2nd Draft Proposal

I was initially thinking of adding in security problems with artificial intelligence with my research on robotics, but I went back to my original research topic of comparing both United States and Japan's use of robotics in healthcare for the elderly.

According to a wpi pdf on "The Emerging Role of Robotics in Personal Health Care", the definition of a robot is composed of three things: actuate, sense and process. " A robot is a machine that is capable of obtaining data from its environment by means of sensors, processing the data at least to some extent, and reacting to this data by means of actuators."(pg 41)

As noted in my earlier proposals, Japan is one of the countries actively exploring this field to tackle the aging population.They have created different types of robotic companions such as a robotic seal, a bear carebot, and robotic nurses. 

There are two different opinions about the robotic companions. They are either like what the authors of a KALW online article "Robotic seals comfort dementia patients but raise ethical concerns" mentioned; that it does not matter whether Paro is real or not in the long run as "humans are wired for connection". As Dr. Geoffrey Lane, the psychologist who brought Paro to the Livermore hospital asserts, "There's a pretty large body of evidence to show that interacting with animals can help things like lower blood pressure, reduce depression, reduce subjective pain, decrease the time it takes to recover from chronic ailments".  Or, they would be what Shannon Vallor, an ethicist and philosophy professor at Santa Clara University said, that nurses and therapists at the Livermore V.A does not explicitly tell patients that Paro the seal is a robot, instead, they play along with questions as if Paro is real. It just seems unfair for the dementia patients whose line between reality and imagination is already blurred. There's also another problem, and it has to do with us, the people who are actually doing the caring.

Shannon Vallor brought up some really good questions to ponder about:

1. What happens to our moral character and our virtues in a world where we increasingly have more and more opportunities to transfer our responsibilities for caring for others, to robots?

2. Where is the quality of those robots that increasingly encourages us to feel more comfortable with doing this, to feel less guilty about it, to feel that in fact maybe that's the best way that we can care for our loved ones?

I think she has a good point. It is helping therapists do their job better, and also helping the patients, but at the same time, it's an ethical concern that we are pushing our responsibilities onto robots.

As 2015 Pew Research Center article "Family Support in Graying Societies" mentioned, "Germany and Italy, two of the “oldest” nations in the world...are already where the U.S. will be in 2050: a fifth of the population in each country is age 65 or older. Compared with the U.S. today, a higher share of adults in Germany and Italy report helping their aging parents with basic tasks, and more in Italy have also provided personal care. However, in both countries, fewer adults than in the U.S. say they have provided financial assistance to their aging parents."

But is providing financial assistance for the elders, or helping out with basic tasks really enough?

Sometimes, we need a robotic companion or a robotic caretaker for the elders. As a 2014 New York Times article, "The Future of Robot Caregivers" noted, "in an ideal world, it would be: Each of us would have at least one kind and fully capable human caregiver to meet our physical and emotional needs as we age. But most of us do not live in an ideal world, and a reliable robot may be better than an unreliable or abusive person, or than no one at all."

Caregiving is a really hard work. I agree with the article that it is tedious, awkwardly intimate and physically and emotionally exhausting. Sometimes it's also dangerous as caregiving are almost always women's work and immigrants' work. They are usually strangers as well. 

Personally I have mixed feelings about caretakers, as I have personal experiences with them. My grandaunt, and my deceased grandmother have been taken care of by foreign caretakers in Malaysia since my family moved out of the country due to my father's work. And initially, it is alright as they could still walk and can communicate with the foreign caretakers, but in recent years, especially after my grandaunt fell and could not walk anymore, it has gotten difficult to take care of them. I am also very uncomfortable with having strangers living and taking care of my family members, but there was nothing I can do. They are the only ones able to take care of them until we go back to visit them. But there's always the concern of dangerous caretakers, or caretakers taking advantage of the elders. Of course, having a robotic caretaker may have ethical issues and safety concerns as well. I would also be worried of whether or not the robotic caretaker is able to call 911, in a case of emergency, or what if they don't provide the right help, and in turn harmed my family members?

But caregiving is a task that not just anybody is willing to do. Some countries have acknowledged this reality, and thus invested in robotics. Japan, especially, is one country that is actively researching this field in creating better robotic healthcare for the aging population.

Some other approaches, other than robotic companions like the robotic seal "Paro", are robotics use in clinical applications and in intelligent prosthetics.

The Dali walker or c-walker is a current project of the European Union and the Seimans Corporation.

"The Dali walker is a programmable walker with multiple digital sensing devices for use in individuals with memory loss, dementia. The sensor system allows the walker to perceive and interpret its spatial environment in real time. By its navigational capabilities, this technologically advanced walker is mentally functioning for as well as affording physical support. This potent combination of both physical and mental assistance is potentially invaluable to an elderly person, who may have become timid about venturing out alone, especially in crowded or unfamiliar public places." (Mayo Clinic's article "Robots/Robotics in Healthcare")

1. Clinical Applications.

1. Surgical robots have become extremely sophisticated, even allowing surgeons to operate them from thousands of miles away.  The da Vinci surgical robot system is a good example of the progress surgical robotics has made since its conception.
2. da Vinci System
1. One of the most well-known surgical robots, the da Vinci robot. More than 800 hospitals in the United States and Europe use the robot in various types of surgery. This system has been successfully applied in general surgery, cardiothoracic surgery, urology, gynecology, and possibly otolaryngology. The da Vinci system is made up of three primary components (many other applications can be added on): a surgical cart, vision cart, and surgeon console.
3. Description about the figure "da Vinci Surgical System" (pg 44):



