Speech Interaction with Personal Assistive Robots Supporting Aging at Home for Individuals with Alzheimer’s Disease

Socially Assistive Robots for patients with Alzheimer's Disease: A scoping review

BACKGROUND

The most common form of dementia, Alzheimer's Disease (AD), is challenging for both those affected as well as for their care providers, and caregivers. Socially assistive robots (SARs) offer promising supportive care to assist in the complex management associated with AD.

OBJECTIVES

To conduct a scoping review of published articles that proposed, discussed, developed or tested SAR for interacting with AD patients.

METHODS

We performed a scoping review informed by the methodological framework of Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist for reporting the results. At the identification stage, an information specialist performed a comprehensive search of 8 electronic databases from the date of inception until January 2022 in eight bibliographic databases. The inclusion criteria were all populations who recive or provide care for AD, all interventions using SAR for AD and our outcomes of inteerst were any outcome related to AD patients or care providers or caregivers. All study types published in the English language were included.

RESULTS

After deduplication, 1251 articles were screened. Titles and abstracts screening resulted to 252 articles. Full-text review retained 125 included articles, with 72 focusing on daily life support, 46 on cognitive therapy, and 7 on cognitive assessment.

CONCLUSION

We conducted a comprehensive scoping review emphasizing on the interaction of SAR with AD patients, with a specific focus on daily life support, cognitive assessment, and cognitive therapy. We discussed our findings' pertinence relative to specific populations, interventions, and outcomes of human-SAR interaction on users and identified current knowledge gaps in SARs for AD patients.

Mapping sedentary behaviour (MAPS-B) in winter and spring using wearable sensors, indoor positioning systems, and diaries in older adults who are pre-frail and frail: A feasibility longitudinal study

Older adults who are frail are likely to be sedentary. Prior interventions to reduce sedentary time in older adults have not been effective as there is little research about the context of sedentary behaviour (posture, location, purpose, social environment). Moreover, there is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. The aim of our study was to determine the feasibility of measuring context of sedentary behaviour in older adults with pre-frailty or frailty using a combination of objective and self-report measures. We defined "feasibility process" using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and "feasibility resource" if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone) and are all participants willing to use the measures. Context was assessed using a wearable sensor to assess posture, a smart home monitoring system for location, and an electronic or hard-copy diary for purpose and social context over three days in winter and spring. We approached 80 potential individuals, and 58 expressed interest; of the 58 individuals, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts due to medical mistrust or worsening health (90% retention). The wearable sensor, indoor positioning system, and electronic diary accurately captured one domain of context, but the hard copy was often not completed with enough detail, so it was challenging to link it to the other devices. Although not all participants were willing to use the wearable sensor, indoor positioning system, or electronic diary, we were able to triage the measures of those who did. The use of wearable sensors and electronic diaries may be a feasible method to assess context of sedentary behaviour, but more research is needed with device-based measures in diverse groups.

Implementation of an assistive technology for meal preparation within a supported residence for adults with acquired brain injury: a mixed-methods single case study

OBJECTIVES

This study aimed to investigate the feasibility of implementing an assistive technology for meal preparation called COOK within a supported community residence for a person with an acquired brain injury.

METHODS

Using a mixed-methods approach, a multiple baseline single-case experimental design and a descriptive qualitative study were conducted. The participant was a 47-year-old woman with cognitive impairments following a severe stroke. She received 21 sessions of training on using COOK within a shared kitchen space. During meal preparation, independence and safety were evaluated using three target behaviours: required assistance, task performance errors, and appropriate responses to safety issues, which were compared with an untrained control task, making a budget. Benefits, barriers, and facilitators were assessed via three individual interviews with the client and three focus groups with the care team.

RESULTS

Both quantitative and qualitative analyses showed that COOK significantly increased independence and safety during meal preparation but not in the control task. Stakeholders suggested that the availability of a training toolkit to a greater number of therapists at the residence and installation of COOK within the client's apartment would help with successful adoption of this technology.

