1 Introduction
1.1 Defining Mutual Shaping
1.2 Mutual Shaping and Socially Assistive Robots
1.3 Studying Conventional Therapy to Inform SAR Design
2 Related Work
2.1 Methods for Mutual Shaping
2.2 Mutual Shaping and Socially Assistive Robots
3 Methodology
Focus group | Participants |
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1 | OT1, OT2, OT3 |
2 | SR1, P1, OT4, SL1 |
3 | P2, P3, P4, P5 |
4 | SL2, OT5, P6 |
5 | SL3, P7, SR2, OT6, OT7 |
Section | Key topics |
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Before discussion | Acceptance questionnaire |
Discussion part 1 | Use of social robots in therapy |
Conventional therapy delivery | |
Group activity on factors affecting | |
adherence | |
Project talk and demo | Study motivations |
Supporting literature | |
Project aims and objectives | |
2\(\times \) Pepper assistance scenarios | |
Discussion part 2 | Revisit use of social robots in |
therapy | |
Useful data collection | |
After discussion | Extended acceptance questionnaire |
3.1 Pre-focus Group Questionnaire
3.2 Pre-demonstration Discussion
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What do you think about using robots to support a therapy program?
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How do you think that robots might be able to do that?
3.3 Project Presentation and Robot Demonstrations
3.4 Post-demonstration Discussion
3.5 Post-focus Group Questionnaire
3.6 Data Analysis
4 Findings
4.1 SARs in Therapy: Mutual Shaping Issues Identified for Consideration
4.1.1 Issues Regarding the Patient’s Social Life, Circle and Support
Some warned however that, particularly if the therapy was initially instigated or particularly encouraged by a particular family member, too much of this co-operation between the therapist and family could isolate the patient:His wife will always come back to me and say what he has and hasn’t been able to do...she likes to make sure he’s doing everything he’s meant to do and sometimes he’s sitting there and he’s like ‘well I tried to do it’ (P2)
Some participants also noted the strain that therapy can put on personal relationships, and similarly whilst social support could be key in encouraging engagement, it could also have a negative impact as well:if the person around them is the one that’s referred them and you’re seen as that you’re coercing, it’s a bit of a conspiracy then isn’t it and the person’s going to feel a bit left out (SL1)
he’s a good example of someone I’ve seen and given him exercises to do and challenges to do when I’m not there...he’s got someone with him there who enables him to do it but he sometimes gets a little bit irritated because it’s his wife (laughs)...And that’s not uncommon either (P2)
Participants were enthusiastic about the use of SARs to somehow address this, considering how SARs for therapy in the home could reduce carer load and relationship strain, but also raised potential concerns, e.g. the potential for guilt, that might be associated with that:sometimes the patient won’t want to do the exercises with their for example husband because they know he’s already doing all of the activities that they used to do and they don’t want to be that additional burden ‘they’ve already had a busy day I can’t ask them to do my exercises with me so I just can’t do my exercises (P5)
Such discussions generally focused on the SAR becoming a ‘third-party’; i.e. something which could neutrally prompt the patient or alternatively be more convincing than a family member (especially in the case of young people):Parents, carers, they are absolutely knackered...we spend our lives telling them not to sit their children down in front of the telly to look after them so I think there might be, there’s an issue of this around that as well like ‘ooh I’m handing my child over to a machine to do what I should be doing’...I think it could help but there could be a guilt loop as well (SL3)
Just thinking about I suppose the child-parent dynamic...actually the parent sometimes, you know, children say they’re quite tired after school and parents like ‘oh you don’t need to do it tonight’ or the opposite they try to get them to do it and they’re like ‘I’m not going to do that’. So actually with kids I think it could be a useful tool actually...a little bit more independent (OT4)
But then also a lot of people respond to a professional and not their family...So you could have the spouse sort of whistles to the robot ‘Go on, give him a shout’ (SL3)
4.1.2 How We Would, Could or Should Talk to Robots
I think bits of me like the human aspects but bits of me want it to almost to be a computer that talks (agreement from others) because I’m not sure... I would want to say please, and then I would hate myself for saying please to a machine (SL1)
I don’t like speaking to Siri because it doesn’t recognise when I say please, it then confuses it... when I’m talking in the car and my kids are hearing it I don’t want them hearing it as if it’s an instruction (OT7)
4.1.3 Therapist-Patient Relationship and Communication
A suggested benefit of the system was addressing individual patient preferences with regard to monitoring and disclosure. For example, patients who didn’t like reporting to the therapist could instead report to the robot, whereas those who seemed to benefit from therapist reinforcement could be reminded of that by the robot:as therapists we’ve got the, well, sort of luxury of having time with people, so you do build up a relationship and mostly there’s quite a lot of trust there and they put quite a lot of trust in what you say so you can be very influential with it (P2)
One participant also noted that patients might be more willing to ask questions or ask for help via the robot based on previous experience with an email based system:For some patients the idea that it’s not a human that you’re reporting to, and it would be faceless entity, could be a benefit to them, and them knowing that someone else is going to read it and observe it could be an issue for them... I would say it does make a difference because some of the technology that I use where it says about reporting the number of steps, they’re waiting to be told off, even though you don’t tell them off, or waiting to be praised. (P5)
...what it also does is enable the patients to respond and write back in to their therapist with questions ‘should I, shouldn’t I, how do I do it’ and in fact we have had a couple of patients who’ve been very engaged with it and even do so from their hospital bed and that was really interesting in terms of opening up and at what stage they share information and do those things and because there wasn’t somebody there in front of them, which wasn’t as off putting then actually you got very different information. (OT6)
4.1.4 Robot Dependency
