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

Therapeutic use of the humanoid robot, Telenoid, with older adults: A critical interpretive synthesis review

This review sought to critically evaluate the use of the teleoperated humanoid robotic communications device, Telenoid, for therapeutic purposes with older adults, and identify and highlight key considerations for future research and clinical practice within gerontechnology. A critical interpretive synthesis was conducted, with nine electronic databases and online sources searched using the keyword "Telenoid." Studies were included in the review if they were: written in English; reported primary research; employed a qualitative, quantitative, or mixed-method design; and described or measured effects, experiences, or perceptions of using Telenoid for therapeutic purposes with older adults. Critical engagement with the studies identified key themes, as well as opportunities to advance future research. Ten studies involving Telenoid were identified, with eight focused on older adults living with dementia. Study findings centered around two themes: effects (including positive effects and negative reactions), and challenges and considerations (including technical issues, operator training, acceptability, and dosage). Although several issues currently challenge the use of Telenoid, available studies show some therapeutic potential of using Telenoid with older adults, including those living with dementia, particularly for communication and mood. Higher-quality studies are required to advance understanding, and considerations for the field are outlined to aid development.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Robots and Robotics in Nursing

Technological advancements have led to the use of robots as prospective partners to complement understaffing and deliver effective care to patients. This article discusses relevant concepts on robots from the perspective of nursing theories and robotics in nursing and examines the distinctions between human beings and healthcare robots as partners and robot development examples and challenges. Robotics in nursing is an interdisciplinary discipline that studies methodologies, technologies, and ethics for developing robots that support and collaborate with physicians, nurses, and other healthcare workers in practice. Robotics in nursing is geared toward learning the knowledge of robots for better nursing care, and for this purpose, it is also to propose the necessary robots and develop them in collaboration with engineers. Two points were highlighted regarding the use of robots in health care practice: issues of replacing humans because of human resource understaffing and concerns about robot capabilities to engage in nursing practice grounded in caring science. This article stresses that technology and artificial intelligence are useful and practical for patients. However, further research is required that considers what robotics in nursing means and the use of robotics in nursing.

Alignment of the attitude of teleoperators with that of a semi-autonomous android

Studies on social robots that can communicate with humans are increasingly important. In particular, semi-aautonomous robots have shown potential for practical applications in which robot autonomy and human teleoperation are jointly used to accomplish difficult tasks. However, it is unknown how the attitude represented in the autonomous behavior of the robots affects teleoperators. Previous studies reported that when humans play a particular role, their attitudes align with that role. The teleoperators of semi-autonomous robots also play the role given to the robots and may assimilate their autonomous expression. We hypothesized that the attitude of teleoperators may align with that of robots through teleoperation. To verify this, we conducted an experiment with conditions under which a participant operated a part of the body of an android robot that autonomously expressed a preferential attitude toward a painting and a condition under which they did not. Experimental results demonstrated that the preferential attitude of participants who teleoperated the android aligned statistically significantly more with that of the robot in comparison to those who did not teleoperate it, thereby supporting our hypothesis. This finding is novel regarding attitude change in teleoperators of semi-autonomous robots and can support the implementation of effective human-robot collaboration systems.

The use of technology for social interaction by people with dementia: A scoping review

People with dementia (PwD) are at risk of experiencing loneliness, which is associated with physical and mental health difficulties [1]. Technology is a possible tool to increase social connection and reduce loneliness. This scoping review aims to examine the current evidence regarding the use of technology to reduce loneliness in PwD. A scoping review was carried out. Medline, PsychINFO, Embase, CINAHL, Cochrane database, NHS Evidence, Trials register, Open Grey, ACM Digital Library and IEEE Xplore were searched in April 2021. A sensitive search strategy was constructed using combinations of free text and thesaurus terms to retrieve articles about dementia, technology and social-interaction. Pre-defined inclusion and exclusion criteria were used. Paper quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and results reported according to PRISMA guidelines [2,3]. 73 papers were identified publishing the results of 69 studies. Technological interventions included robots, tablets/computers and other forms of technology. Methodologies were varied and limited synthesis was possible. There is some evidence that technology is a beneficial intervention to reduce loneliness. Important considerations include personalisation and the context of the intervention. The current evidence is limited and variable; future research is warranted including studies with specific loneliness outcome measures, studies focusing on PwD living alone, and technology as part of intervention programmes.

