Passive Exercise Adaptation for Ankle Rehabilitation Based on Learning Control Framework

[EN] Ankle injuries are among the most common injuries in sport and daily life. However, for their recovery, it is important for patients to perform rehabilitation exercises. These exercises are usually done with a therapist's guidance to help strengthen the patient's ankle joint and restore its range of motion. However, in order to share the load with therapists so that they can offer assistance to more patients, and to provide an efficient and safe way for patients to perform ankle rehabilitation exercises, we propose a framework that integrates learning techniques with a 3-PRS parallel robot, acting together as an ankle rehabilitation device. In this paper, we propose to use passive rehabilitation exercises for dorsiflexion/plantar flexion and inversion/eversion ankle movements. The therapist is needed in the first stage to design the exercise with the patient by teaching the robot intuitively through learning from demonstration. We then propose a learning control scheme based on dynamic movement primitives and iterative learning control, which takes the designed exercise trajectory as a demonstration (an input) together with the recorded forces in order to reproduce the exercise with the patient for a number of repetitions defined by the therapist. During the execution, our approach monitors the sensed forces and adapts the trajectory by adding the necessary offsets to the original trajectory to reduce its range without modifying the original trajectory and subsequently reducing the measured forces. After a predefined number of repetitions, the algorithm restores the range gradually, until the patient is able to perform the originally designed exercise. We validate the proposed framework with both real experiments and simulation using a Simulink model of the rehabilitation parallel robot that has been developed in our lab.This work has been partially funded by the FEDER-CICYT project with reference DPI2017-84201-R (Integracion de modelos biomecanicos en el desarrollo y operacion de robots rehabilitadores reconfigurables) financed by Ministerio de Economia, Industria e Innovacion (Spain).Abu-Dakka, FJ.; Valera Fernández, Á.; Escalera, JA.; Abderrahim, M.; Page Del Pozo, AF.; Mata Amela, V. (2020). Passive Exercise Adaptation for Ankle Rehabilitation Based on Learning Control Framework. Sensors. 20(21):1-23. https://doi.org/10.3390/s20216215S123202

Passive exercise adaptation for ankle rehabilitation based on learning control framework

This article belongs to the Special Issue Human-Robot Interaction.Ankle injuries are among the most common injuries in sport and daily life. However, for their recovery, it is important for patients to perform rehabilitation exercises. These exercises are usually done with a therapist's guidance to help strengthen the patient's ankle joint and restore its range of motion. However, in order to share the load with therapists so that they can offer assistance to more patients, and to provide an efficient and safe way for patients to perform ankle rehabilitation exercises, we propose a framework that integrates learning techniques with a 3-PRS parallel robot, acting together as an ankle rehabilitation device. In this paper, we propose to use passive rehabilitation exercises for dorsiflexion/plantar flexion and inversion/eversion ankle movements. The therapist is needed in the first stage to design the exercise with the patient by teaching the robot intuitively through learning from demonstration. We then propose a learning control scheme based on dynamic movement primitives and iterative learning control, which takes the designed exercise trajectory as a demonstration (an input) together with the recorded forces in order to reproduce the exercise with the patient for a number of repetitions defined by the therapist. During the execution, our approach monitors the sensed forces and adapts the trajectory by adding the necessary offsets to the original trajectory to reduce its range without modifying the original trajectory and subsequently reducing the measured forces. After a predefined number of repetitions, the algorithm restores the range gradually, until the patient is able to perform the originally designed exercise. We validate the proposed framework with both real experiments and simulation using a Simulink model of the rehabilitation parallel robot that has been developed in our lab

Development of lower-limb rehabilitation exercises using 3-PRS Parallel Robot and Dynamic Movement Primitives

