Due to their potential to reduce occupational physical strain and enhance human performance, the development of exoskeletons has gained significant attention. This study presents a musculoskeletal simulation pipeline designed to evaluate the biomechanical effects of shoulder-supporting exoskeletons. The focus of the investigation is on the biomechanical tools obtained from musculoskeletal simulations for the evaluation of exoskeletons. Such tools result in many biomechanical values, such as joint kinematics, external joint torques, muscle activation and joint reaction forces. The pipeline was applied to a use case, where electromyography (EMG) signals were collected and compared with simulated muscle activations for validation. The simulated muscle activations had a relative root mean square error (RMSE) of 37% in the area under the curve (AUC) compared to the EMG muscle activation. Joint reaction force analysis revealed altered magnitude and direction of the tangential JRF in the glenohumeral joint during exoskeleton support. This work raises the question of whether the focus in the development of shoulder exoskeletons should be on reducing the load on the subacromial space. By analyzing joint reaction forces and muscle activations, the pipeline can help to identify design parameters that reduce the load on the rotator cuff in the subacromial space.
Ebenbichler et al. (2026) studied this question.