J. A.
Saglia1 A High-performance
N. G. Tsagarakis
J. S. Dai1
D. G. Caldwell
Istituto Italiano di Tecnologia,
via Morego 30,
16163 Genoa,
Italy
jody.saglia@kcl.ac.uk
Abstract
In this paper we present a redundantly actuated parallel mecha-
nism for ankle rehabilitation. The proposed device has the advan-
tage of mechanical and kinematic simplicity when compared with
the state-of-the-art multi-degree-of-freedom parallel mechanism pro-
totypes while at the same time it is fully capable of carrying out the
exercises required by the ankle rehabilitation protocols. Optimization
of the device workspace, dexterity, torque output and size was carried
out during the design phase of the device. The development of the
system involved the realization of a new customized linear actuator
able to meet the speed and force requirements of the device function-
ality. We also discuss the impedance-based control scheme used for
the redundantly actuated device, which allows the execution of both
assistive and resistive strengthening rehabilitation regimes. Results
from the control of a single linear actuator and further experimental
tests including the position tracking of the fully actuated platform are
presented. It is believed that the performance and the simplicity of the
proposed mechanism will allow the widespread use of the system as a
new aid tool for ankle rehabilitation.
KEY WORDS—parallel mechanism, redundant actuation, an-
kle rehabilitation
1. Introduction
Healthcare is a dominant issue in the 21st century. Efforts have
been made to improve healthcare and new devices have been
developed to contribute to the societal living standards. It has
The International Journal of Robotics Research
Vol. 28, No. 9, September 2009, pp. 1216–1227
DOI: 10.1177/0278364909104221
2
c The Author(s), 2009. Reprints and permissions:
http://www.sagepub.co.uk/journalsPermissions.nav
Figures 3, 7–12, 15–18 appear in color online: http://ijr.sagepub.com
1216
Redundantly Actuated
Parallel Mechanism for
Ankle Rehabilitation
been indicated that there are three ways to improve the health-
care quality and clinical rehabilitation process:
(i) to develop evidence-based therapy (for example, deliver
the optimal therapy to a particular patient’s need),
(ii) to re-allocate personnel and tasks (for example, min-
imize paperwork and free more personnel to deliver
care)1 and
(iii) to increase the productivity of each caregiver (for exam-
ple, provide therapists with appropriate tools).
In rehabilitation, robotic aids can have an impact on all of
these modes and increase the healthcare quality and produc-
tivity not only by introducing new efficiency into certain rou-
tine physical and occupational therapy activities, but also by
providing a rich stream of objective data to assist in patient
diagnosis, prognosis, customization of therapy, assurance of
patient compliance with treatment regimens and maintenance
of patient records (Krebs et al. 1998).
Moreover, robotic rehabilitation systems help in the assess-
ment of injuries and choosing the most appropriate rehabil-
itation protocol. In combination with virtual reality environ-
ments, such systems allow qualification of and, in particular,
the quantification of the level of recovery an injury, therefore
improving actual rehabilitation protocols and helping to define
more effective protocols.
More specifically, robotic rehabilitation systems allow pa-
tients to perform a wide range of self-administered tasks from
passive repetitive actions to functional activities and from as-
sistive tasks to those providing opposition. These systems al-
low patients to train repetitively and intensively and provide
the physiotherapists with tools that allow them to treat pa-
tients with minimal supervision. Further, physiotherapists can
1 Also at King’s College London, University of London, Strand, London
WC2R 2LS, UK.
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation
gather objective measures regarding a patient’s performance
and progress using the robotic aid systems.
As a result of the above, in the last decade there has been
a lot of work towards robotic-based physiotherapy and reha-
bilitation. Within this research, an increasingly wide and di-
verse range of systems have been developed. These systems
range from simple powered two-link orthoses to commercial
products. They use a variety of actuation methods and control
strategies and they are targeted at different disabilities.
Among these systems there are a number of devices devel-
oped to aid in the execution of ankle physiotherapy and re-
habilitation regimes. Ankle sprains are very common injuries
that can take a few weeks up to several months to fully re-
cover. In the majority of the cases, ankle rehabilitation is per-
formed directly by the physiotherapist or with the aid of ded-
icated tools, each of which is used for a specific exercise. For
instance, strength training is performed using elastic bands or
applying weights to the foot and proprioceptive training is per-
formed with wooden wobble boards or foam rollers.
More recently, physiotherapists have started to make use
of automatic systems such as Fisiotek 2000 (available at
http://www.rimec.it/EN/) and the Biodex Balance System
(available at http://www.biodex.com/index.html), while re-
search efforts in this area have resulted in the development of
a number of ankle rehabilitation robotic devices. In the past,
an ankle rehabilitation robot based on a Stewart–Gough plat-
form with six degrees of freedom (DOFs) powered by pneu-
matic linear actuators (The “Rutgers Ankle” Rehabilitation In-
terface) was proposed (Girone et al. 1999, 2000, 2001). The
system was designed to assist the patient in participating in
interactive computer games during the rehabilitation of the an-
kle and later trials were performed on post-stroke patients and
people with musculoskeletal injuries in order to verify the ef-
fectiveness of the robotic device (Deutsch et al. 2001a,b). The
experiments provided some hints to improve the effectiveness
of such devices. Further, the “Rutgers Ankle” rehabilitation in-
terface was used to develop a virtual walking simulator based
on a dual Stewart platform (Boian et al. 2005). However, such
a device has more DOFs than those of the ankle complex and
it makes use of pneumatic actuators which affects the porta-
bility of the robotic device and impedes their use in a medical
environment.
An equilateral parallel mechanism for ankle rehabilitation
was introduced by Dai and Massicks (1999) and later the mo-
bility and stiffness of three- and four-DOF parallel mecha-
nisms with a central strut (Dai et al. 1994) were analyzed by
Dai et al. (2004). Subsequently, a two-DOF, 3UPS/U parallel
mechanism was proposed and studied (Saglia and Dai 2007).
This last device also uses pneumatic cylinders, which have the
advantage of inherent compliance, but also prevent the use of
the device within clinics.
Two other platform-type ankle rehabilitation mechanisms
were also introduced by Yoon and Ryu (2005) and Liu et
al. (2006). The first is based on a three-DOF parallel mech-
1217
anism that allows plantar/dorsiflexion, inversion/eversion and
vertical translation of the patient’s foot with the addition of
a fourth DOF that allows the person to perform toe motions.
This system also employs pneumatic actuators, to drive the
moving platform. The second device is a direct-drive three-
DOF 3RSS/S parallel mechanism. This rehabilitation robot
