New studies on rehabilitation support the theory that not all therapy needs to be hands-on.
Take stroke patients, for instance. While for most stroke patients, rehabilitation requires physical therapy as patients need to relearn simple motor activities like walking and sitting, occupational therapy (relearning daily activities like eating and dressing), and speech therapy, formal caregivers are not always available due to budget constraints or insufficient staff, and informal caregivers (spouses, family members) don’t always have the skill set or the patience.
Prof. Shelly Levy-Tzedek says socially assistive robots, or robots that assist using social cues, can help support and treat patients in rehabilitation from stroke or other conditions when human caregivers are not available. In her work leading The Cognition, Aging and Rehabilitation Lab at Ben-Gurion University, she regularly conducts studies with other researchers on how these social robots help improve the well-being of people who need rehabilitation.
Earlier this year, Levy-Tzedek, and fellow professors Ayelet Dembovski and Yael Amitai, published the methodology for their system and the initial results of a study that highlighted the use of socially assistive robots that support patients dealing with stroke. The team developed a robot-based gamified exercise platform for long-term post-stroke rehabilitation, came up with seven gamified based on functional tasks, and used the semi-humanoid robot Pepper manufactured by Softbank Robotics for the study.
The study looked at mixed attitudes towards the robots, motivation for use, and the differences in interaction between the patient and a human therapist vs. a patient and an assistive robot. The study was published in the journal Frontiers in Rehabilitation Science.
Socially assistive robots “help the person, not physically – they don’t move their limbs or they don’t move something in the world for the person – but they get them to do something themselves. So one of the biggest projects in the lab in the past few years has been a socially assistive robot that helps people who’ve had a stroke, do their exercise,” Prof. Shelly Levy-Tzedek tells NoCamels.
While the person can do the exercise on their own, Prof. Levy-Tzedek says socially assistive robots can provide extra benefits like motivation, companionship, and a gamified system that could make the patient feel like he is playing a game rather than relearning skills or completing tasks.
The other benefit is that the robot could be taken home in the future.
In the study, researchers collected and analyzed information from 23 patients (11 stroke patients and 12 informal caregivers) who participated in a total of six focus-group discussions. The patients answered questions regarding the use of a socially assistive robot to promote physical exercises during the rehabilitation process including the advantages and disadvantages, specific needs the robot would address, adaptions the patient would propose to include, and concerns regarding the technology.
“We found that the majority of the participants in both groups were interested in experiencing the use of a SAR (socially assistive robot) for rehabilitation, in the clinic and at home,” the authors wrote in the study.
“This is a study that we ran in the clinic with patients who have had a stroke, previously being healthy individuals. This was a pilot experiment in the lab, and then we ran it with actual stroke patients in the clinic. We did over two years during COVID-19,” she explains.
The clinical results have not yet been published, but Levy-Tzedek says they are “promising.”
“This is the first experiment of its kind in the world in that it’s a long-term experiment with stroke patients in the clinic with a social robot. So this hasn’t been done before. There were studies with stroke patients that were just one-off meetings with a robot which is a good first start, but You need to do the experiment in the long term because rehabilitation is a long-term endeavor. So you have to see how people react to it over the long term and whether the novelty wears off after a while. And then do people still continue and we see that they do,” she says.
Rehab robots assist stroke patients
Levy Tzedek, a biomedical engineer who studied at UC Berkeley and earned a Master of Science and PhD from Massachusetts Institute of Technology (MIT,) uses what she calls “off-the-shelf robots” and fits them with a platform developed in the lab. “Off-the-shelf” means they are commercially available.
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“It’s not a robot we built. What we did is build a whole platform around it,” she explains. In the case of stroke patients, “this is a platform that helps people after stroke perform exercises.”
“Now, you might wonder, is it the robot that matters? Or is it the platform that we developed? People who used the computer instead of the robot to give them instructions and feedback – so exactly the same platform, but a computer was providing the instructions and the feedback [instead of the robot] – they also got better, but not to the same extent,” she explains, “So more people got better with a robot.”
People who have had a stroke often lose the ability to perform tasks that were trivial before something like buttoning their own shirt, slicing bread, or placing a jar on a shelf. These are things that have to be practiced thousands of times, and some of this practice is done in a clinic with a physical therapist or an occupational therapist, but a lot of the practice has to be done on its own.
“In general, when we look at compliance with physical therapy exercises, it’s around 30 percent. So we wanted to get people to do more self-exercise, but in a guided way – giving them motivation but also feedback. So that’s the idea behind this,” she says.
Stroke patients often lose the ability to perform daily actions with everyday objects. Tasks that were trivial before — like buttoning a shirt, slicing bread, or placing a jar on a shelf — are suddenly tasks that have to be practiced thousands of times. Some of the practice is done in a clinic with a physical therapist but a lot of it is done at home, where the patient needs to do it on his own.
“So if they have to relearn how to button a shirt, they actually have to use a button and try to do the actual activity because they have to relearn how to coordinate their muscle activity. And just strengthening their muscles is not enough, using virtual reality is good, but not sufficient, they have to actually do the tasks that they’re trying to relearn how to do, which is why we use everyday objects in all of the practice,” Levy-Tzedek explains, “
The everyday objects have RFID (radio frequency identification) tags on them. RFID is a form of wireless communication that can identify an object. This is done so researchers can know where each item is placed and the robot can give feedback to the person.
“What they do is they give a task using the screen and also speech and they say to place the, in this case, orange, green and blue cups in this particular arrangement. And the person does that. And because we have these sensors, we know exactly where they place the objects and we and the robot can then give them feedback,” Levy-Tzedek says.
During the interview, Levy-Tzedek showed some of the setups where a patient was practicing various tasks using the help of a socially assistive robot. In one kitchen setup, the patient was tasked with placing kitchen items on a shelf. They had to place the items as well as remember where they should be placed. In another escape room setup, they had to find items as requested by the robot. In a third setup, a robot played Blackjack with the patient and the patient had to remember his cards and play the game correctly.
The value of a socially assistive robot
What is it about the robot that makes it better or different from a human? Levy-Tzedek says it’s “something that we’re trying to figure out.” Her team has done numerous in-depth interviews with people over time, including in the beginning and middle of the experiment, and even after they’ve completed it.
“We asked them about their experience and what they thought and it seems that at the same time they were treating it as a human but then also not as a human,” she explains, citing examples that the robot made mistakes (they would tell the patient he did something wrong when he was correct) and some were frustrated by the incident while others let it roll off their back. On the other hand, patients were afraid that a human therapist would be judgemental of them, even though therapists aren’t supposed to be judgemental. The robot could not be judgemental and this was a plus.
“At the same time, they treat it as a human, but then also not as a human. And they take the best out of each. And I will say, though, that people were most interested in continuing to work with a robot when they felt that they actually had a benefit to their functional rehabilitation and when they felt they got better when they would go home at the end of the session, and they were able to do something that they weren’t able to do before,” Levy-Tzedek explains, “That was the strongest predictor of how much they would want to come and then work with it again, and continue working with a robot. So it wasn’t just some sort of halo effect of using technology, but the actual benefit that they reaped from working with it.