Social Robots for Hospitalized Children

Online Ambassador Visits for Hospitalized Children With Cancer: Qualitative Evaluation of Implementation

BACKGROUND

Children with cancer or cancer-like disease risk treatment-related isolation, which can negatively impact their peer relationships and social competencies and exacerbate their loneliness. During the COVID-19 pandemic, increased online socialization became the new normal imposed by national isolation guidelines. To adhere to the treatment-related isolation guidelines, children with cancer were offered online classmate "ambassador" visits during hospitalization.

OBJECTIVE

This study aimed to identify facilitators and barriers to online classmate "ambassador" visits during children with cancer's hospitalization through a qualitative descriptive process evaluation using the Consolidated Framework for Implementation Research.

METHODS

From January to April 2022, we conducted 39 individual semistructured interviews with hospitalized children (n=16), their classmates (n=16), teachers from their schools (n=3), and study nurses (n=4) from involved hospitals. Most interviews (n=37, 95%) were conducted online using Microsoft Teams or Google Meet, while 2 (5%) interviews were conducted in person at the participants' residences. This approach allowed us to gain a broad understanding of the facilitators and barriers to online ambassador visits.

RESULTS

We identified four themes: (1) working together, (2) ensuring participation, (3) staying connected, and (4) together online. The themes are described in terms of facilitators and barriers to online ambassador visits with 3 Consolidated Framework for Implementation Research domains: innovation, individuals, and the implementation process.

CONCLUSIONS

Addressing the social needs of hospitalized children through online visits with their classmates may be relevant when one-on-one meetings are problematic. The online visits are highly dependent on collaboration between study nurses and teachers and assessing the needs of the hospitalized children. While a high degree of adult engagement and a stable internet connection are pivotal, these online visits can promote much-needed social interaction between children across physical settings.

Child life specialist services, practice, and utilization across health care: a scoping review

OBJECTIVE

The objective of this review was to map the available evidence regarding the scope of child life specialist services, practice, and utilization.

INTRODUCTION

The concept of child life services began in 1922 and emerged as the child life specialist services specialty in the United States in the 1970s and 1980s. Child life specialists are members of multidisciplinary health care system teams who prioritize the developmental needs of pediatric patients to support and improve patient and family health care experiences. Evidence of the effectiveness of child life specialist services and the utilization of those services is often incorporated in multidisciplinary research reports and thus overlooked.

INCLUSION CRITERIA

All quantitative, qualitative, and mixed methods research study reports and systematic reviews investigating child life specialist services, practice, and utilization in health care systems were included.

METHODS

This review was guided by the JBI methodology for scoping reviews and a published a priori protocol. CINAHL (EBSCOhost), MEDLINE (PubMed), Scopus, and PsycINFO (APA) were searched for evidence published from January 1980 to August 2022.

RESULTS

Research publications about child life specialist services, practice, and utilization have increased dramatically over the past decade, with more than 50% of studies published in the past 5 years. Although the first authors of the majority of the research publications were physicians, these multidisciplinary author teams depicted child life specialist services in a variety of roles, including co-investigators, interventionists, and research subjects. The 105 full-text publications reviewed were from 9 countries, plus 1 publication that surveyed people across Europe. The contexts spanned a wide scope of clinical settings and medical subspecialties, but primarily in hospitals and health centers, and to a lesser extent, in ambulatory clinics and communities. A wide variety of child life specialist services were described across these settings.

CONCLUSION

Mapping the research can help delineate the barriers and facilitators to child life specialist services in health care systems. This scoping review provides evidence of the global diffusion of child life specialist services across health care system settings, with recent increases in research publications involving child life specialist services.

The effect of virtual reality glasses used during intravenous catheter application on the Child's emotional responses

PURPOSE

This study was conducted to determine the effect of virtual reality glasses used during intravenous catheter insertion on the child's emotional responses.

DESIGN AND METHODS

The sample of the research, which was carried out as a randomized controlled experimental study, consisted of 102 children, including 51 in the control group and 51 in the study group, who were aged between 7 and 12 years and were on treatment in the pediatric emergency department(PED). Research data were collected using a Descriptive Data Form for Children and the Children's Emotional Manifestation Scale. No intervention was applied to the control group. After the tourniquet was tied in the study group, the children started watching a video of their choice through virtual reality glasses. When the process was completed, the video was stopped. During this period, the child was evaluated using the Children's Emotional Manifestation Scale.

RESULTS

A statistically significant difference was found between the Children's Emotional Manifestation Scale scores of the children in the study and control groups (p = 0.000). The scores of the children in the study group were statistically significantly lower than the scores of the children in the control group.

CONCLUSION

During the intravenous catheter insertion process, children who watched cartoons on virtual reality glasses showed less negative emotional behavior than those who did not.

PRACTICE IMPLICATIONS

The use of virtual reality glasses is a developing technology in child health services, and it is recommended to encourage their use in these services.

Exploring the impact of socially assistive robots on health and wellbeing across the lifespan: An umbrella review and meta-analysis

BACKGROUND

Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice.

OBJECTIVE

To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862).

DESIGN

An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect.

METHODS

14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews.

RESULTS

35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use.

DISCUSSION

Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews.

CONCLUSION

Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.

Social robotics as an adjuvant during the hospitalization process in pediatric oncology patients

OBJECTIVE

To describe the experience of implementing social robotics as an adjuvant during the hospitalization process in pediatric oncology patients.