uses electric motors and it has a compact design. However,
the rehabilitation device allows the rotation of the foot in the
transverse plane, which is not very relevant in ankle rehabili-
tation.
Exoskeleton mechanisms for lower-limb and, in particular,
ankle rehabilitation have also been proposed. A wearable, low-
cost mechanism using spring over muscle-based pneumatic ac-
tuators, which allows plantar and dorsiflexion of the human
ankle was introduced for post-stroke rehabilitation by Bharad-
waj et al. (2004). At the same time, an ankle robot with three
DOFs was designed and built at MIT and used for modular
gait rehabilitation (Wheeler et al. 2004). The system uses two
electric motors to actively drive two of the three DOFs, namely
plantar/dorsiflexion and inversion/eversion and leaves the third
DOF passive allowing free internal and external rotation of the
foot. Another robotic device that could be used for ankle reha-
bilitation was presented by Dong et al. (2006). A single DOF
mechanism provides resistance while the patient is moving
the hip, knee or ankle, using a magneto-rheological damper.
The device is reconfigurable for various body joints. Never-
theless, exoskeleton devices cannot allow balance exercises,
therefore this study focused on a platform-type rehabilitation
device.
The parallel mechanism introduced in this paper has the ad-
vantage of mechanical and kinematic simplicity when com-
pared with existing multi-DOF parallel mechanism proto-
types, while at the same time it is fully capable of carrying
out the exercises required in ankle rehabilitation protocols.
The proposed device allows plantar/dorsiflexion and inver-
sion/eversion using an improved performance parallel mech-
anism that makes use of actuation redundancy to eliminate
singularity and greatly improve the workspace dexterity. This
assures smooth motion of the platform during clinical rehabili-
tation since the mechanism workspace does not contain singu-
larities. In addition, the requirements for high torque capacity
and backdrivability are further satisfied with the employment
of a customized cable-driven linear electric actuator that com-
bines high force capacity with low friction and high backdriv-
ability. The simplicity and compactness of the device together
with its redundant characteristic, which allows simultaneous
control of position and stiffness, will improve the quality and
increase the productivity of ankle physiotherapy delivered by
the clinicians.
The presentation of this work is structured as follows. Sec-
tion 2 introduces the device specifications in terms of the range
of motion, torque capacity and degrees of freedom derived by
the needs of the human ankle anatomy and the ankle rehabil-
itation protocol prerequisites. Section 3 introduces the kine-
1218 THE INTERNATIONAL JOURNAL OF ROBOTICS RESEARCH / September 2009
Fig. 1. Human ankle and its corresponding movements (Det-
twylera et al. 2004).
matic geometry of the proposed mechanism and reports on
the inverse kinematics of the device. Section 4 presents the
workspace and dexterity analysis followed by the presenta-
tion of the mechanism and particularly the presentation of the
mechanical design of the custom-made linear actuator used to
power the system limbs.
Section 5 reports the overall ankle rehabilitation system
control and architecture, while Section 6 presents experimen-
tal tracking performance measures of the overall system and
the customized actuator. Finally Section 7 presents the conclu-
sions and aspects of the future developments.
2. Device Specifications
To derive a technical specification for an ankle rehabilitation
mechanism the anatomical data of the human ankle as well as
data derived from the analysis of rehabilitation protocols are
considered. The human ankle is composed of two articulations
and their kinematics can be represented with two hinge joints1
see Fig. 1 (Dettwylera et al. 2004). However, the axes of ro-
tation are skewed and angular displacements in the two ankle
joints produce rotations of the foot in all three planes (sagittal,
frontal and transverse planes). Therefore, the foot is capable
of three kinds of movement referred to as plantar/dorsiflexion,
inversion/eversion and adduction/abduction.
Nevertheless, when considering gross motion, especially in
rehabilitation, only the first and second motions of the foot are
considered important. It has been clinically shown by Payne et
al. (1997) and Mattacola and Dwyer (2004) that the first two
motions are the dominant actions in proprioceptive training
and ankle rehabilitation. Although exercises which involve the
abduction/adduction of the foot, such as drawing the alphabet
letters, are still included in rehabilitation protocols, most exer-
cises require only plantar/dorsiflexion and inversion/eversion
Table 1. Range of Motion of the Human Ankle.
Type of motion Range Torques (Nm)
3 3
Plantar/dorsiflexion –60 , 30 –80, 80
3 3
Inversion/eversion –30 , 15 –40, 40
(Mattacola and Dwyer 2004). Therefore, these degrees of mo-
bility (Dai et al. 2006) formed the basis for the design of the
rehabilitation device.
Hence, the robotic device needs to have two rotational
DOFs. The ranges of motion and torques for the human’s ankle
are reported in Table 1 (Parenteau et al. 1998).
Referring to clinical guidelines, and in particular to Matta-
cola and Dwyer (2004), a series of exercises that an ankle re-
habilitation robotic device should be able to perform in order
to accomplish the rehabilitation process has been elaborated.
According to Table 2, the rehabilitation process is divided
into three stages, namely the preliminary, intermediate and ad-
vanced stages, during which the patient gradually regains the
range of motion and strength at the injured ankle. The patient
needs to perform passive and active exercises, hence the device
has to provide assistive and resistive operational modes. This
indicates that for active mode exercises, the patient applies a
force/torque to the platform and the robotic device should pro-
vide a certain level of assistance or resistance to the movement
of the patient. This requires the backdrivability of the linear
actuators.
Proprioceptive exercises require the patient to stand on the
robotic device, in both a unilateral and bilateral stance, and
to try to maintain the balance and not to exceed a maximum
inclination of the platform. This type of rehabilitation exercise
requires the robotic device to fully support the patient’s body
weight. Thus, the actuator must be powerful enough to keep
the platform in a stall position, when the patient reaches the
maximum permitted inclination level.
In addition to the above specifications, as with most de-
signs, options that keep complexity to a minimum will tend
to improve reliability and reduce cost, and these were always
under consideration during the mechanism design process.
3. Parallel Mechanism Description
3.1. Geometry
The kinematic geometry of the proposed ankle rehabilitation
device is presented in Fig. 2. The parallel mechanism consists
of a base, a moving platform, three identical active limbs and
a passive central strut.
The limbs are attached with universal and spherical joints to
the base and the moving platform, respectively. The points of
attachment lie at equal distances along the two circumferences
of radius ra for the base and rb for the platform.
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation 1219

