Use of a Therapeutic, Socially Assistive Pet Robot (PARO) in Improving Mood and Stimulating Social Interaction and Communication for People With Dementia: Study Protocol for a Randomized Controlled Trial

Pilot of an animal-assisted activity program to support intergenerational and intercultural community connections to reduce loneliness and social isolation

BACKGROUND AND PURPOSE

The COVID-19 pandemic challenged social support systems leading to loneliness and social isolation, particularly for older adults and international university students. This study explored the potential of using a shared interest in pets to support intergenerational and intercultural social connections, with a hypothesis that such interactions could enhance health-related quality of life and wellbeing and reduce feelings of loneliness.

METHODS

The study adopted an action research approach to co-design and pilot an Animal-Assisted Activity (AAA) group intervention (called the 'Pets and People program') across two aged care facilities in Melbourne, Australia. The 18-week program was designed to facilitate social connections through the presence of live or robotic pets, and/or animal-assisted activities. The program was evaluated using mixed methods.

RESULTS

Thirty older adults and 11 international students participated in the program. Six older adults, 10 international university students and three senior management staff participated in the evaluation. Both the older adult and student groups experienced a significant decrease in feelings of loneliness and a significant and clinically meaningful increase in the EQ-5D-5L utility index after program completion. The cost of implementation was $237 per person who participated in 10 weeks or more of the 18-week program. The explorative cost-utility analysis indicated a cost of $4,017 per quality adjusted life year gained, which is well below the threshold for the Australian Government's health related expenditure.

CONCLUSIONS

The Pets and People program holds potential to be replicated and scaled in aged care settings both in Australia and internationally.

Establishing the Foundations of Emotional Intelligence in Care Companion Robots to Mitigate Agitation Among High-Risk Patients With Dementia: Protocol for an Empathetic Patient-Robot Interaction Study

BACKGROUND

An estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy.

OBJECTIVE

This study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia.

METHODS

A design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community.

RESULTS

The study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning.

CONCLUSIONS

This innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/55761.

Intelligent assistive technology devices for persons with dementia: A scoping review

Assistive technology (AT) with context-aware computing and artificial intelligence capabilities can be applied to address cognitive and communication impairments experienced by persons with dementia (PwD). This paper aims to provide an overview of current literature regarding some characteristics of intelligent assistive technology devices (IATDs) for cognitive and communicative impairments of PwD. It also aims to identify the areas of impairment addressed by these IATDs.A multi-faceted systematic search strategy yielded records. Predefined criteria were applied for inclusion and data extraction. Thereafter data was thematically analysed and synthesised. This review demonstrates that almost all of the research involving IATDs has focused on cognitive impairments of PwD and has not yet evolved past the conceptual or prototype stages of development. Summaries of commercially available IATDs for PwD and relevant prototypes are provided at the end of this review.This research concluded that IATDs for PwD targeting cognition and communication problems primarily focus on social robots, and that they address cognitive impairments of attention, affect, and social-pragmatic communicative impairments. Future research endeavours concerning AT for PwD should explore collaboration between computer engineering and health practitioners to address the identified gaps. This may contribute to the available information for evidence-based decision making for PwD.

Caregiving in Older Adults; Experiences and Attitudes toward Smart Technologies

(1) Background: The development of assistive technologies has become a key solution to reduce caregiver burden. The objective of this study was to survey caregivers on perceptions and beliefs about the future of modern technology in caregiving. (2) Methods: Demographics and clinical caregiver characteristics were collected via an online survey along with the perceptions and willingness to adopt technologies to support caregiving. Comparisons were made between those who considered themselves caregivers and those who never did. (3) Results: 398 responses (mean age 65) were analyzed. Health and caregiving status of the respondents (e.g., schedule of care) and of the care recipient were described. The perceptions and willingness to use technologies were generally positive without significant differences between those who ever considered themselves as caregivers and those who never did. The most valued features were the monitoring of falls (81%), medication use (78%), and changes in physical functioning (73%). For caregiving support, the greatest endorsements were reported for one-on-one options with similar scores for both online and in-person alternatives. Important concerns were expressed about privacy, obtrusiveness, and technological maturity. (4) Conclusions: Online surveys as a source of health information on caregiving may be an effective guide in developing care-assisting technologies receiving end users' feedback. Caregiver experience, whether positive or negative, was correlated to health habits such as alcohol use or sleep. This study provides insight on caregivers' needs and perceptions regarding caregiving according to their socio-demographic and health status.

