pith. machine review for the scientific record. sign in

arxiv: 2604.20967 · v2 · submitted 2026-04-22 · 💻 cs.RO · cs.SY· eess.SY

Recognition: unknown

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

Juwairiya S. Khan , Mostafa Mohammadi , Alexander L. Ammitzb{\o}ll , Ellen-Merete Hagen , Jakob Blicher Izabella Ob\'al , Ana S. S. Cardoso , Oguzhan Kirtas , Rasmus L. K{\ae}seler
show 2 more authors
John Rasmussen Lotte N.S. Andreasen Struijk
Authors on Pith no claims yet

Pith reviewed 2026-05-09 23:57 UTC · model grok-4.3

classification 💻 cs.RO cs.SYeess.SY
keywords upper-limb exoskeletonwrist abduction-adductiontongue controlamyotrophic lateral sclerosisspinal cord injuryactivities of daily livingclinical evaluationassistive robotics
0
0 comments X

The pith

Wrist abduction-adduction assistance in a tongue-controlled upper-limb exoskeleton improves success rates in daily living tasks for people with ALS and spinal cord injury.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper tests whether adding wrist abduction-adduction movement to a six-degree-of-freedom exoskeleton helps users with severe motor loss perform everyday actions more reliably. In tests with drinking from a cup and leveling a scratch stick, the extra wrist control cut spills and placement failures sharply while users reported no added discomfort. A sympathetic reader would care because restoring even small wrist motions could reduce reliance on caregivers and increase independence for those with ALS or spinal injuries. The study uses tongue control for all commands, making the wrist addition a key variable to isolate.

Core claim

Enabling wrist Ab-Ad in the EXOTIC2 exoskeleton raised task success across drinking and scratch stick leveling activities. Spillage dropped from 77.8 percent to 22.2 percent and failed placements from 66.7 percent to 16.7 percent. Users applied only task-specific portions of the available wrist range, showing that functional control mattered more than full motion. No extra discomfort appeared in questionnaires, and participants perceived better performance overall.

What carries the argument

Wrist abduction-adduction assistance, which adds side-to-side wrist tilting to the exoskeleton's control while keeping tongue-operated commands for the other degrees of freedom.

If this is right

  • Task success rates increase when wrist Ab-Ad is enabled for both drinking and leveling activities.
  • Spillage and placement failures decrease consistently with the added assistance.
  • Users do not experience increased discomfort from the extra degree of freedom.
  • Perceived task performance improves according to participant feedback.
  • Effectiveness varies with specific task demands and individual control strategies.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

  • Designers of future exoskeletons should prioritize controllable ranges that match common daily tasks rather than maximum possible motion.
  • Larger trials across more activities could confirm whether the benefits hold for a wider set of users and actions.
  • The tongue-control interface may interact differently with wrist assistance than other control methods, warranting direct comparisons.
  • Reducing caregiver assistance for basic tasks could lower overall care costs and improve quality of life.

Load-bearing premise

The results from six participants doing only two tasks can stand in for the larger population of ALS and SCI users and the full variety of daily living activities.

What would settle it

A follow-up study with at least twenty participants performing a broader set of tasks that shows no difference in success rates or comfort between conditions with and without wrist Ab-Ad assistance.

Figures

Figures reproduced from arXiv: 2604.20967 by Alexander L. Ammitzb{\o}ll, Ana S. S. Cardoso, Ellen-Merete Hagen, Jakob Blicher Izabella Ob\'al, John Rasmussen, Juwairiya S. Khan, Lotte N.S. Andreasen Struijk, Mostafa Mohammadi, Oguzhan Kirtas, Rasmus L. K{\ae}seler.

Figure 3
Figure 3. Figure 3: Experimental tasks demonstration (a) Trial start at home position, (b) experimental trial for each task and (c) Trial outcomes in each task, Top trial outcome: shows drinking task with the cup (inside bottle) placement position on table and Bottom trial outcome: shows Scratch stick task, with stick placement position on table [PITH_FULL_IMAGE:figures/full_fig_p004_3.png] view at source ↗
read the original abstract

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.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Referee Report

4 major / 2 minor

Summary. The manuscript reports a within-subject clinical evaluation of wrist abduction-adduction (Ab-Ad) assistance in the tongue-controlled 6-DoF upper-limb exoskeleton EXOTIC2. Six participants (one with ALS, five with SCI) performed drinking and scratch-stick leveling tasks under two conditions (with and without wrist Ab-Ad enabled). The authors claim that enabling wrist Ab-Ad improved task success rates, reduced spillage (77.8% to 22.2%) and failed placements (66.7% to 16.7%), involved task-specific use of available wrist ROM, and yielded questionnaire responses showing no increase in discomfort with perceived performance gains. They conclude that wrist Ab-Ad assistance enhances functional task performance in ULEs without compromising comfort, though effectiveness depends on task context and user strategies.