Table 2. Ankle Rehabilitation Exercises.

Stage Class of exercise Exercise mode (patient) Type of exercise
Preliminary ROM (Range of Passive Pain-free passive motion
rehabilitation Motion)
Pain-free, non-weight bearing Achilles tendon
(ACT) stretching
Active Pain-free, weight bearing ACT stretching
Strength training Active Isometric Plantar flexion, dorsiflexion, inversion and ever-
sion
Isotonic (full ROM)
Intermediate Proprioceptive Active Clockwise and counter clockwise rotation with
rehabilitation training wobble board
Move the foot through functional patterns experi-
encing perturbations and resistance
Advanced Balance exercises experiencing external perturba-
rehabilitation tions

The parallel mechanism presents two DOFs, due to the

universal joint connecting the central strut and the platform.
Therefore, the presence of three actuators makes the parallel
mechanism redundantly actuated (Saglia et al. 2008).

3.2. Inverse Kinematics

Let ai and bi be the position vector of the ith universal and

spherical joint on the base and on the platform, respectively.
Let p be the vector describing the distance between the points
O and P0 , where the only non-zero entry is the z-component
that is equal to h (the height of the parallel mechanism). Hence,
it is possible to define the limb vector as

di 4 di si 4 p 5 bi 6 ai 1 (1)
Fig. 2. Geometry of the two-DOF over-actuated parallel mech-
anism. where di is the limb length and si as a unit vector along the
longitudinal axis of the ith limb.
The inverse kinematics of the parallel mechanism can be
obtained as the square root of the expression given by the dot
product of (1) with itself as
Each limb consists of a spherical joint, a prismatic joint
1
and a universal joint. The central strut is attached to the plat-
di 4 7 bi2 5 ci2 5 2bi ci 1 (2)
form with a universal joint. The prismatic joints are actuated
by means of linear actuation drives. with
Let O(x1 y1 z) and P0 (u 0 1 2 0 1 30 ) be two fixed reference ci 4 p 6 ai 6
frames attached to the base and the end of the central strut re-
spectively and, P(u1 21 3) be the reference frame of the moving Differentiating the expression in (1) yields the velocity re-
platform. The distance h between the points O and P0 , as well lation as
as P, is fixed and represents the height of the parallel mech- di 7 i 8 si 5 d9i si 4 7 P 8 bi 1 (3)
anism. The orientation of the moving platform with respect where 7 i is the angular velocity of the ith limb and
to the base can then be expressed with two rotations 4 and 5 2 3
about the fixed axes u0 and v0 . 7 P 4 49 59 0 (4)
1220 THE INTERNATIONAL JOURNAL OF ROBOTICS RESEARCH / September 2009

is the angular velocity of the moving platform. It contains the

time derivatives of the orientation angles.
Dot multiplying both sides of the expression in (3) with the
vector si gives the relation between a single limb velocity and
the angular velocity of the moving platform as

d9i 4 8bi 8 si 9 7 P 6 (5)

Consequently, writing (5) for i 4 11 2 and 3, and rearranging

in a matrix form gives

d9 4 J617 P 1 (6)

where2 J is the Jacobian

3 matrix of the parallel mechanism and
d9 4 d91 d92 d93 is the vector that contains the limb linear
velocities.