METHODS

Before and after cohort study, applying an intervention with the Lego Mindstorms EV3 kit in patients between 8 and 17 years old that are hospitalized with a cancer diagnosis. We excluded patients from the intensive care unit or when their treating physician recommended so. The intervention consisted of a three-phase workshop: an open architecture story, building a car robot using the Lego Mindstorm EV3 kit, and cooperative playing activities such as races and passing obstacles.

RESULTS

Thirteen patients received the intervention with robotic lego. The median age was 15 years (IQR = 3), and 84.6% of the population (n = 11) were male. We found significant improvement in the language (topic management p = .011 and communicative intention p = .034). Other characteristics improved, but not significantly (self-care activities index, catching). No adverse events occurred during the intervention.

CONCLUSIONS

The results of this pilot study suggest that implementing social robotics during hospitalization in children with cancer is a therapeutic adjuvant and safe intervention that promotes better communication, self-care, and a physical activity improvement. For future studies, the impact of this intervention could be measured in hospitalized pediatric cancer patients.

The League: A person-centred approach to the development of social robotics for paediatric anxiety

BACKGROUND

Social robots are promising tools to improve the quality of life of children and youth living with anxiety and should be developed based on the priorities of end users. However, pathways to include young people in patient-oriented research, particularly in the overlap between technology and mental health, have been historically limited.

OBJECTIVE

In this work, we describe engagement with experts with lived experiences of paediatric anxiety in a social robotics research programme. We report the experiences of patient advisors in a co-creation process and identify considerations for other research groups looking to involve end users in technology development in the field of youth mental health.

DESIGN

We engaged individuals with a lived experience of paediatric anxiety (current, recent past, or from a parent perspective) using three different models over the course of three years. Two initial patient partners were involved during project development, eight were engaged as part of an advisory panel ('the League') during study development and data analysis and four contributed as ongoing collaborators in an advisory role. League members completed a preparticipation expectation survey and a postparticipation experience survey.

FINDINGS

Eight individuals from a range of anxiety-related diagnostic groups participated in the League as patient partners. Members were teenagers (n = 3), young adults aged 22-26 years who had connected with a youth mental health service as children within the past eight years (n = 3) or parents of children presently living with anxiety (n = 2). Preferred methods of communication, expectations and reasons for participating were collected. The League provided specific and actionable feedback on the design of workshops on the topic of social robotics, which was implemented. They reported that their experiences were positive and fairly compensated, but communication and sustained engagement over time were challenges. Issues of ethics and language related to patient-centred brain health technology research are discussed.

CONCLUSIONS

There is an ethical imperative to meaningfully incorporate the voices of youth and young adults with psychiatric conditions in the development of devices intended to support their mental health and quality of life.

PATIENT OR PUBLIC CONTRIBUTION

Six young people and two parents with lived experiences of paediatric anxiety participated in all stages of developing a research programme on social robotics to support paediatric mental health in a community context. They also provided input during the preparation of this manuscript.

Preoperative anxiety management in children. Benefits of humanoid robots: an experimental study

Objective

The purpose of this study was to determine whether the use of a humanoid robot (Estrabot) could reduce preoperative anxiety levels in children.

Methods

An experimental study was conducted at Azienda Ospedaliero Universitaria delle Marche Hospital, involving the Pediatric Surgery ward and the Operating Room (OR). Patients aged between 2 and 14 years who underwent minor surgery were included. The Instruments used were the Children's Emotional Manifestation Scale to evaluate anxiety levels, and Estrabot, a humanoid robot that interacts with people. Medical records between April and May 2023 were analyzed and the data was anonymous. The level of anxiety is extrapolated in Pediatric Surgery during the administration of oral pre-medication, and in the Operating Room, during the induction of anesthesia. Patients were divided into an intervention group treated with Estrabot, and a control group without a robot.

Results

The population consists of 60 patients (86.7% male) with a median (IQR) age of 6 (4-8) years. The median (IQR) anxiety score during premedication was 7 (5-11), while the median (IQR) anxiety score during anesthesia was 6 (5-10). A significantly lower level of anxiety was reported in the Estrabot group. Patients in the Estrabot group had significantly lower anxiety levels in different age groups.

Conclusion

A humanoid robot can reduce preoperative anxiety levels in children during premedication and the induction of anesthesia.

Education by a social robot on nutrition and catheter care in pediatric oncology patients

PURPOSE

To improve knowledge on nutrition and catheter care in children with cancer by an educational intervention with a social robot.

METHODS

We conducted a cohort study on pediatric cancer patients in a high complexity Hospital in Bogotá, Colombia. We included 14 patients (8-17 years old) who underwent an educational intervention with the help of a humanoid robot (Nao V6). The robot was programmed to transmit educational messages about self-care in feeding and using the central venous catheter. A survey with yes-no questions was administered before and after the intervention.

RESULTS

We found an improvement in understanding of the subject matter related to nutrition and catheter care, when comparing the knowledge on topics before and after the educational intervention (p < .001).

CONCLUSION

Education by a social robot on nutrition and catheter care showed a positive effect on children's knowledge on these topics. Therefore, it potentially decreases the risk of poor feeding habits and inadequate central venous catheter management, and improves adherence to recommendations and quality of life.

