Robotic Orthosis for the Rehabilitation of
Marching Syndrome in Steppage
Cárdenas Andrés I. Navarrete Rómulo M.
Universidad de las Fuerzas Armadas ESPE
Sangolqui – Ecuador
{aicardenas, rnavarrete1}@espe.edu.ec
Abstract .- This paper presents the construction and control
of a robotic orthosis of the lower right limb with a degree of
freedom, with the aim of helping in the rehabilitation of
walking, optimizing the recovery of people with this
syndrome, Through the analysis of the electromyographic
signals (EMG) that are emitted by the muscles, these signals
are classified by means of a neural network which will
identify the movement made to apply a control strategy, in
order that the designed orthosis is able to follow a pattern of
normal movement in conjunction with the right lower
extremity.
Keywords- Robotic orthosis, neural networks,
electromyography.
I. INTRODUCTION
The march in "stepagge" is a neuromuscular disorder that
affects the patient to raise the foot to the height of the ankle;
Walking becomes a challenge, due to the inability of the
patient to control the tibiofibular-talar joint, causing an
excessive lifting of the knee and a drag of the foot. Many
times the pendulum foot is the cause of a peroneal nerve
injury. Rehabilitation treatment is one of the ways in which
impairment and disability can be reduced in people who have
suffered this marching syndrome [1][2].
To carry out this rehabilitation, different types of orthoses
have been studied. The orthoses currently have been created
in order to reduce the motor limitations existing in the human
body because they manage to modify the functional
characteristics of the neuronal-muscular-skeletal system, but
for the most part these are subject to a harness or are rigid,
and to carry out the movement of the lower extremities
requires the effort of one or more physiotherapists, to solve
this problem has opted to use robotic orthoses [3]–[5].
Mechanical orthoses are still a partial solution for foot
disorders, so, in the field of rehabilitation engineering or
medical robotics, the development of mechanisms that allow
functional compensation of foot movement have been
proposed as an alternative applied by actuator systems that
adapt to the different phases of the running cycle. A robotic
orthosis allows to work in conjunction with the movements
exercised by the person, the rehabilitation managed by this
technology based on robotic orthosis can perform prolonged
training sessions in a simple way and in their own home. [6]
This adaptation can be achieved through sensors applied to
the person, which record muscle activity, these signals are
known as electromyographic signals or EMG'S [7], [8]. The
electromyography provides electrical signals produced by the
muscles that allow the control of the robotic orthosis of the
person, [9] the information provided by these signals are
selected in order to minimize errors in the control of the
robotic orthosis. To increase the precision in the control of
the orthosis and improve the classification of movement
patterns, the following classifiers are highlighted: the
Bayesian classifier and those based on neural networks,
fuzzy logic and neurofuzzy networks [9]–[14].
Of these classifiers stands out the method of artificial neural
networks (ANN) because they respond faster than the
methods based on the domain of the frequency, this method
has a high success rate and are supported on online platforms
and in real time [7], [9], [15]. ANNs have the ability to solve
problems, train the system and make it available to produce
the desired outputs when it is evaluated with the learned
inputs [12], [16] .
In the design of the control system based on the knowledge
of the biological system of the foot and the pathology of gait
in steppage, we have arrived at the approach of the model of
an active robotic orthosis with a control system to assist the
walking of people with fallen foot applying principles of
biomechanics and engineering. In recent years this topic has
been of great interest because the power to use the EMG
signals from our own body the patient can occupy these
signals and this leads to that he manages to work in
conjunction with the orthosis implanted in his body, in
addition to Technological advances in neuronal orthoses for
the correction of foot drop have been growing. The review
examines the role of artificial sensors, such as replacements
for the foot switch as the primary control sensor in foot drop
stimulators. In 2002 Gerard Lyons, provides a review of
portable neuronal orthoses based on FES for the correction
of foot drop. A real-time controller for foot drop correction
by using surface electromyography sensor, was studied by
Yousif Mashhadany and Nasrudin Rahim using surface
electromyography of the actual human leg electromyography
signal and parameters extracted from the signal of Surface
electromyography was then used to train an artificial neural
network for predicting the angle of the joint. [9], [13], [17]–
[19]
The construction of the robotic orthosis, the extraction of
characteristics of the EMG signals and the development of
the artificial neural network is discussed in the VI Sections 2) Average position
of this work including the Introduction. Section II presents a In this phase the foot and leg provide stable support at 0
biomechanical analysis of the lower limb showing the finish degrees with respect to the sole of the foot. If the foot
of the structure to be used and, in addition, defines the continues to pronate it will cause an imbalance of the body
biomechanics and the analysis of the gait cycle. Section III which would cause a loss of balance. In this phase, all the
shows real measurements of the electromyographic signals weight of the body falls only on the supporting limb (Fig. 2)
using an EMG sensor and illustrates the identification of the [4, 5].
parameters necessary for the realization of the neural network
and its training. Section IV shows the development of the
specific control technique to manipulate the position of the
robotic orthosis through the motors, the torque and response
time are important for an adequate rehabilitation, in Section
V the results obtained in this study will be analyzed and
finally the conclusions are presented in Section VI.