4. Mechanism Design Fig. 3. Reachable workspace of the parallel mechanism with

different radii ratios.
4.1. Selection of Geometric Parameters
Table 3. Geometric Parameters for Workspace Analysis.
The selection of the geometric parameters was based on a
study of the reachable workspace, dexterity, torque output and Platform radii Base radius, Platform
compactness of the robotic device. ratio, ra
ra ra (m) radius, rb (m)
The geometric parameters to consider for the design of the =1 0.125 0.125
parallel mechanism are the mechanism height h, the base and
1 0.125 0.085
platform radii ra and rb and the actuators’ stroke. It is obvious
that, given the radius of the base ra , the greater the platform ra- 1 0.085 0.125
dius rb the higher the torque output of the mechanism is, while
the lower the workspace will be. Moreover, the higher the par-
cases, the stroke should be equal to ds 4 06143 m and ds 4
allel mechanism, the greater the actuator stroke needs to be in
06139 m, respectively, with the radii ratio equal to and lower
order to obtain a certain range of motion and the less compact
than one. For the sake of compactness the configuration with
the device will be. As a first step, the mechanism height h has
radii ratio greater than one was chosen for the design of the
been set to
mechanism.
h 4 063 m1
In addition to the workspace analysis, a study of the device
in order to allow the patient to place the foot on the moving dexterity was carried out in order to evaluate the mechanism’s
platform while sitting on a normal chair. kinematic performance for the different sets of geometric pa-
Consequently, the actuator stroke was set to ds 4 061 m rameters. The reason why the over-actuation had been chosen
(see Section 4.2 for details), resulting in a limb length of 0.277 for this rehabilitation robot is that the singularities are com-
to 0.377 m with a mid value of dm 4 06327 m. A computer pletely removed and the dexterity of the parallel mechanism is
simulation was performed to calculate the limits of the reach- greatly improved (Saglia et al. 2008).
able workspace for different ratios of the base and platform The Jacobian matrix in (6) can be used to analyze the mech-
radii. Figure 3 depicts the results for three different values of anism dexterity. Considering the condition number of the ma-
radii ratio presented in Table 3. The values of the two radii in trix as the ratio between the maximum max and the minimum
Table 3 were selected to satisfy the range of motion and torque min singular values of the matrix,
requirements of the ankle joint. Other combinations are pos- max
sible, however this was selected to satisfy both requirements 4 1 (7)
min
while at the same time to keep the device as compact as possi-
ble. a local dexterity index (LDI) can be defined as
It is possible to see that the largest workspace is given
1 min
by the radii ratio greater than one, meaning that the plat- L DI 4 4 1 (8)
form is smaller than the base. The same reachable workspace  max
could of course be achieved with the other two geomet- which varies in the range [0 1], where 0 represents singularity
ric configurations by increasing the actuator stroke. In those and 1 represents isotropy.
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation 1221

Fig. 4. Local dexterity of the parallel mechanism with ra 4 rb . Fig. 6. Local dexterity of the parallel mechanism with ra  rb .

dexterity any of the three sets of geometric parameters could

be selected, giving roughly the same mechanism performance.
Hence, the values

ra 4 06125 m1

rb 4 06085 m1

were chosen for the design together with those of the actua-
tor stroke and the length of the strut mentioned above, since
those are the geometric parameters that guarantee the largest
workspace.

Fig. 5. Local dexterity of the parallel mechanism with ra  rb . 4.2. Linear Actuator Mechanical Design

