Positive Emotional Responses to Socially Assistive Robots in People With Dementia: Pilot Study.

Background: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. Objective: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. Methods: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for "happy," "sad," "angry," "surprised," "scared," and "disgusted" were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for "happy" was compared between the different types of robots. Results: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for "happy" was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. Conclusions: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.

Robotic Care Equipment Improves Communication between Care Recipient and Caregiver in a Nursing Home as Revealed by Gaze Analysis: A Case Study.

The use of robotic nursing care equipment is an important option for solving the shortage of nursing care personnel, but the effects of its introduction have not been fully quantified. Hence, we aimed to verify that face-to-face care is still provided by caregivers in transfer situations when using robotic nursing care equipment. This study was conducted at a nursing home where the bed-release assist robot "Resyone Plus" is installed on a long-term basis. Caregiver gaze was analyzed quantitatively for one user of the equipment during transfer situations, and communication time, which involved looking at the face of the care recipient, as well as face-to-face vocalization, was measured. The caregiver spent 7.9 times longer looking at the face of and talking to the care recipient when using Resyone than when performing a manual transfer. In addition, the recipient was observed to smile during Resyone separation, which takes about 30 s. The results indicate a possible improvement in the QOL of care recipients through the use of robotic nursing care equipment as a personal care intervention. The ongoing development of robot technology is thus expected to continue to reduce the burden of caregiving as well as to improve the QOL of care recipients.

Moderating effect of age on the relationship between physical health loss and emotional distress post-acute care in Japanese older hospitalized patients.

BACKGROUND: At present, there are no consistent findings regarding the association between physical health loss and mental health in older adults. Some studies have shown that physical health loss is a risk factor for worsening of mental health. Other studies revealed that declining physical health does not worsen mental health. This study aimed to clarify whether the relationship between physical health loss and emotional distress varies with age in older inpatients post receiving acute care. METHODS: Data for this study were collected from 590 hospitalized patients aged ≥ 65 years immediately after their transfer from an acute care ward to a community-based integrated care ward. Emotional distress, post-acute care physical function, and cognitive function were assessed using established questionnaires and observations, whereas preadmission physical function was assessed by the family members of the patients. After conducting a one-way analysis of variance (ANOVA) and correlation analysis by age group for the main variables, a hierarchical multiple regression analysis was conducted with emotional distress as the dependent variable, physical function as the independent variable, age as the moderator variable, and cognitive and preadmission physical function as control variables. RESULTS: The mean GDS-15 score was found to be 6.7 ± 3.8. Emotional distress showed a significant negative correlation with physical function in younger age groups (65-79 and 80-84 years); however, no such association was found in older age groups (85-89, and ≥ 90 years). Age moderated the association between physical function and emotional distress. Poor physical function was associated with higher emotional distress in the younger patients; however, no such association was observed in the older patients. CONCLUSIONS: Age has a moderating effect on the relationship between physical health loss and increased emotional distress in older inpatients after acute care. It was suggested that even with the same degree of physical health loss, mental damage differed depending on age, with older patients experiencing less damage.

Prediction of early falls using adherence and balance assessments in a convalescent rehabilitation ward.

Objectives: To predict falls by adding an adherence assessment to a static balance ability assessment, and to evaluate fall prediction accuracy. Methods: This study included 416 patients who were admitted to a 45-bed convalescent rehabilitation ward over a 2-year period. The patients were assessed at the time of admission using the Standing Test for Imbalance and Disequilibrium (SIDE) and three additional, newly developed adherence items. Patients were divided into two groups: a group that experienced falls (fall group) and a group that did not experience falls (non-fall group) within 14 days of admission. The sensitivity and specificity of the assessment items for predicting falls were calculated. Results: Sensitivity was 0.86 and specificity was 0.42 when the cutoff was between SIDE levels 0-2a and 2b-4. Combining balance assessment using the SIDE with the memory and instruction adherence items improved fall prediction accuracy such that the sensitivity was 0.75 and the specificity was 0.64. Conclusions: Our analysis suggested that adherence assessment can improve fall risk prediction accuracy.

Quality of life after brain injury-overall scale, Japanese version: assessment of reliability and validity.

This study analyzed the linguistic and psychometric validation of the Japanese version of the Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) consisting of six items which cover several TBI-relevant domains. We hypothesized that the Japanese version has good reliability, convergent validity, and divergent validity, compared with its long version, the 37-item QOLIBRI. The QOLIBRI-OS Japanese version was forward and back-translated from the English version. In total, 129 individuals participated in this study after experiencing a traumatic brain injury and attending clinics, rehabilitation centers, and support centers in Japan. The structure of the QOLIBRI-OS was investigated by confirmatory factor analyses and compared with the QOLIBRI. Only one factor was extracted, and a model with one underlying factor had a good fit. The QOLIBRI-OS showed good-to-excellent internal consistency and test-retest reliability. The QOLIBRI-OS was positively correlated with the QOLIBRI, Short Form Health Survey-36 version 2, and Glasgow Outcome Scale Extended, and negatively correlated with the Hospital Anxiety and Depression Scale. The results suggest that the QOLIBRI-OS Japanese version is a reliable and valid tool for assessing disease-specific health-related QOL in individuals after traumatic brain injury in Japan.

