Issue 3 / 2010 The Official Voice of iACToR
FEATURES: Probo, a “Huggable” Robot for Interactive Therapy p 16
Assistive Social Robots for Elderly Care p 34 PRODUCT COMPARISON: Medical & Military Robots p 28
COUNTRY FOCUS: Romania p 46
COVER STORY: Robots: Almost Commonplace and much more...
ISSN 2031 - 278
Letter from the Secretary General and Editor-in-Chief Professor Dr. Brenda K. Wiederhold “Videogame expertise may be among the most valuable skills for armed services that depend increasingly on robots. In a battle - field situation, soldiers and pilots grow conditioned to violence, which helps to ‘inoculate’ them from the effects of stress.”
Dear Reader, expertise may be among the most valuable skills for armed services that depend increasingly on robots. Anecdotal reports indicate that pilots who remotely In a battlefield situation, soldiers and pilots grow bomb targets in Operation Enduring Freedom using conditioned to violence, which helps to “inoculate” unmanned aerial vehicles (UAVs) may be at greater them from the effects of stress. In contrast, UAV risk for posttraumatic stress disorder (PTSD) than pilots talk about the unreality of working with part - those who fly combat missions. ners they never meet against an enemy that exists (for them) only on a video screen. Perhaps this emo - Associated Press reporter Scott Lindlaw suggests that tional disengagement is another reason for reports there may be several reasons for this. of PTSD: Subconsciously, they may find it hard to justify killing when their lives are not in danger. 1. UAV pilots work longer shifts and tours than pilots deployed to a war zone. But what if you’re in a “boots on the ground” posi - tion and a robot saves your life? What happens to 2. Unlike manned flights, UAVs are often your emotions then? 1 required to linger and assess the bomb damage, showing the pilot the resultant “The EOD [Explosive Ordnance Disposal] soldier car - carnage in high-resolution detail. ried a box into the robot repair facility at Camp Victory, Iraq. ‘Can you fix it?’ he asked, with tears 3. Very little decompression time elapses welling in his eyes. Inside the box was a pile of bro - between a pilot’s bombing run and being ken parts. It was the remains of ‘Scooby-Doo,’ the at home with spouse and family, resulting team's PackBot, which had been blown up by an IED in a jarring transition between a virtual [improvised explosive device]. On the side of reality and a physical reality. Scooby's ‘head’ was a series of handwritten hash marks, showing the number of missions that the lit - What helicopters were to Vietnam, UAVs are to tle robot had gone on. All told, Scooby had hunted Afghanistan – essential to the engagement and a down and defused 18 IEDs and one car bomb, dan - symbol of technological superiority. The number of gerous missions that had saved multiple human UAVs or drones has grown from less than 200 eight lives. ‘This has been a really great robot,’ the soldier years ago to more than 7,000 today. Each Predator told Master Sergeant Ted Bogosh, the Marine in and Reaper aircraft has a two-person crew: an Air charge of the repair yard.” Force pilot, who flies the drone, and a sensor opera - tor, who runs the camera and targeting laser. Drone In addition to the UAVs, which range from the 48- pilots can complete training in just months, versus foot Predator to the hand-thrown Raven, there are the years it takes an F-15 fighter pilot. Videogame more than 12,000 unmanned ground vehicles such Letter from the Secretary General (continued from page 1)
as the lawnmower-sized PackBot deployed to the someday replace the two-person UAV teams – Middle East and South Asia. Soldiers are project - though the field of roboethics, established in ing their emotions onto these machines, with 2004, needs to grow quickly to address increasing - undreamed-of consequences. ly complex issues.
As they begin to bond with their robot as part of One issue in particular, outside the obvious ethical the team, they may, for example, promote the concerns, will need to be given due attention in robot to private first-class and give him an EOD the future – the popularized science fiction badge. But this same anthropomorphizing may notion that robots will be able to develop on their result in an EOD soldier running into enemy fire own, begin to think for themselves, and end up attacking their own troops. “For the time being, the Department of Defense Such instances have been reported, although on a has a unique opportunity to conduct longitudinal small scale. In 2007 a robot studies of drone pilots and other human-robot killed nine and injured 14, a teams to determine the extent and causes of their report the South African National Defence investi - PTSD – and to help those who are suffering from gated and blamed on a this disabling condition. And it’s possible that "mechanical problem" – Virtual Reality assisted exposure therapy could be poor design or modifica - the treatment of choice for this and future groups tion. 2 of videogame-based warriors.” For the time being, the Department of Defense has to “rescue” his robot – the exact opposite of what a unique opportunity to conduct longitudinal was intended by the robot’s creation. Perhaps it is studies of drone pilots and other human-robot because the soldier realizes that he may not be teams to determine the extent and causes of their alive without this machine, so he chooses not to PTSD – and to help those who are suffering from view it that way. There is a physiological reason for this disabling condition. And it’s possible that this: When people look at robots, their mirror neu - Virtual Reality assisted exposure therapy could be rons fire, indicating that we consider robots alive the treatment of choice for this and future groups and deserving of empathy. of videogame-based warriors.
In the future, it may be desirable to create a PackBot with a slightly annoying personality, so that soldiers don’t feel so bad when it’s destroyed. Create your own reality! And perhaps a “drone with a conscience” can Brenda Wiederhold Volume 13, Number 1 t February 2010 t 1SSN: 2152-2715 Cyberpsychology, Behavior, and Social Networking
Special Issue on Now Available Online! Posttraumatic Stress Disorder Lessons Learned from VR Sessions with Special Issue Warriors with Combat-Related PTSD Behavioral Treatment of Earthquake on PTSD Survivors PTSD Due to Motor Vehicle Accident Therapeutic Alliance in Telepsychotherapy Visit Virtual Reality in Iraq www.liebertpub.com/cpb to And More... view the issue for free!
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LETTER FROM THE EDITOR-IN-CHIEF B. Wiederhold p 1 COVER STORY Robots: Almost Becoming Commonplace M.D. Wiederhold, B.K. Wiederhold p 11 FEATURES Quality of Life Technology Robots for People with Disabilities and Older Adults R. Cooper, S. Srinivasa, C. Atkeson, J. Xu, p 14 Probo, a “Huggable” Robot for Interactive Therapy J. Saldien p 16 Arm Therapy Robot for Neurorehabilitation T. Nef, R. Riener p 18 Robot Assisted Radical Prostatectomy D. Lee p 20 Robots Assist with Stroke Therapy and Rehabilitation How Was Your Day? Virtual Agents as Companions M. Cavazza p 22 Every year, over one million people in Europe Robotic Arm Exoskeletons for Rehabilitation and .7 million people in the U.S. are affected C. Carignan p 24 by stroke. Rehabilitation for these patients has been a costly, time, and labor intensive MindMentor Online Mental Coach endeavor for decades. Now, aided by robots J. Hollander p 26 such as the ARMin (Arm Therapy Robot for 7 PRODUCT COMPARISON CHART Nuerorehabilitation), victims of stroke may Medical & Military Robots p 28 have better options available to them during VR for Robot-Assisted Gait Training in Children their recovery. Robots enable repetitive train - K. Brütsch p 30 ing and can even provide biofeedback infor - mation to assess the progress of rehabilita - Beneficial Effects of Human-robot tion as it occurs. Interaction in Healthcare J. Arendsen, A. Mert p 31 Assistive Social Robots for Elderly Care J. Broekens, K. Hindriks, M. Wisse p 34 The Need for Cognitive Systems in Medical Care J. Bryson p 35 Social Robots for Self-management of Health-promoting Activities M. Neerincx p 36 Enhancing Robotic-Assisted Gait Training in Children with Cerebral Palsy via Interactive Gaming P. Bonato p 38 Robots to Enhance Quality of Life
ACROSS THE POND & FURTHER AFIELD A recent study concluded that 84% of power G. Ling, L. Kong p 40 wheelchair users would purchase a robotic arm Transforming VR into a Reality for Behavioral Health if one were available on the market. Quality of Care: The NeuroVR Project Life Robots have been developed to perform G. Riva, A. Gaggioli, C. Vigna p 43 helpful tasks such as reheating containers of COUNTRY FOCUS food in a microwave and these actions will Romania work towards improving the life of disabled A. Rimbu p 46 patients. International Association of CyberPsychology, Training & Rehabilitation (iACToR) Conference Participation Report Fall 2010
The American Psychological ICT 2010 Association Convention Digitally Driven Cutting Edge Science for Clinicians - Where is Brussels, Belgium / September 27-29, 2010 Addiction Treatment Going? San DIego, California, U.S.A / August 12-15, 2010 A three-day event, from September 27-29, brought together 6,000 participants from all over Europe, including businessmen, re - searchers and policymakers. The “ICT 2010-Digitally Driven” con - The Annual Convention of the American Psychological ference and exhibition housed more than 100 groundbreaking Association Convention is an important event aimed information and communication technology (ICT) research proj - at the advancement of psychology as a means to pro - ects funded by the European Commission. This year’s event was mote health, education and human welfare. This year’s hosted by the Belgian Presidency of the EU’s Council of Minis - Convention featured a symposium dedicated to addic - ters. tion treatment development and psychological impli - cations. As part of the Division 50 on Addictions, the The major themes at the conference were digital solutions for symposium aimed to promote advances in psycholog - sustainable growth in a low carbon economy and the role of ICT ical research, technology, and professional training, in the life of citizens, as well as public participation and support. among many others, with regards to problematic use In keeping with the theme of cooperation, Prime Minister of Bel - of addictive substances and behaviors. iACToR Board gium Yves Leterme emphasized the importance of intensifying Members participated in this year’s conference on such cooperation at the European level as well, needing to act as a topics as the benefits of using VR to treat drug and nico - union, towards the EU 2020 target. tine addiction. Alongside this are calls for raising ICT research and innovation Next year’s conference will take place August 4-7, 2011, to help increase quality of life and overcome social challenges, in Washington, D.C. 84 as well as improve healthcare. Twenty-five to thirty-five percent For further information, please visit: of the exhibits focused on healthcare, showing that ICT is indeed http://www.apa.org/convention/ crucial for the future of medicine. These health-focused exhibits 8 ranged from supporting independent living and offering compan - ionship, to catering to the elderly, battling cognitive decline, con - trolling and treating seizures, diabetes, cardiovascular disease, epilepsy, and to easing life for the paralyzed. European Conference on For further information, please visit: Cognitive Ergonomics http://www.ict2011.org/ Caring Technology for the Future Delft, The Netherlands / August 25-27, 2010
The 28th edition of the Annual European Conference on Cognitive Ergonomics proved an opportunity to dissem - inate information in the areas of cognitive ergonomics, European Association for Behavioral & human technology interaction and cognitive engineer - Cognitive Therapies ing amongst researchers and practitioners seeking to en - LINKS hance the relationship between cognitive sciences and October 7-10, 2010 technical information processing systems. Milan, Italy /
The conference theme “Caring Technology for the Fu - The 40th Annual European Association for Behavioral & Cognitive ture” addressed the capacity for computer technology to Therapies Conference took place this year in Milan, Italy, on 7-10 Oc - be further implemented in the healthcare sector and to tober. In keeping in line with its theme, “LINKS,” the event aimed to improve patients’ mental and physical health and quali - create networks and LINKS between associations, disciplines, coun - ty of life. This can be done not only in clinical settings, tries, innovations, experts, professionals and students. It further sought but crisis settings as well, and the conference explored to LINK the worlds of clinical practice and theory, classical expression new types of cognitive ergonomics issues in this area. and innovative developments, as well as intervention and prevention.
Next year’s conference will be held August 24-26, 2011, Next year’s conference will be held August 30-September 3, 2011, in in Rostock, Germany. Reykjavik, Iceland.
For further information, please visit: For further information, please visit: http://ecce2011.eace.net/ http://www.congress.is/eabct/ prevention, therapy, and rehabilitation. therapy,prevention, and training, for education, technologies of uses to advanced explore is the Its mission International Association of Association CyberPsychology,International &Rehabilitation Training The JCR SUBSCRIBE J ournal of CyberTherapyournal &Rehabilitation TODAY! Please visit visit Please advanced technologies in technologies advanced access to information on the healthcarethe industry. And receiveAnd unrivaled w ww.vrphobia.eu
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COVER STORY
Robots: Almost Becoming Commonplace In the past few decades, robots have become increasingly prevalent, and while many may consider this still a page out of a sci-fi novel, it is now becoming an everyday reality. While it might seem the robotics revolu - tion has appeared to blossom overnight, the ideas driving these tech - nologies have actually been around for centuries.