Significance. If the observed improvements hold under more rigorous analysis, this work supplies clinically relevant, user-centered evidence supporting the inclusion of wrist Ab-Ad in upper-limb exoskeletons for individuals with severe motor impairments. The direct outcome measures (success rates, spillage, placement failures) and within-subject design provide practical insights into balancing added DoF with usability, which could guide future assistive device development.

major comments (4)
  1. [Abstract] Abstract: The aggregate improvements (spillage reduced from 77.8% to 22.2%; failed placements from 66.7% to 16.7%) are presented without statistical tests, p-values, confidence intervals, effect sizes, or per-participant breakdowns. Given the small n=6 and heterogeneous sample, these deltas cannot be reliably attributed to the added DoF rather than variability or task-specific factors.
  2. [Methods] Methods (Participants and Study Design): The cohort of six participants (one ALS, five SCI) with varying impairment levels performs only two ADLs; no power analysis, sample-size justification, or discussion of generalizability is provided, undermining the broader claim that wrist Ab-Ad 'enhances functional task performance' in ULEs.
  3. [Results] Results: The finding that participants utilized task-specific subsets of wrist ROM is noted but not quantified or analyzed for its implications on generalization; this directly weakens the central assertion of functional enhancement beyond the tested drinking and scratch-stick tasks.
  4. [Discussion] Discussion: The within-subject design is appropriate, yet the manuscript does not address potential order or learning effects, nor does it include a no-exoskeleton baseline, leaving open whether benefits stem specifically from wrist Ab-Ad assistance.
minor comments (2)
  1. [Abstract] Abstract: Explicitly state the number of participants, trials per condition, and any statistical methods (or their absence) to allow readers to assess the reported percentages.
  2. Figures/Tables: Ensure any kinematic or ROM plots include individual data points or error bars to illustrate variability across the small cohort.

Simulated Author's Rebuttal

4 responses · 0 unresolved

We thank the referee for the constructive and detailed feedback on our manuscript. We have addressed each major comment below with honest responses and indicate where revisions will be made to improve the paper.

read point-by-point responses

  1. Referee: [Abstract] The aggregate improvements (spillage reduced from 77.8% to 22.2%; failed placements from 66.7% to 16.7%) are presented without statistical tests, p-values, confidence intervals, effect sizes, or per-participant breakdowns. Given the small n=6 and heterogeneous sample, these deltas cannot be reliably attributed to the added DoF rather than variability or task-specific factors.

    Authors: We agree that the small and heterogeneous sample precludes meaningful inferential statistics. In the revised manuscript, we will add a supplementary table with per-participant outcome data (success rates, spillage, and placement failures) to allow transparent assessment of individual variability. We will also revise the abstract and results to present the percentages as descriptive observations only and explicitly note the exploratory nature of the study due to sample size. revision: yes

  2. Referee: [Methods] The cohort of six participants (one ALS, five SCI) with varying impairment levels performs only two ADLs; no power analysis, sample-size justification, or discussion of generalizability is provided, undermining the broader claim that wrist Ab-Ad 'enhances functional task performance' in ULEs.

    Authors: The study was conceived as a preliminary within-subject evaluation in a rare and heterogeneous population where larger samples are logistically challenging. We will add a paragraph in the Methods and Discussion sections providing feasibility-based justification for n=6, referencing similar prior exoskeleton studies, and explicitly discussing limitations on generalizability to broader populations or other ADLs. Claims will be tempered to the tested tasks and cohort. revision: yes

  3. Referee: [Results] The finding that participants utilized task-specific subsets of wrist ROM is noted but not quantified or analyzed for its implications on generalization; this directly weakens the central assertion of functional enhancement beyond the tested drinking and scratch-stick tasks.