Dyadic Art Appreciation and Self-Expression Program (NCGG-ART) for People with Dementia or Mild Cognitive Impairment and Their Family Caregivers: A Feasibility Study.

BACKGROUND: Non-pharmacological interventions effective for depressive mood and bilateral relationships among persons with cognitive impairment (PwCI) and their family caregivers (FCGs) have not been established. OBJECTIVE: To examine the feasibility of a newly developed group-based art appreciation and self-expression program (NCGG-ART) for dyads of PwCI and their FCGs. METHODS: This pilot randomized control trial included 34 dyads of PwCI diagnosed with mild to moderate Alzheimer's disease or mild cognitive impairment, and their FCGs, from an outpatient rehabilitation service (Holistic Physio-Cognitive Rehabilitation [HPCR]). Participants were randomly divided equally into the HPCR (control group) or NCGG-ART and HPCR (intervention group) groups. Both included 1-hour weekly, 6-week programs. The primary outcome was depressive symptoms among FCGs assessed using the Patient Health Questionnaire-9 (PHQ-9). Feasibility outcomes included participant satisfaction and motivation. FCGs were interviewed about their experiences and feelings regarding the program, which were analyzed using content analysis. RESULTS: Thirty-two dyads (intervention group:16; control group:16) completed the study period. High participation rates, satisfaction, and motivation were demonstrated throughout the intervention. Scores in the PHQ-9 among FCGs did not show positive effects: mean changes in the score were 1.3 for the intervention group and -0.8 for the control group (Cohen d:0.56). However, the qualitative analysis revealed favorable experiences and feelings of the FCGs, such as positive emotions, social interactions, and person-centered attitudes to and positive relationships with PwCI. CONCLUSIONS: This program demonstrated high feasibility with FCGs' favorable responses to emotions and relationships with PwCI, ensuring future investigations with a confirmatory study design.

Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults.

BACKGROUND: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. OBJECTIVE: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity. METHODS: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. RESULTS: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. CONCLUSIONS: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults.

Neuropsychological tests used for dementia assessment in Japan: Current status.

AIM: This study aimed to investigate the assessment tools dementia specialists use in clinical practice, reasons for their use and assessment-related factors. METHODS: A questionnaire survey was carried out from 15 September 2021 to 20 October 2021 among 1858 dementia specialists in Japan, with responses obtained via mail or using a Web form accessed via a Web address. RESULTS: Of the 1858 specialists who were sent the questionnaire, 574 responded, yielding a response rate of 32.2%. Almost all respondents stated that the main purposes of neuropsychological testing were to identify the pathophysiology and aid diagnosis. Most respondents identified behavioral and psychological symptoms of dementia as important factors for assessment. The most commonly used tests were the Hasegawa Dementia Scale-Revised and Mini-Mental State Examination, often used as screening tools. The Mini-Mental State Examination, Clock Drawing Test and Cube Copying Test were common assessments carried out directly by specialists. Quality of life and burden of care were less commonly assessed. CONCLUSIONS: Despite the main purpose of carrying out neuropsychological tests on dementia patients is to "understand the pathophysiology" and "aid in diagnosis," many assessment methods were chosen as screening methods carried out in a short time during clinic hours. The lack of evaluation of care burden and QOL, considered important by specialists, is an issue for the future in treating people with dementia, a life disability. Geriatr Gerontol Int 2023; ••: ••-••.

Improved upper extremity function following low-frequency hybrid assistive neuromuscular dynamic stimulation therapy in a patient with hemiplegia: A case report.