By Mark D. Wiederhold & Brenda K. Wiederhold
The word “robot” comes from the Czech As the baby boom generation reaches Assisted motor-coordination therapy treats word robota, meaning forced labor, and retirement age and life expectancy con - injuries to the brain or nervous system drudgery, and was coined by Czech writer tinues to increase, there has been an in - that impair motor skills and coordination. Karel Capek in his play R.U.R (Rossum’s creasing demand on healthcare needs. While there is much that is still unknown Universal Robotics), published in 1920. People living longer does not necessar - about how the brain works, repeated The term “robotics” first appeared in ily mean that people are living healthi - movement is believed to eventually lead 11 Isaac Asimov’s science fiction short-sto - er lives, and as the population grows old - to the restoration of brain function and ry “Liar,” in 1941. While literature con - er, care for the elderly has become a the ability to control movement. Robots ceived robots as supernatural, the con - dilemma that many people are strug - have been developed to aid patients in cept of robots in real life had actually gling to address. Robotic technologies repetitive rehabilitation in the upper and existed for quite some time. Among his have the potential to alleviate some of lower extremities. These robots help guide many other scientific blueprints, Leonar - these issues. Robotic systems not only the movements of limbs to ensure opti - do de Vinci had already developed de - can perform activities that cannot be mal effects from therapy, and can regulate signs for a humanoid mechanical knight performed by humans, but they can also force feedback. Hocoma’s Lokomat is used robot in 1495. Although mechanical de - reduce labor costs, increase independ - in gait-impaired patients to improve mo - vices were used for entertainment and ence and social participation, and in - bility following stroke, spinal cord injury, theater, it wasn’t until the 1900s that me - crease quality of care. In recent years, and neurological diseases and injuries. A chanical robots would start to resemble a large amount of robotics research has robotic gait orthosis guides the patient’s robots as we know them today. The first focused on the prevention and diagno - legs on a treadmill, while the machine industrial robot, Unimate, was created by sis of illness, helping the disabled and carefully assesses the patient’s move - George Devol in the 1950s, and was used chronically ill in their daily lives, assist - ments. The Lokomat is able to prepro - in the assembly lines at General Motors. ing professional care and assisting sur - gram training sessions that are individu - Factories and large manufacturing com - gical procedures, and has also largely fo - ally adjusted to each patient, allowing for panies were the first sector to integrate cused on rehabilitation. Rehabilitation a faster recovery, while also reducing phys - and embrace robots for their ability to robotics has extended into the fields of ical strain on the therapist. work efficiently and accurately, while also assisted motor-coordination therapy, relieving humans from the burden of physical training, and mental, cognitive Assisted physical training therapy utilizes physical labor. Since the invention of the and social therapy. Not only are reha - robots for muscle sustaining therapies computer chip in the 1950s there have bilitation robots available to the com - based on fundamental and repetitive mo - been three main functions that define a mercial market, but they can also be tor activities. For many of these systems, robot. It must be able to: act on environ - used at home, as opposed to only in the clinical supervision is not required, allow - mental stimuli, sense, and perform logi - clinic, making them accessible and con - ing the patient to heal from home, with cal reasoning. venient. some utilizing only a regular PC. COVER STORY
Assisted mental, cognitive and social ther - picking up and carrying a tray of dishes, ing on a bipedal robot. In 1996, they re - apies have also benefited greatly from ro - and doing the wash. The robot has sensors leased the very first autonomous bipedal botic advancements. Their controllable on its head to locate objects in front of it, humanoid robot, and in 2000, created an behavior and ability for repeated actions and is trained to repeat tasks that it fails to updated version of the initial prototype allow robots an edge over human thera - carry out properly. that was more compact and lightweight, pists since robots do not have the same appropriately calling it ASIMO which stands physical demands as humans, such as pa - Assistive technologies for the elderly and for “advanced step in innovative mobility.” tience, frustration, fatigue, and an hourly disabled have become a major focus in ASIMO has been greatly improved in the rate. People with communication disor - developing new robotic technologies. meantime, includes an infrared and CCD ders, such as autism, as well as disorders Within the last ten years, Carnegie Mel - camera, and an array of sensors such as of the elderly like dementia where social lon University’s People and Robots Lab - optical, ultrasonic, and floor surface sen - interaction might be a challenge, have re - oratory, along with the University of Pitts - sors. It can walk, run six kilometers in an sponded well to robotic systems. The com - burgh School of Nursing, Stanford hour, swerve from left to right, grasp ob - mercially available Paro is a soft white- University, the University of Michigan, and jects with grip force sensors, and walk furred seal that is equipped with tactile, the Art Institute of Pittsburgh, collaborat - alongside someone, holding their hand, while maintaining the same speed as the person. As the baby boomer generation reaches retirement age and life expectancy continues to increase, there has been an Japan is a worldwide leader in robotics and their development of improved robotic tech - increasing demand on healthcare needs. People living longer nologies has not only skyrocketed in the does not necessarily mean that people are living healthier past few decades, but the country is swiftly lives, and as the population grows older, care for the elderly embracing robots into their culture. This past year Japan introduced Geminoid-F, a has become a dilemma that many people are struggling to “fembot” who took the stage alongside hu - address. Robotic technologies have the potential to alleviate man actors while being controlled by hu - mans backstage. Japan has also been de - some of these issues. veloping robots for the purpose of learning. Assistant and substitute teachers have been light, audition, temperature, and posture ed on a project for developing a robot introduced to classrooms throughout Japan, sensors. The robotic seal provides the nurse. The NurseBot project aimed to de - and their presence is welcomed as being an 12 same therapeutic benefits as animal ther - velop a personal service robot that can as - aid to education. Japan’s robotic innova - apy and can recognize the direction of sist the elderly with everyday tasks. Their tion and swift embrace of robots stems from voice and respond to its own name as well prototype, Pearl, a four-foot-tall au - their overall outlook on technology, and their as greetings and praise, and can learn to tonomous mobile robot with a humanoid point of view differs significantly from the behave in a way that its user prefers. Paro face can recognize speech and is able to attitudes expressed in many Western cul - has proved to reduce patient stress and in - communicate through a touch screen tures. Japan’s history of Shinto and Bud - duce relaxation, and improved socializa - mounted on its torso area. Their next step dhist teachings emphasize the intercon - tion in patients by stimulating interaction. is to program Pearl to remind patients to nectedness with all things and a respect for take medication, go to the doctor, and pre - both animate and inanimate beings. Ro - Overall, one of the major goals for robotics vent them from getting lost. Pearl would botic innovation in Japan dates back to the manufacturing companies is to introduce be a live-in robot assistant to elderly who 17th century with a tradition of making robots to the general public, and integrate are ill or who have no one to help care for mechanized dolls called karakuri ningyo that them into people’s daily lives. This goal is them, providing an alternate option to were used in performances similar to pup - slowly but surely being achieved. One ro - nursing homes, and helping individuals pet shows. By contrast, the U.S. has focused bot that has already become widely known live independently for a longer period of on an ongoing discussion about the dan - is the Roomba, developed by the iRobot time. Pearl is also being used as a tool to gers and potential threats of robots. company, and is a robotic vacuum cleaner observe how people respond to humanoid that navigates its way through a space, robots by assessing which physical fea - Medicine has profited greatly from new ro - cleaning up scraps along the way. Similar - tures are appealing, what tasks are most botic technologies, allowing, for example, ly, the University of Tokyo and the Informa - important to a patient, as well as devel - robot-assisted surgeries so intricate and tion and Robot Technology Research Ini - oping an increased vocabulary to improve complicated that the human hand often tiative (IRT) have teamed up with major the overall robot experience. struggled to accomplish them. The da Vin - companies like Toyota to develop a robot ci Surgical System made by Intuitive Sur - that performs basic household chores. The Increasing mobility and agility in robots is gical was introduced to the world of med - Home Assistant Robot is a humanoid that important when attempting to apply hu - icine in 2000 and has since grown in operates on two wheels and has two hands man tasks to robots. Japan has been work - popularity. The da Vinci system consists both equipped with three finger graspers. ing diligently on this challenge since the of a surgeon’s console, a patient-side cart Its main functions are mopping the floor, 1980s when Honda Motor Co. began work - that includes four interactive robotic arms,
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation an InSite Vision System, and EndoWrist sur - gical instruments. Sitting at the console, Assisted mental, cognitive and social therapies have also bene - a surgeon views a 3-D image of the surgi - fited greatly from robotic advancements ... People with commu - cal field, while grasping the master controls nication disorders, such as autism, as well as disorders of the below the display. The system scales and filters the surgeon’s hand, wrist, and finger elderly like dementia where social interaction might be a chal - movements, and translates them to the lenge, have responded well to robotic systems. The commercial - surgical instruments on the patient-side cart where the actions are then performed ly available Paro is a soft white-furred seal that ... provides the on the patient in real-time. With its excel - same therapeutic benefits as animal therapy. lent range of motion, fine tissue manipu - lation, and intuitive control as well as min - imal invasiveness, the da Vinci is a a similar system for the public to experi - The U.S. has also utilized the development remarkable tool for surgeons dealing with ment with, which will allow anyone to write of unmanned aerial vehicles (UAVs), one areas of the body that require immense tasks and watch a robot carry them out. of the most popular being the Predator care and require tiny, intricate procedures. drone. While UAVs are used for reconnais - The Telemedicine and Advance Technolo - sance, they have recently been armed with Robot-assisted surgery is also becoming gy Research Center (TATRC), part of the U.S. missiles, and are increasingly being used more common as products such as the RO - Army Medical Research and Material Com - for attack missions. This has caused much BODOC are introduced to the market. Ap - mand, has developed the Battlefield Ex - controversy, as some people feel that there proved by the FDA to assist in orthopedic traction-Assist Robot (BEAR). BEAR is are unresolved ethical questions regarding surgeries, ROBODOC has been particular - roughly the size of an adult male and is de - responsibility of a robot’s actions, especial - ly successful in assisting with hip replace - signed to lift and carry large objects up to ly as they become more and more au - ments due to its specialized high-speed 500 lbs. for long distances and set them tonomous. A common question is “Who drill that surpasses manual precision with down gently, maneuvering through rough is to blame when there is a malfunction a less amount of trauma to the patient. terrains, over obstacles, and even up and that ends in unintended casualties?” No Urology has also benefited greatly from ro - down stairs, adjusting its speed to adapt to international laws have been developed so bot-assisted surgery due to the level of pre - its surroundings. BEAR is remotely oper - far concerning robots, and the question of cision required to manipulate the tiny ves - ated and includes motion control, pressure how to regulate them remains unanswered. sels that reside in that part of the body. and touch sensors, and has tank-like tracks Indeed, robotics has come a long way in on its corresponding thigh and calf areas the past century, from the first industrial Over the years the military has invested that allow it to balance upright on its hips, robot to humanoid robots that can speak 13 considerable time and resources in the de - knees, and lower wheels, standing upright. and even act somewhat independently. velopment of robotics. Foster-Miller, a U.S.- It can also crouch low to the ground and While this is true, it is evident that robots based military robotics manufacturer has even move while almost lying flat, slither - still have a long way to go, and like their developed a line of military robots called ing on the ground while holding a person human creators, have many flaws that still the TALON Operations. TALON robots are or object. BEAR’s main purpose in the bat - need to be addressed. Accuracy and pre - divided into “families” by size and function tle zone is to find wounded soldiers and cision can be further enhanced and learn - and range from explosive ordnance dispos - carry them to safety and BEAR has been ing how humans respond to robots in al (EODs) that remove and dispose of especially useful when rescues need to be everyday life is an ongoing project. Ro - grenades, to Modular Advanced Armed Ro - carried out in dangerous environments or bots are an important part of our future, botic System (MAARS), a remotely-operat - for disaster rescue missions. Similar de - and the time to research them is now. ed vehicle that has weapons such as rifles, signs have been adopted by health care machine guns, and grenade launders systems for the transport of elderly and dis - mounted directly on top. abled patients.
The Defense Advanced Research Projects TATRC has also focused energy on improv - Agency (DARPA) also works to develop new ing medical robots, especially for military Mark D. Wiederhold, M.D., technologies for the military. One of their use. From electronic information carriers Ph.D., FACP latest projects is the Autonomous Robotic (EICs), a portable wireless storage device Virtual Reality Medical Center Manipulation (ARM) program. ARM is a that carries soldier’s medical records, to a San Diego, California four-year program that is trying to lift some non-invasive brain ultrasound that assess [email protected] of the limitations in robots’ function and cerebral vascular activities and measures execution. The goal of the program is to accurate blood flood flow velocity in pa - Brenda K. Wiederhold, Ph.D., develop software and hardware that will in - tients who have experienced traumatic MBA, BCIA crease the autonomy of robots and reduce brain injuries, TATRC’s technological Virtual Reality Medical Institute the amount of human interaction required progress has allowed medical care to be - Belgium by the robot, while improving the execu - come more mobile and accessible, creat - [ office @vrp hobia .eu ] tion and performance of the tasks per - ing instruments that are easily transport - formed. DARPA is also planning to release ed and provide accurate information.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Quality of Life Technology Robots for People with Disabilities and Older Adults There is great room for growth for robotics to address rehabilita - tion needs, both physical and mental. Robots act as caretakers in a way, and this relationship “can be called quality of life technology (QoLT) systems that create a sym - biosis of human and technology maxi - mizing the use of the abilities of the per - son and the capabilities of technology in 14 natural environments.” By Rory A. Cooper et al
The Quality of Life Technology Center this paper is the two QoLT center quality (QoLT) was started as a result of funding of life technology robots (QoLTBots): the from the National Science Foundation as Personal Mobility and Manipulation Ap - an Engineering Research Center, for which pliance (PerMMA) and the Home Environ - it receives support. Within the QoLT Cen - ment Robotic Butler (HERB). PerMMA is ter there are four research thrusts, and a collaborative project with the Depart - four system integration testbeds. The re - ment of Veterans Affairs, and the HERB is search thrusts include human systems in - similarly a collaborative project with Intel terface, perception and awareness, mobil - Research in Pittsburgh. ity and manipulation, and person and society. The person and society thrust ties PerMMA was developed starting in 2006, the research of the technical thrusts to - and has served as a platform for research Home gether, and ensures that the QoLT Center and development in bi-manual manipu - Environment Robotic Butler (HERB) is designed to provide assistance is well grounded in the needs of con - lation on a robotic wheelchair base to pro - to older adults and people with disabilities sumers, caregivers, and clinicians. The four vide functional assistance and expanded in their homes. system integration testbeds are safe driv - mobility to people with disabilities and ing, virtual coaches, home and communi - older adults. This groundbreaking robot - An emerging area of technology to help ty health technologies, and quality of life ics system has the potential to spawn a people with disabilities (PwD) is to seam - technology robots. number of research projects and industri - lessly combine mobility and manipulation. al applications, gaining visibility both in Some PwD cannot retrieve a remote con - The system integration testbeds serve as the research community and the media trol, book/magazine, or a drink if not placed a critical path in the research pipeline of at large. Robotic systems have emerged in their immediate proximity. Frequently, the thrusts, and provide the important as a rehabilitation engineering solution to PwD will have a family member or assis - role of integrating research through real - ameliorate disabling conditions. A survey tant pre-prepare their meals and place istic systems. Of course, the systems and by Prior showed that 84% of power wheel - them in their refrigerator; thus requiring thrusts are essentially in a continuous chair users would purchase a robotic arm only reheating or simply removing and eat - feedback-feed forward loop. The focus of if it were available. ing. Therefore, work is being done to de -
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by remotely op - may lift and carry one side of a table while erating a robot - a human lifts and carries the other side, Quality of Life Technology ic device to per - requiring HERB to work collaboratively with form difficult the person. Home environments present tasks. This could some interesting challenges for robotic as - result in robotic sistants. A home is partially structured as Robots for People with mobility and people tend to have routines, and there are manipulation a number of fixed built environment fea - devices being tures; however, there is also a significant deployed for use degree of randomness. A lot of the random - Disabilities and Older Adults by PwD faster. ness includes clutter; imagine taking items PerMMA is one out of a grocery bag and putting them research project away. Even removing the correct object de - that aims to pro - sired by the human user from a refrigera - vide these capa - tor is a substantial technical problem. Thus bilities and far we have made some important break - more, both with - throughs in motion planning, recognizing in the home objects and their orientation, identifying and within the objects within a cluttered environment, community at grasp planning for natural objects, and pose large. PerMMA is control such as keeping a pitcher of water not a wheelchair upright as it is moved. There is much work with "added in - that remains such as human-robot inter - telligence" and action, completing realistic activities rather arms; it is an in - than discrete tasks. We are working towards tegrated mobile realistic tasks such as actually preparing 15 robotic manipu - chocolate chip cookies. lator with full seating and elec - While both of our QoLTBots have made tric powered tremendous progress, and are breaking new The Home Environment Robotic Butler (HERB) is preparing to grasp wheelchair func - ground in the area of robots working sym - the drink bottle, while the leader of the HERB project, Sidd Srinivasa, tions for the per - biotically with a human end-user; there are grabs the end-effecter to show that it is possible for humans to safely son. extraordinary hurdles to overcome. Working interact with HERB. in human environments (e.g., home, school, HERB is intend - work, communities) and in close proximity velop symbiotic systems to retrieve real-life ed to be an au - and in some cases actual contact with hu - objects through user, remote, and au - tonomous robotic assistant within the mans is a daunting task that requires a large tonomous methods in a time-efficient, safe, home environment. The goal of HERB is and diverse group of talented and dedicat - acceptable, and reliable manner. to be able to provide meaningful assistance ed people. However, the pay-off in terms of with home chores, such as meal prepara - making a positive difference in people's lives A core aspect of symbiotic systems is the tion, unpacking and storing food supplies, can be huge. melding of robotics and its traditional ap - cleaning dishes, light cleaning and organ - proach to develop autonomous systems with izing clutter. HERB may perform these tasks assistive technology which are user operat - in cooperation with a person in the home. ed systems to produce what can be called For example, HERB may move or lift a piece quality of life technology (QoLT) systems of furniture while the person cleans under - Rory A. Cooper, Ph.D. that create a symbiosis of human and tech - neath the furniture. Long-term HERB work will focus on providing physical assistance University of Pittsburgh nology maximizing the use of the abilities Siddhartha Srinivasa, Ph.D. to the user through physical contact to per - of the person and the capabilities of tech - Department of Veterans Affairs form such tasks as transfers, or assisting nology in natural environments. The capa - Chris Atkeson, Ph.D. someone after a fall. HERB moves au - bilities to remove a sealed plastic container Robotics Research Intel Pittsburgh from a refrigerator, place it in a microwave tonomously within the home and must Jijie Xu, Ph.D. oven, heat it, open it, and place it where the safely interact with and negotiate around Carnegie Mellon University user can eat it are tasks that may be well people. However, it may also work more di - U.S.A. suited for QoLT systems, and of great poten - rectly with a person as well. One of the ar - tial value to PwD. One novel approach is to eas being investigated is closed-kinematic [ RCOO PER@ pitt.e du ] use a remote caregiver to provide assistance chain activities where, for example, HERB
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Probo , a “Huggable” Robot for Interactive Therapy “Social robots” are showing promising growth and can fulfill multiple applications for therapy. One example is Probo, which serves as a multidisciplinary research platform for human-robot interaction (HRI) focused on children. By Jelle Saldien
A new generation of robots is being creat - ed to live among humans and become a nearly ubiquitous part of our day-to-day lives. These robots will be better accepted if they measure up to a certain standard of social interaction and human-like commu - nication, achieving the label of “social ro - bot.” No robot today can fulfill the role of a 16 fully social interactive robot, but new re - search domains such as human-robot in - teraction (HRI) are gaining vastly more in - terest. In this context there is a strong need for robotic platforms that support this HRI research. One specific subclass of HRI fo - cuses on the use of social robots for thera - peutic purposes. Based on the positive ef - fects that have been found in Animal Assisted Therapy (ATA), the first robots are being tested for similar purposes (termed RAT – Robot Assisted Therapy). These so - cial pet-type robots are being used for ther - apy targeting children and elderly patients.
