Agreement in the Postural Assessment of Older Adults by Physical Therapists Using Clinical and Imaging Methods.

Postural assessment is one of the indicators of health status in older adults. Since the number of older adults is on the rise, it is essential to assess simpler methods and automated ones in the future. Therefore, we focused on a visual method (imaging method). The purpose of this study is to determine the degree of agreement between the imaging method and the palpation and visual methods (clinical method). In addition, the influence of differences in the information content of the sagittal plane images on the assessment was also investigated. In this experiment, 28 sagittal photographs of older adults whose posture had already been assessed using the clinical method were used. Furthermore, based on these photographs, 28 gray and silhouette images (G and S images) were generated, respectively. The G and S images were assessed by 28 physical therapists (PTs) using the imaging method. The assessment was based on the Kendall classification, with one of four categories selected for each image: ideal, kyphosis lordosis, sway back, and flat back. Cross-tabulation matrices of the assessments using the clinical method and imaging method were created. In this table, four categories and two categories of ideal and non-ideal (KL, SB, and FB) were created. The agreement was evaluated using the prevalence-adjusted bias-adjusted kappa (PABAK). In addition, sensitivity and specificity were calculated to confirm the reliability. When comparing the clinical and imaging methods in the four posture categories, the PABAK values were -0.14 and -0.29 for the S and G images, respectively. In the case of the two categories, the PABAK values were 0.57 and 0.5 for the S and G images, respectively. The sensitivity and specificity were 86% and 57% for the S images and 76% and 71% for the G images, respectively. The four categories show that the imaging method is difficult to assess regardless of the image processing. However, in the case of the two categories, the same assessment of the clinical method applied to the imaging method for both the S and G images. Therefore, no differences in image processing were observed, suggesting that PTs can identify posture using the visual method.

Validating Knee Varus Alignment Measurements Using Markerless Motion Capture.

This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren-Lawrence classification (KL) and Pearson's correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA.

Effects of neurofeedback on standing postural control task with combined imagined and executed movements.

Introduction: Motor imagery (MI) is a method of imagining movement without actual movement, and its use in combination with motor execution (ME) enhances the effects of motor learning. Neurofeedback (NFB) is another method that promotes the effects of MI. This study aimed to investigate the effects of NFB on combined MI and ME (MIME) training in a standing postural control task. Methods: Sixteen participants were randomly divided into MIME and MIME + NFB groups and performed 10 trials of a postural control task on an unstable board, with nine trials of MI in between. Electroencephalogram was assessed during MI, and the MIME + NFB group received neurofeedback on the degree of MI via auditory stimulation. A postural control task using an unstable board was performed before and after the MIME task, during which postural instability was evaluated. Results: Postural instability was reduced after the MIME task in both groups. In addition, the root mean square, which indicates the sway of the unstable board, was significantly reduced in the MIME + NFB group compared to that in the MIME group. Conclusion: Our results indicate that MIME training is effective for motor learning of standing postural control. Furthermore, when MI and ME are combined, the feedback on the degree of MI enhances the learning effect.

Spinal alignment measurement with Kinect sensor is valid for thoracic kyphosis but not for lumbar lordosis.

BACKGROUND: Spinal alignment evaluation is commonly performed in the clinical setting during rehabilitation. However, there is no simple method for its quantitative measurement. Recently, the depth cameras in Kinect sensors have been employed in various commercial and research projects in the healthcare field. We hypothesized that the time-of-flight technology of the Kinect sensor could be applied to quantitatively evaluate spinal alignment. The purpose of this study was to develop a simple and noninvasive evaluation for spinal alignment using the Kinect sensor and to investigate its validity. METHODS: Twenty-four healthy men participated in the study. Measurement outcomes were the thoracic kyphosis and lumbar lordosis angles in the standing position, using a Spinal Mouse, the validity of which has been previously reported, and the Kinect sensor. In the measurement by the Kinect sensor, a program was created to obtain the three-dimensional coordinates of each point within an area marked on the monitor, and the sums of the angles at each vertebral level were calculated for the thoracic and lumbar areas. Pearson's correlation coefficient was used to analyze the relationship between the Kinect sensor and Spinal Mouse measurements of thoracic kyphosis and lumbar lordosis angles. RESULTS: There was a significant positive and moderate correlation between the thoracic kyphosis measurements taken by each device. Contrarily, there was no significant correlation in the lordosis angle between measurements using the Kinect sensor and Spinal Mouse. CONCLUSIONS: Our results demonstrated the validity of measuring the thoracic kyphosis angle using the Kinect sensor. This indicates that the depth camera in the Kinect sensor is able to perform accurate thoracic alignment measurements quickly and noninvasively.