Artificial intelligence in elderly healthcare: A scoping review

The ageing population has led to a surge in the adoption of artificial intelligence (AI) technologies in elderly healthcare worldwide. However, in the advancement of AI technologies, there is currently a lack of clarity about the types and roles of AI technologies in elderly healthcare. This scoping review aimed to provide a comprehensive overview of AI technologies in elderly healthcare by exploring the types of AI technologies employed, and identifying their roles in elderly healthcare based on existing studies. A total of 10 databases were searched for this review, from January 1 2000 to July 31 2022. Based on the inclusion criteria, 105 studies were included. The AI devices utilized in elderly healthcare were summarised as robots, exoskeleton devices, intelligent homes, AI-enabled health smart applications and wearables, voice-activated devices, and virtual reality. Five roles of AI technologies were identified: rehabilitation therapists, emotional supporters, social facilitators, supervisors, and cognitive promoters. Results showed that the impact of AI technologies on elderly healthcare is promising and that AI technologies are capable of satisfying the unmet care needs of older adults and demonstrating great potential in its further development in this area. More well-designed randomised controlled trials are needed in the future to validate the roles of AI technologies in elderly healthcare.

Assessing the Topics and Motivating Factors Behind Human-Social Chatbot Interactions: Thematic Analysis of User Experiences

Background

Although social chatbot usage is expected to increase as language models and artificial intelligence improve, very little is known about the dynamics of human-social chatbot interactions. Specifically, there is a paucity of research examining why human-social chatbot interactions are initiated and the topics that are discussed.

Objective

We sought to identify the motivating factors behind initiating contact with Replika, a popular social chatbot, and the topics discussed in these interactions.

Methods

A sample of Replika users completed a survey that included open-ended questions pertaining to the reasons why they initiated contact with Replika and the topics they typically discuss. Thematic analyses were then used to extract themes and subthemes regarding the motivational factors behind Replika use and the types of discussions that take place in conversations with Replika.

Results

Users initiated contact with Replika out of interest, in search of social support, and to cope with mental and physical health conditions. Users engaged in a wide variety of discussion topics with their Replika, including intellectual topics, life and work, recreation, mental health, connection, Replika, current events, and other people.

Conclusions

Given the wide range of motivational factors and discussion topics that were reported, our results imply that multifaceted support can be provided by a single social chatbot. While previous research already established that social chatbots can effectively help address mental and physical health issues, these capabilities have been dispersed across several different social chatbots instead of deriving from a single one. Our results also highlight a motivating factor of human-social chatbot usage that has received less attention than other motivating factors: interest. Users most frequently reported using Replika out of interest and sought to explore its capabilities and learn more about artificial intelligence. Thus, while developers and researchers study human-social chatbot interactions with the efficacy of the social chatbot and its targeted user base in mind, it is equally important to consider how its usage can shape public perceptions and support for social chatbots and artificial agents in general.

SAR-Connect: A Socially Assistive Robotic System to Support Activity and Social Engagement of Older Adults

Multi-domain activities that incorporate physical, cognitive, and social stimuli can enhance older adults' overall health and quality of life. Several robotic platforms have been developed to provide these therapies in a quantifiable manner to complement healthcare personnel in resource-strapped long-term care settings. However, these platforms are primarily limited to one-to-one human robot interaction (HRI) and thus do not enhance social interaction. In this paper, we present a novel HRI framework and a realized platform called SAR-Connect to foster robot-mediated social interaction among older adults through carefully designed tasks that also incorporate physical and cognitive stimuli. SAR-Connect seamlessly integrates a humanoid robot with a virtual reality-based activity platform and a multimodal data acquisition module including game interaction, audio, visual and electroencephalography responses of the participants. Results from a laboratory-based user study with older adults indicates the potential of SAR-Connect that showed this system could 1) involve one or multiple older adults to perform multi-domain activities and provide dynamic guidance, 2) engage them in the robot-mediated task and foster human-human interaction, and 3) quantify their social and activity engagement from multiple sensory modalities.

