journal article·2026-02-19Open access

Design of a Safe Active Orthosis for Full Assistance of the Human Knee Joint

Jonas Paul David, Johannes Schick, Robin Neubauer, Markus Glaser

Applied Sciences· Volume 16· Issue 4

Abstract

Ensuring user safety while enabling independent mobility is crucial to autonomous healthcare and rehabilitation robots, such as active lower-limb orthoses and exoskeletons. A key requirement for these devices is to provide full assistance without supervision; however, existing designs do not simultaneously satisfy autonomous operation and inherent safety. To address this gap, a novel safety principle, Safety by Design, and a corresponding system architecture for a fully assistive active knee orthosis are introduced. The proposed architecture is based on a comprehensive risk analysis for the use of active orthoses and exoskeletons and integrates redundancies for all safety-critical components while minimizing additional weight. This redundancy enables the orthosis to remain operational at reduced power in the event of component failure, improving both user safety and system reliability. The design supports safe, unsupervised operation by ambulatory users, enhancing independent patient mobility and the performance of the gait activities of level walking, stair climbing and sitting down/standing up. The proposed architecture is scalable and adaptable to a wide range of robotic devices. By improving robustness, efficiency, and safety, this work contributes to the advancement of autonomous biomedical robotic systems and wearable assistive devices.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Prosthetics and Rehabilitation Robotics · Stroke Rehabilitation and Recovery · Total Knee Arthroplasty Outcomes

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

Affiliations

Institute for High Integrity Mechatronic Systems (ZMS), Aalen University, 73430 Aalen, Germany

Funding

Ministry of Economic Affairs, Labour and Tourism Baden-Württemberg

References (65)