if she can go and get him a cup of tea then she would be loved. (OT3) That would be great (OT2) but at the same time your patients aren’t getting mobile they’re not getting up and aren’t getting up and engaging. (OT3)
it’s really important to keep the responsibility with the person themselves, which probably is going to be a factor with the robot as well you want to potentially be able to remove the robot from the situation at some stage (P6)
4.1.5 Cost and Patient Demographics
In addition however, when considering factors which affect engagement (in which patient demographics was highlighted as a factor), some participants identified that those who might struggle with motivation most are least likely to be able to afford private therapy or related technologies:I find that people do the work more in private practice than they ever did in the NHS (SL3) But then, the fact that they are paying means that they have a vested interest (OT6)
I was at a sports medicine conference...and [Professor Greg Whyte] was talking about how actually interventions that we use to try and improve people’s health through basically trying to improve their motivation to exercise...he’s saying we’re trying to solve sort of lower class problems with middle class, upper class solutions with things like apps and things you know...these are people who potentially don’t have smart phones and yet all our efforts are being pointed at things like that technology which can’t be afforded to these people (SR2)
4.2 Willingness to Work With/Adapt to Using SARs
One participant offered an interesting reflection concerning what’s best for therapists versus what’s best for patients, and how those two things might unintentionally be misaligned, based on a previous experience working with technology in therapy:I think if you work with people, patients then anything that makes a positive difference preferably (laughs) is worth considering (OT6)
One participant raised the issue that in the case of patients experiencing pain, the robot would have to tell them to stop, whereas a therapist would assess the situation and (if appropriate) reassure them that some pain is to be expected and suggest they should carry on. In response to this, another participant suggested this could be addressed by having the robot contact the therapist directly to facilitate this exchange as necessary:I did a project quite some years ago about using video conferencing for face to face sessions and what was really interesting was that therapists were dead against it, including me, and felt that that would erode our one to one thing... and we really weren’t very keen, people really weren’t very keen, myself included. The patients loved it, so suddenly certainly for me I had to make a real leap into ‘ok...I thought I was thinking of my patients’ best interests but what I was actually thinking was about my satisfaction and the rewards for me’ so I really had to change that and...so I’m probably coming at this much more positively than I perhaps would have done, having had that experience. (SL2)
you’ve also got to think about the questions that come along the route... the robot’s just going to say ‘stop you need to refer back to therapist’, that sets up quite a sort of big message in the patients’ brain of ‘actually no I shouldn’t be doing this because it hurts’ and we might say ‘oh its fine as long as its not making too much trouble for you, that’s to be expected’... (P5)
Generally, participants who were less accepting or enthusiastic about the idea of using SARs were still able to identify ways in which they could be helpful; however these were more focused on fitting into current (conventional) therapy delivery. For example one participant expressed multiple doubts about robot technologies being suitable for occupational therapy (e.g. in their ability to ‘read’ the patient or be empathetic); however they were still able to identify how a robot might help to make better use of their own time with the patient:But then you could have the robot doing that, so it could say ‘ok sort of keep going, keep going for the moment, maybe not quite so strongly, let’s message through to the therapist now’...and if the therapist gets a text that says this is what’s going on and she can give you a call... it could be worked in (SL3)
In contrast, those that were more enthusiastic were able to come up with completely new applications and potential uses which the research team had not considered:I think you know the robot could help with something so if you say to the patient for next time prepare a list so that we can think about the groceries you need to do to be able to cook this meal or whatever it is I guess you know a robot or whatever could say have you prepared the list have you done this for tomorrow... so that sort of prompts that engagement into the task. (OT1)
it’s prompted me thinking of using some aspects of it for training other carers... a lot of the work I’m doing at the moment is teaching people in care homes working with people with dementia how to communicate with them... if you could show them how that works with a robot so ‘this is what the robot is doing, isn’t that more endearing when it does that, what would happen if you do that?’ (SL1)
4.3 Impact of Study Participation on Participants
It doesn’t go upstairs does it... so you’d have to have another one upstairs (OT2)
Potentially but that’s something you can get over isn’t it (OT3)
But I mean it is a real issue then if someone’s downstairs during the day... then they’re upstairs for night time (OT2)
The difference in participant acceptance before and after the study is also evidenced by the results of the pre/post-session questionnaire. The questionnaire results were quantified (using reverse coding where applicable) and a Wilcoxon Signed Rank Test was applied in order to measure the difference between the pre and post data sets for each acceptance statement. All statements except I think social robots might be somewhat intimidating to service users showed a significant (p < 0.05) increase in positive responses. The full results are listed in Table 3. The shift in acceptance is also shown visually for each statement in Fig. 6, which shows the spread of individual participant responses, and Fig. 7, which shows the shift in mean response across participants.I’m sure there is an adaptation you can stick on the bottom of the robot that she could get up the stairs (OT3)
Statement label | Result |
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Apprehensive | (\(\hbox {Z} = -\,2.818, p = 0.005\)) |
Intimidating (me) | (\(\hbox {Z} = -\,2.309, p = 0.021\)) |
Intimidating (user) | (\(\hbox {Z} = 1.811, p = 0.70\))* |
Good idea | (\(\hbox {Z} = -\,2.46, p = 0.014\)) |
More engaging | (\(\hbox {Z} = -\,3.116, p = 0.002\)) |
Useful | (\(\hbox {Z} = -\,3.0, p = 0.003\)) |
Improve success | (\(\hbox {Z} = -\,2.48, p = 0.013\)) |