Authors: Jun-Ming Lu, Yeh-Liang Hsu (2011-05-25); recommended: Yeh-Liang Hsu (2011-05-25).
Note: This article is a book chapter of “Contemporary Issues in System
Science and Engineering,” to be published by IEEE/Wiley.
robots for medical and homecare applications
Over the past
few decades, robotics has made tremendous progress in saving, protecting, and
improving human lives, and is now adopted across a broad range of applications
in medicine and homecare services. While technologies are developed at a rapid
pace, people are expecting robots to be part of their lives in a more natural
way. Among the wide variety of robots, telepresence robots, which allow the
user to experience the virtual presence in another place, offer the potential
to meet this rising demand better and is thus of great concern. This section
will explore the up-to-date research findings and industry practices in
telepresence robots for medical and homecare applications. Moreover, the key
contributing factors to the success of telepresence robots will be discussed as
well to address the future trends and opportunities.
robots, medical telepresence, homecare telepresence, user acceptance
1. Robotics in medicine and homecare
Tracing back to
the first use of the term “robot” by Čapek in his play entitled “Rossum's
Universal Robots” in 1920, robots were originally regarded as the artificial
people produced to work as servants. From then on, the term “robot” began to be
widely adopted to describe the human-like machines that assist human beings. In
the beginning, most robots were developed to facilitate repetitive works for the
performance of industrial applications [Robot Institute of America, 1979]. With
further advancement of robotics, more people realized the great potential of
robots. Hence, robots were also expected to enrich the daily lives of human beings
more naturally and directly by performing all kinds of services [International
federation of Robotics, 1998]. Nowadays, robots are generally categorized by
the application fields into two main types: industrial robots and service
robots. More specifically, either category of robots can include both
autonomous and teleoperated robots, depending on how the robots are controlled.
Robots have the
advantages of high precision, strong consistency and reliable stability. Thus, in
the field of medical application, the use of robots exactly helps to overcome
the technical limitations of conventional surgery. The first robot-assisted
surgery was performed in 1985. The Unimation Puma 200 robot, which was equipped
with a computerized tomographic scanner and a probe guide, was used for stereotactic
brain surgery [Kwoh et al., 1988]. With the advancement of technologies,
medical robotics was further developed to extend human capabilities in surgery.
Intuitive Surgical  introduced
the da Vinci® Surgical System with advanced supersensory for telepresence. By
integrating a surgeon’s console, a patient-side cart with robotic arms, and a
high-performance vision system, the surgeon’s hand movements can be seamlessly
translated into precise and minimally invasive movements. In addition, robots also play an increasingly important role in modern medicine, ranging
from training the medical and nursing staff, assisting diagnosis, to
facilitating patients’ rehabilitation and care. Some medical schools make use
of Human Patient Simulator (HPS), a robot that mimic human’s feelings of pain
or discomfort, to help the soon-to-be doctors and nurses prepare to treat real patients
[METI, 2011]. Besides, the InTouch Health  developed a mobile robot
called RP-7 to enable the physician to be remotely present for diagnosis. It
helps to remove time and distance barriers and effectively extend the physician’s
reach to manage patient care. In this way, patients feel more satisfied because
physicians seem to spend more time with them [Gerrard et al., 2010]. Further, Kaczmarski
and Granosik  presented the rehabilitation robot RRH1. By helping the
patients replay trained exercises such as hip and knee flexion/extension and leg
abduction/adduction, the rehabilitation for the lower extremities can be easily
performed with safety. Moreover, robotic assistive limbs which enhance the
caregiver’s strength for patient handling [Satoh et al., 2009] and the robotic
wheelchair with the function of automatic navigation [Pineau and Atrash, 2007]
can provide much help in homecare. Toward a higher quality of life, interactive
robots serve as a new type of communication tool for medical or homecare use. Seal
robot Paro is an example of robot-assisted therapy for improving mental health [Wada
et al., 2008].
