Assistive Social Robots in Elderly Care: A Review of their Impact on Health and Wellbeing, Guías, Proyectos, Investigaciones de Medicina

¡Descarga Assistive Social Robots in Elderly Care: A Review of their Impact on Health and Wellbeing y más Guías, Proyectos, Investigaciones en PDF de Medicina solo en Docsity! Assistive social robots in elderly care: a review. Joost Broekens, Marcel Heerink, and Henk Rosendal Delft University of Technology, Delft, The Netherlands (D.J.Broekens@tudelft.nl ) University of Applied Sciences, Amsterdam, The Netherlands (m.heerink@hva.nl) University of Applied Sciences, Leiden, The Netherlands (rosendal.h@hsleiden.nl) Abstract Context: Assistive social robots, a particular type of assistive robotics designed for social interaction with humans could play an important role with respect to health and psychological wellbeing of elderly. Objectives: Assistive social robots are believed to be useful in eldercare for two reasons, a functional one and an affective one. Such robots are developed to function as an interface for elderly to digital technology, and to help increase the quality of life of elderly by providing companionship respectively. There is a growing attention for these devices in the literature. However, no comprehensive review is yet performed to investigate the effectiveness of such robots in the care for elderly. Therefore, we systematically reviewed and analyzed existing literature on the effects of assistive social robots in healthcare for elderly. We focused on the companion function. Data Sources: A systematic search of MEDLINE, CINAHL, PSYCHINFO, The Cochrane Library databases, IEEE, ACM libraries and finally Google Scholar was performed for records through December 2007 to identify articles of all studies with actual subjects aimed to assess the effects of assistive social robots on elderly. This search was completed with information derived from personal expertise, contacts and reports. Study Selection and Data Extraction: Since no randomized controlled trials (RCT)’s have been found within this field of research, all studies reporting effects of assistive robotics in elderly populations were included. Information on study design, interventions, controls, and findings were extracted for each article. In medical journals only a few articles were found, whereas about 50 publications were found in literature on ICT and robotics. Data Synthesis: The identified studies were all published after 2000 indicating the novelty of this area of research. Most of these publications contain the results of studies that report positive effects of assistive social robots on health and psychological well-being of elders. Solid evidence indicating that these effects can indeed be attributed to the actual assistive social robot, its behavior and its functionality is scarce. Conclusions: There is some qualitative evidence as well as limited quantitative evidence of the positive effects of assistive social robots with respect to elderly. The research designs however are not robust enough to establish this. Confounding variables can often not be excluded. This is partly due to the chosen research designs, but also because it is unclear what research methodology is adequate to investigate such effects. Therefore, more work on methods is needed as well as robust, large-scale studies to establish the effects of these devices. Keywords: Assistive Robotics, Companion robots, Elderly, Aibo, Paro, Huggable, iCat, Effects, Review INTRODUCTION Because of the graying of our western population, there is a growing necessity for new technologies that can assist elderly in their daily living. There are two main arguments for this. First, it is expected that western countries will face a tremendous shortage on staff and qualified healthcare personnel in the near future [1]. Second, people prefer more and more to live in their own homes as long as possible instead of being institutionalized in sheltered homes, or nursery homes when problems related to ageing appear. To address these issues, we not only need sufficient healthcare personnel, but also the presence and appliance of high-tech devices [2]. ICT-technology and robotics are developing quickly nowadays, resulting in products that have the potential to