[EN] The design of rehabilitation exercises applied to sprained ankles requires extreme caution, regarding the trajectories and the speed of the movements that will affect the patient. This paper presents a technique that allows a 3-PRS parallel robot to control such exercises, consisting of dorsi/plantar flexion and inversion/eversion ankle movements. The work includes a position control scheme for the parallel robot in order to follow a reference trajectory for each limb with the possibility of stopping the exercise in mid-execution without control loss. This stop may be motivated by the forces that the robot applies to the patient, acting like an alarm mechanism. The procedure introduced here is based on Dynamic Movement Primitives (DMPs).This work has been partially funded by FEDER-CICYT project with reference DPI2017-84201-R financed by Ministerio de Economía, Industria e Innovación (Spain).Escarabajal Sánchez, RJ.; Abu Dakka, FJM.; Pulloquinga Zapata, J.; Mata Amela, V.; Vallés Miquel, M.; Valera Fernández, Á. (2020). Development of lower-limb rehabilitation exercises using 3-PRS Parallel Robot and Dynamic Movement Primitives. Multidisciplinary Journal for Education, Social and Technological Sciences. 7(2):30-44. https://doi.org/10.4995/muse.2020.13907OJS304472Abu-Dakka, F. J., Valera, A., Escalera, J. A., Vallés, M., Mata, V., & Abderrahim, M. (2015). Trajectory adaptation and learning for ankle rehabilitation using a 3-PRS parallel robot. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 9245, 483-494. https://doi.org/10.1007/978-3-319-22876-1_41Atkeson, C. G., Moore, A. W., & Schaal, S. (1997). Locally Weighted Learning. Artificial Intelligence Review, 11(1-5), 11-73. https://doi.org/10.1007/978-94-017-2053-3_2Brockett, C. L., & Chapman, G. J. (2016). Biomechanics of the ankle. Orthopaedics and Trauma, 30(3), 232-238. https://doi.org/10.1016/j.mporth.2016.04.015Dai, J. S., Zhao, T., & Nester, C. (2004). Sprained Ankle Physiotherapy Based Mechanism Synthesis and Stiffness Analysis of a Robotic Rehabilitation Device. Autonomous Robots, 16(2), 207-218. https://doi.org/10.1023/B:AURO.0000016866.80026.d7Díaz-Rodríguez, M., Mata, V., Valera, Á., & Page, Á. (2010). A methodology for dynamic parameters identification of 3-DOF parallel robots in terms of relevant parameters. Mechanism and Machine Theory, 45(9), 1337-1356. https://doi.org/10.1016/j.mechmachtheory.2010.04.007Díaz, I., Gil, J. J., & Sánchez, E. (2011). Lower-Limb Robotic Rehabilitation: Literature Review and Challenges. Journal of Robotics, 2011(i), 1-11. https://doi.org/10.1155/2011/759764Fanger, Y., Umlauft, J., & Hirche, S. (2016). Gaussian Processes for Dynamic Movement Primitives with application in knowledge-based cooperation. IEEE International Conference on Intelligent Robots and Systems, 2016-Novem, 3913-3919. https://doi.org/10.1109/IROS.2016.7759576Gosselin, C., & Angeles, J. (1990). Singularity Analysis of Closed-Loop Kinematic Chains. IEEE Transactions on Robotics and Automation, 6(3), 281-290. https://doi.org/10.1109/70.56660Hesse, S., & Uhlenbrock, D. (2000). A mechanized gait trainer for restoration of gait. Journal of Rehabilitation Research and Development, 37(6), 701-708.Ijspeert, A. J., Nakanishi, J., Hoffmann, H., Pastor, P., & Schaal, S. (2013). Dynamical movement primitives: Learning attractor models formotor behaviors. Neural Computation, 25(2), 328-373. https://doi.org/10.1162/NECO_a_00393Ijspeert, A. J., Nakanishi, J., & Schaal, S. (2002). Movement imitation with nonlinear dynamical systems in humanoid robots. Proceedings - IEEE International Conference on Robotics and Automation, 2, 1398-1403. https://doi.org/10.1109/ROBOT.2002.1014739Liu, G., Gao, J., Yue, H., Zhang, X., & Lu, G. (2006). Design and kinematics simulation of parallel robots for ankle rehabilitation. 