筑波学院大学紀要第12集

25 〜 35 ページ

2017年Study on Transition of the Elderly Peopleʼs Reaction
in Robot Therapy
Toshimitsu HAMADA＊ , Yoshihito KAGAWA＊＊ ,Hisashi ONARI＊＊＊ , Mitsuru NAGANUMA＊＊＊＊,Tomomi HASHIMOTO＊＊＊＊＊ and Toshihiko YONEOKA＊＊＊＊＊＊
Abstract
Most elderly people staying in nursing homes have dementia, and various kinds of recreational
programs are provided in order to prevent or ameliorate this problem. Robot therapy is a recreational program that has recently been introduced in some nursing homes. However, the effects ofrobot therapy are difficult to evaluate. In this study, we identified events occurring during therapy
that are important in the proliferation and evolution of robot therapy. We also found that the presence of an intervener encourages elderly people to be more active.
Key words: robot therapy, aging society, dementia, recreation, nursing care, work sampling

1. Introduction
Most elderly people staying in nursing homes have dementia, and various kinds of recreational
program are provided in order to prevent or ameliorate this problem. Robot therapy is a recreational
program that has recently started in some nursing homes in which robots replace real animals usedin animal therapy. There are thought to be 3 beneficial effects of animal therapy:
1) Physiological effects (e.g., improvement of vital functions)
2) Psychological effects (e.g., relaxation, motivation)
3) Social effects (e.g., promotion of communication among inpatients and care-givers)
However, animal therapy is executed in few hospitals and nursing homes in Japan because there
are risks such as allergies, infections, bites, and scratches even though there are these positiveeffects [1] -[3]. Robot therapy may be more useful than animal therapy because robots do not carrysuch risks and robot actions are easily programmable for specific purposes.
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筑波学院大学経営情報学部、Tsukuba Gakuin University＊＊

拓殖大学、Takushoku University＊＊＊

早稲田大学、Waseda University＊＊＊＊

帝京大学、Teikyo University of Science＊＊＊＊＊

埼玉工業大学、Saitama Institute of Technolog＊＊＊＊＊＊

パーストン浅間台、Passetemps Asamadai─ 25 ─

筑波学院大学紀要122017Studies on robot therapy started when a seal-type robot named Paro and an entertainment robot
named AIBO were launched on the market [4]. Shibata et al. developed Paro and used it at pediatricwards and facilities for elderly people [5]-[9]. Kanamori et al. examined the usefulness of the pettype robot AIBO among elderly patients and those with disabilities in nursing homes or at homeusing biochemical markers, self-assessment, or health-related QOL questionnaires [10]. Yokoyama,a researcher on animal therapy and a psychiatrist, used AIBO in a pediatrics ward and observed theinteraction between AIBO and the children [11]. He said the introduction of robots into hospitals
was much easier than expected compared to the introduction of animals. Ohkubo et al. discussed
the effective use of a wireless LAN-controlled robot, and developed a simple operating console forwireless LAN [12]. The robot can be controlled by a therapist through a wireless LAN.
We discussed the possibility of robot therapy when AIBO appeared, and concluded thatrobot therapy is promising based on the results of a questionnaire survey [13][14]. Moreover, we
discussed effective methods of robot therapy from the viewpoint of intervention and robot behavior.
We showed what type of intervention induces spontaneous actions of elderly people and what is the
optimal intervention time based on experimental therapy for elderly subjects with dementia. The
results of the experiment also indicated that some robot behaviors frequently induce elderly people
to react to the robot spontaneously [15][16].
However, it is difficult to evaluate the effects of robot therapy. Most evaluation results are
dependent on questionnaires or observations. Physiological tests, for example, testing urine andsputum, have been applied to investigate the mental stress of subjects in some researches [17][18]. Evaluation by analyzing EEG signals has also been reported [19]. However, these evaluation
methods may not be ideal because most therapy executors have no skill in physiological testingor using EEG. We developed a recreational program in which we conducted games using a pettype robot and induced elderly people to perform specific actions. The effects of recreation were
evaluated by measuring the degree of occurrence of an elderly personʼs action [23]. In this method,
it is difficult to design useful games. An evaluation method that is easy and acceptable to mosttherapy executors has not been developed yet.
Many studies have reported that robot therapy is useful for activating elderly people andpromising for improvement of dementia. However, there is no quantitative evidence that robot
therapy is effective for the activation of elderly people and why robot therapy is useful for the
improvement of dementia. In this study, we investigated events occurring during therapy andsought to identify and understand events that are important in the proliferation and evolution ofrobot therapy. Our investigation was based on a work sampling method and the reactions of elderly
people and the presence of interveners were recorded. In addition, we analyzed the reactions of theelderly people by comparison with evaluation values that were recorded for each subject throughdiscussions with robot therapy administrators and nursing home staff members.