Innovative protocol of an exploratory study evaluating the acceptability of a humanoid robot at home of deaf children with cochlear implants

The purpose of this paper is to introduce a research methodology for the assessment of the acceptability of a humanoid robot at home for children with cochlear implants (CI). The quality of audiology rehabilitation for cochlear implanted child administrated at the hospital with pluri-weekly sessions is a major prognostic factor in the outcome on communications abilities, but represents also a constraint for families related to the access to care that are more difficult. Further, home training with tools would balance the equitable distribution of care in the territory and promote the child's progress. The humanoid robot should allow an ecological approach to this complementary training. Before developing this approach, it is necessary to study the acceptability of the humanoid robot at home, both by cochlear implanted child and their families. Ten families were chosen to have a humanoid robot at home, to explore their acceptability of the humanoid robot Pepper. The study lasts for 1 month per participants (i.e. cochlear implemented children and parent). Participants were invited to use the robot at home as much as they want. The humanoid robot Pepper was able to communicate and proposed activities not related to rehabilitation. Once a week during the study, data were collected from participants (questionnaires and robot's logs) and the smooth running of the study was checked. Questionnaires are used to evaluate the acceptability of the robot by children and parents. User data from the robot's logs are used to quantify the time and the actual use of the robot over the period of the study. Results of the experimentation will be reported, once all 10 participants have completed their passation. The robot is anticipated to be used and accepted by children with cochlear implants and their families. Clinical trial registration: Clinical Trials ID: NCT04832373; https://clinicaltrials.gov/.

Artificial intelligence ecosystem for computational psychiatry: Ideas to practice

Computational psychiatry is an emerging field that not only explores the biological basis of mental illness but also considers the diagnoses and identifies the underlying mechanisms. One of the key strengths of computational psychiatry is that it may identify patterns in large datasets that are not easily identifiable. This may help researchers develop more effective treatments and interventions for mental health problems. This paper is a narrative review that reviews the literature and produces an artificial intelligence ecosystem for computational psychiatry. The artificial intelligence ecosystem for computational psychiatry includes data acquisition, preparation, modeling, application, and evaluation. This approach allows researchers to integrate data from a variety of sources, such as brain imaging, genetics, and behavioral experiments, to obtain a more complete understanding of mental health conditions. Through the process of data preprocessing, training, and testing, the data that are required for model building can be prepared. By using machine learning, neural networks, artificial intelligence, and other methods, researchers have been able to develop diagnostic tools that can accurately identify mental health conditions based on a patient’s symptoms and other factors. Despite the continuous development and breakthrough of computational psychiatry, it has not yet influenced routine clinical practice and still faces many challenges, such as data availability and quality, biological risks, equity, and data protection. As we move progress in this field, it is vital to ensure that computational psychiatry remains accessible and inclusive so that all researchers may contribute to this significant and exciting field.

The effect of an interactive robot on children's post-operative anxiety, mobilization, and parents' satisfaction; randomized controlled study

PURPOSE

To evaluate the effect of an interactive robot on Turkish children's post-operative anxiety, mobilization, and parents' satisfaction related to post-operative care.

METHOD

A randomized controlled study was conducted with 84 children who will undergo day surgery aged 5-10 years and their parents at a university hospital between June 2020-April 2022. The interactive robot was provided to accompany the children during the postoperative mobilization. Children in the control group received standard care during mobilization. Data were collected using the Personal Information Form, Children's State Anxiety (CSA), Parental Satisfaction Scale-Visual Analog Scale, and Mobilization Chart.

RESULTS

It was determined that the CSA score of the children in the control group were higher than the intervention group before their first mobilization after surgery (p = 0.005). During the first (p = 0.042) and second (p = 0.012) mobilization, it was determined that the mobilization duration of children in the intervention group was longer than the children in the control group. It was found that the parents of the children in the intervention group had a high level of satisfaction.

CONCLUSION

It has been determined that interactive robots positively affect postoperative mobilization in children undergoing day surgery, reduce the anxiety level of children before mobilization, and increase the duration of mobilization. In addition, the use of interactive robots increased parents' satisfaction with post-operative mobilization care.

PRACTICE IMPLICATIONS

Using interactive robots to reduce the stress and anxiety of children during the perioperative process can be a promising approach to improve their recovery by providing early mobilization.

A Systematic Review on Social Robots in Public Spaces: Threat Landscape and Attack Surface

There is a growing interest in using social robots in public spaces for indoor and outdoor applications. The threat landscape is an important research area being investigated and debated by various stakeholders. Objectives: This study aims to identify and synthesize empirical research on the complete threat landscape of social robots in public spaces. Specifically, this paper identifies the potential threat actors, their motives for attacks, vulnerabilities, attack vectors, potential impacts of attacks, possible attack scenarios, and mitigations to these threats. Methods: This systematic literature review follows the guidelines by Kitchenham and Charters. The search was conducted in five digital databases, and 1469 studies were retrieved. This study analyzed 21 studies that satisfied the selection criteria. Results: Main findings reveal four threat categories: cybersecurity, social, physical, and public space. Conclusion: This study completely grasped the complexity of the transdisciplinary problem of social robot security and privacy while accommodating the diversity of stakeholders’ perspectives. Findings give researchers and other stakeholders a comprehensive view by highlighting current developments and new research directions in this field. This study also proposed a taxonomy for threat actors and the threat landscape of social robots in public spaces.