Artificial intelligence and Psychiatry: An overview

The burden of mental illness both in world and India is increasing at an alarming rate. Adding to it, there has been an increase in mental health challenges during covid-19 pandemic with a rise in suicide, loneliness and substance use. Artificial intelligence can act as a potential solution to address this shortage. The use of artificial intelligence is increasingly being employed in various fields of mental health like affective disorders, psychosis, and geriatric psychiatry. The benefits are various like lower costs, wider reach but at the same time it comes with its own disadvantages. This article reviews the current understanding of artificial intelligence, the types of Artificial intelligence, its current use in various mental health disorders, current status in India, advantages, disadvantages and future potentials. With the passage of time and digitalization of the modern age, there will be an increase in the use of artificial intelligence in psychiatry hence a detailed understanding will be thoughtful. For this, we searched PubMed, Google Scholar, and Science Direct, China national Knowledge Infrastructure (CNKI), Globus Index Medicus search engines by using keywords. Initial searches involved the use of each individual keyword while the later searches involved the use of more than one word in different permutation combinations.

Tactile Interaction with a Humanoid Robot: Effects on Physiology and Subjective Impressions

This study investigated how touching and being touched by a humanoid robot affects human physiology, impressions of the interaction, and attitudes towards humanoid robots. 21 healthy adult participants completed a 3 (touch style: touching, being touched, pointing) × 2 (body part: hand vs buttock) within-subject design using a Pepper robot. Skin conductance response (SCR) was measured during each interaction. Perceived impressions of the interaction (i.e., friendliness, comfort, arousal) were measured per questionnaire after each interaction. Participants’ demographics and their attitude towards robots were also considered. We found shorter SCR rise times in the being touched compared to the touching condition, possibly reflecting psychological alertness to the unpredictability of robot-initiated contacts. The hand condition had shorter rise times than the buttock condition. Most participants evaluated the hand condition as most friendly and comfortable and the robot-initiated interactions as most arousing. Interacting with Pepper improved attitudes towards robots. Our findings require future studies with larger samples and improved procedures. They have implications for robot design in all domains involving tactile interactions, such as caring and intimacy.

Socially Assistive Robots for Dementia Care: Exploring Caregiver Perceptions of Use Cases and Acceptance

As the older population increases, the number of persons living with dementia (PWD) will increase as well. Yet, at the same time, there are fewer health care professionals per care recipient. To address the rising demand on healthcare professionals and informal care partners of PWD, socially assistive robots (SARs) can potentially facilitate care provision. It is crucial to understand the divergent tasks of these two caregiver groups so that the SAR's intervention can meet each group's needs. This qualitative study investigated and compared both caregiver groups' acceptance of a SAR. Six use cases involving a SAR (NAO, SoftBank) were demonstrated to both caregiver groups (N=20 persons). Both groups expressed willingness to adopt such technology and found that it could be useful in dementia care. However, participants' perceptions varied by task. Results indicate that healthcare professionals focused more on the assistive aspects, whereas care partners focused more on the social aspects of the SAR.

Needs and Preferences of Middle-Aged and Older Adults in Taiwan for Companion Robots and Pets: Survey Study

Background

In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear.

Objective

This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots.

Methods

A total of 273 middle-aged and older adults aged ≥45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis.

Results

Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants’ marital status and whether or not they lived alone affected their preference of functions in the companion robot.

Conclusions

Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies.

Effects of robotic care interventions for dementia care: A systematic review and meta-analysis randomised controlled trials

BACKGROUND

The role of robotic care has been studied because it may be a care option applicable to dementia care. However, the effects of robotic care in dementia care are still inconclusive.

AIM

To explore the span of the effects of robotic care intervention among patients with dementia.

DESIGN

Systematic review and meta-analysis.