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

Introduction

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

Methods

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

Results

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

Conclusions

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

6G and Artificial Intelligence Technologies for Dementia Care: Literature Review and Practical Analysis

Background

The dementia epidemic is progressing fast. As the world’s older population keeps skyrocketing, the traditional incompetent, time-consuming, and laborious interventions are becoming increasingly insufficient to address dementia patients’ health care needs. This is particularly true amid COVID-19. Instead, efficient, cost-effective, and technology-based strategies, such as sixth-generation communication solutions (6G) and artificial intelligence (AI)-empowered health solutions, might be the key to successfully managing the dementia epidemic until a cure becomes available. However, while 6G and AI technologies hold great promise, no research has examined how 6G and AI applications can effectively and efficiently address dementia patients’ health care needs and improve their quality of life.

Objective

This study aims to investigate ways in which 6G and AI technologies could elevate dementia care to address this study gap.

Methods

A literature review was conducted in databases such as PubMed, Scopus, and PsycINFO. The search focused on three themes: dementia, 6G, and AI technologies. The initial search was conducted on April 25, 2021, complemented by relevant articles identified via a follow-up search on November 11, 2021, and Google Scholar alerts.

Results

The findings of the study were analyzed in terms of the interplay between people with dementia’s unique health challenges and the promising capabilities of health technologies, with in-depth and comprehensive analyses of advanced technology-based solutions that could address key dementia care needs, ranging from impairments in memory (eg, Egocentric Live 4D Perception), speech (eg, Project Relate), motor (eg, Avatar Robot Café), cognitive (eg, Affectiva), to social interactions (eg, social robots).

Conclusions

To live is to grow old. Yet dementia is neither a proper way to live nor a natural aging process. By identifying advanced health solutions powered by 6G and AI opportunities, our study sheds light on the imperative of leveraging the potential of advanced technologies to elevate dementia patients’ will to live, enrich their daily activities, and help them engage in societies across shapes and forms.

Human-like tele-health robotics for older adults – A preliminary feasibility trial and vision

Introduction

The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults’ vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely.

Aim

This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care.

Method

Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians.

Results

The findings demonstrated the system’s capability to support remote examination of participants, and validated the system’s perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination.

Conclusion

This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

A Library of Old Photos Supporting Conversation of Two Generations Serving Reminiscence Therapy

In Japan, a shift in family patterns has led to a sense of social isolation among older people, which increases the risk of major neurocognitive disorder. Interventions for them using old photos to implement reminiscence therapy (RT) have been proved to be effective. A super-aged society has in turn led to a shortage of medical resources and older people prefer home care over institutional care. Therefore, there is an urgent need for volunteers to help in RT. However, the age of volunteers tends to be increasingly younger. The lack of knowledge and experience of the past for the young volunteers makes it difficult for them to select appropriate stimulated materials. To improve this situation, a library of old photos for RT was developed to support conversation between the two generations. A two-factor experiment and emotion assessment scales were designed to explore the effect of different old photo types on the fluency of conversation between the two generations and their emotion. It was found that the types of old photos have little effect on older people and that conversations were almost pleasant. However, the pleasantness of older people was enhanced when using photos that they wanted to talk about (P = 0.006). Meanwhile, pleasure in conversation of the older people increased with the attention of the young people to the topic (R = 0.304, p < 0.001). Conversely, photo type has a strong impact on young people. When photos are selected that older people do not want to talk about or photos that young people do not know the content and are not interested in, concern for the topic of young people drops dramatically. Therefore, when RT, it is important to avoid using the types of photos above that cause a drop in younger people's attention.

Use of Robotic Pet in a Distributed Layout Elderly Housing with Services: A Case Study on Elderly People with Cognitive Impairment

In recent years, robotic pets have been used by many countries worldwide as a method for treating behavioral and psychological symptoms of dementia (BPSD). The seal robot PARO was loaned intermittently to a distributed layout elderly housing with services over a seven-month period, during which it was observed that three residents with cognitive dysfunctions showed improvements in their BPSD and the nursing care load of the staff was reduced during the periods when PARO was present. The objective of this study is to investigate, through a case study, the effects of intermittent interaction with PARO on those with cognitive dysfunctions and the staff workers. The short version of the Dementia Behavior Disturbance Scale (DBD-13) was used as the medical outcome index, and the KJ method was used to analyze the qualitative data, such as staff reports and interviews. The results show that the DBD-13 total scores reduced during the periods when PARO was present and increased during the periods when PARO was absent. The KJ method yielded similar findings. The use of DBD-13 and the KJ method complemented the results of each other and increased the persuasive power of the findings. By using the KJ method, it was further determined that the workload of the staff was reduced, allowing them to recuperate, which reconfirmed the value of PARO. Further case studies will be undertaken in the future with the aim of constructing a methodology for implementing case studies.