CONCLUSION

COOK is a promising assistive technology for individuals with cognitive deficits who live in supported community residences.Implication For RehabilitationCOOK is a promising assistive technology for cognition to increase independence and safety in meal preparation for clients with ABI within their supported living contexts.Receiving training from an expert and the availability of technical support are imperative to the successful adoption of COOK.

COOK technology to support meal preparation following a severe traumatic brain injury: a usability mixed-methods single-case study in a real-world environment

INTRODUCTION

Following a traumatic brain injury (TBI), meal preparation may become challenging as it involves multiple cognitive abilities and sub-tasks. To support this population, the Cognitive Orthosis for coOKing (COOK) was developed in partnership with an alternative residential resource for people with severe TBI. However, little is known about the usability of this technology to support people with TBI living in their own homes.

METHODS

A usability study was conducted using a mixed-methods single-case design with a 35-year-old man with severe TBI living alone at home. The number of assistances provided, time taken and the percentage of unnecessary actions during a meal preparation task were documented nine times to explore the usability of COOK. Interviews were also conducted with the participant to document his satisfaction with COOK. Potential benefits were explored via the number of meals prepared per week.

RESULTS

The usability of COOK was shown to be promising as the technology helped the participant prepare complex meals, while also reducing the number of assistances needed and the percentage of unnecessary actions. However, several technical issues and contextual factors influenced the efficiency and the participant's satisfaction with COOK. Despite improving his self-confidence, COOK did not help the participant prepare more meals over time.

CONCLUSION

This study showed that COOK was easy to use and promising, despite technical and configuration issues. Results suggest the importance of further technological developments to improve COOK's usability and fit with the needs of people with TBI living in their own homes.

Digital Intervention For The Management Of Alzheimer's Disease

Alzheimer's disease (AD) is a progressive, multifactorial, chronic, neurodegenerative disease with high prevalence and limited therapeutic options, making it a global health crisis. Being the most common cause of dementia, AD erodes the cognitive, functional, and social abilities of the individual and causes escalating medical and psychosocial needs. As yet, this disorder has no cure and current treatment options are palliative in nature. There is an urgent need for novel therapy to address this pressing challenge. Digital therapeutics (Dtx) is one such novel therapy that is gaining popularity globally. Dtx provides evidence based therapeutic interventions driven by internet and software, employing tools such as mobile devices, computers, videogames, apps, sensors, virtual reality aiding in the prevention, management, and treatment of ailments like neurological abnormalities and chronic diseases. Dtx acts as a supportive tool for the optimization of patient care, individualized treatment and improved health outcomes. Dtx uses visual, sound and other non-invasive approaches for instance-consistent therapy, reminiscence therapy, computerised cognitive training, semantic and phonological assistance devices, wearables and computer-assisted rehabilitation environment to find applications in Alzheimer's disease for improving memory, cognition, functional abilities and managing motor symptom. A few of the Dtx-based tools employed in AD include "Memory Matters", "AlzSense", "Alzheimer Assistant", "smart robotic dog", "Immersive virtual reality (iVR)" and the most current gamma stimulation. The purpose of this review is to summarize the current trends in digital health in AD and explore the benefits, challenges, and impediments of using Dtx as an adjunctive therapy for the management of AD.

A simulated experiment to explore robotic dialogue strategies for people with dementia

Introduction

Persons with dementia (PwDs) often show symptoms of repetitive questioning, which brings great burdens on caregivers. Conversational robots hold promise of helping cope with PwDs’ repetitive behavior. This paper develops an adaptive conversation strategy to answer PwDs’ repetitive questions, follow up with new questions to distract PwDs from repetitive behavior, and stimulate their conversation and cognition.

Methods

We propose a general reinforcement learning model to interact with PwDs with repetitive questioning. Q-learning is exploited to learn adaptive conversation strategy (from the perspectives of rate and difficulty level of follow-up questions) for four simulated PwDs. A demonstration is presented using a humanoid robot.

Results

The designed Q-learning model performs better than random action selection model. The RL-based conversation strategy is adaptive to PwDs with different cognitive capabilities and engagement levels. In the demonstration, the robot can answer a user’s repetitive questions and further come up with a follow-up question to engage the user in continuous conversations.