METHODS

This study searched systematically using the following databases: Academic Search Complete, CINAHL, Cochrane Library, MEDLINE, PubMed, SocINDEX, UpToDate (OVID) and Web of Science. The eligibility criteria were patients with dementia, randomised controlled trials and publications in English. The PEDro scale was used to assess the methodological quality in the included studies. The meta-analysis was performed using a fixed-effects model to calculate the pooled effects of robotic care interventions. STATA 16.0 was used for statistical analysis. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

RESULTS

A total of 15 studies met the eligibility criteria and included 1684 participants. Overall, the robotic care interventions had positive effects on agitation (SMD = 0.09; 95% CI [-0.22-0.33]), anxiety (SMD = -0.07; 95% CI [-0.42-0.28]), cognitive function (SMD = 0.16; 95% CI [-0.08-0.40]), depression (SMD = -0.35; 95% CI [-0.69-0.02]), neuropsychiatric symptoms (SMD = 0.16; 95% CI [-0.29-0.61]), total hours of sleep during daytime (SMD = -0.31; 95% CI [-0.55 to 0.07]) and quality of life (SMD = 0.24; 95% CI [-0.23-0.70]).

CONCLUSION

Robotic care intervention may be an effective and alternative intervention for improving the health outcomes for people with dementia. The robotic care effect on anxiety should be confirmed. Further studies may consider the frequency, duration of intervention and possible negative outcomes after robotic care interventions.

RELEVANCE TO CLINICAL PRACTICE

As a non-pharmacological approach, nursing staff may consider the robotic care intervention in providing care for patients with dementia since this intervention has clinical benefits.

A Systematic Review of Robotic Rehabilitation for Cognitive Training

A large and increasing number of people around the world experience cognitive disability. Rehabilitation robotics has provided promising training and assistance approaches to mitigate cognitive deficits. In this article, we carried out a systematic review on recent developments in robot-assisted cognitive training. We included 99 articles in this work and described their applications, enabling technologies, experiments, and products. We also conducted a meta analysis on the articles that evaluated robot-assisted cognitive training protocol with primary end users (i.e., people with cognitive disability). We identified major limitations in current robotics rehabilitation for cognitive training, including the small sample size, non-standard measurement of training and uncontrollable factors. There are still multifaceted challenges in this field, including ethical issues, user-centered (or stakeholder-centered) design, the reliability, trust, and cost-effectiveness, personalization of the robot-assisted cognitive training system. Future research shall also take into consideration human-robot collaboration and social cognition to facilitate a natural human-robot interaction.

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults' activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants' visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri's ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR's impact on apathy in LTC older adults.

The effect of PARO robotic seals for hospitalized patients with dementia: A feasibility study

Robotic seals have been studied in long-term care settings; though, no studies of patients with dementia in the acute care setting have been reported. The purpose of this study was to evaluate the feasibility of PARO interventions for hospitalized patients with dementia, determine physiological effects and describe social-affective interactions. Using a prospective descriptive design with pre-post PARO intervention physiological measurements, we studied 55 participants who received up to five 15-min PARO interventions. The PARO was favorably accepted for 212 (95%) of the 223 PARO interventions. Differences in pre- and post-physiological measures for mean arterial pressure, pulse, respiration, oxygenation, stress, and pain levels were evaluated using Wilcoxon Signed Rank test with statistically significant pre and post differences (p=<0.05); however, the differences were not clinically significant. Participants (95%) demonstrated beneficial PARO interactions with the most frequent interactions being speaking and petting. The PARO shows promise for enhancing social and affective responses for hospitalized patients with dementia.

Social Robots on a Global Stage: Establishing a Role for Culture During Human–Robot Interaction

Robotic agents designed to assist people across a variety of social and service settings are becoming increasingly prevalent across the world. Here we synthesise two decades of empirical evidence from human–robot interaction (HRI) research to focus on cultural influences on expectations towards and responses to social robots, as well as the utility of robots displaying culturally specific social cues for improving human engagement. Findings suggest complex and intricate relationships between culture and human cognition in the context of HRI. The studies reviewed here transcend the often-studied and prototypical east–west dichotomy of cultures, and explore how people’s perceptions of robots are informed by their national culture as well as their experiences with robots. Many of the findings presented in this review raise intriguing questions concerning future directions for robotics designers and cultural psychologists, in terms of conceptualising and delivering culturally sensitive robots. We point out that such development is currently limited by heterogenous methods and low statistical power, which contribute to a concerning lack of generalisability. We also propose several avenues through which future work may begin to address these shortcomings. In sum, we highlight the critical role of culture in mediating efforts to develop robots aligned with human users’ cultural backgrounds, and argue for further research into the role of culturally-informed robotic development in facilitating human–robot interaction.