The effects of sound-and-light toy as a distraction method on pain and physiological parameters in infants regarding circumcision procedure

Background/Aim: Circumcision is a common surgical procedure and a cause of pain and stress for infants. Nurses are in a key role for providing pain relief through implementation of non-pharmacological practices for pain management. This study aimed to assess the impact of distraction using a sound- and light-producing toy on pain and physiological parameters in infants regarding circumcision procedure. Methods: This randomized controlled study was conducted with infants between six months and two years of age who presented to a private circumcision clinic. The sample consisted of 60 infants randomly allocated into intervention (n = 30) and control (n = 30) groups. During the procedure, the mothers of the infants in the intervention distracted the infants with the toy for 15 min. Infants in the control group were accompanied by their mothers during the procedure and did not receive any additional intervention other than the standard care. Data were collected using a questionnaire and the face, legs, activity, cry, consolability (FLACC) pain scale. Data were assessed using descriptive statistical analyses and parametric tests. Results: Infants in the intervention and control groups were similar in terms of current and gestational ages, lengths, weights, and maternal and paternal ages and showed no differences in terms of physiological parameters before and after the procedure (P > 0.05). Post-operative pain scores were lower in infants exposed to the toy with light- and sound than that in the infants in the control group; however, no significant difference between groups was found (P > 0.05). Conclusion: Considering the effect of sound- and light-producing toys on causing a reduction in pain severity, it may be recommended to use distracting practices by nurses to reduce/relieve pain associated with circumcision.

Caregiver Views on Prospective Use of Robotic Care in Helping Children Adapt to Hospitalization

Children in hospitals endure a variety of stressful situations. Children feel friendly toward and have fun with robots. Care robots are considered to be an alternate technique to relieve stress after hospitalization. A mixed-methods study was conducted on caregivers to understand the ideal care robot. One hundred and fifty caregivers of pediatric patients participated in a quantitative online survey, and eleven participated in focus group interviews for qualitative analysis. Quantitative data underwent descriptive statistics. Content analysis was conducted for qualitative data. Regarding the overall awareness and necessity of a care robot, the caregivers thought it would help patients adapt to the hospital environment more quickly. The caregivers' preferred character-shaped robots of child height. For sound, they preferred an animated character's voice. For movement, they preferred the robot to roll on wheels. Regarding functions, medicine was the item for which they most wanted to use game elements. For the educational element, the caregivers wanted to teach children the reasons for and methods of medicine administration. Four themes were derived from the qualitative results. The findings are expected to contribute to the future development of care robots that can assist pediatric patients.

An Immersive Human-Robot Interactive Game Framework Based on Deep Learning for Children’s Concentration Training

In order to alleviate bottlenecks such as the lack of professional teachers, inattention during training processes, and low effectiveness in concentration training, we have proposed an immersive human–robot interactive (HRI) game framework based on deep learning for children’s concentration training and demonstrated its use through human–robot interactive games based on gesture recognition. The HRI game framework includes four functional modules: video data acquisition, image recognition modeling, a deep learning algorithm (YOLOv5), and information feedback. First, we built a gesture recognition model containing 10,000 pictures of children’s gestures, using the YOLOv5 algorithm. The average accuracy in recognition trainingwas 98.7%. Second, we recruited 120 children with attention deficits (aged from 9 to 12 years) to play the HRI games, including 60 girls and 60 boys. In the HRI game experiment, we obtained 8640 sample data, which were normalized and processed.According to the results, we found that the girls had better visual short-term memory and a shorter response time than boys. The research results showed that HRI games had a high efficacy, convenience, and full freedom, making them appropriate for children’s concentration training.

Inviting Robot Touch (By Design)

What is the role of touch in inviting social interaction with robots? Forms of functional haptics in collaboration and socially assistive robots for example indicate one pathway. But what of more naturalistic and affective forms of touch that are more inviting, that encourage pro-social behaviors? This is a tale of three loops. First, the haptic feedback loop, where human-human touch still remains underexplored, and where human-machine touch is produced through mechanical engineering as ‘force display’ and perceived by the user as tactile (e.g. Srinivasan and Basdogan 1997). Second, the affective feedback loop, courtesy of Höök (2008; 2009) and Dumouchel and Damiano (2017), where technical systems influence, and are influenced by, a human user corporeally. Bringing these loops together encourages interaction design to consider how touch and affect may more effectively invite a range of users to interact with social robots, and their role in the perception of Artificial Empathy (AE).

Endowing a NAO Robot With Practical Social-Touch Perception

Social touch is essential to everyday interactions, but current socially assistive robots have limited touch-perception capabilities. Rather than build entirely new robotic systems, we propose to augment existing rigid-bodied robots with an external touch-perception system. This practical approach can enable researchers and caregivers to continue to use robotic technology they have already purchased and learned about, but with a myriad of new social-touch interactions possible. This paper presents a low-cost, easy-to-build, soft tactile-perception system that we created for the NAO robot, as well as participants’ feedback on touching this system. We installed four of our fabric-and-foam-based resistive sensors on the curved surfaces of a NAO’s left arm, including its hand, lower arm, upper arm, and shoulder. Fifteen adults then performed five types of affective touch-communication gestures (hitting, poking, squeezing, stroking, and tickling) at two force intensities (gentle and energetic) on the four sensor locations; we share this dataset of four time-varying resistances, our sensor patterns, and a characterization of the sensors’ physical performance. After training, a gesture-classification algorithm based on a random forest identified the correct combined touch gesture and force intensity on windows of held-out test data with an average accuracy of 74.1%, which is more than eight times better than chance. Participants rated the sensor-equipped arm as pleasant to touch and liked the robot’s presence significantly more after touch interactions. Our promising results show that this type of tactile-perception system can detect necessary social-touch communication cues from users, can be tailored to a variety of robot body parts, and can provide HRI researchers with the tools needed to implement social touch in their own systems.

