Interview

Introduction to Demonstration Research on Robotic Devices for Nursing Care

In today’s super-aging society, we face the challenge of a labor shortage in the nursing care field. While demand for robotic devices for nursing care is increasing, they have yet to spread widely.
Among the various applications of robotic devices for nursing care, communication robots are very effective for recreation at nursing care facilities and for monitoring family members living apart.
In the development and manufacturing of robotic devices for nursing care, demonstration research is conducted to verify the effects of device use, with the aim of developing more useful, more functional devices and putting them into use at nursing care sites.
For this article, we spoke with Tsuneki Ninomiya, PALRO Project Department, Product Business Division, Fujisoft Incorporated, about the demonstration research on and product history of PALRO (a humanoid communication robot), which was developed by the company.

PALRO was released for elderly welfare facilities in 2012.
Upon release, we had few connections with nursing care facilities, so we were unsure how to proceed with conducting demonstrations.
Then, in 2013, PALRO was adopted as a priority project of the “Sagami Robot Industry Special Zone” in Kanagawa Prefecture, which enabled us to conduct various demonstrations with the special zone’s support.
First, with the cooperation of Fujisawa City in Kanagawa Prefecture, PALRO was lent to 23 nursing care facilities, such as special nursing homes and dementia group homes, for two weeks each as a trial verification. We verified the robot’s usefulness and potential as well as the needs of nursing care sites and safety while feeding back information to development.
At that time, communication robots were not included among the “Priority fields for the use of robotic technology in nursing care” (hereinafter referred to as “priority fields”) established as support for the development of robotic technology by the Ministry of Economy, Trade and Industry and the Ministry of Health, Labour and Welfare. For this reason, with Kanagawa Prefecture’s continued support, we conducted various demonstrations at universities, research institutions, and within own company. With the aim of expanding the scope of application of communication robots (from mild to severe levels of care) and expanding the priority fields (adding communication robots), we focused on obtaining evidence of the effects in care recipients.
After that, following the large-scale demonstration study (1) on the potential use of communication robots at nursing care sites conducted by the Japan Agency for Medical Research and Development (AMED) in fiscal year 2016, communication robots were added as a priority field in 2017. Since then, application of public support from Japan’s national and local governments for development and introduction has expanded, and this was a major turning point in spreading such robots into the nursing care field.
Currently, in anticipation of the revision to nursing care fees, we are continuing to develop and demonstrate the robot in order to contribute to the government`s goal of improving productivity at nursing care sites, with the aim of obtaining evidence for promoting the effects.
Through such development and demonstrations, in addition to the software updates, we have made improvements to the hardware. At present, we are offering the “PALRO Business Series Model III for Elderly Welfare Facilities.” In 2018, we also released the “PALRO Gift Package” for elderly people living at home. Aiming to expand the elderly care field, we continue to evolve.

At a software company like ours, it is very difficult to find nursing care facilities that will serve as demonstration facilities as well as universities or research institutions to collect evidence from scratch. By participating in initiatives led by the national and local governments, we have built up a network by partnering with more demonstration sites and collaborating organizations.
As for demonstration sites, if a facility is using PALRO for the first time, we must provide follow-ups on everything from the initial setup through to how to handle the robot. For this reason, depending on the demonstration schedule and content, we may need to ask for cooperation from facilities where the robot has already been introduced. We believe that it is also important to build relationships and develop systems with sites where the robot has already been introduced.
As a secondary effect, since there were few nursing care facilities using robots around 2012 to 2014 during the early phase following the robot’s release, the facilities employing the robot received much more media exposure due to the robot’s novelty and popularity, resulting in PR for the facilities. This enabled us to secure cooperation from some facilities.
We also think it is important for the facilities accepting demonstrations to benefit.
As the robot’s characteristics make it difficult to understand how to use it based on appearance alone, the first step is to ensure that the users can use it. To this end, it is important to identify which conditions are effective while introducing to facilities examples of other facilities where effective results have been obtained.

As a means of publicizing the demonstration results to the target elderly welfare facilities, we mainly post them on our company website. For some facilities, we also provide information by sending brochures and flyers by direct mail, which is a means more likely to catch their attention than websites.
The demonstration results we post on our website present the effects associated with PALRO’s representative functions. For example, we post evidence of the recreational effects as well as the effects of the communication and prompting functions based on demonstration results obtained in partnership with universities and research institutions.
When providing explanations, we avoid using too many technical terms and instead use easy-to-understand expressions. We also provide summaries of English papers translated into Japanese to facilitate understanding the information.
At the same time, academic papers are an effective way to appeal to the government and research institutions. For this reason, we collaborate with researchers at partner universities and research institutions (mainly in the medical and welfare fields) and ask them to write papers and disseminate our work.
In particular, our presentation of results at academic conferences in the medical and welfare fields served as a trigger to directly appeal to and garner interest from medical and welfare professionals, which led to further demonstration research and introductions. Moreover, academic papers have led to inquiries from government agencies, thus contributing to promotion to the government.

Since the initial release, we have collected various opinions and feedback from nursing care facilities and added new functions to the product.
We have also collected data on malfunctions and other failures, which we analyzed to provide feedback for development, including hardware improvements, in order to expand functionality and to improve safety and usefulness.
For functions with established utilization methods, we collaborated with medical and welfare professionals to obtain evidence of the utilization benefits in order to validate the functions.
For communication robots, due to their product characteristics, it is difficult to evaluate the effects quantitatively, so we used various evaluation indicators to conduct a multifaceted analysis.
In order to apply the demonstration results to introduce our robots at nursing care facilities, we make every effort to explain the results in accordance with the type of facility and occupations of the care providers.
For example, for medical professionals such as doctors, occupational therapists, and physical therapists, we sometimes use papers and indicators to highlight specific effects, while for onsite staff members, we use simple expressions and focus on concrete cases so that they can visualize use. We feel it is important to present the results in a balanced way

To increase the credibility of demonstration results, statistical data and analysis are necessary.
Especially when using results as evidence to appeal to the government, it is necessary to compare use over a certain period (6 months to 1 year) and to secure a sufficient number of subjects. It is difficult for our company to cover all necessary equipment and personnel for demonstrations due to costs.
As already mentioned, it is difficult to observe quantitative effects for communication robots due to their product characteristics, so there is the challenge of lacking clear outcomes to promote their effects. To identify the indicators to be used as criteria in the future, we are promoting demonstrations and discussions while utilizing the Living Lab of the Ministry of Health, Labour and Welfare’s platform project (2).
Regarding the ethical review required for conducting demonstration research, companies that newly enter the nursing care field are unfamiliar with it and have difficulty completing it.
Our company was able to smoothly undergo the review thanks to the support we received through the initiative in the “Sagami Robot Industry Special Zone” in Kanagawa Prefecture and the national strategic special zone in Kitakyushu City, but we feel that support for companies unfamiliar with ethical reviews must be expanded.
We think that many challenges to the widespread adoption of nursing care robots remain. However, as one measure against the shortage of nursing care workers due to the decreasing birthrate and aging population, we are promoting the development and introduction of such robots under the belief that they can contribute to maintaining and improving the quality of nursing care, improving productivity, and maintaining and improving the physical and mental functions of the elderly.

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