With a special focus on hospitalized chil - dren, Probo can contribute to this new re - Figure 1: The prototype of the huggable robot Probo interacting with children. search domain. A hospitalization is a seri - ous physical and mental occurrence, Reduced motivation and drop out are often tive game play builds upon the online CBT especially for children. Besides therapy, encountered during therapy for children. How - treatment for relaxation. Various experiments Probo can play an important role in the ever, artificial creatures, games and robots re - are now being performed to explore whether preparation of children to reduce anxiety ceive a lot of their attention. Recently, a new this innovative device, Electronic Relaxation for medical operations. Reports of the inci - game concept named “Probogotchi” (Figure Therapy Interface (ERTI), offers advantages dence of preoperative anxiety in children 2) has been developed as part of the Probo over currently utilized therapies. have varied over the years but are estimat - project. It is a successful game where the user ed to effect around 60% of children. Preop - has to keep an artificial creature alive and sat - The robot Probo is an imaginary animal that erative anxiety in young children undergo - isfied through interaction with a stuffed an - looks similar to the ancient mammoths. ing surgery is associated with a more painful imal with sensors. The idea is to start a CBT The main aspects are a huggable appear - postoperative recovery and a higher inci - relaxation therapy with this game, where this ance, an attractive trunk or proboscis, ani - dence of sleep disturbances and other prob - new form of social interaction can play an mated ears, eyes, eyebrows, eyelids, mouth, lems. important motivational factor. This interac - neck, and finally, an interactive belly-screen.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Legend interaction with user current implementation under development RCC Probo Platform Operator
Perceptual-System Cognitive Control-System Expressional-System Motor-System
Vision-Stimuli Attention-System Animations Motion Mixer
Audio-Stimuli Emotion-System Gaze Behavior-System Motor Control Tactile-Stimuli Facial Expressions Homeostatic Actions System Gestures Object ID-System Sound-System Affective Speech Needs
Figure 2: Software Architecture of the robot Probo. Child 17 The internal mechanics of the robot are ence the attention and homeostatic system and transmitted to the actuation systems. covered with foam and a removable fur- used to define the robot's point of attention, To facilitate interaction with children, Probo jacket, in such a way that Probo looks and current emotional state and corresponding has an identity and corresponding history. feels like a stuffed animal. With this ap - facial expression. The recognition of these The name “Probo” is derived from the word proach, choosing an imaginary animal as facial expressions has been evaluated in var - proboscidea. Proboscidea is an order that the basic design, there is no exact similar - ious user studies. now contains only one family of living an - ity with a well-known creature and conse - imals, Elephantidae or “the elephants.” The quently, there are no specific expectations The degrees of freedom (DOF) in Probo’s history of Probo starts in the Ice Age where towards the behavior of this creature as head are based on the Action Units (AU) de - he lived among other similar species such would be the case for a cat or dog. fined by the Facial Action Coding System as the mammoths and mastodons. For (FACS) developed by Ekman and Friesen. AUs thousands of year he remained frozen un - Probo's purpose is to serve as a multidisci - express motion of mimic muscles as 44 kinds der an ice cap in the North Pole, but arrived plinary research platform for HRI focused on of basic operations, with 14 AU to express at Mainland Europe after global warming children. In terms of a social robot, Probo is the six basic emotions – anger, fear, disgust, melted large chunks of ice, setting them classified as a social interface supporting sadness, happiness, and surprise. In contrast adrift in the open sea. Now Probo’s quest non-verbal communication. Probo's social with other robotic heads, a special body part, is to help children overcome their difficul - skills are thereby limited to a reactive level. namely the trunk, is added to intensify cer - ties and diseases and to make there lives To close the gap with higher levels of inter - tain emotional expressions and to increase happier and more fulfilling. With future ap - action, an innovative system for shared con - interactivity. plications to come, Probo is an ideal plat - trol with a human operator is introduced. form to create a friendly companion for The software architecture defines a modu - Safety is ensured through Probo's soft body hospitalized children. lar structure to incorporate all systems into and intrinsic safe actuation systems. To con - a single control center for the operator vey the illusion of life in a robotic creature, named the Robot Control Center (RCC). The tools for the creation and management of robot reacts on basic input stimuli that it motion sequences are put into the hands of perceives during interaction with children. the operator. All motions generated from op - Prof. dr. ing. Jelle Saldien The input stimuli that can be referred to as erator-triggered systems are combined with University College West Flanders low-level perceptions are derived from vision the motions originating from the au - Belgium analysis, audio analysis, touch analysis and tonomous reactive systems. The resulting [ jelle .sald ien@ how est. be ] object identification. The stimuli will influ - motion is subsequently made more smooth
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Arm Therapy Robot for Neurorehabilitation Rehabilitation for victims of stroke can be a costly, labor intensive, and time intensive undertaking. With the aid of robots, rehabilitation could be improved by reducing the number of therapist hours needed, and increas - ing the duration and number of patient training sessions. While physiothera - pists’ work load would be lightened, patients would have a more effective rehabilitation experience and as a result, increased quality of life.
By Tobias Nef and Robert Riener
Motivation for Robot-supported Training
18 Stroke is the leading cause of long-term disability. It affects more than one million people in the E.U. and more than 700,000 in the U.S. each year. The major symptom of stroke is severe sensory and motor hemi - paresis of the contralesional side of the body. Restoration of arm and hand func - tion is essential for the patient to cope with activities of daily living (ADL). Sensorimo - tor movement therapies have positive ef - fects on the rehabilitation of the upper limb function, and relevant factors for success - ful rehabilitation training include a high level of intensity, sufficient duration, and repetitive but variable movement tasks. However, with respect to these criteria, one- to-one manually assisted training has sev - eral limitations. It is more labor intensive, time consuming, and expensive.
In contrast, robot-assisted arm training can reduce the number of therapist hours, ARMin III whereas the duration and number of train - Robot with a healthy test person ing sessions can be increased and well monitored. Furthermore, a robot enables repetitive training and can provide quan - pists would benefit from a less physical ty of Zurich in Switzerland. It has an exoskele - titative measures, stimulating biofeedback workload, as well as resulting in a lower ton structure that is empowered by six elec - functions and supporting the assessment cost of healthcare. tric motors. The motors and gears are back - of the rehabilitation progress. The possible drivable and equipped with redundant benefits of the robotic training are multi - Technical Components of position sensors, allowing the device either farious, if projected into the future. Patients the ARMin-robot to control the position or the interacting force. may benefit from a more effective and di - The device can be used for left and right arm versified rehabilitation leading to an im - The ARMin arm therapy robot has been de - training and usually connects to the most af - proved quality of life, while physiothera - veloped and tested at the ETH and Universi - fected arm. It can be operated in three modes:
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passive mobilization; active game-support - more than 20 stroke subjects in order to ther scores to assess transfer effects. Three ed arm therapy; and active training of ADL. evaluate the technical and ergonomic func - out of four patients showed pronounced and tionality of the different ARMin versions – significant improvements (p<0.05) in the For passive mobilization, a teach and repeat I, II and III. A first pilot study with three chron - main outcome measure, and were in line procedure has been implemented, where ic stroke subjects was performed in order with improvements in the secondary out - the therapist can move the patient’s arm to investigate whether the arm training with come measurements as well. Most improve - on an arbitrary but patient-individual trajec - the robotic rehabilitation device ARMin I ments were maintained, and some even fur - tory, while the robot actively compensates improves motor function of the paretic up - ther increased between discharge and the friction and gravity. The recorded movement per extremity. The study had an A-B design six month follow-up. The data clearly indi - with two weeks of cate that the intensive arm therapy with the multiple baseline ARMin robot can significantly improve mo - measurements (A), tor function of the paretic arm in some eight weeks of stroke patients. Even those who are in a training (B) with re - chronic state yield sustainable results. These spective measure - findings encouraged us to start a subsequent ment, and a follow- controlled randomized clinical trial. up measurement eight weeks after Conclusion and Outlook: training. The train - The prospective controlled and randomized ing included shoul - study started in 2009. Its goal is to compare der and elbow task oriented robot-aided therapy to con - movements in - ventional therapy with respect to promot - duced by ARMin I. ing functional recovery of the paralyzed arm. Two subjects had The study is ongoing and a total number of three one hour ses - 80 chronic stroke patients will be included. sions per week and Meanwhile, an industrial partner (Hocoma one subject re - AG, Volketswil, Switzerland) is commercial - ceived five one izing the ARMin technology. The commer - Figure: Graphical display for the ARMin training. The computer hour sessions per cial version of the ARMin robot is named 19 screen (a) is shown during passive mobilization, screen (b) and (c) week. ArmeoPower® and is expected to be avail - during game training, and screen (d) during ADL-training. able for sale in 2011. We expect that the data The main outcome that has been collected within the prospec - measurement was tive randomized clinical trial and the com - can be repeated by the robot while the pa - the upper limb portion of the Fugl-Meyer mercial availability of the device will facili - tient is instructed to behave passively. Assessment (FMA). It showed moderate, but tate its transfer from the research lab into significant improvement in all three sub - rehabilitation clinics. In game mode, ARMin serves as an input de - jects (p<0.05). Most improvements were vice driving a graphical object (e.g. a ball or maintained eight weeks after discharge. Acknowledgment: a cursor) inside a game scenario (e.g. a ping- However, patients stated that the daily use We thank all people who contributed to the pong scenario). The robot detects the con - of their paretic arm in the real world did development and clinical evaluation of the tribution of the patient to the movement not change. This could be explained by the ARMin, including Prof. Dr. med. V. Dietz, M. and assists as much as necessary. In the ADL fact that mainly non-ADL related proximal Guidali, Dr. med. V. Klamroth, A. Brunschweil - training mode, the patient has to solve an joint movements were trained (with only er, A. Rotta and A. Kollmar. Furthermore, we ADL task presented by the audiovisual dis - three degrees of freedom). thank all participating patients and our clin - play (e.g. set a table, fill a glass and drink). ical partners that are contributing to the Therefore, another study was performed to multicenter study. The research was and is A key feature in the game and ADL mode investigate the effects of intensive arm train - still funded in part by NCCR Neuro, Swiss is a specific patient-responsive strategy that ing on motor performance, using the ARMin National Science Foundation, Hans-Eggen - supports the patient only as much as need - II robot, incorporating distal joints and ADL berger Foundation, Bangerter-Rhyner Foun - ed. Current ADL training tasks include set - tasks were. This study included four chron - dation and ETH Foundation. ting a table, cooking, filling a cup, drinking, ic stroke subjects that received robot-assist - eating, personal hygiene, using a ticket ma - ed therapy over a period of eight weeks, chine, and playing the piano. We expect that three to four days per week, one hour per the training of functional movements will day. Two patients had four one hour train - Tobias Nef, Ph. D University of Bern facilitate the carry-over of gains in motor ing sessions per week, and the other two abilities into improvements that are rele - patients had three one hour training ses - Robert Riener, Ph. D ETH and University of Zurich vant to ADL. sions per week. Switzerland Clinical Testing of the ARMin-robot: The primary outcome variable was the FMA [email protected] of the upper extremity. Secondary outcomes [email protected] After approval from the institutional review were the Wolf Motor Function Test (WMFT), [ ] www.sms.mavt.ethz.ch board, preliminary tests were performed on maximum voluntary joint torques, and fur -
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Robot Assisted Radical Prostatectomy Minimally invasive surgery utilizes robotics in certain specialty areas. Although the daVinci Surgical System manufactured by Intuitive Surgical was originally conceived for heart surgery, radical prostatectomy for prostate cancer now successfully implements this technology.
By David I. Lee
Prostate cancer is the most common - complete removal of the prostate and Robotics in Surgery ly diagnosed cancer in men in the U.S. seminal vesicles including reconstruc - It is estimated that nearly 200,000 tion of the bladder to the remnant ure - The innovative work of Menon and col - men were diagnosed and nearly 28,000 thra, has been shown to reduce the in - leagues showed that the use of the daVin - 20 men died because of prostate cancer cidence of distant metastasis and ci Surgical System manufactured by Intu - in the U.S. in 2009. While a myriad of death from prostate cancer as com - itive Surgical in Sunnyvale, California, treatments exist including external ra - pared to active surveillance. However, could benefit the surgeon in allowing a diation, brachytherapy, proton radia - open surgery involves significant side difficult laparoscopic radical prostatecto - tion therapy, high intensity focused ul - effects and morbidity including incon - my to be performed with the advantages trasound, cryosurgery and active tinence, impotence, pain, significant that the robotic platform provides (see surveillance, many men opt for surgi - blood loss, and a lengthy recovery Figure 1). These benefits include a visual cal removal. Radical prostatectomy, or process. system that can provide 3-D vision. Un -
Figure 1: The daVinci Surgical System pictured here has become the platform that is widely used for robotic prostate surgery.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
like standard laparoscopic systems ly stage prostate cancer has been open where the image is sent to a video mon - radical prostatectomy. In 2009, it is es - itor, the camera system transmits a dual timated that more than 80% of all rad - image captured by a dual lens and dual ical prostatectomy cases in the U.S. were camera head. When seated at the con - performed with robotic assistance. Post - sole, the surgeon views each image with operative stress, urinary incontinence, a different eye and thus can see in 3-D and erectile dysfunction can result from inside the patient. The image is also either open or robotic surgery and cause magnified tenfold. a considerable decrease in quality of life. However, with increased experience The robotic instruments are available comes improved outcomes. Data from in a variety of shapes and functions in - reputable centers with radical prostate - cluding scissors, monopolar and bipo - ctomy demonstrate excellent results in lar cautery instruments, needle drivers, regard to maintaining continence and forceps, etc. However, the differentiat - potency. Generally large series report ing feature of the robotic instruments 90% pad free rate by 12 months and is a hinged wrist near the instrument 80% potency after complete nerve spar - tip (see Figure 2). This robotic wrist mir - ing procedures for robotic prostatecto - rors the flexibility of the human wrist. my and open radical prostatectomy. It Because this wrist is miniaturized, it al - is important to note, one clear benefit lows exceptional mobility deep within of robot prostatectomy is convalescence. the operative field, thereby facilitating Our patients at the University of Penn - dissection and suturing. sylvania leave the hospital on the first Figure 2: Significant advantages of the system day 96% of the time, where the stay af - include 3-D vision for the operating surgeon. Ro - The robot interface also provides sever - ter open radical prostatectomy is typi - botic instruments are controlled by the surgical al advantages to the surgeon. The con - cally 2-4 days. Our patients resume full masters and allow for very precise movements sole is very ergonomic, allowing the op - unrestricted activities within 3 weeks. to be transmitted to the robotic instruments. erating surgeon to be seated with arms This takes 6-8 weeks after an open rad - 21 supported, thus greatly reducing fatigue. ical prostatectomy. This likely results in When performing surgery, the hand con - a large societal benefit, both in worker trols or "masters" have the ability to fil - productivity and decreased overall costs ter hand tremor. With the additional abil - due to a shortened recovery period. ity to scale the motion of the robot There is increasing evidence that there instruments, incredibly delicate and fine are fewer medical and surgical compli - work can be performed. This dexterity cations after robot prostatectomy, fur - allows even very complex skills such as ther improving the cost balance. laparoscopic suturing to be performed with amazing ease. With these multiple The Penn Technique benefits provided by the robotic plat - form, the application of laparoscopy to Our technique for performing robot Figure 3: The laparoscopic stapler is here prostatectomy has become a much prostatectomy is quite similar to many shown being inserted around the deep dorsal more feasible option. other centers with a few modifications. vein complex to provide rapid and precise liga - tion and hemostasis. We utilize a six port transperitoneal ap - There are some limitations to the abil - proach. By using a transperitoneal ap - ity of the robot. There is no tactile feed - proach, the peritoneum must be incised back to the robotic instrument and this to gain access to the bladder and can be a considerable hurdle for expe - prostate. This is performed over the an - rienced open surgeons when adapting terior abdominal wall. With the bladder to the robotic approach. Many steps of dropped, the endopelvic fascia is visu - the radical prostatectomy are facilitat - alized and incised to mobilize the ed by feel. Therefore, the improved vi - prostate from the surrounding levator sualization that the robot provides must muscles. We then use a laparoscopic be substituted during these steps. This, stapler to ligate the dorsal venous com - however, does represent a significant plex (see Figure 3). The bladder is then learning curve. divided away from the prostate and the seminal vesicles and vasa are divided Figure 4: Our technique has pioneered the use Robotic Versus Open next. The rectum is then mobilized of a plication stitch pictured here. This helps to Radical Prostatectomy away from the prostate and erectile funnel the bladder neck allowing men to have function nerve sparing can then be per - more rapid control of continence postoperatively. The gold standard for treatment of ear - formed. We do this in an athermal tech -
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES Robot Assisted Radical Prostatectomy
nique which avoids any heat sources such prostate. For example, this operation has margin rates have steadily improved to the as cautery to avoid additional injury to the been successfully performed on men point where we have seen rates of 4-5% neurovascular bundles. The urethra is then weighing up to 360 pounds with a prostate for organ-confined disease and 11-12% divided, freeing the prostate and a long weighing up to 250g (a normal-sized overall. urethral stump is left to increase the speed prostate is about 30g). Many surgeons have of continence return. The prostate is placed worried that previous hernia repairs could Conclusion into a laparoscopic entrapment sac until lead to complications with open radical the rest of the case is completed. A lymph prostatectomy. However, we had little dif - Robot prostatectomy is the new preferred node dissection can easily be performed ficulty, even in cases where patients had method of performing radical prostatec - if indicated. Reconstruction is then per - previous laparoscopic hernia repairs with tomy in the U.S. Patients convalesce more formed. Our technique has pioneered the mesh. Therefore, virtually all men who are quickly and experience fewer complica - use of an anterior plication stitch as shown candidates for open radical prostatectomy tions. Functional outcomes seem equiva - in the diagram (see Figure 4). This helps to may be candidates for robot prostatecto - lent and may be improved. Cancer control take tension off the anastomosis and to my as long as they have what appears to in the form of margin rates and early PSA perhaps lengthen the functional length of be localized prostate cancer. recurrence are also comparable at this the urethra. We have noted that since we point. Future improvements will allow im - have been using this stitch that continence Positive Surgical Margins proved prostatectomy results and wider has returned earlier on average than with - application of the robotic platform to oth - out the stitch. A positive surgical margin is defined as the er procedures and specialties. presence of tumor cells adjacent to the Indications inked surgical margin. Increasing experi - ence has been shown to be a large deter - David I. Lee, M.D., FACS We have found that we can perform this mining factor for the incidence of positive University of Pennsylvania robotic operation for most men who have margins in the setting of open prostatec - U.S.A. had previous abdominal surgery, regard - tomy. This is likely true for surgeons per - [ dav id.le e@ uph s.up enn .ed u ] less of their body habitus or size of the forming robot prostatectomy as well. Our 22
“How Was Your Day?” Virtual Agents as Companions Using the simple phrase “how was your day?”, a virtual companion could effectively engage their user in natural conversation and begin to build a meaningful, personal relationship. Here, the author discusses ways in which this scenario is becoming plausible.
