Recent Advances in Sensor-Based Upper-Limb and Hand Exoskeletons for Post-Stroke Rehabilitation: A Technical and Biomedical Review

Background: Recent advancements in enabling technologies, including artificial intelligence and telemedicine, alongside robust clinical study outcomes, have led to significant progress in upper limb and hand exoskeletons utilised for post-stroke rehabilitation. Objectives: This review aims to synthesize the recent scientific literature (2010–2025) on post-stroke upper-limb and hand exoskeletons, with particular attention to the sensing architectures—sensing modalities, signal processing, sensor fusion, and sensor-driven control—that integrate technical and biomedical domains to examine device architecture, clinical context, and outcome selection. Methods: A search of PubMed and Scopus was conducted on 10 November 2025, cross-checked against IEEE Xplore, Web of Science, Embase, and ACM Digital Library. We included studies evaluating wearable exoskeletons or robotic orthoses for the upper limb/hand in post-stroke rehabilitation. Two independent reviewers screened records and extracted data, with disagreements resolved by consensus. Data were synthesised using a predefined label-based taxonomy. The review protocol was not registered. Results: From 1889 identified records, 219 studies met the inclusion criteria. The synthesis reveals a transition from rigid, laboratory-centered systems to lighter, soft, and home-oriented solutions. Available evidence suggests potential impairment-level benefits, particularly for proximal motor control, but certainty remains limited due to heterogeneity, small samples, blinding limitations, inconsistent dosing, and limited long-term follow-up; gains in hand/finger dexterity appear even more variable. Discussion: While exoskeleton-assisted therapy appears associated with impairment-level gains, transfer to activities of daily living (ADLs) and real-world function remains inconsistently documented and insufficiently powered to support firm conclusions.