Acceptance and Influencing Factors of Social Virtual Reality in the Urban Elderly

In the stage of aging society and population aging, the social needs of the elderly are widely discussed by researchers. Especially driven by the demand of tele-medical treatment and tele-rehabilitation therapy, it is vital for the elderly to integrate into virtual communities by combining social virtual reality (VR) with different medical services and entertainment needs. In addition, affected by the COVID-19 epidemic, it is more difficult for people to have face-to-face contacts. With more remote consultation, entertainment and virtual social connectivity, the application of social VR is more urgent and valuable. However, there is little discussion on the acceptability and influencing factors of social VR among the elderly at present. Therefore, in order to get further data, we used (1) early stage semi-structured interviews and then (2) Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaires for investigation. One hundred fourteen elderly people aged 60–89 living in the metropolitan area of Taipei were taken as the subjects. To help them understand the situation and state of using social VR, these elderly people were asked to use a head-mounted display (HMD) to experience social VR games. The preliminary results showed that the elderly had obvious preference for entertainment (32.4%) and medical treatment (31.3%). The interview showed that this was related to the physiological condition or medical needs of the age range. In order to further understand how social VR would affect the social life of the elderly, we proposed the further demand structure of UTAUT Model based on the interview of both experts and the elderly. The model structures include (1) Performance Expectancy, (2) Perceived Enjoyment, (3) Social Influence, (4) User Attitude, (5) Behavioral Intention, and so on. These structures were applied to conduct interviews and questionnaires to find out the influence extent and relevance of the elderly on different structural needs, and suggestions were given accordingly. The results of the above interviews showed that (1) the elderly thought that the functions of entertaining and interacting of social VR could increase their social opportunities, and also meet medical needs (teleconference, cognitive decline, etc.), (2) the closeness of social relations (between family members, friends, doctors, and places), and also affect the relevance of Perceived Enjoyment (β = 0.77, p = 0.000 < 0.05). The results of these phenomena and interviews showed the interplay between the demand structures and their special relevance. They also indicated that as to social VR technologies, various demands and functional issues of the elderly need to be considered, and these demands would appear in the subtle usage, and different social VR interfaces and functions would emerge based on their special living ways and physical and psychological demands.

Learning-Enabled Robotic Assistive Support: Understanding Older Adult Opinions and Comparing Them to Younger Adult Opinions

Background

As older adults age, they may require assistance completing activities of daily living (ADLs). Robotic assistance can offset healthcare costs and allow older adults to preserve their autonomy. Younger adults are often involved in the design and purchase of these robotic technologies, and must take into account the needs and expectations of the target population (i.e., older adults) to create a robot that the end-user will adopt.

Research Aim/Questions

This study evaluated the opinions of both younger and older adults regarding the design and performance of the Robot Activity Support (RAS) system. It is important to understand points of agreement and divergence between these populations' perspectives so that effective robotic aids are created for older adults.

Methods

Fifty-two younger and older adults completed three scripted tasks with the RAS robot in a smart home environment. Each participant made task errors to cue the robot to offer help via three prompt modalities (guide to the object, video of forgotten step, and video of the full task). After interacting with the robot, participants completed questionnaires to evaluate their opinions of and satisfaction with the robot.

Results

There were no differences between younger and older adults' perceptions of the robot across a variety of factors (e.g., likability, cognitive demand), with both age groups expressing generally neutral opinions. Both groups rated the Full Video prompt as least helpful, effective, and liked. Participants recommended the robot's response accuracy, movement speed, alerting style and system flexibility be improved. Younger adults overestimated how much older adults would want a robot like this.