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Toshimitsu HAMADA, Yoshihito KAGAWA, Hisashi ONARI, Mitsuru NAGANUMA, Tomomi HASHIMOTO, Toshihiko YONEOKA：Study on Transition of the Elderly People s Reaction in Robot Therapy

2. Robot Therapy in Groups and Evaluation of Elderly People’s Reactions
2.1. Form of Robot Therapy
There are two types of robot therapy. One is therapy where the therapist communicates withthe subject using a robot. The other is group therapy. In this research, we investigated grouptherapy. Figure 1 shows a photograph of robot group therapy where elderly people sit around atable on which several robots perform their functions. There is one intervener for a few elderly
people. They facilitated the elderly peopleʼs interactions with the robots by explaining the functions
and movements of the robots or selecting suitable robots for the elderly people etc. Therapists, staffof the nursing home, or student assistants acted as the interveners. About 10 to 20 elderly persons
joined the activities of robot therapy, and the activities continued for about one hour.
2.2. Evaluation of Elderly People’s Reactions in Robot Therapy
In this research, we recorded evaluation values for each subject through discussions with robot
therapy administrators and nursing home staff members. The evaluation values consisted of fivegrades: “ 5 ” is the best and “ 1 ” is the worst. Figure 2 shows the distribution of the evaluation

Figure 1

Figure 2

Appearance of Robot Therapy

Distribution of Evaluation

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筑波学院大学紀要122017values, which were obtained from 75 elderly persons in 11 robot therapy activities. These activities
were executed for 14 months. As most of the results were grade “ 3 ” or higher, it was concluded
that robot therapy is effective for the activation of elderly people. The number of recorded elderly
peopleʼs reaction is 643, and the number of reaction which occurred in the activities with theintervener is 310.

3. Investigation of Elderly People’s Reactions by Work Sampling Method
Robot therapy activities are evaluated based on events during activities. However, mostanalysis of events is not quantitative. In this research, in order to investigate and analyze events
macroscopically, the observers recorded the subjectʼs reactions, the intervenerʼs presence and thekind of robot every five minutes by the work sampling method.
Table 1 shows the work sampling sheet used to record the events. We recorded events asshown in Table 1. We categorized the elderly peopleʼs reactions into 9 kinds: 1：accompanying
the robot, 2：laughing or pleasing, 3：touching or patting, 4: looking or listening, 5: talking
with inter vener, 6: disliking, 7: no reaction, 8: sleeping, 9: others. Subjectʼs reactions such as
Table 1
Subject: Name:
Time (min)Subject

Work Sampling Sheet
Robot

Date :
Inter vener

Comment

0
5
10
15
20
25
30
35
40
45
50
55
60

Intervener
0：No-presence
1：Presence

Kind of Robot─ 28 ─

Toshimitsu HAMADA, Yoshihito KAGAWA, Hisashi ONARI, Mitsuru NAGANUMA, Tomomi HASHIMOTO, Toshihiko YONEOKA：Study on Transition of the Elderly People s Reaction in Robot Therapy

accompanying the robot, laughing, pleasing, touching, patting, looking listening, or talking with theintervener were considered positive, and subjectʼs reactions such as disliking, no reaction, sleeping
or others were considered negative. And accompanying the robot, laughing, pleasing, touching, or
patting were considered active reactions, and looking listening, or talking with the intervener wereconsidered passive reactions.