    Authors: We acknowledge that the current description of task-specific ROM use is qualitative. In revision, we will add quantitative kinematic summaries (e.g., mean and range of wrist Ab-Ad angles utilized per task and condition) drawn from the available motion data and discuss how these support the importance of functional rather than maximal ROM. This will strengthen the results section and address generalization implications. revision: yes

  4. Referee: [Discussion] The within-subject design is appropriate, yet the manuscript does not address potential order or learning effects, nor does it include a no-exoskeleton baseline, leaving open whether benefits stem specifically from wrist Ab-Ad assistance.

    Authors: We agree that order and learning effects merit explicit discussion. In the revised Discussion, we will add a limitations paragraph noting that while the within-subject design controls for inter-individual differences, potential order effects were not formally analyzed and represent a limitation. Regarding the no-exoskeleton baseline, the study scope was to isolate the incremental effect of wrist Ab-Ad within the exoskeleton for users who require it; a no-exo condition was not included because many participants could not perform the tasks unassisted and it fell outside the protocol. We will clarify this scope and list it as a direction for future work. revision: yes

Circularity Check

0 steps flagged

No circularity: direct empirical reporting from user trials

full rationale

This is a clinical evaluation paper reporting measured outcomes (task success rates, spillage, placement failures, ROM usage, and questionnaire scores) from a within-subject study of six participants performing two ADLs under two conditions. No equations, models, fitted parameters, predictions, or derivation chains appear anywhere in the text. Claims rest on observed deltas in the data rather than any reduction to self-defined inputs or self-citations. The analysis is therefore self-contained empirical reporting with no opportunity for the circularity patterns listed.

Axiom & Free-Parameter Ledger

0 free parameters · 0 axioms · 0 invented entities

This is an empirical clinical evaluation study with no mathematical models, derivations, or theoretical constructs; therefore it introduces no free parameters, axioms, or invented entities.

pith-pipeline@v0.9.0 · 5704 in / 1421 out tokens · 52474 ms · 2026-05-09T23:57:19.255210+00:00 · methodology

discussion (0)

Sign in with ORCID, Apple, or X to comment. Anyone can read and Pith papers without signing in.

Reference graph

Works this paper leans on

37 extracted references · 31 canonical work pages · 2 internal anchors

  1. [1]

    Spinal cord injury,

    World Health Organization, “Spinal cord injury,” Factsheet 2024

    2024

  2. [2]

    Amyotrophic lateral sclerosis,

    E. L. Feldman et al., “Amyotrophic lateral sclerosis,” The Lancet, vol. 400, no. 10360, pp. 1363 –1380, 2022, doi: 10.1016/S0140 - 6736(22)01272-7

    work page doi:10.1016/s0140 2022

  3. [3]

    Elsevier Inc

    B. Murray, “Amyotrophic Lateral Sclerosis,” Encyclopedia of the Neurological Sciences , pp. 165 –167, 2014, doi : 10.1016/B978 -0-12- 385157-4.00608-4

    work page doi:10.1016/b978 2014

  4. [4]

    J. L. Pons, Wearable robots : biomechatronic exoskeletons. Chichester, England ; John Wiley & Sons, 2008. Fig. 7 Qualitative feedback from system usability questionnaire of each participant (a) Responses from questions 5 and 6, (b) Responses from questions 11 and 12, (c) Responses from questions 9 and 10 and (d) Responses from questions 13 and 14 9

    2008

  5. [5]

    A review on design of upper limb exoskeletons,

    M. A. Gull, S. Bai, and T. Bak, “A review on design of upper limb exoskeletons,” Robotics, vol. 9, no. 1, pp. 1 –35, 2020, doi: 10.3390/robotics9010016

    work page doi:10.3390/robotics9010016 2020

  6. [6]

    URLhttps://aclanthology.org/2024.acl-long.44

    J. S. Khan, M. Mohammadi, J. Rasmussen, S. Bai, and N. S. Lotte Andreasen Struijk, “A review on the design of assistive cable -driven upper-limb exoskeletons and their experimental evaluation,” in 2022 IEEE International Conference on Systems, Man, and Cybernetics (SMC), 2022, pp. 59–64. doi: 10.1109/SMC53654.2022.9945523

    work page doi:10.1109/smc53654.2022.9945523 2022

  7. [7]

    Sensors and Actuation Technologies in Exoskeletons: A Review,

    M. Tiboni, A. Borboni, F. Vérité, C. Bregoli, and C. Amici, “Sensors and Actuation Technologies in Exoskeletons: A Review,” Sensors, vol. 22, no. 3, pp. 1–61, 2022, doi: 10.3390/s22030884

    work page doi:10.3390/s22030884 2022

  8. [8]

