{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:39:06Z","timestamp":1778164746946,"version":"3.51.4"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Traditional physiotherapy rehabilitation systems are evolving into more advanced systems based on exoskeleton systems and Virtual Reality (VR) environments that enhance and improve rehabilitation techniques and physical exercise. In addition, due to current connected systems and paradigms such as the Internet of Things (IoT) or Ambient Intelligent (AmI) systems, it is possible to design and develop advanced, effective, and low-cost medical tools that patients may have in their homes. This article presents a low-cost exoskeleton for the elbow that is connected to a Context-Aware architecture and thanks to a VR system the patient can perform rehabilitation exercises in an interactive way. The integration of virtual reality technology in rehabilitation exercises provides an intensive, repetitive and task-oriented capacity to improve patient motivation and reduce work on medical professionals. One of the system highlights is the intelligent ability to generate new exercises, monitor the exercises performed by users in search of progress or possible problems and the dynamic modification of the exercises characteristics. The platform also allows the incorporation of commercial medical sensors capable of collecting valuable information for greater accuracy in the diagnosis and evolution of patients. A case study with real patients with promising results has been carried out.<\/jats:p>","DOI":"10.3390\/s20030858","type":"journal-article","created":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T03:13:27Z","timestamp":1581045207000},"page":"858","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Connected Elbow Exoskeleton System for Rehabilitation Training Based on Virtual Reality and Context-Aware"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5697-0354","authenticated-orcid":false,"given":"Daniel H.","family":"de la Iglesia","sequence":"first","affiliation":[{"name":"Expert Systems and Applications Lab, Faculty of Science, University of Salamanca, Plaza de los Ca\u00eddos s\/n, 37002 Salamanca, Spain"},{"name":"Facultad de Inform\u00e1tica, Universidad Pontificia de Salamanca, C\/Compa\u00f1\u00eda 5, 37002 Salamanca, Spain"}]},{"given":"Andr\u00e9 Sales","family":"Mendes","sequence":"additional","affiliation":[{"name":"Expert Systems and Applications Lab, Faculty of Science, University of Salamanca, Plaza de los Ca\u00eddos s\/n, 37002 Salamanca, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6536-2251","authenticated-orcid":false,"given":"Gabriel Villarrubia","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Expert Systems and Applications Lab, Faculty of Science, University of Salamanca, Plaza de los Ca\u00eddos s\/n, 37002 Salamanca, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-7627","authenticated-orcid":false,"given":"Diego M.","family":"Jim\u00e9nez-Bravo","sequence":"additional","affiliation":[{"name":"Expert Systems and Applications Lab, Faculty of Science, University of Salamanca, Plaza de los Ca\u00eddos s\/n, 37002 Salamanca, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9461-7922","authenticated-orcid":false,"given":"Juan F.","family":"de Paz Santana","sequence":"additional","affiliation":[{"name":"Expert Systems and Applications Lab, Faculty of Science, University of Salamanca, Plaza de los Ca\u00eddos s\/n, 37002 Salamanca, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.healthpol.2012.06.004","article-title":"Systematic review of the methodological quality of clinical guideline development for the management of chronic disease in Europe","volume":"107","author":"Knai","year":"2012","journal-title":"Health Policy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.promfg.2015.07.123","article-title":"Explore Home Care Needs and Satisfaction for Elderly People with Chronic Disease and their Family Members","volume":"3","author":"Huang","year":"2015","journal-title":"Procedia Manuf."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.dss.2014.06.001","article-title":"Mobile health: Four emerging themes of research","volume":"66","author":"Varshney","year":"2014","journal-title":"Decis. Support Syst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.procs.2013.09.046","article-title":"The Future of Mobile E-health Application Development: Exploring HTML5 for Context-aware Diabetes Monitoring","volume":"21","author":"Preuveneers","year":"2013","journal-title":"Procedia Comput. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1109\/MIS.2008.19","article-title":"Ambient intelligence the next step for artificial intelligence","volume":"23","author":"Ramos","year":"2008","journal-title":"IEEE Intell. Syst."