As shown in Table
1, the robots for medical and homecare applications are summarized according to
the participants and activities involved. Generally speaking, the use of robots
has made revolutionary changes by greatly helping the medical community in
various ways to save patients, improve quality of life and prevent health
Table 1. Categories of robots for medical and
family & friends
C, D, K
C, D, K
C, G, J, M
C, G, J, M
A, R, U, V
A, R, U, V
E, O, P, Q
E, O, P, Q
J, M, Q, T
B, C, J, M, Q, T
B, C, J, M, Q, T
A: [Böhm and
Gruber, 2010], B: [Breazeal, 2000], C: [Brière et al., 2009], D: [Gerrard et
al., 2010], E: [Helal and Abdulrazak: 2006], F: [Intuitive Surgical, 2010], G:
[iRobot Corporation, 2011], H: [Kaczmarski and Granosik, 2011], I: [Kwoh et
al., 1988], J: [Lu et al., 2011], K: [Luo et al., 2009], L: [METI, 2011], M:
[Michaud et al., 2008], N: [Mouri, 2009], O: [Mukai et al., 2008], P: [Pineau
and Atrash, 2007], Q: [Powers and Kiesler, 2006], R: [Saito et al., 2003], S:
[Satoh et al., 2009], T: [Tsai et al., 2006], U: [Wada and Shibata, 2007], V:
[Wada et al., 2008], W: [Intelligent Hospital Systems, 2011], X: [Tsoli and
Among the wide
variety of robots, telepresence robots do have the benefits of providing closer
connections between the two ends of users, which is often emphasized and
demanded in health care. Thus, in the next section, recent advances of
telepresence robots for medical and homecare applications will then be
introduced for better understanding. Subsequently, key factors contributing to
the success of telepresence robots will be further discussed to reveal the real
needs from the users’ perspective.
Recent advances of telepresence
robots for medicine and homecare
As Section 1
introduces, robots for medical and homecare applications can assist human
beings across a wide range of activities. Considering the special needs with
regard to telepresence, some up-to-date research findings and industry
practices are reviewed in the following context for a comprehensive overview.
2.1 Surgery, diagnosis and consultation
As mentioned in
the previous section, the
da Vinci® Surgical System makes use of telepresence technology to enable
surgeons to perform delicate and complex operations with increased vision,
precision, dexterity and control [Intuitive Surgical, 2010]. In addition to serving as the assistant on the first line of
medical services, telepresence robots can assist the doctors in diagnosis and
consultation as well. InTouch Health  released the mobile robot RP-7 that
enables the physician to extend their reach to manage health care by making
themselves remotely present near the patients. The robot doctor also allows direct
connection to Class II medical devices, such as electronic stethoscopes,
otoscopes and ultrasound, for transmitting medical data to the remote
physician. Medical personnel can thus discuss treatment plans and interact with
patients remotely, which helps improve the efficiency of medical diagnosis and
treatment for non-life threatening emergencies. In order to expand the range of
use, Brière et al.  presented Telerobot, an in-home telehealth robot for
clinical application. Telerobot is controlled using two screens. One is for the
clinical information system, and the other displays the control interface with a
virtual joystick and the video stream. In addition, Luo et al.  also developed
a telemedicine robot that allows the medical staff from long distance to
provide consultation for the elderly people living at home. Combined with the
wearable sensors, the robot will detect the emergencies such as falls and
immediately inform the family members.
2.2 Rehabilitation and therapy
helps extend not only human vision and hearing but also the sense of touch,
which is important for physical rehabilitation. Mouri et al.  proposed a
novel hand telerehabilitation system comprising a hand rehabilitation support
system for the patient, an anthropomorphic robot hand for the therapist, and a
remote monitoring system for diagnosing the degree of recovery. The therapist
applies the force to the robot hand, and the force is then transmitted to the
patient via the rehabilitation support system. This makes both participants experience
the face-to-face rehabilitation even though they are in fact far way from each
other. Besides, the remote monitoring system provides quantitative data in real
time, resulting in higher efficiency of treatments. Psychologically, therapeutic
robots based on telepresence also have the potential for improving people’s
mental health. The EU project IROMEC (Interactive RObotic social MEdiators as
Companions) developed a therapeutic robot for children with minor motor
disabilities or communication deficiencies. Since autonomous robots pose the
particular hazard to handicapped children who are not able to react properly to
a moving robot, the IROMEC robot makes use of telepresence and is controlled by
the remote therapeutic personnel to play with the children by following them or
dancing [Böhm and Gruber, 2010].
2.3. Monitoring and assistance
The use of a robot can be an alternative to locating
cameras everywhere in the house. Instead of having the feeling of being watched
all the time, the robot will only look around when there is any possible risk
detected. iRobot LE was developed for people to use it as a security guard to
monitor house as if the remote user actually goes around in the home
environment. With the telepresence capability, it gives the remote user access
of not only security in monitoring house or investigating household, but also checking
the conditions of the elderly people living alone [iRobot Corporation, 2011]. To
be more active while living with people, telepresence robots can provide
assistance in various ways. By extending the concept of smart homes, Helal and
Abdulrazak  proposed the development of TeCaRob, a telecare robot, to
provide physical assistance for people with special needs in the health care
center. Caregivers stay in the remote operation center and wait for the senior
people’s needs. The robots can assist the elderly in many ways such as
transferring and moving them, feeding them, giving medications, or doing some
tasks for them.
