Pivotal response treatment and applied behavior analysis interventions for autism spectrum disorder delivered by human vs robotic agents: a systematic review of literature.

Robotic technology-aided instruction and interventions have been designed to support both Applied Behavior Analysis (ABA) and Pivotal Response Treatment (PRT) interventions for children with ASD. However, to the best of our knowledge, this field has not been systematically reviewed. Thus, we aimed to systematically review the literature to determine whether ABA or PRT methods in a robotic therapeutic context yield better outcomes for individuals with ASD, specifically in terms of approaching and accepting robots. A comprehensive search of electronic databases including PubMed, EMBASE, and Google Scholar was conducted. Randomized control trials (RCT) and pre-post-test design investigations that assessed the impact of ABA vs. PRT approach via robot-mediated technology vs. human trainers on intervention outcomes of children with ASD were selected and included in this systematic review. Finally, 13 papers met the criteria for inclusion in the systematic review. Two independent reviewers extracted the associated data from each selected study according to the standardized data extraction form. Two reviewers also assessed the quality of each study independently using the Cochrane Back Review Scale and JBI tool for quasi-experimental studies. We categorized two general classifications of findings including ABA vs. PRT as well as robotic technology vs. human. In conclusion, the existing investigations on the effect of robotic assistive technology using ABA or PRT approach are promising particularly in therapeutic contexts with a more natural context and social flavor.

Assistive robotic technology could teach social skills with both Applied Behavior Analysis (ABA) and Pivotal Response Treatment (PRT) approach to children with Autism Spectrum Disorders (ASD) with an acceptable efficiency and efficacy as human delivered therapies.The use of robotic technology as a means of delivering ABA or PRT interventions could offer a valuable alternative approach to human trainers in the treatment of children with ASD, potentially enhancing their acceptance and engagement with therapy.

Corrigendum: Assimilation of socially assistive robots by older adults: an interplay of uses, constraints and outcomes.

[This corrects the article DOI: 10.3389/frobt.2024.1337380.].

Care Providers' Perspectives on the Design of Assistive Persuasive Behaviors for Socially Assistive Robots.

OBJECTIVES: The main objectives of this research are (1) to uniquely design assistive behaviors for socially assistive robots using the principles of persuasion from behavioral psychology, and (2) to investigate caregivers' perspectives and opinions on the use of these behaviors to engage and motivate older adults in cognitive activities. DESIGN: We developed 10 unique robot persuasive assistive behavior strategies for the social robot Pepper using both verbal and nonverbal communication modes. Robot verbal behaviors were designed using Cialdini's principles of persuasion; nonverbal behaviors included expansive movements of the body. Care providers' perceptions of the quality, strength, and persuasiveness of these robot persuasive behaviors were assessed based on the Perceived Argument Strength Likert scale. SETTING AND PARTICIPANTS: Eighteen formal and informal care providers caring for older adults including those living with mild cognitive impairments participated. METHODS: An online survey was designed consisting of short videos of the Pepper robot displaying each behavior. After viewing each video, care providers completed the Perceived Argument Strength Likert scale to evaluate 6 attributes for each behavior. They also provided comments. RESULTS: Results show robot assistive behaviors using praise with emotion, along with emotion with commitment were the most positively rated by care providers. Qualitative responses indicate robot body language and speech quality were influencing factors in how a person perceives assistance in human-robot interactions. CONCLUSIONS AND IMPLICATIONS: Our findings provide new insights into incorporating persuasive strategies into the design of assistive social robot behaviors with the aim of engaging and motivating older adults in an activity. The majority of care providers rated the robot persuasive behaviors positively. In designing a persuasive socially assistive robot for older adults, it is beneficial to display a combination of persuasive strategies, such as praise and commitment with emotion, to address individual users' needs and cognitive levels.

Barriers and facilitators to technology acceptance of socially assistive robots in older adults - A qualitative study based on the capability, opportunity, and motivation behavior model (COM-B) and stakeholder perspectives.

This study aimed to identify barriers and facilitators to older adults' acceptance of socially assistive robots from a stakeholder perspective. We enlisted 36 distinct stakeholders, including older adult, nurses, retirement home managers, and employees from robotics companies. Data collection was conducted through semi-structured interviews. The research findings were mapped onto the Capability, Opportunity, Motivation-Behavior (COM-B) model. We obtained a total of 14 facilitators and barriers. (1) Capability: High technological familiarity (Facilitator); insufficient technical experience and low level of education (Barriers). (2) Motivation: Strong interest in new things, perceived convenience usefulness, and emotional support (Facilitators); concerns about technical reliability, perceived lack of ease of use, inability to establish emotional connection, and low level of need (Barriers). (3) Opportunity: Insufficient policy support and economic capacity, robotics technical problems (Barriers). Collaborative efforts among stakeholders are vital for fostering an environment conducive to socially assistive robot adoption, maximizing its potential to improve older adults' well-being.

