Upper Limb Exoskeletons

Upper limb exoskeletons are engineering controls that can reduce musculoskeletal disorders (MSDs) of shoulders and arms by relocating the burden of hand tools on a worker’s body in overhead tasks.


Upper limb exoskeletons are assistive mechanical devices that apply ergonomic concepts (i.e., replacing muscle energy with stored energy of mechanical components) to reduce shoulder overexertion, specifically in overhead tasks. With many potential applications in the construction industry, these lightweight wearable devices (Figure 1) decrease the strain on human muscles and joints to prevent MSDs and enhance productivity without the use of any external power sources.

Exoskeletons are types of collaborative robots, also called cobots ‒ robots that can interact with humans and help them in a particular task ‒ that can address the ergonomic needs associated with various manual tasks. These solutions have been tested in different fields including the military, healthcare settings, the automotive industry, etc. The construction industry also can benefit from these tools to reduce the number of MSDs while improving the productivity of workers. However, the uniqueness of each project and the broad array of construction tasks could have contributed to the slow adoption of these innovative tools in the industry. For these reasons and to limit this study to specific tasks and solutions, we will focus only on overhead tasks and introduce a type of exoskeleton that can reduce fatigue when workers’ arms are raised and outstretched for a lengthy period of time while holding hand tools.

Upper limb exoskeletons are designed and engineered for overhead construction tasks. This device consists of an actuator (for each arm) to generate the required torque and a system of frames and couplers to distribute forces among arms, shoulders, and hips. The device also needs to be adaptive to different body/tool sizes and must enable users to adjust the amount of torque in each arm based on weight of the tool and position of the arm.

Other upper limb exoskeletons are also available. Besides weight of the device, other factors in selecting the right model can include convenience of wearing and using the device and its ability to adjust to different tasks. Table 1 provides more information on some of the available models on the market.

Table 1. Types of upper limb exoskeletons

ManufacturerFeatures and specifications
Ekso bionics
  • Weight: 9.5 lb.
  • Adjustable lift assistance: 5-15lb. per arm
  • Adjustable work envelope: 20" of adjustment
  • Worker height range: 5' 0" - 6' 4"
  • All mechanical
  • Strapping in about 60 seconds
  • Mainly used in automotive (i.e., Ford) industry
  • Anthropometric profile
  • Weight: 9.4 lb. with one arm and 11.7 lbs with two arms
  • Adjustable support
  • Optimized support
  • Adjustable size
  • All mechanical
  • Anthropometric profile
  • Waterproof, dust proof and easy to maintain
  • Designed for all-day wear
  • One or two arm uses
  • Compatible with exoskeletons for back and lower limbs
  • Strapping in about 60 seconds
  • Aerodynamic design and lightweight material
  • Custom-fitted to individual users
  • Provides full-range motion


Risks Addressed:

Any injury of the soft tissues (muscles, tendons, ligaments, joints, and cartilage) and nervous system could be classified as a musculoskeletal disorder or MSD (OSHA, 2000). These injuries, which often damage upper limbs/extremities (arms, from fingers to shoulder, and neck), lower limbs/extremities (legs from hips to toes) and back (http://www.hse.gov.uk/msd/index.htm), could cause numbness, stiff joints, or muscle loss. More specifically, MSDs include “cases in which the nature of the injury or illness is pinched nerve; herniated disc; meniscus tear; sprains, strains, tears; hernia (traumatic and nontraumatic); pain, swelling, and numbness; carpal or tarsal tunnel syndrome; Raynaud's syndrome or phenomenon; musculoskeletal system and connective tissue diseases and disorders, and when the event or exposure leading to the injury or illness is overexertion and bodily reaction, unspecified; overexertion involving outside sources; repetitive motion involving microtasks; other and multiple exertions or bodily reactions; and rubbed, abraded, or jarred by vibration” (https://www.bls.gov/news.release/osh2.t06.htm).

The Bureau of Labor Statistics has reported that in 2015 MSDs accounted for 31 percent of all cases of nonfatal occupational injuries and illnesses requiring days away from work (https://www.bls.gov/news.release/osh2.nr0.htm). The incidence rate of MSDs that year in the construction industry was 34.6 per every 10,000 full-time workers (https://www.bls.gov/news.release/osh2.t01.htm). Data from National Safety Council (NSC) also show that MSDs are as twice likely as a combination of amputations, fractures, bruises, contusions, cuts, lacerations, burns, and chemical burns to occur in workers’ compensation claims. The National Institute for Occupational Safety and Health (NIOSH) has named construction tradespeople and construction industry among the highest-risk workers and industries for MSDs.