The prerequisites for an ankle robotic aid system but also in

general for any rehabilitation robot are significantly different
The local dexterity characteristic (Dai and Shah 2003) of from those of a typical industrial robot. A robotic aid device
the parallel mechanism changes when choosing different geo- that is used for movement regimes for the treatment of ankle
metric parameters. The greatest change can be seen when the injuries or other neurological impairments should exhibit the
ratio between the base radius ra and platform radius rb varies. following characteristics.
Simulations were performed to calculate the mechanism LDI
(i) High force and speed capacity (particularly required for
for a certain range of motion of the platform and three ex-
the execution of the balance exercises).
amples of different mechanism local dexterity characteristics,
with different platforms radii ratios are given in Figures 4–6. (ii) High backdrivability and low apparent inertia (allowing
The geometric parameters used for the simulations are those the subjects to see the effect of their effort).
reported in Table 3.
It should be noted that with ra
rb 4 1, the local dexterity As the role of the actuation system is vital in obtaining the
surface assumes a bell shape, having a single isotropic point above characteristics, various types of actuation were consid-
that corresponds to 4 4 03 and 5 4 03 . In the cases of ra
rb  ered during the design process varying from fluidic actuator
1 and ra
rb  1, the surface presents more than one isotropic (pneumatics and hydraulics) to electrical drives.
point even though the smoothness of the surfaces worsens. Fluidic actuators were excluded, mainly because of the re-
A highly dexterous workspace is needed since the device quirement of an external fluidic source which is not commonly
should support the patient’s body weight during balance exer- available in medical environments. In addition to this, fluidic
cises. Therefore, the higher the dexterity, the smaller the ac- actuators exhibit non-linearities in both force and flow dynam-
tuator size, which reduces the device size. In fact, in terms of ics.
1222 THE INTERNATIONAL JOURNAL OF ROBOTICS RESEARCH / September 2009

Fig. 7. Transmission system for the linear actuator.

Fig. 8. Platform position, velocity and torques for an isotonic
exercise involving plantar and dorsiflexion.
On the other hand, commercial electric linear actuators sel-
dom fulfill all of the requirements of the ankle rehabilita-
tion system, particularly the requirement of backdrivability.
Usually commercial linear actuators make use of ball–screw
transmission systems making them either high-force/low-
backdrivability or low-force/high-backdrivability actuators. In
this study, high-force and high-backdrivability actuators are re-
quired. Hence, a customized linear actuator which can provide
both was developed.
The linear actuator is based on a cable-driven (capstan
drive) system of pulleys that transforms the rotatory motion
of a brushed DC motor to the linear motion of a piston sliding
in and out the actuator cylinder. As a result of the use of the
capstan drive, the overall actuator unit has low friction and ex-
hibits high backdrivability while at the same time it can main-
tain a high-force capacity. The transmission system and a cross
section of the actuator overall assembly are shown in Fig. 7.
Note that the capstan mechanism works only with a limited
number of turns of the cable around the motor pulley, namely Fig. 9. Actuators trajectories, velocities and forces for an iso-
1.5 turns. The stroke of the linear actuator can be increased by tonic exercise.
extending the radius of the motor pulley. On the other hand,
the greater the pulley radius, the lower the output force of the
linear actuator is. Thus, to keep the design compact and limit be performed under such conditions1 however, this can be con-
the size of the DC motor the stroke of the linear actuator has sidered as the worst case for the dimensioning of the motor
been set to 0.1 m. specifications.
To derive the specifications of the DC motor, rehabilita- From the simulation, it has been concluded that the reha-
tion regimes are simulated using the selected device geome- bilitation device needs a maximum actuator force of f max 4
try. Looking at Table 1, a worse case for an isotonic exercise 63665 Nm (Fig. 10). The radius of the motor pulley was set to
can be set, considering the maximum torque that the ankle r p 4 0601 m to provide 0.1 m of displacement with 1.5 turns
can generate. It is assumed that the patient plantar and dorsi of the motor pulley, thus the required torque for the motor is
flexes the foot in a range of 4 4 7253 with a sinusoidal mo-
tion and experiences a resistive torque whose absolute value is  max 4 f maxr p 4 66365 Nm6 (9)


4 80 Nm. Trajectories, torques and forces of the platform
and actuators are shown in Fig. 8 and Fig. 9. The period of This torque is delivered by a combination of a Maxon DC
sinusoidal motion is 2 s. In fact, a real exercise would hardly brushed motor RE40 and a planetary gearbox unit with a low
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation 1223

Table 4. Speed and Torque/Force Specifications of the DC Motor and the Linear Actuator.

Operating mode (gearbox/motor) DC motor Linear actuator

Max speed (rpm) Max torque (mNm) Max speed (m s61 ) Max force (N)
Continuous/Continuous 8,000 184 0.7 220.8
Continuous/Intermittent 6,660 625 0.58 750
Intermittent/Intermittent 5,697 941.6 0.5 1130

Fig. 10. Force/speed curves for the isotonic exercise in the Fig. 11. Maximum speed and torque isokinetic exercise.
worst case.

gear ratio of 12:1. The low-inertia motor combined with com-

paratively low gear ratio and the low-friction capstan trans-
mission system ensure the high backdrivability of the linear
actuator. The specifications of the motor unit together with the
performance of the linear actuator are shown in Table 4.
For the prototype actuator a highly flexible multi strand
(7 8 7) steel cable 1.2 mm in diameter was used. This cable
is capable of withstanding a maximum load of 1,500 N. This
is well above the instantaneous peak force of 1,200 N that can
be delivered by the actuator. Note that in case of mechanical
failures in the proposed capstan transmission system, the actu-
ation redundancy allows the full control of the output position
Fig. 12. Prototype of the ankle rehabilitation robot.
and torque of the footplate. This increases the safety of the
proposed rehabilitation device.
The designed system allows the execution of an isoki-
netic exercise in continuous mode for a displacement of at
4 4 7253 a constant speed of 49 4 5003 s61 , with a max- As it can be seen in Figure 12 the foot of the user is fixed
imum resistant torque of  4 4 28 Nm1 see Fig. 11. Again, on the moving platform by means of Velcro stripes allowing
such conditions are very unlikely to occur in a rehabilitation easy doming and removal.
exercise1 however, the example has been reported in order to The static friction torque of the rehabilitation device is
present the robotic device performance. 1.2 Nm while the maximum apparent inertia that a patient
Using three actuator groups, a prototype of the ankle reha- can perceive when the actuators are not powered is equal to
bilitation robotic device was fabricated and is shown in Fig. 12. 0.2 kgm2 .
1224 THE INTERNATIONAL JOURNAL OF ROBOTICS RESEARCH / September 2009

