Journal of Robotics, Networking and Artificial Life, Vol. 3, No. 1 (June 2016), 28-32

Redefining robot based technologies for elderly people assistance: a survey
1Luigi Pagliarini

1,2

1Henrik Hautop Lund

Center for Playware, Technical University of Denmark, Building 326, 2800 Kgs. Lyngby, Denmark2
Academy of Fine Arts of Macerata, Via Berardi, 6, 405111 Macerata, Italy
E-mail: luigipagliarini@gmail.com
www.playware.elektro.dtu.dkAbstract
We analyse the state of the art of hi-tech and robot based technologies in terms of Assistive Technology for allpatients and, in particular, elderly people assistance and everyday activities aid. We focus on different aspects andcharacteristics of these tools, such as playfulness, invasiveness, learning-speed, efficiency, short and long-term
effect, active vs. passive, etc. We do so by showing the most important existing examples, and by taking into
account all the possible factors that might help researchers when thinking of developing appropriate technologies
for elderly care, as well as, for their relative assistance personnel. Indeed, while in rehabilitation robotics, a majorrole is played by the human–machine interface (HMI) used to gather the patient’s intent from biological signals,
and convert them into control signals for the robotic artefacts, surprisingly, decades of research have not yet
declared what the optimal HMI is in this context [1]. Further, there is an urgent need to clarify how various
technologies can be a goal or an approach for preventive, rehabilitative and assistive interaction. Therefore, we try
to make a first step towards a redefinition of Robotics Assistive Technology.
Keywords: Assistive Technology, Robotics, Prevention, Rehabilitation, Healing, Production.

1. Introduction
Quite recently, a new field has emerged from bothprivate and public research that has been denominated
Assistive Technology. In few cases such researchreaches the final state, and releases specific Assistive
Technology Products. As matter of fact, Assistive
Technology seems to be a generic definition [2] thataims at covering technologies, services, apparatus,
products as well as systems mostly used by
disadvantaged people, like disabled and elderly ones.
The aim is to increase those people’s quality of life byhelping them reaching the best possible autonomy either
in social or private life. In other words, it means giving
them the chance to recuperate their impaired orweakened skills, both motor and cognitive ones so thatthey can execute tasks, which might have become too
difficult or too dangerous to them. Therefore, thedefinition of assistive technologies relies on theclassification of either social or medical models ofdisability. This is an important point that tends todistinguishludic
productions
fromassistive
technologies themselves. Although, this is surely a good
way to look at Assistive Technology, along this paper
we will try to enrich such a vision by including in theset of Assistive Technology Products tools that mightwork at a prevention level, a level that from our point ofview is still one of the most desirable ones.
Normally, the definition of assistive technology
products, as described by Hersh [3], can be classified in
at least five “flexible” categories, such as:

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Luigi Pagliarini, Henrik Hautop Lund•••••

Mainstream Products (i.e. general population
products that are available everywhere);
Universal Design Products (i.e. products thatare conceived to be used by the largest possiblegroup of users) ;Assistive Products (i.e. designed to remove
barriers for elderly and disabled people);
Rehabilitation Products (i.e. products designed
to restore functions in elderly and disablepeople);
Medical Products (i.e. products designed tosupport a range of health care practices andpromote healing).

It is to be noticed that the difference between
assistive and rehabilitative products stand in the fact thatthe assistive products modify the people interaction withthe environment by removing the “obstacles” in someway, while the rehabilitative ones are meant to directly
re-enable persons, in order to overcome their“limitations”.
Once such a product is released, there are a numberof different ways of classifying evaluation andevaluation methods (e.g. evaluation can be purely
evaluative or diagnostic). By generalising acategorisation inherited from human computerinteraction [4], assistive products gives at least fourclasses:••••

Analytical methods: specialists manipulate
system models to predict performance.
User reports: users work with representationsor their memories of particular products. (i.e.
interviews and questionnaires, etc.).
Specialist reports: human factors specialists orother professionals assess real products,prototypes or simulations.
Observational methods: real users assess real
products, prototypes or simulations.

