journal article·2025-07-11Open access

Cable-Driven Exoskeleton for Ankle Rehabilitation in Children with Cerebral Palsy

Iñaki Dellibarda Varela, Pablo Romero-Sorozabal, Gabriel Delgado-Oleas, Jorge Muñoz, Álvaro Gutiérrez, Eduardo Rocon

Applied Sciences· Volume 15· Issue 14

Abstract

Cerebral palsy is the leading cause of motor disability in early childhood, with no curative treatment currently available. To mitigate its effects and promote motor rehabilitation, robotic-assisted therapies have emerged as a complement to conventional physiotherapy. In particular, cable-driven exoskeletons offer notable advantages, providing patients with additional mobility and interaction with their environment while preserving motion assistance. Within this context, the Discover2Walk project introduces a modular cable-driven robotic platform designed for early-stage gait rehabilitation. This article presents a novel ankle control module capable of actuating 3 degrees of freedom: 2 translational (in the x and z directions) and 1 rotational (dorsiflexion/plantarflexion). Experimental results confirm the technical feasibility of the approach and its effectiveness in guiding motion within the targeted degrees of freedom.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Cerebral Palsy and Movement Disorders · Prosthetics and Rehabilitation Robotics · Stroke Rehabilitation and Recovery

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas (CSIC-UPM), 28500 Madrid, Spain

Ingeniería Electrónica, Universidad del Azuay, Cuenca 010107, Ecuador

ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain

Funding

Spanish Ministry of Science and Innovation · Ministry of Science and Innovation · CSIC JAE program

References (55)