Show source-provided references
1. Load-bearing optimization for customized exoskeleton design based on kinematic gait reconstruction10.1007/s11517-024-03234-5 ↗
2. Shi, D., Wang, L., Zhang, Y., Zhang, W., Xiao, H., and Ding, X. (2022). Review of human—Robot coordination control for rehabilitation based on motor function evaluation. Front. Mech. Eng., 17.10.1007/s11465-022-0684-4 ↗
3. Design of active orthoses for a robotic gait rehabilitation system10.1007/s11465-015-0350-1 ↗
4. An admittance controller based on assistive torque estimation for a rehabilitation leg exoskeleton10.1007/s11370-019-00289-4 ↗
5. Bellitto, A., Cordera, M.E., Mandraccia, S., Leoncini, C., Massone, A., Casadio, M., and Pierella, C. (2025). Personalized Exoskeleton Gait Training in Incomplete Spinal Cord Injury. Appl. Sci., 15.10.3390/app15179269 ↗
6. Rosales-Luengas, Y., Salazar, S., Rangel-Popoca, S.J., Cortés-García, Y., Flores, J., and Lozano, R. (2025). Active Gait Retraining with Lower Limb Exoskeleton Based on Robust Force Control. Appl. Sci., 15.10.3390/app15074032 ↗
7. Review of assistive strategies in powered lower-limb orthoses and exoskeletons10.1016/j.robot.2014.09.032 ↗
8. de La Tejera, J.A., Bustamante-Bello, R., Ramirez-Mendoza, R.A., and Izquierdo-Reyes, J. (2021). Systematic Review of Exoskeletons towards a General Categorization Model Proposal. Appl. Sci., 11.10.3390/app11010076 ↗
9. Lower-Limb Medical and Rehabilitation Exoskeletons: A Review of the Current Designs10.1109/RBME.2021.3078001 ↗
10. Lower Extremity Exoskeletons and Active Orthoses: Challenges and State-of-the-Art10.1109/TRO.2008.915453 ↗
11. Exoskeletons and orthoses: Classification, design challenges and future directions10.1186/1743-0003-6-21 ↗
12. Compliant lower limb exoskeletons: A comprehensive review on mechanical design principles10.1186/s12984-019-0517-9 ↗
13. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments10.1186/s12984-021-00815-5 ↗
14. Tiboni, M., Borboni, A., Vérité, F., Bregoli, C., and Amici, C. (2022). Sensors and Actuation Technologies in Exoskeletons: A Review. Sens., 22.10.3390/s22030884 ↗
15. (2025, September 14). ReStore™ Soft Exo-Suit for Stroke Rehabilitation. Available online: https://golifeward.com/products/restore-exo-suit/.
16. (2025, September 14). Exoesqueletos. Exoesqueleto Médico|Hank|Rehabilitación I Gogoa. Available online: https://www.gogoa.eu/en-us/exoesqueleto-rehabilitacion-neurologica-traumatologica-hank.
17. (2025, September 14). Ekso Indego Personal—Eksobionics. Available online: https://eksobionics.com/de/ekso-indego-personal/.
18. CYBERDYNE (2024, April 22). Medical HAL Lower Limb. Available online: https://www.cyberdyne.jp/english/products/LowerLimb_medical.html.
19. (2025, September 14). Lifeward|ReWalk 7 Personal Exoskeleton for Spinal Cord Injury. Available online: https://golifeward.com/products/rewalkpersonal-exoskeleton/.
20. Rex Bionics (2024, April 14). Rex Bionics—Reimagining Rehabilitation. Available online: https://www.rexbionics.com/.
21. (2025, September 14). Atalante X|A new kind of rehabilitation. Available online: https://en.wandercraft.eu/atalante-x-rehabilitation-exoskeleton.
22. Walking propulsion generation in double stance by powered exoskeleton for paraplegics10.1016/j.robot.2019.03.002 ↗
23. A multiple-task gait analysis approach: Kinematic, kinetic and EMG reference data for healthy young and adult subjects10.1016/j.gaitpost.2010.08.009 ↗
24. Rohatgi, A. (2025, September 14). WebPlotDigitizer (Version 5.2), Available online: https://automeris.io.
25. Stair ascent and descent at different inclinations10.1016/S0966-6362(01)00162-X ↗
26. Schick, J., Glaser, M., and Kennel, R. (2020). Risk Assessment and Mitigation Strategies for Active Lower Limb Exoskeletons. Proceedings of the 2020 Annual Reliability and Maintainability Symposium (RAMS), IEEE Press.10.1109/RAMS48030.2020.9153676 ↗
27. Bessler, J., Prange-Lasonder, G.B., Schaake, L., Saenz, J.F., Bidard, C., Fassi, I., Valori, M., Lassen, A.B., and Buurke, J.H. (2021). Safety Assessment of Rehabilitation Robots: A Review Identifying Safety Skills and Current Knowledge Gaps. Front. Robot. AI, 8.10.3389/frobt.2021.602878 ↗
28. Safety in Wearable Robotic Exoskeletons: Design, Control, and Testing Guidelines10.1115/1.4066900 ↗
29. Staff, I. (2012). Test method for contact safety assessment of a wearable robot—Analysis of load caused by a misalignment of the knee joint. Proceedings of the 2012 IEEE Ro-Man. 2012 RO-MAN: The 21st IEEE International Symposium on Robot and Human Interactive Communication, Paris, France, 9–13 September 2012, IEEE.
30. Assessing effects of exoskeleton misalignment on knee joint load during swing using an instrumented leg simulator10.1186/s12984-022-00990-z ↗
31. Anthropomorphic design and control of a polycentric knee exoskeleton for improved lower limb assistance10.1007/s11370-024-00512-x ↗
32. Active Safety Functions for Industrial Lower Body Exoskeletons: Concept and Assessment
33. Beer, M., and Zio, E. (2019). Safety and Reliability Analysis of an Actuation System. Proceedings of the 29th European Safety and Reliability Conference (ESREL), Hannover, Germany, 22–26 September 2019, Research Publishing Services. European Safety and Reliability Association.
34. Popp, J., Glaser, M., Bertsche, B., Imle, S., and Winter, T. (2020). High Available, Fault Tolerant and Safety Critical Subsea Actuator System. Proceedings of the 2020 Annual Reliability and Maintainability Symposium (RAMS), Palm Springs, CA, USA, 27–30 January 2020, IEEE.10.1109/RAMS48030.2020.9153688 ↗