Considering the pragmatic of productions, it has
been proven that there are factors that are mostimportant in product success and product screening
decisions, as well as factors that influence decisions onwhether or not to discontinue a product. They aresomehow crucial in understanding the effective value ofa product and they include [5, 6, 7, 8]:•••••

Product advantages and expected market
reaction;
Expected financial potential, including market
share, sales and market growth and expected
profitability;
The implications for the firm's financial,physical and human resources;
Fit to current business, organisation,technology, marketing and managerial skills;
The potential or availability of new products
and alternative opportunities, as well as theproduct range policy.

In this perspective, we will here report someexamples of Assistive Technology Products based on
Robotics and will compare them to both review the stateof the art in such fields’ intersection, and to try tounderline how it fits with the general standards ofAssistive Technology.
2. Assistive Technology - Examples
The first examples of Assistive Technology Product we
present are the HONDA Walking Assist Device and its
Cyberdyne precursor HAL (Fig. 1). They both represent
the classical Assistive Technology devices designed toremove barriers for elderly and disabled people, and that
help users to support bodyweight to reduce the load on
the user's legs while walking, going up and down stairs,and in a semi-crouching position.

Fig. 1. Cyberdyne HAL, and HONDA’s Walking Assist
Device.

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Redefining robot based technologies

Both HAL and Walking Assist are examples of an
efficient production that is professionally evaluatedthroughout specialist reports. They both fit their firm’scurrent business, organisation, technology, marketingand managerial skills and financial potential, including a
big potential market share. In other words, in theirassistive niche, they represent the perfect product andproduct design, although they almost exclusively act in
the no-rehabilitation zone.
On the same line are the Assistive Robotic
Manipulator, as InMotion’s Arm, Wrist, Hand andExoskeletal Arm Robot produced by the Interactive
Motion Technologies. These technologies should help
patients with Stroke, Cerebral Palsy, Traumatic Brain
Injury, Spinal Cord Injuries, Multiple Sclerosis, andParkinsons to add a level of independence to their lives.
These products are evaluated either by the patients andthe specialists are well tested and seem to be promising
for Assistive Technology Clinical practice, at least.
Further, there are a long number of productions
oriented towards becoming caregiver robots. Amongstthem, the RIBA (or Robear) developed by researchers atRIKEN and Tokai Rubber Industries (TRI) is the mostadvanced example. It is in between an Assistive and a
Medical Product since besides removing barriers, it ismeant to take care of patients, substituting some nursery
functions.
Besides those, there are other fields of research, likefor example Socially Assistive Robotics - see "TheRobotics Primer" [9] for further information - which arecurrently trying to develop robot-assisted therapies forchildren with autism spectrum disorders, stroke andtraumatic brain injury, and individuals with Alzheimer's
Disease and other forms of dementia. But, despite of thefact that the field seems to be promising and important,
and with some good indications from the Paro robot byShibata, there is not an effective Assistive Products
outcome, yet.

Fig. 2. The RIBA Robot lifting a patient.

Fig. 3. RoboCoach.

On the contrary, on the side of what we will here call
Active Assistive Robotics the production can beconsidered much more concrete. One example could be
RoboCoach, developed by Yaacob Ibrahim at theNgee Ann Polytechnic, that coaches the elderly inperforming 15 types of arm exercise each week,
recognizing a human voice that tells it to start theworkout.
Vice versa, on the Rehabilitative Robotics Products
side there seems to be a quite fruitful production that
results in an enlarging number of companies specialized
on different branches of artefacts. AlterG Inc., thatmakes anti-gravity treadmills and bionic legs for athletic
training and physical therapy. Ekso Bionics, that makes
robotic exoskeletons providing gait training andneurorehabilitation by extending the individual'sstrength and also helping the therapist to work with theirpatients. Hocoma, that provides spine evaluation
devices that enables computer-assisted analysis anddisplay of the spine's shape and mobility, or robotic gait
orthosis in which the patient’s legs are guided to a preprogrammed physiological gait pattern on the treadmil.
Bioextreme, specialized in robotics rehabilitation
innovative Error Enhancement treatment for patients.
Intead Technologies and Kinestesica, specialized inneuromotoric disorders. A very interesting approach is
the one from the Kinetic Muscles that is merging digital
gaming, robotic, and telemedicine technologies with themost up-to-date discoveries in neurorehabilitation
science to provide solutions that are practical andclinicallyeffectiveforengaging
post-stroke
rehabilitation. MediTouch, that produces wearable
motion capture devices and dedicated rehabilitation
software that allow patients with upper and/or lower
extremity movement dysfunction to practice intensive
virtual functional task training. SynTouch that makes theonly sensor technology in the world that endows robots

