Professional Documents
Culture Documents
FEATURES:
Probo, a “Huggable” Robot for Interactive Therapy
p 16
PRODUCT
COMPARISON:
Medical & Military Robots
p 28
COUNTRY FOCUS:
Romania
p 46
COVER STORY:
Robots: Almost
Commonplace
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.
Cyberpsychology,
Behavior, and
Social Networking
Special Issue on
Now Available Online! Posttraumatic Stress Disorder
Special Issue Lessons Learned from VR Sessions with
Warriors with Combat-Related PTSD
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TABLE OF CONTENTS
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/
JCR The Journal of
CyberTherapy
& Rehabilitation
SUBSCRIBE
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access to information on
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advanced technologies in
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40
The Journal of CyberTherapy & Re ha bilitation (JCR) is the official journal of the
International Association of CyberPsychology, Tra i n i ng & Re ha bil itation (iACToR ).
Its m ission is to explore the uses of adva nced tech nolog ies for ed ucation, tra i n i ng,
prevention, thera py, a nd reha bil itation .
P l e a s e v i s i t w w w.vr p h o b i a .e u f o r m o r e i nf o r m a t i o n .
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,
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
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
below the display. The system scales and
nication disorders, such as autism, as well as disorders of the
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
considerable time and resources in the de-
that allow it to balance upright on its hips,
knees, and lower wheels, standing upright.
robot to humanoid robots that can speak
and even act somewhat independently.
13
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 mwiederhold@vrphobia.com
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@vrphobia.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.
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
by remotely op- may lift and carry one side of a table while
erating a robot- a human lifts and carries the other side,
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
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-
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.
cleaning dishes, light cleaning and organ-
[ ]
melding of robotics and its traditional ap-
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-
neath the furniture. Long-term HERB work Rory A. Cooper, Ph.D.
that create a symbiosis of human and tech- University of Pittsburgh
nology maximizing the use of the abilities will focus on providing physical assistance
Siddhartha Srinivasa, Ph.D.
of the person and the capabilities of tech- to the user through physical contact to per-
Department of Veterans Affairs
nology in natural environments. The capa- form such tasks as transfers, or assisting
Chris Atkeson, Ph.D.
bilities to remove a sealed plastic container someone after a fall. HERB moves au- 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 RCOOPER@pitt.edu
use a remote caregiver to provide assistance chain activities where, for example, HERB
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
Legend
interaction with user
current implementation
under development
RCC
Operator
Probo Platform
Perceptual-System Cognitive Control-System Expressional-System Motor-System
Affective Speech
Needs
[ ]
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.saldien@howest.be
object identification. The stimuli will influ- motion is subsequently made more smooth
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
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
screen (a) is shown during passive mobilization, screen (b) and (c)
hour sessions per cial version of the ARMin robot is named 19
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
Tobias Nef, Ph. D
the training of functional movements will day. Two patients had four one hour train-
University of Bern
facilitate the carry-over of gains in motor ing sessions per week, and the other two
Robert Riener, Ph. D
abilities into improvements that are rele- patients had three one hour training ses-
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
tobias.nef@artorg.unibe.ch
of the upper extremity. Secondary outcomes
riener@mavt.ethz.ch
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-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
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
in the U.S. in 2009. While a myriad of
cidence of distant metastasis and
death from prostate cancer as com-
ci Surgical System manufactured by Intu-
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-
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
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
shown being inserted around the deep dorsal
prostatectomy has become a much prostatectomy is quite similar to many
vein complex to provide rapid and precise liga-
more feasible option. other centers with a few modifications.
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-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
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- david.lee@uphs.upenn.edu
less of their body habitus or size of the forming robot prostatectomy as well. Our
22
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
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
[ ]
of the conversation. and real-time animation of facial expres-
sions and gestures. Marc Cavazza, M.D., Ph.D.
In such a context, the need for robustness Teesside University
in speech understanding has led us to ex- The following dialogue example illustrates U.K.
plore different natural language process- the companion affective strategy when it m.o.cavazza@tees.ac.uk
ing solutions, such as Information Extrac- concludes that the user’s attitude may be
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
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.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
(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
of the shoulder (Figure 1), while a joint
the exoskeleton to replicate standard ex-
ercise machines. In these “isolateral” ex- A virtual wall-painting task designed to
25
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-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Robotic Arm Exoskeletons for Rehab
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. craigc@ssl.umd.edu
strength following a rotator cuff injury, Arm exoskeletons designed for treating
26
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
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-
ing and emotional responses, the program
such a dumb pile of rust! Don't your see
who you are working with here? This is
solution percentage of 47%.
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@iepdoc.nl
son associated position) and as an observer. to focus in on the central issue. I find the
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
PRODUCT COMPARISON
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
www.vrphobia.eu, cvalenti@vrphobia.com
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.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
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
amplitudes – with VR-based RAGT than
By shifting the height of the legs, the col-
or and the speed of the avatar, the envi-
tional outcome, as a result of patient co-
operative strategies such as VR.
31
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
Karin.Bruetsch@kispi.uzh.ch
a new serious game was developed – therefore meets therapeutic goals.
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES Robots that Care
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.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
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- jeroenarendsen@gmail.com
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 a.mert@mrcdoorn.nl.
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
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
[ ]
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.broekens@gmail.com
surfaces, or handing objects such as a phone, ios. Experiments have demonstrated that so-
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
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 jjb@cs.bath.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
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
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 mark.neerincx@tno.nl
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 nitiveRobotics
ed in 2010, developing methods for design- can initiate or support mitigation activities,
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
FEATURES
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FEATURES
[ ]
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- pbonato@partners.org
tion introduced by the robot decreases veloping exoskeleton systems for gait train- http://spauldingrehab.org/
gradually over time once the perturbation ing. An example of such systems is the
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
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.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
FURTHER AFIELD
FURTHER AFIELD:
Japan: Leading the Way in Elderly Care with
Rehabilitation Robots
Japanese descent that can mimic speaking, ton-based orthoses, such as knee-ankle-foot
By Lingjun Kong 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,
r a p i d l y 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-
ber of disabling age-related diseases, such as
trol of upper extremity muscles after stroke.
The mirror neuron system encourages the
41
population is expected to be 65 years or old-
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-
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
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 lkong@vrphobia.com
the visual feedback of the virtual world pro- and therapeutic robots is more than necessary www.vrphobia.com
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:
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-
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the management of psychological stress: a clinical scenario. Stud Health Technol Inform, 154, 20-25.
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
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- giuseppe.riva@unicatt.it
o f C y b e r P s y c h o l o g y , Tr a i n i n g & R e h a b i l i t a t i o n
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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
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continues to suffer from the anteceding 60 years, but
modern efforts have quickly sprung to the rescue.
46
Mental healthcare suf fered such tactics, while others became mad mark, increasing only .2% since
T h e O ff ic i a l Vo ice o f t h e I n te rn a t i o n a l Association
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