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Review
. 2025 May 21;10(5):340.
doi: 10.3390/biomimetics10050340.

Adverse Effects Due to the Use of Upper Limbs Exoskeletons in the Work Environment: A Scoping Review

Omar Flor-Unda  1 , Rafael Arcos-Reina  2 , Susana Nunez-Nagy  3   4 , Bernardo Alarcos  5
Affiliations
Review

Adverse Effects Due to the Use of Upper Limbs Exoskeletons in the Work Environment: A Scoping Review

Omar Flor-Unda et al. Biomimetics (Basel). .

Abstract

Both for design issues and for the study, analysis, and understanding of the interaction of workers with exoskeletons, the study of adverse effects provides criteria to improve the design of more efficient exoskeletons with better ergonomics and long-term usability. In this work, a scoping review was carried out on adverse effects due to the prolonged use of upper-limb exoskeletons, which have been evidenced in the scientific literature. The causes of the effects are described in terms of their impacts on the physiological, psychological, and technological aspects that affect the user. A scoping review of articles of the last ten years on negative effects of upper-extremity exoskeletons for industrial tasks was carried out following the guidelines of the PRISMA® methodology with three phases: formulation of questions, definition of scopes and exhaustive search in SCOPUS, Web of Science, Science Direct, Taylor & Francis, and PubMed. The selection was made by two review authors with a Cohen's Kappa coefficient of 0.9530, indicating high agreement. The effectiveness of upper-limb exoskeletons depends on the environment and the task, so an adaptable ergonomic design, field validations, and standards are required to ensure their functionality and acceptance. Use of exoskeletons mainly activates the posterior deltoid and latissimus dorsi and reduces the activity of muscles such as the trapezius, pectoralis major, anterior and middle deltoids, biceps brachii, brachioradialis, and flexor carpi radialis.

Keywords: exoskeleton device; muscle fatigue; musculoskeletal diseases; postural balance; upper-limb exoskeleton.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Bibliometric graph of articles related to the SCOPUS database that address the negative effects on the musculoskeletal system due to the interaction of using upper-limb exoskeletons. The graph was obtained with VOSviewer® version 1.6.20.
Figure 2
Figure 2
Relative frequency of studies addressing the advantages and disadvantages of using upper limb exoskeletons for industrial work.
Figure 3
Figure 3
Contributions of the development of exoskeletons to the Sustainable Development Goals proposed by the UN.
Figure 4
Figure 4
Workflow according to the guidelines of the PRISMA® methodology.
Figure 5
Figure 5
Negative effects of using exoskeletons in the workplace.
Figure 6
Figure 6
Compensation and deactivation of muscles during the use of upper-limb exoskeletons.
Figure 7
Figure 7
Risks associated with increased muscle activity due to prolonged use of exoskeletons.
Figure 8
Figure 8
Artificial intelligence contributes to improving exoskeletons’ performance in the work environment.
See this image and copyright information in PMC

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