    Review of control strategies for robotic movement training after neurologic injury,

    L. Marchal-Crespo, “Review of control strategies for robotic movement training after neurologic injury,” J. Neuroeng. Rehabil., vol. 14, pp. 22– 44, Jan. 2007

    2007

  9. [9]

    Design, Modelling and Experimental Evaluation of a Tendon-driven Wrist Abduction-Adduction Mechanism for an upper limb exoskeleton

    J. Khan, M. Mohammadi, J. Rasmussen, and L. N. S. A. Struijk, “Design, Modelling and Experimental Evaluation of a Tendon -driven Wrist Abduction-Adduction Mechanism for an upper limb exoskeleton ,” Under Review in IEEE Transaction on Mechatronics , doi: https://doi.org/10.48550/arXiv.2604.20893

    work page internal anchor Pith review Pith/arXiv arXiv doi:10.48550/arxiv.2604.20893

  10. [10]

    Low -Profile Two -Degree-of- Freedom Wrist Exoskeleton Device Using Multiple Spring Blades,

    T. Higuma, K. Kiguchi, and J. Arata, “Low -Profile Two -Degree-of- Freedom Wrist Exoskeleton Device Using Multiple Spring Blades,” IEEE Robot. Autom. Lett. , vol. 3, no. 1, pp. 305 –311, 2018, doi: 10.1109/LRA.2017.2739802

    work page doi:10.1109/lra.2017.2739802 2018

  11. [11]

    Khan et al

    J. Khan et al. , Wrist Range of Motion Variability for Adaptive Exoskeleton Design: A Study on users with and without SCI or ALS, vol

  12. [12]

    A., and Elmar W., L

    2025. doi: 10.1109/EMBC58623.2025.11251763

    work page doi:10.1109/embc58623.2025.11251763 2025

  13. [13]

    An Analysis of Wrist Motions During Daily Activities From a Directional Perspective: The Significance of Directions Beyond the Dart -Throwing Motion,

    Q. Wei et al., “An Analysis of Wrist Motions During Daily Activities From a Directional Perspective: The Significance of Directions Beyond the Dart-Throwing Motion,” Orthop. Surg. , vol. 17, no. 5, pp. 1486 – 1502, May 2025, doi: https://doi.org/10.1111/os.70024

    work page doi:10.1111/os.70024 2025

  14. [14]

    Hand synergies: Integration of robotics and neuroscience for understanding the control of biological and artificial hands,

    M. Santello et al. , “Hand synergies: Integration of robotics and neuroscience for understanding the control of biological and artificial hands,” Phys. Life Rev. , vol. 17, pp. 1 –23, 2016, doi: https://doi.org/10.1016/j.plrev.2016.02.001

    work page doi:10.1016/j.plrev.2016.02.001 2016

  15. [15]

    Freivalds, Biomechanics of the upper limb

    A. Freivalds, Biomechanics of the upper limb . 2010. doi: 10.1201/9781420075250

    work page doi:10.1201/9781420075250 2010

  16. [16]

    A Tendon-Driven Wrist Abduction-Adduction Joint Improves Performance of a 5 DoF Upper Limb Exoskeleton -- Implementation and Experimental Evaluation

    J. Khan et al. , “A Tendon -Driven Wrist Abduction -Adduction Joint Improves Performance of a 5 DoF Upper Limb Exoskeleton - Implementation and Experimental Evaluation ,” Under 2nd Review in IEEE Transaction on Biomedical Engineering , 2026, doi: https://doi.org/10.48550/arXiv.2604.20898

    work page internal anchor Pith review Pith/arXiv arXiv doi:10.48550/arxiv.2604.20898 2026

  17. [17]

    Upper limb soft robotic wearable devices: a systematic review,

    E. Bardi, M. Gandolla, F. Braghin, F. Resta, A. Pedrocchi, and E. Ambrosini, “Upper limb soft robotic wearable devices: a systematic review,” J. Neuroeng. Rehabil. , vol. 19, Aug. 2022, doi: 10.1186/s12984-022-01065-9

    work page doi:10.1186/s12984-022-01065-9 2022

  18. [18]

    The impact of interdisciplinarity and user involvement on the design and usability of an assistive upper limb exoskeleton - a case study on the EXOTIC,