A Minimal Design of a Human Infant Presence: A Case Study Toward Interactive Doll Therapy for Older Adults With Dementia

We introduce a minimal design approach to manufacture an infant-like robot for interactive doll therapy that provides emotional interactions for older people with dementia. Our approach stimulates their imaginations and then facilitates positive engagement with the robot by just expressing the most basic elements of humanlike features. Based on this approach, we developed HIRO, a baby-sized robot with an abstract body representation and no facial features. The recorded voice of a real human infant emitted by robots enhances the robot’s human-likeness and facilitates positive interaction between older adults and the robot. Although we did not find any significant difference between HIRO and an infant-like robot with a smiling face, a field study showed that HIRO was accepted by older adults with dementia and facilitated positive interaction by stimulating their imagination. We also discuss the importance of a minimal design approach in elderly care during post–COVID-19 world.

Social Robot Interventions for People with Dementia: A Systematic Review on Effects and Quality of Reporting

Background:

Using non-pharmacological interventions is a current approach in dementia care to manage responsive behaviors, to maintain functional capacity, and to reduce emotional stress. Novel technologies such as social robot interventions might be useful to engage people with dementia in activities and interactions as well as to improve their cognitive, emotional, and physical status.

Objective:

Assessing the effects and the quality of reporting of social robot interventions for people with dementia.

Methods:

In our systematic review, we included quasi-experimental and experimental studies published in English, French, or German, irrespective of publication year. Searching CINAHL, Cochrane Library, MEDLINE, PsycINFO, and Web of Science Core Collection was supplemented by citation tracking and free web searching. To assess the methodological quality of included studies, we used tools provided by the Joanna Briggs Institute. To assess the reporting of the interventions, we applied CReDECI 2 and TIDieR.

Results:

We identified sixteen studies published between 2012 and 2018, including two to 415 participants with mostly non-defined type of dementia. Eight studies had an experimental design. The predominant robot types were pet robots (i.e., PARO). Most studies addressed behavioral, emotion-related, and functional outcomes with beneficial, non-beneficial, and mixed results. Predominantly, cognitive outcomes were not improved. Overall, studies were of moderate methodological quality.

Conclusion:

Heterogeneous populations, intervention characteristics, and measured outcomes make it difficult to generalize the results with regard to clinical practice. The impact of social robot interventions on behavioral, emotion-related, and functional outcomes should therefore be assessed considering the severity of dementia and intervention characteristics.

Optimal robot for intervention for individuals with autism spectrum disorders

With recent rapid advances in technology, human-like robots have begun functioning in a variety of ways. As increasing anecdotal evidence suggests, robots may offer many unique opportunities for helping individuals with autism spectrum disorders (ASD). Individuals with ASD often achieve a higher degree of task engagement through the interaction with robots than through interactions with human trainees. The type and form of robots to be used for individuals with ASD have been meticulously considered. Simple robots and animal robots are acceptable because of their simplicity and the ease of interesting and engaging interactions. Android robots have the benefit of the potential of generalization into daily life to some extent. Considering the affinity between robots and users is important to draw out the potential capabilities of robotic intervention to the fullest extent. In the robotic condition, factors such as the appearance, biological motion, clothes, hairstyle, and disposition are important. Many factors of a user, such as age, sex, and IQ, may also affect the affinity of individuals with ASD toward a robot. The potential end-users of this technology may be unaware or unconvinced of the potential roles of robots in ASD interventions. If trainers have extensive experience in using robots, they can identify many potential roles of robots based on their experience. To date, only a few studies have been conducted in the field of robotics for providing assistance to individuals with ASD, and future studies are needed to realize an optimal robot for this purpose.

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.

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.