Can Socially Assistive Robots Be Accepted by Older People Living Alone in the Community?: Empirical Findings from a Social Work Project in China.

A pilot study was undertaken between March 2019 and September 2021, loaning socially assistive robots (SARs) for a 7-day trial to older people living alone in China. Quantitative assessments of participants' acceptance of technology and loneliness were conducted before and after the intervention, supplemented with qualitative interviews. Unexpectedly, participants' intention to use SARs decreased significantly, largely due to emotional anxiety. Meanwhile, participants' level of loneliness remained unchanged. Follow-up interviews revealed anxious emotion, hesitant attitudes, unreal social presence, usability difficulties as contributing factors. The study provides social workers with valuable insights into introducing SARs into community care of older people.

Assimilation of socially assistive robots' by older adults: an interplay of uses, constraints and outcomes.

By supporting autonomy, aging in place, and wellbeing in later life, Socially Assistive Robots are expected to help humanity face the challenges posed by the rapid aging of the world's population. For the successful acceptance and assimilation of SARs by older adults, it is necessary to understand the factors affecting their Quality Evaluations Previous studies examining Human-Robot Interaction in later life indicated that three aspects shape older adults' overall QEs of robots: uses, constraints, and outcomes. However, studies were usually limited in duration, focused on acceptance rather than assimilation, and typically explored only one aspect of the interaction. In the present study, we examined uses, constraints, and outcomes simultaneously and over a long period. Nineteen community-dwelling older adults aged 75-97 were given a SAR for physical training for 6 weeks. Their experiences were documented via in-depth interviews conducted before and after the study period, short weekly telephone surveys, and reports produced by the robots. Analysis revealed two distinct groups: (A) The 'Fans' - participants who enjoyed using the SAR, attributed added value to it, and experienced a successful assimilation process; and (B) The 'Skeptics' - participants who did not like it, negatively evaluated its use, and experienced a disappointing assimilation process. Despite the vast differences between the groups, both reported more positive evaluations of SARs at the end of the study than before it began. Overall, the results indicated that the process of SARs' assimilation is not homogeneous and provided a profound understanding of the factors shaping older adults' QE of SARs following actual use. Additionally, the findings demonstrated the theoretical and practical usefulness of a holistic approach in researching older SARs users.

Exploring a GPT-based large language model for variable autonomy in a VR-based human-robot teaming simulation.

In a rapidly evolving digital landscape autonomous tools and robots are becoming commonplace. Recognizing the significance of this development, this paper explores the integration of Large Language Models (LLMs) like Generative pre-trained transformer (GPT) into human-robot teaming environments to facilitate variable autonomy through the means of verbal human-robot communication. In this paper, we introduce a novel simulation framework for such a GPT-powered multi-robot testbed environment, based on a Unity Virtual Reality (VR) setting. This system allows users to interact with simulated robot agents through natural language, each powered by individual GPT cores. By means of OpenAI's function calling, we bridge the gap between unstructured natural language input and structured robot actions. A user study with 12 participants explores the effectiveness of GPT-4 and, more importantly, user strategies when being given the opportunity to converse in natural language within a simulated multi-robot environment. Our findings suggest that users may have preconceived expectations on how to converse with robots and seldom try to explore the actual language and cognitive capabilities of their simulated robot collaborators. Still, those users who did explore were able to benefit from a much more natural flow of communication and human-like back-and-forth. We provide a set of lessons learned for future research and technical implementations of similar systems.

Care-receivers with physical disabilities' perceptions on having humanoid assistive robots as assistants: a qualitative study.

