The use of robots in therapy for children with autism spectrum disorder raises issues concerning the ethical and social acceptability of this technology and, more generally, about human–robot interaction. However, usually philosophical papers on the ethics of human–robot-interaction do not take into account stakeholders’ views; yet it is important to involve stakeholders in order to render the research responsive to concerns within the autism and autism therapy community. To support responsible research and innovation in this field, (...) this paper identifies a range of ethical, social and therapeutic concerns, and presents and discusses the results of an exploratory survey that investigated these issues and explored stakeholders’ expectations about this kind of therapy. We conclude that although in general stakeholders approve of using robots in therapy for children with ASD, it is wise to avoid replacing therapists by robots and to develop and use robots that have what we call supervised autonomy. This is likely to create more trust among stakeholders and improve the quality of the therapy. Moreover, our research suggests that issues concerning the appearance of the robot need to be adequately dealt with by the researchers and therapists. For instance, our survey suggests that zoomorphic robots may be less problematic than robots that look too much like humans. (shrink)

Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position (...) sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved 7 chronic hemiparetic subjects over three weeks. The protocol included evaluation sessions, that consisted of a psychometric estimate of the subject’s kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their improvement in time. (shrink)

Objective:This study aimed to investigate the effect of robot-assisted gait training therapy combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury.Data sourcesPubMed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Web of Science were searched.Study selectionRandomized controlled trials published as of 3 March 2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct current stimulation and repetitive transcranial magnetic stimulation, for lower limb function and activities in patients (...) with stroke and SCI were included.Data extractionTwo reviewers independently screened the records, extracted the data, and assessed the risk of bias.Data synthesisA meta-analysis of five studies and risk of bias were conducted. Pooled estimates demonstrated that RAGT combined with NIBS significantly improved lower limb function [standardized mean difference = 0.52; 95% confidence interval = 0.06–0.99] but not lower limb activities. Subgroup analyses also failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation. No significant differences between participant characteristics or types of NIBS were observed.ConclusionThis meta-analysis demonstrated that RAGT therapy in combination with NIBS was effective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation. (shrink)

Recent research showed the potential benefits of robot-assisted therapy in treating children with Autism Spectrum Disorder. These children often have some form of Intellectual Disability too, but this has mainly been neglected by previous robotics research. This article presents an empirical evaluation of robot-assisted imitation training, where the child imitated the robot, integrated into the Treatment and Education of Autistic and related Communication handicapped Children program. The sample included six hospitalized children with different levels (...) of ID, from mild to profound. We applied mixed methods to assess their progress, during treatment and three months later. Results show increased Gross Motor Imitation skills in the children, except for those with profound ID and the therapists’ positive attitude towards the humanoid robot. Furthermore, the therapists suggest how a robot could be used to autonomously collect and analyze the information obtained in the rehabilitation training for a continuous evaluation of the participants. (shrink)

The social impact of robotics applied to domains such as education, religion, nursing, and therapy across the world depends on the level of technology as well as the culture in which it is used. By studying how robots are used in Iran, a technologically-savvy country with a long history and a rich culture, we explore their possible impact on interrelated areas of religious and ethical features in education in an Islamic society. To accomplish this task, a preliminary exploratory study (...) was conducted using two social robots as teaching assistants in Islamic religion classes for 42 elementary students. More than 90% of the participants in the study absolutely preferred the robot-assisted religion class over one taught by a human. Building on the results from the students’ viewpoints and exam scores, the acceptability and potential of using social robots in the education of Islamic religious concepts in Iran are further discussed in this paper. (shrink)

This paper aims to study the role of the social robot Probo in providing assistance to a therapist for robot assisted therapy (RAT) with autistic children. Children with autism have difficulties with social interaction and several studies indicate that they show preference toward interaction with objects, such as computers and robots, rather than with humans. In 1991, Carol Gray developed Social Stories, an intervention tool aimed to increase children's social skills. Social stories are short scenarios written (...) or tailored for autistic individuals to help them understand and behave appropriately in social situations. This study shows that, in specific situations, the social performance of autistic children improves when using the robot Probo, as a medium for social story telling, than when a human reader tells the stories. The robot tells Social Stories to teach ASD children how to react in situations like saying “hello“, saying “thank you“ and “sharing toys“. The robot has the capability of expressing emotions and attention via its facial expressions and its gaze. The paper discusses the use of Probo as an added-value therapeutic tool for social story telling and presents the first experimental results. Keywords: social robot; ASD children; social story; robot assisted therapy. (shrink)

