Current practices and limitations of testing procedures for rehabilitative and assistive hand exoskeletons

INTRODUCTION: The development of hand exoskeletons for assistance and rehabilitation of dexterity impairments has been ongoing for decades, although advancements are hindered by inconsistent evaluation metrics. AREAS COVERED: This review aims to identify all methods used to test and compare the devices. Using these, it outlines an evaluative framework to standardize research and reduce heterogeneity moving forward. Literature from 2010-2025 was searched for using Scopus, IEEE Xplore, and PubMed. This comprised of publications detailing each exoskeleton and overall reviews of the technologies. Current testing methods were identified within mathematical and computational modeling, non-clinical prototype testing, clinical feasibility trials, and rehabilitative trials. EXPERT OPINION: At present, clinical adoption of hand exoskeletons is limited due to the lack of thorough, methodical analysis. The variation of assessment methods is partially attributed to the absence of suggested guidelines but may also be driven by intentions to mask device limitations. The current practices for theoretical analyses are sufficient for design optimization, verification, and defining control systems. However, both non-clinical and clinical prototype testing are used to validate device performances, therefore the suggested standardized protocols would improve inter-device comparisons. This would produce faster advancements, leading to improved rehabilitation outcomes and patient independence.