Derived from the idea of a mobile robot with
videophone embedded, Michaud et al.  presented a teleoperated robot with
wheels. Telepresence is provided for both ends with auditory and visual
information. But the feeling of “staying with the person at the same place” is
however limited due to the machine-like appearance. Tsai et al., 
developed a telepresence robot for interpersonal communication (TRIC) for the
daily use of the elderly in the home environment. With the human-like
appearance, the robot can better serve as the avatar of the children or grandchildren
for expressing their care. Given high mobility by means of omnidirectional
wheels and ultrasonic sensors, it is able to move in all directions, turn
around and avoid collisions with the environment. Toward a better convenience
of home use, it was then redesigned into a compact size with more plentiful
presentation of the remote user’s emotions and feelings, by means of eye
contact, facial expression, and body language. The physical face-to-face
interaction among people can be thus rebuilt to provide a more natural
communication as if both users are being together with each other [Lu et al.,
3. Key factors contributing to the success of telepresence robots
Although technologies have made great contribution to the development of
telepresence robots, the most important concern remains the user acceptance. In
other words, since a telepresence robot is intended to serve as the avatar or
agent of a human for interacting with the environment or other people, it is
necessary to provide the realistic sense of “being there” for the remote
controller, as well as the experience of “acting like a real person” for the local
user who stays with the robot. Broadbent et al.  discussed the user
acceptance of social robots in terms of robot factors and human factors. The
two categories provide totally different views for the requirements of a robot.
The former focuses on the functions or utility of the robot, while the latter
highlights the relationships between the user characteristics and the feelings
toward the robot. Based on this concept, the key affecting factors to the
success of telepresence robots are further discussed and summarized hereafter.
These findings can provide practical guidelines for researchers, professionals
and practitioners in this field.
3.1 Robot factors of acceptance
Robots are regarded as the products of technology
and scientific innovation. In addition to the advanced functions that benefit
human beings, how the robot interacts with people actually influences the user
acceptance more greatly. This is especially critical for telepresence robots, in
which the feeling of presence is highlighted. It is not only about making the
remote user experience exactly what the robot perceives and where it travels,
but also about whether the local user considers the robot as a realistic one. Generally,
these robot factors include its anthropomorphism, physical characteristics, and
personality. As the robot acts or reacts more naturally as real humans do, the
user will show greater interest and be more willing to interact with it.
Anthropomorphism, or human likeness, refers to projecting
human characteristics to non-human animals or non-living things. Generally, it
involves various attributes of the robot, such as appearance, facial expression,
and body motion. As the level of anthropomorphism goes higher, the interaction
performance can be further improved [Li et al., 2010]. For example, Goetz et
al.  indicated that the appearance of a robot influences people’s
perceptions of a robot, as well as their willingness to follow the instructions
given by the robot. However, the humanoid robots are not always the preferred
ones. As shown in the 2000-people survey conducted by Arras and Cerqui , only 19% prefer a
humanoid appearance. In fact, the user acceptance depends on whether the level
of anthropomorphism matches the sociability required in the jobs. More
specifically, people would prefer human-like robots as office clerk or hospital
message carrier, while machine-like robots are expected to be lab assistant, inspector,
or guardian [Goetz et al., 2003]. Considering the task involved, people also
tend to cooperate with human-like robots rather than machine-like robots [Hinds
et al., 2004]. Further, the user perception also relates to the dimension of
the robot’s head and its facial expression. Powers and Kiesler  found
that a shorter chin contributes to the perception of higher sociability and
higher intentions to follow the robot’s medical advice. In addition, large
smiles with slow transitions are seen as more appealing by the users [Powers et
(2) Physical characteristics
As a robot becomes closer to a real human, the
physical characteristics such as gender, age, height and weight will then have impacts
on the user acceptance. Powers et al.  reported that participants said
fewer words to the female robot than to the male robot in a human-robot
dialogue. This phenomenon might be explained by the traditional role
stereotypes. Besides, the age of a robot can influence its role that people
experience. For example, if the robot has an adult humanoid appearance, people
will expect it to be able to converse more naturally than the robot with a
younger appearance [Breazeal, 2000]. Moreover, the preference of the robot size
is determined by the tasks it involves. Robots for home use are expected to
have a smaller size [Giuliani et al., 2005], whereas robots for patient
handling require a larger size to support the weight and increase user’s
confidence [Mukai et al., 2008].
