A method to optimize shoe stiffness for stroke

gait using a bipedal walking model

Karna Potwar ∗1 , Elizabeth Chandler 2 , Valerie Pomeroy2,3 , Leif
Johannsen2,4 , and Dongheui Lee1,5
1
Chair of Human Centered Assistive Robotics, Technical University
of Munich (TUM), Munich, Germany
2
School of Health Sciences, University of East Anglia (UEA),
Norwich, UK
3
National Institute of Health Research (NIHR) Brain Injury
MedTech, Cooperative, Cambridge, UK
4
Institute for Psychology, RWTH Aachen University, Aachen,
Germany
5
Institute of Robotics & Mechatronics, German Aerospace Center
(DLR), Wessling, Germany

December 10, 2020

Abstract
Background Hemiparesis after stroke affects one half of the body and
leads to unequal strength in the lower limbs. Process to design shoes
for stroke gait can help in reducing ground reaction force (GRF) under
the foot.
Research question Can a bipedal model be used to optimize shoe stiffness
for stroke gait?
∗
Corresponding author. Email: karna.potwar@tum.de, Tel.: +49 89 289 26885
Abstract: 249 words, Article: 2995 words

1
 Method To achieve this we propose a process of tuning the elasticity of the
shoe sole. We use a bipedal model that provides effective stiffness for
the leg and shoe complex by simulating steady state gait. We provide
a center of pressure progression model that tries to generate the move-
ment of plantar pressure under the foot. We compare the GRF trajec-
tory, center of pressure (COP) displacement and heel strike touch down
(TD) angle for the model with gait data from n=15 stroke subjects.
Results The best fit values of GRF occur at for the paretic leg with coeffi-
cient of determination R2 = 0.92 at 1.2 m/s for n=1 , for slow walking
speed of 0.88 m/s R2 = 0.73 for n=9. For non paretic leg at very slow
walking speed of 0.39 m/s with R2 = 0.82 for n=8 and very slow walk-
ing speed of 0.55 m/s with R2 = 0.80 for n=3. The model is able to
estimate the TD angle for n=5 with the least error for the paretic leg
with -15.29% and for the non-paretic leg 0.62%. COP displacement
values show large errors.
Significance A simple sagittal bipedal model that can estimate stroke GRF
can help in optimization of orthotic elements such as shoe soles, lifts,
inserts and wedges that can benefit stroke patient in equalizing GRF
and regain roll over ankle dynamics. (Stroke, Gait, Walking, Biome-
chanics, Footwear)

1 Introduction
Independent walking is among the primary concerns of individuals affected by
stroke [5]. Up to 95% of stroke patients demonstrate some recovery of locomotor
ability, ranging from assisted to independent walking, within 11 weeks post-stroke
[12] but less than 50% will be able to achieve independent community ambulation
[27]. Three months after stroke, up to 85% of patients show indications of im-
paired walking, such as reduced gait speed [6], which is still the case for 70-80%
in the long-term [20, 34]. Control of forces under each foot in combination with
inter-limb symmetry determines hemiparetic gait velocity in stroke patients [26].
Stroke patients experience difficulties in controlling the ground forces under their
paretic foot, which results in impaired stability of standing balance [29]. As such,
stroke survivors often portray an asymmetrical gait, due to an asymmetrical weight
bearing and shifting, and poor postural control, which can lead to an increased risk
of falling [11, 16, 17]. Shoe modifications have shown to restore gait symmetry
in stroke patients [32]. Cross et al. [4] suggested that by reducing power to lift
the paretic leg can provide faster transition for the hemiplegic side to the swing