35. Çetin, A., Yıldırım, T., and Bolat, B. (2024). Functional Safety Analysis and Proposal of Fail-Operational Steer-by-Wire System. Proceedings of the 2024 Innovations in Intelligent Systems and Applications Conference (ASYU), Ankara, Turkiye, 16–18 October 2024, IEEE.
36. Li, M., and Eckstein, L. (2019). Fail-Operational Steer-By-Wire System for Autonomous Vehicles. Proceedings of the 2019 IEEE International Conference on Vehicular Electronics and Safety (ICVES), Cairo, Egypt, 4–6 September 2019, IEEE.10.1109/ICVES.2019.8906395 ↗
37. Pimentel, J.R. (2006). Safety-Critical Automotive Systems, Society of Automotive Engineers.10.4271/PT-103 ↗
38. Tian, C., Zong, C., He, L., Wang, X., and Dong, Y. (2009). Fault tolerant control method for steer-by-wire system. Proceedings of the 2009 International Conference on Mechatronics and Automation, ICMA 2009, Changchun, China, 9–12 August 2009, IEEE.
39. (2025, August 06). Regulation-2017/745-EN-Medical Device Regulation-EUR-Lex, 2025. Available online: https://eur-lex.europa.eu/eli/reg/2017/745/oj/eng.
40. Official Journal of the European Union (2025, July 19). REGULATION (EU) 2017/745 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL: On Medical Devices, Amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32017R0745.
41. (2025, August 06). Regulation-2023/1230-EN-EUR-Lex, 2025. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32023R1230.
42. (2025, August 06). Regulation-2016/425-EN-EUR-Lex, 2025. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32016R0425.
43. (2025, August 06). Directive-2014/35-EN-Low Voltage Directive-EUR-Lex, 2025. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32014L0035.
44. (2025, August 06). Regulation-2023/988-EN-EUR-Lex, 2025. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32023R0988.
45. US FDA (2025, August 06). eCFR: 21 CFR Part 890—Physical Medicine Devices, Available online: https://www.ecfr.gov/current/title-21/chapter-I/subchapter-H/part-890?toc=1.
46. (2025, August 05). COVR. Available online: https://www.safearoundrobots.com/.
47. Relevance of hazards in exoskeleton applications: A survey-based enquiry10.1186/s12984-023-01191-y ↗
48. Statistisches Bundesamt (2025, August 27). Körpermaße Nach Altersgruppen und Geschlecht. Available online: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Gesundheitszustand-Relevantes-Verhalten/Tabellen/liste-koerpermasse.html#104708.
49. HapticWalker—A novel haptic foot device10.1145/1060581.1060589 ↗
50. Marinelli, C., Giberti, H., and Resta, F. (2015). Conceptual design of a gait simulator for testing lower-limb active prostheses. Proceedings of the 2015 16th International Conference on Research and Education in Mechatronics (REM), Bochum, Germany, 18–20 November 2015, IEEE.10.1109/REM.2015.7380413 ↗
51. Winter, D.A. (2009). Biomechanics and Motor Control of Human Movement, Wiley.10.1002/9780470549148 ↗
52. How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: A narrative review10.1136/bjsports-2017-097628 ↗
53. Risk management and regulations for lower limb medical exoskeletons: A review
54. Winter, T., Schnitzler, J., Schick, J., Popp, J., Imle, S., Glaser, M., and Bertsche, B. (2019, January 22–26). Empirical Reliability Analysis of a Safety-related Battery. Proceedings of the 29th European Safety and Reliability Conference, Hannover, Germany.10.3850/978-981-11-2724-3_0913-cd ↗
55. David, J.P., Schick, D., Rapp, L., Schick, J., and Glaser, M. (2024). SensAA—Design and Verification of a Cloud-Based Wearable Biomechanical Data Acquisition System. Sensors, 24.10.20944/preprints202401.0686.v1 ↗
56. Changcheng, C., Li, Y.-R., and Chen, C.-T. (2022). Assistive Mobility Control of a Robotic Hip-Knee Exoskeleton for Gait Training. Sensors, 22.10.3390/s22135045 ↗
57. Chen, J., Hochstein, J., Kim, C., Damiano, D., and Bulea, T. (2018, January 26–29). Design Advancements toward a Wearable Pediatric Robotic Knee Exoskeleton for Overground Gait Rehabilitation. Proceedings of the 2018 7th IEEE International Conference on Biomedical Robotics and Biomechatronics (Biorob), Enschede, The Netherlands.10.1109/BIOROB.2018.8487195 ↗
58. A new lower limb portable exoskeleton for gait assistance in neurological patients: A proof of concept study10.1186/s12984-020-00690-6 ↗
59. Lithium Werks (2026, January 26). Cells-ANR26650m1B-Lithium Werks. Available online: https://lithiumwerks.com/products/lithium-ion-26650-cells/.
60. Custom orthotic design by integrating 3D scanning and subject-specific FE modelling workflow10.1007/s11517-024-03067-2 ↗
61. (2009). Ausfallraten Bauelemente (Standard No. SN 29500).
62. Union Technique de l’Electricite (2013). RDF 2000: Reliability Data Handbook, Union Technique de l’Electricite. UTE C80-810.
63. United States Department of Defense (DoD) (1991). Military Handbook: Reliability Prediction of Electronic Equipment, United States Department of Defense (DoD). MIL-HDBK-217F.
64. Age-Related Imbalance Is Associated with Slower Walking Speed: An Analysis From the National Health and Nutrition Examination Survey10.1519/JPT.0000000000000093 ↗
65. Wittenstein Cyber Motor (2026, January 31). Cyber® Dynamic Motor-brushless Servo Motors-WITTENSTEIN Cyber Motor. Available online: https://cyber-motor.wittenstein-us.com/products/servo-motors/rotative-synchronous-motors/cyber-dynamic-motor-brushless-servo-motors/.