Conclusions

The designed Q-learning model demonstrates noteworthy effectiveness in adaptive action selection. This may provide some insights towards developing conversational social robots to cope with repetitive questioning by PwDs and increase their quality of life.

Socially assistive robots for people with dementia: Systematic review and meta-analysis of feasibility, acceptability and the effect on cognition, neuropsychiatric symptoms and quality of life

BACKGROUND

There is increasing interest in using robots to support dementia care but little consensus on the evidence for their use. The aim of the study is to review evidence about feasibility, acceptability and clinical effectiveness of socially assistive robots used for people with dementia.

METHOD

We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, PsychINFO, CINHAL, IEEE Xplore Digital Library, and EI Engineering Village from inception to 04 - 02-2022 - included primary studies assessing feasibility, acceptability, or effectiveness of socially assistive robots for people with dementia. Two independent reviewers screened studies for eligibility, and assessed quality. Narrative synthesis prioritized higher quality studies, and random-effect meta-analyses compared robots with usual care (UC) or active control (AC) immediately after the intervention (short-term; ST) or long-term (LT) on cognition, neuropsychiatric symptoms, and quality of life.

FINDINGS

66 studies and four categories of robots were eligible: Companion robots (Pet and humanoid companion robots), telepresence communication robots, homecare assistive robots and multifunctional robots. PARO (companion robot seal) was feasible and acceptable but limited by its weight, cost, and sound. On meta-analysis, PARO had no ST or LT compared to UC or AC over 5-12 weeks on agitation (ST vs UC, 4 trials, 153 participants: pooled standardized mean difference (SMD) 0.25; - 0.57 to 0.06; LT vs UC; 2 trials, 77 participants, SMD = -0.24; - 0.94, 0.46), cognition (ST vs UC, 3 trials, 128 participants: SMD= 0.03; -0.32, 0.38), overall neuropsychiatric symptoms (ST vs UC, 3 trials, 169 participants: SMD= -0.01; -0.32, 0.29; ST vs AC, 2 trials, 145 participants: SMD =0.02, -0.71, 0.85), apathy (ST vs AC, 2 trials, 81 participants: SMD= 0.14; 0.29, 0.58), depression (ST vs UC, 4 trials, 181 participants; SMD= 0.08; -0.52, 0.69; LT vs UC: 2 trials, 77 participants: SMD =0.01; -0.75, 0.77), anxiety (ST vs UC: 2 trials, 104 participants, SMD= 0.24; -0.85, 1.33) and quality of life (ST vs UC, 2 trials, 127 participants: SMD=-0.05; -0.52, 0.42; ST vs AC: 2 trials, 159 participants, SMD =-0.36, -0.76, 0.05). Robotic animals, humanoid companion robots, telepresence robots and multifunctional robots were feasible and acceptable. However, humanoid companion robots have speech recognition problems, and telepresence robots and multifunctional robots were often difficult to use. There was mixed evidence about the feasibility of homecare robots. There was little evidence on any of these robots' effectiveness.

CONCLUSION

Although robots were generally feasible and acceptable, there is no clear evidence that people with dementia derive benefit from robots for cognition, neuropsychiatric symptoms, or quality of life. We recommend that future research should use high quality designs to establish evidence of effectiveness.

A Robot-Mediated Activity Using the Nao Robot to Promote COVID-19 Precautionary Measures among Older Adults in Geriatric Facilities

