Advances in Pneumatic Upper-Limb Rehabilitation Robots: A Critical Review of Structural Design, Human–Robot Interaction, and Clinical Translation

Abstract

Upper-limb motor dysfunction resulting from neurological disorders severely limits patients’ activities of daily living and social participation. Pneumatic upper-limb rehabilitation robots have emerged as a promising intervention owing to their inherent compliance, lightweight design, and high power-to-weight ratio, which facilitate safe, repetitive, and home-based training. Despite these advantages, extensive clinical translation remains hindered by challenges including actuator hysteresis, nonlinear dynamics, limited accuracy in intention recognition, and inconsistent clinical evaluation metrics. This review systematically examines recent advancements in pneumatic upper-limb rehabilitation robots across four critical dimensions: structural design, human–robot interaction, control strategies, and clinical translation. We comparatively analyze rigid exoskeletons, soft wearable devices, and rigid–soft hybrid configurations based on output capability, motion accuracy, comfort, and clinical applicability. The findings suggest that while rigid systems offer high precision and soft systems maximize safety, rigid–soft hybrid architectures represent a critical developmental trend for balancing motion accuracy with interaction compliance. Furthermore, the review evaluates multimodal sensing techniques (e.g., EMG, EEG, and IMUs) for motion intention decoding and training state monitoring, alongside conventional, adaptive, and artificial intelligence-driven control methods aimed at compensating for pneumatic nonlinearity and improving real-time response. Current clinical evidence indicates that these systems effectively enhance upper-limb function and muscle strength, particularly in post-stroke rehabilitation; however, existing trials are frequently constrained by small sample sizes, short interventions, and heterogeneous protocols. Future research must prioritize rigid–soft hybrid architectures, robust multimodal sensor fusion, digital twin-assisted assessment, adaptive intelligent control, and standardized home-based rehabilitation platforms. Ultimately, this comprehensive review provides a concise reference for the design optimization and clinical deployment of next-generation pneumatic rehabilitation systems.