This paper aims to study the role of the social robot Probo in providing assistance to a therapist for robot assisted therapy with autistic children. Children with autism have difficulties with social interaction and several studies indicate that they show preference toward interaction with objects, such as computers and robots, rather than with humans. In 1991, Carol Gray developed Social Stories, an intervention tool aimed to increase children’s social skills. Social stories are short scenarios written or (...) tailored for autistic individuals to help them understand and behave appropriately in social situations. This study shows that, in specific situations, the social performance of autistic children improves when using the robot Probo, as a medium for social story telling, than when a human reader tells the stories. The robot tells Social Stories to teach ASD children how to react in situations like saying “hello”, saying “thank you” and “sharing toys”. The robot has the capability of expressing emotions and attention via its facial expressions and its gaze. The paper discusses the use of Probo as an added-value therapeutic tool for social story telling and presents the first experimental results. Keywords: social robot; ASD children; social story; robot assisted therapy. (shrink)

The debate about the use of robots in the care of older adults has often been dominated by either overly optimistic visions (coming particularly from Japan), in which robots are seamlessly incorporated into society thereby enhancing quality of life for everyone; or by extremely pessimistic scenarios that paint such a future as horrifying. We reject this dichotomy and argue for a more differentiated ethical evaluation of the possibilities and risks involved with the use of social robots. In a critical discussion (...) surrounding the capabilities approach to the ethical evaluation of quality of life, we develop an ethical framework that is more appropriate to the situation of the oldest old. We urge employment of a context-dependent approach to the ethical evaluation of new technologies in the care and therapy of older adults, and using the example of the robotic seal Paro, we show how this can be accomplished in a sensible and practical way. (shrink)

This paper aims to study the role of the social robot Probo in providing assistance to a therapist for robot assisted therapy with autistic children. Children with autism have difficulties with social interaction and several studies indicate that they show preference toward interaction with objects, such as computers and robots, rather than with humans. In 1991, Carol Gray developed Social Stories, an intervention tool aimed to increase children’s social skills. Social stories are short scenarios written or (...) tailored for autistic individuals to help them understand and behave appropriately in social situations. This study shows that, in specific situations, the social performance of autistic children improves when using the robot Probo, as a medium for social story telling, than when a human reader tells the stories. The robot tells Social Stories to teach ASD children how to react in situations like saying “hello”, saying “thank you” and “sharing toys”. The robot has the capability of expressing emotions and attention via its facial expressions and its gaze. The paper discusses the use of Probo as an added-value therapeutic tool for social story telling and presents the first experimental results. Keywords: social robot; ASD children; social story; robot assisted therapy. (shrink)

Interactive robots are used increasingly not only in entertainment and service robotics, but also in rehabilitation, therapy and education. The work presented in this paper is part of the Aurora project, rooted in assistive technology and robot-human interaction research. Our primary aim is to study if robots can potentially be used as therapeutically or educationally useful ‘toys’. In this paper we outline the aims of the project that this study belongs to, as well as the specific qualitative contextual (...) perspective that is being used. We then provide an in-depth evaluation, in part using Conversation Analysis, of segments of trials where three children with autism interacted with a robot as well as an adult. We focus our analysis primarily on joint attention which plays a fundamental role in human development and social understanding. Joint attention skills of children with autism have been studied extensively in autism research and therefore this behaviour provides a relevant focus for our study. In the setting used, joint attention emerges from natural and spontaneous interactions between a child and an adult. We present the data in the form of transcripts and photo stills. The examples were selected from extensive video footage for illustrative purposes, i.e. demonstrating how children with autism can respond to the changing behaviour of their co-participant, i.e. the experimenter. Furthermore, our data shows that the robot provides a salient object, or mediator for joint attention. The paper concludes with a discussion of implications of this work in the context of further studies with robots and children with autism within the Aurora project, as well as the potential contribution of robots to research into the nature of autism. (shrink)

Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of (...) the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children, and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good >0.79). Proprioceptive error was larger for children with uCP than TDC, indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies. (shrink)