2006 IEEE International Conference on Mechatronics and Automation, ICMA 2006, 2006, 1109-1113. https://doi.org/10.1109/ICMA.2006.257780Nakanishi, J., Morimoto, J., Endo, G., Cheng, G., Schaal, S., & Kawato, M. (2004). Learning from demonstration and adaptation of biped locomotion. Robotics and Autonomous Systems, 47(2-3), 79-91. https://doi.org/10.1016/j.robot.2004.03.003Nemec, B., & Ude, A. (2012). Action sequencing using dynamic movement primitives. Robotica, 30(5), 837-846. https://doi.org/10.1017/S0263574711001056Patel, Y. D., & George, P. M. (2012). Parallel Manipulators Applications-A Survey. Modern Mechanical Engineering, 02(03), 57-64. https://doi.org/10.4236/mme.2012.23008Paul, R. P. (1981). Robot Manipulators: Mathematics, Programming, and Control : the Computer Control of Robot Manipulators (p. 279).Reinkensmeyer, D. J., Aoyagi, D., Emken, J. L., Galvez, J. A., Ichinose, W., Kerdanyan, G., Maneekobkunwong, S., Minakata, K., Nessler, J. A., Weber, R., Roy, R. R., De Leon, R., Bobrow, J. E., Harkema, S. J., & Reggie Edgerton, V. (2006). Tools for understanding and optimizing robotic gait training. Journal of Rehabilitation Research and Development, 43(5), 657-670. https://doi.org/10.1682/JRRD.2005.04.0073Safran, M. R., Benedetti, R. S., Bartolozzi, A. R., & Mandelbaum, B. R. (1999). Lateral ankle sprains: A comprehensive review part 1: Etiology, pathoanatomy, histopathogenesis, and diagnosis. In Medicine and Science in Sports and Exercise (Vol. 31, Issue 7 SUPPL., pp. S429-S437).https://doi.org/10.1097/00005768-199907001-00004Saglia, J. A., Tsagarakis, N. G., Dai, J. S., & Caldwell, D. G. (2013). Control strategies for patient-assisted training using the ankle rehabilitation robot (ARBOT). IEEE/ASME Transactions on Mechatronics, 18(6), 1799-1808. https://doi.org/10.1109/TMECH.2012.2214228Schaal, S. (2006). Dynamic Movement Primitives -A Framework for Motor Control in Humans and Humanoid Robotics. In Adaptive Motion of Animals and Machines (pp. 261-280). https://doi.org/10.1007/4-431-31381-8_23Sui, P., Yao, L., Lin, Z., Yan, H., & Dai, J. S. (2009). Analysis and synthesis of ankle motion and rehabilitation robots. 2009 IEEE International Conference on Robotics and Biomimetics, ROBIO 2009, 3, 2533-2538. https://doi.org/10.1109/ROBIO.2009.5420487Tsoi, Y. H., Xie, S. Q., & Graham, A. E. (2009). Design, modeling and control of an ankle rehabilitation robot. Studies in Computational Intelligence, 177, 377-399. https://doi.org/10.1007/978-3-540-89933-4_18Vallés, M., Díaz-Rodrguez, M., Valera, Á., Mata, V., & Page, Á. (2012). Mechatronic development and dynamic control of a 3-dof parallel manipulator. Mechanics Based Design of Structures and Machines, 40(4), 434-452. https://doi.org/10.1080/15397734.2012.687292Xie, S. (2016). Advanced robotics for medical rehabilitation: current state of the art and recent advances. In Springer tracts in advanced robotics (Issue 108). https://doi.org/10.1007/978-3-319-19896-5Yoon, J., Ryu, J., & Lim, K. B. (2006). Reconfigurable ankle rehabilitation robot for various exercises. Journal of Robotic Systems, 22(SUPPL.), 15-33. https://doi.org/10.1002/rob.2015

