J.L. Pons et al. (Eds.): Converging Clinical & Engi. Research on NR, BIOSYSROB 1, pp. 255258.

DOI: 10.1007/978-3-642-34546-3_40 Springer-Verlag Berlin Heidelberg 2013

Design of a Pediatric Exoskeleton for the
Rehabilitation of the Physical Disabilities
Caused by Cerebral Palsy
Marina Canela
1
, Antonio J. del Ama
2
, and Jos Luis Pons
1

1
Bioengineering Group of the Spanish National Research Council, Madrid, Spain
mcr1088@gmail, jose.pons@csic.es
2
Biomechanics and Technical Aids Department National Hospital for Spinal Cord Injury,
Toledo, Spain
Abstract. Exoskeletons for lower limbs represent a tool to assist gait training on
patients with impaired mobility resulting from spinal cord injury or cerebral palsy,
among other pathologies. The exoskeleton designs proposed so far are generally
oriented to adult patients. In this work, we propose a new exoskeleton specifically
focused on children with cerebral palsy in the age range of 7 and 17. Its design
and development process is here presented and future application proposed.
Keywords: exoskeleton, cerebral palsy, pediatrics, rehabilitation, design.
1 Introduction
Cerebral palsy (CP) is the term to define a group of disorders of movement and/or
posture that results from a permanent injury of the central nervous system, causing
ultimately a physical disability. There are different types of CP, which can be
classified by predominant motor disorder, anatomical distribution and functional
status. Every type of CP requires different rehabilitation strategies. Furthermore,
the same pathology may result in different clinical features, requiring more
customization in the design of the rehabilitation management.
An exoskeleton is an artificial external structure that assists the natural skeleton
of the user in the performance of usual tasks like moving or carrying weights.
These devices can also be used in the rehabilitation of children with impaired
locomotion such as in CP.
Like in other disorders, musculoskeletal problems caused by CP can be
improved if they are treated in initial stages. Consequently, it is crucial to offer to
this type of patients the available rehabilitation technology at earlier ages.
In this paper we present the process and results of the mechanical design of a
pediatric exoskeleton for the rehabilitation of the physical disabilities caused
by CP. The starting points of this methodology are, on the one hand, the
anthropometric requirements needed to fit to a majority of users, and on the other
hand, a previous adult version of the device, which has been adequately adapted to
meet the cited necessities.
256 M. Canela, A.J. del Ama, and J.L. Pons

2 Materials and Methods
The design of the pediatric exoskeleton for the rehabilitation of physical
disabilities caused by CP consisted in two fundamental stages. First, the
specifications of the users were obtained from a preliminary study of the target
population. After that, the design of the exoskeleton was developed.
2.1 Definition of Users Specifications and Device Requirements
The exoskeleton is focused to a child population, aged between 7 and 17 years old.
From public anthropometric data [1][2], including tibial and femoral lengths in
children, and an estimation of the ankle height performed at the laboratory, it was
possible to calculate the height range of the three articulations involved in the
design of the exoskeleton.
A variety of exclusion criteria for the target users must be taken into account
in order to guarantee a correct operation of the device: epilepsy, arthrodesis,
anatomical anomalies, anatomical dysmetria, high pelvic obliquity (> 10),
spasticity (> 2 in the Modified Ashworth scale), injuries and fractures and obesity.
2.2 Design of the Exoskeleton
The pediatric exoskeleton has been developed from a previous adult version
developed in the context of the EU funded projects Hyper [3], and Gait [4].
Independent legs compose the adult exoskeleton. Each leg is constituted by two
segments (tibial and femoral) and a foot support. These three parts are articulated
by three joints and are adjusted to the body by means of several belts. This base
configuration has evolved with modifications and ended up in a pediatric version.
Specifically, the tibial segments has been replaced by telescopic bars of three
interchangeable sizes (Table 1), allowing to fit a larger population.
Table 1 Corresponding articulation heights for each tibial telescopic system size


The rest of the components, including electric motors, reducers (Table 2), belts
and fixations, have been resized to meet the force requirements of a child, which
are lower than in an adult.
Tibial
telescopic
bar size
Ankle height
range (mm)
Knee height
range (mm)
Hip height
range (mm)
Small
95.0
100.0
219.4
266.0
489.5
536.0
Medium
100.0
110.0
266.0
313.0
536.0
620.0
Large
110.0
110.5
313.0
359.6
520.0
666.5
Design of a Pediatric Exoskeleton for the Rehabilitation of the Physical Disabilities 257

Table 2 Components of the actuator system in the pediatric and adult version. Both
adult and pediatric version reducers are harmonic drive and remain the same. Notice that
only the hip motor of the adult version had to be resized to meet the pediatric version needs.


The exposed knowledge and modifications were taken into account and
incorporated into the design performed with the 3D computer-aided design (CAD)
tool for solid modeling Pro/Engineer (Parametric Technology Corp., Needham,
Massachusetts, USA) that yielded the pediatric exoskeleton final design.
3 Results and Conclusions
Results of the design process are shown in Figures 1 to 3. The render of a single
leg of the pediatric exoskeleton is shown in Figure 1 from two different
perspectives.

Fig. 1 Render of the 3D model of the left leg of the pediatric exoskeleton from two points of
view
In figure 2, the three exoskeleton articulations are shown, detailing the main
components that form them.
A view of the smallest size of the pediatric exoskeleton model is represented in
Figure 3, including the segments and articulations measures.
In this article the methodology used to design and develop a pediatric
exoskeleton capable of assisting the rehabilitation of the locomotor effects of the
CP has been discussed. Prior to the design tasks, anthropometric requirements of
child population have been considered. After that, the mechanical system has been
designed from a previous adult version of the exoskeleton. In a near future a series
of experiments will be held in patients to validate the usefulness of the device
during the rehabilitation.

Joint Adult version
motor
Pediatric
version motor
Reducer
Ankle EC-45 70W 24V EC-45 70W 160/1
Knee EC-45 70W 24V EC-45 70W 160/1
Hip EC-90 90W 24V EC-45 70W 160/1
258 M. Canela, A.J. del Ama, and J.L. Pons


Fig. 2 Schematics for the three articulations, including its main components

Fig. 3 The small size version of the exoskeleton model. Mean height of the 7-year-old
children is compared to the mean adult height.
References
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(2003)
[2] Anderson, M.: Distribution of Lengths of the Normal Femurand Tibia in Children
from One to Eighteen Years of Age. Journal of Bone and Joint Suregery American 46,
11971202 (1964)
[3] del Alma, A.J.: Actuadores multimodales para compensacin de la marcha de
personas con patologa neurolgica. XXXII Jornadas Automtica, Vigo
[4] Cullell, A.: Biologically based design of an actuator system for a kneeanklefoot
orthosis. Mechanism and Machine Theory 44, 860872 (2009)