Social robots are increasingly used in different areas of society such as public health, elderly care, education, and commerce. They have also been successfully employed in autism spectrum disorders therapy with children. Humans strive to find in them not only assistants but also friends. Although forms and functionalities of such robots vary, there is a strong tendency to anthropomorphize artificial agents, making them look and behave as human as possible and imputing human attributes to them. The more human a (...) robot looks, the more appealing it will be considered by humans. However, this linear link between likeness and liking only holds to the point where a feeling of strangeness and eeriness emerges. We discuss possible explanations of this so-called uncanny valley phenomenon that emerges in human–robot interaction. We also touch upon important ethical questions surrounding human–robot interaction in different social settings, such as elderly care or autism spectrum disorders therapy. (shrink)

This paper presents a novel methodological approach of how to design, conduct and analyse robot-assisted play. This approach is inspired by nondirective play therapy. The experimenter participates in the experiments, but the child remains the main leader for play. Besides, beyond inspiration from non-directive play therapy, this approach enables the experimenter to regulate the interaction under specific conditions in order to guide the child or ask her questions about reasoning or affect related to the robot. (...) This approach has been tested in a long-term study with six children with autism in a school setting. An autonomous robot with zoomorphic, dog-like appearance was used in the studies. The children’s progress was analyzed according to three dimensions, namely, Play, Reasoning and Affect. Results from the case-study evaluations have shown the capability of the method to meet each child’s needs and abilities. Children who mainly played solitarily progressively experienced basic imitation games with the experimenter. Children who proactively played socially progressively experienced higher levels of play and constructed more reasoning related to the robot. They also expressed some interest in the robot, including, on occasion, affect. Keywords: Human–Robot Interaction, Robot-Mediated Therapy, Robot-Assisted Play, Non-Directive Play Therapy, Assistive Technology, Autism, Children. (shrink)

Classic studies in human sensorimotor control use simplified tasks to uncover fundamental control strategies employed by the nervous system. Such simple tasks are critical for isolating specific features of motor, sensory, or cognitive processes, and for inferring causality between these features and observed behavioral changes. However, it remains unclear how these theories translate to complex sensorimotor tasks or to natural behaviors. Part of the difficulty in performing such experiments has been the lack of appropriate tools for measuring complex motor skills (...) in real-world contexts. Robot-assisted surgery (RAS) provides an opportunity to overcome these challenges by enabling unobtrusive measurements of user behavior. In addition, a continuum of tasks with varying complexity – from simple tasks such as those in classic studies to highly complex tasks such as a surgical procedure – can be studied using RAS platforms. Finally, RAS includes a diverse participant population of inexperienced users all the way to expert surgeons. In this perspective, we illustrate how the characteristics of RAS systems make them compelling platforms to extend many theories in human neuroscience, as well as, to develop new theories altogether. (shrink)

Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among researchers seeking to investigate psychedelic (...) therapies in active-duty service members of the US military, particularly those with treatment refractory mental health conditions. At the same time, psychedelics remain in early stages of clinical investigation, have not yet achieved regulatory approval for general clinical use and may confer unique psychological and neurobiological effects that could raise novel ethical considerations when treating active-duty service members. Should psychedelics achieve regulatory approval, military relevant considerations may include issues of access to these treatments, appropriate procedures for informed consent, confidentiality standards, and possible unanticipated mental health risks and other psychological sequelae. A service member’s deployability, as well as their ability to return to full military duty following PAT, may also be of unique concern. The authors argue that MDMA-assisted therapy currently represents a promising treatment that should be more rapidly investigated as a clinical therapy for service members while still taking a measured approach that accounts for the many military-specific uncertainties that remain. (shrink)

This study examines the practices of Equine Assisted Therapy and Learning in Australia. Among Equine Assisted Therapy and Equine Assisted Learning centers there is a large degree of variation in practice worldwide. The current study outlines a range of practices in two states in Australia whereeatandealhave arisen and evolved from models developed elsewhere. The philosophical foundations, training and certification processes followed along with the types and training of horses involved are compared across facilities. The findings (...) of the study illustrated the large variation ineatandealin current practice in Australia. The results suggested that if the practices ofeatandealare to move out of the “fringe” of mental health and learning professional practice and into the mainstream, their theoretical underpinnings, certification and licensure procedures, and methodology of practice must become more clearly defined. (shrink)