Parallel robot for knee rehabilitation: Reduced order dynamic linear model, mechanical assembly and control system architecture

In this work we present the development of a dynamic linear model of a 3UPS+1RPU parallel robot for knee rehabilitation, which allows the reduction of the error with respect to simulation carried out based on its non-linear model. Furthermore, the design and implementation of a control algorithm in a real robot is detailed, for which a dynamic linear model has been developed based on inertial parameters including a friction model in Coulomb and viscosity parameters. Subsequently, the linear model has reduced applying the numerical method of decomposition into singular values, resulting in a model expressed as function of base parameters. This method uses a base parameter identification path obtained by finite Fourier series. This path is optimized through minimization algorithms restricted by distance, velocity and acceleration of the linear actuators of the robot, as well as the working space of its spherical joints. Then, the compatibility level of the reduced dynamic model is quantified by estimating mean square error determined between the generalized forces of the independent joints obtained from the model and compared with those resulting from simulations performed in Adams/View software for a trajectory obtained by finite Fourier series. Afterwards, mechanical components involved in the implementation of the prototype are selected and the control system of its actuators is designed. Finally, tests are performed in a laboratory through photogrammetry equipment, in order to validate joints mobility in the robot and study its performance, for this task defined trajectories based on criteria of a physiotherapist are used

Design and Control of Robotic Systems for Lower Limb Stroke Rehabilitation

Lower extremity stroke rehabilitation exhausts considerable health care resources, is labor intensive, and provides mostly qualitative metrics of patient recovery. To overcome these issues, robots can assist patients in physically manipulating their affected limb and measure the output motion. The robots that have been currently designed, however, provide assistance over a limited set of training motions, are not portable for in-home and in-clinic use, have high cost and may not provide sufficient safety or performance. This thesis proposes the idea of incorporating a mobile drive base into lower extremity rehabilitation robots to create a portable, inherently safe system that provides assistance over a wide range of training motions. A set of rehabilitative motion tasks were established and a six-degree-of-freedom (DOF) motion and force-sensing system was designed to meet high-power, large workspace, and affordability requirements. An admittance controller was implemented, and the feasibility of using this portable, low-cost system for movement assistance was shown through tests on a healthy individual. An improved version of the robot was then developed that added torque sensing and known joint elasticity for use in future clinical testing with a flexible-joint impedance controller

I-BaR: Integrated Balance Rehabilitation Framework

Neurological diseases are observed in approximately one billion people worldwide. A further increase is foreseen at the global level as a result of population growth and aging. Individuals with neurological disorders often experience cognitive, motor, sensory, and lower extremity dysfunctions. Thus, the possibility of falling and balance problems arise due to the postural control deficiencies that occur as a result of the deterioration in the integration of multi-sensory information. We propose a novel rehabilitation framework, Integrated Balance Rehabilitation (I-BaR), to improve the effectiveness of the rehabilitation with objective assessment, individualized therapy, convenience with different disability levels and adoption of an assist-as-needed paradigm and, with an integrated rehabilitation process as a whole, i.e., ankle-foot preparation, balance, and stepping phases, respectively. Integrated Balance Rehabilitation allows patients to improve their balance ability by providing multi-modal feedback: visual via utilization of Virtual Reality; vestibular via anteroposterior and mediolateral perturbations with the robotic platform; proprioceptive via haptic feedback.Comment: 37 pages, 2 figures, journal pape

Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots

Objective; This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. Method. English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of “Ankle” AND “Robot” AND “Effect OR Improv OR Increas.” Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. Result. A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR) game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF) training. Conclusion. Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy

A 3-DoF robotic platform for the rehabilitation and assessment of reaction time and balance skills of MS patients

The central nervous system (CNS) exploits anticipatory (APAs) and compensatory (CPAs) postural adjustments to maintain the balance. The postural adjustments comprising stability of the center of mass (CoM) and the pressure distribution of the body influence each other if there is a lack of performance in either of them. Any predictable or sudden perturbation may pave the way for the divergence of CoM from equilibrium and inhomogeneous pressure distribution of the body. Such a situation is often observed in the daily lives of Multiple Sclerosis (MS) patients due to their poor APAs and CPAs and induces their falls. The way of minimizing the risk of falls in neurological patients is by utilizing perturbation-based rehabilitation, as it is efficient in the recovery of the balance disorder. In light of the findings, we present the design, implementation, and experimental evaluation of a novel 3 DoF parallel manipulator to treat the balance disorder of MS. The robotic platform allows angular motion of the ankle based on its anthropomorphic freedom. Moreover, the end-effector endowed with upper and lower platforms is designed to evaluate both the pressure distribution of each foot and the CoM of the body, respectively. Data gathered from the platforms are utilized to both evaluate the performance of the patients and used in high-level control of the robotic platform to regulate the difficulty level of tasks. In this study, kinematic and dynamic analyses of the robot are derived and validated in the simulation environment. Low-level control of the first prototype is also successfully implemented through the PID controller. The capacity of each platform is evaluated with a set of experiments considering the assessment of pressure distribution and CoM of the foot-like objects on the end-effector. The experimental results indicate that such a system well-address the need for balance skill training and assessment through the APAs and CPAs