II. BIOMECHANICAL ANALYSIS OF THE

LOWER LIMB AND MECHANICAL
STRUCTURE APPROACH

Biomechanics, studies the effects of mechanical forces on

the organic systems of living beings and their structures, the
main applications of biomechanics are related to the areas of
medicine, occupational rehabilitation and sports. The human
March is a process of locomotion carried out by the human
body in an upright position, with the objective of moving
forward with the help of the movement of both legs. Then,
everything necessary to establish an adequate march is
presented.
Fig. 2 Average Position
3) Propulsion or digital takeoff
This stage begins with the unfolding of the heel as the big
toe dorsiflexes; later the mechanism "windlass" comes into
action raising the arch of the foot and tightening the plantar
fascia. This causes the foot to become a lever and allow a
forward impulse to be generated (Fig. 3) [4, 5].

A. The cycle of the march

The Cycle of March begins when a foot makes contact
with the ground and finishes when the same foot makes
contact with the ground again [4, 5]. In a given moment of
the march both feet touch the ground at the same time.

The cycle of the march is divided in the following

moments:
a) Support heel
b) Plant support
c) Heel take-off
d) Take off the fingers Fig. 3 Propulsion or digital takeoff

B. Phases of walking 4) Rolling phase

1) Contact or support of the heel In this stage the foot is completely in the air finishing the
Contact is the cushioning phase of the walking cycle; the lever movement, this allows a balanced balance of the body.
action he performs has the purpose of flexing the knee before (Fig. 4) [4,5].
it touches the ground and is pronated. This causes the foot
and leg to work mutually as a shock absorber. The foot needs
to be sufficiently mobile to allow any unevenness in the
ground (Fig. 1) [4, 5].