2
phase and back to stance phase. By streamlining the distribution of GRF through
auxiliary devices speed up gait transition and increase gait speed.
Gait assistive orthotics such as shoe lifts, shoe wedges, compliant shoe soles
to regain symmetry and increase paretic leg contribution towards stance power
generation can be accomplished [7, 8, 18, 24, 39]. These devices either reorient the
foot or provide means of reducing load under the foot by absorbing impact forces.
There also exist orthotic devices that show importance of stiffness tuning for an
individual patient [19, 21, 30, 38]. Design of compliant orthoses can benefit from
a process providing optimal stiffness for reducing peak GRF forces. To accomplish
this we need a bipedal model that can not only simulate asymmetric stroke gait but
also estimate the COP movement during stroke gait. COP movement describes the
rate of change of plantar pressure due to GRF. Usually people with stroke walk
with very slow walking speeds (<0.8m/s) and the bipedal model should be able to
reproduce GRF dynamics at these slow speeds. There exist bipedal models with
COP translation but are limited either by their walking speed range (medium to
fast walking speed) or inaccuracy in generating GRF [2, 13, 15, 22, 35].
The objective of this study is to obtain stiffness values for shoe that can lead to
reduction of peak vertical GRF and improve ambulation of stroke patients (Fig. 1A.
In this study we develop a variant of the spring loaded inverted pendulum (SLIP)
model with COP translation [9, 25] that can simulate asymmetric leg parameters
based on the design parameters obtained from the data (Fig. 2). We do not esti-
mate horizontal GRF as majority of the stroke patients showed an increasing or
decreasing horizontal GRF profile which the SLIP model cannot handle. We ob-
tain periodic walking gaits by tuning the leg stiffness and comparing the GRF and
COP displacement from the model with data from 15 stroke survivors. We provide
recommended effective stiffness values which can lead to decrease in peak force
under the foot. Through these effective stiffness we can obtain shoe stiffness values
catering to individual patients.

2 Gait analysis & stiffness optimization

Gait data consisted of 15 subjects (82 ± 16.75 kg, 1.74 ± 0.10m) (see Table 1) with
varying degree of hemiparesis provided from data collected by SWIFT CAST Trial
[28]. The gait was captured using a twelve camera motion capture system (Vicon
Mx Giganet, Oxford Metrics, UK) and four force plates (Kistler Instrumente AG,
Switzerland). Data sampling was set at 100 Hz. A marker set (Fig. 1B consisting
of five rigid clusters, each comprised of four 14mm diameter markers and 17 skin

3
markers placed on anatomical landmarks on the region as shown in Fig. 1B, the
latter for calibration purpose only, was employed. All markers were of the pas-
sive reflective type. Clusters were positioned on the distal part of the thigh and
shank segments and on the back of test subjects using hypoallergenic double sided
tape [3]. Three additional markers on each foot were positioned on the first and
fifth metatarsal head and on the calcaneus to describe the 3D motion of the foot.
This marker set allowed the definition of anatomical frames of reference in ac-
cordance with standard recommendations [1, 37] and hence the reconstruction of
the segment model. Four force plates were used to measure the GRF and center of
pressure (COP) excursion during stance. Joint kinetics were obtained using inverse
dynamics.
To simulate the bipedal SLIP model (Fig. 1C we relied on design parameter
relations obtained from the data as shown in Fig. 2A. Due to very low R2 values
for all the parameters except heel strike touch down angle, we scanned the whole
parameter space for θo , k̃ef f , d. To calculate the heel strike touch down (TD) angle,
the link joining the center of mass (COM) to the medial mallelous ((L/R)MMAL)
marker (Fig. 1B) was used at the beginning of the stance. GRF of the paretic and
non-paretic leg were extracted for the stance phase. Apex velocity (vapex ) of each
subject is obtained from the data, when the COM achieves upright stance during
the single stance phase. This velocity is then used as an initial condition in the
bipedal model to simulate two consecutive apexes1 (Fig. 1C. COP translation is
measured as the distance traveled by the COP on the force plates from heel strike
to toe lift off during stance phase.
We provide a COP translation model that depends on the horizontal COM ac-
celeration. During stance phase, the leg stores energy and releases upon leg lift
off (LO). To obtain a generic bipedal model, we non-dimensionalize our model
equations qby dividing the √ length terms with uncompressed leg length lo , dividing
lo
time by g , velocity by glo and acceleration by g, where g is acceleration due
to gravity. The leg force, COM acceleration and COP acceleration during stance
1
An apex is a state during stance phase when the leg is orthogonal to the walking surface and
vertical COM velocity is 0