Diseño e implementación de un sistema de control de robots mediante la ingeniería del software basada en componentes. Aplicación a un robot paralelo de 3DOF

Tesis por compendioIn this thesis, using techniques related to component-based software engineering, a variety of advanced controllers for a parallel robot of 3 degrees of freedom have been developed in a modular way. A novel and a complete application based on all of the above has been implemented as well. Initially, a state of the art is developed both in the software component development and advanced control for parallel manipulators. Subsequently, a methodology for the development of dynamic controllers is presented, as well as more advanced controllers such as adaptive or hybrid. Finally, a complete application for the rehabilitation of lower limbs is developed. Through the previous proposed methodologies, it has been able to discuss problems regarding the implementation of controllers for robotic systems, being the main contributions of the Thesis: - Development of modular controllers. Through an appropriate design of the controllers, the possibility of implementing them in a modular way, following a series of guidelines related to the development of software based on components, is exhibited. Thanks to this, all the advantages that this entails (in real use case) such as reusability, robustness, dynamism and cost are demonstrated. - Design and implementation of advanced dynamic controllers. Based on the development of modular controllers, several controllers have been designed, implemented and verified experimentally in which the dynamics of the system affects the main control loop. In addition, a novel adaptive control has been implemented, able to approximate parameters that affect the dynamics of the system (which are unknown or variants in time) dynamically. - Design and implementation of hybrid controllers. By integrating a force sensor into the robotic system, a new hybrid force / position controller has been developed. This controller allows the modification, at run time, of the position reference, by including the force sensor in the control loop. - Application of the technologies developed for the creation of a complete and new application. From the numerous controllers developed and the integration between different frameworks, an application to perform numerous rehabilitation exercises is presented. Also, by means of the frameworks integration, the application can be done in remotely in a controlled way.En la presente Tesis se emplean técnicas de la ingeniería del software basada en componentes, con el objetivo de desarrollar controladores avanzados para un robot paralelo de 3 grados de libertad, así como crear una novedosa aplicación partiendo de todo lo anterior. Inicialmente, se realiza un estado del arte tanto en el desarrollo de componentes software como en controladores avanzados para manipuladores paralelos. Posteriormente, se presenta la metodología utilizada para el desarrollo de controladores dinámicos, así como controladores más avanzados como los adaptativos o híbridos. Finalmente, se desarrolla una aplicación completa para la rehabilitación de miembros inferiores. Mediante las anteriores metodologías propuestas, se han podido tratar problemas referentes a la implementación de controladores para sistemas robóticos, siendo las siguientes las principales aportaciones de la Tesis: - Desarrollo de controladores modulares. Mediante un apropiado diseño de los controladores, se exhibe la posibilidad de implementarlos de forma modular, siguiendo una serie de pautas relacionadas con el desarrollo de software basado en componentes. Gracias a ello, se demuestran todas las ventajas que ello conlleva (en un caso de uso real) tales como la reusabilidad, robustez, dinamismo y coste. - Diseño e implementación de controladores dinámicos avanzados. Basándose en el desarrollo de controladores modulares, se han diseñado, implementado y comprobado experimentalmente diversos controladores en los que la dinámica del sistema afecta al bucle de control principal. Además, se ha implementado un novedoso control adaptativo, capaz de aproximar parámetros que afectan a la dinámica del sistema (los cuales son desconocidos o variantes en el tiempo) de forma dinámica. - Diseño e implementación de controladores híbridos. Mediante la integración de un sensor de fuerza en el sistema robótico, se ha conseguido desarrollar un novedoso controlador híbrido fuerza/posición. Este controlador permite la modificación, en tiempo de ejecución, de la referencia de posición, mediante la inclusión