This article presents a novel set of ten play scenarios for robot-assisted play for children with special needs. This set of scenarios is one of the key outcomes of the IROMEC project that investigated how robotic toys can become social mediators, encouraging children with special needs to discover a range of play styles, from solitary to collaborative play. The target user groups in the project were children with Mild Mental Retardation,1 children with Severe Motor Impairment and children with (...) Autism. The play scenarios were developed against specific educational and therapeutic objectives that were discussed with panels of experts in various countries, during several user panel meetings for each of the above mentioned target user groups. These objectives were classified with reference to the ICF-CY, the International Classification of Functioning – version for Children and Youth. The article presents a detailed description of the play scenarios, each with its relevant educational and therapeutic objectives in five key developmental areas. While the play scenarios described in this paper originally were developed for and tested with the above user groups and with the IROMEC robot, the play scenarios can potentially be applied to other user groups and to a wide range of other applications involving human-robot interaction using different robotic toys. Keywords: human-robot interaction; assistive technology; play scenarios; autism; mild mental retardation; sever motor impairment; assisted play. (shrink)

This essay looks askance at how robot-assisted childcare is constructed in the public domain of the Internet. Complex interactions of rhetorical manoeuvres, narratives and postnarrativity, and semiotic slippages may channel the apperception of this application of robotics. The prospect of robots in childcare roles is exceptionally contentious, for it connotes interference with the child-caregiver attachment bond. The industry’s response to psychology-informed concerns is to ‘rebrand’ the product as a robot companion for a child or as a home (...) robot for the family. A technocentric bias in information disseminated online creates an illusion of expertise and may endorse technology-driven morality. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

Is nonhuman animal-assisted therapy a form of exploitation? After exploring possible moral vindications of AAT and after establishing a distinction between "use" and "exploitation," the essay distinguishes between forms of animal-assisted therapy that are morally unobjectionable and those modes of it that ought to be abolished.

Since the 1970s, new therapeutic practices, involving the interaction between humans and dolphins - Tursiops truncatus in particular, have developed. Such practices are known as dolphin-assisted therapies (DAT), a specific case of a more heterogeneous set of experiences with dolphins called dolphin-assisted activities (DAA): these include programmes of dolphin watching and swimming in high seas, as well as shows in dolphinariums and marine parks. DAT has grown rapidly as a highly attractive form of therapy, due to the (...) well-liked animals used in an aquatic, and often exotic, environment. This kind of co-therapy seems to testify the enchantement that dolphins - in myths and chronicles often reported in rescue at sea, perceived as especially charismatic - exert on people; the human attempt of bonding with them, possibly in response to the need of building a human-animal bodily intersubjectivity. (shrink)

Robot-assisted retinal cannulation is an eye surgical procedure which can dissolve the obstruction by using robot to inject anticoagulant into occluded vessel. The current research on the critical parameters of cannulation for human is scarce because of the immature technology. Considering the influence of microneedle, this work investigated the effects of drug concentration, injection velocity, injection position, and size of clot on cannulation by theoretical analysis and finite element analysis. For finite element analysis, the multiphysics continuum model (...) was established to demonstrate species transport and reaction which simulates the entire lytic process of the occlusive clot, and four cell zones were established to describe the generation of plasmin with the addition of tissue-type plasminogen activator and fibrinolysis of clot by importing subroutines into each cell zone under the conditions of constant clot size and variable size, respectively. The results imply that the most efficient value of tPA concentration is 50 nM, injection velocity is 60 mm/s for clot length of 0.1 mm, and the best position to insert the cannula is 0.5 mm in front of the thrombus. For different clot lengths of 0.1 mm to 0.6 mm, the optimal range of tPA concentration and injection velocity is from 20 nM to 70 nM and from 40 mm/s to 60 mm/s, respectively, and explores the reasonable injection position of 0.3 mm to 0.5 mm in front of clot in a vein of 100 μm. This conclusion can be used to perform robot-assisted cannulation surgery to improve fibrinolytic efficiency. (shrink)

Here we provide an overview of some of the central ethical issues related to the use of surgical robots. Subsequently we introduce an anticipatory ethical analysis of possible consequences for the use of robotic surgery. Anticipatory ethics aims at identifying ethical problems with emerging technologies while they are at the introductory stages for a wide range of stakeholders. Robotic surgery presents a range of positive possibilities, which include treating patients more safely and effectively to caring for patients with telesurgery at (...) remote locations. However, injuries and deaths caused by robotic surgical platforms (RSPs) pose roadblocks to full realization of this technology. Investment in RSPs by for-profits like hospitals requires a detailed stakeholder analysis that takes into account both institutional and patient perspectives. It will take carefully crafted policy and regulation based upon sound technical and ethical analysis to induce the widespread adoption of this surgical method. (shrink)