5. Impedance Control and Rehabilitation

Architecture
Control algorithms such as impedance/admittance control, as-
sistive control and force control are usually implemented in re-
habilitation robotic systems to allow patients to perform active
exercises, while position tracking control is commonly used to
perform passive exercises.
The control technique presented in this section is an ex-
tended compliance control which provides motion assistance
or resistance in the direction the patient is trying to push the
foot plate. The proposed algorithm allows us to set the stiff-
ness parameter as well as the viscosity.
For this application the rehabilitation device and, in particu-
lar, its control scheme should assist a subject when interacting
with the device, to execute the movement when the person has
a weak ankle complex or resist the user voluntary motion when Fig. 13. Schematic diagram of the human and ankle rehabilita-
a strengthening exercise is carried out. An impedance control tion device.
scheme to achieve these two functionalities is employed.
The following equation describes the dynamic behavior of
the rehabilitation device:
where M E , B E , K E are the inertia, damping
2 and
3 stiffness ma-
 79 P 5 C
M  79 P 5 N
 5 J6T joint 4  d 1 (10) trices, and  4 [41 5] and  E 4 4 E 1 5 E are the actual
and desired angle of the moving platform. The above equa-
where: tion defines the desired characteristics of the motion of the pair
(Subject, Ankle Rehabilitation Device).
  1 7 P 1 79 P are the platform angular position, velocity
Having specified the desired behavior of the system, the
and acceleration, respectively1 control law can now be derived by eliminating 79 P from (10).
  joint is the actuated joints torque vector1 Solving (11) for 79 P yields

 is the Cartesian inertia matrix1

 M 79 P 4 M61  s 6 B E 7 P 6 K E 8 6  E 99 6
E 8 (12)
 is the Cartesian Coriolis/centripetal vector1
 C Combining (10) and (12), 79 P can be eliminated and the
resulting expression is
 is the Cartesian gravity vector1
 N 4 5
M M61E 8 s 6 B E 7 P 6 K E 8 6  E 99
  d is the torque vector that the device generates at the
platform1  7P 5 N
5 C7  5 J6T joint 4  d 6 (13)
6T
 J is the transpose Jacobian of the parallel mechanism
in (6).
Note that, the dynamic model in (10) is expressed in the
Cartesian space (Saglia et al. 2009).
Consider the scenario described in Fig. 13, where the sub-
ject’s foot is attached to the device platform via a force sensor.
Let  s denote the torque that the subject exerts on the device
platform (which is actually the torque felt by the subject),  d
is the torque that the device applies to the subject and Z E 8s9
is the system desired mechanical impedance. To make the pair
(device plus subject’s foot) motion to follow the simulated as-
sistive/resistive impedance dynamics, the following expression
must be applied
Z E 8s9 8 6  E 9 4 M E 79 P 5 B E 7 P 5 K E 8 6  E 9
4  s1 (11)
To keep the Cartesian inertia of the rehabilitation device
unchanged, the inertia matrix M E can be expressed as

M E 4 M6 (14)
Considering also slow motions typical in rehabilitation, the as-
sumption  d 4 6 s can be made and the Coriolis term of
the dynamics C7  7 P can be neglected. Therefore, substituting
in (13) this yields

 joint 4 JT 8B E 7 P 5 K E 8 6  E 99 6 N6 (15)
The above equation describes the impedance control law for
the rehabilitation device. The damping and the stiffness matri-
ces B E and K E are 2 8 2 diagonal matrices and depend on the
assistive/resistive dynamics to be modeled.
In the assistive control mode the rehabilitation system ap-
plies assistive torque signals dependent on the patient’s desired
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation 1225

Fig. 14. Control scheme for assistive/suppression exercises.

motion. In this mode of operation the direction of motion is

required. To enable detection of the patient’s desired motion a
force/torque sensor is mounted on top of the platform.
Adding the force/torque sensor does not affect the angular
displacement and velocity. It introduces a small offset from the
center of rotation which can be compensated by small motion Fig. 15. Reference trajectory and position error of a single lin-
of the knee joint while a person performs the rehabilitation ear actuator.
exercise.
This sensor monitors the torque signals applied by the pa-
tient. Based on these torque signals the desired position of the Table 5. Reference Trajectory and Controller Gains.
system  E is updated in (15). The new desired position is de- Variable Value
rived from the sensed torque signal as
Trajectory 640 sin 82065t9 8mm9
6
 iE 4  iE61 5  if dt1 i 4 11 2 (16) Proportional gain, k P 3
Derivative gain, k D 300
7 4 5
8
8 ka  is 6 a  is  a1
8
9
 if 4 0 6a   is  a1 (17) and the position error for a period of 10 s. The controller gains
8
8
8