Fig. 4 Balancing phase

Fig. 1 Heel contact or contact phase

C. Analysis and Design of the robotic orthosis
In this design section, the different components with which
the orthosis was implemented were investigated, making an
appropriate choice of materials capable of meeting the needs
of the rehabilitation team, taking into account the parameters
of the walking cycle and variables such as angle of travel
rotation of the lower limb. In this way the decision was made
to use the PLA material, as it offers resistance, low weight
and is very economical. In addition two servomotors with a
high torque were chosen so that they have the ability to give
the movement of flexion and extension of the lower limb
joint.
To carry out the design, the total design of the orthosis is
made piece by piece with its respective planes (Fig. 5, Fig 6),
then all the parts of the prosthesis are assembled in order to
perform an analysis of stresses.
Fig. 5 Orthosis prototype plan
Fig. 6 Plane for servo support, show each of the parts that make up the
supports of the servomotors in different views.
With the help of the software Autodesk Inventor the 3D
design of the prosthesis is made, this will be printed on the
PLA material by means of a 3D vector printer.
III. MEASUREMENT AND PROCESSING OF
EMGS SIGNALS
Given that the objective of this research is to develop a
robotic orthosis controlled by EMG capable of following a
normal movement pattern of the human ankle, the EMG
signals of the muscles must be measured in an essential way,
so surface signals were used (sEMG ) during contraction of
muscle tissue, such signals are generated by muscle cells
when they are activated electrically [20]. 8 electrodes were
placed in the muscles involved in the movement of the ankle,
with the help of the recommendations of the SENIAM project
[21] which aims to place electrodes and signal processing
methods for EMG in order to adequately capture muscle
signals.
The (sEMG) are obtained with the help of the Myo
Armband device, which delivers raw signals, these require
going through a normalization process since they are very
small (0-6mV) and cannot be processed directly. The number
of sensors used by the Myo Armband influences the training
algorithm of the neural network the more there are better the
identification of patterns in the network. The reading of the
eight sensors that are immersed in the Myo Armband are
captured by the Windows SDK [9].
The obtained EMG signals are concatenated to form a
vector of their characteristics, these are plotted to identify a
routine of movements and thus analyze points of interest
between graphs. To identify which signals to use, aspects
such as amplitudes, duration and repeatability of the waves
are taken into account (Fig. 7).
Fig. 7 Typical main components for a controller based on myoelectric
signals based on pattern recognition
For the control of the orthosis to be successful depends on
the extraction of the most important, necessary and sufficient
data to discriminate in the least the error that appears at the
time of performing the movements of the walking cycle.
These data are obtained from characteristic extraction
techniques.
Below we present the set of characteristics of the signals with
their respective characteristic description.

A. Feature extraction techniques

1) Absolute Mean Value (MAV): Estimates the absolute

mean value of the EMG signal of segment i with length
of N samples, related to points of muscle contraction
[22]. This can be expressed by the following form:
𝑁 ( 1)
1
𝑋̅ = ∑|𝑥𝑖 |
𝑁
𝑖=1

Where 𝑥𝑖 is the i-esima sample in segment 𝑖.