The focus of this chapter is on some of the ethical and philosophical issues at the intersection of robotics and artificial intelligence (AI) applications in the health care sector and medical assistance in dying (e.g. physician-assisted suicide and euthanasia), including: (1) Is there a role for robotic systems/AI to play in the orchestration or delivery of assisted dying?; (2) Can the use of robotic systems/AI make the orchestration of assisted dying more ethical?; and (3) What insights can (...) be generated in the ethical debate on physician assisted suicide and euthanasia from considering the prospect of robotic systems/AI assisting with the provision of or providing assistance in dying? The prospect of including robotic systems/AI in the context of assisted dying provides opportunity to revisit longstanding philosophical and ethical issues under new light. Indeed, reflecting on these questions may invigorate debate, for example in reconsidering the de-medicalization of assisted dying, reconsidering whether assisted dying is within the proper scope of medicine, and reconsidering which normative approach to the ethics of assisted dying is the most appropriate. (shrink)

Twenty-five years ago, robotics guru Joseph Engelberger had a mission to motivate research teams all over the world to design the ‘Elderly Care Giver’, a multitasking personal robot assistant for everyday care needs in old age. In this article, we discuss how this vision of omnipotent care robots has influenced the design strategies of care robotics, the development of R&D initiatives and ethics research on use of care robots. Despite the expectations of robots revolutionizing care of older people, the (...) role of robots in human care has remained marginal. The value of world trade in service robots, including care robots, is rather small. We argue that the implementation of robots in care is not primarily due to negative user attitudes or ethical problems, but to problems in R&D and manufacturing. The care robots currently available on the market are capable of simple, repetitive tasks or colloquial interaction. Thus far, also research on care robots is mostly conducted using imaginary scenarios or small-scale tests built up for research purposes. To develop useful and affordable robot solutions that are ethically, socially and ecologically sustainable, we suggest that robot initiatives should be evaluated within the framework of care ecosystems. This implies that attention has to be paid to the social, emotional and practical contexts in which care is given and received. Also, the political, economic and ecological realities of organizing care and producing technological commodities have to be acknowledged. It is time to openly discuss the drivers behind care robot initiatives to outline the bigger picture of organizing care under conditions of limited resources. (shrink)

There is an urge to introduce high technology and robotics in care settings. Assisted living is the fastest growing form of older adults’ long-term care. Resident autonomy has become the watchword for good care. This article sheds light on the potential effects of care robotics on the sense of autonomy of older people in AL. Three aspects of the residents’ sense of autonomy are of particular interest: interaction-based sense of autonomy, coping-based sense of autonomy, and potential-based sense of autonomy. (...) Ethnographical data on resident autonomy in an AL facility and existing literature on care robots are utilized in studying what kind of assurances different types of robots would provide to maintain the sense of autonomy in AL. Robots could strengthen the different types of sense of autonomy in multiple ways. Different types of robots could widen the residents’ space of daily movements, sustain their capacities, and help them maintain and even create future expectations. Robots may strengthen the sense of autonomy of older persons in AL; however, they may simultaneously pose a threat. Multi-professional discussions are needed on whether robots are welcomed in care, and if they are, how, for whom, and in what areas. (shrink)

Socially Assistive Robots are increasingly conceived as applicable tools to be used in aged care. However, the use carries many negative and positive connotations. Negative connotations come forth out of romanticized views of care practices, disregarding their already established technological nature. Positive connotations are formulated out of techno-deterministic views on SAR use, presenting it as an inevitable and necessary next step in technological development to guarantee aged care. Ethical guidance of SAR use inspired by negative connotations tends to be over-restrictive (...) whereas positive connotations tend to provide over-permissive guidance. To avoid these extremes, we report on the development and content of 21 ethical orientations regarding SAR use in aged care. These orientations resulted from a multi-phased project, which consisted of empirical-ethical research focusing on older adults’ intuitions regarding SAR use and philosophical-ethical research focusing on philosophical-ethical argumentations regarding SAR use. This project led to the Socio-historical contextualization of the ethics of SAR use, in which the ethical impact of SAR use is localized on three interrelated analysis levels: societal, organizational, and individual-relational. The 21 novel orientations regarding SAR use are structured according to these levels and further categorized into foundational and applied orientations. The first category leads to critical reflection on SAR use while the latter category inspires decision-making processes regarding this use. While going beyond the care-romantic and techno-deterministic gaze of SAR use in aged care, the described orientations balance themselves between their over-restrictiveness and over-permissiveness. (shrink)