4 5 and the reference trajectory are reported in Table 5.
ka  is 5 a  is  a6
By injecting the desired position vector derived from (16)
into (15), assistive torques governed by the spring constant K E
of the impedance network are generated to augment the pa-
tient desired actions/motions. At the same time, the damping
coefficient B E of the impedance filter serves the purpose of
damping erratic movements in the direction of motion. The
scheme of the proposed controller is shown in Fig. 14.
6. System Preliminary Performance Measures
A preliminary experimental setup has been realized in order to
verify the performance of a single custom linear actuator but
also the efficacy of the overall platform to accurately generate
motion trajectories. A PCI four-axis motion control board from
National Instruments was used to run a PD controller for the
DC motor and an experiment with a sinusoidal position refer-
ence was performed. Figure 15 shows the reference trajectory
Looking at Fig. 15, it is possible to notice that the tracking
error reaches a maximum value of 1.2 mm, which is about 3%
of the amplitude of the reference trajectory.
Furthermore, the fully assembled prototype was tested with
a PD controller in the joint space in order to evaluate the track-
ing performance of the overall platform. Defining a reference
sinusoidal trajectory of 0.5 Hz for the orientation of the plat-
form and using the inverse kinematics in (2), the reference limb
trajectories were computed and used as the reference input for
the joint space PD controllers. The results for a circular motion
of the platform are shown in Fig. 16.
Figure 16 depicts a good position tracking performance.
Position control algorithms can be used to perform passive ex-
ercise in the early stage of the rehabilitation process when the
patient is not able to autonomously move the foot.
Figure 17 shows the position tracking error of the platform
and it can be noticed that a good position tracking performance
is achieved by the overall system. The same result can be ob-
served in Figure 18 where the trajectories of the limb actuators
are reported.
1226 THE INTERNATIONAL JOURNAL OF ROBOTICS RESEARCH / September 2009
Fig. 16. Platform response to a sinusoidal reference trajectory.
Fig. 17. Position tracking error of the platform.
The final prototype meets the design requirements in terms
of speed and position tracking and output torque capability.
7. Conclusions
We have presented the kinematic analysis, mechanical design
and impedance control of an ankle rehabilitation robotic device
based on a redundantly actuated parallel mechanism. The pro-
posed mechanism has a fairly simple kinematic structure when
compared with the state-of-the-art ankle rehabilitation devices.
The system is capable of delivering the required forces and
torques needed for strengthening and balance exercises.
The design underwent the optimization of the mechanism
workspace, dexterity, torque output and device compactness.
In order to meet requirements of force, speed and backdriv-
ability given by the design specifications, a customized linear
Fig. 18. Position tracking of the three limb actuators.
actuator was developed and used for the realization of the pro-
totype rehabilitation device.
The control algorithm based on the theory of impedance
control, which the authors intend to apply to the rehabilita-
tion system for assistive exercises, has been presented and the
preliminary performance of the control of a single linear ac-
tuator and the performance of the fully assembled prototype
have been reported. The experimental position tracking tests
of the system demonstrate the smooth operation of the device.
In particular, the singularity that causes the drivability prob-
lem and mechanism failure in the rehabilitation has been elim-
inated owing to the use of this redundantly actuated parallel
mechanism and the dexterity has been improved for isotropic
force distribution during the physiotherapy. The device also
provides an extra dimension for stiffness control that satisfies
the clinical requirement of different patients.
Future work will include experiments with patients affected
by ankle injuries or other sorts of impairments to fully evaluate
the impedance based assistive/resistive control scheme. Fur-
thermore, the intrinsic compliance of the rehabilitation device
will be improved by inserting springs in series to the linear
actuators of the limbs.
Acknowledgment
The project was supported by the Italian Institute of Technol-
ogy (IIT) in collaboration with King’s College London, Uni-
versity of London.
References
Bharadwaj, K., Hollander, K. W., Mathis, C. A., and Sugar,
T. G. (2004). Spring over muscle (SOM) actuator for re-
habilitation devices. Proceedings of the 26th International
 Saglia et al. / A High-performance Redundantly Actuated Parallel Mechanism for Ankle Rehabilitation
Conference of the IEEE EMBS, Vol. 1, San Francisco, CA,
September, pp. 2726–2729.