Comparison of Subjective Facial Emotion Recognition and "Facial Emotion Recognition Based on Multi-Task Cascaded Convolutional Network Face Detection" between Patients with Schizophrenia and Healthy Participants.

Patients with schizophrenia may exhibit a flat affect and poor facial expressions. This study aimed to compare subjective facial emotion recognition (FER) and FER based on multi-task cascaded convolutional network (MTCNN) face detection in 31 patients with schizophrenia (patient group) and 40 healthy participants (healthy participant group). A Pepper Robot was used to converse with the 71 aforementioned participants; these conversations were recorded on video. Subjective FER (assigned by medical experts based on video recordings) and FER based on MTCNN face detection was used to understand facial expressions during conversations. This study confirmed the discriminant accuracy of the FER based on MTCNN face detection. The analysis of the smiles of healthy participants revealed that the kappa coefficients of subjective FER (by six examiners) and FER based on MTCNN face detection concurred (κ = 0.63). The perfect agreement rate between the subjective FER (by three medical experts) and FER based on MTCNN face detection in the patient, and healthy participant groups were analyzed using Fisher's exact probability test where no significant difference was observed (p = 0.72). The validity and reliability were assessed by comparing the subjective FER and FER based on MTCNN face detection. The reliability coefficient of FER based on MTCNN face detection was low for both the patient and healthy participant groups.

Dynamic three-dimensional shoulder kinematics in patients with massive rotator cuff tears: a comparison of patients with and without subscapularis tears.

BACKGROUND: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. METHODS: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. RESULTS: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. -1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. CONCLUSIONS: In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.

Robots and Robotics in Nursing.

Technological advancements have led to the use of robots as prospective partners to complement understaffing and deliver effective care to patients. This article discusses relevant concepts on robots from the perspective of nursing theories and robotics in nursing and examines the distinctions between human beings and healthcare robots as partners and robot development examples and challenges. Robotics in nursing is an interdisciplinary discipline that studies methodologies, technologies, and ethics for developing robots that support and collaborate with physicians, nurses, and other healthcare workers in practice. Robotics in nursing is geared toward learning the knowledge of robots for better nursing care, and for this purpose, it is also to propose the necessary robots and develop them in collaboration with engineers. Two points were highlighted regarding the use of robots in health care practice: issues of replacing humans because of human resource understaffing and concerns about robot capabilities to engage in nursing practice grounded in caring science. This article stresses that technology and artificial intelligence are useful and practical for patients. However, further research is required that considers what robotics in nursing means and the use of robotics in nursing.

Remote-Controlled Drone System through Eye Movements of Patients Who Need Long-Term Care: An Intermediary's Role.

The use of a remote-controlled drone system (RDS) by eye movements was studied to assist patients in psychiatric long-term care (PLTC) to allow them to view the environment outside the hospital, hoping that this will bring them some enjoyment. However, successfully applying this system requires human intermediaries in facilitating the interactions between patients and RDS operators. The aim of the study was to describe the role of nurses as intermediaries in the application of an RDS through eye movements of patients PLTC. This study employed the Intentional Observational Clinical Research Design. Data collection was performed in November 2021 at a psychiatric hospital with selected patients in PLTC. Seventeen patients took part in the indoor experiment, whereas 23 patients took part in the outdoor experiment. Fifteen of the 23 patients in the outdoor experiment were the same patients who took part in the indoor experiment. Most of the patients in the indoor and outdoor test arenas could successfully, delightfully, and safely fly the drone. This study demonstrated that RDS using just eye movements could increase the quality of life in older patients with psychiatric problems in PLTC. For the successful use of this drone system, nurse intermediaries assumed critically significant roles.