The pilot study of group robot intervention on pediatric inpatients and their caregivers, using 'new aibo'

The study on robot-assisted therapy in a pediatric field has not been applied sufficiently in clinical settings. The purpose of this pilot study is to explore the potential therapeutic effects of a group robot intervention (GRI), using dog-like social robot (SR) 'aibo' in pediatric ward. GRI by aibo was conducted for those children with chronic illness (127 in total) who are hospitalized in National Centre for Child Health and Development (NCCHD), and their caregivers (116 in total), from March to April 2018. The observer made structured behavioural observation records, based on which qualitative research on the features of their words and conducts, were carried out. As a result, first, during the GRI, about 2/3 of total expression by children were positive, while about 1/4 were negative or inappropriate. On the other hand, as seen in the 'change' group, those children who had originally responded with negative expression eventually came to express positive expression, while getting involved in a ternary relationship or participating in a session more than once. Secondly, as for the expression from the caregivers during the GRI, active expressions such as 'participation' and 'exploration' accounted for the 2/3, while 1/3 turned out to be rather placid expressions such as 'watch over' or 'encourage.'Conclusion: There has not been any precedent study on the features of words and conducts expressed by patients and their caregivers during the GRI by aibo. The outcome suggests that aibo could possibly be used as a tool for group robot-assisted therapy in the pediatric treatment setting. What is Known: • The study on robot-assisted therapy in a pediatric field has only just begun. • Though many kinds of social robot have been reportedly used so far, none has yet to be applied in clinical settings What is New: • Our study revealed the features of words and behaviour expressed by the patients and their caregivers, when dog-like social robot 'aibo' was used for a group robot intervention in the pediatric ward. • The outcome suggests that aibo could possibly be used as a tool for group robot-assisted therapy in the pediatric treatment setting.

Review of Smart Hospital Services in Real Healthcare Environments

OBJECTIVE

Smart hospitals involve the application of recent information and communications technology (ICT) innovations to medical services; however, the concept of a smart hospital has not been rigorously defined. In this study, we aimed to derive the definition and service types of smart hospitals and investigate cases of each type.

METHODS

A literature review was conducted regarding the background and technical characteristics of smart hospitals. On this basis, we conducted a focus group interview with experts in hospital information systems, and ultimately derived eight smart hospital service types.

RESULTS

Smart hospital services can be classified into the following types: services based on location recognition and tracking technology that measures and monitors the location information of an object based on short-range communication technology; high-speed communication network-based services based on new wireless communication technology; Internet of Things-based services that connect objects embedded with sensors and communication functions to the internet; mobile health services such as mobile phones, tablets, and wearables; artificial intelligence-based services for the diagnosis and prediction of diseases; robot services provided on behalf of humans in various medical fields; extended reality services that apply hyper-realistic immersive technology to medical practice; and telehealth using ICT.

CONCLUSIONS

Smart hospitals can influence health and medical policies and create new medical value by defining and quantitatively measuring detailed indicators based on data collected from existing hospitals. Simultaneously, appropriate government incentives, consolidated interdisciplinary research, and active participation by industry are required to foster and facilitate smart hospitals.

Social robots and therapeutic adherence: A new challenge in pediatric asthma?

Social Robots are used in different contexts and, in healthcare, they are better known as Socially Assistive Robots. In the context of asthma, the use of Socially Assistive Robots has the potential to increase motivation and engagement to treatment. Other positive roles proposed for Socially Assistive Robots are to provide education, training regarding treatments, and feedback to patients. This review evaluates emerging interventions for improving treatment adherence in pediatric asthma, focusing on the possible future role of social robots in the clinical practice.

Experience with an Affective Robot Assistant for Children with Hearing Disabilities

This study presents an assistive robotic system enhanced with emotion recognition capabilities for children with hearing disabilities. The system is designed and developed for the audiometry tests and rehabilitation of children in a clinical setting and includes a social humanoid robot (Pepper), an interactive interface, gamified audiometry tests, sensory setup and a machine/deep learning based emotion recognition module. Three scenarios involving conventional setup, tablet setup and setup with the robot+tablet are evaluated with 16 children having cochlear implant or hearing aid. Several machine learning techniques and deep learning models are used for the classification of the three test setups and for the classification of the emotions (pleasant, neutral, unpleasant) of children using the recorded physiological signals by E4 wristband. The results show that the collected signals during the tests can be separated successfully and the positive and negative emotions of children can be better distinguished when they interact with the robot than in the other two setups. In addition, the children’s objective and subjective evaluations as well as their impressions about the robot and its emotional behaviors are analyzed and discussed extensively.

Using social robot NAO for emotional support to children at a paediatric emergency department: a randomised clinical trial

Background

Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations.

Objective

This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels.

Methods

This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r).

Results

A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57).

Conclusions

SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting.