4
are defined as
k̃leg k̃s
k̃ef f = (1)
k̃leg + k̃s
F = k̃ef f (1 − l) (2)
ẍ = Fp sin θp + Fnp sin θnp (3)
ÿ = Fp cos θp + Fnp cos θnp − 1 (4)
x − xcp
θ = tan−1 (5)
y
ẍcp = µẍ (6)
p k l
where l = (x − xf )2 + y 2 , k̃ef f = efmgf o is relative effective stiffness,(x, y)
is COM horizontal and vertical position, xcp is COP position, kef f is effective
stiffness and m is mass. Subscripts p and np denote paretic and non paretic leg re-
spectively. The model is simulated for two consecutive apexes as shown in Fig. 1C.
The initial apex speeds vapex and leg lengths lo of the subjects are provided in Table
1. The model is simulated in MATLAB, Mathworks Inc. Natick, Massachusetts.
The periodic solutions of the SLIP model are calculated by minimizing the cost
function given by

e = [∆xnp(i+2) − ∆xnp(i) ; ynp(i+2) − ynp(i) ; ẋnp(i+2) − ẋnp(i) ] (7)

where ∆xnp(i) corresponds to the horizontal distance between the COM position xi
and COP position xcp(i) at apex state i. To optimize the shoe stiffness, we combine
the leg stiffness element and shoe stiffness element in series to obtain the effec-
tive stiffness as shown in Fig. 1C and Fig. 1B-D. The paretic and non-paretic leg
stiffness and combined effective leg stiffness of the leg shoe system are obtained
as below
Fpeak − Fo
kleg = (8)
∆l
kleg ks
kef f = (9)
kleg + ks
where Fpeak is the peak vertical GRF during stance and Fo (usually 0) is the force
at heel strike (Fig 1C). The best fit vertical GRF are measure using the coefficient
of determination R2 . The periodic solutions generated by the SLIP model are then
compared with the GRF and k̃ef f of each subject to obtain recommended stiffness
region for peak force reduction. As the bipedal model’s stance phase for individual

5
leg comprises of symmetric behavior along the y axis, modeling a fully accelerat-
ing or decelerating horizontal GRF would require an external force/moment and a
damper which is beyond the scope of this study. To calculate the %error estimates
shown in Table 2 we use the equations below
valuemodel − valuedata
%Error = (10)
valuedata

3 Results
Fig. 2B) shows the COP translation generated through the horizontal COM accel-
eration function Eqn. 6. This is a heuristic function which considers the fact that
COM and COP acceleration are related. We consider COP velocities greater than
0 at heel strike and by symmetry of the model the velocity at toe lift off is equal to
that at heel strike.
Fig. 3 shows model and experimental GRF values showing the model’s ability
to estimate GRF profile. We provided the coefficient of determination R2 to deter-
mine the degree of fit along with the overall COP displacement d for each subject.
The COP displacement for the subject is calculated as the difference traveled by
the COP from heel strike to toe lift off. For paretic subjects (n=1,3 and 5) our
model shows very good fit R2 >= 0.7 and for non-paretic leg subjects n=3,5 and
8 show very good fit (Fig. 3). The model fails to estimate GRF profile for walking
speed less than 0.33 m/s as seen for subjects n=7,12,14 and 15. We compare only
the vertical GRF profiles due to the model’s limitation as discussed in the Method
section.
Error estimates corresponding to the GRF values of the model are shown in
Table 2. Apart from subject n=5, the model estimates significantly high error for
TD angle and COP displacement. For subjects with very good fit (n=1,3,5,8 and
9), we provide the effective stiffness distribution corresponding to the peak vertical
GRF generated at those values. These values can be used to estimate the shoe
stiffness corresponding to kef f less than the calculated effective stiffness.

4 Discussion
The aim of the research is to provide stiffness values that can reduce the peak GRF
values experienced due to hemiparesis. We provide a simplistic model of a shoe
sole modelled as a linear constant stiffness spring that can store energy upon heel