Investigation of Methods to Create Future Multimodal Emotional Data for Robot Interactions in Patients with Schizophrenia: A Case Study.

Rapid progress in humanoid robot investigations offers possibilities for improving the competencies of people with social disorders, although this improvement of humanoid robots remains unexplored for schizophrenic people. Methods for creating future multimodal emotional data for robot interactions were studied in this case study of a 40-year-old male patient with disorganized schizophrenia without comorbidities. The qualitative data included heart rate variability (HRV), video-audio recordings, and field notes. HRV, Haar cascade classifier (HCC), and Empath API© were evaluated during conversations between the patient and robot. Two expert nurses and one psychiatrist evaluated facial expressions. The research hypothesis questioned whether HRV, HCC, and Empath API© are useful for creating future multimodal emotional data about robot-patient interactions. The HRV analysis showed persistent sympathetic dominance, matching the human-robot conversational situation. The result of HCC was in agreement with that of human observation, in the case of rough consensus. In the case of observed results disagreed upon by experts, the HCC result was also different. However, emotional assessments by experts using Empath API© were also found to be inconsistent. We believe that with further investigation, a clearer identification of methods for multimodal emotional data for robot interactions can be achieved for patients with schizophrenia.

Usefulness of 2D Video Analysis for Evaluation of Shoulder Range of Motion during Upper Limb Exercise in Patients with Psychiatric Disorders.

Aging and its associated problems related to movement impacts the care of people with psychiatric disorders. This study sought to clarify the usefulness of 2D video analysis for evaluating shoulder range of motion (ROM) during upper limb exercises in patients with psychiatric disorders. Subjects (N=54) were patients with psychiatric disorders categorized as the following:having either a high or low activities of daily living (ADL) score using the Barthel Index;experiencing shoulder ROM limitation, and whether or not compensatory movements were exhibited. Compensatory movement was also considered in patients with Parkinsonism, cerebrovascular disease, and cognitive dysfunction. Shoulder joint ROM was measured using a goniometer and active ROM was captured using ImageJ. No significant difference between passive ROM measured by a goniometer and active ROM measured by ImageJ considering disease groups, ADL level, and shoulder ROM limitation was found. Factoring in compensatory movements, however, significant differences were found between passive and active ROM:existence compensatory movement group, left side (z=-2.30, p=0.02);nonexistence compensatory movement group, right side (z=-2.63, p<0.001). Image-evaluating devices help assess ROM in patients with psychiatric disorders, enhancing the development of physical rehabilitation programs to regain critical ADL, sustaining self-care capabilities. J. Med. Invest. 69 : 70-79, February, 2022.

Relationship between Standing Trunk Extension Angle and Medial Elbow Injuries in Young Baseball Pitchers.

Purpose: The purpose of this study was to investigate the relationship between the standing trunk extension angle and medial elbow injuries. Subjects and methods: The study participants were 90 male baseball pitchers (10−12 years) belonging to youth baseball teams. Pitching elbow injuries were evaluated by an orthopedic surgeon using ultrasound scans and physical examination findings. A single optical three-dimensional motion analysis system was used for the trunk extension measurements, with three-dimensional coordinates captured. The overall, upper, and lower trunk angles were then analyzed. Results: Trunk extension angle during standing trunk extension was significantly smaller among participants who were positive for medial elbow injuries on ultrasound scans (positive: 71.4° ± 10.3°; negative: 75.7° ± 9.2°; t = 2.05, p < 0.05). The upper trunk extension angle was significantly smaller than the lower trunk extension angle among participants who were positive for medial elbow injuries on physical examination (upper: 33.0° ± 6.9°; lower: 41.2° ± 8.2°; t = −2.42, p < 0.05). Conclusions: Trunk extension angle during standing trunk extension is associated with medial elbow injuries. Evaluating the trunk extension angle as multiple segments rather than a single rigid body is valuable.

Characteristics of interactive communication between Pepper robot, patients with schizophrenia, and healthy persons.

