In future decades, the need for effective strategies for medical rehabilitation will increase significantly, because patients' rate of survival after diseases with severe functional deficits, such as a stroke, will increase. Socially assistive robots (SARs) are already being used in rehabilitation for this reason.
In the journal Science Robotics, a research team including Dr. Shelly Levy-Tzedek of BGU's Department of Physical Therapy and the Zlotowski Center for Neuroscience and doctoral students Ronit Feingold-Polak, along with neuroscientist Dr. Philipp Kellmeyer of the Freiburg University Medical Center and Prof. Oliver Müller from the Department of Philosophy of the University of Freiburg, analyzes the improvements necessary to make SARs valuable and trustworthy assistants for medical therapies.
The researchers conclude that the development of SARs not only requires technical improvements, but primarily social, trust-building measures. Rehabilitation patients in particular are dependent on a reliable relationship with their therapists, so there must be trust in the safety of the robotic system, especially regarding the predictability of the machines' behavior. Given the ever-growing intelligence of the robots and with it their independence, this is highly important.
In addition, robots and patients can only interact well, the scientists explain, when they have shared goals that they pursue through the therapy. To achieve this, aspects of philosophical and developmental psychology must also be taken into account in the development of SARs: the ability of robots to recognize the aims and motives of a patient is a critical requirement if cooperation is to be successful. So there must also be trust for the participants to adapt to one another. The frustration felt by patients, for instance as a result of physical or linguistic limitations, would be avoided if the robots were adapted to the specific needs and vulnerabilities of the patient in question.
"Patients during rehabilitation, after a stroke for example, are in a vulnerable and emotional state", explains Dr. Levy-Tzedek. "To a great extent they rely on the feeling of trust they have established with their carers. For this reason, we have to carefully analyze what the advantages and disadvantages of using SARs in rehabilitation after a stroke are. As well as the pioneering contribution of robots to patient rehabilitation, their use raises important ethical and social questions. We contend that the creation of trust is a necessary condition for the success of this interaction, simultaneous with technological progress."
According to Levy-Tzedek, SARs can assist with exercises the patient has to do, but it should be taken into consideration the difficulties that could arise between the person undergoing rehabilitation and the robot: "For example, there could be expectations from a robot who looks like and behaves like a human that the robot cannot fulfill", she says. "This could lead to disappointment and a break in trust, and to decide not to exercise because of this". Likewise, a robot that becomes stuck or behaves unpredictably, will make it harder for the patient to trust that it is a successful partner in the rehabilitation project.
The researchers suggest in the article several ways to build trust between the patient and the robot: The patient should be trusting and be sure that the interaction with the robot is safe and that he is carrying out movements beneficial to his treatment. Patients should be able to identify and predict the intentions of the robot during treatment, and the robot should be aware of the mental and physical state of the patient. As such, the robot should be able to communicate with people experiencing communication difficulties – both in understanding spoken language and speaking.
In recent years, Levy-Tzedek has headed The Cognition, Aging and Rehabilitation Lab in BGU's Faculty of Health Sciences examining the effects of age and disease (in particular, Parkinson's disease & stroke) on the control of body movement, and how to best employ robotics to facilitate a fast and efficient rehabilitation process.
She takes a multi-disciplinary approach to her studies: the students on her team come from varied backgrounds, including physical therapy, engineering and psychology, and she collaborates with faculty members from Israel, Canada, England, the United States and Germany who come from diverse fields such as Industrial Engineering, Psychology, Computer Science, Robotics, Education and Philosophy.
Her work is supported by several grants from various sources, including the ISF (Israeli Science Foundation), the Swedish Promobilia rehabilitation foundation, and the Leir, Bronfman and Borten foundations in the US.