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Schilit, B., Adams, N., and Want, R. (1994, January 8\u20139). Context-aware computing applications. Proceedings of the 1994 First Workshop on Mobile Computing Systems and Applications, Santa Cruz, CA, USA.","DOI":"10.1109\/WMCSA.1994.16"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1007\/s10514-016-9551-7","article-title":"Assist On-Ankle: A reconfigurable ankle exoskeleton with series-elastic actuation","volume":"41","author":"Erdogan","year":"2017","journal-title":"Auton. Robots"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wang, C., Wang, L., Qin, J., Wu, Z., Duan, L., Li, Z., Cao, M., Li, W., Lu, Z., and Wang, Y. (2015, January 8\u201310). Development of an ankle rehabilitation robot for ankle training. Proceedings of the 2015 IEEE International Conference on Information and Automation, Lijiang, China.","DOI":"10.1109\/ICInfA.2015.7279265"},{"key":"ref_9","unstructured":"Lu, Z., Li, W., Li, M., Wu, Z., Duan, L., Li, Z., Ou, X., Wang, C., Wang, L., and Wang, Y. (2015, January 1\u20134). Development of a three freedoms ankle rehabilitation robot for ankle training. Proceedings of the IEEE Region 10 Annual International Conference, Macao, China."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pan, C.T., Lin, Z.C., Sun, P.Y., Chang, C.C., Wang, S.Y., Yen, C.K., and Yang, Y.S. (2018, January 13\u201317). Design of virtual reality systems integrated with the lower-limb exoskeleton for rehabilitation purpose. Proceedings of the 4th IEEE International Conference on Applied System Innovation 2018, Chiba, Japan.","DOI":"10.1109\/ICASI.2018.8394296"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/17483107.2018.1493754","article-title":"Shape synthesis of an assistive knee exoskeleton device to support knee joint and rehabilitate gait","volume":"14","author":"Singh","year":"2019","journal-title":"Disabil. Rehabil. Assist. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1109\/TCST.2016.2565385","article-title":"Toward Lower Limbs Functional Rehabilitation Through a Knee-Joint Exoskeleton","volume":"25","author":"Rifai","year":"2017","journal-title":"IEEE Trans. Control Syst. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3389\/fnbot.2019.00067","article-title":"Development of an EMG-Controlled Knee Exoskeleton to Assist Home Rehabilitation in a Game Context","volume":"13","author":"Lyu","year":"2019","journal-title":"Front. Neurorobot."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tu, X., Huang, J., and He, J. (2016, January 18\u201320). Leg hybrid rehabilitation based on hip-knee exoskeleton and ankle motion induced by FES. Proceedings of the ICARM 2016\u20142016 International Conference on Advanced Robotics and Mechatronics, Macau, China.","DOI":"10.1109\/ICARM.2016.7606925"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1759019","DOI":"10.1142\/S0218001417590194","article-title":"Model-Based Hybrid Cooperative Control of Hip-Knee Exoskeleton and FES Induced Ankle Muscles for Gait Rehabilitation","volume":"31","author":"Tu","year":"2017","journal-title":"Int. J. Pattern Recognit. Artif. Intell."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.robot.2015.10.001","article-title":"Developments in hardware systems of active upper-limb exoskeleton robots: A review","volume":"75","author":"Gopura","year":"2016","journal-title":"Robot. Auton. Syst."},{"key":"ref_17","unstructured":"Holmes, D., Charles, D.K., Morrow, P., McClean, S., and McDonough, S.M. (2016, January 20\u201322). Usability and performance of leap motion and oculus rift for upper arm virtual reality stroke rehabilitation. Proceedings of the 11th International Conference on Disability, Los Angeles, CA, USA."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhou, X., Mont, A., and Adamovich, S. (2019). Evaluation of a 1-DOF Hand Exoskeleton for Neuromuscular Rehabilitation. arXiv.","DOI":"10.1007\/978-3-030-43195-2_32"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.mechatronics.2017.12.008","article-title":"A Dual-cable Hand Exoskeleton System for Virtual Reality","volume":"49","author":"Park","year":"2018","journal-title":"Mechatronics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/978-3-030-02828-2_16","article-title":"Multifunctional Exoskeletal Orthosis for Hand Rehabilitation Based on Virtual Reality","volume":"Volume 884","author":"Cartagena","year":"2019","journal-title":"Advances in Intelligent Systems and Computing"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Liu, F., Han, X., Lin, M., Wu, X., Sun, Q., and Song, A. (2019, January 24\u201327). Remote Upper Limb Exoskeleton Rehabilitation Training System Based on Virtual Reality. Proceedings of the 2019 16th International Conference on Ubiquitous Robots (UR), Jeju, Korea.","DOI":"10.1109\/URAI.2019.8768618"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"168781401774338","DOI":"10.1177\/1687814017743388","article-title":"Active rehabilitation training system for upper limb based on virtual reality","volume":"9","author":"Han","year":"2017","journal-title":"Adv. Mech. Eng."