How to use robot interventions in intramural psychogeriatric care; A feasibility study.

BACKGROUND: Social robots, with Paro being an example, offer new opportunities for innovative approaches in dementia care. OBJECTIVES: To investigate how interventions, with the socially assistive robot Paro, can be implemented in daily care practice. DESIGN: Paro was used according to individualized interventions, aiming at predefined specific care problems, during a 3-week period. Selected residents were offered Paro once or twice a week. SETTING: Small scale care units (8-10 residents each) in three Dutch care institutions for intramural psychogeriatric care. PARTICIPANTS: A total of 23 dementia patients, 22 female and 1 male, participated. INTERVENTION: Three intervention types were applied, one for therapeutic purposes, one for facilitating daily care activities and one to support social visits. MEASUREMENTS: The experience of care staff, informal caregivers and patients with Paro were registered qualitatively by means of a registration form in which each occasion of Paro use was briefly reported. Additionally, care staff was interviewed using a semi-structured qualitative questionnaire. RESULTS: The 23 residents were involved in 36 individually defined interventions, and in total 71 sessions were carried out. In the majority of cases, care staff and patients considered the Paro interventions to be of added value for the care provided. CONCLUSION: The use of Paro can be well individualized to the needs of patients, the resulting individual Paro intervention can be well implemented in day to day care, and Paro may have added value when used in a well-directed way.

Robots and ICT to support play in children with severe physical disabilities: a systematic review.

PURPOSE: Play is an essential part of children's lives. Children with physical disabilities experience difficulties in play, especially those with severe physical disabilities. With the progress of innovative technology, the possibilities to support play are increasing. The purpose of this literature study is to gain insight into the aims, control options and commercial availability of information and communication technology (ICT) and robots to support play (especially play for the sake of play) in children with severe physical disabilities. METHODS: A systematic literature search in the databases PubMed, CINAHL, IEEE and ERIC was carried out. Titles and abstracts were assessed independently by three reviewers. In addition, studies were selected using Google Scholar, conference proceedings and reference lists. RESULTS: Three main groups of technology for play could be distinguished: robots (n = 8), virtual reality systems (n = 15) and computer systems (n = 4). Besides, ICT and robots developed for specific therapy or educational goals using play-like activities, five of the in total 27 technologies in this study described the aim of "play for play's sake". CONCLUSIONS: Many ICT systems and robots to support play in children with physical disabilities were found. Numerous technologies use play-like activities to achieve therapeutic or educational goals. Robots especially are used for "play for play's sake". Implications for Rehabilitation This study gives insight into the aims, control options and commercial availability for application of robots and ICT to support play in children with severe physical disabilities. This overview can be used in both the fields of rehabilitation and special education to search for new innovative intervention options and it can stimulate them to use these innovative play materials. Especially robots may have great potential in supporting "play for play's sake".

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction.

There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3-17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities.

OBJECTIVE: To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3-18 years). METHOD: Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers. RESULTS: Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified. CONCLUSION: Evaluation of parents' service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Overview and Categorization of Robots Supporting Independent Living of Elderly People: What Activities Do They Support and How Far Have They Developed.

Over the past decades, many robots for the elderly have been developed, supporting different activities of elderly people. A systematic review in four scientific literature databases and a search in article references and European projects was performed in order to create an overview of robots supporting independent living of elderly people. The robots found were categorized based on their development stage, the activity domains they claim to support, and the type of support provided (i.e., physical, non-physical, and/or non-specified). In total, 107 robots for the elderly were identified. Six robots were still in a concept phase, 95 in a development phase, and six of these robots were commercially available. These robots claimed to provide support related to four activity domains: mobility, self-care, interpersonal interaction & relationships, and other activities. Of the many robots developed, only a small percentage is commercially available. Technical ambitions seem to be guiding robot development. To prolong independent living, the step towards physical support is inevitable and needs to be taken. However, it will be a long time before a robot will be capable of supporting multiple activities in a physical manner in the home of an elderly person in order to enhance their independent living.

Effectiveness of Robot Paro in Intramural Psychogeriatric Care: A Multicenter Quasi-Experimental Study.