By Marc Cavazza
Recent progress in affective dialogue sys - personal assistants, which served as in - with its owner, and establish personal re - tems makes it possible to consider a new terfaces to various services, such as elec - lationships. The COMPANIONS project application for Embodied Conversation - tronic TV guides or e-commerce sites. By addresses this research challenge, and al Agents (ECA), which can become vir - comparison, a companion agent should has recently released its final demonstra - tual companions to their users. Previous be able to depart from task-based dia - tion. The system presents itself as an ECA research has mostly developed ECA as logue, engage in natural conversations with which the user can engage in an
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
unrealistic or inappropriate. In this case, the user is reporting worrisome news but user input analysis detects a positive mood.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Robotic Arm Exoskeletons for Rehabilitation
By Craig Carignan
Blockbuster hits like “Ironman” have made exoskeletons more readily rec - ognizeable to the public and their use in rehabilitation is a realistic option to be used in medicine today. Here, the author discusses a portable arm exoskeleton to be used to treat many different types of injuries.
Exoskeletons have been gaining increas - enemy. However, what many people directly bear the load. When coupled ing notoriety in the media for their su - don’t realize is the vast potential of ex - with powerful actuators, it may give the perhuman strength capabilities on dis - oskeletons not so much as super soldiers appearance of having superhuman play in several Hollywood blockbuster but as rehabilitation tools in the clinic. strength by allowing the wearer to lift hits. In the 1986 epic “Aliens,” Captain heavier objects than they normally could. Ripley used an exoskeleton munitions While the real life version of Ironman, But the exoskeleton can actually be re - “Loader” to battle the mother alien and the Sarcos XOS-1, is a marvel of modern garded as a robot with a human pilot on - 24 save her crew from certain doom. In the engineering, it does not actually give the board that is commanded by the arm more recent movie “Ironman” released wearer super strength. Like its counter - and leg movements of its occupant. in 2008, Tony Stark builds a fusion-pow - part in the animal kingdom, the exoskele - ered armored exoskeleton suit to escape ton functions as a shell to allow the user By contrast, rehabilitation exoskeletons his captors and wreak havoc upon the to apply higher forces without having to are designed specifically to assist (or re - sist) the movement of the person wear - ing it. These exoskeletons are attached at various points along the arm or leg so that forces can be applied directly to the limbs. This allows the exoskeleton to move individual joints during therapy, much like a physical therapist would do. Rehabilitation exoskeletons also have the ability to precisely control forces and gen - erate movement in multiple planes, an ability not afforded by standard exercise machines. Moreover, position and force feedback from embedded sensors can be used for quantitative assessment, al - lowing the patient’s progress to be mon - itored during therapy.
The Maryland-Georgetown-Army (MGA) Exoskeleton is the result of a collabora - tive effort between the Georgetown Uni - Figure 1: Side view of exoskele - versity Medical Center and the Univer - ton shows the shoulder and fore - sity of Maryland to build a portable arm arm assembly with hand grip exoskeleton for treating a wide range of (bottom right). injuries. The exoskeleton has six joints
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Figure 2 (left): Force sensors (blue Figure 3 (above): Graphical discs) located at the upper arm cuff user interface panel for and hand grip provide force feed - shoulder rotation exercises. back to the control system.
(one passive) and weighs approximately normal strength. Isotonic mode is typi - tional training that emphasizes a se - 11 kg. Its five powered joints are driven cally used in the latter stages of therapy quence and timing of sensorimotor stim - by brushless DC motors coupled to har - and for healthy individuals. uli similar to those encountered in daily monic drives and can provide torque tasks has been shown to accelerate recov - comparable to the average adult male Several shoulder rotation exercises were ery from neurological deficits caused by (120 N-m at the shoulder). Three joint developed to demonstrate the ability of stroke and traumatic brain injury. axes intersect at the ball-and-socket joint the exoskeleton to replicate standard ex - 25 of the shoulder (Figure 1), while a joint ercise machines. In these “isolateral” ex - A virtual wall-painting task designed to mounted on the torso elevates the whole ercises, the exoskeleton constrains the ro - increase reaching ability in subjects with shoulder assembly to replicate “shoulder tation to occur about a single axis, such impaired arm movement is shown in Fig - shrug.” A single pitch joint drives elbow as about the humerus during internal/ex - ure 4. In this scenario, the exoskeleton flexion/extension, and a passive forearm ternal shoulder rotation or the shoulder simulates forces exerted by contact with roll joint allows forearm supination/prona - abduction/adduction axis as shown pre - a virtual wall as the subject "paints" with tion. The scapula, upper arm, and fore - viously in Figure 1. The graphical inter - a roller brush. An icon of a paintbrush is arm links are passively adjustable to ac - face used to set up the shoulder exercis - drawn on a plain background and tracks commodate different arm geometries. es is shown in Figure 3. The exercise the position of the exoskeleton hand grip. Force sensors mounted at the upper arm selection is on the left side of the panel, Movement of the exoskeleton hand caus - cuff and hand grip provide force feedback and the mode is at the top. The level of es movement of the paintbrush in the to the control system (Figure 2). resistance, speed, and range are then se - graphical interface. When the roller lected using sliders. Telemetry such as makes contact with the wall at a certain The large range of motion (ROM) and range of motion and torque level is dis - force threshold, a green swath is painted high torque capacity of the exoskeleton played on the right. along the surface. A bar graph super - enable a wide range of muscle degrada - posed on the wall indicates the level of tions to be treated. A patient with a low The exoskeleton can also be coupled with force to the user who attempts to keep it muscle grade could thus progress from a Virtual Reality (VR) to create novel reha - within a specified range. passive condition in which he cannot bilitation protocols for functional train - move his own limb, to resistive therapy ing. In this scenario, the patient views a The exercises developed so far only be - where he can move his limb against max - simulated task on a computer graphics gin to tap the potential of the exoskele - imum external resistance. Different con - display while the exoskeleton provides ton as an exercise and functional train - trol modes are used to realize different force feedback to the subject’s arm as it ing tool. While the ability to vary the therapeutic modalities. For example, iso - makes “contact” with objects in the vir - parameters of an exercise at the touch of metric mode is used for strength assess - tual environment. Thus, when the pa - a button is a powerful feature, the real ad - ment once the patient surpasses the pas - tient’s hand pushes against a wall or picks vantage of the exoskeleton is its ability to sive condition, while isokinetic mode is up a bucket in the virtual environment, execute multi-axis motion with precise used to modify resistance over the ROM the exoskeleton will replicate the appro - levels of resistance which cannot be done until the patient has restored almost all priate reaction forces on the arm. Func - on a standard exercise machine. For ex -
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES Robotic Arm Exoskeletons for Rehab
stroke, Parkinson’s disease, and other neu - rological conditions are already undergo - ing clinical trials in several major rehabil - itation centers worldwide. While these exoskeletons are not powerful enough to treat orthopedic injuries (typically only 10-20% human strength), they are already making serious inroads as powerful “neu - ro-rehabilitation” tools. As these exoskele - tons gain acceptance in rehabilitation cen - ters, the door will hopefully open for more powerful treatment tools such as the MGA Exoskeleton that can be used to treat mus - culoskeletal injuries as well.
Acknowledgment: Figure 4: The exoskeleton being used for a virtual wall-painting task shown in the This research was supported by the U.S. graphical display on the right. Army Telemedicine and Advanced Technol - ogy Research Center (TATRC).
ample, the “empty can” (EC) exercise but therapists are reluctant to prescribe mimics lifting a can with the hand and it because improper performance can lead pouring out the contents and thus in - to shoulder impingement. However, the Craig Carignan, Sc.D. volves rotation about multiple axes of the exoskeleton could be easily programmed University of Maryland shoulder. This exercise has been shown to guide the arm along the correct trajec - U.S.A. to be very effective at rapidly increasing tory to avoid injury. [ crai gc@ ssl.u md .edu ] strength following a rotator cuff injury, Arm exoskeletons designed for treating 26
MindMentor “Robot Psychologist” acts as Online Mental Coach By Jaap Hollander
In 2006 Dutch psychologists started developing MindMentor, an online computer program that acts The program has a generic as a mental coach. To state it in a more popular structure and will work with fashion: they developed a robot psychologist (pic - any type of human problem or tured, right). The MindMentor computer program goal including stress, family prob - guides clients through a series of psychological steps lems, relationship problems, motiva - and helps clients solve problems and achieve goals. tion, life mission questions, sleepless It does not present clients with standard answers nights, worrying, conflicts with friends based on problem-solution relationships from a or colleagues, etc. Apart from severe database, but stimulates clients through a series of disorders like schizophrenia, bipolar generic process steps to look inside, understand disorder, and drug addiction whose their inner mental processes and strategies, and sufferers could use MindMen - then offers them algorithms to find their own so - tor as a resource but who lutions. The MindMentor process takes about an need live support from a hour. You can find it – and actually try it for your - psychologist or a psychi - self – at http://www.mindmentor. com. atrist as well, research
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
shows that MindMentor can help clients blend of artificial intelligence, NLP, and oth - solve a wide range of problems and achieve Projective testing is a series of techniques er goal-directed therapeutic techniques ef - a wide range of possible goals. widely used by psychologists including the fective.” But some of Hollander's colleagues ink-blot Rorschach test. Projective testing have responded with deep skepticism, es - Tenets of the MindMentor Approach brings unconscious knowledge into the con - pecially being concerned that MindMentor sciousness. MindMentor utilizes this ap - will not be able to handle severe psycho - The MindMentor approach is based on five proach for verification of both the client logical disorders. Said Hollander in an in - psychological systems, most of which have defined problem and solutions. Rather than terview in Dutch national newspaper a solid scientific background and may be evaluating clients' responses based on a ‘Trouw’: “People with severe psychological considered evidence-based. fixed interpretative system like the problems, like bipolar disorders … hard drug Rorschach test, the MindMentor system addictions or disabling phobia’s … still need Neurolinguistic programming (NLP) is Mind - uses a pattern detection approach. Clients help from live professionals. For them, Mind - Mentor's main tenet and a model for per - are asked to associate pictures with for their Mentor may be an interesting adjunct but sonal development that emerged in Cali - problem, as well as solutions, and these pic - never a replacement of live treatment.” fornia in the early '80s. NLP helps clients tures are then connected to verbal state - change the structure of their subjective ex - ments. The process is then repeated again Encouraging Research Results perience. Even though NLP is still often not clients are stimulated to detect a recurring considered evidence-based, recent scientif - pattern. In 2006, 1,600 clients from roughly 25 coun - ic research has shown NLP to be quite ef - tries participated in the MindMentor fective. Based on the NLP model, the Mind - Provocative therapy is an innovative system process. The process used at the time was Mentor program asks the client for specific of psychotherapy and mental coaching a much simpler form of the MindMentor situations in which encouter the problem which helps clients by challenging them. In program than the version online today, but and analyze their inner experience with order to preserve a positive relationship the process was roughly the same. Clients questions like, "What do you say to your - with the main character the robot Mind - who finished the process were asked how self?" or "What do you find most impor - Mentor, this function is represented by a many days they needed to try out the so - tant?" separate robot, ProvoBot. who will barge lutions they had found. After the designat - into MindMentor’s office and say thing like, ed number of days, are MindMentor con - Once the client has defined their problem “For heavens sake, MindMentor! You're tacted participants with a survey an average and MindMentor has analyzed their think - such a dumb pile of rust! Don't your see solution percentage of 47%. ing and emotional responses, the program who you are working with here? This is 27 looks for counterexamples – a moment Marcin we're talking about. How could he Future Directions when the circumstances are more or less ever achieve this?” the same, but the client does not experi - Plans for MindMentor in the short term are ence the problem – and analyze their sub - Client centered therapy is a very common to restructure the process, which can now jective experience in that context and con - type of psychotherapy that helps people take up to 90 minutes, into a series of 5-7 trast this subjective experience with the gain clarity by approaching them with a very shorter sessions of approximately 10 min - problem thinking it has found before. In positive attitude (unconditional positive re - utes each. Each step will end with a tested this way, it helps clients find a more effec - gard) and restating what they have said. milestone and be connected to the users tive way of mental processing, more effec - real life social environment involving tive self-talk, more productive mental im - Pavlovian conditioning connects certain friends, family, coworkers, etc. Hollander agery, and more effective values. mental and emotional responses to im - hopes this will lead to more widespread use ages. This is MindMentor's way of help - in toda fast-paced culture, give the client Some solutions are worse than the prob - ing people to easily connect or "anchor" more time to think about their responses, lems they were designed to solve. The Mind - inner resources to the situations where and counterbalance the justified concern Mentor program helps clients check their they need them. MindMentor mostly uses of some colleagues that using MindMentor solutions for problematic consequences or colors – problem states, general process might result in less real, live social interac - unwanted side effects. Does the problem states, creative or meditative states and tion. Longer term plans include having have advantages that they will lose when solutions states are all associated with dif - MindMentor users with similar problems they solve it? If so, the program retraces its ferent colors. connect anonymously and give each other steps to find new solutions without these advic, as well as creating specific MindMen - drawbacks. Responses from the Field tor procedures for specific problem areas like cigarette smoking, allergies, and rela - To complete the process, the MindMentor Some psychologists have responded posi - tional discord, among others. program completes a detailed mental prac - tively to their robot colleague, and some tice session with the client. Neurophysio - have reacted with great skepticism. Said logic research shows that mental practice David Van Nuys, Ph.D. of Sonoma State Uni - is important for behavioral change. The versity said, “At the end of the hour-long Jaap Hollander, Ph.D. mind mentor program helps clients imag - session, I have to say my outlook and spir - Institute for Eclectic Psychology ine how they will use the solutions in fu - its were lifted considerably. It was smart, The Netherlands ture situations, both from within (first per - supportive, fun, and funny, and helped me [ jh @ie pdo c.n l ] son associated position) and as an observer. to focus in on the central issue. I find the
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation PRODUCT COMPARISON
RESEARCHER: Product Comparison Chart: Chelsea Barclay Editorial Medical Robots Department C&R Magazine The vast field of robotics ap - cus on in C&R is robotics as better care for patients, and plications covers many indus - they apply to medicine, both even avoid potential mistakes. www.vrphobia.eu tries, from manufacturing to physical and mental, and reha - Here, we offer a list of some ex - [email protected] education. A largely important bilitation, in particular. These amples of products currently and growing field that we fo - robots can save money, provide on the market.