Precautionary measures (e.g., social distancing, mask wearing, washing hands regularly) to limit the transmission of the Coronavirus 19 (COVID-19) have been put in place worldwide. However, a limited understanding of precautionary measures and low compliance with them has been observed in older adults with neurocognitive disorders, persons with intellectual disability, or mental illness. The objective of this study is to create and evaluate a robot-mediated activity to deliver information on COVID-19 precautionary measures in an accessible and engaging way using the humanoid robot Nao. An interactive scenario explaining and demonstrating COVID-19 precautionary measures is created using the verbal and non-verbal behaviours of the robot. The scenario (≈5 min) is presented to 124 users of a geriatric hospital, including the following: older patients (n = 45), accompanying persons (n = 39), and health professionals (n = 40). The data regarding perceived usefulness, acceptability, and accessibility are collected using a questionnaire. A video analysis of the participants' behaviour during the interaction with the robot is performed to examine the quality of engagement in the activity. The results show a good acceptance, satisfaction, and perceived usefulness of the robot-mediated activity. These findings suggest that robot-mediated interventions using humanoid robots can be an effective tool for the delivery of health promotion information.

Conversational System as Assistant Tool in Reminiscence Therapy for People with Early-Stage of Alzheimer's

Reminiscence therapy is a non-pharmacological intervention that helps mitigate unstable psychological and emotional states in patients with Alzheimer’s disease, where past experiences are evoked through conversations between the patients and their caregivers, stimulating autobiographical episodic memory. It is highly recommended that people with Alzheimer regularly receive this type of therapy. In this paper, we describe the development of a conversational system that can be used as a tool to provide reminiscence therapy to people with Alzheimer’s disease. The system has the ability to personalize the therapy according to the patients information related to their preferences, life history and lifestyle. An evaluation conducted with eleven people related to patient care (caregiver = 9, geriatric doctor = 1, care center assistant = 1) shows that the system is capable of carrying out a reminiscence therapy according to the patient information in a successful manner.

Intelligent Sensing Technologies for the Diagnosis, Monitoring and Therapy of Alzheimer's Disease: A Systematic Review

Alzheimer’s disease is a lifelong progressive neurological disorder. It is associated with high disease management and caregiver costs. Intelligent sensing systems have the capability to provide context-aware adaptive feedback. These can assist Alzheimer’s patients with, continuous monitoring, functional support and timely therapeutic interventions for whom these are of paramount importance. This review aims to present a summary of such systems reported in the extant literature for the management of Alzheimer’s disease. Four databases were searched, and 253 English language articles were identified published between the years 2015 to 2020. Through a series of filtering mechanisms, 20 articles were found suitable to be included in this review. This study gives an overview of the depth and breadth of the efficacy as well as the limitations of these intelligent systems proposed for Alzheimer’s. Results indicate two broad categories of intelligent technologies, distributed systems and self-contained devices. Distributed systems base their outcomes mostly on long-term monitoring activity patterns of individuals whereas handheld devices give quick assessments through touch, vision and voice. The review concludes by discussing the potential of these intelligent technologies for clinical practice while highlighting future considerations for improvements in the design of these solutions for Alzheimer’s disease.

Towards Privacy-Preserved Aging in Place: A Systematic Review

Owing to progressive population aging, elderly people (aged 65 and above) face challenges in carrying out activities of daily living, while placement of the elderly in a care facility is expensive and mentally taxing for them. Thus, there is a need to develop their own homes into smart homes using new technologies. However, this raises concerns of privacy and data security for users since it can be handled remotely. Hence, with advancing technologies it is important to overcome this challenge using privacy-preserving and non-intrusive models. For this review, 235 articles were scanned from databases, out of which 31 articles pertaining to in-home technologies that assist the elderly in living independently were shortlisted for inclusion. They described the adoption of various methodologies like different sensor-based mechanisms, wearables, camera-based techniques, robots, and machine learning strategies to provide a safe and comfortable environment to the elderly. Recent innovations have rendered these technologies more unobtrusive and privacy-preserving with increasing use of environmental sensors and less use of cameras and other devices that may compromise the privacy of individuals. There is a need to develop a comprehensive system for smart homes which ensures patient safety, privacy, and data security; in addition, robots should be integrated with the existing sensor-based platforms to assist in carrying out daily activities and therapies as required.