Background: Expressing enjoyment when conversing with healthcare robots is an opportunity to enhance the value of human robots with interactive capabilities. In clinical practice, it is common to find verbal dysfunctions in patients with schizophrenia. Thus, interactive communication characteristics may vary between Pepper robot, persons with schizophrenia, and healthy persons. Objective: Two case studies aimed to describe the characteristics of interactive communications, 1) between Pepper as a healthcare robot and two patients with schizophrenia, and 2) between Pepper as a healthcare robot and two healthy persons. Case Report: The "Intentional Observational Clinical Research Design" was used to collect data. Using audio-video technology, the conversational interactions between the four participants with the Pepper healthcare robot were recorded. Their interactions were observed, with significant events noted. After their interactions, the four participants were interviewed regarding their experience and impressions of interacting with the Pepper healthcare robot. Audio-video recordings were analyzed following the analysis and interpretation protocol, and the interview data were transcribed, analyzed, and interpreted. Discussion: There were similarities and differences in the interactive communication characteristics between the Pepper robot and the two participants with schizophrenia and between Pepper and the two healthy participants. The similarities were experiences of human enjoyment while interacting with the Pepper robot. This enjoyment was enhanced with the expectancy of the Pepper robot as able to entertain, and possessing interactive capabilities, indicating two-way conversational abilities. However, different communicating characteristics were found between the healthy participants' impressions of the Pepper robot and the participants with schizophrenia. Healthy participants understood Pepper to be an automaton, with responses to questions often constrained and, on many occasions, displaying inaccurate gaze. Conclusion: Pepper robot showed capabilities for effective communication pertaining to expressing enjoyment. The accuracy and appropriateness of gaze remained a critical characteristic regardless of the situation or occasion with interactions between persons with schizophrenia, and between healthy persons. It is important to consider that in the future, for effective use of healthcare robots with multiple users, improvements in the areas of the appropriateness of gaze, response time during the conversation, and entertaining functions are critically observed.

Motion Analysis Focusing on Rotational Movements of Professional Female Baseball Pitchers: Comparison with Male University Baseball Pitchers.

PURPOSE: The purpose of this study was to compare pitching motion of the professional female baseball pitchers with the male university baseball pitchers focused on the pelvic and thoracic movements. SUBJECTS AND METHODS: The participants were 15 healthy professional female baseball pitchers (11 right-handers and 4 left-handers; age, 21.7 ± 3.2 years; height, 162.5 ± 5.1 cm; weight, 59.0 ± 6.6 kg) and 14 healthy male university baseball pitchers (12 right-handers and 2 left-handers; age, 19.9 ± 0.8 years; height, 176.4 ± 3.0 cm; body mass, 73.1 ± 3.0 kg). Throwing motion was captured by three-dimensional motion analysis system. Kinematic data of the lead hip, pelvis, thorax, and dominant shoulder were collected and the joint angle at maximum external rotation phase and ball release phase were compared. RESULTS: The female baseball pitchers rotated pelvis and thorax more than the male at the maximum external rotation phase and ball release phase (p < 0.05). At the same, the pelvis and thorax of the female baseball pitchers were tilted significantly closer to horizontal plane than the male (p < 0.05). The pelvis and thorax of the male baseball pitchers was tilted to non-dominant lateral side. CONCLUSIONS: The results of this study indicate that the pelvic and thoracic movements of the professional female baseball pitchers was different from male university pitchers.

Intentional Observational Clinical Research Design: Innovative Design for Complex Clinical Research Using Advanced Technology.

The growing use of robots in nursing and healthcare facilities has prompted increasing research on human-robot interactions. However, specific research designs that can guide researchers to conduct rigorous investigations on human-robot interactions are limited. This paper aims to discuss the development and application of a new research design-the Intentional Observational Clinical Research Design (IOCRD). Data sources to develop the IOCRD were derived from surveyed literature of the past decade, focusing on clinical nursing research and theories relating robotics to nursing and healthcare practice. The distinction between IOCRD and other research design is the simultaneous data generation collected using advanced technological devices, for example, the wireless Bonaly-light electrocardiogram (ECG) to track heart rate variability of research subjects, robot application programs on the iPad mini to control robot speech and gestures, and Natural Language Processing programs. Even though IOCRD was developed for human-robot research, there remain vast opportunities for its use in nursing practice and healthcare. With the unique feature of simultaneous data generation and analysis, an interdisciplinary collaborative research team is strongly suggested. The IOCRD is expected to contribute guidance for researchers in conducting clinical research related to robotics in nursing and healthcare.