Boian, R. F., Bouzit, M., Burdea, G. C., Lewis, J., and Deutsch,
J. E. (2005). Dual Stewart Platform Mobility Simulator.
Proceedings of the 2005 IEEE 9th International Conference
on Rehabilitation Robotics, Chicago, IL, June–July.
Dai, J. S., Huang, Z., and Lipkin, H. (2006). Mobility of
overconstrained parallel mechanisms. Transactions of the
ASME: Journal of Mechanical Design, 128(1): 220–229.
Dai, J. S. and Massicks, C. P. (1999). An equilateral ankle re-
habilitation device based on parallel mechanisms. Off-Line
Simulation Workshop for Robotic End-Effectors and Ma-
nipulators, 2nd World Manufacturing Congress, Durham,
UK.
Dai, J. S. and Shah, P. (2003). Orientation capability of planar
manipulators using virtual joint angle analysis. Mechanism
and Machine Theory, 38(3): 241–252.
Dai, J. S., Sodhi, C., and Kerr, D. R. (1994). Analysis of a
new six-component force transducer for robotic grasping.
Proceedings of the Second Biennial European Joint Confer-
ence on Engineering Systems Design and Analysis, ASME
PD 64(8–3): 809–817.
Dai, J. S., Zhao, T., and Nester, C. (2004). Sprained an-
kle physiotherapy based mechanism synthesis and stiffness
analysis of a robotic rehabilitation device. Autonomous Ro-
bots, 16(2): 207–218.
Dettwylera, M., Stacoffa, A., Kramers-de Quervaina, I. A.,
and Stüssi, E. (2004). Modeling of the ankle joint complex.
Reflections with regards to ankle prostheses. Foot and An-
kle Surgery, 10: 109–119.
Deutsch, J., Latonio, J., Burdea, G., and Boian, R. (2001a). Re-
habilitation of musculoskeletal injuries using the Rutgers
ankle haptic interface: three case reports. Eurohaptics Con-
ference, Birmingham, UK, July.
Deutsch, J., Latonio, J., Burdea, G., and Boian, R. (2001b).
Post-stroke rehabilitation with the Rutgers ankle system: a
case study. Presence: Teleoperators and Virtual Environ-
ments, 10(4): 416–430.
Dong, S., Lu, K.-Q., Sun, J. Q., and Rudolph, K. (2006). A
prototype rehabilitation device with variable resistance and
joint motion control. Medical Engineering and Physics,
28(4): 348–355.
Girone, M. J., Burdea G. C., and Bouzit, M. (1999). The
Rutgers ankle orthopedic rehabilitation interface. Proceed-
ings of the ASME International Mechanical Engineering
Congress and Exposition on Dynamic Systems and Con-
trol Division, Vol. 67, Nashville, TN, November, pp. 305–
312.
Girone, M., Burdea, G., Bouzit, M., and Deutsch, J. (2000).
Orthopedic rehabilitation using the ‘Rutgers Ankle’ inter-
1227
face. Proceedings of Medicine Meets Virtual Reality, Janu-
ary. IOS Press, pp. 89–95.
Girone, M., Burdea, G., Bouzit, M., Popescu, V., and Deutsch,
J. (2001). A Stewart platform-based system for ankle telere-
habilitation, invited article. Autonomous Robots, 10: 203–
212.
Krebs, H. I., Hogan, N., Aisen, M. L., and Volpe, B. T.
(1998). Robot-aided neuro-rehabilitation. IEEE Transac-
tions on Rehabilitation Engineering, 6(1): 75–87.
Liu, G., Gao, J., Yue, H., Zhang, X., and Lu, G. (2006). Design
and kinematics analysis of parallel robots for ankle rehabil-
itation. Proceedings of the IEEE/RSJ International Confer-
ence on Intelligent Robots and Systems, Beijing, October,
pp. 253–258.
Mattacola, C. G. and Dwyer, M. K. (2002). Rehabilitation of
the ankle after acute sprain or chronic instability. Journal of
Athletic Training, 37(4): 413–429.
Payne, K. A., Berg, K., and Latin, R. W. (1997). Ankle injuries
and ankle strength, flexibility, and proprioception in col-
lege basketball players. Journal of Athletic Training, 32(3):
221–225.
Parenteau, C. S., Viano, D. C., and Petit, P. Y. (1998). Bio-
mechanical properties of human cadaveric ankle–subtalar
joints in quasi-static loading. Journal of Biomechanical En-
gineering, 120(1): 105–110.
Saglia, J. A. and Dai, J. S. (2007). Geometry and kinematic
analysis of a redundant type parallel mechanism for reha-
bilitation. Proceedings of the ASME International Design
Engineering Technical Conferences and Computers and In-
formation in Engineering Conference, Las Vegas, NV, Sep-
tember.
Saglia, J. A., Dai, J. S., and Caldwell, D. G. (2008). Geometry
and kinematic analysis of a redundantly actuated parallel
mechanism that eliminates singularities and improves dex-
terity. Transactions of the ASME: Journal of Mechanical
Design, 130(12): 124501.
Saglia, J. A., Tsagarakis, N. G., Dai, J. S., and Caldwell, D. G.
(2009). Inverse-kinematics-based control of a redundantly
actuated platform for rehabilitation. Proceedings of the In-
stitution of Mechanical Engineers, Part I: Journal of Sys-
tems and Control Engineering, 223(1): 53–70.
Wheeler, J. W., Krebs, H. I., and Hogan, N. (2004). An an-
kle robot for a modular gait rehabilitation system. Proceed-
ings of the IEEE RSJ International Conference on Intelli-
gent Robots and Systems, Vol. 2, Sendal, Japan, September,
pp. 1680–1684.
Yoon, J. and Ryu, J. (2005). A novel reconfigurable ankle/foot
rehabilitation robot, Proceedings of the 2005 IEEE Interna-
tional Conference on Robotics and Automation, Daejeon,
Korea, April, pp. 2290–2295.