Biomechanically-Aware Robotic Assistance in Musculoskeletal Rehabilitation: Gaps, Clinical Potential, and Research Directions

Abstract

Robotic technologies are increasingly integrated into musculoskeletal (MSK) rehabilitation to augment physiotherapy by providing repetitive, task-specific training. However, many robotic interventions have yet to fully leverage biomechanical insights for personalised, safe, and effective therapy. This review surveys recent advances (2022–2025) in rehabilitation robotics that explicitly incorporate biomechanical modelling, sensing, and control. We discuss how patient-specific musculoskeletal models and real-time biomechanical feedback can improve safety, target muscle activation, and quantify progress.

Wearable exoskeletons and robotic orthoses for gait and upper-limb rehabilitation have demonstrated improvements in motor function, range of motion, and spasticity. Key gaps include limited long-term evidence, lack of standardised protocols, and insufficient integration of personalised biomechanics in control algorithms (e.g. adaptive force strategies). We highlight clinical implications for allied health professionals – namely, that biomechanically-aware robots can enhance therapy intensity and objectivity while reducing therapist burden – and outline future directions. These include developing real-time adaptive controllers informed by musculoskeletal dynamics, employing artificial intelligence to personalise assistance, and rigorous clinical trials to establish efficacy. Addressing these interdisciplinary challenges will help fulfil the potential of robotics to improve outcomes in MSK rehabilitation.