play an important role in assisting elderly [3]. In order to use new technology in an effective and efficient way, robust information with respect to their effects is needed, especially when used in health-care. In this review we focus on health- and psychological well-being-related effects of assistive social robots on elderly. Robot research in eldercare concerns assistive robots that can be both rehabilitation robotics and social robots (Figure 1). The first type of research features physical assistive technology that is not primarily communicative and is not meant to be perceived as a social entity. Examples are smart wheelchairs [4], artificial limbs and exoskeletons [5]. The field of social robotics concerns systems that can be perceived as social entities that communicate with the user. Of course there are also projects with social robots aimed at rehabilitation [6] and vice versa. (Figure 1 about here) Studies on social robots in eldercare feature different robot types. First, there are robots that are used as assistive devices which we will refer to as service type robots. Functionalities are related to the support of independent living by supporting basic activities (eating, bathing, toileting and getting dressed) and mobility (including navigation), providing household maintenance, monitoring of those who need continuous attention and maintaining safety. Examples of these robots are ‘nursebot’ Pearl [7], the Dutch iCat (although not especially developed for eldercare) and the German Care-o-bot [8]. Also categorized as such could be the Italian Robocare project, in which a robot is developed as part of an intelligent assistive environment for elderly people [9]. The social functions of such service type robots exist primarily to facilitate interfacing with the robot. Studies typically investigate what different social functions can bring to the acceptance of the device in the living environment of the elder, as well as how social functions can facilitate actual usage of the device. Second, there are studies that focus on the pet-like companionship a robot might provide. The main function of these robots is to enhance health and psychological well-being of elderly users by providing companionship. We will refer to these robots as companion type robots. Examples are the Japanese seal shaped robot Paro [10], the Huggable [11] (both especially developed for experiments in eldercare) and Aibo (a robot dog by Sony, see below). Social functions implemented in companion robots are primarily aimed at increasing health and psychological well-being. For example, studies investigate whether companion robots can increase positive mood in elderly living in nursery homes. However, not all robots can be categorized strictly in either one of these two groups. For example, Aibo is usually applied as a companion type robot, but can also be programmed to perform assistive activities [12] and both Pearl and iCat can provide companionship. This review aims to provide a first overall overview of studies that investigate the effects of assistive social robots on the health and wellbeing of elderly. Since the majority of the assistive social robot studies with actual elderly people as subjects involve the robots Aibo, Paro, iCat and ‘nursebot’ Pearl, these robots are briefly highlighted next. Aibo Aibo is an entertainment robot developed and produced by Sony [13]. It is currently out of production. It has programmable behavior, a hard plastic exterior and has a wide set of sensors and actuators. Sensors include a camera, touch sensors, infra red and stereo sound. Actuators include 4 legs, a moveable tail, and a moveable head. Aibo is mobile and autonomous. It can find its power supply by itself and it is programmed to play and interact with humans. It has been used extensively in studies with elderly in order to try to assess the effects on the quality of life and symptoms of stress. In this article we will review these studies. Paro Paro is a soft seal robot [10, 14]. It has been developed by the Intelligent Systems Research Institute (ISRI) of the National Institute of Advanced Industrial Science and Technology (AIST) in Japan, and is produced by Intelligent System Co., Ltd.. It is developed to study the effects of Animal Assistive