    L. N. S. A. Struijk et al. , “The impact of interdisciplinarity and user involvement on the design and usability of an assistive upper limb exoskeleton - a case study on the EXOTIC,” in 2022 International Conference on Rehabilitation Robotics (ICORR) , Philadelphia: F.A. Davis Company, 2022, pp. 1 –5. doi: 10.1109/ICORR55369.2022.9896500

    work page doi:10.1109/icorr55369.2022.9896500 2022

  19. [19]

    M. B. Thøgersen et al. , “User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5 -DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control,” Sensors, vol. 22, no. 18, 2022, doi: 10.3390/s22186919

    work page doi:10.3390/s22186919 2022

  20. [20]

    T. Nef, M. Mihelj , G. Kiefer, C. Perndl, R. Muller, and R. Riener, ARMin - Exoskeleton for Arm Therapy in Stroke Patients . 2007. doi: 10.1109/ICORR.2007.4428408

    work page doi:10.1109/icorr.2007.4428408 2007

  21. [21]

    A survey on robotic devices for upper limb rehabilitation,

    P. Maciejasz, J. Eschweiler, K. Gerlach -Hahn, A. Jansen -Toy, and S. Leonhardt, “A survey on robotic devices for upper limb rehabilitation,” J. Neuroeng. Rehabil., vol. 11, p. 3, Jan. 2014, doi: 10.1186/1743-0003- 11-3

    work page doi:10.1186/1743-0003- 2014

  22. [22]

    Eyes -Free Tongue Gesture and Tongue Joystick Control of a Five DOF Upper -Limb Exoskeleton for Severely Disabled Individuals,

    M. Mohammadi et al., “Eyes-Free Tongue Gesture and Tongue Joystick Control of a Five DOF Upper-Limb Exoskeleton for Severely Disabled Individuals,” Front. Neurosci., vol. 15, no. December, pp. 1 –14, 2021, doi: 10.3389/fnins.2021.739279

    work page doi:10.3389/fnins.2021.739279 2021

  23. [23]

    Design and evaluation of a noninvasive tongue -computer interface for individuals with severe disabilities,

    O. Kirtas, M. Mohammadi, B. Bentsen, P. Veltink , and L. N. S. A. Struijk, “Design and evaluation of a noninvasive tongue -computer interface for individuals with severe disabilities,” in 2021 IEEE 21st International Conference on Bioinformatics and Bioengineering (BIBE), 2021, pp. 1–6. doi: 10.1109/BIBE52308.2021.9635238

    work page doi:10.1109/bibe52308.2021.9635238 2021

  24. [24]

    A tongue-controlled FES-robotic exoskeleton restores hand function in users with long -term spinal cord injury,

    O. Kirtas et al., “A tongue-controlled FES-robotic exoskeleton restores hand function in users with long -term spinal cord injury,” Submitted to npj Robotics (Under review)

  25. [25]

    A high-resolution tongue-based joystick to enable robot control for individuals with severe disabilities,

    M. Mohammadi, H. Knoche, M. Gaihede, B. Bentsen, and L. N. S. A. Struijk, “A high-resolution tongue-based joystick to enable robot control for individuals with severe disabilities,” in 2019 IEEE 16th International Conference on Rehabilitation Robotics (ICORR) , 2019, pp. 1043–1048. doi: 10.1109/ICORR.2019.8779434

    work page doi:10.1109/icorr.2019.8779434 2019

  26. [26]

    Abnormal Respiratory Sound Identification Using Audio-Spectrogram Vision Transformer

    J. S. Khan, M. Mohammadi, J. Rasmussen, and L. N. S. Andreasen Struijk, “Simulation-based design optimization of a wrist exoskeleton,” in Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS , Institute of Electrical and Electronics Engineers Inc., 2023. doi: 10.1109/EMBC40787.2023.10340424

    work page doi:10.1109/embc40787.2023.10340424 2023

  27. [27]

    Exploring User Requirements for an Exoskeleton Arm Insights from a User-Centered Study with People Living with Severe Paralysis,

    F. Kobbelgaard, A. Kanstrup, and L. Struijk, “Exploring User Requirements for an Exoskeleton Arm Insights from a User -Centered Study with People Living with Severe Paralysis,” 2021, pp. 312 –320. doi: 10.1007/978-3-030-85623-6_19

    work page doi:10.1007/978-3-030-85623-6_19 2021

  28. [28]