BACKGROUND: Together with care professionals, specific psychogeriatric care applications were developed for the seal robot Paro. OBJECTIVES: This study aims to evaluate the outcomes of the developed Paro interventions, applying the robot in psychogeriatric care. DESIGN: A multicenter quasi-experimental time series ABAB study (n = 91) with within-subject comparison was conducted to assess both the short-term effects of the Paro interventions for therapeutic applications, and the facilitation of daily care activities by care providers. SETTING: Small-scale care units (8-10 residents each), spread over 6 different locations, in 3 Dutch care institutions for intramural psychogeriatric care. PARTICIPANTS: A total of 91 patients with dementia, in all stages of dementia. INTERVENTION: Two user-centered intervention types were applied, one for therapeutic purposes and one for the facilitation of daily care activities. MEASUREMENTS: Effectiveness was measured with a goal attainment scale (IPPA) and a mood scale (Coop/Wonca), by means of a registration form. RESULTS: A total of 106 user-specific interventions were defined for 91 participants; 71 participants completed the study, 14 were men and 57 were women. All interventions combined show a significant effect (P < .001). CONCLUSION: Paro should be seen as a tool for care staff and not as a replacement of care. Successful implementation of Paro in daily intramural psychogeriatric care practice can increase the quality of care and the quality of life for the elderly.

Effects and effectiveness of dynamic arm supports: a technical review.

Numerous dynamic arm supports have been developed in recent decades to increase independence in the performance of activities of daily living. Much effort and money have been spent on their development and prescription, yet insight into their effects and effectiveness is lacking. This article is a systematic review of evaluations of dynamic arm supports. The 8 technical evaluations, 12 usability evaluations, and 27 outcome studies together make 47 evaluations. Technical evaluations were often used as input for new developments and directed at balancing quality, forces and torques, and range of motion of prototypes. Usability studies were mostly single-measure designs that had varying results as to whether devices were usable for potential users. An increased ability to perform activities of daily living and user satisfaction were reported in outcome studies. However, the use of dynamic arm supports in the home situation was reported to be low. Gaining insight into why devices are not used when their developers believe them to be effective seems crucial for every new dynamic arm support developed. The methodological quality of the outcome studies was often low, so it is important that this is improved in the future.

Which activities threaten independent living of elderly when becoming problematic: inspiration for meaningful service robot functionality.

PURPOSE: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®. METHOD: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons (n = 41), (2) formal caregivers (n = 40) and (3) informal caregivers (n = 32). RESULTS: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic. CONCLUSIONS: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution.

An overview and categorization of dynamic arm supports for people with decreased arm function.

BACKGROUND: Assistive devices that augment arm function were already introduced during the polio era. Devices are still being developed, but a review has not been performed thus far. OBJECTIVE: To create an overview and categorize assistive devices facilitating arm function in activities of daily living for people with decreased arm function. STUDY DESIGN: Literature review. METHODS: A systematic review in three scientific literature databases. Conference proceedings, assistive technology databases, and references were searched and experts consulted. This resulted in a database of dynamic arm supports. Product information was added, and the devices were categorized. RESULTS: A total of 104 dynamic arm supports were found. These could be categorized as nonactuated devices (N = 39), passively actuated devices (N = 24), actively actuated devices (N = 34), or devices using the functional electrical stimulation principle (N = 7). Functionality analysis resulted in second-level categorization: tremor suppression, facilitation of anti-gravity movement, and assistance of specific joint motion. CONCLUSION: All devices could be ordered in a categorization of low complexity. Many have been developed; most have disappeared and have been succeeded by similar devices. Limitations of the devices found mainly concern interfacing and the range of motion facilitated. Future devices could make use of whatever residual strength is available in the users' arm for control. CLINICAL RELEVANCE: The provided overview of devices in this article and the classification developed is relevant for practitioners seeking assistive solutions for their clients as it makes the range of developed solutions both accessible and comprehensible.

Development of a team-based method for assuring the quality of assistive technology documentation.

Good practice in assistive technology (AT) service delivery targeting children with disabilities has come increasingly to include providing AT stakeholders with a final text record that documents the rationale and procedures behind the recommendations made during the AT assessment process (AT documentation). In the present case study of one AT service provider, we developed a team-based approach for conducting an evaluation of the quality of the AT documentation. A service-specific scale for the evaluation of AT documentation was developed following a five-step approach. The scale was employed to'review AT documentation utilizing specific review criteria in order to evaluate the quality of AT documentation practices with regard to the service investigated. Two independent reviewers examined the AT documentation for 130 cases of AT service provision. Weighted kappa and Intraclass correlation coefficients (ICC) were employed as a measure of inter-rater agreement. The results of the documentation evaluation allowed AT professionals to objectively assess the quality of the AT documentation produced by the service under investigation, identify shortcomings in the documentation process, and make related corrections. AT services may benefit from the employment of strategic approaches for the evaluation of service provision. Possible applications to other AT service providers are discussed.

