Comparison of Verbal and Emotional Responses of Elderly People with Mild/Moderate Dementia and Those with Severe Dementia in Responses to Seal Robot, PARO

Social Robots for People with Aging and Dementia: A Systematic Review of Literature

Background: Social robots are currently a form of assistive technology for the elderly, healthy, or with cognitive impairment, helping to maintain their independence and improve their well-being. Objective: The main aim of this article is to present a review of the existing research in the literature, referring to the use of social robots for people with dementia and/or aging. Methods: Academic databases that were used to perform the searches are IEEE Xplore, PubMed, Science Direct, and Google Scholar, taking into account as date of publication the last 10 years, from 2007 to the present. Several search criteria were established such as "robot" AND "dementia," "robot" AND "cognitive impairment," "robot" AND "social" AND "aging," and so on., selecting the articles of greatest interest regarding the use of social robots in elderly people with or without dementia. Results: This search found a total of 96 articles on social robots in healthy people and with dementia, of which 38 have been identified as relevant work. Many of the articles show the acceptance of older people toward social robots. Conclusion: From the review of the research articles analyzed, it can be said that use of social robots in elderly people without cognitive impairment and with dementia, help in a positive way to work independently in basic activities and mobility, provide security, and reduce stress.

Improving well-being in patients with major neurodegenerative disorders: differential efficacy of brief social robot-based intervention for 3 neuropsychiatric profiles

Background

Behavioral and psychological symptoms of dementia (BPSD) affect patients’ daily life and subjective well-being. International recommendations stress nonpharmacological interventions as first-line treatment. While newer psychosocial initiatives adapted to geriatric populations based on social robot therapy have emerged, to our knowledge, no studies on differential efficacy depending on BPSD profiles have been conducted yet.

Objectives

This pilot study examined the impact of short exposure to a social robot (Paro^®) on the subjective emotional well-being of patients with major neurocognitive disorder as well as its impact on differential effects for 3 BPSD profiles.

Methods

Seventeen patients with major NCD with apathy (n=6), depression (n=7), and agitation (n=4) were recruited. The intervention was composed of four 15-minute individual sessions. Exposure occurred without the simultaneous presence of a health care provider. A pre–post assessment of emotional well-being was conducted with the International Positive and Negative Affect Schedule Short-Form, which measures positive and negative affectivity.

Results

Overall findings showed a significant increase of positive affectivity (p=0.02). Subgroup analysis demonstrated that agitated patients reduced negative affectivity significantly more than depressed patients (p=0.03). Results also confirmed users’ overall acceptability of the robot.

Conclusion

These findings support the usefulness of brief interactive sessions with the Paro robot for elderly patients with major NCD. These preliminary results encourage further research focused on brief interventions using social robotics, as well as on their specific benefits depending on the behavioral typology of patients with neurocognitive disorders.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Understanding Engagement in Dementia Through Behavior. The Ethographic and Laban-Inspired Coding System of Engagement (ELICSE) and the Evidence-Based Model of Engagement-Related Behavior (EMODEB)

Engagement in activities is of crucial importance for people with dementia. State of the art assessment techniques rely exclusively on behavior observation to measure engagement in dementia. These techniques are either too general to grasp how engagement is naturally expressed through behavior or too complex to be traced back to an overall engagement state. We carried out a longitudinal study to develop a coding system of engagement-related behavior that could tackle these issues and to create an evidence-based model of engagement to make meaning of such a coding system. Fourteen elderlies with mild to moderate dementia took part in the study. They were involved in two activities: a game-based cognitive stimulation and a robot-based free play. The coding system was developed with a mixed approach: ethographic and Laban-inspired. First, we developed two ethograms to describe the behavior of participants in the two activities in detail. Then, we used Laban Movement Analysis (LMA) to identify a common structure to the behaviors in the two ethograms and unify them in a unique coding system. The inter-rater reliability (IRR) of the coding system proved to be excellent for cognitive games (kappa = 0.78) and very good for robot play (kappa = 0.74). From the scoring of the videos, we developed an evidence-based model of engagement. This was based on the most frequent patterns of body part organization (i.e., the way body parts are connected in movement) observed during activities. Each pattern was given a meaning in terms of engagement by making reference to the literature. The model was tested using structural equation modeling (SEM). It achieved an excellent goodness of fit and all the hypothesized relations between variables were significant. We called the coding system that we developed the Ethographic and Laban-Inspired Coding System of Engagement (ELICSE) and the model the Evidence-based Model of Engagement-related Behavior (EMODEB). To the best of our knowledge, the ELICSE and the EMODEB constitute the first formalization of engagement-related behavior for dementia that describes how behavior unfolds over time and what it means in terms of engagement.