Trial Registration

ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909

Robotic Psychology: A PRISMA Systematic Review on Social-Robot-Based Interventions in Psychological Domains

Current technological advancements have allowed robots to be successfully employed in the healthcare sector. However, the recently acquired ability of social robots to process social information and act according to it has potentially made them very well suited to support or conduct psychological interventions. The present paper carried out a systematic review of the available literature regarding social-robot-based interventions in psychological domains using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The inclusion criteria were: (i) publication date until 2020; (ii) being an empirical study, master thesis, or project report; (iii) written in English or Italian languages (the two languages spoken by the authors); (iv) published in a scholarly peer-reviewed journal or conference proceedings, or were Ph.D. or master’s theses; and (v) assessed “social robot”-based intervention in psychological domains. Overall, the review showed that three main areas may benefit from social-robot-based interventions: social skills, mood, and wellbeing (e.g., stress and anxiety levels). Interestingly, social robots seemed to have a performance comparable to, and sometimes even better than, human operators. The main, but not exclusive, target of robot-based interventions in the psychological field was children with autism spectrum disorder (ASD). As evidence is, however, still limited and in an embryonic state, deeper investigations are needed to assess the full potential of social robots for the purposes of psychological intervention. This is relevant, considering the role that social robots could have in overcoming barriers to access psychological assessment and therapies.

Using social robot PLEO to enhance the well-being of hospitalised children

Hospitalisation is stressful for children. Play material is often offered for distraction and comfort. We explored how contact with social robot PLEO could positively affect a child's well-being. To this end, we performed a multiple case study on the paediatric ward of two hospitals. Child life specialists offered PLEO as a therapeutic activity to children in a personalised way for a well-being related purpose in three to five play like activity sessions during hospital visits/stay. Robot-child interaction was observed; care professionals, children and parents were interviewed. Applying direct content analysis revealed six categories of interest: interaction with PLEO, role of the adults, preferences for PLEO, PLEO as buddy, attainment of predetermined goal(s) and deployment of PLEO. Four girls and five boys, aged 4-13, had PLEO offered as a relief from stress or boredom or for physical stimulation. All but one started interacting with PLEO and showed behaviours like hugging, caring or technical exploration, promoting relaxation, activation and/or making contact. Interaction with PLEO contributed to achieving the well-being related purpose for six of them. PLEO was perceived as attractive to elicit play. Although data are limited, promising results emerge that the well-being of hospitalised children might be fostered by a personalised PLEO offer.

Play interventions for paediatric patients in hospital: a scoping review

OBJECTIVE

Play is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions.

DESIGN

Scoping review.

DATA SOURCES

PubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000- 9 September 2020).

STUDY SELECTION AND DATA EXTRACTION

We systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0-18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented.

RESULTS

Of the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety.

CONCLUSIONS

Play in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.

User Experience in Social Robots

Social robots are increasingly penetrating our daily lives. They are used in various domains, such as healthcare, education, business, industry, and culture. However, introducing this technology for use in conventional environments is not trivial. For users to accept social robots, a positive user experience is vital, and it should be considered as a critical part of the robots' development process. This may potentially lead to excessive use of social robots and strengthen their diffusion in society. The goal of this study is to summarize the extant literature that is focused on user experience in social robots, and to identify the challenges and benefits of UX evaluation in social robots. To achieve this goal, the authors carried out a systematic literature review that relies on PRISMA guidelines. Our findings revealed that the most common methods to evaluate UX in social robots are questionnaires and interviews. UX evaluations were found out to be beneficial in providing early feedback and consequently in handling errors at an early stage. However, despite the importance of UX in social robots, robot developers often neglect to set UX goals due to lack of knowledge or lack of time. This study emphasizes the need for robot developers to acquire the required theoretical and practical knowledge on how to perform a successful UX evaluation.

An Immersive Investment Game to Study Human-Robot Trust

As robots become more advanced and capable, developing trust is an important factor of human-robot interaction and cooperation. However, as multiple environmental and social factors can influence trust, it is important to develop more elaborate scenarios and methods to measure human-robot trust. A widely used measurement of trust in social science is the investment game. In this study, we propose a scaled-up, immersive, science fiction Human-Robot Interaction (HRI) scenario for intrinsic motivation on human-robot collaboration, built upon the investment game and aimed at adapting the investment game for human-robot trust. For this purpose, we utilize two Neuro-Inspired COmpanion (NICO) - robots and a projected scenery. We investigate the applicability of our space mission experiment design to measure trust and the impact of non-verbal communication. We observe a correlation of 0.43 (p=0.02) between self-assessed trust and trust measured from the game, and a positive impact of non-verbal communication on trust (p=0.0008) and robot perception for anthropomorphism (p=0.007) and animacy (p=0.00002). We conclude that our scenario is an appropriate method to measure trust in human-robot interaction and also to study how non-verbal communication influences a human’s trust in robots.

Evaluating the Role of a Socially Assistive Robot in Children's Mental Health Care

Socially assistive robots (SARs) present a promising intervention for addressing the increasing prevalence of childhood stress. This innovative technology has become increasingly common in practical implementation. However, empirical support has not kept pace with the robots' growing popularity. The present study set out to provide an empirical test of the stress-buffering capability of this technology. We examined the effects of the presence of an SAR on self-reported measures of stress in a community sample of 70 children (40 girls, 30 boys) between the ages of 7 and 10 years old. Child participants were randomly assigned to either a robot-present or a robot-absent condition during the Trier Social Stress Test for Children. Contrary to our predictions, we did not detect a stress-buffering effect of the presence of the robot. Instead, the primary analysis showed that the robot's presence led to a larger decrease in positive affect following the task. However, further analyses found no significant difference in positive affect when accounting for baseline group differences. Exploratory analyses of the nature of children's interactions with the SAR during the stressful task found that higher levels of parent-reported social anxiety were associated with greater prosocial behaviors towards the SAR, thus signifying a potential target for future interventions. Further work on SARs is needed to determine the optimal timing and robotic specifications that would maximize the potential of this developing technology to improve children's mental health care.