In addition to the physical characteristics, the
personality of a robot, including its emotional, attitudinal, and behavioral
response patterns, also plays an important role in user acceptance. For an efficient
use, it has to match either the user’s characteristics or its own role.
Obviously, a caring and empathic personality will encourage interaction between
the user and the robot [Bickmore and Picard, 2004]. Besides, Heerink et al. 
reported that a more socially communicative robot would be more likely to be accepted
as a conversational partner. Further, perceptions of knowledge and sociability were
found to be able to change people’s intention to follow the robot’s advice [Powers
and Kiesler, 2006]. Moreover, Ţăpuş et al.  demonstrated that a robot’s adaptability
to the user’s personality is important for user improvements of rehabilitation exercises.
3.2 Human factors of acceptance
There is a great diversity of human beings. People
are with quite different physical characteristics, backgrounds and experiences.
In addition to the robot factors, the user acceptance is also affected by these
many human factors. For telepresence robots, from the remote user’s point of
view, the feeling of presence may vary among different people even though the
condition remains the same. As for the local user, one unique activity that the
robot performs may produce different perception or response among people. Thus,
it is necessary to investigate the causes and consequences of these factors for
a better robot design.
(1) Physical characteristics
Arras and Cerqui  investigated the relationship
between age and the willingness of living on a daily basis with robots. The
results show that young adults tend to give more positive responses than older adults
(over the age of 65). Nevertheless, under the assumption that one is with
impaired mobility and is unable to handle the daily activities, the older
adults will be more willing to accept a robot to help them gain independence. Besides,
gender of the user also makes difference. While interacting with a robot, males
wonder more about the technical aspects, whereas females are more interested in
its name [Taggart et al., 2005]. Further, in Nomura et al.’s study , the
experimental results imply a gender difference in relationships between
negative attitudes and anxiety, and behavior toward robots. Among people who
have high negative attitudes and anxiety toward interaction with robots, males
tend to avoid touching or talking with robots, while females still talk to the
robot but not engage in much self-disclosure with it.
(2) Backgrounds and experiences
With different background and experiences, people
may have varied attitudes toward technologies or robots. Giuliani et al. 
reported that as the educational level gets higher, one will try to make
connections with technological solutions more frequently. Besides, lack of
familiarity with technologies can be a major reason for people feeling
uncertain about robots [Dijkers, 1991). As people stay longer with a robot, it
will also change their attitudes toward it. Over a two-month study conducted by
Wada and Shibata , residents in a care center finally developed much
better personal relationships with the therapy robot. Moreover, cultural
differences also make impacts on people’s attitudes towards robots. Bartneck et
al.  reported that Americans were more positive in their attitudes
towards robots than other cultures across Asia, Europe and North
America. Differences were also found between European groups, in
which French-speaking people would accept a human-like robot more than Germans did
(3) Roles and needs
People will have different attitudes toward robots
while they are playing different roles. For example, robots are generally accepted
by patients and their families as a powerful assistant. However, robots often
produce negative attitudes among the medical and nursing staff. Wasen  indicated
that robots sometimes make assistant surgeons feel isolated in surgery, and
they are also annoyed because of the difficulty in moving the robots around. As
for nurses’ reactions, many of them were distrustful of the technology, worrying
that their job security was threatened [Novek et al., 2000], as well as feeling
stressed while working with a robot [Saito et al., 2003].
From the robot’s perspective, since a telepresence
robot is intended to serve as an avatar of a real human, it is expected to look
and act like human beings do. Besides, in order to meet the local user’s
expectations, it would be better to make the robot’s physical characteristics
or personality match its own role or those of the remote controller. From the
user’s perspective, human-centered design is definitely critical to the success
of a telepresence robot. Once the real demands can be explored and realized,
telepresence robots will eventually enter our lives as new roles for modern
medicine and homecare.
4. Concluding remarks
Robots have greatly changed people’s lives by contributing to the
advancement of modern medicine and healthcare. Telepresence especially assists
in realizing the remote medicine and healthcare with realistic senses and
feedbacks. Nevertheless, no matter how technologies are accelerating the
development of robotics, the most important thing is meeting the real demands
of human beings. From both robot and human perspectives, the principle of using
telepresence robots is to rebuild the face-to-face experiences among people in medical
treatment or homecare services. Besides, customized considerations can further improve
the acceptance for a wide range of users. Unlike autonomous robots,
telepresence robots are never expected to totally take over the medical and
nursing staff’s jobs. Instead, they cooperate with the professionals toward a
higher quality without borders of time and distance. As long as people have
needs for medical and homecare services, plenty of opportunities will be there
for telepresence robots.
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