Selecting services for a service robot: evaluating the problematic activities threatening the independence of elderly persons.

Sustaining independent living for the elderly is desirable both for the individual as well as for societies as a whole. Substantial care interventions are provided to citizens supporting their independent living. Currently, such interventions are primarily based on human care provision, but due to demographic changes the demand for such support is continuously increasing. Assistive Robotics has the potential to answer this growing demand. The notions research towards service robots that support the independence of elderly people has been given increased attention. The challenge is to develop robots that are able to adequately support with those activities that pose the greatest problems for elderly people seeking to remain independent. In order to develop the capabilities of the Care-O-bot 3 in the ACCOMPANY project, problematic activities that may threaten continued independent living of elderly people were studied. Focus groups were conducted in the Netherlands, UK, and France and included three separate user groups: (1) elderly (N=41), (2) formal caregivers (N=40), and (3) informal caregivers (N=32). This resulted in a top 3 of problematic activity domains that received the highest priority: (1) Mobility, (2) Self-care, and (3) Social isolation. The findings inform the further development of the Care-O-bot. In the ACCOMPANY project the Care-O-bot 3 will be developed further to enable it to support independently living older persons in one of these domains.

Dynamic arm supports: overview and categorization of dynamic arm supports for people with decreased arm function.

In the 1940s the wish for independent feeding in polio survivors has led to the development of the first dynamic arm supports. By now polio is eradicated, but persons with difficulty to perform activities of daily living due to a limited arm function still exist. Many devices aiming to support these persons have been developed in the past 70 years. A review making an inventory of devices developed was performed in scientific literature databases, conference proceedings, assistive technology databases and by consultation of experts. A total of 97 devices were found, and three main categories were recognized: the non-actuated devices (N=39), the passively-actuated devices (N=24) and the actively-actuated devices (N=34). Of the 97 devices encountered 43 devices were commercially available in October 2012, the lowest percentage found in the actively-actuated devices. This means that the more advanced systems are not (yet) available for users. The continuous efforts in developing new devices suggest there is potential for actively activated arm supports. Developing these into products ready for the market would be a first step in fulfilling this potential.

The development of an indoor mobility course for the evaluation of electronic mobility aids for persons who are visually impaired.

PURPOSE: To develop a suitable mobility course for the assessment of mobility performance as part of a user evaluation of Electronic Mobility Aids (EMA) aimed at obstacle detection and orientation. METHOD: A review of the literature led to a list of critical factors for the assessment of mobility performance of persons who are visually impaired. Based upon that list, method, test situations, and determining elements were selected and presented to Dutch orientation and mobility experts. Due to expert advice and a pilot study, minor changes were made and the final version was used for the evaluation of two EMA by eight persons who are visually impaired. RESULTS: The results of the literature study are summarized in an overview of critical factors for the assessment of the mobility performance of persons who are visually impaired. Applied to the requirements of the above mentioned user evaluation a replicable indoor mobility course has been described in detail and tested. CONCLUSION: Based upon evidence from literature an indoor mobility course has been developed, which was sensitive to assess differences in mobility incidents and obstacle detection when using an EMA compared to the regular mobility aid. Experts' opinion confirmed its face and content validity.

User evaluation of two electronic mobility aids for persons who are visually impaired: a quasi-experimental study using a standardized mobility course.

This study was conducted to enhance insight into the functionality, usability, and efficacy of two systematically selected Electronic Mobility Aids (EMA) aimed at obstacle detection and orientation. Eight persons who are visually impaired participated in a user evaluation of the UltraCane and the Miniguide. The participants' mobility performance was observed while completing a standardized indoor mobility course with their regular mobility aid, then with each EMA, and assessed in terms of speed, Percentage Preferred Walking Speed (PPWS), type and number of mobility incidents made. Interviews were administered to ascertain users' satisfaction with the functionality, effectiveness and specific features of the assistive devices. Walking speed and PPWS declined when using an EMA compared to the long cane. The mean total number of previously defined mobility incidents decreased significantly and also the type of mobility incidents changed. Generally, participants were quite satisfied with the use of the EMA, and detailed advantageous as well as disadvantageous aspects concerning functionality and certain features of both devices. The UltraCane and the Miniguide have proven to be effective on an indoor mobility course. Individual users' characteristics and preferences appear to be critical for their appraisal of the devices.