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Luigi Pagliarini, Henrik Hautop Lund

with the ability to replicate the human sense of touch, orTouchBionics provider of world-leading prosthetic
technologies and supporting services. Besides them, thetechnologies realized by Kinova, Rehab-Robotics, RehaStim, YouRehab and the above mentioned Interactive
Motion Technologies are very interesting.
All of them work with patients suffering from partial
spinal cord injuries, strokes, multiple sclerosis,
traumatic brain injuries, cerebral palsy, Parkinson’s
disease: generally speaking with nervous system injuriesand patients with minimal forearm strength andproblems in standing and walking. Some of these have amainly passive approach while other push a proactive
exercising. Amongst these last ones a few are also
targeting playfulness as a philosophy. They also differ
as level of Human-Machine Interface (HMI)
invasiveness, although in different cases appropriate andengaging HMI design to be the only effective way.
On the Robotics Medical Products side, there is alarge production. Medical apparatus, especially insurgery, are day-by-day moving towards a roboticsbased practice. As, for example, Magnetic Microbots, agroup of tiny robots used in various operations, such asremoving plaque from a patient's arteries or helping
with ocular conditions and disease screenings. In short,robotic advancements are used to better the day-to-day
lives of patients, helping them eat (e.g Bestic Arm), or
helping a patient regain her ability to walk (e.g Toyota's
Healthcare Assistants). Obviously, robotics is a very
attractive industry since within the hospitals, a robot’s
work can fulfil the full-time work of one or more
employees (e.g Aethon TUG) and outside of themcaregivers use robots to enhance telemedicine and carefor those restricted to their homes (e.g. Vasteras Giraff)or, surprisingly enough, in the open (e.g. Anybots).
Some of them are playful and non-invasive ones, as
those used to enhance the therapy of developmentallydisabled children between 5 and 12 years old (e.g.
CosmoBot).
On the Mainstream and Universal Design Products
side there is a large number of contributions whichmainly focus their attention on fitting products in theecological system of humans. Therefore the products try
to be portable, fit in the apartment or outside homes
trying to follow the scheme of the “walk up and use”
design philosophy, to be scalable, to allow user toinitiate interaction, to provide different choices for any
given task, to provide multiple and multimodal output
and feedback, to provide mutable functionality and totarget the largest number of people and contexts. See[10] for further information.
Good examples can be considered the iRobotproducts, the Toyota’s i-REAL, the Universal Robots
products, and many other products for the toys andgaming industry (e.g. WowWee) or, sometimes, thosethat are specifically targeted for the assistive technology
market (e.g. Cyberdyne).
3. Moto tiles
In this context, we present our Moto tiles, robot tiles thatlight up when you touch them and that are mostly used
to improve the balance of the elderly, and strengthen
their muscles and endurance with a high grade ofefficiency, as it has been demonstrated by scientifictests [11, 12]. Despite of their specific Medical
Technology target and rehabilitative application, Mototiles use can be easily translated in quite differentcontexts since they fulfil almost all of the typical criteriaof the Universal Design Products. Their use is easy tolearn. They are multimodal and can easily adapt to any
kind situation, either indoor or outdoor, since they arevery portable, reconfigurable and well fit to any context
and user’s age. Therefore, they might be used either asgaming or educational platform. More than that, theyshow their best when combining playfulness withfitness, rehab or educational exercises, all together.
Besides, if compared with the mainstream assistive
technology or medical technology products, they show
their peculiarity in being a mostly “active” tool. Indeed,
the software platform they use promotes users’ motor
and/or cognitive activation at the best and tends to adapt
to the rate of users’ responses in a fairly adaptive way.

