A Flow-Theoretic Multimodal Control Framework Fusing Mental and Physical Engagement for Upper-Limb Rehabilitation

Robot-assisted therapy can deliver high-dose, task-specific training after neurologic injury, but most systems act primarily at the limb level-engaging the impaired neural circuits only indirectly-which remains a key barrier to truly contingent, neuroplasticity-targeted rehabilitation. We address this gap by implementing online, dual-state motor imagery control of an upper-limb exoskeleton, enabling goal-directed reaches to be both initiated and terminated directly from non-invasive EEG. Eight participants used EEG to initiate assistance and then volitionally halt the robot mid-trajectory. Across two online sessions, group-mean hit rates were 61.5% for onset and 64.5% for offset, demonstrating reliable start-stop command delivery despite instrumental noise and passive arm motion. Methodologically, we reveal a systematic, class-driven bias induced by common task-based recentering using an asymmetric margin diagnostic, and we introduce a class-agnostic fixation-based recentering method that tracks drift without sampling command classes while preserving class geometry. This substantially improves threshold-free separability (AUC gains: onset +56%, p = 0.0117; offset +34%, p = 0.0251) and reduces bias within and across days. Together, these results help bridge offline decoding and practical, intention-driven start-stop control of a rehabilitation exoskeleton, enabling precisely timed, contingent assistance aligned with neuroplasticity goals while supporting future clinical translation.

Assist-as-needed (AAN) control must distinguish between changes in intended motion and changes in effective voluntary torque capability, even though both can produce similar kinematic and interaction responses. A dual-measurand multimodal MHE-MPC architecture is developed as the base framework, in which the intended trajectory and the task-dependent effective voluntary torque capability are estimated online as distinct quantities, and both estimates are used to adapt robotic assistance. Building on this architecture, the ambiguity between the two update channels is formulated as a continuous credit-assignment problem and resolved by an attribution gate. A trajectory-change indicator is obtained from persistent corrective interaction, whereas a capability-change indicator is derived from the residual between normalized muscle activation and dynamics-reconstructed voluntary torque. Nine healthy participants completed factorial target-height-load trials and a pre-post fatigue cup-transport task. Without target-height input, the gated method generated correctly ordered Low-Middle-High references under every load: target changes were preferentially assigned to trajectory adaptation, whereas added load shifted adaptation toward the capability channel. It achieved the lowest RMSE in all nine conditions (0.017 rad versus 0.041 rad for ungated dual estimation and 0.127 rad for fixed-reference error-based AAN). Post-fatigue capability estimates decreased and assistance increased at all heights, supporting functional feasibility.

Providing assistance across diverse movements is a central objective of exoskeletons, and anatomical knowledge can enable responsive support that generalizes across tasks. However, anatomical assistance has mainly been studied for lower-limb exoskeletons, where periodic, weight-bearing motions impose lower demands on torque precision. Extending such assistance to complex, nonperiodic upper-limb movements remains challenging. This paper proposes Anatomical Torque with Passivity-Based Control (ATP) for safe upper-limb exoskeleton assistance. First, a scalable musculoskeletal simulation framework trains a unified reinforcement-learning muscle controller that generalizes across upper-limb movements and generates anatomical reference torques without complex biomechanical computations. Second, an online torque-refinement scheme adapts the reference to diverse movements, suppresses tendon-induced spikes, and incorporates a learned anomaly score for safe and comfortable assistance. Third, an interaction torque controller delivers assistance through a cable-driven compliant exoskeleton without constraining motion to predefined trajectories, while an energy tank preserves passivity with theoretical guarantees on torque tracking and system passivity. Simulations and real-world experiments show accurate tracking of long-duration motion sequences and generalization to real-time human movements. The controller achieves accurate torque tracking while preserving passivity and resumes tracking after energy-tank replenishment. An EMG study with five participants further shows reduced target-muscle activity during static and dynamic tasks compared with gravity compensation and open-loop assistance, with reductions of up to 48% relative to movement without the exoskeleton in a dynamic multi-joint task.