Mitigating Children’s Pain and Anxiety during Blood Draw Using Social Robots

Young pediatric patients who undergo venipuncture or capillary blood sampling often experience high levels of pain and anxiety. This often results in distressed young patients and their parents, increased treatment times, and a higher workload for healthcare professionals. Social robots are a new and promising tool to mitigate children’s pain and anxiety. This study aims to purposefully design and test a social robot for mitigating stress and anxiety during blood draw of children. We first programmed a social robot based on the requirements expressed by experienced healthcare professionals during focus group sessions. Next, we designed a randomized controlled experiment in which the social robot was applied as a distraction method to measure its capacity to mitigate pain and anxiety in children during blood draw in a children’s hospital setting. Children who interacted with the robot showed significantly lower levels of anxiety before actual blood collection, compared to children who received regular medical treatment. Children in the middle classes of primary school (aged 6–9) seemed especially sensitive to the robot’s ability to mitigate pain and anxiety before blood draw. Children’s parents overall expressed strong positive attitudes toward the use and effectiveness of the social robot for mitigating pain and anxiety. The results of this study demonstrate that social robots can be considered a new and effective tool for lowering children’s anxiety prior to the distressing medical procedure of blood collection.

A COVID-19 Emergency Response for Remote Control of a Dialysis Machine with Mobile HRI

Healthcare workers face a high risk of contagion during a pandemic due to their close proximity to patients. The situation is further exacerbated in the case of a shortage of personal protective equipment that can increase the risk of exposure for the healthcare workers and even non-pandemic related patients, such as those on dialysis. In this study, we propose an emergency, non-invasive remote monitoring and control response system to retrofit dialysis machines with robotic manipulators for safely supporting the treatment of patients with acute kidney disease. Specifically, as a proof-of-concept, we mock-up the touchscreen instrument control panel of a dialysis machine and live-stream it to a remote user’s tablet computer device. Then, the user performs touch-based interactions on the tablet device to send commands to the robot to manipulate the instrument controls on the touchscreen of the dialysis machine. To evaluate the performance of the proposed system, we conduct an accuracy test. Moreover, we perform qualitative user studies using two modes of interaction with the designed system to measure the user task load and system usability and to obtain user feedback. The two modes of interaction included a touch-based interaction using a tablet device and a click-based interaction using a computer. The results indicate no statistically significant difference in the relatively low task load experienced by the users for both modes of interaction. Moreover, the system usability survey results reveal no statistically significant difference in the user experience for both modes of interaction except that users experienced a more consistent performance with the click-based interaction vs. the touch-based interaction. Based on the user feedback, we suggest an improvement to the proposed system and illustrate an implementation that corrects the distorted perception of the instrumentation control panel live-stream for a better and consistent user experience.

Exploring Teens as Robot Operators, Users and Witnesses in the Wild

As social robots continue to show promise as assistive technologies, the exploration of appropriate and impactful robot behaviors is key to their eventual success. Teens are a unique population given their vulnerability to stress leading to both mental and physical illness. Much of teen stress stems from school, making the school environment an ideal location for a stress reducing technology. The goal of this mixed-methods study was to understand teens' operation of, and responsiveness to, a robot only capable of movement compared to a robot only capable of speech. Stemming from a human-centered approach, we introduce a Participatory Wizard of Oz (PWoz) interaction method that engaged teens as operators, users, and witnesses in a uniquely transparent interaction. In this paper, we illustrate the use of the PWoz interaction method as well as how it helps identify engaging robot interactions. Using this technique, we present results from a study with 62 teens that includes details of the complexity of teen stress and a significant reduction in negative attitudes toward robots after interactions. We analyzed the teens' interactions with both the verbal and non-verbal robots and identified strong themes of (1) authenticity, (2) empathy, (3) emotional engagement, and (4) imperfection creates connection. Finally, we reflect on the benefits and limitations of the PWoz method and our study to identify next steps toward the design and development of our social robot.

Are friends electric? The benefits and risks of human-robot relationships

Social robots that can interact and communicate with people are growing in popularity for use at home and in customer-service, education, and healthcare settings. Although growing evidence suggests that co-operative and emotionally aligned social robots could benefit users across the lifespan, controversy continues about the ethical implications of these devices and their potential harms. In this perspective, we explore this balance between benefit and risk through the lens of human-robot relationships. We review the definitions and purposes of social robots, explore their philosophical and psychological status, and relate research on human-human and human-animal relationships to the emerging literature on human-robot relationships. Advocating a relational rather than essentialist view, we consider the balance of benefits and harms that can arise from different types of relationship with social robots and conclude by considering the role of researchers in understanding the ethical and societal impacts of social robotics.