Therapy with companion robots, and is targeted at elderly. It has programmable behavior as well as a set of sensors. Sensors include a touch sensor over the complete body, an infra red sensor, stereoscopic vision and hearing. Actuators include eyelids, upper body motors, front paw and hind limb motors. Paro is not mobile. It has been used extensively in studies with elderly to assess the effects of robot therapy. iCat The iCat has been developed and is produced by Philips [15]. Its design aim is to be a research platform for human-robot interaction. It is made of hard plastic and has a cat-like appearance. Furthermore, it has a face that is able to express emotions. Studies typically investigate how users perceive the iCat as interface to new technology. The iCat is not particularly aimed at being a companion (i.e., affective assistance) but more at functional assistance (classified as service type). However, it is included in this study as some studies methods that are able to attribute the causality of the beneficial effects to the robot as well as invest in robust, large-scale cross-cultural studies to better establish the effects of these devices. IMPLICATIONS FOR FUTURE RESEARCH Given the large number of studies that show positive effects of either the robot or it’s placebo version, such as a non-functional robot or a pet toy, we believe this type of devices have definitely merits in eldercare. Further, and of importance, elderly seem to be open to this kind of technology (see, e.g., Heerink et al. [25-28]). We consider it necessary to address the methodological problems, or at the very least vagueness regarding methodology often encountered in these studies. It is a little unfair to judge so harsh these studies, as they attempt to do something quite difficult and novel: experiment with a novel form of treatment in a real life situation without having the benefit of being able to set up randomized blind trials, as the placebo version of the robot is also perceptually different. This is obviously not the case with drug-research for example. However, we surely think that several of the other experimental design issues need to be addressed. First, it is absolutely necessary to have a control group that is not in contact with the experimental group. Second, researchers need to start replicating results of others, and for this to be possible they need to have access to the methods used, the same control conditions and preferably the same robots. This implies that all studies should describe their research design and methods clearly and in such a way that the research can be completely repeated somewhere else. Third, studies must be long-term. The novelty value of something that enters the life of an elderly person may take some time to wear off. Fourth, many studies attempt to derive statistical significant results from a far too small number of subjects. This is problematic, because of sample group selection bias and lack of statistical power. In summary, we need large-scale experiments that are rigorously set up, and an adequate methodology by which these studies are done and compared to each other. Further, we need more variation in the form and function of these robots to figure out what parts actually contribute to the beneficial effects. 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Proceedings of the IEEE, 2004b. 92(11): p. 1780-1788. 49. Wada, K., T. Shibata, T. Saito, and K. Tanie, Effects of three months robot assisted activity to depression of elderly people who stay at a health service facility for the aged. SICE 2004 Annual Conference, 2004c. 3. 50. Wada, K., T. Shibata, T. Saito, K. Sakamoto, and K. Tanie, Psychological and Social Effects of One Year Robot Assisted Activity on Elderly People at a Health Service Facility for the Aged. Robotics and Automation, 2005. Proceedings of the 2005 IEEE International Conference on, 2005a: p. 2785-2790. Table 1 Author Ref. Companion Design Outcome measures n Results Term Fujita 2004 [30] Aibo Kanamori et al. 2002 [31] Aibo 3 1,5 3 + ? Kanamori et al. 2003 [32] Aibo 3 1,3,4,5 5 + 7 weeks Mival et al. 2004 [33] Aibo 6 5 10, 12 Suga et al. 2002 [34] Aibo 3 1 23 + 2 months Sakairi 2004 [35] Aibo 3 3,5 8 + 30 minutes Suga et al. 2003 [36] Aibo 3? 