Social Robotics in Therapy of Apraxia of Speech

Apraxia of speech is a motor speech disorder in which messages from the brain to the mouth are disrupted, resulting in an inability for moving lips or tongue to the right place to pronounce sounds correctly. Current therapies for this condition involve a therapist that in one-on-one sessions conducts the exercises. Our aim is to work in the line of robotic therapies in which a robot is able to perform partially or autonomously a therapy session, endowing a social robot with the ability of assisting therapists in apraxia of speech rehabilitation exercises. Therefore, we integrate computer vision and machine learning techniques to detect the mouth pose of the user and, on top of that, our social robot performs autonomously the different steps of the therapy using multimodal interaction.

Care staff perceptions of a social robot called Paro and a look-alike Plush Toy: a descriptive qualitative approach

OBJECTIVES

Social robots such as Paro, a therapeutic companion robot, have recently been introduced into dementia care as a means to reduce behavioural and psychological symptoms of dementia. The purpose of this study was to explore care staff perceptions of Paro and a look-alike non-robotic animal, including benefits and limitations in dementia care.

METHODS

The study assumed a descriptive qualitative approach, nested within a large cluster-randomised controlled trial. We interviewed a subsample of 20 facility care staff, from nine long-term care facilities in Southeast Queensland, Australia. Thematic analysis of the data, which was inductive and data-driven, was undertaken with the assistance of the qualitative software, ATLAS.ti®.

RESULTS

The findings refer to four categories: increasing excitement for Paro and decreasing enthusiasm for Plush Toy; value and function of Paro; opportunities for engagement; and alternatives vs. robustness.

CONCLUSION

Staff caring for people with dementia preferred Paro compared to a look-alike Plush Toy. Staff identified that Paro had the potential to improve quality of life for people with dementia, whereas the Plush Toy had limitations when compared to Paro. However, participants expressed concern that the cost of Paro could reduce opportunities for use within aged care.

Scoping review on the use of socially assistive robot technology in elderly care

OBJECTIVE

With an elderly population that is set to more than double by 2050 worldwide, there will be an increased demand for elderly care. This poses several impediments in the delivery of high-quality health and social care. Socially assistive robot (SAR) technology could assume new roles in health and social care to meet this higher demand. This review qualitatively examines the literature on the use of SAR in elderly care and aims to establish the roles this technology may play in the future.

DESIGN

Scoping review.

DATA SOURCES

Search of CINAHL, Cochrane Library, Embase, MEDLINE, PsychINFO and Scopus databases was conducted, complemented with a free search using Google Scholar and reference harvesting. All publications went through a selection process, which involved sequentially reviewing the title, abstract and full text of the publication. No limitations regarding date of publication were imposed, and only English publications were taken into account. The main search was conducted in March 2016, and the latest search was conducted in September 2017.

ELIGIBILITY CRITERIA

The inclusion criteria consist of elderly participants, any elderly healthcare facility, humanoid and pet robots and all social interaction types with the robot. Exclusions were acceptability studies, technical reports of robots and publications surrounding physically or surgically assistive robots.

RESULTS

In total, 61 final publications were included in the review, describing 33 studies and including 1574 participants and 11 robots. 28 of the 33 papers report positive findings. Five roles of SAR were identified: affective therapy, cognitive training, social facilitator, companionship and physiological therapy.