BACKGROUND: Although hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity functionality in patients with paralysis or paresis due to stroke, it is usually only provided in hospitals as a frequent intervention during the phase of early recovery in stroke. Home-based rehabilitation is limited by frequency and duration of visits. PURPOSE: To investigate the effectiveness of low-frequency HANDS therapy using motor function assessment. STUDY DESIGN: Case report. METHODS: We performed HANDS therapy for 1 month on the patient, who was a woman in her 70s with left-sided hemiplegia. It was initiated on day 183 post the onset of stroke. Movement and motor function were evaluated using the Fugl-Meyer Assessment upper-extremity (FMA-UE) motor items and the Motor Activity Log consisting of Amount of Use (MAL-AOU), as well as Quality of Movement (MAL-QOM) scales. This evaluation was performed before starting HANDS therapy and after its conclusion. RESULTS: Following HANDS therapy, there was improvement in the FMA-UE (21 points â†’ 28 points), MAL-AOU (0.17 points â†’ 0.33 points), and MAL-QOM (0.08 points â†’ 0.33 points) scores when compared to the scores before therapy, and the patient was able to use both hands for activities of daily living (ADLs). CONCLUSIONS: Low-frequency HANDS therapy combined with encouragement to include the affected hand in ADLs may improve upper extremity function in cases of paralysis.

The use of a companion robot to improve depression symptoms in a community-dwelling older adult during the coronavirus disease 2019 state of emergency.

Objective: We investigated the impact of using a companion robot on the mental state of a community-dwelling older adult who was receiving home-visit rehabilitation services during the state of emergency for coronavirus disease 2019 (COVID-19). Methods: This case involved an 80-year-old woman with compression fractures of lumbar vertebrae 1 and 2. Her medical history included hypothyroidism, hypertension, dyslipidemia, and depression. The companion robot used was Smibi®, a healing baby robot that responds in various ways depending on how the user interacts with it. The patient interacted (e.g., hugging, conversing) with Smibi® for 30 minutes per day for 1 month, from April 2020 (immediately before the declaration of a state of emergency in Japan) to May 2020. The patient was evaluated with the Self-Rating Depression Scale (SDS) before and after using Smibi®. Results: The SDS score decreased from 37 points to 26 points after the use of Smibi®. The items related to diurnal variation, sleep, despair about the future, and dissatisfaction decreased by 2-3 points. Conclusion: Our findings suggest that interacting with Smibi® may improve depression in older adults who have been forced to refrain from going out due to the spread of COVID-19. Future studies with long-term follow-up and large sample sizes are required to confirm the effectiveness of companion robots in improving depression among community-dwelling older adults.

The current state of family caregiver burden and support of toilet problems for elderly with mild cognitive impairment and Alzheimer's disease.

OBJECTIVE: To conduct an exploratory examination of caregiver burden involving toilet problems in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) and related characteristics. METHODS: We included 50 outpatients with amnestic MCI and AD and their caregivers. Patients were subclassified into three groups: MCI, mild AD, and moderate/severe AD. We used the Japanese version of the Zarit Burden Interview (J-ZBI) to evaluate caregiver burden and conducted a questionnaire on the frequency of lower urinary tract symptoms and related caregiver burden. We compared the frequency of questionnaire items with the level of burden in each group and subsequently determined the J-ZBI correlation coefficient. RESULTS: Among the questionnaire items, the caregiver's burden of "increased daytime urinary frequency," "nocturia," "urinary incontinence," and "they cannot clean the toilet" statistically significantly correlated with J-ZBI scores (ρ = 0.52, 0.65, 0.79, and 0.83, respectively). Items including "they cannot clean the toilet," "the smell of excrement is bothersome," "assistance for transfer is necessary," "they soil the clothes and bed," and "they cannot clean the genital region" were significantly more common in the patient group with moderate/severe AD. CONCLUSIONS: Lower urinary tract symptoms and toilet problems were significantly correlated with caregiver burden. Toilet problems differ depending on the severity of dementia. Therefore, a support system based on dementia severity is required to address toilet problems.

Reduction of multiple-caregiver assistance through the long-term use of a transfer support robot in a nursing facility.

The long-term use of transfer support robots in nursing facilities is an important option for improving the efficiency of care work. The "Resyone" transfer support robot is a combination of an electric care bed and a wheelchair, and the wheelchair half of the bed can be detached at the touch of a button. The purpose of this study was to investigate how the long-term use of Resyone would improve the performance of transfer assists, such as reducing the need for multiple caregivers. One Resyone was installed in a nursing facility in Japan and 17 caregivers used it for more than 11 months. The time and number of caregivers required for each transfer assist were surveyed for three 1-week periods: 1 week before (Phase 1) and at 3 weeks (Phase 2) and 11 months (Phase 3) after the introduction of Resyone. In Phase 1, approximately 60% of all transfer assists were performed by two caregivers, but in Phase 2, this was reduced to approximately 20%, and finally, in Phase 3, all transfer assists were performed by a single caregiver. These results suggested that the long-term use of Resyone was associated with improved work efficiency in transfer assistance in a nursing facility.

Relationship between cognitive domains and hearing ability in memory clinic patients: How did the relationship change after 6 months of introducing a hearing aid?