PRODUCT DESCRIPTION OF PRODUCT MANUFACTURER The da Vinci® Surgical a surgical robot containing a surgeon console, patient side cart with Intuitive Surgical, Inc. System four interactive arms, EndoWrist instruments, and a vision system to treat a wide variety of conditions including different types of cancers, kidney and uterine disorders, coronary artery disease, and obesity Sensei® X Robotic a flexible, purely robotic platform that combines the latest in 3-D Hansen Medical Catheter System catheter control and 3-D visualization to achieve accurate results in placing the catheter inside patient's hearts PROBOT a robot for prostate resection that allows surgeons to define a volume Imperial College London to be automatically cut within the prostate without further interfer - ence from the surgeon CyberKnife® Robotic a premier radiosurgery system within the field of radiation oncology Accuray Incorporated 28 Radiosurgery System that delivers extremely accurate high doses of radiation to anywhere in the body ROBODOC ROBODOC incorporates 3-D pre-surgical planning with active robotics CUREXO Technology for precision and comfort in patented total joint hip and knee replace - Corporation ment surgery PinTrace in initial clinical use for hip fractures, the PinTrace is based on robot Medical Robotics assistance (for increased levels of surgical precision and a reduction of cumulative exposure time of radiation) and an open configuration for input data CosmoBot (V3) used to motivate children with and without developmental disabil - AnthroTronix ities to participate in therapy and education more extensively PARO the Paro Therapeutic Robot allows for the benefits of animal therapy PARO Robots U.S., Inc. to patients in environments where animal therapy poses difficulties. - Developed by AIST Found to reduce patient stress and improve relaxation, motivation, and improve socialization between patients and caregivers Lokomat®Pro a driven robotic treadmill that guides gait-impaired patients' legs to Hocoma improve mobility in those who have incurred stroke, spinal cord in - jury, cerebral palsy, multiple sclerosis, and neurological injuries and diseases iARM (iARM) is a wheelchair attachable, customizable mobile robot. The Exact Dynamics iARM assists disabled people by enabling a vast amount of daily ac - tivities and functions that were previously unachievable PRODUCT COMPARISON
RESEARCHER: Product Comparison Chart: Christina Valenti , Editorial Department C&R Magazine
Military Robots www.vrphobia.eu, [email protected]
Product Description/Function Manufacturer TALON Responder operated from a laptop controller, it is used for pubic safety Foster-Miller, a subsidiary of missions as well as by fire and rescue organizations. It in - QinetiQ North America cludes a disruptor-ready manipulator arm, wrist and gripper, and three infrared cameras SMSS (Squad Mission Sup - six wheeled robotic vehicle with a platform that can carry up Lockheed Martin port System) to 1,000 pounds designed to carry equipment and supplies to support a single squad BEAR (Battlefield Extraction- life-size humanoid robot that is designed to search for wound - Vecna Robotics (sponsored by Assist Robot) ed soldiers on the battlefield and transport them to safety – TATRC) equipped with wheels and tracks it can move standing straight up and also while lying almost flat to the ground EOD (explosive ordnance in use since 2000, designed to safely move and dispose of live Foster-Miller disposal) grenades ARIES (Acoustic Radio Inter - remote-controlled submarine that is used for research as well Naval Postgraduate School active Exploratory Sensor) as underwater mine detection Throwbot compact two-wheeled reconnaissance robot intended to be Recon 29 thrown into an environment capturing real-time images in order to evaluate the surroundings before entering the area Global Hawk unmanned aircraft that flies at high-altitudes to survey tens Northrop Grumman of thousands of squares miles a day, sending the images back to a control station on the ground Predator unmanned aerial vehicle (UAV) used for reconnaissance mis - General Atomics sions as well as carries missiles or similar weapons MAARS (modular advanced remotely operated vehicle the size of a lawn mower, armed with Foster-Miller armed robotic system) weapons including machine guns and a grenade launcher CBRNE (chemical, biological, utilizes joint architecture unmanned systems (JAUS) software Foster-Miller radiological, nuclear, and used for detection, has the ability to plug in up to seven differ - explosive) /Hazmat ent devices to collect audio and visual images using its various sensors Goalkeeper close-in weapon system (CIWS) that defends ships from incom - Lockheed Martin ing missiles and ballistic shells BigDog stands on four legs, roughly the size of a mule, designed to ac - DARPA company soldiers in terrains too rough for vehicles, carrying with it supplies and other equipment PackBot series of military robots designed to perform multiple tasks that iRobot assist missions such as bomb removal, reconnaissance, route clearance, and hazardous materials detection FEATURES
Virtual Reality for Robot- Assisted Gait Training in Children “Recent achievements in rehabilitation engineering resulted in the development of sever - al robotic systems that aim to improve walking ability in patients with neurological gait dis - orders. These robot-assisted gait training (RAGT) devices, such as the Lokomat® (Hocoma AG, Volketswil, Switzerland), appear promising, since they might intensify locomotor train - ing by increasing both the number of steps per training session as well as the training fre - quency, while decreasing the therapist’s manual assistance.”
By Karin Brütsch
Impaired movement, particularly walking, is frequently observed in patients with neurological disorders. Recent achievements in rehabilitation engineering resulted in the development of sever - al robotic systems that aim to improve walking ability in these patients. These robot-assisted gait training (RAGT) devices, such 30 as the Lokomat® (Hocoma AG, Volketswil, Switzerland), appear promising, since they might intensify locomotor training by in - creasing both the number of steps per training session as well as the training frequency, while decreasing the therapist’s manual assistance.
However, despite these positive effects, one complication of im - plementing robotic devices might be the patient’s passivity in the driven gait orthosis. It is believed that passive guidance is less effective for motor learning and restoration of walking when com - pared to active performance. Another possible shortcoming in RAGT might be the fact that rehabilitation training is indeed repet - itive and repetition tends to “decouple” the mind and reduce pa - tients’ motivation. Indeed, clinical experiments revealed that chil - dren in particular show little motivation towards the training process in a conventional repetitive RAGT, because this training is rather monotonous and provides little incentive to continue for longer periods of time. Thus, pediatric rehabilitation centers Figure 1: The Lokomat setup with a virtual reality game in using RAGT try to boost the patient’s motivation by simultane - front of the patient. ously showing DVDs or playing music. Such strategies, however, may distract children from the actual gait training, causing them to become completely passive and inattentive during the Loko - support of body weight. A device like the Lokomat® provides con - mat® training. Therefore, in RAGT, it appears essential that pa - sistent assistance and moves the patient’s legs along a predefined tients participate actively rather than just letting themselves “be fixed trajectory, while also assessing forces between the patient walked.” and the leg orthoses. Indeed, these man-machine interaction forces at hip and knee joint linear drives provide feedback values An advantage of RAGT devices combined with Virtual Reality (VR) and can be used to quantify the participant’s level of activity and (Figure 1) is that it has the capability to create a rehabilitation en - participation during RAGT. By controlling and manipulating feed - vironment with individualized treatment needs while providing back parameters, VR games can be adequately adapted to the standardization of assessments and training protocols. During a children’s cognitive and physical capacity, thereby keeping the training session the duration of training can be adjusted, as well level challenging and providing motivation without losing focus as other factors such as intensity of training, the amount of force and attention on actual gait training. Several studies support the needed to support leg movements, walking speed, and provided fact that patients’ motivation plays a crucial role in determining
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
Figure 2: Different samples of the virtual planet Gabarello (© GABARELLO).
the outcome of therapy. Moreover, in cer - Gabarello (“GAme BAsed REhabiliation Despite these new VR developments, our tain patient populations it may even be for LOkomat”) – to counteract the prob - previous studies also showed that the the most critical factor in defining the lem of adequately maintaining children’s therapist is still an important motivator, success of rehabilitation training (e.g. motivation during consecutive training which might be of interest for defining children, stroke patients). sessions and to improve the quality of optimal RAGT protocols. Indeed, accord - VR design elements and immersion. In ing to our clinical experience, the use of Indeed, preliminary studies demonstrat - this VR game Gabarello, the patient is VR during rehabilitation therapy should ed the success of adding virtual environ - immersed in an environment on anoth - not replace the physical therapist, but ments to RAGT and enhancing motiva - er planet. A large monitor in front of the rather provide an additional means of tion of the patient during therapy. It was patient (Figure 1), portrays an astronaut enhancing training efficiency and moti - demonstrated that patients with neuro - exploring the planet’s surface by scout - vation. Further research should reveal logical gait disorders and healthy chil - ing different routes, collecting objects whether an increase in motivation and dren participated more actively – quan - and planting plants that start blooming. active participation leads to a better func - tified by biofeedback values or leg EMG By shifting the height of the legs, the col - tional outcome, as a result of patient co - 31 amplitudes – with VR-based RAGT than or and the speed of the avatar, the envi - operative strategies such as VR. with other supportive interventions, such ronment reflects the patient’s active par - as watching DVDs or encouraging in - ticipation in the Lokomat® (Figure 2). In structions by therapists. The gaming as - other words, the man-machine interac - Karin Brütsch, Ph.D. pect of VR keeps children highly engaged tion forces of the patient in the Loko - Rehabilitation Centre of the Univer - during repetitive tasks. mat® control the VR game. The level de - sity Children's Hospital Zurich sign of the game requires deliberate Switzerland In collaboration with different institutes, changes in exertion of the patient and [K arin .Br uets ch@ kis pi.u zh.c h ] a new serious game was developed – therefore meets therapeutic goals.
Robots that Care Some beneficial effects of human-robot interaction in healthcare
By Jeroen Arendsen & Agali Mert
Robots are a type of technology that inter - potential beneficial effects this might have Therefore, this overview also includes hy - acts with people in a special way. They can in healthcare. This field of scientific study pothesized and speculative effects. be put to good use in all kinds of domains, – sometimes referred to as “social robot - of which healthcare is, at the moment, a ics” – is very young. Published controlled Features very important one. Here, an overview is and randomized studies are still sparse and given of current developments in the field importantly, they represent only a small Naturally, it is essential for a robot to of human-robot interaction and of some fraction of the fast pace of developments. be able to move on its own (or be
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES Robots that Care
Human-robot interaction features and their effects
Feature Effect (proven or hypothesized) Example Captures attention, can relay ‘presence’ Asimo, Nao, Care-o-Bot, RP-7 (remote Being and moving with us and conversation presence), Telenoid Activates associations with familiar handling Comfortable weight Paro actions (e.g. holding a baby) Engages play, stimulates motor activity, Responding to handling Paro, TriBot pleasant somatosensory experience Engage caring instincts, pleasant tactile Respond to affectionate touching Paro, Alive Cubs, Probo experience, emotional bonding Less physical demands on caregivers, Support, lift and carry people Hal 3, Sarcos, NESS L300 & H200 higher mobility Assisting with embarrassing things Less shame; higher self esteem; less depression Avant Santelubain 999, Roxxy
Aid independent eating More satisfaction; higher self esteem Meal Buddy, MySpoon Making eye contact Captures personalized attention Paro, Opto-Isolator, Probo Looking away & blinking Reduces tension (prolongs interactions) Opto-Isolator More personal, emotional interaction; Frowning or smiling at you Jules (and others from Hanson Robotics) conveys attitude to input 32 Establishing joint attention Helps therapy, less social problems Keepon, Asimo, Leonardo ‘Minimal design’ Better focus, less distraction, less anxiety (autism) Keepon, Paro Stimulate motor activity, easier transfer Imitating human movement Bandit, ALICE framework of knowledge (social learning) Gesturing Richer communication Leonardo, MDS Pointing Greater shared situational awareness Melvin, iCub, Asimo Robots using AGR or game console input Seeing gestures Stimulates motor activity (Wii, Kinect, Eye-Toy) Talking Stimulates responses, suggests intelligence iCat, Kismet, Leonardo, MDS, Probo Robots using ASR (many), i-Sobot, Understanding speech Stimulates spoken communication Robosapien, Leonardo More personal interaction, higher adaptation to Person recognition Paro (voice) individual characteristics
steered by remote). The “mere” feature dar, GPS, beacons) to move around teractive dolls is by handling them. Hav - of being able to move alongside us al - quickly and safely. Being and moving ing robots respond to being handled lows robots to capture most people’s together with people is also a feature can engage people’s attention, stimu - attention much longer and stronger that drives “telepresence” robots, like late motor activity of, for example, in - than computer programs on a screen, RP-7, that can relay conversation and active elderly people, or generate a especially if the robot walks and moves attention of a distant doctor to a pa - pleasant, soothing somatosensory ex - likes us (with feet and hands), as do Asi - tient’s bedside. Robots like Telenoid are perience. Paro was “designed for han - mo and its smaller brother Nao. These designed to enable dutiful Japanese dling” with a weight reminiscent of that robots can navigate our man-made sons to (virtually) visit their distant fa - of a human baby. It also senses being spaces better and engage in shared ac - thers more often without the hassle of touched or stroked, due to advanced tivities, such as imitation games or travel. surface tactile sensors in its body dances. In many robots, such as Care- (which it likes) and whiskers (which it o-Bot, vision is supplemented with ex - One of the oldest available means of doesn’t like) and will respond with tra-human sensing capabilities (e.g. Li - interacting with robot animals and in - sounds.