4. Elderly People’s Reactions and Evaluation of Therapy
The reactions of 75 elderly persons in 11 robot therapy activities are shown in Figure 3. On
the whole the percentage of positive reactions was 75％, and this was considered to correspond to
the results of therapy evaluation. The differences in elderly peopleʼs reactions to evaluation valuesof therapy are shown in Figure 3. Table 2 presents a summary of the results. The figure and the

Figure 3

Elderly People’s Reactions and Evaluation Values in Robot Therapy─ 29 ─

筑波学院大学紀要122017

Table 2
Evaluation
Value

Reactions of Elderly People
Reaction
Positive

Negative

ActivePassive

4

53

34

13

3

28

50

22

2

13

57

30

Total

36

39

25
(unit：％)

table show that negative reactions increase as evaluation values decrease. As evaluation values
decreased at 4, 3, and 2 or less, the percentages of negative reactions increased at 13％, 22％,and30％. Moreover, they show that the percentages of active reactions indicate a major influence on
therapy evaluation. The percentage of active reactions in the case of evaluation value “ 4 ” was 53％,
and about double that of evaluation value “3.” Robot therapy administrators and nursing home staff
members appreciate elderly peopleʼs active reactions highly. These results indicate that one of theadvantages of robot therapy is that it induces the elderly people to have many active reactions.

5. Presence of the Inter vener in Robot Therapy
As mentioned above, the inter vener plays various important roles in the therapy. In thisresearch, we investigated the influence of the intervenerʼs presence on the evaluation of therapy.
Figure 4 shows the reactions of elderly people without and with interveners. A comparison ofthese figures reveals that the presence of interveners makes the reactions of the elderly people lessnegative. Negative reactions decreased from 30％ to 10％.
Moreover, we considered the relation between therapy evaluation and the presence ofinterveners. Figure 4 shows the reactions of elderly people without and with the interveners withan evaluation value of “4.” In this case, the presence of interveners decreased the negative reactionslightly. The percentage of talking with the inter vener increased, and the percentage of active
reaction decreased slightly. However we did not consider this to be a problem, and elderly people
who achieved evaluation value “ 4 ” showed positive and active reactions in spite of the presence ofinterveners.
Figure 4 also shows the reactions of elderly people without and with inter veners with anevaluation value of “3.” In this case, the presence of interveners decreased the negative reaction
and increased the positive and passive reaction a lot. The presence of interveners is important forincreasing positive reactions.
Figure 4 also shows the reactions of elderly people without and with inter veners with anevaluation value of “2.” In this case, the presence of interveners decreased the negative reaction
more and increased the positive reaction more too. The presence of interveners is more important─ 30 ─

Toshimitsu HAMADA, Yoshihito KAGAWA, Hisashi ONARI, Mitsuru NAGANUMA, Tomomi HASHIMOTO, Toshihiko YONEOKA：Study on Transition of the Elderly People s Reaction in Robot Therapy

for increasing positive reactions and decreasing negative reactions. This result shows thatinterveners may be able to develop a means of inducing the elderly people who do not act positively
to have more positive and active reactions.
Table 3 shows a summary of these results. The table and 8 graphs of figure show that thepresence of interveners has a major influence upon changes in elderly peopleʼs reactions.

Figure 4

Elderly People’s Reactions and Evaluation Values with and without Intervener

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筑波学院大学紀要1220176.	Transition of Elderly People’s Reactions and Presence of the Inter vener inRobot Therapy
As mentioned above, the presence of interveners brings good influence to the elderly peopleʼsreactions. Then we discuss the transition of the elderly peopleʼs reactions caused by the presence ofinterveners. In the discussion we classify the elderly peopleʼs reactions into four categories; active
reactions, passive reactions, negative reactions, and others. Table 4 shows the transition states ofthe elderly peopleʼs reactions on the whole. There are no changes of reaction category in about 70％of transition at each case of active, passive and negative reactions. This indicates that the elderly
people almost continue the same reaction category. Then we compare the differences between theelderly peopleʼs reaction transition in activities with and without interveners. Table 5 and Table
6 indicate transition of the elderly peopleʼs reactions in activities with and without inter veners
respectively. These tables show that the presence of inter veners causes good transition: fromnegative reactions to active or passive reactions and from passive reactions to active reactions. On
the other hand the presence of interveners doesnʼt exactly bring good transition in active reactions.
It is considered as its cause that the transition from active reaction to talking with the intervener
increases. However this transition is not necessarily bad, but the elderly people were only talking
Table 3

