Clinical Evaluation of a Tongue-Controlled Wrist Abduction-Adduction Assistance in a 6-DoF Upper-Limb Exoskeleton for Individuals with ALS and SCI

Upper-limb exoskeletons (ULEs) have the potential to restore functional independence in individuals with severe motor impairments; however, the clinical relevance of wrist degrees of freedom (DoF), particularly abduction-adduction (Ab-Ad), remains insufficiently evaluated. This study investigates the functional and user-perceived impact of wrist Ab-Ad assistance during two activities of daily living (ADLs). Wrist Ab-Ad assistance in a tongue-controlled 6-DoF ULE, EXOTIC2, was evaluated in a within-subject study involving one individual with amyotrophic lateral sclerosis and five individuals with spinal cord injury. Participants performed drinking and scratch stick leveling tasks with EXOTIC2 under two conditions: with and without wrist Ab-Ad assistance. Outcome measure included task success, task completion time, kinematic measures, and a usability questionnaire capturing comfort, functional perception, and acceptance. Enabling wrist Ab-Ad improved task success rates across both ADLs, with consistent reductions in spillage (from 77.8% spillages to 22.2%) and failed placements (from 66.7% to 16.7%). Participants utilized task-specific subsets of the available wrist range of motion, indicating that effective control within functional ranges was more critical than maximal joint excursion. Questionnaire responses indicated no increase in discomfort with the additional DoF and reflected perceived improvements in task performance. In conclusion, wrist Ab-Ad assistance enhances functional task performance in assistive exoskeleton use without compromising user comfort. However, its effectiveness depends on task context, control usability, and individual user strategies. This study provides clinically relevant, user-centered evidence supporting the inclusion of wrist Ab-Ad in ULEs, emphasizing the importance of balancing functional capability with usability in assistive device design.