exosuits seem to work particularly well for lower-limbs movements, where small bursts of well-timed assistance can have a big impact on the dynamics and metabolic cost of locomotion . Yet, Park et al. have shown that they have the potential for assisting the upper-limbs in quasi-static movements too: using a tendon-driving mechanism, a textile interface and an elastic component they found a significant reduction in the activity of the deltoid muscle when supporting the weight of the arm .
Similar results were reported by Chiaradia et al., where a soft exosuit for the elbow was shown to reduce the activation of the biceps brachii muscle in dynamic movements , and by Khanh et al., where the same device was used to improve the range of motion of a patient suffering from bilateral brachial plexus injury .
While there is extensive work on the analysis of the effects of wearing a soft exosuit on the kinematics, energetics and muscular activation during walking , the authors are unaware of comparable studies on movements of the upper limbs, whose variety of volitional motions is fundamentally different from the rhythmic nature of walking.
Understanding how these devices affect the physiology and mechanics of human movements is fundamental for quantifying their benefits and drawbacks, assessing their suitability for different applications and guiding a continuous data-driven design refinement.
In this study we investigate the kinematic and physiological effects of wearing a cable-driven exosuit to support elbow movements. We hypothesize that the low inertia and soft nature of the exosuit will allow it to work in parallel with the user’s muscles, delaying the onset of fatigue while having little to no impact on movement kinematics.
We propose a variation of the design and controller presented in [32, 34] and introduce a controller that both detects the wearer’s intention, allowing the suit to quickly shadow the user’s movements, and compensates for gravitational forces acting on the limb, thus reducing the muscular effort required for holding a static posture. We collect kinematic, dynamic and myoelectric signals from subjects wearing the device, finding that the exosuit affects motion smoothness, significantly reduces muscular effort and delays the onset of fatigue. The analysis offers interesting insights on the viability of using this technology for human augmentation/assistance and medical purposes.
An exosuit is a device consisting of a frame made of soft material that wraps around the human body and transmits forces to its wearer’s skeletal structure. In a cable-driven exosuit, artificial tendons are routed along a targeted joint and attached to anchor points on both of its sides. When the tendons are tensioned they deliver an assistive moment to the joint.