Fig. 4. Moto tiles – an example of an active tool for prevention
and rehabilitation (www.mototiles.com).

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Redefining robot based technologies

Furthermore, they represent a rather unique exampleof Assistive Technology Robotics applied to“prevention”, a “medical zone” which is rarely
considered within the field and that, on the contrary,might represent one of the most important fields ofrobotics applications, in the future.
In other words, the Moto tiles might represent, bythemselves, a new dimension of how to apply robotics
within an Assistive Technology context, by promoting
the idea of cure as “prevention” and therefore by
stressing the “activation” at its best. The Moto tiles also
show how, by focusing on such a direction, Assistive
Technology can reach important results in either shortor long term effects.
4. Discussion and Conclusion
In this paper we discussed the most important generalprinciples of Assistive Technologies and, in particular,
analysed the state of the art Robotics AssistiveTechnologies. At a first sight, it seems that much is tobe done and that despite of decades of research, both theoptimal HMI is in this context is still to be understoodand the borders of such a field is to be defined. We also
reported the most successful examples of market andscience industries trying to underline differencesamongst what is to be considered a good or a bad
example of production. By doing that we also
highlighted the different application fields and how
production itself is moving within them, by providing
possible solutions under different circumstances.
In this context, we presented the Moto tiles robotic
system as an innovative example on how to approach
Assistive Technology, by opening new fields ofapplication and new approaches to users’ attitude.
Indeed, in our opinion, it is important to continuously
change the philosophy by which we approach robotics(i.e. either as research and as an applicative field ofproduction), trying to find new technological andbehavioural scenarios that better fit to users’ need ofeasily understanding and use of technology in assistive,
rehabilitative, and preventive robotics. We believe that,
ideally, as already happened in telecommunication
technologies, user and patient oriented robotic
technologies must get simpler, adaptable, and enlarge
the range of action as much as possible.

References
1. http://journal.frontiersin.org/article/10.3389/fnbot.2014.0
0024/full?utm_source=newsletter&utm_medium=email&utm_campaign=Robotics_and_AI-w49-2015
2. M.A. Hersh, and M.A. Johnson. Assistive technology forvisually impaired and blind people. (Springer Verlag.
978-1-84628-866-1. 2008)
3. M.A. Hersh. 2010. The Design and Evaluation ofAssistive Technology Products and Devices Part 2:
Evaluation of Assistive Products. In: JH Stone, M Blouin,editors. International Encyclopedia of Rehabilitation.
4. A. Whitefield, Wilson F, Dowell J. 1991. A frameworkfor human factors evaluation. Behaviour and Information
Technology 10(1):65-79.
5. G. J. Avlonitis 1993. Project Dropstrat: what factors domanagers consider in deciding whether to drop a project.
European Journal of Marketing 27(4):35-57.
6. Brentani de U. 1986. Do firms need a custom-designed
new product screening model. Journal of ProductInnovation Management 3:108-119.
7. J. R. Schmidt, Sarangee, KR, Montoya MM. 2009.
Exploring new product development project review
practices. Journal of Product Innovation Management
26:520-535.
8. X. M. Song, Parry ME. 1996. What separates Japanese
new product winners from losers. Journal of ProductInnovation Management 13:422-439.
9. https://mitpress.mit.edu/books/robotics-primer
10. http://repository.cmu.edu/cgi/viewcontent.cgi?article=1044&context=hcii
11. H. H. Lund, Modular Robotics for Playful Physiotherapy,
in Proceedings of IEEE International Conference onRehabilitation Robotics (IEEE Press, 571-575, 2009)
12. H. H. Lund, and J. D. Jessen, Effects of short-term
training of community-dwelling elderly with modular
interactive tiles. GAMES FOR HEALTH: Research,Development, and Clinical Applications, 3(5), 277-283,
2014.

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