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Vision is a very important feature for arm and hand gestures). This makes ro - stances, creates meaning from this in - robots. Fitting one or two cameras, bots more equal, interactive partners teraction. preferably as eyes, into a robot’s head and gives robots a greater power to is easy, but making sense of the video stimulate desirable behaviour. In this The Road Ahead input is often challenging. Seeing where way, the iCat has been used to stimu - people are enables robots, like Paro and late elderly users to participate in fit - There are robots like Asimo or Probo, Opto-Isolator, to look at us and make ness exercises. for example, which seem to integrate eye contact. Robots can express non- nearly all of the available features. Asi - verbal actions to create a very lifelike Caring mo was originally presented as a robot impression, capture our attention, and As discussed above, users can obvious - who could help out in a house or a hos - set the stage for prolonged personal ly handle robots, but robots can handle pital by, for example, bringing people and emotional interaction. For exam - humans as well. Robot nurses RIBA and coffee. After some 15 years of develop - ple, blinking and looking away now and RI-MAN lift patients from their bed, car - ment, it is one of the most sophisticat - then, instead of staring people down, ry them and help to relieve the heavy ed and expensive robots on the mar - is an important mechanism to reduce physical demands placed on nurses. ket. It is mostly a showcase and tension in social interactions. Seeing Likewise, nurses can strap on exoskele - entertains people in Disneyland. Probo also enables robots, like Bandit, to im - tons Hal 3 or Sarcos. Disabled people is designed as a “research platform to itate and understand our actions. can also use (partial) exoskeletons to study cognitive human-robot interac - regain their own mobility or rehabili - tion (cHRI) with a special focus on chil - Gesturing, defined as acting with an in - tate better (e.g. NESS L300 Foot Drop dren” and is loaded with features that tention to communicate, requires ro - System). Other nursing activities are it may or may not need for actual bots to move body parts, to address also being marked as robot jobs. Hav - healthcare applications. For example, people and to understand what an ac - ing a robot wash patients or help them children with autism, one of the stated tion means or communicates. Automat - with their bath (e.g. Avant Santelubain target research groups, may prefer not ic Gesture Recognition (AGR) is an area 999) can be useful because with these to have to interpret difficult emotion - of development that is immature and, activities people, both patients and al expressions or the meaning of a at the moment, mostly independent nurses, can experience feelings of raised trunk. from robotics research. Some robots shame or embarrassment (especially in use AGR technology to see and under - societies with strict social conventions). For the future, we may do well to let suc - 33 stand gestures, like Asimo or Nao. Per - This is even more so with assistance in cessful designs like Paro, Keepon, the haps most powerfully, gestures can be sexual activities for which robots are NESS L300 Foot Drop System, or Care- used together with speech to create a also available, such as Roxxxy. o-Bot inspire us. These robots share a convincing talking robot. Gestures and quality, which is that they were designed facial expressions are used by the MDS Robots can also help people in their Ac - without compromise to fulfil a specific (Mobile Dexterous Social) Robot, for ex - tivities of Daily Living (ADL). Robot feed - goal and only have the features they re - ample, to make robots appear lively and ers, such as MySpoon, Meal Buddy, or ally need. Apart from robots that are capable of expressing emotions. the Mealtime Partner Dining System, successful, it is just as important to iden - help disabled people eat independent - tify those projects that were not as suc - Most robots can listen and respond to ly. This makes eating more satisfying cessful. They also give insight into key speech by using the automatic speech and it lifts a time-consuming burden elements of robots for successful inter - recognition (ASR) technology that has from nurses. Robot arms, like Focal’s action with humans. Even more so, developed over the last fifty years (but Jaco or Bridget, can help people with knowing the circumstances under which which is still awkward in many respects). limited arm function to grab things, the human brain is willing to postpone Users can use their voice to control ro - open doors, etc. This improves their in - its disbelief that interaction with robots bots like i-Sobot, Robosapien, Robopet dependence and self esteem, and is actually mediated, is in this stage of and many others, which stimulates in - makes robots suitable for training ADL robot development a practical research teraction. ASR technology also includes functioning. and development focus. identification of people’s voices, which Paro uses to know who is handling it Robots, equipped with many interac - and to adapt its behavior accordingly. tive features, as described above, are also outfitted with ever more sophisti - Talking is an art mastered by only a few cated cognitive models. Their percep - Jeroen Arendsen, Ph.D. robots. Most robots can play soundbites tion of us is interpreted on pragmatic, TNO Human Factors or use Text-To-Speech (TTS) engines to semantic, intentional, or emotional lev - [email protected] read out text, but do so without lip or els. In turn, their responses, speech, ges - Agali Mert, M.D. mouth movements which can appear tures, and other expressive actions are National Military Rehabilitation somewhat strange and disrupt the illu - shaped according to rules of empathic Center Aardenburg sion of artificial life. However, robots and social interaction. Does that mean [email protected]. like iCat, Kismet and MDS speak with they actually care? They act like they The Netherlands their mouths, combined with facial ex - care and sound like they care, so the [ ] pressions (MDS also integrates head, human brain, under the right circum - http://robotsthatcare.com
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Assistive Social Robots for Elderly Care “... there are numerous scenarios in which [elderly patients’] independence would strongly increase if a robot is around to assist.” By Joost Broekens, Koen Hindriks & Martijn Wisse
The developed countries face a serious demo - remote control, food, or drink to the elderly per - graphic challenge. In these countries, almost son. one fifth of the population was aged 60 or old - er in the year 2000, and by 2050, this Devel - The feasibility of fetch-and-carry robots has al - oped countries face a serious demographic ready been demonstrated by mounting an in - challenge. In these countries, almost one fifth tuitive point-and-click interface on a mobile ro - of the population was aged 60 or above in the bot with a robotic arm. A typical example of year 2000, and according to the UN, by 2050, such a fetch-and-carry robot is provided by the Delft Personal Robot 34 this proportion is expected to reach one third. Delft Personal Robot (see Fig. 1). For large-scale The aging population will require more elder - usage of a robot like this the robot design should cial functions of robots are very important in ly care than is available and could impede the be low-cost and support grasp adaptivity re - elderly care settings. elderly population's wish to maintain an inde - quired for long-term operations in an environ - pendent life at home for as long as possible. ment with a broad variety of objects. The Delft A recent exhaustive review of assistive social However, without assistance for physical and Personal Robot is able to fetch, carry, and hand robots showed that, although there are prom - cognitive functions (i.e., there may be prob - over objects with a variety of shapes such as ising results, much work still has to be done. A lems with walking as well as with remember - towels, paper cups, phones, etc. large number of studies show positive effects ing to take medicine), staying independent is of either the robot or its placebo version. Fur - impossible. Fetch-and-carry robots will operate in an envi - thermore, the elderly seem to be open to this ronment surrounded by elderly people that are kind of technology. The review provides sever - According to Statistics Netherlands, function - novice users of such technology. Apart from al observations and recommendations that al limitations of the elderly can be categorized operating effectively and safely, it is very impor - need follow-up. In summary, it states that large- into four groups, namely hearing, seeing, mo - tant that the interaction between the robot and scale experiments are needed that are rigor - bility and speaking. Mobility problems are by the user is intuitive and feels natural. This means ously set up, and an adequate methodology is far the most prominent limitation for the eld - the robot must be able to understand and fol - needed to perform such studies and to com - erly, and this problem increases significantly low commands, as well as be able to respond pare them. Setting up arge scale, national and with age. Fourteen percent of men above 65 to various forms of spontaneously communi - international European programs to establish and 33% of women over 65 have mobility prob - cated positive and negative user feedback con - the merits of these, and related, assistive social lems. Within the age group of 75 and over, these cerning performance of the robot. This requires devices, is of great importance for the elderly, percentages are higher with 23% of men and that the robot is able to interpret explicit and as well as for technology-assisted healthcare.). nearly 50% of women affected. implicit feedback signals provided via body lan - guage (pointing, nodding, shaking), emotional The general advice to elderly with mobility lim - expressions (frowning, smiling), and affective Joost Broekens, Ph.D. itations is to stay active as much as possible. speech (no, yes, good job, nice robot) by a hu - Koen Hindriks, Ph.D. Nevertheless, there are numerous scenarios in man. This natural communication often in - Martijn Wisse, Ph.D. which their independence would strongly in - volves a component of emotion. Therefore, fu - Man-Machine Interaction Group crease if a robot is around to assist. Such a ro - ture service robots and fetch-and-carry robots The Netherlands bot, for example, could perform fetch-and-car - in particular, need to be social robots that will ry tasks in order to tidy up the floor and other be accepted and usable in long term scenar - [ joost. broek ens@ gmail .com ] surfaces, or handing objects such as a phone, ios. Experiments have demonstrated that so -
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The Need for Cognitive Systems in Medical Care “Not every system is a robot — in fact, hardly any systems are robots. System-level think - ing means thinking about patients, their friends, partners, parents and dependents, doc - tors and other health-care professionals, homes, hospitals, streets and — where avail - able — intelligent technology.” By Joanna J. Bryson
The idea of cognitive systems for medical erate in a particular sequence every day in touch-screen interface, or to provide light - care might conjure a frightening image of order to ensure all rooms are attended to, ing or verbal prompts to help people re - a silent, insensitive hospital full of unheed - but with the help of AI, either a human or member and stick to their intended sched - ing robot nurses. But not every system is a robotic system could safely resequence ules and tasks. a robot — in fact, hardly any systems are a particular room if entering it at a partic - 35 robots. System-level thinking means think - ular moment would inconvenience some - None of the above is to say there is no role ing about patients, their friends, partners, one. With the help of AI, this resequencing for personal robotics in healthcare. For ex - parents and dependents, doctors and oth - could be done without danger that the er health-care professionals, homes, hospi - room would be forgotten from the day’s tals, streets and — where available — in - schedule. telligent technology. A system is a gestalt of interconnected parts. In a cognitive sys - However, health care is not unique to hos - tem, some of those parts are able to sense, pitals only, and care giving is not provided evaluate, plan, and interact. But this does primarily by professionals. Our society is not necessarily imply robots replacing hu - increasingly recognizing the role of care - man nurses. Patients — that is, each of us givers fulfilled by parents, children, part - — require human contact and attention ners, friends and even just concerned for our mental and physical wellbeing. This neighbors. Again, as with any caring task, is something any health-care system needs while some aspects of the task may be very to take into account. personally rewarding, there are also im - mensely tedious parts of care giving. For Even if we were to banish robots entirely example, people with dementia lose their from patient care, contemporary hospitals short term memory and may try to “dou - and health care more generally could cer - ble” check whether they have locked their tainly benefit from cognitive systems ap - door hundreds of times in a single night. While an apple a day may still be a chal - proaches. Many of the most tedious tasks For a human caregiver monitoring and cor - lenge for humanoid robotics, cognitive in a hospital, such as cleaning, do not re - rection of this sort of behavior for days and systems more generally have a role in quire contact with patients, yet are essen - years on end might be maddening. Tech - health care and well being. tial to patient care. Adding cognitive capac - nology, on the other hand, is perfect for ities, such as intelligent sensing of infection, repetitive tasks. Sensors can be utilized to ample, one of the great inconveniences of scheduling of cleaning, tracking of equip - check whether doors are open or locked, a disability can be the perceived debt of so - ment and so forth, could increase the reli - and to notice when someone is getting out cial obligation that comes from having to ability of cleanliness while actively decreas - of bed. It is now technically feasible for a accept help for even trivial tasks. For a para - ing the amount of patient disruption. A home itself to offer assistance, either by re - plegic, having robotic assistance for lifting human cleaner of wards might need to op - porting the state of the doors via voice or a glass can make the difference between
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES
whether a trip to a cafe is a pleasant diver - governments, private companies, public hos - them as something taking power away from sion or a socially-distancing event. Robot - pitals, libraries and Internet services all have us, but no artificial system “naturally” seeks ics in this situation can be seen as an ex - roles to play in helping us maintain our power. It is up to us and our society to de - tension of an individual’s self, as it is the health and wellbeing. Artificial cognition cide how we incorporate artificial intelli - human owner that determines what the ro - can be introduced at many points, for ex - gence into our lives, including our health. bot will do. But these robots still benefit ample, online agents that help us keep track Cognitive systems should be seen as exten - from intelligence for determining how and of our medications and schedule of treat - sions of our own minds and powers, there when that thing should be done. The more ments regardless of our location; intelligent to help us achieve our goals and allow us the robot is able to sense, appreciate tim - homes can help us maintain a warm, se - to focus our attention on the things we con - ing, adapt and act in a coordinated way, the cure environment well-stocked with food sider most worthwhile. more use it will be to its user, and the less and medicines; social networking sites may control the user will be obliged to be able alert designated friends or family if we seem to exert in order to exploit the benefits of to have dropped out of contact for too long the robot. and might be facing injury or depression; Joanna J. Bryson, Ph.D. robot companions might help us engage in University of Bath A healthcare system should be considered exercises to recover from a stroke or tutor United Kingdom to include the entire community around us to help us overcome autism. Cognitive [ jj b@c s.bat h.ac .uk ] each of us — our selves, our neighbors, our systems may sound scary if we think of
36 Social Robots for Self-management of Health-promoting Activities “With contributions from different disciplines — computer, health and social sci - ences — various social robot applications have been developed that support self-management, e.g. for exercises, pediatrics, and autism therapy. To foster progress and application of “social robotics for self care,” coordinated efforts between research institutes, companies and end-users are being set up.” By Mark A. Neerincx
In Western society, the need for health-pro - developed that support self-management, medical dossier, and other “personal agents” moting activities of young and old citizens e.g. for exercises, pediatrics, and autism ther - (e.g., medical and technical specialist). This is increasing vastly. Assistive technologies apy. To foster progress and application of framework was developed in the SuperAs - are being developed that help to prevent or “social robotics for self care,” coordinated sist project on digital assistants for chroni - cope with chronic diseases like obesity or efforts between research institutes, compa - cally ill, e.g. a (virtual) iCat robot to reduce diabetes (which are often life-style related), nies and end-users are being set up. the Body Mass Index of persons with obe - and incidents like falling down or allergic sity. Fig. 2 presents a picture of the iCat. reactions. By integrating social robots into Personal Assistance in Context these care systems, the self-care capabilities For older adults, current research focuses of citizens can be substantially enhanced. Figure 1 provides an overview of the envi - on the provision of daily assistance for med - With contributions from different disciplines ronment of a “social robot” – it communi - ication usage, healthy, regular meals, exer - — computer, health and social sciences — cates with its user (“patient”) at home, the cises for physical and mental fitness, re - various social robot applications have been equipment and sensors in the home, the minders of events and activities, and
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Figure 1: Social robots act in a social environment, communicating with human and technical actors.
warnings to avoid dangerous situations or ing and testing interactive, mobile robots accidents. For effective persuasion, the as - which will be able to interact with children sistant should express social behaviors, be over extended periods of time, i.e. a possi - trustworthy and show empathy. Based on bly non-continuous succession of interac - the principles from motivational interview - tions which can refer back to, and build forth ing and social human-technology interac - on, previous experiences (EU-funded FP7 tion, we designed and tested a set of social project, grant number 248116). ALIZ-E will robot behaviors including high-level dia - instantiate and evaluate these methods in logue acts (semantics, intentions), natural working systems that interact with hospital - cues (e.g., gaze, posture), emotion expres - ized children undergoing diabetes treatment, sions (e.g., compassionate face), and inter - using the Nao robot platform (see Fig. 4). 37 action conventions (e.g., turn taking). In an experiment on a “one-week diabetics sce - In conclusion, we are currently developing nario,” older adults viewed a robot charac - methods and technologies for social robots ter as more empathic and trustworthy than that support personal self-management and a conventional text-based assistant, and ex - well-being on five aspects – comprehen - pressed more conversational behavior with sion, persuasion, resilience, mitigation and the robots. mood. Comprehension of an individual’s state is being improved, because the robot Based on these findings, we are developing can complement automatic monitoring sys - Figure 2 (top): An older adult is assisted by an iCat robot to maintain fitness levels. and testing different robot behaviors for tems with systematic questions. Factual Figure 3 (middle): A child who plays three scenarios – to stop wandering behav - questions can be posed (“What time did Tic-Tac-Toe with an iCat robot. ior (e.g., leaving the house in the middle of you awake?”), as well as affective questions Figure 4 (bottom): The ALIZ-E project the night), to assist when a possible fall- (“How do you feel this morning?”). Persua - uses the Nao robot to develop robot down has been detected, and to support sion of desired behavior is being established support for children with diabetes. regular drinking behavior. The research ques - by attuning the feedback of the robot to the tion is how to optimize the different social patient’s general state and specific external such as alarming and giving advice. Last but behaviors of the robot. It should be able to conditions. Positive hints improve adher - not least, the robot can help to improve a offer direction to stop wandering, ask ence to medical procedures (e.g., taking patient’s mood by acting as a buddy and whether the person has fallen and needs medication or blood sugar monitoring), and potential actor during play games. further assistance, and motivate elderly pa - can be tailored to personal goals. By provid - tients to drink regularly by providing friend - ing personalized medical background infor - ly hints. mation, patients can be educated and coached. It can be expected that their re - Mark A. Neerincx, Ph.D. For children, current research focuses on the silience is improved by better understand - Delft University of Technology development of a “buddy” for learning rou - ing and therapy adherence. Furthermore, The Netherlands tines, for improving motivation to adhere to the information should help to cope with [email protected] medical recommendations, and for playing possible incidents, like a hypo for diabetes. http://mmi.tudelft.nl/SocioCog- (educative) games. The ALIZ-E project start - When incidents are monitored, the robot [ n itiveR obo tics ] ed in 2010, developing methods for design - can initiate or support mitigation activities,
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Enhancing Robotic-Assisted Gait Training in Children with Cerebral Palsy via Interactive Gaming The combination of interactive gaming and robotic-assisted gait training carries sig - nificant potential to address the need for fully engaging children with cerebral palsy in robotic-assisted therapy, thus leading to maximizing rehabilitation outcomes. By Paolo Bonato
Recovering gait function after a neurolog - Preliminary results are encouraging. Our variability in children’s responses to ro - ical injury such as a stroke or a traumatic own results, consistent with results pub - botic-assisted treadmill gait training. brain injury is a major goal of rehabilita - lished by Dr. Meyer-Heim’s research tion. Gait is a key motor task for activities group, show average improvements in One area, among others, that is current - of daily living and the ability to walk inde - gait function of 20-30% when using clin - ly under investigation in an attempt to 38 pendently is important for quality of life. ical scales such as the Gross Motor Func - answer the above questions is the mat - Consequently, a great deal of effort has tion Measure Scale or using clinical ter of how engaged a child may be dur - been devoted to developing effective gait measures of gait speed and endurance ing training. The team led by Dr. Meyer- training interventions. such as the 10-meter walk test and the Heim at University Children's Hospital in 6-minute walk test. There is one caveat, Zurich and our team at Spaulding Reha - One approach that is widely used in indi - however. Whereas average group results bilitation Hospital in Boston have ex - viduals requiring assistance walking is train - demonstrate large improvements in plored the possibility of increasing a ing patients on a treadmill while providing walking ability in children following ro - child’s involvement in robotic-assisted weight support via a harness and manual - botic-assisted treadmill gait training, a treadmill gait training by using interac - ly guiding a patient’s limbs. For therapists, closer inspection of results on an indi - tive games. Fig. 1 (opposite page) shows this technique can be both labor intensive vidual basis shows a large variability in the setup both groups have used. A robot - and potentially injurious. As a result, re - response to the intervention. This obser - ic device (the Lokomat system by Hoco - searchers and R&D engineers have begun vation has caused a major effort by sev - ma AG, Zurich Switzerland) provides ro - to focus on an easier and more effective eral research groups aimed at optimiz - botic guidance to a child during a training rehabilitation technique – robotic-assist - ing training procedures on an individual session while a large video screen ahead ed treadmill gait training. basis. shows an avatar walking in a virtual envi - ronment. The first robotic systems were designed Why do some children respond positive - for adult populations with spinal cord in - ly to robotic-assisted treadmill gait train - Dr. Meyer-Heim’s research team has per - juries but there is now a growing interest ing while others don’t? Is it because chil - formed an assessment of the above-de - in using this technology for children with dren who respond to gait training are scribed technique based on measures of conditions such as cerebral palsy. Our different at baseline from those who do the magnitude of the forces generated by group at Spaulding Rehabilitation Hospi - not respond? Is it because the training children walking in the robotic system tal in Boston, Massachusetts and the group procedures are not properly optimized with the use of the interactive game ver - led by Dr. Meyer-Heim at University Chil - for all children? Would an individualized sus those without. This is an intuitive and dren's Hospital in Zurich, Switzerland have training approach lead to positive reha - reliable measure of the level of engage - been the first to study robotic-assisted bilitation outcomes in all children? These ment of the child during the training ses - treadmill gait training in children with cere - are the questions we need to answer in sion. The results show that patients gen - bral palsy. order to identify all potential sources of erate forces of larger magnitudes (i.e. are
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more engaged in the training session) when using an interactive game.