Directing and Orienting ICT Healthcare Solutions to Address the Needs of the Aging Population

BACKGROUND

With an aging population, it is essential to maintain good health and autonomy for as long as possible. Instead of hospitalisation or institutionalisation, older people with chronic conditions can be assisted in their own home with numerous "smart" devices that support them in their activities of daily living, manage their medical conditions, and prevent fall incidents. Information and Communication Technology (ICT) solutions facilitate the monitoring and management of older people's health to improve quality of life and physical activity with a decline in caregivers' burden.

METHOD

The aim of this paper was to conduct a systematic literature review to analyse the state of the art of ICT solutions for older people with chronic conditions, and the impact of these solutions on their quality of life from a biomedical perspective.

RESULTS

By analysing the literature on the available ICT proposals, it is shown that different approaches have been deployed by noticing that the more cross-interventions are merged then the better the results are, but there is still no evidence of the effects of ICT solutions on older people's health outcomes. Furthermore, there are still unresolved ethical and legal issues.

CONCLUSION

While there has been much research and development in healthcare ICT solutions for the aging population, ICT solutions still need significant development in order to be user-oriented, affordable, and to manage chronic conditions in the aging wider population.

Investigating the Accessibility of Voice Assistants With Impaired Users: Mixed Methods Study

Background

Voice assistants allow users to control appliances and functions of a smart home by simply uttering a few words. Such systems hold the potential to significantly help users with motor and cognitive disabilities who currently depend on their caregiver even for basic needs (eg, opening a door). The research on voice assistants is mainly dedicated to able-bodied users, and studies evaluating the accessibility of such systems are still sparse and fail to account for the participants’ actual motor, linguistic, and cognitive abilities.

Objective

The aim of this work is to investigate whether cognitive and/or linguistic functions could predict user performance in operating an off-the-shelf voice assistant (Google Home).

Methods

A group of users with disabilities (n=16) was invited to a living laboratory and asked to interact with the system. Besides collecting data on their performance and experience with the system, their cognitive and linguistic skills were assessed using standardized inventories. The identification of predictors (cognitive and/or linguistic) capable of accounting for an efficient interaction with the voice assistant was investigated by performing multiple linear regression models. The best model was identified by adopting a selection strategy based on the Akaike information criterion (AIC).

Results

For users with disabilities, the effectiveness of interacting with a voice assistant is predicted by the Mini-Mental State Examination (MMSE) and the Robertson Dysarthria Profile (specifically, the ability to repeat sentences), as the best model shows (AIC=130.11).

Conclusions

Users with motor, linguistic, and cognitive impairments can effectively interact with voice assistants, given specific levels of residual cognitive and linguistic skills. More specifically, our paper advances practical indicators to predict the level of accessibility of speech-based interactive systems. Finally, accessibility design guidelines are introduced based on the performance results observed in users with disabilities.

A Conversational Robot for Older Adults with Alzheimer’s Disease

Amid the rising cost of Alzheimer’s disease (AD), assistive health technologies can reduce care-giving burden by aiding in assessment, monitoring, and therapy. This article presents a pilot study testing the feasibility and effect of a conversational robot in a cognitive assessment task with older adults with AD. We examine the robot interactions through dialogue and miscommunication analysis, linguistic feature analysis, and the use of a qualitative analysis, in which we report key themes that were prevalent throughout the study. While conversations were typically better with human conversation partners (being longer, with greater engagement and less misunderstanding), we found that the robot was generally well liked by participants and that it was able to capture their interest in dialogue. Miscommunication due to issues of understanding and intelligibility did not seem to deter participants from their experience. Furthermore, in automatically extracting linguistic features, we examine how non-acoustic aspects of language change across participants with varying degrees of cognitive impairment, highlighting the robot’s potential as a monitoring tool. This pilot study is an exploration of how conversational robots can be used to support individuals with AD.