The end of the robotic arm contains surgical instruments. It is crafted to mimic “human-like” wrist motion. – Da Vinci System (Picture from Mayo Clinic's article "Robots/Robotics in Healthcare")

1. The surgical cart is a robotic manipulator with three arms: one camera arm with a 12mm stereoscopic laparoscope and two others arms that hold 8mm instruments. One interesting technology applied here is the EndoWrist Instruments technology. Tiny computer-enhanced mechanical wrists allow a full 7 degrees of freedom at the instrument tips. Instrument tips are aligned with the instrument controllers electronically to provide optimal hand-eye orientation and natural operative capability.
2. This innovative wrist was inspired from the Black Falcon of MIT. Overall visualization of operation is performed by the vision cart, which consist of two three-chip cameras mounted within one integrated and three dimensional 12mm stereo endoscope with two separate optical channels. The operative images are transmitted to a high-resolution binocular display at the surgeon console. The surgeon can see the operation in a 3-D (can be changed into 2-D) stereoscopic illustration on the console. Then he maneuvers robotic manipulators, which allow him to control the robotic arms and cameras.
3. This setup achieves more precise and accurate manipulations of instruments than those that can be achieved from conventional endoscopic surgery
4. da Vinci Surgical System - Peeling A Grape
5. Here are some of Mayo Clinic's views of the Da Vinci System in the article  "Robots/Robotics in Healthcare":
1. Advantages:
1. More controllable, and thus, potentially safer environment for both the patient and physician, increased precision of surgical manipulation, improved vision due to magnification, and better ergonomics for the operator. Due to the minimally invasive nature of the surgery, hospital stays for patients who have undergone robotic surgery are also shorter. Robotic surgery has an advantage over laparoscopic surgery, the other form of minimally invasive surgery, due to the aforementioned degree of motion of the robot “arm” and “wrist”. There is untapped potential for simulation of surgical procedures and techniques using surgical robotic systems. Finally, the global application/potential of these systems is just beginning to be imagined.
2. Robotic assisted surgical systems have been used extensively in urology for prostate surgery, and, less commonly, in general surgery and most surgical subspecialties. Additional applications for these surgical-assist robots are continually being developed, the latest for ophthalmic/eye surgery.
2. Disadvantages:
1. The degree of training required, and the cost, especially since patient outcomes are, overall, similar to traditional surgery. Surgeons have some difficulty adjusting to the lack of tactile input from operating with these machines.
4. Robot draw blood from a patient
5. "Telemedical Network is Key in Accessibility " -Robotics in Healthcare
1. InTouch Health in Action | InTouch Health's Telehealth Network
2. With InTouch Health, patients in remote areas will be able to have access to high-quality emergency consultations for stroke, cardiovascular, and burn services through the tablet or on the personal computer.
6. Bestic, the assistive eating robotic device

1. Developed in 2004 by Sten Hemmingsson who had suffered a crippling paralysis from polio. The device is designed to lift food from the plate to the mouth, and is controllable of the user by touch of a button. 
7. The “Sedasys” System – Anesthesia (Mayo's article)
1. It's a robotic machine that delivers anesthesia without an anesthesiologist. It has been developed for use in clinical settings and routine procedures such as colonoscopy and endoscopy. The rollout, by Johnson and Johnson, has been slow and the system is only used in four medical centers at this time, as the acceptance rate has been low due to fears regarding completely autonomous medical care .
1. 

1. Today, robots are capable of not only surgery, but also various other jobs in the field of health care, such as rehabilitating patients, providing/supporting professional care, and providing diagnostic assistance.

 Preventive Therapies and Diagnosis-Intelligent Fitness System

1.  Preventive therapies and diagnosis covers independent diagnostic methods such as robotized endoscope and teleoperation systems which independently monitor patients and preventive technologies such as intelligent fitness system and multiple objects motion/sound recognition system. 

Robotic Assistance Technology-Intelligent Prosthetics

1. Robotized assistance, such as intelligent prosthetics, robotized transportation system and manipulation assistances, is another important field of health care.
2. An example will be the robotized artificial ankle shown in the figure above. This mechanical ankle senses which phase of stride the ankle is on, and manipulates
   the angle of the bottom plates with springs.  The stored energy in the spring releases to the next phase of walking which saves between 14 and 23% of the energy spent using conventional prosthesis. 
3. Robot Suits and Exoskeletons: Musculoskeletal and Muscular Assistive Devices (Mayo's article "Robots/Robotics in Healthcare")

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   “ReWalk” by ReWalk Robotics is a mobile lower body exoskeleton for walking assist and/or walking rehabilitation, and potentially a replacement to the wheel chair. It is the only such exoskeleton currently approved for home use by the FDA.

   
   

   

   A soft robotic grasp assist glove that's being developed at Harvard, is designed to assist any attempted movements of the hand. It is hoped that these gloves can help individuals regain some hand function both in their daily lives and in rehabilitation.

   YouTube video: Soft robotic gloves
   
   

   

   Ekso Bionics engineers has created this Ekso skeleton that may allow formerly wheelchair-bound users, the ability to walk.

   
   

   
   

   

   HAL robot suit / "bionic" suit (developed by Cyberdyne of Japan)  can be worn as a full body suit or a lower body suit. It is utilized in Japan for rehabilitation purposes, for generalized and specific muscular assist after injury, and for normal people who are in occupations where they need increased strength.

Links:
Robots/Robotics in Healthcare
Family Support in Graying Societies
The ethical dilemmas of robotics

Japan is running out of people to take care of the elderly, so it's making robots instead