Overview

The following section focuses on researched concepts that provided a basis for our project, accompanied by relevant literature. Using robots as a tool and companion for patients has been an area of research for a significant time. This project aims to focus on developing such a robot for patients with dementia (PwD) while keeping in mind objectives such as keeping the patient healthy and improving their quality of life. In this section we analyze the previous research done with robots in association with people with dementia, analyze the role of music, and finally assess activities performed using robots in order to gain inspiration and momentum for our own idea. 

Dementia and Robots

Robots therapy and engagement for people with dementia is a research field with many diverse applications and interpretations. As we know robots can range from virtual to humaniod to animal like, with all having their advantages and disadvantages. One such study takes a deeper look at the effectiveness of a robot dog called AIBO in occupational therapy with demented patients and compared its effectiveness with a toy dog [1]. Experimentation and results of the study showed that although both versions, the robot and the toy dog could trigger some kind of memory and positive emotion, these seemed to be greater for when interacting with AIBO. Interactions with AIBO mostly consisted of caring for and interacting with the robot, and hence the final conclusion of the study showed that AIBO was clearly an effective rehabilitation tool in the treatment of severely demented patients.

PARO is another interactive robot designed in Japan with five types of sensors: light, tactile, posture, temperature, and audio. Kang et al. utilized PARO to conduct studies in various countries and settings, such as nursing homes, family homes, and day-care centers to analyze the effectiveness of PARO in relation to people with dementia. Interactions with the PARO robot were both individual and group setting, with a maximum of 15 participants. Final results demonstrated that interventions with PARO could be beneficial for improving quality of life, positive emotions, and feelings resulting from social interaction [2]. Additionally, the study also concluded that interactions with PARO can reduce feelings of depression and anxiety in people with dementia. Using these studies as our basis, we conclude that interactions with robots can indeed have a positive effect on people with dementia. 

Activity Aid

Engaging in activities and hobbies that we enjoy improve our day and mood significantly, and unfortunately this is an aspect of life that is severely compromised for for people with dementia. In the paper "Perspectives of People with Dementia About Meaningful Activities: A Synthesis", the authors studied the meanings of engagement in daily activities from the perspective of people with dementia [3]. In their study, they found that people with dementia often want to engage in personally meaningful activities that can connect with others, but as the stage of their illness becomes more severe it becomes harder and harder to do so. Engagement in personally valued activities is highly important as it reminds people of their interests and personalities, and hence losing this often feels like slowly losing a part of yourself. 

Being unable to participate in activities that they previously enjoyed, people with dementia may face decreased cognitive abilities, behavioral symptoms, and other far from ideal repercussions. Therefore a large part of our solution is to aid the patient by engaging them in activities they previously used to enjoy. Since steps of complex activities are often times forgotten, our solution consists of establishing a step by step activity breakdown that the patient can easily follow in order to perform their desired task. This steps are also customized to the cognitive ability of the particular PwD in question and hence ensure that no frustration results from going too fast or too slow.

Music Integration

Myriad of research has been performed on the effect of music on patient with dementia. From research it is clear that music with a stronger personal meaning can enhance the social, cognitive experience of people with dementia[4]. The importance of relation building through music was another key theme that was identified as valuable by McDermott et al. Although our prototype did not implement features where music is tailored to prior personal meaning, we attempt use it as a relation building tool to create importation associations for the PwD. For example music is played by Pepper to gain attention of the PwD before a medication reminder task. With repeated use, we aim that this musical piece can be related to taking medication even before Pepper reminds verbally to take the medication. Such associations might help improve memory and sense of autonomy. 

Evaluation

Our evaluation starts by constructing two questionnaires. When making questionnaires, it is usually recommended to use pre-existing commonly used questionnaires because they have been already validated. The downside of using a commonly used questionnaire is that it does not allow to design the questionnaire in a way that is specific to the experiments being performed. In order to create a specific yet valid questionnaire, we made our own questionnaire inspired by the Subjective Assessment of Speech System Interfaces (SASSI)[6]. We took a subset of the questions in SASSI and modified them to fit our needs. 

For the statistical test, we used the Wilcoxon test [6] because we do not assume that our data is normally distributed.
We used the Wilcoxon Signed-rank test to measure the statistical significance of the mood change before and after Pepper's interaction because the data comes from the same group of participants.
To measure the statistical significance between two different groups (like gardening group and dislike gardening group), we used the Wilcoxon Rank-Sum test.
The statistics value of the test is the sum of the difference in the rank.
The p-value is the probability of obtaining results at least as extreme as the one we obtained given that the null hypothesis is true. We decided to set a threshold of 5% to claim statistical significance.

References

[1] Tamura, T., Yonemitsu, S., Itoh, A., Oikawa, D., Kawakami, A., Higashi, Y., ... & Nakajima, K. (2004). Is an entertainment robot useful in the care of elderly people with severe dementia?. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(1), M83-M85. https://sci-hub.mksa.top/10.1093/gerona/59.1.M83
[2] Kang, H. S., Makimoto, K., Konno, R., & Koh, I. S. (2020). Review of outcome measures in PARO robot intervention studies for dementia care. Geriatric Nursing, 41(3), 207-214. https://sci-hub.hkvisa.net/10.1016/j.gerinurse.2019.09.003
[3] Han, A., Radel, J., McDowd, J. M., & Sabata, D. (2016). Perspectives of people with dementia about meaningful activities: a synthesis. American Journal of Alzheimer's Disease & Other Dementias®, 31(2), 115-123. https://journals.sagepub.com/doi/full/10.1177/1533317515598857
[4] Peeters, M. M., Harbers, M., & Neerincx, M. A. (2016). Designing a personal music assistant that enhances the social, cognitive, and affective experiences of people with dementia. Computers in Human Behavior, 63, 727-737. https://www.sciencedirect.com/science/article/pii/S0747563216304319?casa_token=6AeK_ClUscYAAAAA:YFjAd3zvdl6ZlVaZIw5Vl9Fhxduc7FAE12mKyOxHde1w347lABJMVCAYM-Cl5hanRZgnStKi7I0
[5] McDermott, O., Orrell, M., & Ridder, H. M. (2014). The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists. Aging & mental health, 18(6), 706-716. https://www.tandfonline.com/doi/full/10.1080/13607863.2013.875124
[6] Hone, K. S., & Graham, R. (2000). Towards a tool for the subjective assessment of speech system interfaces (SASSI). Natural Language Engineering, 6(3-4), 287-303. https://doi.org/10.1017/S1351324900002497
[7] Wilcoxon, F. (1992). Individual comparisons by ranking methods. In Breakthroughs in statistics (pp. 196-202). Springer, New York, NY. https://link.springer.com/chapter/10.1007/978-1-4612-4380-9_16