Conclusions

This study underscores the importance of testing technology with the end-user, as older adults were less interested in having a similar robot in their home than younger counterparts expected. Future studies will show if older adults' opinions can be improved after making the recommended changes.

User Experiences of Social Support From Companion Chatbots in Everyday Contexts: Thematic Analysis

BACKGROUND

Previous research suggests that artificial agents may be a promising source of social support for humans. However, the bulk of this research has been conducted in the context of social support interventions that specifically address stressful situations or health improvements. Little research has examined social support received from artificial agents in everyday contexts.

OBJECTIVE

Considering that social support manifests in not only crises but also everyday situations and that everyday social support forms the basis of support received during more stressful events, we aimed to investigate the types of everyday social support that can be received from artificial agents.

METHODS

In Study 1, we examined publicly available user reviews (N=1854) of Replika, a popular companion chatbot. In Study 2, a sample (n=66) of Replika users provided detailed open-ended responses regarding their experiences of using Replika. We conducted thematic analysis on both datasets to gain insight into the kind of everyday social support that users receive through interactions with Replika.

RESULTS

Replika provides some level of companionship that can help curtail loneliness, provide a "safe space" in which users can discuss any topic without the fear of judgment or retaliation, increase positive affect through uplifting and nurturing messages, and provide helpful information/advice when normal sources of informational support are not available.

CONCLUSIONS

Artificial agents may be a promising source of everyday social support, particularly companionship, emotional, informational, and appraisal support, but not as tangible support. Future studies are needed to determine who might benefit from these types of everyday social support the most and why. These results could potentially be used to help address global health issues or other crises early on in everyday situations before they potentially manifest into larger issues.

How Can Robots Make People Feel Intimacy Through Touch?

This study investigates the effects of the touch characteristics that change the intimacy perceived by humans in human-robot touch interaction with an android robot having a human-like feminine appearance. Past studies on human-robot touch interaction focused on understanding which types of human touches are used to express emotions to robots. However, they less focused on how a robot’s touch characteristics can affect humans’ perceived intimacy. In this study, first, we concentrated on two types of touch characteristics (type and place) and their effects on the perceived intimacy of a commonly used emotion in human-robot interaction, namely happiness. The results showed that the touch types are useful for changing the perceived intimacy, although the touched place did not exhibit any significant effects. Based on the results of our first experiment, we investigated the effects of different touch characteristics (length and part). We concluded that the touch part is useful to change the perceived intimacy, although the touch length did not exhibit any significant effects. Finally, the results suggested that a pat (type) by the fingers (part) is a better combination to express intimacy with our robot.

Effects of Robot’s Awareness and its Subtle Reactions Toward People’s Perceived Feelings in Touch Interaction

This study addresses the effects of a robot’s awareness and its subtle reactions toward the perceived feelings of people who touch a robot. When another unexpectedly touches us, we subtly and involuntarily react. Because such reactions are involuntary, it is impossible to eliminate them for humans. However, intentionally using them for robots might positively affect their perceived feelings, in particular, when a robot has a human-like appearance that evokes human-like reactions. We investigate the relationship between subtle reactions and the awareness of the existence of a human, i.e., whether a robot’s awareness and its subtle reactions influence people’s impressions of the robot when they touch it. Our experimental results with 20 participants and an android with a female-like appearance showed significant effects between awareness and subtle reactions. When the robot did not show awareness, its subtle reaction increased the perceived human-likeness. Moreover, when the robot did not show subtle reactions, showing awareness beforehand increased the perceived human-likeness.

Gaze-Height and Speech-Timing Effects on Feeling Robot-Initiated Touches

This paper reports the effects of communication cues on robot-initiated touch interactions at close distance by focusing on two factors: gaze-height for making eye contact and speech timing before and after touches. Although both factors are essential to achieve acceptable touches in human-human touch interaction, their effectiveness remains unknown in human-robot touch interaction contexts. To investigate the effects of these factors, we conducted an experiment whose results showed that being touched with before-touch timing is preferred to being touched with after-touch timing, although gaze-height did not significantly improve the feelings of robot-initiated touch.