BACKGROUND: People with physical disabilities due to disease or injury face barriers to their daily activities and participation in society. Many depend on formal or informal caregivers for assistance to live independently. However, future healthcare challenges due to demographic changes threaten access to home care and assistants. Assistive technologies, such as robots for physical assistance, can support the independence and autonomy of people with physical disabilities. This study explore Norwegian care-receivers' perceptions of using robot assistance in their homes, including preferences for tasks acceptable or unacceptable for robot assistance and the underlying reasons. METHOD: Purposive sampling was employed to recruit 18 participants, aged between 18 and 77 years, with differences in physical function including diagnoses such as stroke, spinal cord injury, amputations, and muscular dystrophy. Qualitative data were gathered through four focus group interviews wherein participants watched videos featuring a humanoid assistive robot, EVEr3. The collected data underwent analysis using reflexive thematic analysis. RESULTS: Three themes with associated sub-themes were constructed: (a) How a robot could assist in daily life, (b) The robot's appearance and functionality, and (c) Concerns about having a robot as an assistant. The participants welcomed the idea of a future robotic assistant in areas that may contribute to an increased feeling of independence and autonomy. CONCLUSION: A robot assisting in activities of daily living would need to be individually customized to meet the needs of each user in terms of which tasks to assist with, how to assist in these defined tasks, and how it is controlled.

Perspective analysis of assistive robots for elderly in India.

PURPOSE: Assistive technology for elderly are advancing, and this study aimed to analyse the Indian perspective on utilising assistive robot technology for aiding elderly individuals. MATERIALS AND METHODS: A population-based survey was undertaken to collect data from three perspectives: Relatives of the elderly, Healthcare professionals and Elderly individuals. The survey gathered 389 responses. The responses are statistically analysed, and data is visualised with different plots for better understanding. RESULTS: It is observed that the older people rate with less conviction on the use of technology when compared to the relatives and healthcare professionals. Out of the three target groups, the elderly individuals had the most correlating attributes to purchasing the robot. Also, healthcare personnel, relatives, and older people gave 82%, 63% and 55% affirmatives to the question on purchasing the robot, respectively. And the cost of the robot is preferred to be under 6 lakh rupees. CONCLUSIONS: Though the younger generation has more orientation towards technology, older people are skeptical about handling computer gadgets or robots. However, there are significant expectations and concerns expressed by three target groups such as conversational, navigational, reminder features, security and malfunction concerns.

Comparison of proactive and reactive interaction modes in a mobile robotic telecare study.

Mobile robotic telepresence systems require that information about the environment, the task, and the robot be presented to a remotely located user (operator) who controls the robot for a specific task. In this study, two interaction modes, proactive and reactive, that differ in the way the user receives information from the robot, were compared in an experimental system simulating a healthcare setting. The users controlled a mobile telepresence robot that delivered and received items (medication, food, or drink), and also obtained metrics (vital signs) from a simulated patient while the users performed a secondary healthcare-related task (they compiled health records which were displayed to them on the screen and answered related questions). The effect of the two interaction modes on overall performance and user perception was evaluated through a within-participant study design conducted with 50 participants belonging to two different types of populations (with and without a technological background). Efficiency, effectiveness, understanding, satisfaction, and situation awareness were defined as the dependent variables measured both objectively and subjectively. The proactive mode increased user performance, and understanding of the system and reduced the workload compared to the reactive mode. However, several of the users valued the option of increased user control experienced in the reactive mode. We, therefore, proposed design suggestions to highlight some of the benefits of factoring the reactive mode into the design as a hybrid mode.

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

BACKGROUND: Socially assistive robots offer an alternate source of connection for interventions within health and social care amidst a landscape of technological advancement and reduced staff capacity. There is a need to summarise the available systematic reviews on the health and wellbeing impacts to evaluate effectiveness, explore potential moderators and mediators, and identify recommendations for future research and practice. OBJECTIVE: To explore the effect of socially assistive robots within health and social care on psychosocial, behavioural, and physiological health and wellbeing outcomes across the lifespan (PROSPERO registration number: CRD42023423862). DESIGN: An umbrella review utilising meta-analysis, narrative synthesis, and vote counting by direction of effect. METHODS: 14 databases were searched (ProQuest Health Research Premium collection, Scopus, PubMed, Web of Science, ASM Digital Library, IEEE Xplore, Cochrane Reviews, and EPISTEMONIKOS) from 2005 to May 4, 2023. Systematic reviews including the effects of socially assistive robots on health outcomes were included and a pooled meta-analysis, vote counting by direction of effect, and narrative synthesis were applied. The second version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) was applied to assess quality of included reviews. RESULTS: 35 reviews were identified, most focusing on older adults with or without dementia (n = 24). Pooled meta-analysis indicated no effect of socially assistive robots on quality of life (standard mean difference (SMD) = 0.43), anxiety (SMD = -0.02), or depression (SMD = 0.21), although vote counting identified significant improvements in social interaction, mood, positive affect, loneliness, stress, and pain across the lifespan, and narrative synthesis identified an improvement in anxiety in children. However, some reviews reported no significant difference between the effects of socially assistive robots and a plush toy, and there was no effect of socially assistive robots on psychiatric outcomes including agitation, neuropsychiatric symptoms, and medication use. DISCUSSION: Socially assistive robots show promise for improving non-psychiatric outcomes such as loneliness, positive affect, stress, and pain, but exert no effect on psychiatric outcomes such as depression and agitation. The main mechanism of effect within group settings appeared to be the stimulation of social interaction with other humans. Limitations include the low quality and high amount of overlap between included reviews. CONCLUSION: Socially assistive robots may help to improve loneliness, social interaction, and positive affect in older adults, decrease anxiety and distress in children, and improve mood, stress, and reduce pain across the lifespan. However, before recommendations for socially assistive robots can be made, a cost-effectiveness analysis of socially assistive robots to improve mood across the lifespan, and a quantitative analysis of the effects on pain, anxiety, and distress in children are required.