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/11762320902959250","article-title":"A force-feedback exoskeleton for upper-limb rehabilitation in virtual reality","volume":"6","author":"Frisoli","year":"2009","journal-title":"Appl. Bionics Biomech."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Montagner, A., Frisoli, A., Borelli, L., Procopio, C., Bergamasco, M., Carboncini, M.C., and Rossi, B. (2007, January 27\u201329). A pilot clinical study on robotic assisted rehabilitation in VR with an arm exoskeleton device. Proceedings of the 2007 Virtual Rehabilitation, Venice, Italy.","DOI":"10.1109\/ICVR.2007.4362131"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1743-0003-8-63","article-title":"Effects of a robot-assisted training of grasp and pronation\/supination in chronic stroke: A pilot study","volume":"8","author":"Lambercy","year":"2011","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1474-4422(13)70305-3","article-title":"Three-dimensional, task-specific robot therapy of the arm after stroke: A multicentre, parallel-group randomised trial","volume":"13","author":"Blanco","year":"2014","journal-title":"Lancet Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1109\/TNSRE.2017.2692520","article-title":"Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects","volume":"25","author":"Khor","year":"2017","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.patcog.2014.07.007","article-title":"A context-aware approach for long-term behavioural change detection and abnormality prediction in ambient assisted living","volume":"48","author":"Forkan","year":"2015","journal-title":"Pattern Recognit."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.comnet.2016.12.019","article-title":"ViSiBiD: A learning model for early discovery and real-time prediction of severe clinical events using vital signs as big data","volume":"113","author":"Forkan","year":"2017","journal-title":"Comput. Networks"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"142","DOI":"10.15837\/ijccc.2016.1.1333","article-title":"A context-aware mHealth system for online physiological monitoring in remote healthcare","volume":"11","author":"Zhang","year":"2016","journal-title":"Int. J. Comput. Commun. Control"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"de la Iglesia, D.H., de Paz, J.F., Gonz\u00e1lez, G.V., Barriuso, A.L., and Bajo, J. (2018). A context-aware indoor air quality system for sudden infant death syndrome prevention. Sensors, 18.","DOI":"10.3390\/s18030757"},{"key":"ref_32","unstructured":"S\u00e1nchez, C.R. (2017). Considering Adaptation in the Development of Context-Aware Systems for Tele-Rehabilitation. [Ph.D. Thesis, University of Castilla\u2013La Mancha]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10916-015-0296-1","article-title":"A Context-Aware Application to Increase Elderly Users Compliance with Physical Rehabilitation Exercises at Home via Animatronic Biofeedback","volume":"39","author":"Gamecho","year":"2015","journal-title":"J. Med. Syst."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Jaquero, V., Rodr\u00edguez, A.C., Teruel, M.A., Montero, F., Navarro, E., and Gonzalez, P. (2016). A bio-inspired model-based approach for context-aware post-WIMP tele-rehabilitation. Sensors, 16.","DOI":"10.3390\/s16101689"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"155014771772215","DOI":"10.1177\/1550147717722154","article-title":"Combination of multi-agent systems and embedded hardware for the monitoring and analysis of diuresis","volume":"13","author":"Villarrubia","year":"2017","journal-title":"Int. J. Distrib. Sens. Networks"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"de la Iglesia, D.H., Gonz\u00e1lez, G.V., Mendes, A.S., Jim\u00e9nez-Bravo, D.M., and Barriuso, A.L. (2018). Architecture to Embed Software Agents in Resource Constrained Internet of Things Devices. Sensors, 19.","DOI":"10.3390\/s19010100"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.future.2013.07.009","article-title":"CoCaMAAL: A cloud-oriented context-aware middleware in ambient assisted living","volume":"35","author":"Forkan","year":"2014","journal-title":"Futur. Gener. Comput. Syst."},{"key":"ref_38","unstructured":"(2019, October 30). Plataforma de Desarrollo en Tiempo Real de Unity|Visualizaciones de VR y AR en 3D y 2D. Available online: https:\/\/unity.com\/es."},{"key":"ref_39","unstructured":"(2019, October 30). Oculus. Available online: https:\/\/www.oculus.com\/?locale=es_ES."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/3\/858\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:55:13Z","timestamp":1760172913000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/3\/858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,6]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["s20030858"],"URL":"https:\/\/doi.org\/10.3390\/s20030858","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,6]]}}}