CONCLUSIONS

Although many positive outcomes were reported, a large proportion of the studies have methodological issues, which limit the utility of the results. Nonetheless, the reported value of SAR in elderly care does warrant further investigation. Future studies should endeavour to validate the roles demonstrated in this review.

SYSTEMATIC REVIEW REGISTRATION

NIHR 58672.

The Cost-Effectiveness of Using PARO, a Therapeutic Robotic Seal, to Reduce Agitation and Medication Use in Dementia: Findings from a Cluster-Randomized Controlled Trial

OBJECTIVES

To examine the within-trial costs and cost-effectiveness of using PARO, compared with a plush toy and usual care, for reducing agitation and medication use in people with dementia in long-term care.

DESIGN

An economic evaluation, nested within a cluster-randomized controlled trial.

SETTING

Twenty-eight facilities in South-East Queensland, Australia.

PARTICIPANTS

A total of 415 residents, all aged 60 years or older, with documented diagnoses of dementia.

INTERVENTION

Facilities were randomized to 1 of 3 groups: PARO (individual, nonfacilitated 15-minute sessions, 3 afternoons per week for 10 weeks); plush toy (as per PARO but with artificial intelligence disabled); and usual care.

MEASUREMENTS

The incremental cost per Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF) point averted from a provider's perspective. Australian New Zealand Clinical Trials Registry (BLINDED FOR REVIEW).

RESULTS

For the within-trial costs, the PARO group was $50.47 more expensive per resident compared with usual care, whereas the plush toy group was $37.26 more expensive than usual care. There were no statistically significant between-group differences in agitation levels after the 10-week intervention. The point estimates of the incremental cost-effectiveness ratios were $13.01 for PARO and $12.85 for plush toy per CMAI-SF point averted relative to usual care.

CONCLUSION

The plush toy used in this study offered marginally greater value for money than PARO in improving agitation. However, these costs are much lower than values estimated for psychosocial group activities and sensory interventions, suggesting that both a plush toy and the PARO are cost-effective psychosocial treatment options for agitation.

Use of a Robotic Seal as a Therapeutic Tool to Improve Dementia Symptoms: A Cluster-Randomized Controlled Trial

OBJECTIVES

To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities.

DESIGN

Parallel, 3-group, cluster-randomized controlled trial conducted between June 14, 2014, and May 16, 2015.

SETTING

Twenty-eight long-term care facilities operated by 20 care organizations located in South-East Queensland, Australia.

PARTICIPANTS

Four hundred fifteen participants aged ≥60 years, with a documented diagnosis of dementia.

INTERVENTION

Stratified by private/not-for-profit status and randomized using a computer-generated sequence, 9 facilities were randomized to the PARO group (individual, nonfacilitated, 15-minute sessions 3 times per week for 10 weeks); 10 to plush toy (same, but given PARO with robotic features disabled); and 9 to usual care. Treatment allocation was masked to assessors.

MEASUREMENTS

Primary outcomes were changes in levels of engagement, mood states, and agitation after a 10-week intervention, assessed by coded video observations (baseline, weeks 1, 5, 10, and 15) and Cohen-Mansfield Agitation Inventory-Short Form (baseline, weeks 10 and 15). Analyses followed intention-to-treat, using repeated measures mixed effects models. Australian New Zealand Clinical Trials Registry (ACTRN12614000508673).

RESULTS

Video data showed that participants in the PARO group were more verbally [3.61, 95% confidence interval (CI): 6.40-0.81, P = .011] and visually engaged (13.06, 95% CI: 17.05-9.06, P < .0001) than participants in plush toy. Both PARO (-3.09, 95% CI: -0.45 to -5.72, P = .022) and plush toy (-3.58, 95% CI: -1.26 to -5.91, P = .002) had significantly greater reduced neutral affect compared with usual care, whilst PARO was more effective than usual care in improving pleasure (1.12, 95% CI: 1.94-0.29, P = .008). Videos showed that PARO was more effective than usual care in improving agitation (3.33, 95% CI: 5.79-0.86, P = .008). When measured using the CMAI-SF, there was no difference between groups.

