PRACTICAL RESEARCH

Robot-Guided Exercise Program for the Rehabilitation of Older Nursing Home Residents

June 17, 2013
Authors: 

Iivari Bäck, PhD 1,2 • Kari Makela, PhD 2 • Jouko Kallio, MSc Student 2

Citation: 

Bäck I, Makela K,Kallio J. Robot-guided exercise program for the rehabilitation of older nursing home residents. Annals of Long-Term Care: Clinical Care and Aging. 2013;21(6):38-41.

Affiliations:

1Department of Management, University of Vaasa, Vaasa, Finland

2Department of Biomedical Engineering, Tampere University of Technology, Tampere, Finland


Abstract: Physical activity has a significant impact on the health of older adults. Socially interactive robots can be used to encourage and guide the performance of rehabilitation exercises designed for elderly people. In this article, the authors present the results of their project, which studied the use of a small humanoid robot to facilitate rehabilitation exercises in three private nursing homes in the Finnish county of South Ostrobothnia. The researchers programmed the robot to lead several exercise regimens, which could be performed by the residents while seated on chairs. During the exercise sessions, the robot demonstrated the hand and leg motions, while providing prerecorded instructions for each motion. The feedback from both the residents and the nursing home staff was mainly positive. 

Key words: Rehabilitation, quality of life, robotics, exercise.


The aging population is increasingly placing pressure on an already taxed healthcare system. In assisted living facilities and nursing homes, there are considerable financial challenges and staffing shortages to contend with, yet the growing elderly population is projected to generate an even more severe shortage of caretakers in the near future. To address this concern, various technical concepts, including technologies that incorporate artificial intelligence and telemedicine systems, have been developed.1,2

Because physical activity may delay the onset of physical deficits while contributing to overall improved health in older adults,3 different types of exercise programs have been used for this population. These programs have been implemented in various care settings, including nursing homes, but because they are beneficial only when followed regularly and consistently, adherence is essential to maximize benefits. Due to financial and resource constraints, it is often difficult to arrange regular exercise sessions with a physical therapist and/or a fitness trainer. One way to potentially address this problem is to use robot technology to fill the gaps. In this article, we present the results of our study, which assessed the use of a robot as a means of guiding nursing home residents through an exercise program.

Methods Aldebaran Robotics, robotics in healthcare, exercise, rehabilitation of the elderly

We used an NAO H25 robot manufactured by Aldebaran Robotics in our study (Figure 1). This robot is a programmable, humanoid robot that is approximately 22 inches in height and capable of autonomous movement by using its electric motors and actuators, which enable 25 degrees of freedom. The robot also has a variety of sensors and devices, including cameras, microphones, distance sensors, a voice synthesizer, speakers, and a wireless local area network connection for communication and information transmission.

We assessed the NAO robot as an exercise trainer at three private nursing homes in the Finnish county of South Ostrobothnia. These nursing homes had a small population of residents (≤22 persons). Many of these residents had a limited ability to walk or had some cognitive problems related to memory. Before initiating the robot-guided exercise program, all residents were shown how it worked so that they could decide whether to participate. After watching the demonstration, 34 of the 44 residents (77%) at these homes decided to do the program (Table), and the robot-guided exercise program was tested from November 2011 to May 2012.Aldebaran Robotics, robotics in healthcare, exercise, rehabilitation of the elderly

During this period, the robot was tested four times in each nursing home. A member of the nursing home staff supervised the testing and was assisted by a member of the research group, whose presence was required to ensure that the robot worked properly. For the testing, the robot was programmed to demonstrate several different exercise routines. These routines were then implemented in a group session with both the robot and the participants sitting in chairs (Figure 2). The robot showed the participants arm and leg motions and provided prerecorded instructions for each motion. The exercise programs typically lasted 10 to 20 minutes and included three to five repetitions of each motion, with three to four different motions for both arms and legs. Different music played during each testing session.Aldebaran Robotics, robotics in healthcare, exercise, rehabilitation of the elderly

The exercise program was continuously developed during the testing period based on the feedback we received from the residents. This feedback was obtained through informal discussions with the residents at the end of each testing session. To obtain more structured feedback on the robot-guided exercise program, we also designed a written survey for the personnel of the nursing homes. The survey, which was conducted during the final testing day, included the following questions:

(1)    What is your opinion of the robot-guided exercise program? How well does it work?

(2)    What kind of feedback have you received from the residents regarding the robot-guided exercise program?

(3)    What are your suggestions on how to improve the robot-guided exercise program?

(4)    What other uses can you identify for the robot in the rehabilitation of the elderly?

Results

After engaging in the program, most residents had positive feedback, although some of the participants were more interested in the robot than the exercise program. The residents also had several ideas on how the program could be improved. Initially, the robot’s hands and legs had no color, but the residents recommended that we add color to them to make them more visible. Another suggestion was to delineate each exercise (eg, arm movements, leg movements) by playing different music, rather than only switching the music for each testing session. We made these changes, and they were well received at sub-sequent testing sessions. 

Of the staff surveys, we received responses from all of the staff members from the three nursing homes who were present during the testing sessions (N=13). With regard to the first question, the general consensus was that a robot-guided exercise program is well suited for the elderly, especially more active persons, as these individuals are the most likely candidates to participate in a variety of exercises and activities in the nursing home. They also noted that more passive residents do not always follow along with the exercises without support from staff; thus, for such individuals, exercises led by a human might be more appropriate. In addition, because the robot is relatively small, the staff stated that it must be located on a table close to the participants during the sessions so that everyone can see it clearly.

Regarding the second survey question, the staff indicated that resident feedback was mainly positive. They noted that several residents were curious about the robot and expressed an interest in the robot-guided exercises. They also stated that many residents spoke about the robot afterwards and asked a variety of questions about it.

With regard to the third question, most suggestions for improvement were related to the speed of the robot’s motions, volume of speech and music, and visibility of the robot’s hands, arms, and legs. The staff noted the importance of the motions of the robot being slow enough for residents to follow along and the speech being clear and loud so that they could understand the prompts. They noted that some residents had difficulty seeing the robot’s hand and arm movements because of the robot’s small size, but once we added color to the robot’s extremities, this improved.

Regarding the third survey question, several other uses for the robot were suggested. One suggestion was to use the robot to entertain the residents, such as functioning as an interactive music player. Another recommendation was to program the robot to provide cognitive exercises, such as question and answer sessions, but that such exercise sessions should be no longer than 8 to 10 minutes because of residents’ limited ability to maintain concentration for long periods of time.