Reactions of Elderly People with and without
Interveners

Evaluation
Value
4
3
2
Total

Reaction
Positive

Intervener

ActivePassive

N

60

23

17

P

46

33

11

N

27

42

31

P

30

60

10

N

7

49

44

P

19

68

13

N

33

37

30

P

35

55

N：without interveners
P：with interveners

Table 4

Negative

10(unit：％)

 ransitionof Elderly People’s Reactions (on theTwhole)
Reaction after transition

Reaction before
transition

activepassive

negative

othersactive

66.0％

27.4％

5.6％

1.0％

passive

16.7％

72.4％

7.7％

3.3％

negative

11.4％

15.8％

68.4％

4.4％

others

17.6％

35.3％

17.6％

29.4％

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Toshimitsu HAMADA, Yoshihito KAGAWA, Hisashi ONARI, Mitsuru NAGANUMA, Tomomi HASHIMOTO, Toshihiko YONEOKA：Study on Transition of the Elderly People s Reaction in Robot Therapy

with the intervener among active reactions. We think that good communication among the elderly
people, the intervener and robot was achieved.
We discuss details of the transition of elderly peopleʼs reactions with the intervener. Table 7,
Table 8 and Table 9 show the transition from negative reaction state, passive reaction state andactive reaction state respectively. As shown in Table 7 when the intervener was present, the elderly
people who made negative reactions tried to do the reaction related to robot such as accompanying
the robot, laughing for the robot, pleasing with the robot, touching the robot, patting therobot,
looking at the robot, or listening to the robot. Table 8 shows that the elderly people who madepassive reactions tried to do the reaction related to robot moreover. We may conclude that thepresence of the intervener activate the communication among the elderly people, the intervener
and robot

7. Conclusion
We investigated elderly peopleʼs reactions in robot therapy. Our investigation was based on awork sampling method and the reactions of the elderly people and the presence of interveners wereTable 5 ransitionof Elderly People’s Reactions (withTInterveners)

activepassive

negative

othersactive

57.0％

38.4％

2.3％

2.3％

passive

19.0％

76.2％

3.4％

1.4％

negative

17.0％

27.7％

51.1％

4.3％

others

22.2％

55.6％

0.0％

22.2％

Table 6

Table 7

Transitionof Elderly People’s Reactions (without
Interveners)
Reaction after transition

Reaction before
transition

activepassive

negative

othersactive

73.0％

18.9％

8.1％

0.0％
6.1％

passive

13.1％

66.7％

14.1％

negative

7.5％

7.5％

80.6％

4.5％

others

12.5％

12.5％

37.5％

37.5％

Transition from Elderly People’s Negative Reactions (with Interveners)

Reaction
before accompanying
transition
the robot
negative

Reaction after transition

Reaction before
transition

6％

Reaction after transition
laughing,
pleasing

touching,
patting2％

9％looking, talking withdisliking no reaction sleeping
listening the intervener17％

─ 33 ─

11％

0％

51％

0％

筑波学院大学紀要12

Table 82017

Transition from Elderly People’s Passive Reactions (with Interveners)

Reaction
before accompanying
transition
the robot

Reaction after transition
laughing,
pleasing

touching,
patting

1％

7％

12％

passive

Table 9

41％

36％

0％

3％

1％

Transition from Elderly People’s Active Reactions (with Interveners)

Reaction
before accompanying
transition
the robot
passivelooking, talking withdisliking no reaction sleeping
listening the intervener

Reaction after transition
laughing,
pleasing

touching,
patting

1％

7％

12％

looking, talking withdisliking no reaction sleeping
listening the intervener
41％

36％

0％

3％

1％

recorded. Through analysis of the reactions of the elderly people by comparison with the evaluation
values, we concluded that most reactions are positive and active reactions are appreciated highly.
The quantities of active reactions determined the evaluation values of the subjects in therapy. It is
important for more effective robot therapy to develop many more ideas to induce elderly people tohave more active reactions.
We also investigated the effects of interveners. The presence of interveners induced the elderly
people to have more positive reactions. Even if the subject showed negative reactions without theintervener, he/she often showed positive reactions with the intervener. The interveners hold theimportant roles and create active communication in robot therapy. According to this result, it isimportant for more effective robot therapy to take on more of the role and actions of the intervener.
As above-mentioned we have demonstrated two items to develop in the next study. We would like toreport necessary and desired roles and actions of the interveners in the near future.

Acknowledgments
We would like to thank the staff of the nursing home for their cooperation in this research. In
addition, we thank Professor N. Yago of Aikoku Gakuen University for his advice and discussion inthis research.
This work was supported by JSPS KAKENHI Grant Number 2551008.
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