Show source-provided references
1. Cerebral palsy: An overview
2. Parálisis Cerebral en Pediatría: Problemas Asociados10.46997/revecuatneurol30100115 ↗
3. Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults10.1016/j.amepre.2017.08.019 ↗
4. Systematic review of the economic impact of cerebral palsy10.1016/j.ridd.2018.06.012 ↗
5. Wearable Lower-Limb Exoskeleton for Children with Cerebral Palsy: A Systematic Review of Mechanical Design, Actuation Type, Control Strategy, and Clinical Evaluation10.1109/TNSRE.2021.3136088 ↗
6. A Robotic Exoskeleton for Treatment of Crouch Gait in Children with Cerebral Palsy: Design and Initial Application10.1109/TNSRE.2016.2595501 ↗
7. Improvement of Walking Abilities After Robotic-Assisted Locomotion Training in Children with Cerebral Palsy10.1136/adc.2008.145458 ↗
8. Rehabilitation Robotics: Performance-Based Progressive Robot-Assisted Therapy10.1023/A:1024494031121 ↗
9. Effectiveness of Robot-Assisted Therapy on Ankle Rehabilitation—A Systematic Review10.1186/1743-0003-10-30 ↗
10. Embodiment for Robotic Lower-Limb Exoskeletons: A Narrative Review10.1109/TNSRE.2022.3229563 ↗
11. A Systematic Review on Rigid Exoskeleton Robot Design for Wearing Comfort: Joint Self-Alignment, Attachment Interface, and Structure Customization10.1109/TNSRE.2024.3479283 ↗
12. Delgado, E., Cumplido, C., Ramos, J., Garcés, E., Puyuelo, G., Plaza, A., Hernández, M., Gutiérrez, A., Taverner, T., and Destarac, M.A. (2021). ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children with Cerebral Palsy. A Case Series Study. Front. Pediatr., 9.10.3389/fped.2021.753226 ↗
13. Castro, P., Martí, M., Oliván-Blázquez, B., Boñar, N., García, V., Gascón-Santos, S., Panzano, A., Vela, S., Tajadura, S., and Peña, A. (2024). Benefits of Robotic Gait Assistance with ATLAS 2030 in Children with Cerebral Palsy. Front. Pediatr., 12.10.3389/fped.2024.1398044 ↗
14. Lokomat: A Therapeutic Chance for Patients with Chronic Hemiplegia
15. Wu, L., Xu, G., and Wu, Q. (2023). The Effect of the Lokomat Robotic-Orthosis System on Lower Extremity Rehabilitation in Patients with Stroke: A Systematic Review and Meta-Analysis. Front. Neurol., 14.10.3389/fneur.2023.1260652 ↗
16. Blazkiewicz, M., and Hadamus, A. (2024). Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy: A Progress Evaluation. J. Clin. Med., 13.10.3390/jcm13216417 ↗
17. The State-of-the-Art of Soft Robotics to Assist Mobility: A Review of Physiotherapist and Patient Identified Limitations of Current Lower-Limb Exoskeletons and the Potential Soft-Robotic Solutions10.1186/s12984-022-01122-3 ↗
18. Koch, M.A., and Font-Llagunes, J.M. (2021). Lower-Limb Exosuits for Rehabilitation or Assistance of Human Movement: A Systematic Review. Appl. Sci., 11.10.3390/app11188743 ↗
19. Opportunities and Challenges in the Development of Exoskeletons for Locomotor Assistance10.1038/s41551-022-00984-1 ↗
20. Kóra, S., Bíró, A., Prontvai, N., Androsics, M., Drotár, I., Prukner, P., Haidegger, T., Széphelyi, K., and Tollár, J. (2024). Investigation of the Effectiveness of the Robotic ReStore Soft Exoskeleton in the Development of Early Mobilization, Walking, and Coordination of Stroke Patients: A Randomized Clinical Trial. Robotics, 13.10.3390/robotics13030044 ↗
21. Chandran, V.D., Nam, S., Hexner, D., Bauman, W.A., and Pal, S. (2023). Comparison of the Dynamics of Exoskeletal-Assisted and Unassisted Locomotion in an FDA-Approved Lower Extremity Device: Controlled Experiments and Development of a Subject-Specific Virtual Simulator. PLoS ONE, 18.10.1371/journal.pone.0270078 ↗
22. The ReWalk ReStore™ Soft Robotic Exosuit: A Multi-Site Clinical Trial of the Safety, Reliability, and Feasibility of Exosuit-Augmented Post-Stroke Gait Rehabilitation10.1186/s12984-020-00702-5 ↗
23. Cable Driven Exoskeleton for Upper-Limb Rehabilitation: A Design Review10.1016/j.robot.2020.103445 ↗
24. A Novel Cable Configuration Method for Fully-Actuated Parallel Cable-Driven Systems: Application in a Shoulder Rehabilitation Exoskeleton10.1016/j.mechmachtheory.2024.105693 ↗
25. Gonçalves, R.S., Alves, T., Carbone, G., and Ceccarelli, M. (2020). Cable-Driven Robots in Physical Rehabilitation: From Theory to Practice. Handbook of Research on Advancements in Robotics and Mechatronics, IGI Global.10.4018/978-1-7998-1382-8.ch003 ↗
26. Lee, S.H., Park, G., Cho, D.Y., Kim, H.Y., Lee, J.Y., Kim, S., Park, S.B., and Shin, J.H. (2020). Comparisons Between End-Effector and Exoskeleton Rehabilitation Robots Regarding Upper Extremity Function Among Chronic Stroke Patients with Moderate-to-Severe Upper Limb Impairment. Sci. Rep., 10.10.1038/s41598-020-58630-2 ↗
27. Effects of Robot-Assisted Therapy for the Upper Limb After Stroke10.1177/1545968316666957 ↗
28. Design of a 7-DOF Cable-Driven Arm Exoskeleton (CAREX-7) and a Controller for Dexterous Motion Training or Assistance10.1109/TMECH.2016.2618888 ↗