Differences in Electromyographic Activities and Spatiotemporal Gait Parameters between General and Developed Insoles with a Toe-Grip Bar.

The present study was aimed at comparing the muscle activities and gait parameters between the toe-grip bar insoles and general insoles during walking using randomized crossover design. Twelve healthy men participated in this study. Temporal and spatial gait parameters and electromyography (EMG) results were concurrently collected while the subjects walked along an 8 m walkway with the developed and general insoles. Developed insoles provide a three-dimensional mesh structure at the toe portion and a convex bulging structure (toe-grip bar) near the center of the proximal phalanx of the first to fifth toe. The linear mixed model was used to estimate the toe-grip bar insole effect. The results showed that there were no sequence or period effects for any of the examined parameters. During the stance phase, those wearing the developed insoles had significantly higher %IEMG for the TA, GM, and GL than those wearing the general insoles (TA: 5.03%IEMG, p = 0.005; GM: 4.65%IEMG, p = 0.046; and GL: 6.50%IEMG, p = 0.008). During the swing phase, those wearing the developed insoles had significantly higher activity for only the TA compared to those wearing the general insoles (5.54%IEMG, p = 0.011). With respect to gait parameters, those wearing the developed insoles had greater step length (2.81 cm, p = 0.038), longer stance time (0.03 s, p = 0.001), and shorter swing time (-0.02 s, p = 0.003) compared to those wearing the general insoles. The results suggest that walking with toe-grip bar insoles contributes to increased crural muscle activity and step length.

The effect of wearing insoles with a toe-grip bar on occupational leg swelling and lower limb muscle activity: A randomized cross-over study.

OBJECTIVE: Sitting or standing for hours decreases the blood flow in the legs and results in increased pressure on the veins, leading to the development of chronic venous disease. This study aimed to investigate the effects of insoles with a toe-grip bar on occupational leg swelling and lower limb muscle activity. METHODS: This randomized cross-over study enrolled 12 healthy men who work in a sitting or standing position. They were randomly divided into groups A (wore shoes with insoles with a toe-grip bar for 8 hours each) and B (wore shoes with regular insoles for 8 hours each). After 1 week, groups A and B wore shoes with regular insoles and shoes with insoles with a toe-grip bar, respectively, for 8 hours each. Lower leg volume was measured before and after each intervention, and lower limb muscle activity was measured at the start of each intervention. RESULTS: Occupational leg swelling was significantly smaller in men wearing insoles with a toe-grip bar (P < .05). Moreover, the integrated electromyogram value of the tibialis anterior muscle and medial and lateral gastrocnemius muscles during the stance phase of walking, and tibialis anterior muscle during the swing phase of walking was significantly greater in men wearing insoles with a toe-grip bar (all P < .05). CONCLUSION: Insoles with a toe-grip bar contribute to increased lower limb muscle activity, attenuating occupational leg swelling.

Evaluation of the Remote-controlled Drone System using an Eye-tracking device through the Internet for patients in bedridden conditions

In many countries, the rate of aging in their population is rapidly increasing. It is expected that this increasing trend influences the number of patients in bedridden states who have difficulty moving their extremities, such as those patients with amyotrophic lateral sclerosis (ALS). The patients are limited in many aspects of their daily lives; this includes not seeing what is outside of their rooms, affecting their quality of life (QOL). Thus, this study aims to evaluate the Remote-controlled Drone System using the Eye-tracking device through the Internet (RDSEI) to improve QOL for patients in bedridden conditions. The novel RDSEI is proposed and developed by the Kai laboratory. The RDSEI consists of a drone, a transmitter, a control screen, an eye-tracking device, a video capture device, a server computer, and a client computer. The subjects of this experimental evaluation of the RDSEI were five healthy male adults (average age: 20.6 years old). Experimental results indicated that all the subjects could control the drone easily by using this system, although there were delays, blurriness, and freezing of the video. Therefore, it was concluded that by using this system, the subjects could control the drone by only their eye movements, thereby enabling them to see the outside world through the drone's camera. In the future, the patients will be able to control the RDSEI from remote locations and converse with persons in remote locations