A Survey of Robots in Healthcare

In recent years, with the current advancements in Robotics and Artificial Intelligence (AI), robots have the potential to support the field of healthcare. Robotic systems are often introduced in the care of the elderly, children, and persons with disabilities, in hospitals, in rehabilitation and walking assistance, and other healthcare situations. In this survey paper, the recent advances in robotic technology applied in the healthcare domain are discussed. The paper provides detailed information about state-of-the-art research in care, hospital, assistive, rehabilitation, and walking assisting robots. The paper also discusses the open challenges healthcare robots face to be integrated into our society.

Children’s Evaluations of a Therapy Dog and Biomimetic Robot: Influences of Animistic Beliefs and Social Interaction

Social robots are being used increasingly across a range of settings, including in the context of therapeutic interactions with children. While research has shown that interaction with live therapy dogs can be calming and enjoyable for children, it is currently unclear whether social robots can produce similar outcomes. In this study, 11–12-year old children completed a questionnaire about their biophilic beliefs and attitudes to dogs and robots before engaging in two separate free-play, non-goal directed, non-therapeutic sessions with an interactive biomimetic MiRo-E robot and a living therapy dog in a controlled setting. Behavioural observations of social interaction, initiation and reaction behaviours by the child and dog/robot showed that participants spent a similar amount of time engaging in positive social touch with the robot and the dog, but overall more time interacting with the robot. This may be because the robot was more responsive to the children’s initiation behaviours. In self-report, participants significantly preferred the session with the living dog. However, overall enjoyment was high and more positive emotions were reported following interaction with the robot. The more participants attributed mental attributes and animacy to the dog/robot, the more they enjoyed the interactions, demonstrating that participants’ animistic beliefs were an important factor in their evaluations. Levels of social interaction did not correlate with enjoyment, suggesting that the nature of the interaction was less important than pre-existing participant attitudes in producing reported positive outcomes. Although there were some differences in behaviour and evaluations, these preliminary results suggest that MiRo-E provides a useful comparison to therapy dogs and may be a suitable alternative for use in interventions with children.

Perspectives of Child Life Specialists After Many Years of Working With a Humanoid Robot in a Pediatric Hospital: Narrative Design

Background

Child life specialists (CLSs) play an important role in supporting patients and their families during their visits to a children’s hospital. Although CLSs are equipped with considerable expertise to support families during some of the most difficult moments of their lives, we introduced an additional resource to them in the form of a humanoid robot named MEDi.

Objective

The aim of this study is to explore the experiences of CLSs using a robot to support children.

Methods

We interviewed 7 CLSs who had worked with this robot for several years. The transcribed interviews were analyzed using open and axial coding.

Results

The first main theme that emerged was the process of navigating from fear to friendship in learning to use a humanoid robot for therapeutic support. The second major theme was MEDi as a source of connection and support to children. CLSs’ perceptions of MEDi as an adaptable resource and working with the limits of MEDi constituted the last 2 themes.

Conclusions

These descriptions show how CLSs can incorporate a robot into their practice.

Sex and gender differences and biases in artificial intelligence for biomedicine and healthcare

Precision Medicine implies a deep understanding of inter-individual differences in health and disease that are due to genetic and environmental factors. To acquire such understanding there is a need for the implementation of different types of technologies based on artificial intelligence (AI) that enable the identification of biomedically relevant patterns, facilitating progress towards individually tailored preventative and therapeutic interventions. Despite the significant scientific advances achieved so far, most of the currently used biomedical AI technologies do not account for bias detection. Furthermore, the design of the majority of algorithms ignore the sex and gender dimension and its contribution to health and disease differences among individuals. Failure in accounting for these differences will generate sub-optimal results and produce mistakes as well as discriminatory outcomes. In this review we examine the current sex and gender gaps in a subset of biomedical technologies used in relation to Precision Medicine. In addition, we provide recommendations to optimize their utilization to improve the global health and disease landscape and decrease inequalities.

Feasibility and acceptability of an animatronic duck intervention for promoting adaptation to the in-patient setting among pediatric patients receiving treatment for cancer

BACKGROUND

During cancer treatment, children undergo potentially stressful hospitalizations and procedures. Animatronic devices are a promising means of distraction intervention. This study aimed to assess acceptability and feasibility of the My Special Aflac Duck® (MSAD) intervention among pediatric oncology patients and parents. We hypothesized that MSAD would be feasible to implement, have greater than 50% acceptance, and be useful distraction.

PROCEDURES

This feasibility study enrolled oncology patients aged 3-11 years admitted to Children's Healthcare of Atlanta between May and August 2018. Patients were exposed to MSAD for 3 days and completed quantitative and qualitative assessments of acceptability. Patient and hospital data were abstracted.

RESULTS

Seventeen (80.9%) of 21 eligible patients enrolled; 64.7% were <7 years, 47% were female, 52.9% had leukemia, 41.2% had solid tumors, and 5.9% had brain tumors. Patients had 1-12 previous admissions (mean 4.8, SD 3.1) and approximately 65% were planned hospitalizations. Approximately 69% reported MSAD helped reduce in-patient distress and 93.7% were satisfied with MSAD overall. Child satisfaction was high. There were no significant differences in acceptability or satisfaction with MSAD based on age, gender, number of inpatient procedures or previous hospitalizations, or hospitalization reason. Qualitative interviews revealed patients liked expressing feelings with tokens and thought MSAD was a fun distraction.

CONCLUSIONS

MSAD implementation was feasible, and its acceptability was high among both patients and parents. MSAD shows potential as good distraction and an alternative means of communicating feelings. Future research should expand upon the effectiveness of MSAD on reducing distress.