Most neuroimaging research in stroke rehabilitation mainly focuses on the neural mechanisms underlying the natural history of post-stroke recovery. However, connectivity mapping from resting-state fMRI is well suited for different neurological conditions and provides a promising method to explore plastic changes for treatment-induced recovery from stroke. We examined the changes in resting-state functional connectivity (RS-FC) of the ipsilesional primary motor cortex (M1) in 10 post-acute stroke patients before and immediately after 4 weeks of robot-assisted bilateral arm therapy (...) (RBAT). Motor performance, functional use of the affected arm, and daily function improved in all participants. Reduced interhemispheric RS-FC between the ipsilesional and contralesional M1 (M1-M1) and the contralesional-lateralized connections were noted before treatment. In contrast, greater M1-M1 functional connectivity and disturbed resting-state networks were observed after RBAT relative to pre-treatment. Increased changes in M1-M1 RS-FC after RBAT were coupled with better motor and functional improvements. Mediation analysis showed the pre-to-post difference in M1-M1 RS-FC was a significant mediator for the relationship between motor and functional recovery. These results show neuroplastic changes and functional recoveries induced by RBAT in post-acute stroke survivors and suggest that interhemispheric functional connectivity in the motor cortex may be a neurobiological marker for recovery after stroke rehabilitation. (shrink)

Psilocybin-assisted psychotherapy, i.e., psilocybin treatment with psychological support, has demonstrated the efficacy of psilocybin to reduce depressive symptoms. However, in clinical trials, the structure of psilocybin-assisted psychotherapy is primarily based on preparation, navigation, and integration. For psychotherapeutic guidance, the application of this structure is favored over the usage of theoretical models. The applied psychotherapeutic models may be of critical importance if the effects are augmented due to the psychologically insightful experiences during the navigation and integration sessions. One of (...) the important next steps is to provide therapists with guidance on how to provide psilocybin-assisted psychotherapy. We present an integrated protocol for psilocybin-assisted psychotherapy for depression based on the theoretical model and psychotherapeutic framework of Compassion Focused Therapy. We hypothesize that CFT can provide the theoretical model and compassion practices that will reinforce the experiences during the navigation and follow-up therapy sessions. In this paper, we describe the rationale for selecting CFT, the compatibility of CFT and psilocybin-therapy, an overview of the psilocybin-assisted CFT protocol, the study protocol, and limitations to this approach. (shrink)

Sports physicians are continuously confronted with new biotechnological innovations. This applies not only to doping in sports, but to all kinds of so-called enhancement methods. One fundamental problem regarding the sports physician's self-image consists in a blurred distinction between therapeutic treatment and non-therapeutic performance enhancement. After a brief inventory of the sports physician's work environment I reject as insufficient the attempts to resolve the conflict of the sports physician by making it a classificatory problem. Followed by a critical assessment of (...) some ideas from the US President's Council on Bioethics, the formulation of ethical codes and attempts regarding a moral topography, it is argued that the sports physician's conflict cannot be resolved by the distinction between therapy and enhancement. Instead, we also have to consider the possibility that the therapy-based paradigm of medicine cannot do justice to the challenges of the continuously increasing technical manipulability of the human body and even our cognitive functions as well. At the same time we should not adhere to transhumanist ideas, because non-therapeutic interventions require clear criteria. Based on assistive technologies an alternative framework can be sketched that allows for the integration of therapeutic and non-therapeutic purposes. After a thorough definition of standards and criteria, the role of the sports physician might be defined as that of an assistant for enhancement. Yet the process of defining such an alternative framework is a societal and political task that cannot be accomplished by the sports physicians themselves. Until these questions are answered sports physicians continue to find themselves in a structural dilemma that they partially can come to terms with through personal integrity. (shrink)

This article describes an equine-assisted experiential therapy approach and presents treatment outcomes in 31 participants in an equine-assisted, experiential therapy program. Participants completed psychological measures prior to treatment, immediately following treatment, and 6 months after treatment. Reported reductions in psychological distress and enhancements in psychological well being were significant immediately following treatment and were stable at 6-month follow-up. The article discusses the clinical implications and limitations of the present study and directions for further research.