Our own study shows similar results. A case series led by Dr. Patritti at Spaulding Reha - bilitation Hospital indicated that better outcomes are achieved when interactive games are used along with robotic-assist - ed training. In the study, we compared re - sults achieved in children with cerebral pal - sy using the robotic system combined with interactive games with the results achieved when the robotic system was used on its Figure 1: A robotic de - own. In kids using the interactive games, vice (the Lokomat sys - we observed larger improvements in walk - tem by Hocoma AG, ing function (as measured using the Gross Zurich Switzerland) pro - Motor Function Measure scale), walking vides robotic guidance to a child during a train - speed (as measured using the 10-meter ing session while a large walk test), and walking endurance (as meas - video screen ahead ured using the 6-minute walk test). shows an avatar walking in a virtual environment. The above-summarized results are prelim - inary and need to be confirmed by future studies on large groups of children with 39 cerebral palsy. However, additional factors are likely to play an important role in gain - ing a better understanding of how robot - is removed. Our own study using the same Active Knee Rehabilitation Orthotic Device ic-assisted treadmill gait training should principle was translated to the lower limbs (AKROD), developed by Dr. Mavroidis’ re - be modified for better outcomes. An in - and paralleled observations previously gath - search team at Northeastern University in triguing factor affecting motor gains using ered for the upper limbs. Now a question Boston, that we are currently testing at the treadmill is the baseline ability of the of great interest is whether such an abili - Spaulding Rehabilitation Hospital. Though child to respond to the interaction with ty to adapt to perturbations introduced by results are still preliminary and challenges the robot. This is a fundamental question robots is maintained in children with cere - still exist, the first commercially-available concerning if and how motor learning can bral palsy. An intriguing hypothesis is that exoskeletons are now coming to market be achieved via interaction between the only children who have maintained such (e.g. the Tibion Bionic Leg and the eLeg ex - robot and the subject. ability have the potential to respond to ro - oskeleton by Berkeley Bionics). This sug - botic-assisted treadmill gait training. Fu - gests that we will soon achieve better gait To further explore this question, our group ture studies are needed to confirm this hy - training results in children with cerebral pal - is conducting an experiment on the low - pothesis. sy as well as in adults with neurological con - er limbs that was originally designed to un - ditions such as stroke or spinal cord injury. derstand motor adaptations of upper limb A final question intriguing researchers is Thanks to progress in robotics and the sci - control. The original experiments were per - whether the lack of positive rehabilitation ence of gait training, we hope to soon see formed by Dr. Mussa-Ivaldi and Dr. Shad - outcomes in certain children is due to an the day when mobility is not hindered by mehr, and showed that healthy subjects inability to translate improvements they disability. respond to perturbations introduced by a achieve during treadmill training to level robot during arm reaching movements by ground walking. In other words, should ro - generating a force that compensates for botic-assisted gait training on a treadmill Paolo Bonato, Ph.D. such perturbation. They also showed that be combined with robotic-assisted gait Harvard Medical School the magnitude of the force generated by training over ground? Researchers are at - U.S.A. subjects to compensate for the perturba - tempting to address this question by de - [email protected] tion introduced by the robot decreases veloping exoskeleton systems for gait train - [ h ttp:// spau ldin greh ab.or g/ ] gradually over time once the perturbation ing. An example of such systems is the
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation ACROSS THE POND: DARPA Leads Revolution in Prosthetics
By Colonel Geoffrey Ling and Kent Pankratz Nearly 300 Warriors have lost arms in combat since 2001. The Defense Advanced Research Projects Agency’s Revo - lutionizing Prosthetics Program aims to provide them a chance to regain near-normal function.
For Colonel Geof - gery. The other team is developing im - frey Ling, the plantable micro-electric arrays that will record DARPA Program and translate the user’s brain signals to con - Manager who leads trol the prosthesis. the program enter - ing its fifth year, two Both teams created virtual reality environ - 40 main tasks remain. ments to assist prosthetists, engineers, and The first is for per - users to collaborate in development of the formers to gain reg - arm system. Users can visualize completing ulatory approval to tasks while clinicians calibrate control soft - Col. Geoffrey Ling transition the arms ware. for commercial sale. The second is for The virtual arm images move using the sig - performers to initi - nals sent to the actual limb, allowing engi - ate clinical trials of neers to compare intended motions with ac - the implantable mi - tual arm movement. cro-electric arrays that will enable More than 300 engineers, scientists, and med - brain control of the ical professionals have contributed to the pro - prostheses. Colonel gram, which also serves as a model of intera - Ling views the pro - gency collaboration. The Department of Photo credit: gram as keeping a Veterans Affairs has conducted an optimiza - DEKA Integrated Solutions Corporation Kent Pankratz pact – restoration tion study using 26 volunteer subjects with Figures: Split-hook prostheses, most widely to near-normal all levels of upper limb amputation. Feedback used and available on today’s market, do function – with the warriors that have made from these subjects provided valuable insight not allow for great range of motion or dex - terity. To better address the needs of upper tremendous personal sacrifice for the nation. into design of the final non-invasively con - limb amputees, subjects, like those pictured trolled arm. Users performed more than 3,000 above, performed over 1,500 hours of daily DARPA has committed nearly $150 million hours of daily living tasks, many of which are living tasks using new prosthetic systems to improve the entire upper limb prosthetic not possible with the limitations of current created by DARPA’s teams. system, including sockets and control soft - split-hook prostheses. By addressing the needs of these individuals, ware. Two performing teams have produced the addressable market increases along with two different prosthetic arm systems. DARPA DARPA is expanding the user community for the chance of attracting commercial partners. contracted with one team to develop a “strap- its Revolutionizing Prosthetics program to in - Goals for commercialization are 2011 for the and-go” system that could be donned and clude patients with spinal cord injuries and non-invasively controlled arm and 2013 for controlled by the user with no additional sur - victims of stroke and other neural disorders. the brain-controlled system.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FURTHER AFIELD
FURTHER AFIELD: Japan: Leading the Way in Elderly Care with Rehabilitation Robots By Lingjun Kong Japanese descent that can mimic speaking, ton-based orthoses, such as knee-ankle-foot breathing, and blinking, and Telenoid R1 Ro - orthosis, hip-knee-ankle orthosis, and poly - The use of as - bots, created by Dr. Hiroshi Ishiguro at Osa - centric knee orthosis, now move much more sistive and ka University, which are humanoids that can smoothly and comfortably. Furthermore, ro - therapy ro - sense facial expressions and mirror them bot-aided assessment and feedback present bots in reha - with their own face. Currently, Japan occu - patients’ gait performance in feedback val - bilitation has pies a dominant position in the global robot - ues with the use of the robot device sensors, rapidly ics market; 70% of the world’s industrial ro - ultimately helping the patients adapt their evolved in bots are made by Japanese companies. movement patterns and improving the user Japan for sev - For many years, the use of robotics in Japan experience. eral reasons. has deeply penetrated the medical field. From There is a growing need for improved tech - surgical robots used in coronary artery by - Robotic mechanical devices are being effec - nology as the average age of the country’s pass operations to androids used as test sub - tively applied not only to physical rehabilita - population is quickly increasing. Due to a jects in medical school and robot nurses used tion, but to cognitive rehabilitation as well. falling birth rate, a miniscule net immigra - in retirement houses, automated technolo - A great example is the use of the mirror neu - tion, and one of the highest life expectan - gy is found in various forms of healthcare. ron system for the revitalization of the con - cies in the world, over a quarter of Japan’s This is especially due to the increasing num - trol of upper extremity muscles after stroke. 41 population is expected to be 65 years or old - ber of disabling age-related diseases, such as The mirror neuron system encourages the er by the year 2020. The aging society has stroke and other chronic diseases. Rehabili - development of motor neurons through im - created an increased demand for the devel - tation, in particular, has been one area where itation. Observation followed by execution opment of practical robotics applications in robotics has truly shined. is a more effective method for gaining mo - lifestyle-related areas, specifically healthcare. tor memory compared to motor training The tradition of having the young take care Prosthetics and robotic devices for locomo - alone because observing another’s move - of the old has shown to be inadequate and tion and manipulation aids have been wide - ments activates the primary motor cortex, is steadily declining in the culture. Moreover, ly developed in Japan for physical rehabilita - the premotor cortex, and the appropriate many children of the elderly may be aging tion purposes. Many studies have focused muscles. Repetitive use of this biological sys - as well, and are in need of caring for them - on a robotic hand that has sensory capabil - tem through observation and execution, selves. Thus, robotics has been a common - ities and neuromuscular controls. These stud - known as “mirror therapy,” can help stroke ly sought solution for the care and treatment ies have led to the development of several patients regain the ability to control their of the aging population in Japan. different forms of hand devices, including limbs through the aid of robotic devices to exoskeletons that are worn by the human support movement. Recent clinical results Fortunately, Japan has been the leading pi - hand, haptic devices that interact with the have shown that the use of therapeutic ro - oneer in robotics in the past few decades, es - human hand, and prosthetics that imitate botics is an effective method for post-stroke pecially with humanoid machines. Many of the human hand. Similar products have also rehabilitation. its citizens grew up watching cartoons with been developed for lower limb rehabilitation robot protagonists, which corresponds with as well. In addition to mind-controlled wheel - Virtual Reality (VR) has recently been uti - the country’s many technological advance - chairs to aid in mobility, exoskeletons that lized to supplement robot-assisted thera - ments in humanoid robotics. The Interna - support the legs are used as gait trainers to py and treatments. At research centers such tional Robot Exhibition is the largest robot regain walking ability. Active knee and ankle as Osaka University and Gifu University, re - trade fair in the world and is held annually joints give flexibility and mobility to those habilitation systems are now equipped so in Tokyo due to the multitudes of exhibits with lower extremity disabilities. Recently, when patients are placed in a virtual envi - from Japanese researchers. A few of the re - high performance actuator technologies and ronment and equipped with haptic devices, cent unveilings include the newest model of control strategies have greatly improved ro - patient interactions with objects in the vir - Actroid, originally developed by Osaka Uni - bot-assisted gait rehabilitation for mobility tual environment will actually generate versity, modeled after a young woman of and manipulation rehabilitation. Exoskele - feedback forces. This interactive rehabilita -
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FURTHER AFIELD
tion gives disabled patients a method of vides a more interactive experience to en - to aid the aging population. As the rest of the enabling muscle and bone to regain hance training outcomes. world faces similar situations, Japan’s pioneer - strength through repetition and goal-ori - ing advancements in robotic rehabilitation will ented objectives. By taking advantage of There are many technical difficulties to be over - lead the way towards a better quality of life. the plasticity of the brain to help rewire come with the expanding field of rehabilitation damaged neuronal networks and exercis - robots; however, the real challenge is to help Lingjun Kong, PMP ing limbs, combining robotics and VR can people live happier, longer lives. In a place with Virtual Reality Medical Center improve patient performance in both cog - high healthcare costs and limited human ther - U.S.A. nitive and physical treatments. In addition, apeutic services, the development of assistive [ l kon g@v rph obia .co m ] the visual feedback of the virtual world pro - and therapeutic robots is more than necessary www.vrphobia.com
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Transforming VR into a Reality for Behavioral Healthcare: The NeuroVR Project By Giuseppe Riva, Andrea Gaggioli & Cinzia Vigna
Here, the authors discuss why Virtual Reality is not more widely used in a clinical setting by health care practitioners, but rather in the inves - tigational stage. Ways in which this might be changed are addressed, particularly with the help of their NeuroVR 2 software.
Although the papers in previ - 43 ous issues of C&R have shown that Virtual Reality (VR) has come of age for clinical and re - search applications, the major - ity of them are still in the lab - oratory or investigational stage. Data presented at the 2010 Cybertherapy conference held in Seoul, Korea, showed that the real impact of VR in European behavioral health is still low:
The penetration of VR in be - havioral health care/research centers is minimal: around 0.5/1%
The penetration of VR be - tween behavioral health pro - fessionals is even lower: less than 0.001%
Why is VR more virtual than Figure 1: A view of the NeuroVR 2 SceneEditor software. real for many health care prac - titioners? From the experience of the current researchers in - the lack of standardization in VR hard - the low availability of standardized pro - volved in this area it is possible to identi - ware and software, and the limited pos - tocols that can be shared by the com - fy four major issues that are limiting the sibility of tailoring the virtual environ - munity of researchers; use of VR in psychotherapy and behav - ments (VEs) to the specific requirements ioral neuroscience: of the clinical or the experimental setting; The high costs (up to 100.000 ¤) re - FEATURES The NeuroVR Project
Table 1: NeuroVR Scientific papers
Albani, G., Raspelli, S., Carelli, L., Morganti, F., Weiss, P. L., Kizony, R., et al. Executive functions in a vir - tual world: a study in Parkinson's disease. Studies in Health Technology and Informatics, 154 , 92-96.
Carelli, L., Morganti, F., Poletti, B., Corra, B., Weiss, P. L., Kizony, R., et al. (2009). A NeuroVR based tool for cognitive assessment and rehabilitation of post-stroke patients: two case studies. Stud Health Technol Inform, 144 , 243-247.
Gatti, E., Massari, R., Sacchelli, C., Lops, T., Gatti, R., & Riva, G. (2008). Why do you drink? Virtual real - ity as an experiential medium for the assessment of alcohol-dependent individuals. Stud Health Technol Inform, 132 , 132-137.
Gorini, A., & Riva, G. (2008). Virtual reality in anxiety disorders: the past and the future. Expert Review of Neurotherapeutics, 8 (2), 215-233.