CONCLUSIONS

Although more effective than usual care in improving mood states and agitation, PARO was only more effective than a plush toy in encouraging engagement.

A Pilot Randomized Trial of a Companion Robot for People With Dementia Living in the Community

OBJECTIVES

To investigate the affective, social, behavioral, and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting.

DESIGN

A pilot block randomized controlled trial over 12 weeks. Participants were randomized to the intervention (Paro) or control condition (standard care).

SETTING

Two dementia day care centers and participants' homes in Auckland, New Zealand.

PARTICIPANTS

Thirty dyads (consisting of a care recipient with dementia and their caregiver) took part in this study. All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia.

INTERVENTION

Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks. Participants also had Paro at home for 6 weeks.

MEASUREMENTS

At the day care centers, observations of the care recipients' behavior, affect, and social responses were recorded using a time sampling method. Observations of interactions with Paro for participants in the intervention were also recorded. Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care. In the home setting, level of cognition, depressive symptoms, neuropsychiatric symptoms, behavioral agitation, and blood pressure were measured at baseline, 6 weeks, and 12 weeks. Hair cortisol measures were collected at baseline and at 6 weeks.

RESULTS

Observations showed that Paro significantly improved facial expressions (affect) and communication with staff (social interaction) at the day care centers. Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro. There were no significant differences in care recipient dementia symptoms, nor physiological measures between the intervention and control group.

CONCLUSION

Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context. Larger randomized controlled trials in community settings, with longer time frames, are needed to further specify the contexts and characteristics for which Paro is most beneficial.

Robotic Seals as Therapeutic Tools in an Aged Care Facility: A Qualitative Study

Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: “a therapeutic tool that's not for everybody,” “every interaction is powerful,” and “keeping the momentum.” Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration.

Group activity with Paro in nursing homes: systematic investigation of behaviors in participants

BACKGROUND

A variety of group activities is promoted for nursing home (NH) residents with dementia with the aim to reduce apathy and to increase engagement and social interaction. Investigating behaviors related to these outcomes could produce insights into how the activities work. The aim of this study was to systematically investigate behaviors seen in people with dementia during group activity with the seal robot Paro, differences in behaviors related to severity of dementia, and to explore changes in behaviors.

METHODS

Thirty participants from five NHs formed groups of five to six participants at each NH. Group sessions with Paro lasted for 30 minutes twice a week during 12 weeks of intervention. Video recordings were conducted in the second and tenth week. An ethogram, containing 18 accurately defined and described behaviors, mapped the participants' behaviors. Duration of behaviors, such as "Observing Paro," "Conversation with Paro on the lap," "Smile/laughter toward other participants," were converted to percentage of total session time and analyzed statistically.

RESULTS

"Observing Paro" was observed more often in participants with mild to moderate dementia (p = 0.019), while the variable "Observing other things" occurred more in the group of severe dementia (p = 0.042). "Smile/laughter toward other participants" showed an increase (p = 0.011), and "Conversations with Paro on the lap" showed a decrease (p = 0.014) during the intervention period.

CONCLUSIONS

Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.

Can We Talk through a Robot As if Face-to-Face? Long-Term Fieldwork Using Teleoperated Robot for Seniors with Alzheimer's Disease

This work presents a case study on fieldwork in a group home for the elderly with dementia using a teleoperated robot called Telenoid. We compared Telenoid-mediated and face-to-face conditions with three residents with Alzheimer's disease (AD). The result indicates that two of the three residents with moderate AD showed a positive reaction to Telenoid. Both became less nervous while communicating with Telenoid from the time they were first introduced to it. Moreover, they started to use more body gestures in the face-to-face condition and more physical interactions in the Telenoid-mediated condition. In this work, we present all the results and discuss the possibilities of using Telenoid as a tool to provide opportunities for seniors to communicate over the long term.