29. Design and Development of the Cable Actuated Finger Exoskeleton for Hand Rehabilitation Following Stroke10.1109/TMECH.2012.2224359 ↗
30. Germanotta, M., Guerrini, A., Siotto, M., Fasano, A., Cipollini, V., Cortellini, L., Pavan, A., Insalaco, S., Antonacci, E., and Ruco, E. (2024). Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation. Nutrients, 16.10.3390/nu16213589 ↗
31. Robotic-Assisted Rehabilitation of the Upper Limb After Stroke: The Role of the Diego System
32. Cable-Driven Lower Limb Rehabilitation Robot10.1007/s40430-018-1172-y ↗
33. Design and Development of a New Cable-Driven Parallel Robot for Waist Rehabilitation
34. Development of a novel cable-driven parallel robot for full-cycle ankle rehabilitation10.1016/j.mechatronics.2024.103210 ↗
35. Prasad, R., El-Rich, M., Awad, M.I., Agrawal, S.K., and Khalaf, K. (2023). Bi-Planar Trajectory Tracking with a Novel 3DOF Cable Driven Lower Limb Rehabilitation Exoskeleton (C-LREX). Sensors, 23.10.3390/s23031677 ↗
36. Prasad, R., El-Rich, M., Awad, M.I., Kim, J., and Khalaf, K. (2024). Muscle-inspired bi-planar cable routing: A novel framework for designing cable driven lower limb rehabilitation exoskeletons (C-LREX). Sci. Rep., 14.10.1038/s41598-024-55785-0 ↗
37. A cable-driven locomotor training system for restoration of gait in human SCI10.1016/j.gaitpost.2010.11.016 ↗
38. Wu, M., Landry, J.M., Yen, S.C., Schmit, B.D., Hornby, T.G., and Rafferty, M. (2021). A novel cable-driven robotic training improves locomotor function in individuals post-stroke. Annu. Int. Conf. IEEE Eng. Med. Biol. Soc., 8539–8542.
39. Dellibarda, I., Romero-Sorozabal, P., Delgado-Oleas, G., Gutiérrez, Á., Muñoz, J., and Rocon, E. (2024, January 6–8). A Cable-Driven Exoskeleton to Control Ankle Mobility During Gait in Children with Cerebral Palsy. Proceedings of the 2024 7th Iberian Robotics Conference (ROBOT), Madrid, Spain.
40. Romero-Sorozabal, P., Delgado-Oleas, G., Laudanski, A.F., Gutiérrez, Á., and Rocon, E. (2024, January 14–18). Discover2Walk: A Cable-Driven Robotic Platform to Promote Gait in Pediatric Population. Proceedings of the 2024 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Madrid, Spain.10.1109/IROS58592.2024.10802838 ↗
41. Bioinspired Hierarchical Electronic Architecture for Robotic Locomotion Assistance: Application in Exoskeletons10.1109/ACCESS.2023.3336003 ↗
42. Romero-Sorozabal, P., Delgado-Oleas, G., Gutiérrez, Á., and Rocon, E. (2023, January 1–5). Individualized Three-Dimensional Gait Pattern Generator for Lower Limbs Rehabilitation Robots. Proceedings of the 2023 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Detroit, MI, USA.10.1109/ICORR58425.2023.10304753 ↗
43. EEG Control of Gait in Children with Cerebral Palsy: Preliminary Data for the Construction of a Brain-Computer Interface10.1016/j.gaitpost.2015.06.082 ↗
44. Collection of Normative Data for Spatial and Temporal Gait Parameters in a Sample of French Children Aged Between 6 and 1210.1016/j.rehab.2015.04.001 ↗
45. Pott, A. (2018). Cable-Driven Parallel Robots: Theory and Application, Springer. [1st ed.].10.1007/978-3-319-76138-1 ↗
46. Human-Robot Cooperative Movement Training: Learning a Novel Sensory Motor Transformation during Walking with Robotic Assistance-as-Needed10.1186/1743-0003-4-8 ↗
47. Minimal Assist-as-Needed Controller for Upper Limb Robotic Rehabilitation10.1109/TRO.2015.2503726 ↗
48. Carmichael, M.G., and Liu, D. (2013, January 3–7). Admittance Control Scheme for Implementing Model-Based Assistance-as-Needed on a Robot. Proceedings of the 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Osaka, Japan.10.1109/EMBC.2013.6609639 ↗
49. Development and reliability of a system to classify gross motor function in children with cerebral palsy10.1111/j.1469-8749.1997.tb07414.x ↗
50. The Central Nervous System Stabilizes Unstable Dynamics by Learning Optimal Impedance10.1038/35106566 ↗
51. Human-like Adaptation of Force and Impedance in Stable and Unstable Interactions10.1109/TRO.2011.2158251 ↗
52. Training task planning-based adaptive assist-as-needed control for upper limb exoskeleton using neural network state observer10.1007/s00521-024-09922-5 ↗
53. Assisting walking balance using a bio-inspired exoskeleton controller10.1186/s12984-023-01205-9 ↗
54. Almeida, J.F., and Santos, C.P. (2025, July 08). A Review on Bio-Inspired Control Strategies for Wearable Robotic Devices. SSRN Electron. J., Available online: https://ssrn.com/abstract=4895828.10.2139/ssrn.4895828 ↗
55. Dellibarda Varela, I., Romero-Sorozabal, P., Delgado-Oleas, G., Gutiérrez, Á., Muñoz, J., and Rocon, E. (2024, January 13–15). Implementación y control de un exoesqueleto basado en estructura de cables para la asistencia de tobillo durante la marcha en niños con parálisis cerebral. Proceedings of the CASEIB, Sevilla, Spain.