1 15 + ? Tamura et al. 2004 [19] Aibo 3 3 ? +/- 5 minutes intervention Turkle et al. 2006 [37] Aibo, My Real Baby 3 5, 6 2 + several months Yanagi and Tomura 2002 [29] Aibo 3 5 46 + Several hours Graf et al. 2004 [8] Care-o-bot 3 5 6 + ? Heerink et al. 2006a [27] iCat 2 5 40 +/- minutes Heerink et al. 2006b [25] iCat 2 5 40 +/- minutes Heerink et al. 2006c [26] iCat 2 5 40 +/- minutes Heerink et al. 2007 [28] iCat 2 5 40 +/- minutes Looije et al. 2006 [38] iCat 6 5 6 +/- < 1 hour Kriglstein and Wallner 2005 [39] Homie 3 3, 5 2 + ? Giusti and Marti 2006 [40] Paro 3 3 5 1 month twice a week Kazuyoshi et al. 2003 [41] Paro 3 2 12, 11 +/- 3 weeks Kidd et al. 2006 [42] Paro 2 3,2 23 + 4 months Marti et al. 2006 [43] Paro 3 3 1 + 1 time Saito et al. 2002 [44] Paro 3 1 20 + 6 weeks Saito et al. 2003 [18] Paro 3 5 12, 11 - 3 weeks, 4 days a week, 1 hour Taggart et al. 2005 [23] Paro 2 3 18 + 20 minutes Wada et al. 2002a [45] Paro 3 2 11 +/- 3 weeks, 1-3 times per week, 20 minutes Wada et al. 2002b [46] Paro 3 2 11 +/- 3 weeks, 1-3 times per week, 20 minutes Wada et al. 2003a [10] Paro 3 1,2 4,3,9 + 3 weeks, 4 days a week, 1 hour Wada et al. 2003b [20] Paro 3 2 7,11,12,9 + 3 weeks, 4 days a week, 1 hour Wada et al. 2003c [21] Paro 3 1,2 4, 7, 11 + 3 weeks Wada et al. 2003d [22] Paro 3 2 4, 7, 11 + 3 weeks Wada et al. 2004a [47] Paro 3 1 10 + 14 weeks Wada et al. 2004b [48] Paro 3 2 12, 11 + 5 weeks, 1-3 times per week, 20 minutes Wada et al. 2004c [49] Paro 3 2 12,11 + 5 weeks, etc. Wada et al. 2005a [50] Paro 3 2 23 + 1 year Wada et al. 2005b [51] Paro 3 3 ? 1 year Wada et al. 2005d [52] Paro 3 5 14 + 20 minutes Wada et al. 2005c [53] Paro 3 2 8 + 17 months Wada et al. 2006 [54] Paro 3 2 14 + 10 weeks Wada and Shibata 2006 [55] Paro 3 1,3 11 1 month, 9h per day Wada and Shibata 2007 [14] Paro 3 1,3 12 + 1 month, 9h per day Montemerlo et al. 2002 [56] Pearl 3 5 6 + 5 days Pineau et al. 2003 [16] Pearl 3 5 6 + 5 days Giuliani et al. 2005 [24] Robocare - 5 123 ? Legend For the column “Design” For the column “Outcome” 1. RCT 4. Narrative/opinion 1. Health status 4. Loneliness 2. Comparative cohort 5. Other 2. Mood 5. Other / Design criteria 3. Case series 6. Focus group. 3. Communication 6. Remembering / thinking about the past Table 2 Author Specifics Fujita 2004 [30] Overview article Kanamori et al. 2002 [31] All three cases are reported to have decreased stress and decreased loneliness, but the research method is not clear about other influences of the actual visit during the 20 AIBO sessions. Kanamori et al. 2003 [32] 20 sessions, but it is unclear if the positive effects are due to sessions themselves or due to the robot. Mival et al. 2004 [33] A study to find design criteria for companion robots Suga et al. 2002 [34] Positive immune system response. Unclear how AIBO is used exactly, difficult to attribute causality. Sakairi 2004 [35] No control group and no statistics reported, difficult to attribute causality. Suga et al. 2003 [36] No control group, and the study’s design is unclear so its difficult to attribute causality to the AIBO Tamura et al. 2004 [19] Although both toy dog (=control) and AIBO increased activity of demented patients, there was no difference (or even less patient activity) in the AIBO case then in the toy dog case, probably due to the fact that the AIBO was not perceived as a puppy dog. Turkle et al. 2006 [37] The form and behavior of a robot pet might matter for its acceptance. Two cases are described with positive results in terms of social interaction with the My Real Baby robot Yanagi and Tomura 2002 [29] Study in a waiting room in clinic, the exact result measure is unclear from abstract Graf et al. 2004 [8] Describes results with walking aid robot and grabber. Elderly are able to work with the robot. Heerink et al. 2006a [27] Study to investigate robot acceptance and design guidelines Heerink et al. 2006b [25] Study to investigate robot acceptance and design guidelines Heerink et al. 2006c [26] Study to investigate robot acceptance and design guidelines Heerink et al. 2007 [28] Study to investigate conversational behavior Looije et al. 2006 [38] Study to investigate guidelines for iCat interface design. Kriglstein and Wallner 2005 [39] Ideas about design Giusti and Marti 2006 [40] Demented elderly started