BackgroundFunctional changes after spinal cord injury are related to changes in cortical plasticity. These changes can be measured with electroencephalography and has potential to be used as a clinical biomarker.MethodIn this longitudinal study participants underwent a total of 30 sessions of robotic-assisted gait training over a course of 6 weeks. The duration of each session was 30 min. Resting state EEG was recorded before and after 30-session rehabilitation therapy. To measure gait, we used the Walking Index for Spinal (...) Cord Injury Scale, 10-Meter- Walking Test, Timed-Up-and-Go, and 6-Min-Walking Test. Balance was measured using Berg Balance Scale.ResultsFifteen participants with incomplete SCI who had AIS C or D injuries based on American Spinal Cord Injury Association Impairment Scale classification were included in this study. Mean age was 35.7 years and the mean time since injury was 17.08 months. All participants showed clinical improvement with the rehabilitation program. EEG data revealed that high beta EEG activity in the central area had a negative correlation with gait and balance measured at baseline, in a way that greater high beta EEG power was related to worse clinical function at baseline. Moreover, improvement in gait and balance had negative correlations with the change in alpha/theta ratio in the parietal area.ConclusionIn SCI, functional impairment and subsequent improvement following rehabilitation therapy with RAGT correlated with the change in cortical activity measured by EEG. Our results suggest that EEG alpha/theta ratio may be a potential surrogate marker of functional improvement during rehabilitation. Future studies are necessary to improve and validate these findings as a neurophysiological biomarker for SCI rehabilitation. (shrink)

Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between these two fields (...) is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use in aged care to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use in aged care which rests on three pillars: stakeholders’ intuitions about SAR use as sources of knowledge; interpretative dialogues as democratic spaces to discuss the ethics of SAR use; the concretisation of ethics in SAR use. (shrink)

This article discusses the potential of using interactive environments in autism therapy. We specifically address issues relevant to the Aurora project, which studies the possible role of autonomous, mobile robots as therapeutic tools for children with autism. Theories of mindreading, social cognition and imitation that informed the Aurora project are discussed and their relevance to the project is outlined. Our approach is put in the broader context of socially intelligent agents and interactive environments. We summarise results from trials with (...) a particular mobile robot. Finally, we draw some comparisons to research on interactive virtual environments in the context of autism therapy and education. We conclude by discussing future directions and open issues. (shrink)

Socially assistive robotics is a growing area of research. Evaluating SAR systems presents novel challenges. Using a robot for a socially assistive task can have various benefits and ethical implications. Many questions are important to understanding whether a robot is effective for a given application domain. This paper describes several benchmarks for evaluating SAR systems. There exist numerous methods for evaluating the many factors involved in a robot’s design. Benchmarks from psychology, anthropology, medicine, and human–robot interaction (...) are proposed as measures of success in evaluating a given SAR system and its impact on the user and broader population. (shrink)

Socially assistive robotics is a growing area of research. Evaluating SAR systems presents novel challenges. Using a robot for a socially assistive task can have various benefits and ethical implications. Many questions are important to understanding whether a robot is effective for a given application domain. This paper describes several benchmarks for evaluating SAR systems. There exist numerous methods for evaluating the many factors involved in a robot’s design. Benchmarks from psychology, anthropology, medicine, and human–robot interaction (...) are proposed as measures of success in evaluating a given SAR system and its impact on the user and broader population. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and (...) the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

This paper offers an ethical framework for the development of robots as home companions that are intended to address the isolation and reduced physical functioning of frail older people with capacity, especially those living alone in a noninstitutional setting. Our ethical framework gives autonomy priority in a list of purposes served by assistive technology in general, and carebots in particular. It first introduces the notion of “presence” and draws a distinction between humanoid multi-function robots and non-humanoid robots to suggest that (...) the former provide a more sophisticated presence than the latter. It then looks at the difference between lower-tech assistive technological support for older people and its benefits, and contrasts these with what robots can offer. This provides some context for the ethical assessment of robotic assistive technology. We then consider what might need to be added to presence to produce care from a companion robot that deals with older people’s reduced functioning and isolation. Finally, we outline and explain our ethical framework. We discuss how it combines sometimes conflicting values that the design of a carebot might incorporate, if informed by an analysis of the different roles that can be served by a companion robot. (shrink)