OBJECTIVE: We aimed to evaluate the relationship between hearing ability and cognitive domains and determine how the relationship changes after 6 months of introducing a hearing aid. METHODS: We conducted a 6-month hearing aid lending study between September 2014 and March 2019, including 59 older participants who visited the Memory Clinic at the National Center for Geriatrics and Gerontology. The hearing level was assessed using pure tone audiometry. Speech intelligibility was measured using the monosyllabic word discrimination score. We assessed the relationship between hearing ability and cognitive domains using the Mini-Mental State Examination (MMSE) total score and four subscale scores (orientation, memory, attention, and language). Differences in the cognitive function between baseline (pre-) and 6 months later (post-) after introducing a hearing aid were also assessed. RESULTS: The pre-orientation score was significantly associated with the pure-tone average (p = 0.013), and the pre-language score was significantly associated with speech intelligibility (p = 0.006) after adjusting for confounders. None of the MMSE subscale scores were significantly different between pre- and post-scores, however, an expectation of improvement with continuous hearing aid use was implied in the attention domain. CONCLUSION: We found a significant association between hearing ability and cognitive domains in individuals whose cognitive functions were not considered healthy. The presence of a potential relationship between cognitive domains, hearing ability, and auditory compensation is suggested.

Finger Tapping Test for Assessing the Risk of Mild Cognitive Impairment.

Aim: A testing method for early diagnosis of Mild cognitive dementia (MCI) that can be easily applied in clinical practice was investigated in this study. We examined whether MCI risk can be determined through finger movements. Methods: Between 2013 and 2020, 1097 individuals were screened. After applying propensity-score matching to adjust for variability between the groups, 173 individuals each in the mild cognitive impairment and control groups were selected. Thereafter, differences between groups in mean values of parameters extracted from finger tap movements were determined using unpaired t-test and effect size. Furthermore, area under the curve, sensitivity, and specificity were calculated from the receiver operating characteristic curve for parameters with significant difference. Results: A significant difference was observed, especially in the number of taps in the MCI group compared with that in the control group (p < .001; 95% CI, -12.7 to -8.8; r = 0.51). A cut-off value of 30 taps was applied (sensitivity, 0.77; specificity, 0.67; AUC, 0.79). Significant differences were also observed in rhythm-related parameters. Conclusions: These parameters might be useful for capturing MCI risk. Finger taps are easily measured and may be suitable for screening large populations. This tool might be used as a supplemental method to increase the sensitivity of traditional cognitive tests.

A rise-assisting robot extends life space and improves facial expressions of nursing home residents.

BACKGROUND: The introduction of nursing care-support devices using robotic technology is expected to reduce the task burden in long-term care facilities. OBJECTIVE: To investigate the use of the rise-assisting robot, Resyone, in extending and improving the life space of nursing home residents with severe care needs. METHODS: We performed a feasibility study in which Resyone was used to facilitate visits to additional sites in and around the nursing home as part of the care package of three residents. Two weeks before and four weeks after implementation of the new arrangements, the 30 caregivers involved were asked to record transfer times and destinations, while also checking the residents' facial expressions. RESULTS: Before implementation, participants had limited life spaces, but afterwards they regularly visited additional destinations including the garden, home entrance and corridors, which previously they had not visited frequently. The residents' facial expressions became more positive and less negative. This study demonstrates that Resyone can enrich care activities in severely disabled individuals. CONCLUSION: These findings suggest that the sustainable use of Resyone would improve the quality of care at care facilities. Moreover, the extension of otherwise limited life space has the potential to improve care receivers' quality of life. TRIAL REGISTRATION: UMIN Clinical Trials Registry No. UMIN000039204 (20/01/2020); retrospectively registered; interventional study; parallel, non-randomized, single blinded. URL of trial registry records: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044709 .

Gait improvement in stroke patients by Gait Exercise Assist Robot training is related to trunk verticality.

[Purpose] Various types of Gait Exercise Assist Robot (GEAR) have been developed recently, some of which have enabled early improvement in patients with stroke. However, none has yet resulted in independent walking in these patients. Hence, we conducted an exploratory study of the effect of GEAR on achieving independent walking in stroke patients. [Participants and Methods] The participants were 16 patients with severe stroke. We evaluated patients' ability to walk independently after GEAR training. The outcome measure was Stroke Impairment Assessment Set (SIAS) motor score (Hip Flexion, Knee Extension, Foot Pat, Abdominal and Verticality). Differences in five SIAS motor scores were compared between the independent and non-independent walking groups. [Results] There was statistically significant difference between the groups in terms of Verticality among the 5 SIAS items used in the present research . Verticality of SIAS score of 1 was the cut-off value for distinguishing walking independence. [Conclusion] Verticality of SIAS may be a marker of potential walking independence that can be used in rehabilitation plans using walking-assist robots in patients with stroke.