6
impact and release during push-off. Stanley et al. [31] showed that usually shoe
stiffness is optimized by conducting walking trials on treadmill and measuring
change in joint angles due to the worn shoe. These experiments provided range
of stiffness values for different running speed and materials used during the trials
which could also benefit from a process provided in our study. Narrowing down
stiffness can also help in classifying materials that depict those stiffness values.
Although there exist bipedal models in which the leg is modeled as a linear
spring, our model explores the region for very slow walking speed as well as asym-
metric gait parameters. As shown by a previous study on walking using the SLIP
model that at very slow speeds the leg stiffness cannot be approximated as con-
stant which is also one of the limitations of our model [23]. But our model with
a constant spring stiffness is able to estimate GRF values for as low as 0.33 m/s.
This suggests that even at very slow speed, the underlying assumption of the SLIP
model’s design is valid at very slow walking speed. This is in conjunction with
the evidence on very slow gait provided by [36]. The inability of the model to
predict GRF values for walking speed less than 0.33 m/s stems from the fact that
it cannot reproduce values with a non M shaped force profile. This points towards
variability in leg stiffness at very slow walking speed, where the leg hardly decom-
presses during middle stance as shown by the paretic and non-paretic force profile
shown in Fig. 3A and B. Vertical GRF profile at very slow speeds is quite similar
to the hill shape force profile observed in running, suggesting a shift in the double
stance and single stance gait dynamics. Usually the leg is at its peak position dur-
ing mid single stance phase, but at a lower force value than the mid-phase of the
double stance. Adding such a switch in stance phase dynamics to our model might
provide the desired force profile at these speeds for subjects n=11-15. Walking at
very slow speed, also sometimes shows period doubling or tripling in which the
vertical GRF deviates from the M-shaped profile to multi-period cycles as seen in
subjects n=7 and 14. Our model is able to generate these period tripling cycle but
with larger amplitudes as seen by the GRF estimates in some of the subjects. Our
COP excursion model considers the horizontal GRF force of the model as input
but does not estimate the horizontal force from the data. This is due to the fact
that most of the subjects portray a strictly decelerating or accelerating horizon-
tal GRF, unlike the energy conserving SLIP horizontal COM acceleration makes
sure that the positive work done is cancelled out by the negative work during the
stance phase. Hof et al.[10] explained how horizontal COM and COP acceleration
are related during quiet standing balance, which was one of the inspiration for our
bipedal model as very slow walking gaits lie close to the motion of quiet standing
and gait initiation. Although during quiet standing the COM horizontal acceler-

7
ation acts as a restoring force, for the bipedal model it does not. With our COP
acceleration model we are to obtain both backward and forward COP movement.
This was done in the hope to obtain similar COP displacements, ability to handle
COP displacement asymmetry and also to affect the leg stiffness to obtain similar
GRF profiles but that was not the case for all the stroke survivors. Hence, such a
COP translation function makes our bipedal model an autonomous system unlike
other non autonomous models such as the one proposed by Jung et al. [13]. Hof
et al. [10] also suggests that symmetric leg function is not a necessary goal for
gait rehabilitation, however symmetric bipedal models are considered appropriate
in analyzing healthy gait and can serve as a benchmark in designing orthotics and
gait enhancing systems such as shoe lifts, shoe wedges and shoe soles.
In our study we provided a TD angle asymmetry of 1o to obtain periodic solu-
tions. We obtained significant errors in TD angle values for best fit GRF curves as
shown in Table 2. Error estimates for subjects 1,3,8 and 9 show a large error but
for subject 5 we observe low error for TD angle. This could be due to the walk-
ing speed of subject 5 being close to the slow walking speed range rather than the
very slow speed range. Error in COP displacement suggests that horizontal GRF
based COP acceleration is limited in generating similar COP displacement values.
The COP translation is determined by a combination of joint torques and would
require a much more sophisticated model to obtain accurate COP displacement
estimation. Certain bipedal models with COP translation have shown to correctly
estimate spatio-temporal displacement of the COM and GRF profiles for slow to
fast walking speeds but fail to generate periodic solutions for very slow walking
speeds. Our model provides one way to model COP translation for very slow walk-
ing speed. However, there is a need for a more robust model that can handle a
higher degree of asymmetry with COP displacement and TD angles. We did not
consider COP velocity and acceleration from the data to formulate our COP model
so as to not over constraint the model. This is because for energy conserving mod-
els, incorporating asymmetric COP displacement and asymmetric TD angles from
data can lead to generation of no solutions as was the case in our study. The stroke
patients did show a large variation in TD angle difference for very slow walking
speeds going as high as 6o . Obtaining periodic gait at such a large asymmetry
with very slow speeds was not possible and suggests providing input torque or
force excitation along with a damper to provide necessary power for propagation
and stability of the system.
Shoe lifts and wedges are known to reorient the ankle to enable plantarflexion
and stability during walking. The intention of these devices is to regain the roll
over ankle dynamics aiding in smooth translation of plantar pressure and GRF. Our