del sensor de fuerza en el bucle de control. -Aplicación de las tecnologías desarrolladas para la creación de una aplicación novedosa completa. A partir de los numerosos controladores desarrollados y la integración entre diferentes frameworks, se presenta una aplicación capaz de realizar numerosos ejercicios de rehabilitación, optando a la posibilidad de realizar los mismos de una manera controlada de forma teleoperada.En la present Tesi s'empren tècniques de l'enginyeria del software basada en components, amb l'objectiu de desenvolupar controladors avançats per a un robot paral·lel de 3 graus de llibertat, així com la creació d'una nova aplicació partint de l'anterior. Inicialment, es realitza un estat de l'art tant en el desenvolupament de components programari com a controladors avançats per a manipuladors paral·lels. Posteriorment, es presenta la metodologia utilitzada per al desenvolupament de controladors dinàmics, així com controladors més avançats com els adaptatius o híbrids. Finalment, es desenvolupa una aplicació completa per a la rehabilitació de membres inferiors. Mitjançant les anteriors metodologies proposades, s'han pogut tractar problemes referents a la implementació de controladors per a sistemes robòtics, sent les següent les principals aportacions de la Tesi: - Desenvolupament de controladors modulars. Mitjançant un apropiat disseny dels controladors, s'exhibeix la possibilitat d'implementar-de forma modular, seguint una sèrie de pautes relacionades amb el desenvolupament de software basat en components. Gràcies a això, es demostren tots els avantatges que això comporta (en un cas d'ús real) com ara la reusabilitat, robustesa, dinamisme i cost. - Disseny i implementació de controladors dinàmics avançats. Basant-se en el desenvolupament de controladors modulars, s'han dissenyat, implementat i comprovat experimentalment, diversos controladors en què la dinàmica del sistema afecta el bucle de control principal. A més, s'ha implementat un nou control adaptatiu, capaç d'aproximar paràmetres que afecten la dinàmica del sistema (els quals són desconeguts o variants en el temps) de manera dinàmica. - Disseny i implementació de controladors híbrids. Mitjançant la integració d'un sensor de força en el sistema robòtic, s'ha aconseguit desenvolupar un nou controlador híbrid força / posició. Aquest controlador permet la modificació, en temps d'execució, de la referència, mitjançant la inclusió del sensor de força en el bucle de control. - Aplicació de les tecnologies desenvolupades per a la creació d'una aplicació innovadora completa. A partir dels nombrosos controladors desenvolupats i la integració entre diferents frameworks, es presenta una aplicació capaç de realitzar nombrosos exercicis de rehabilitació, optant a la possibilitat de realitzar els mateixos d'una manera controlada de forma teleoperada.Cazalilla Morenas, JI. (2017). Diseño e implementación de un sistema de control de robots mediante la ingeniería del software basada en componentes. Aplicación a un robot paralelo de 3DOF [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/86222TESISCompendi

A Review Study for Robotic Exoskeletons Rehabilitation Devices

Nowadays, robotic exoskeletons demonstrated great abilities to replace traditional rehabilitation processes for activating neural abilities performed by physiotherapists. The main aim of this review study is to determine a state-of-the-art robotic exoskeleton that can be used for the rehabilitation of the lower limb of people who have mobile disabilities as a result of stroke and musculoskeletal conditions. The study presented the anatomy of the lower limb and the biomechanics of human gait to explain the mechanism of the limb, which helps in constructing a robotic exoskeleton. A state-of-the-art review of more than 100 articles related to robotic exoskeletons and their constructions, functionality, and rehabilitation capabilities are accurately implemented. Moreover, the study included a review of upper limb rehabilitation that has been studied locally and successfully applied to patients who exhibited significant improvements. Results of recent studies herald an abundant future for robotic exoskeletons used in the rehabilitation of the lower extremity. Significant improvement in the mechanism and design, as well as the quality, were observed. Also, impressive results were obtained from the performance when used by patients. This study concludes that working and improving the robotic devices continuously in accordance with the cases are necessary to be treated with the best results and the lowest cost