talking a lot about PARO and to PARO, but there was no control group, nor a clear effect measure. Also difficult to establish causality. Kazuyoshi et al. 2003 [41] Same experiment as Saito et al (2003). Different measure. Some hints at positive effect, but no statistical analysis. Control condition (fake PARO) and experimental condition (real PARO) had the same effect. Kidd et al. 2006 [42] More lively communication in the PARO-on case compared to the PARO-off case. Experimenters took care to not influence the sessions. No statistics mentioned. Extra result with My Real Baby: is used to calm down residents, but the baby is often too much of a care burden. Marti et al. 2006 [43] PARO was introduced with therapist. Demented patient accepted PARO and talked about it. Saito et al. 2002 [44] Urinary tests show a lower stress level Saito et al. 2003 [18] Negative (stress hormone) result for the less active PARO in the less demented group (n=12), but there seems to have been a problem with the urine samples. The more demented group with the active PARO had no results. Again difficult to interpret. Taggart et al. 2005 [23] Form is important for expectations (PARO in bathtub). Acceptation is still an important issue. Less active PARO had fewer reactions of subjects. Weird considering the result in the opposite direction in study of Saito et al (2003) Wada et al. 2002a [45] Slightly positive results, one item of the mood scale (vigor) was significantly better in Aibo intervention case. No control group. Wada et al. 2002b [46] Same as Wada et al (2002) Wada et al. 2003a [10] Non-significant increase in immune system function as measured by urinary hormones (n=4). PARO (n=3) and fake PARO group (n=9) both had positive effect on depression Wada et al. 2003b [20] Subjects were happier with the real PARO (n=7) than with fake PARO (n=11) but they kept liking the fake PARO (n=12) better throughout the study compared to the real PARO (n=9). Wada et al. 2003c [21] Same as data and results in study Wada (2003b) and (2003c) Wada et al. 2003d [22] Correlation between emotion change and familiarity with PARO (n=4). Fake PARO (n=11) has same interest effect as real PARO (n=7), i.e. subjects keep liking both robots. Wada et al. 2004a [47] No statistically sound evidence of effect (n=10) of PARO on dementia scale. One case seems promising (woman). Application of PARO to elderly seems different than in other 2003 studies. It is unclear what the amount of involvement of the researcher is. No control condition with fake PARO. Wada et al. 2004b [48] Increase in mood and emotion faces test, but unclear where the effect came from. The intervention with PARO is mediated, and the measurement is before and after intervention. Wada et al. 2004c [49] Same as Wada et al (2004c) Wada et al. 2005a [50] Longer term study with a small number of subjects (n=8). Unclear what the statistical power of the main reported effect (emotion faces) is. Suffers from same problem as many other studies: no control condition and unclear about the researchers’ interactions with the subjects during the study. Wada et al. 2005b [51] Same as Wada et al (2005), but including data on number of utterances. Silent PARO provokes significantly less utterances in subjects than the normal PARO. Wada et al. 2005d [52] Strong intervention and dubious interpretation of cortical neuron activation. Also only a short term effect. Wada et al. 2005c [53] Long term study but no new insights compared to the other work of the same group. Wada et al. 2006 [54] Wada and Shibata 2006 [55] Participants could play themselves with the robot without caregivers intervening. This is a clean study but does not have a good control group/situation. Social network increased in size and stress hormone indicated better immune system. Wada and Shibata 2007 [14] Participants could play themselves without caregivers intervening. This is a clean study because it tries to eliminate researcher intervention, however the control group/situation is not clear. Montemerlo et al. 2002 [56] An experiment with robot guidance, not so much about companions. Pineau et al. 2003 [16] Experiment with elderly guidance using a robot. Same as Montmerlo et al (2002) Giuliani et al. 2005 [24] Evaluation of robot perception amongst elderly