Socially assistive robots in elderly care: a systematic review into effects and effectiveness.

The ongoing development of robotics on the one hand and, on the other hand, the foreseen relative growth in number of elderly individuals suffering from dementia, raises the question of which contribution robotics could have to rationalize and maintain, or even improve the quality of care. The objective of this review was to assess the published effects and effectiveness of robot interventions aiming at social assistance in elderly care. We searched, using Medical Subject Headings terms and free words, in the CINAHL, MEDLINE, Cochrane, BIOMED, PUBMED, PsycINFO, and EMBASE databases. Also the IEEE Digital Library was searched. No limitations were applied for the date of publication. Only articles written in English were taken into account. Collected publications went through a selection process. In the first step, publications were collected from major databases using a search query. In the second step, 3 reviewers independently selected publications on their title, using predefined selection criteria. In the third step, publications were judged based on their abstracts by the same reviewers, using the same selection criteria. In the fourth step, one reviewer made the final selection of publications based on complete content. Finally, 41 publications were included in the review, describing 17 studies involving 4 robot systems. Most studies reported positive effects of companion-type robots on (socio)psychological (eg, mood, loneliness, and social connections and communication) and physiological (eg, stress reduction) parameters. The methodological quality of the studies was, mostly, low. Although positive effects were reported, the scientific value of the evidence was limited. The positive results described, however, prompt further effectiveness research in this field.

The role of the International Classification of Functioning, Disability, and Health and quality criteria for improving assistive technology service delivery in Europe.

OBJECTIVE: People with disabilities are entitled to access assistive technology (AT) to facilitate their full and effective participation in society and may reasonably expect to be central to the decision-making processes of services that provide these technologies. European projects have improved the knowledge and resources available for AT service delivery in many countries, but the outputs are not consistently implemented or published in scientific literature. This article examines European developments in AT service delivery and the barriers to its effective provision. Specifically, it analyzes the role of the International Classification of Functioning, Disability, and Health in service delivery improvement. DESIGN: Published scientific papers, as well as reports from and descriptions of European projects related to AT service delivery, were reviewed. The publications were analyzed in relation to six criteria for AT service delivery described in an earlier, major European project. The findings and recommendations from the publications are synthesized in this article to identify advances and gaps in AT service delivery and to assess the current status and direction of AT service delivery improvement in Europe. RESULTS: Multicountry projects have brought together AT researchers from across Europe to work together and produced promising results that are contextually relevant. Access to AT information and training of practitioners has improved, and efforts are being made to facilitate user involvement. CONCLUSIONS: More effort should be put into integrating research and resources from European projects into practice. Use of the International Classification of Functioning, Disability, and Health model and terminology may support coordination of service delivery systems. The AT research and practice communities in Europe may be able to learn from developments in North America, while continuing to work together, sharing resources and strategies, and communicating results internationally.

Evaluation of short term effects of the IROMEC robotic toy for children with developmental disabilities.

Research shows a reduced playfulness in children with developmental disabilities. This is a barrier for participation and children's health and wellbeing. IROMEC is a purposely designed robot to support play in impaired children. The reported study evaluates short-term effects of the IROMEC robot toy supporting play in an occupational therapy intervention for children with developmental disabilities. Two types of play intervention (standard occupational therapy versus robot-facilitated play intervention) were compared regarding their effect on the level of playfulness, on children's general functional development, goal achievement as well as the therapist's evaluation of the added value of a robot-facilitated play intervention. Three young children took part in this single-subject design study. Evaluation was performed through Test of Playfulness (ToP), the IROMEC evaluation questionnaire and qualitative evaluation by the therapists. Results confirmed the IROMEC robot did partly meet the needs of the children and therapists, and positive impact on TOP results was found with two children. This suggests robotic toys can support children with developmental disabilities in enriching play. Long term effect evaluation should verify these positive indications resulting from use of this innovative social robot for children with developmental disabilities. But it also became clear further development of the robot is required.