Caregiver perspectives on a smart home-based socially assistive robot for individuals with Alzheimer's disease and related dementia

Purpose: Innovative assistive technology can address aging-in-place and caregiving needs of individuals with Alzheimer's disease and related dementia (ADRD). The purpose of this study was to beta-test a novel socially assistive robot (SAR) with a cohort of ADRD caregivers and gather their perspectives on its potential integration in the home context.Methods: The SAR involved a programmable research robot linked with commercially available Internet of things sensors to receive and respond to care recipient's behaviour. Eight caregivers observed the SAR perform two care protocols concerning the care recipient's daily routine and home safety, and then participated in a focus group and phone interview. The researchers used grounded theory and the Unified Theory of Acceptance and Use of Technology as a framework to gather and analyse the data.Results: The caregivers' asserted the potential of the SAR to relieve care burden and envisioned it as a next-generation technology for caregivers. Adoption of the SAR, as an identified theme, was subject to the SAR's navigability, care recipient engagement, adaptability, humanoid features, and interface design. In contrast, barriers leading to potential rejection were technological complexity, system failure, exasperation of burden, and failure to address digital divide.Conclusion: From a broader outlook, success of SARs as a home-health technology for ADRD is reliant on the timing of their integration, commercial viability, funding provisions, and their bonding with the care recipient. Long-term research in the home settings is required to verify the usability and impact of SARs in mediating aging-in-place of individuals with ADRD.IMPLICATIONS FOR REHABILITATIONSocially assistive robots (SARs), an emerging domain of assistive technology, are projected to have a crucial role in supporting aging-in-place of individuals with Alzheimer's disease and related dementia (ADRD).Caregivers of individuals with ADRD who observed and interacted with a novel SAR asserted their acceptance of the technology as well as its scope and feasibility for the upcoming generation of caregivers.Navigability, care recipient engagement, adaptability, humanoid features, and interface design were stated to be critical factors for SAR's acceptance by caregiver and care recipient dyads.In contrast, technological complexity, system failure, exasperation of burden, and failure to address digital divide are detrimental to SAR's adoption.Several design and implementation requirements must be considered towards the full-scale development and deployment of the SARs in the home context.

Speech Melody Matters—How Robots Profit from Using Charismatic Speech

In this article, we address to what extent the proverb “the sound makes the music” also applies to human-robot interaction, and whether robots could profit from using speech characteristics similar to those used by charismatic speakers like Steve Jobs. In three empirical studies, we investigate the effects of using Steve Jobs’ and Mark Zuckerberg's speech characteristics during the generation of robot speech on the robot's persuasiveness and its impressionistic evaluation. The three studies address different human-robot interaction situations, which range from online questionnaires to real-time interactions with a large service robot, yet all involve both behavioral measures and users’ assessments. The results clearly show that robots can profit from using charismatic speech.

Incorporating Conversational Strategies in a Social Robot to Interact with People with Dementia

BACKGROUND

Socially assistive robots (SARs) have the potential to assist nonpharmacological interventions based on verbal communication to support the care of persons with dementia (PwDs). However, establishing verbal communication with a PwD is challenging. Thus, several authors have proposed strategies to converse with PwDs. While these strategies have proved effective at enhancing communication between PwDs and their caregivers, they have not been used or tested in the domain of human-robot interaction.

OBJECTIVES

This study aimed to assess the effectiveness of incorporating conversational strategies proposed in the literature for caregivers, during PwD-robot interactions.

METHODS

We conducted a total of 23 group sessions based on music and conversation therapy, where a SAR interacted with 12 PwDs (mean = 80.25 years) diagnosed with mild to moderate-stage dementia. Using a single subject research approach, we designed an AB study to assess the effectiveness of the conversational strategies in the PwD-robot interaction. Our analysis focuses on the direct communication between the PwDs and the robot, and the perceived enjoyment of PwDs.

RESULTS

The number of utterances made from a PwD to the robot increased significantly when the conversational strategies were included in the robot. In addition, PwDs engaged in more sustained conversations. Additionally, PwDs enjoyed conversing with the robot Eva, as much as listening to music. These results indicate that the use of these conversational strategies is -effective at increasing the interaction between PwD and a SAR.

CONCLUSIONS

PwDs who participated in the study engaged and enjoyed the interaction with the SAR. The results provide evidence of the importance of incorporating appropriate conversational strategies in SARs that support interventions for the care and social stimulation of PwDs.