8
bipedal model provides an estimate in the change in stiffness occurring due to these
orthotic devices. For our study we calculated the effective stiffness of the leg from
the data as shown in Fig. 1C. Although the shoe stiffness is an unknown value
and the effective stiffness is a combination of the leg and shoe complex. How-
ever, leg stiffness is usually not constant for slow and fast walking speeds except
medium walking speeds (1 m/s) [23]. But by using constant stiffness for the effec-
tive stiffness, we are able to narrow down the possible shoe stiffness range which
are usually measured as constants for different materials used to manufacture the
sole [31]. One of the missing pieces in our stiffness equation is the leg stiffness of
the stroke patients, which will help in quantifying the shoe stiffness value. This leg
stiffness can be obtained either by the spasticity measurement scale for stroke pa-
tients or by obtaining barefoot walking GRF profiles for these stroke survivors. As
stroke patients would find it difficult to walk barefoot or without external support,
obtaining these leg stiffness value will be a challenge.
Usherwood et al. [33] showed that for very slow walking inverted pendulum
gait is the most economical, which was one of the reasons of using the bipedal
SLIP model with springy legs. Usually, inverted pendulum models are rigid signi-
fying rigid legs but in our case in order to estimate the stiffness values generating
reduced peak GRF values, modeling the legs as compliant element was impor-
tant. The springy legs also allow double stance weight shifting phase which is
significantly less for very slow walking speeds. Although walking is not an en-
ergy conserving activity, it can be modeled using energy conserving models as
SLIP. Similarly stroke gait requires active control but we attempted in modeling
the hemiparetic gait using the energy conserving SLIP. Although the SLIP model
can handle asymmetry, it does not incorporate body sway during its gait. At very
slow speeds body sway becomes significant as the task at hand is not moving for-
ward but also to balance the body during stance. This sway is reflected in our
bipedal model’s estimation of GRF of the experimental GRF values for certain
subjects (n=11-15) with very poor GRF estimation (Fig. 2B). But for certain cases
like subjects n = (1, 3, 5, 8, 9), the model can estimate the GRF qualitatively. As
the model does not take into account the orientation of the foot’s dorsiflexion, plan-
tarflexion and other joint angle as the model being generic, this could influence es-
timation of the GRF profile. The only influence that the data had was the effective
stiffness calculated as shown in (Fig. 1) and estimation of TD angle and COP error
estimates as shown Table 2.
Gait assistive devices help in providing auxiliary power which the paretic leg
muscles cannot generate. For stroke gait not only equalizing GRF is a priority
but also to increase walking speed. Kerr et al. [14] showed that tibia angle in the

9
sagittal plane for stroke gait provides a good measure for improvement in stroke
gait. On that lines, our bipedal model provides a way to take this angle into account
by approximating the complete leg with a singular segment. In order to achieve
that leveraging the walking surface to move forward efficiently is important. To
achieve proper leverage from the surface, appropriate shoe designs can provide
push off force and impact absorption and equalize load distribution along the length
and breadth of the foot. To narrow down the stiffness contribution of the shoes
toward load reduction we show effective stiffness distribution against peak force
value. This plot provides region of stiffness which can be used to modify the shoe
sole compliance. Over leg plus shoe complex system stiffness is affected by the
elasticity of the sole, height change due to shoe wedges or inserts. Bipedal models
based on the SLIP model have shown to estimate GRF values for varying heel
heights (my paper), which led us to use the SLIP model for our study.