    ARMin: A robot for patient - cooperative arm therapy,

    T. Nef, M. Mihelj, and R. Riener, “ARMin: A robot for patient - cooperative arm therapy,” Med. Biol. Eng. Comput. , vol. 45, pp. 887 – 900, Oct. 2007, doi: 10.1007/s11517-007-0226-6

    work page doi:10.1007/s11517-007-0226-6 2007

  29. [29]

    Compensatory strategies for reaching in stroke,

    C. Cirstea and M. Levin, “Compensatory strategies for reaching in stroke,” Brain, vol. 123 ( Pt 5), pp. 940 –953, Jun. 2000, doi: 10.1093/brain/123.5.940

    work page doi:10.1093/brain/123.5.940 2000

  30. [30]

    Herr, H.: Lower Extremity Exoskeletons and Active Orthoses: Challenges and State-of-the-Art. IEEE Transactions on Robotics 24(1), 144-158,

    A. Dollar and H. Herr, “Herr, H.: Lower Extremity Exoskeletons and Active Orthoses: Challenges and State-of-the-Art. IEEE Transactions on Robotics 24(1), 144-158,” Robotics, IEEE Transactions on, vol. 24, pp. 144–158, Mar. 2008, doi: 10.1109/TRO.2008.915453

    work page doi:10.1109/tro.2008.915453 2008

  31. [31]

    H. K. Yap, J. Lim, F. Nasrallah, J. Cho, and R. C. -H. Yeow, A soft exoskeleton for hand assistive and rehabilitation application using pneumatic actuators with variable stiffness . 2015. doi: 10.1109/ICRA.2015.7139889

    work page doi:10.1109/icra.2015.7139889 2015

  32. [32]

    Non -invasive control interfaces for intention detection in active movement-assistive devices,

    J. Lobo -Prat, P. Kooren, A. Stienen, J. Herder, B. Koopman, and P. Veltink, “Non -invasive control interfaces for intention detection in active movement-assistive devices,” J. Neuroeng. Rehabil. , vol. 11, p. 168, Dec. 2014, doi: 10.1186/1743-0003-11-168

    work page doi:10.1186/1743-0003-11-168 2014

  33. [33]

    Review of control strategies for robotic movement training after neurologic injury,

    L. Marchal -Crespo and D. Reinkensmeyer, “Review of control strategies for robotic movement training after neurologic injury,” J. Neuroeng. Rehabil., vol. 6, p. 20, Jul. 2009, doi: 10.1186/1743-0003-6- 20

    work page doi:10.1186/1743-0003-6- 2009

  34. [34]

    On the tip of the tongue: learning typing and pointing with an intra -oral computer interface,

    H. A. Caltenco, B. Breidegard, and L. N. S. Andreasen Struijk, “On the tip of the tongue: learning typing and pointing with an intra -oral computer interface,” Disabil. Rehabil. Assist. Technol., vol. 9, no. 4, pp. 307–317, Jul. 2014, doi: 10.3109/17483107.2013.823629

    work page doi:10.3109/17483107.2013.823629 2014

  35. [35]

    Tongue control of a five -DOF upper -limb exoskeleton rehabilitates drinking and eating for individuals with severe disabilities,

    M. Mohammadi et al. , “Tongue control of a five -DOF upper -limb exoskeleton rehabilitates drinking and eating for individuals with severe disabilities,” Int. J. Hum. Comput. Stud., vol. 170, p. 102962, 2023, doi: https://doi.org/10.1016/j.ijhcs.2022.102962

    work page doi:10.1016/j.ijhcs.2022.102962 2023

  36. [36]

    Tongue-computer interface for disabled people,

    L. Andreasen Struijk, “Tongue-computer interface for disabled people,” International Journal on Disability and Human Development, vol. 5, no. 3, pp. 223–226, 2006

    2006

  37. [37]

    Remote Tongue -Based Control of a Wheelchair Mounted Assistive Robotic Manipulator and the Effect of Adaptive Semi-Automation,

    Á. A. Pálsdóttir, R. L. Kæseler, S. H. Bengtson, T. B. Moeslund, and L. N. S. A. Struijk, “Remote Tongue -Based Control of a Wheelchair Mounted Assistive Robotic Manipulator and the Effect of Adaptive Semi-Automation,” IEEE Trans. Biomed. Eng. , vol. 72, no. 1, pp. 14 – 23, 2025, doi: 10.1109/TBME.2024.3435837

    work page doi:10.1109/tbme.2024.3435837 2025