1. Introduction

The aim of our project was to provide support for people with dementia in their hobby of painting. This was done to bring some joy and comfort into their lives, especially if they previously enjoyed doing it. This could be done with a human caretaker but having a humanoid robot like Pepper has certain advantages in the overall painting activity. 

Pepper can improve and continue the engagement of PwDs toward painting. This would be done by gently triggering the PwD to paint and then providing support during the activity. Pepper will also as a result of the painting activity improve the quality and life of the PwD. This can be done by supporting them during painting and also playing some calming, ambient music. The painting activity would also bring together the PwD and their family since during the painting activity personalized recommendations could be given to the PwD to paint and once the painting is done, a picture could be taken and sent to the family. This should provide a much better connectedness and relatedness between the PwD and their family. Pepper would not do the painting activity for the PwD instead it will just guide them so it should also provide a much better sense of autonomy towards the task.

For all of these effects, we plan on using different questionnaires geared towards capturing the required measure to effectively evaluate our claims.

2. Method

The prototype was evaluated with an in-person experiment with multiple participants in a between-subject study.

2.1 Participants
Our colleagues from the course CS4235 SCE since the course scope does not allow us to evaluate our robot with actual PwDs.

2.2 Experimental Design

For the experiment, we used a within-subject design, as we did not have enough participants to do a statistically significant between-subject study. To mitigate the transfer effects caused by doing the same activity twice, we had half of the participants start with the control condition, and half of the participants start with the test condition. 

2.3 Tasks

We set up two tasks. One for the control condition and one for the test condition. 

For the test condition, we first provided the participant with painting and drawing utensils and a canvas. Then, we started up the robot to guide the activity. The robot was controlled through a Wizard of Oz system. 

For the control condition, we provided the participant with art supplies as well, but here the robot was not involved. Instead, they received an activity sheet that guided the participants in the same flow as the robot would do. The only main guidance that couldn't be given on paper was the search function for a suitable topic or personal picture to draw/paint.

2.4 Measures

We solely used qualitative measures for our experiment, as painting is a highly subjective experience. 

We gave each participant a questionnaire before and after the session.

In the before questionnaire, we asked them about their mood, painting experience, and general attitude to robots. This was done to later check if those variables have interaction effects with the main results. See here the before questionnaire.

In the after questionnaire, we measured their experience of the activity, using an adapted version of the PACE questionnaire used in [1]. We also asked two extra questions to gauge their likelihood of long-term engagement and perceived self-competence. See here the after questionnaire.

2.5 Procedure

The procedure was conducted as follows:

1. Welcome participants and explain what they are going to be doing.
2. Have them sign the consent form.
3. Complete Questionnaire 1 regarding:
   1. Their current mood
   2. Their previous painting/drawing experience
4. Have them do the painting session, either with the robot or not, depending on which group they belong to. 
5. Complete questionnaire 2 regarding:
   1. Their current mood
   2. Their satisfaction with the activity
   3. Whether they would like to paint more because of the activity
   4. Other feedback

2.6 Material

1. Consent form. To protect the privacy of participants and ensure that they accept that their data was analyzed by researchers, we had each participant fill in a consent form. This consent form and experiment were approved by the Ethics Commission of the TU Delft.
2. Pepper robot. We programmed this robot to interact with the participants as described in our earlier sections.
3. Utensils for painting and drawing: canvas, watercolors, and pencils. We offer each participant the choice of whether they want to draw or paint. 
4. Microsoft forms. All the questionnaires were performed by Microsoft Forms, a GDPR/TU Delft approved tool for gathering data. 

2.7 Human Research Ethics

In order to make sure that we align with TU Delft's standards regarding human research ethics, we have filled in the HREC form and created an informed consent form.

3. Results

We grouped the results of the PACE questionnaires into two partitions:  One set of questions relating more to RQ1 and one set of questions relating more to RQ2. In the following sections, we will outline the results for both research questions.

RQ1: How does the assistance provided by a social robot influence engagement in art-related tasks for people with dementia?

As shown in the figure above, the results were not exactly significant. The only question that obtained a reasonable p-score (P=0.022) was Q14. This implies that the robot did provide a more immersive activity where the urge to do something else was diminished. Due to the fact that the robot gives more active guidance than paper instructions, it could be hypothesized that the participants were more actively feeling part of the activity. 

RQ2: How does the assistance provided by a social robot influence the level of agitation in art-related tasks for people with dementia?

For this research question, the results also proved not to be conclusive. The only result that could be viewed as remotely significant is the result for question 7 (P=0.073). This could be caused either by the positive encouragement given by the robot, and/or the added functionality that the robot could search for pictures to draw. 

Aggregated score

To assess the generally positive impact of the robot, we also aggregated the scores to compare both test settings. This result also proved to be non-conclusive (P= 0.228). 

After Activity questions

We also analyzed the After Activity questions. These were asked to assess the robots' positive influence on EF01: Continued and improved engagement in painting (Q3) and the robots' positive influence on the competence part of the Self Determination Theory (Q4).

The students were agreeing on average with the statement "I would like to paint more in the future with the robot". However, for question 4, the general response was ambivalent. This is understandable as confidence in certain activity often only comes after multiple repetitions and not in one encounter. 

4. Discussion

The results do not show a conclusive effect on the added value of having a robot performing the activity. This is can be attributed to different possible causes. 

First of all, the questions that were asked were more focused on the experience of the activity rather than the specific added value a robot might give to the activity. Painting can be generally viewed as an enjoyable and engaging activity, so when focusing on the enjoyment part, it could be understood that the robot does not make a significant impact there. However, the robot might give a significant improvement in terms of support, motivation, and structure during the activity. Especially if the test was conducted on actual PwDs. For future work, it would be interesting to explore during the design process which parts of the activity the robot might be able to do more than paper instructions and to investigate how these contributions might be measured. 

Moreover, as we alluded to earlier, the activity might be experienced highly differently for PwDs than 20-year-old TU Delft students. Therefore, it is hard to draw any conclusions about the use of the robot by testing it on people who do not need much support from it. 

5. Conclusions

Our project sought to offer support to individuals suffering from dementia in their passion for painting, with the objective of enhancing their emotional well-being. While human caregivers could provide such assistance, utilizing a humanoid robot such as Pepper for painting activities provides several advantages. Pepper has the potential to enhance and sustain the interest of individuals with dementia in painting by encouraging them to paint and providing assistance during the activity. As a result, the quality of life of these individuals could be improved, which may be augmented by playing calming music during the painting process. In addition, this activity could bring together the individuals with their family members, as personalized painting recommendations could be provided, and photos of completed paintings could be shared. Rather than completing the painting activity for the individuals, Pepper would guide them through the process, promoting a greater sense of independence and self-sufficiency. 

We did a study to evaluate the effectiveness of having a robot like Pepper assisting the PwD with painting instead of the PwD doing the activity alone. Our results based on the responses obtained from our custom PACES questionnaire were statistically insignificant and hence we could not conclusively answer our research questions related to engagement and agitation. However, the raw scores of the questions were always in favor of having the robot while performing the activity which could indicate a positive attitude towards having the robot. Due to certain practical limitations of the course, we could not conduct the experiment with actual PwD or set it up in such a way but given enough time and effort the current implementation in Pepper could be extended to an actual care home with PwDs.

References

1. Mullen, S.P., Olson, E.A., Phillips, S.M. et al. Measuring enjoyment of physical activity in older adults: invariance of the physical activity enjoyment scale (paces) across groups and time. Int J Behav Nutr Phys Act 8, 103 (2011). https://doi.org/10.1186/1479-5868-8-103