Soft Artificial Muscle Based on Pre-Detwinned Shape Memory Alloy Spring Actuator Achieving High Passive Assistive Torque for Wearable Robot.

For designing the assistive wearable rehabilitation robots, it is challenging to design the robot as energy efficient because the actuators have to be capable of overcoming human loads such as gravity of the body and spastic torque continuously during the assistance. To address these challenges, we propose a novel design of soft artificial muscle that utilizes shape memory alloy (SMA) spring actuators with pre-detwinning process. The SMA spring was fabricated through a process called pre-detwinning, which enhances the linearity of the SMA spring in martensite phase and unpowered restoring force, which is called passive force. The fabricated SMA spring can contract >60%. Finally, the soft wearable robot that can assist not only the gravitational torque exerted on the elbow by passive force, but also the elbow movements with active force was designed with a soft artificial muscle. A soft artificial muscle consists of the bundles of pre-detwinned SMA springs integrated with the stretchable coolant vessel. The stiffness of the muscle was measured as 1125 N/m in martensite phase and 1732 N/m in austenite phase. In addition, the muscle showed great actuation frequency performances, the bandwidth of which was measured as 0.5 Hz. The proposed wearable mechanism can fully compensate the gravitational torque for all the angles in passive mode. In addition, the proposed mechanism can produce high torque up to 3.5 Nm and movements in active mode.

Cardiology professionals' views of social robots in augmenting heart failure patient care.

Aims: Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Methods and results: Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. Conclusion: The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.

User confidence and electrodermal activity during haptic exploration for perceptual comparisons using a robotic system.

Children with physical impairments may have trouble effectively performing the hand movements used in haptic exploration and may miss information about object properties. Assistive robotic systems with haptic feedback may enable children with physical impairments to haptically explore objects. However, it is important to understand if they might be encountering difficulty in assessing object properties with the system. As such, we examined two methods to ascertain a user's uncertainty or stress when doing the exploration, user confidence and electrodermal activity (EDA). Twenty adults and ten children without physical impairments manipulated four pairs of objects to examine size, roughness, hardness and shape. All participants performed the manipulation by controlling a robotic system and by manual exploration in a randomized crossover design. Adults' confidence was lower when using the robotic system and correlated with lower accuracy at determining object properties. Children's responses indicated that they may not have understood how to self-rate confidence. EDA, a potentially objective measure of stress during the task, was actually lower for adults when they used the robotic system, suggesting less physiological arousal than when using their hands. Children's EDA was variable.

Technology Acceptance of Socially Assistive Robots Among Older Adults and the Factors Influencing It: A Meta-Analysis.

The purpose of this study was to deeply understand older adults' acceptance of socially assistive robots and their influencing factors and to compare the strength of the correlation between each influencing factor variable and the acceptance. The literature search was performed in five databases from their inception to January 17, 2023. The meta-analysis was performed using Review Manager 5.4 and Stata 16.0 software. Thirteen papers were included in this study. The mean value of acceptability after using the inverse variance method was 3.68. Education level is strongly related to technology acceptance; perceived ease of use, perceived usefulness, technology experience, technology attitude, perceived hedonism, and convenience are moderately related; anxiety is only weakly related.

My Precious Friend: Human-Robot Interactions in Home Care for Socially Isolated Older Adults.