5 Conclusion
With our study we found that 5 out of 15 subjects’ GRF could be estimated us-
ing our bipedal model. The value of optimal shoe stiffness is provided for these
5 subjects based on the assumption walking at very slow speeds can be described
using constant stiffness values. We have not provided the stability of the system
at these stiffness value which will be considered in future studies. We also found
that bipedal models can be used to describe GRF profiles for the gait of stroke
survivors at very slow speeds like 0.33 m/s. Our bipedal model , being energy
conserving in nature could reproduce periodic gaits with TD angle asymmetry.
We considered the GRF force just for a single stance phase for a single trial which
is another limiting factor for our model. To enhance the model’s predictive capa-
bilities at asymmetrical parameters addition of hip torques and muscular damping
can benefit our recommendation process.

10
Acknowledgements
We would like to thank German Academic Exchange Service (DAAD). We would
also like to thank Dr. Andrew Kerr and Dr. Philip Rowe from the University of
Strathclyde for the provision of the dataset.

Competing interests
We declare that this manuscript is original and has not been published before. We
know of no conflict of interest associated with this publication.

Author contributions
Karna Potwar developed the bipedal walking model and conducted simulation and
analysis. Karna Potwar, Valerie Pomeroy, Elizabeth Chandler, Leif Johannsen and
Dongheui Lee discussed the results and wrote the manuscript.

Funding
Funding: This work was funded by the German Academic Exchange Service
(DAAD) and TUM International Graduate School of Science & Engineering (IGSSE).

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15
List of Figures
1 Shoe stiffness optimization process. A) Process to improve am-
bulation by adding compliance to orthotic devices B). Superimpo-
sition of the compliant springy leg upon the lower limb of the pa-
tients. The markers represent ASIS/PSIS- Anterior/posterior su-
perior illiac spinae, LEPI/MEPI - Lateral/medial epicondyle, LMAL/MMAL
- Lateral/medial malleolous, L and R in the beginning of the ab-
breviation stand for left and right respectively. C) Graphical rep-
resentation of the shoe along with the leg element, followed by
a two consecutive apexes of the bipedal SLIP model. TD stands
for touch down, d represents COP displacement, i represents apex
state, p for paretic, np for non-paretic, F for leg force, θo heel
strike touch down (TD) angle, l leg length during stance x, ẋ, y, ẏ
are state variables. . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2 Linearly fit gait parameters for 15 subjects. The plot shows gait
parameter fits for paretic and non paretic leg against non dimen-√
sionalized walking speed. The walking speed is divided by glo .
A) Linearly regressed lines for Center of pressure (COP) displace-
ment d, Heel strike touch down (TD) angle, Stance time of leg in
seconds, Vertical GRF divided by the subject’s body weight and
Relative stiffness k̃ BW stands for body weight. B) COP profile
for position xcp , velocity ẋcp and acceleration ẍcp against % stance. 21
3 Vertical GRF estimates for model against gait data. A) Paretic
leg. B) Non-paretic leg. R2 represents coefficient of determination
and d displacement of center of pressure (COP) during stance phase. 22
4 Effective stiffness distribution against peak vertical GRF. The
black diamond marker represents the stiffness and peak vertical
GRF value corresponding to each subject, which is used as a ref-
erence to compare reduction in peak vertical GRF and correspond-
ing stiffness value. k̃ = k̃ef f and BW stands for body weight. . . . 23

16
List of Tables
1 Demographics of stroke survivors.F-female, M-male. The table
displays type of stroke and affected side of stroke along with age,
sex weight, uncompressed leg length lo and apex speed vexp of the
stroke survivors. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2 % Error estimates for TD angle and COP displacement. The
error estimates are calculated at best fit GRF profiles shown in
Fig. 3. θo represents heel strike TD angle and d stands for COP
displacement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

17
 Subject,
Gender Age Weight Affected side lo (m) vapex (m/s)
n
1 M 32 73.7 Right 1.07 1.21
2 M 52 126 Right 1.04 0.62
3 M 74 94.5 Left 0.98 0.55
4 M 92 62 Left 1.00 0.74
5 M 60 67 Right 0.86 0.99
6 M 55 68.3 Left 1.02 0.54
7 F 74 90 Left 0.91 0.30
8 M 78 82 Right 0.98 0.39
9 M 56 85.8 Right 0.95 0.88
10 M 70 72 Right 1.02 0.35
11 F 63 72 Left 0.89 0.37
12 M 48 88 Right 1.01 0.16
13 F 58 64 Left 0.89 0.83
14 M 62 72 Right 0.90 0.26
15 F 82 53 Right 0.92 0.22
Table 1: Demographics of stroke survivors.F-female, M-male. The table dis-
plays type of stroke and affected side of stroke along with age, sex weight, uncom-
pressed leg length lo and apex speed vexp of the stroke survivors.