Ignoring ergonomics principles could expose workers to physical stressors, including vibration, awkward postures, repetitive motions, etc., which could lead to serious MSDs such as carpal tunnel syndrome (CTS). While various risk factors could contribute to MSDs, this study has focused on one specific condition: awkward postures in overhead tasks. Among all body parts, the upper extremities were involved in the largest number of non-fatal occupational incidents (32.4 per 10,000 full-time workers) in 2015 (https://www.bls.gov/news.release/osh2.t06.htm). Bernard et al. (1997), in a report for the Department of Health and Human Services, identified a strong association between MSDs and shoulder postures (with greater than 60 degrees of flexion or abduction), especially when the postures are combined with other physical factors such as “holding a tool while working overhead” (Bernard et al. 1997, page 3-1). Many construction workers work under these conditions, as several construction tasks such as welding, installing lights, etc., require employees to work with their hands stretched out at chest height or overhead. These awkward postures could put significant strain on the arms and shoulders, resulting in the need for more breaks from work (reduced productivity) and more injuries. Furthermore, awkward postures combined with holding construction tools in a stable position would localize the stresses to arms and shoulders. For instance, Herberts and Kadefors (1976) clinically examined ten welders between the ages of 50 to 65 who were experiencing pain around their shoulders. The authors concluded that heavy static loading of overhead postures on the supraspinatus muscle, along with the constant traction in tendons, could contribute to the degeneration of the cuff and shoulder injuries.

How Risks are Reduced:

Ergonomic tools are designed to fit a worker’s body to reduce physical stress and eliminate serious MSDs. To address the risks of MSDs during overhead tasks, Engelhoven et al. (2018) introduced three main design criteria for upper limb exoskeletons:
•  During elevated postures, the exoskeleton should support shoulders. However, during neutral postures this support should be removed;
•  The devices should not limit a worker’s shoulder/spine movements (two degrees of freedom at the spine and three degrees of freedom at the shoulder);
•  The device should not interfere with a worker’s performance.

The first criterion is also known as optimized support: when the arms are elevated at more than 20 degrees, most of the forces will be transferred to the hips; during resting postures, removal of support will allow workers to move freely (Engelhoven et al. 2018). Moreover, to reduce fatigue, the arms on some models lock when workers are completing overhead tasks (http://worksaversystems.com/2016/11/09/exoskeleton-technology/).

Three recent studies have quantified the effects of upper limb exoskeletons on different shoulder muscles. First, Sylla et al. (2014) examined the performance of an upper limb exoskeleton in a screwing task in the automotive industry. The results revealed that exoskeletons could significantly reduce the mechanical energy (i.e., joint torques) on the wearer’s shoulders. However, the joint angle trajectories were not significantly different with or without the device, and the task took more time with the exoskeleton. Next, Gillette and Stephenson (2017) assessed the safety performance of exoskeletons by collecting muscle contractions using EMG signals. The results showed that the most benefit was provided to two areas: anterior deltoid and biceps brachii. Lastly, Engelhoven et al. (2018) acknowledged that the use of exoskeletons reduces muscle activity, suggesting that these devices can change how different industries deal with overhead work.

Effects on Productivity:

A study by Haslegrave et al. (1997) revealed that force exertion in awkward positions like those required for overhead work can be significantly reduced. This effect can consequently result in lower levels of productivity. Exoskeletons can maximize workers’ muscle force and help them finish a task in a shorter time than would be required in a normal posture. In another study, Butler and Wisner (2016) conducted a five-day field test with two experienced workers wearing exoskeletons for two common tasks: welding and painting. To ensure that the quality of work was satisfactory, a scoring system was used to exclude low-quality work from the productivity calculations. In the painting job, the productivity of the two workers improved by 27% and 53%. In the welding job the productivity was reported to be improved by 86%. In both jobs, the results showed that the final quality was higher when using the exoskeletons, most probably due to enhanced hand steadiness. 

Additional Considerations:

Gillette and Stephenson (2017) measured lower back muscle activity and showed that loads are less when using exoskeletons. However, a study by Weston et al. (2018) investigated the biomechanical loading of an exoskeleton on the lower back of workers and found out that both muscle forces in the torso extensor muscles and compressive spinal loads were increased significantly. One should note that the exoskeleton used by Weston et al. (2018) is slightly different than the solutions mentioned in this study. Still, caution must be exercised when using these solutions because they relocate the weights to the backs of workers. As mentioned previously, some models are capable of combining with lower limb exoskeletons that can transfer the weight to the ground. 


Behzad Esmaeili, PhD - Geroge Mason University
Pouya Gholizadeh - Geroge Mason University
Bruce Lippy, PhD - CPWR The Center for Construction Research and Training
David Chan, CIH, CSP

Hazards Addressed:


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Ekso bionics
To obtain information, visit https://eksobionics.com/ or contact 1-510-984-1761

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