Grassi, A., Gaggioli, A., & Riva, G. (2009). The Green Valley: The Use of Mobile Narratives for Reducing Stress in Commuters. CyberPsychology & Behavior, 12 (2), 1-7.
Manzoni, G. M., Cesa, G. L., Villani, D., Castelnuovo, G., Molinari, E., & Riva, G. (2006). VR-enhanced treatment of anxiety in obese subjects: A follow-up study on trait-anxiety, psychological symptorna - tology, and generalized self-efficacy. Cyberpsychology & Behavior, 9 (6), 699-700.
Manzoni, G. M., Pagnini, F., Gorini, A., Preziosa, A., Castelnuovo, G., Molinari, E., et al. (2009). Can 44 relaxation training reduce emotional eating in women with obesity? An exploratory study with 3 months of follow-up. Journal of American Dietetic Association, 109 (8), 1427-1432.
Morganti, F., Gaggioli, A., Strambi, L., Rusconi, M. L., & Riva, G. (2007). A virtual reality extended neu - ropsychological assessment for topographical disorientation: a feasibility study. Journal of Neuroengineering and Rehabilitation, 4 , 26.
Pallavicini, F., Algeri, D., Repetto, C., Gorini, A., & Riva, G. (2009). Biofeedback, VR and Mobile Phones in the treatment of Generalized Anxiety Disorders: A phase-2 controlled trial. J Cyberther Rehab, 2(4), 315-328.
Raspelli, S., Carelli, L., Morganti, F., Poletti, B., Corra, B., Silani, V., et al. Implementation of the multi - ple errands test in a NeuroVR-supermarket: a possible approach. Studies in Health Technology and Informatics, 154 , 115-119.
Riva, G., Bacchetta, M., Cesa, G., Conti, S., Castelnuovo, G., Mantovani, F., et al. (2006). Is severe obe - sity a form of addiction? Rationale, clinical approach, and controlled clinical trial. CyberPsychology and Behavior, 9 (4), 457-479.
Riva, G., Carelli, L., Gaggioli, A., Gorini, A., Vigna, C., Algeri, D., et al. (2009). NeuroVR 1.5 in Practice: Actual Clinical Applications of the Open Source VR System. Stud Health Technol Inform, 144 , 57-60.
Riva, G., Carelli, L., Gaggioli, A., Gorini, A., Vigna, C., Corsi, R., et al. (2009). NeuroVR 1.5 - a free vir - tual reality platform for the assessment and treatment in clinical psychology and neuroscience. Stud Health Technol Inform, 142 , 268-270.
Riva, G., Manzoni, M., Villani, D., Gaggioli, A., & Molinari, E. (2008). Why you really eat? Virtual reali - ty in the treatment of obese emotional eaters. Stud Health Technol Inform, 132 , 417-419.
Riva, G., Raspelli, S., Pallavicini, F., Grassi, A., Algeri, D., Wiederhold, B. K., et al. (2010). Interreality in the management of psychological stress: a clinical scenario. Stud Health Technol Inform, 154 , 20-25.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation FEATURES The NeuroVR Project FEATURES
quired for designing and testing a OpenSceneGraph, an open source high ated using the NeuroVR 2 SceneEditor. clinical VR application; performance 3D graphics toolkit The player offers a set of standard fea - (http://www.openscenegraph.org/pro - tures that contribute towards increas - most VEs in use today are not user- jects/osg). ing the realism of the simulated scene. friendly; expensive technical support These include collision detection to con - or continual maintenance is often re - Using the NeuroVR 2 SceneEditor (see trol movements in the environment, re - quired. Figure 1), the psychological alistic walk-style motion, advanced light - stimuli/stressors appropriate for any ing techniques for enhanced image To address these challenges, the Euro - given scenario can be chosen from a quality, and streaming of video textures pean funded project Interstress rich database of 2D and 3D objects, using alpha channel for transparency. (http://www.interstress.eu) is develop - and easily placed in the pre-designed The player can be configured for two ing NeuroVR 2 (http://www. virtual scenario by using an icon-based basic visualization modalities – immer - neurovr2.org), an advanced version of interface. No programming skills are sive and non-immersive. The immer - the cost-free NeuroVR plat - sive modality allows the form based on open-source “...the neuro platform is used in the assess- scene to be visualized us - software that allows non-ex - ment and treatment of obesity, alcohol abuse, ing a head-mounted dis - pert users to easily modify a play, either in stereoscop - virtual environment (VE) and anxiety disorders, generalized anxiety disorders ic or in mono-mode; to visualize it using either an and cognitive rehabilitation.” compatibility with the immersive or non-immer - head-tracking sensor is sive system (http://www.neurovr.org). required to carry out these steps. In ad - also provided. In the non-immersive NeuroVR, originally developed by the dition to static objects, the NeuroVR 2 modality, the virtual environment can Virtual Reality & Multi Media Park SceneEditor allows objects to overlay be displayed using a desktop monitor (http://www.vrmmp.it) for the Italian on the 3D scene video composited or a wall projector. The user can inter - MIUR Firb NeuroTIV and IVT2010 proj - with a transparent alpha channel. The act with the virtual environment using 45 ects, received the 2007 Laval Virtual Sci - editing of the scene is performed in either keyboard commands, or a mouse ence Award for the best VR science ap - real time, and effects of changes can or a joypad, depending on the hardware plication worldwide. be checked from different views in - configuration chosen. cluding frontal, lateral and top. The majority of existing VEs for health A future goal is to provide software com - care are proprietary and are closed Currently, the NeuroVR 2 library includes patibility with instruments that allow source, meaning they cannot be tailored different pre-designed virtual scenes collection and analysis of behavioral from the ground up to fit specific needs representing typical real-life situations data, such as eye-tracking devices and for different clinical applications. Neu - such as a supermarket, an apartment, sensors for psycho-physiological mon - roVR 2 addresses these issues by pro - or a park. These VEs have been de - itoring. Actually, the neuro platform is viding the clinical professional with a signed, developed and assessed in the used in the assessment and treatment cost-free SceneEditor, which allows non- past ten years by a multidisciplinary re - of obesity, alcohol abuse, anxiety disor - expert users to easily modify a virtual search team in several clinical trials in - ders, generalized anxiety disorders and scene to best suit the needs of the clin - volving over 400 patients. On the basis cognitive rehabilitation (see Table 1 for ical setting. of this experience, only the most effec - a list of published papers that used the tive VEs have been selected for inclu - NeuroVR software) The VR suite leverages two major open- sion in the NeuroVR 2 library. source projects in the VR field: Delta3D Beyond clinical applications, NeuroVR (http://www.delta3d.org) and Open - An interesting feature of the NeuroVR provides the VR research community SceneGraph (http:// www.openscene - 2 SceneEditor is the ability to add new with a free “VR lab,” which allows the graph.org). Both are building compo - objects to the database. This feature al - creation of highly-controlled experimen - nents that integrates with ad-hoc code lows the therapist to enhance the pa - tal simulations for different behavioral, to handle the editing and simulation. tient’s feeling of familiarity and intima - clinical and neuroscience applications. The NeuroVR2 SceneEditor's GUI is now cy with the virtual scene, i.e., by using based on the QT cross-platform appli - photos of objects/people that are part Giuseppe Riva, Ph.D. cation and UI framework from Nokia of the patient’s daily life, thereby im - Andrea Gaggioli, Ph.D. (http://qt.nokia.com/) that grants an proving the efficacy of exposure. Cinzia Vigna, Ph.D. higher level of editing and customiza - The second main component of Neu - Istituto Auxlogico Italiano tion over the editor functionalities, while roVR 2 is the Player, which allows navi - Italy the graphical rendering is done using gation and interaction with the VEs cre - [ ] [email protected]
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation > COUNTRY FOCUS C&R in Romania
After the fall of communism, the health and education
AUTHOR: systems of Romania collapsed, poverty triumphed, and Andreea Rimbu people struggled to get back on their feet. Ceausescu’s Editorial Department C&R Magazine regime left behind irreparable damage, and a nation www.vrphobia.eu that had to reconstruct itself from scratch. The country [][email protected] continues to suffer from the anteceding 60 years, but modern efforts have quickly sprung to the rescue. 46
Mental healthcare suffered such tactics, while others became mad mark, increasing only .2% since a great blow when Ceauses - and suffered mental illnesses. Reha - 1999, and only 3% of that has been M cu banned psychology de - bilitation would aim to repair the dedicated to mental health alone. partments across România, damage caused by the deliberate psy - WHO statistics place România in as psychologists were deemed a chiatric abuse for political reasons third to last place with regards to a threat to the regime. Mental illness during Ceausescu’s regime, yet it took budget for mental health. The NGO was treated with psychiatric medica - another 14 years for any university to sector in the field of mental health tion and nothing more. No talk ther - open for students of psychology and services is scarce, as are funds and apy existed for those patients who introduce psychotherapeutic curricu - mental health experts. Yet unfortu - would have benefited from psy - lum. Since then, the number of nurs - nately, neuro-psychiatric disorders chotherapy, such as those who suf - es working in the mental health sys - are the second main cause of death, fered physical and mental abuse in tem is estimated at about 2000, and claiming 19.3% of the population. prisons and detention centers. only a few have any specific training The figures account for an estimate in psychiatry besides their on-site of 1,018 new cases of mental disor - In 1949, psychiatric abuse was intro - preparations. The number of psychi - ders per 100,000 per year. duced in prisons as a way to instill ter - atric doctors and other mental health ror and destroy the personality of the staff is undoubtedly insufficient, and Another challenging factor in the individual. This aimed to impose con - the prospects of psychiatric care only mental health sector has been formity and punish those suspected diminish the further one gets from scarcity of legislation related to of fascism, treason, or propaganda. the capital. rights of mentally ill civilians. Such These “re-education” programs, as persons face extreme challenges in they became known, were imposed on O Lume Sanatoasa Intr-o the employment area. Many work - over 780 detainees, which were tor - Minte Sanatoasa ers who leave a place of employ - tured, beaten, psychologically abused ment for medical reasons are not and threatened. Many others commit - România’s GDP allocated to health - guaranteed to retain their work ted suicide to escape subjugation to care has lingered around the 3% post, or to find a new one. This is
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation > COUNTRY FOCUS
Population (million) 22.2 Percentage of Urban Population 54.9% Unemployment Rate 7.6 Life Expectancy (Years) Male/Female 61/65.2 Fertility Rate 10.53 Mortality Rate 11.88 & Physcians (per 1000 Inhabitants) 1.26 C R in Romania Hospital Beds per 1000 6.4 GDP on healthcare 3.6 Suicide Rate (per 100,000) 4.9/18.5 Male/Female Extrapolated Prevalence to Eating 410,947 Disorders (total) Extrapolated Prevalence to 180,816 Schizophrenia (total) Extrapolated Prevalence to Anxiety 3,666,310 Disorders (total) Extrapolated Prevalence to 1,184,844 Depression (total) Extrapolated Prevalence to PTSD (total) 427,385 47
a major contributing factor of sui - psychological stress is almost ir - apy, mobilization programs, and cide, the rates of which are above reparable. counseling, among other activities, the EU27 average, and is the main for elderly people, children and the cause of death among Romanian It seems difficult to justify that mentally ill. The charity offers sev - males and second greatest cause of România would allocate the little eral therapeutic programs, such as art death among Romanian females. economic means they have to pre - therapy for disabled patients, who vent mental diseases, when a stag - take part in dance, music, art and Children and young adults are par - gering 41.2% of the total population sensory training sessions. Estuar, the ticularly at risk for mental disorders has neither a bath nor shower in leading mental health charity in Ro - and suicide. It is estimated that one their dwelling, and an overwhelming manian, provides rehabilitation for in five children and adolescents suf - 42.5% have no indoor flushing toilet adults who want to reintegrate into fer from a mental health problem. in their household. the Romanian community through This is also true for the many chil - similar programs. dren left alone by families working Towards Improvement abroad. A National Strategy for Pro - In 1990, mental health professionals tection and Promotion of Child Romania has taken huge leaps to im - founded the Romanian League for Rights has been implemented to prove its mental health care system. Mental Health, which was the official provide special protection for chil - International cooperation has played organization involved in mental dren separated from their parents. an important role in pushing forward health reform. They formulated the these changes. America, Britain, National Mental Health Programme, Unfortunately, the strategy does not Japan and Switzerland are some of which engaged prevention and reha - cover orphans, who are at an espe - the most active donors in the area of bilitation, community psychiatry, leg - cially high risk of mental illness as mental health. A particular UK/Ro - islation and communication with oth - a consequence of years of govern - manian charity known as the “Relief er health care sectors. Since then, ment-sanctioned child neglect and Fund for Romania” has opened a day mental health care has picked up the abuse. This type of deep-rooted care center that provides physiother - pace.
The Official Voice of the International Association of CyberPsychology, Training & Rehabilitation > COUNTRY FOCUS
system. By 2008, the Center of e-health service, which allows pa - General Surgery and Liver Trans - tients the ability to engage more plantation of the Fundeni Clini - closely with their own health and cal Institute purchased its own well-being. Doctors will be able Da Vinci system, and the Insti - to review clients’ medical infor - tute has since performed over mation, prescribe drugs and of - 200 robot-assisted surgeries. fer consultation. Alongside this service, a WristClinic health-mon - In September 2007, România par - itoring device is supplied, which The 1998 National Programme ticipated in its first telemedicine automatically measures blood for Mental Health and Prophylax - project - HealthOptimum. The pressure, pulse, ECG, cardiac is in Psychiatric and Psychosocial goal was to introduce virtual-as - rhythm, level of oxygen satura - Pathology confronted the issues sisted healthcare services into a tion, and many other medical fea - of discrimination, lack of coher - wide range of medical specialties tures. The envisioned goal is con - ence between decision-making – from cardiolog, to psychiatry – necting millions of users with bodies, poor psychiatric care con - as well as offer rehabilitation to health professionals to support ditions, and insufficient mental those recovering from alcohol wellness and disease prevention health personnel. The Law on problems, monitor the elderly at . Mental Health Promotion and home and provide general med - By 2011, the Românian govern - Protection of Persons with Psy - ical advice. ment expects to provide its citi - chiatric Disorders, adopted in zens with electronic health insur - 2002, dedicated a specialized sec - A research program out of Con - ance cards, which will hold tion to persons with mental dis - stanta known as “TELEMEDICINE personal information about the abilities, guaranteeing their APPLICATIONS IN DANUBE individual, from blood type, to 48 rights, confidentiality, and recog - DELTA” and financed by Român - any information about life-threat - nizing their civil, political, eco - ian Space Agency, aims to build ening medical diagnoses. It is an nomic, social and cultural rights. a unique health care program important step in computeriza - The current central institutions comprised of mobile telemedi - tion, and an even greater leap to - involved in the healthcare of the cine using a satellite link. The wards improved healthcare. nation are the Ministry of Public project’s main purpose is to Health and the National Health cater to mentally ill people from Interest and engagement is Insurance Fund. The Ministry of the Danube Delta region who do piquing. Researchers, scientists, Public Health is responsible for not receive adequate care and and professionals are discussing the health of the nation through connect them with trained spe - the future of Virtual Reality en - implementation of policies, cialists. vironments for pre-surgery plan - strategies, health programs, and ning, rehabilitation medicine, allocation of funds, while the Na - In 2007, a 27 month long project learning, and tele-rehabilitation. tional Health Insurance Fund ad - was inaugurated. TELEASIS The future rests on incoming ministers and regulates the so - sought to offer social and med - generations, decision makers cial health insurance system. ical tele-assistance to elderly per - and ICT shoulders to make sig - sons in their homes, with the nificant improvements, for both Viitorul Ne Surâde hopes of improving lifestyle qual - mental health professionals and ity and efficiency in healthcare citizens. România has taken quite a leap institutions, and easing commu - in the field of telemedicine, nication between patients and eHealth and ICT in medicine, healthcare providers. which has the potential to accel - Sources: erate health-care reform. In 2005, România and Medic4all, a România became the first coun - Swedish company of telemedi - CureResearch.com, NationMaster.com, try in Eastern Europe to have suc - cine technology and services, World Health Organization, and the cessfully performed a robot-as - launched Medic4you, the world’s British Medical Association. sisted surgery using the Da Vinci first customer oriented cellular Leading the Path to KNOWLEDGE
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