OBJECTIVES: Using a friendship framework, we explored interactions between a multi-functional companion robot and older adults residing in a low-resource community in South Korea. METHODS: We conducted in-depth interviews with 12 older adults who kept a doll-shaped companion robot called Hyodol for 18 months on average. We applied the Framework Analysis Method to explore three types of friendship (i.e., friendships of utility, pleasure, and the good) that participants cultivated with the robot. RESULTS: The most common aspect of utility companionship reported by all participants was Hyodol's role as their health coach who reminded them to take medication and to exercise. Participants also found pleasure in playing with Hyodol and reported reduced feelings of loneliness. In the absence of other social supports, all participants also regarded Hyodol as a surrogate family member or human-friend, and interacted with Hyodol as such. CONCLUSIONS: Findings illustrated high acceptability of Hyodol among these socially isolated older adults especially during the global COVID-19 pandemic, suggesting that a humanoid like Hyodol could be complementary to homecare services for solo-living older adults. CLINICAL IMPLICATIONS: Well-designed robot interventions, as complements to existing aging service and clinical interventions, have a potential to improve health behaviors among socially isolated older adults.

A portable AFO solution for pneumatic actuator with cable tendon mechanism to assist ankle dorsiflexion.

The limited portability of pneumatic pumps presents a challenge for ankle-foot orthosis actuated by pneumatic actuators. The high-pressure requirements and time delay responses of pneumatic actuators necessitate a powerful and large pump, which renders the entire device heavy and inconvenient to carry. In this paper, we propose and validate a concept that enhances portability by employing a slack cable tendon mechanism. By managing slack tension properly, the time delay response problem of pneumatic actuators is eliminated through early triggering, and the system can be effectively controlled to generate the desired force for dorsiflexion assistance. The current portable integration of the system weighs approximately 1.6 kg, with distribution of 0.5 kg actuation part on the shank and 1.1 kg power system on the waist, excluding the battery. A mathematical model is developed to determine the proper triggering time and volumetric flow rate requirements for pump selection. To evaluate the performance of this actuation system and mathematical model, the artificial muscle's response time and real volumetric flow rate were preliminarily tested with different portable pumps on a healthy participant during treadmill walking at various speeds ranging from 0.5 m/s to 1.75 m/s. Two small pumps, specifically VN-C1 (5.36 L/min, 300 g) and VN-C4 (9.71L/min, 550 g), meet our design criteria, and then tested on three healthy subjects walking at normal speeds of 1 m/s and 1.5 m/s. The kinematic and electromyographic results demonstrate that the device can facilitate ankle dorsiflexion with a portable pump (300-500 g), generating sufficient force to lift up the foot segment, and reducing muscle activity responsible for ankle dorsiflexion during the swing phase by 8% and 10% at normal speeds of 1 m/s and 1.5 m/s respectively. This portable ankle robot, equipped with a compact pump weighing approximately 1.6 kg, holds significant potential for assisting individuals with lower limb weakness in walking, both within their homes and in clinical settings.

A novel socially assistive robotic platform for cognitive-motor exercises for individuals with Parkinson's Disease: a participatory-design study from conception to feasibility testing with end users.

The potential of socially assistive robots (SAR) to assist in rehabilitation has been demonstrated in contexts such as stroke and cardiac rehabilitation. Our objective was to design and test a platform that addresses specific cognitive-motor training needs of individuals with Parkinson's disease (IwPD). We used the participatory design approach, and collected input from a total of 62 stakeholders (IwPD, their family members and clinicians) in interviews, brainstorming sessions and in-lab feasibility testing of the resulting prototypes. The platform we developed includes two custom-made mobile desktop robots, which engage users in concurrent cognitive and motor tasks. IwPD (n = 16) reported high levels of enjoyment when using the platform (median = 5/5) and willingness to use the platform in the long term (median = 4.5/5). We report the specifics of the hardware and software design as well as the detailed input from the stakeholders.

Views about perceived training needs of health care professionals in relation to socially assistive robots: an international online survey.

BACKGROUND: As Artificial Intelligence and social robots are increasingly used in health and social care, it is imperative to explore the training needs of the workforce, factoring in their cultural background. OBJECTIVES: Explore views on perceived training needs among professionals around the world and how these related to country cultures. DESIGN: Cross-sectional, descriptive, mixed-methods international online survey. METHODS: Descriptive statistical analysis explored the ranking across countries and relationships with three Hofstede cultural dimensions. Thematic analysis was conducted on the open-ended text responses. RESULTS: A sample of N = 1284 participants from eighteen countries. Knowing the capabilities of the robots was ranked as the top training need across all participating countries and this was also reflected in the thematic analysis. Participants' culture, expressed through three Hofstede's dimensions, revealed statistically significant ranking differences. CONCLUSIONS: Future research should further explore other factors such as the level of digital maturity of the workplace. IMPACT STATEMENT: Training needs of health and social care staff to use robotics are fast growing and preparation should factor in patient safety and be based on the principles of person- and culture-centred care.