2) Variance: Quantifies the degree of spreading of the data

with respect to the average in relation to the strength of
the signal. It is related to the force developed by the
Fig. 8 Neural Network structure
muscle [22] It is given by:
𝑁 In Fig. 8 the structure of the Neural Network used is shown,
(2)
1 where two stages are considered. a) Identification stage, this
𝑉𝐴𝑅 = 𝜎 2 = ∑ 𝑋(𝐾)2 is done with the help of the test without motor, here we
𝑁−1
𝑖=1 acquire 16 signals of the tibialis anterior muscle with
movement of flexion / extension of the ankle joint. Of the
signals found 8 are the absolute mean value and the
In this work, equations (1) and (2) were used, which was
remaining 8 of the variance, 20 hidden nodes, a sigmoid
enough to obtain an optimal recognition because the equation
activation function and a linear output activation function
(1) relates the samples with the muscle extraction that is to
[25]. The signals are studied with a code made in Matlab for
obtain the amplitude of movement and the equation (2)
the acquisition and processing of the best EMGs, later these
because it is related to the force developed by the muscle.
data enter a window of three seconds where the
characteristics of such signals are obtained that will be used
B. Data acquisition
for the training of the artificial neural network; b) Stage of
recognition and decision making in which the signals found
With the ankle joint relaxed and without movement, the
in the previous stage are used to estimate the angle of the
moments of the walking cycle are used in three seconds.
joint. The amplitudes of the EMG signals are used to find the
angle of the joint in flexion and the angle of extension. Once
C. Clasificación de patrones
the angles are acquired, these will be outputs for the ankle
joint, each value found is a saved weight; these weights will
There is a great variety of pattern classifiers, of which we
move the actuators (motors). [24]
can highlight: the Bayesian classifier ], those based on neural
networks [9] and fuzzy logic [16]. In order to increase the
The number of samples that enter depends on the sampling
precision of the control of the orthosis, the correct classifier
time of the window, as example 0.5 / 0.02, "0.02" is the time
must be chosen, so in this work it was decided to use artificial
it takes to take a sample and will continue to rise until it
neural networks because this method is appropriate to handle
reaches "0.5". In the Network there will be an error that is
EMGs [10], [22].
diminished by the Backpropagation algorithm. This is also
used for network training, because it is faster than other
IV. ARCHITECTURE OF THE ARTIFICIAL
algorithms. To obtain the input-output training data of the
NEURAL NETWORK
neuron for the EMG controller [9], [16], [20], [24].
In order to obtain an adequate use of the network, two tests
To obtain the neuron input-output training data for the
must be taken into account: 1) design test without motor, here
EMG controller, we developed a database in a MAT file of
the input signals for the artificial neural network are acquired
the Matlab software for training which will allow the patient
at different angles and in different positions of the ankle joint;
to learn to control the robotic orthosis using muscle activity
2) design test with the motor signals are acquired that will be
anterior tibial.
sent to the Network with the ankle joint connected to the
actuators (motors) and placing the foot in the correct position
V. RESULTS AND DISCUSSION
for the running cycle. For a correct estimation of the angle of
the ankle joint in the running position, the data of an EMG
In this work, research was presented on the lower limb and
signal of a healthy person were acquired [9], [22], [24].
its biomechanics in the gait cycle, important parts for the
creation and development of the robotic orthosis. Tests were
performed on each device that makes up the rehabilitation
orthosis and meet objectives such as acquiring the signal,
classifying it and showing the results in order to verify the
operation individually and the whole system as a whole.
For the structural analysis we considered the force exerted
by the actuator on its support and the main base printed in 3D
with PLA, obtaining as a result the possible deformations of
the structure (Fig 9).
Fig. 9 Structural analysis
To strengthen the classification of movements using neural
networks, tests were performed such as:
1) The acquisition of signals with the Myo Armband sensor
that reveals the functioning of the sensor to the stimuli
in the area of the tibial muscle performing the exercises
of flexion and extension, in different positions of the
patient if it is in vertical position and sitting.
2) Proof of the success of training between the real value vs
the simulated value, to verify that the error of the training
is the most reduced since the success of the classifier of
artificial neural networks will depend on this, within this
test the healthy person was in vertical position
simulating with the right foot the cycle of march.
In (Fig. 10) the typical graph of an EMG signal obtained
when running the heel support phase of the gait cycle is
shown, typically the signals acquired by the electrodes of the
Myo Armband placed on the person's muscle, when this
executes a movement of contraction or muscular expansion,
they are amplified and processed.
Fig. 10 EMG signal obtained by the Myo Armband in the support or
contact phase of the heel.
The design of the estimation of the data was simulated in
Matlab, we carried out a series of experiments in the training
of the neural network for the movement of the ankle joint.
Fig. 11 Estimated angle of joints and analysis of EMG signals
In the gait cycle at moderately fast speed, the leg moved
with full flexion to the full extension of the tibial muscle. The
angles for flexion and extension of the ankle joint were
estimated. A correct angle was obtained by making a
comparison between the measurement of a goniometer and
the angle estimated by the neural network. The (Fig. 11)
shows the estimation of angles of the ankle joint and the
analysis of the EMG signal.
For the acquisition of the characteristics of the EMG
signals, the behavior of the signals was analyzed over time,
in addition the performance of the classification of the signal
is increased by making use of the absolute mean value that
contains the absolute mean values of the resulting vector
calculated in Each of the k instants of time and the variance
that contains the value of the estimated variance that is
obtained from the resulting vector in the k instants of time,
later this data is stored and saved in a MAT file to train the
network.
The final prototype of the robotic orthosis used to obtain
the EMG signals is shown in (Fig. 12). The electrodes of the
Myo Armband capture the EMG signal of the tibial muscle,
this is sent to the computer for classification in the neural
network and in turn the network output goes to the controller
to proceed to move the actuators responsible for moving the
lower limb.
 speed of response of the electronic devices placed in the
orthosis and the computer.

In effect, the technological devices and the algorithms

developed in the programs such as Matlab and Arduino, are
tools that allow us to advance in studies and applications to
improve the lifestyle of people, so that the knowledge and
experiences of professionals are integrated. This project aims
to present new ideas for the manufacture of orthoses, and to
emphasize that anyone with knowledge in rehabilitation and
electronics is capable of developing new technologies of
human assistance.

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