Survey of Social Touch Interaction Between Humans and Robots

In human-human interaction, social touch provides several merits, from both physical and mental perspectives. The physical existence of robots helps them reproduce human-like social touch, during their interaction with people. Such social touch shows positive effects, similar to those observed in human-human interaction. Therefore, social touch is a growing research topic in the field of human-robot interaction. This survey provides an overview of the work conducted so far on this topic.

What Makes a Social Robot Good at Interacting with Humans?

This paper discusses the nuances of a social robot, how and why social robots are becoming increasingly significant, and what they are currently being used for. This paper also reflects on the current design of social robots as a means of interaction with humans and also reports potential solutions about several important questions around the futuristic design of these robots. The specific questions explored in this paper are: “Do social robots need to look like living creatures that already exist in the world for humans to interact well with them?”; “Do social robots need to have animated faces for humans to interact well with them?”; “Do social robots need to have the ability to speak a coherent human language for humans to interact well with them?” and “Do social robots need to have the capability to make physical gestures for humans to interact well with them?”. This paper reviews both verbal as well as nonverbal social and conversational cues that could be incorporated into the design of social robots, and also briefly discusses the emotional bonds that may be built between humans and robots. Facets surrounding acceptance of social robots by humans and also ethical/moral concerns have also been discussed.

Identity Health

Identity health has especially specific meanings for social relationships in contemporary digital age. First, computerized digital communication makes many citizens in severe maladaptation. The WHO often warns mental addictions of internet usages and online gaming among the youth. The advent of social media and online networking has endangered them in ambiguous situations which are not stabilizing in those basic grounds for human relationships. Further, because social networking sites and social gaming frequently enforce each member to interconnect with the others, many of participating members often hold harder mental debts to respond and maintain their interconnections. In this situation, in other words, it can say that all of users simultaneously might share common conditions under mental illness.

Reducing Patient Loneliness With Artificial Agents: Design Insights From Evolutionary Neuropsychiatry

Loneliness is a growing public health issue that substantially increases the risk of morbidity and mortality. Artificial agents, such as robots, embodied conversational agents, and chatbots, present an innovation in care delivery and have been shown to reduce patient loneliness by providing social support. However, similar to doctor and patient relationships, the quality of a patient’s relationship with an artificial agent can impact support effectiveness as well as care engagement. Incorporating mammalian attachment-building behavior in neural network processing as part of an agent’s capabilities may improve relationship quality and engagement between patients and artificial agents. We encourage developers of artificial agents intended to relieve patient loneliness to incorporate design insights from evolutionary neuropsychiatry.

Psychosocial Health Interventions by Social Robots: Systematic Review of Randomized Controlled Trials

Background

Social robots that can communicate and interact with people offer exciting opportunities for improved health care access and outcomes. However, evidence from randomized controlled trials (RCTs) on health or well-being outcomes has not yet been clearly synthesized across all health domains where social robots have been tested.

Objective

This study aimed to undertake a systematic review examining current evidence from RCTs on the effects of psychosocial interventions by social robots on health or well-being.

Methods

Medline, PsycInfo, ScienceDirect, Scopus, and Engineering Village searches across all years in the English language were conducted and supplemented by forward and backward searches. The included papers reported RCTs that assessed changes in health or well-being from interactions with a social robot across at least 2 measurement occasions.

Results

Out of 408 extracted records, 27 trials met the inclusion criteria: 6 in child health or well-being, 9 in children with autism spectrum disorder, and 12 with older adults. No trials on adolescents, young adults, or other problem areas were identified, and no studies had interventions where robots spontaneously modified verbal responses based on speech by participants. Most trials were small (total N=5 to 415; median=34), only 6 (22%) reported any follow-up outcomes (2 to 12 weeks; median=3.5) and a single-blind assessment was reported in 8 (31%). More recent trials tended to have greater methodological quality. All papers reported some positive outcomes from robotic interventions, although most trials had some measures that showed no difference or favored alternate treatments.

Conclusions

Controlled research on social robots is at an early stage, as is the current range of their applications to health care. Research on social robot interventions in clinical and health settings needs to transition from exploratory investigations to include large-scale controlled trials with sophisticated methodology, to increase confidence in their efficacy.