18
 Subject, % Error, % Error, % Error, % Error,
n θo (p) θo (np) d(p) d(np)
1 73.2106 80.5595 81.2788 90.3356
2 61.2646 32.1023 -217.2865 52.5048
3 54.5136 68.6593 79.3224 79.5098
4 78.2468 79.3529 93.6980 93.0681
5 -15.2936 0.6156 63.3335 -100.4711
6 44.8727 53.5267 54.7283 82.2701
7 90.8622 58.4812 94.5366 100.2075
8 -46.2056 33.6750 104.7239 80.9379
9 23.1663 93.5951 73.3252 65.3743
10 64.2442 76.8728 56.4885 79.7245
11 62.9913 48.6668 85.3652 96.0103
12 90.8574 93.4540 59.7638 36.1032
13 69.0037 74.0208 96.3389 93.0970
14 -36.5062 85.9351 94.5504 96.1611
15 70.1653 56.8883 51.5887 96.4235
Table 2: % Error estimates for TD angle and COP displacement. The error
estimates are calculated at best fit GRF profiles shown in Fig. 3. θo represents heel
strike TD angle and d stands for COP displacement.

19
 A)
Improve ambulation How to optimize stiffness ?

Reduce peak ground

Simulate bipedal model using design
B)
reaction force (GRF)
parameters from data to obtain
best fit GRF
Symmetrical stance phases for
paretic and non-paretic legs
Validating model through
GRF estimation
AFO Shoes

Recommend keff values

Impact absorption at leading to reduction in peak GRF
heel strike through
compliant soles/inserts
Extract shoe stiffness
Optimize stiffness from keff

C) How to simulate bipedal model ?

y
keff = kleg ks /(kleg + ks) x
θ
x(np)(i) y(np)(i) x(p)(i+1) y(p)(i+1) F(p) (np) θ(p) F(np) x(np)(i+2) y(np)(i+2)

kleg
keff(np) θo(p)
θ(p) θo(np) keff(p) θ(np)
ks
TD l(np)
l(p)
d

Figure 1: Shoe stiffness optimization process. A) Process to improve ambulation

by adding compliance to orthotic devices B). Superimposition of the compliant
springy leg upon the lower limb of the patients. The markers represent ASIS/PSIS-
Anterior/posterior superior illiac spinae, LEPI/MEPI - Lateral/medial epicondyle,
LMAL/MMAL - Lateral/medial malleolous, L and R in the beginning of the abbre-
viation stand for left and right respectively. C) Graphical representation of the shoe
along with the leg element, followed by a two consecutive apexes of the bipedal
SLIP model. TD stands for touch down, d represents COP displacement, i repre-
sents apex state, p for paretic, np for non-paretic, F for leg force, θo heel strike
touch down (TD) angle, l leg length during stance x, ẋ, y, ẏ are state variables.

20
A)

B)

Figure 2: Linearly fit gait parameters for 15 subjects. The plot shows gait pa-
rameter fits for paretic and non paretic √ leg against non dimensionalized walking
speed. The walking speed is divided by glo . A) Linearly regressed lines for Cen-
ter of pressure (COP) displacement d, Heel strike touch down (TD) angle, Stance
time of leg in seconds, Vertical GRF divided by the subject’s body weight and
Relative stiffness k̃ BW stands for body weight. B) COP profile for position xcp ,
velocity ẋcp and acceleration ẍcp against % stance.

21
A)

B)

22

Figure 3: Vertical GRF estimates for model against gait data. A) Paretic leg.
B) Non-paretic leg. R2 represents coefficient of determination and d displacement
of center of pressure (COP) during stance phase.
 Recommended k~ values

Figure 4: Effective stiffness distribution against peak vertical GRF. The black
diamond marker represents the stiffness and peak vertical GRF value correspond-
ing to each subject, which is used as a reference to compare reduction in peak
vertical GRF and corresponding stiffness value. k̃ = k̃ef f and BW stands for body
weight.

23