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Development of a knee joint assist suit with a velocity-based mechanical safety device: Control method and experiments

The aim of this study is to examine the proposed control method of the assist suit with a Velocity-Based Mechanical Safety Device (VBMSD) for patients with difficulty moving their lower legs by themselves. The proposed control method for the assist suit assists the patients as if the patients move their knee joint under zero gravity. A physical simulation model is used to examine whether the gravitational torque of the subject's lower leg and foot was canceled by the torque generated by the assist suit. Experimental results indicated that the gravitational torque of the subject's lower leg and foot is canceled by the torque generated by the assist suit. The control of the assist suit was not adversely influenced by the VBMSD. That is, the VBMSD did not prevent the control of the assist suit. The proposed control method makes the assist suit assist the patient in moving his/her knee joint in a zero gravity-like environment. However, a weight of 3 kg was used instead of an actual patient in the experiment. Experiments with actual patients should be conducted to verify the effectiveness of the proposed control method in clinical use. Furthermore, it will be necessary to take into consideration the patients' general conditions and symptoms

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Autonomic nervous activity of patient with schizophrenia during Pepper CPGE-led upper limb range of motion exercises

Healthcare for the increasing senior population is a significant challenge. To address this problem, the use of healthcare robot is increasingly being recognized to have strong potential in addressing older adult and psychiatric patients' healthcare and welfare needs. The purpose of this preliminary study is to evaluate the changes in the autonomic nervous activity of an elderly patient with schizophrenia during upper limb range of motion (ROM) exercises led by Pepper (SoftBank Robotics) with the application program of Care Prevention Gymnastics Exercises (Pepper-CPGE) made by Xing Company in Japan. A Pepper-CPGE-led three-minute radio gymnastics program (Radio Exercises #1, consisted of three types of exercises) and instructions were developed. The normal aging 69-year old schizophrenic subject followed instructions from Pepper throughout the intervention. Electrocardiography (ECG) records, heart rate, acceleration score, and ROM exercises of upper limb were collected and analyzed using the GSM's Bonaly Light instrument and Image-J analysis. (1) The high-frequency (HF) (indicative of parasympathetic nervous activity), and low-frequency (LF)/HF ratio (indicative of sympathetic nerve activity) were increased in reference from the baseline data before the exercise stretching the chest. (2) The momentum decreased as the ROM of shoulder joint flexion declined. Declines in both parasympathetic and sympathetic nervous activity were observed. Also, (3) when the exercise "bend the body forward" was performed, the HF and LF/HF also decreased. Evaluation of robot-based rehabilitation exercise program effectiveness by the ROM exercises image analysis and autonomic nervous activity is essential for the futurist programming of ROM exercise among patients with schizophrenia

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Potential legal issues when caring healthcare robot with communication in caring functions are used for older adult care

The issue of older adults' care is becoming a serious concern in Japan, which has a rapidly aging population and a low birthrate. The development of robots is pushed forward as a measure to compensate for the healthcare worker shortage. The purpose of this paper is to consider the potential legal issues of caring healthcare robot (CHR) for older adults' care. A CHR must recognize the speech, face, and presence of older adults, and make judgments and relay information based on acquired information. CHRs fulfill the caring function by being close to patients, to know them deeply, and to look after them. Therefore, communication functions by advanced artificial intelligence based on caring in nursing are essential for CHRs. The ability to maintain and improve the activities of daily living (ADL) of older adults is to facilitate activities through bidirectional information relay. Furthermore, without guarantees on the safety and ascription of responsibilities, the introduction of CHRs in clinical practice will not proceed. As laws differ from country to country, it is necessary to examine Japanese policies and related laws when using CHRs in Japan. Currently, there are no central rules on information security. In Japan, the law is made after a case has occurred; thus, dealing with novel issues as they occur will not have the benefit of legal guidance. Creating a broad legal framework or taking preventive measures at an early stage is needed. Therefore, as a first step, establishing guidelines for the use of CHRs will be valuable

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