Your Robot Therapist Will See You Now: Ethical Implications of Embodied Artificial Intelligence in Psychiatry, Psychology, and Psychotherapy

Background

Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from ‘virtual psychotherapists’ to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed.

Objective

This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI.

Methods

Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions.

Results

From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; ‘gaps’ in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition.

Conclusions

We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance.

Two-Year Use of Care Robot Zora in Dutch Nursing Homes: An Evaluation Study

The use of the Zora robot was monitored and evaluated in 14 nursing care organizations (15 locations). The Zora robot, a Não robot with software, is designed as a social robot and used for pleasure and entertainment or to stimulate the physical activities of clients in residential care. In the first year, the aim was to monitor and evaluate how the care robot is used in daily practice. In the second year, the focus was on evaluating whether the use of Zora by care professionals can be extended to more groups and other type of clients. Interviews, questionnaires and observations were used as instruments to reveal the progress in the use of the robot and to reveal the facilitators and barriers. Care professionals experienced several barriers in the use of the robot (e.g., start-up time and software failures). The opportunity they had to discuss their experience during project team meetings was seen as a facilitator in the project. Furthermore, they mentioned that the Zora robot had a positive influence on clients as it created added value for the care professionals in having fun at work.

From Lonely to Resilient through Humanoid Robots: Building a New Framework of Resilience

This paper connects different theories and methods from the social sciences and applies them to human-humanoid robot interaction (HHRI) to explain loneliness reduction and the build-up of resilience in older adults through social robots. It allows for user-related aspects such as age, social connectedness, gender role, personality, and need satisfaction as well as robot-related aspects, particularly coaching behaviors and communication styles. From these scientific considerations, solutions to design challenges are pinpointed, proposing novel interaction schemes that enhance the feeling of support and companionship. This paper also opens the way to conducting empirical research to examine HHRI-related designs, measuring user experience in HHRI, while suggesting applications in HHRI in various settings, such as coaching and eldercare.

Nurses' needs for care robots in integrated nursing care services

AIMS

To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in integrated nursing care services.

BACKGROUND

Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced "integrated nursing care services"; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched.

DESIGN

The study applied a cross-sectional survey.

METHODS

In 2016, we conducted a multicentre survey involving 302 Registered Nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care.

RESULTS

Trial centre nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top-three desired primary roles for care robots were "measuring/monitoring", "mobility/activity" and "safety care". "Reduction in workload", especially in terms of "other nursing services" which were categorized as nonvalue-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients.

CONCLUSION

Care robots are expected to be effective in integrated nursing care services, particularly in "measuring/monitoring". Such robots should decrease nurses' workload and minimize nonvalue-added nursing activities efficiently. No matter how excellent care robots are, they must cooperate with and be controlled by nurses.

The Utilization of Robotic Pets in Dementia Care

BACKGROUND

Behavioral problems may affect individuals with dementia, increasing the cost and burden of care. Pet therapy has been known to be emotionally beneficial for many years. Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets. Robotic pet therapy offers an alternative to traditional pet therapy.

OBJECTIVE

The study rigorously assesses the effectiveness of the PARO robotic pet, an FDA approved biofeedback device, in treating dementia-related symptoms.

METHODS

A randomized block design with repeated measurements guided the study. Before and after measures included reliable, valid tools such as: RAID, CSDD, GDS, pulse rate, pulse oximetry, and GSR. Participants interacted with the PARO robotic pet, and the control group received standard activity programs. Five urban secure dementia units comprised the setting.

RESULTS

61 patients, with 77% females, average 83.4 years in age, were randomized into control and treatment groups. Compared to the control group, RAID, CSDD, GSR, and pulse oximetry were increased in the treatment group, while pulse rate, pain medication, and psychoactive medication use were decreased. The changes in GSR, pulse oximetry, and pulse rate over time were plotted for both groups. The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate, while GSR had several weeks when changes were similar between groups.

CONCLUSIONS

Treatment with the PARO robot decreased stress and anxiety in the treatment group and resulted in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia.