JMIR Publications

ABSTRACT

Background:

Apathy is common among older adults residing in long term care (LTC) and impairs the quality of life for both older adults and their care providers. Few pharmacological remedies exist; non-pharmacologic approaches are resource intensive. There is a growing interest in the use of non-immersive or immersive virtual reality (VR) and/or socially assistive robots (SAR) to enhance LTC older adults’ function and quality of life but older adults and staff are often absent in the design of interactive health technologies. Given the range of physical and cognitive impairments, involving older LTC adults in the development of interactive health technologies is necessary to enhance the functionality, usability, and likelihood in promoting the intended health outcome.

Objective:

Our aim was to establish a library of SAR-VR dyadic activities that combined cognitive, physical, and social domains and encouraged human-to-human (HHI) engagement during the activities.

Methods:

We implemented a multi-step, user-centered design (UCD) to develop and evaluate SAR-VR dyadic multimodal activities that encourages human-human interaction (HHI) through human-computer interaction (HCI) and human-robot interaction (HRI). A humanoid SAR and animal SAR were used. An interdisciplinary team of engineers, nurses, and physicians collaborated with an advisory panel comprising LTC activity coordinators, staff, and residents to prototype the activities. The study resulted in four virtual dyadic activities: three with the humanoid robot, Nao, and one with the animal robot, Aibo. Fourteen older adults at two LTCs participated in the design and evaluation of the different components of the system and provided feedback throughout all stages of development. Site 1 participants were instrumental in the development of the prototype activities; Site 2 participants validated the prototype activities and provided feedback for further refinement. At each session, participants at both sites rated their degree of comfort and confidence in a) using the wands, b) interacting with the robot, and c) interacting with the VR environment. To determine whether LTC staff could administer the system, 5 staff from Site 2 (mean age 34.2, standard deviation ±15.8) were recruited. Staff participants were asked to set up and run the system based on a written setup guide. All components of the system were labeled and color coded and the labels were referenced in the written guide. Every section had a video guide accompanying the written manual. Only minimal verbal assistance was provided by the researchers when required. After each session, the system set-up and interface were refined based on objective and subjective feedback.

Results:

Four of six participants (mean age: 85 ±9.3, all with mild to moderate cognitive impairment) completed Field Testing 1. Participant approval increased significantly over successive iterations of the system across all categories (Wilcoxon signed rank test, p = 0.025). Eight residents (mean age: 80 ± 4.7, all with mild to moderate cognitive impairment) completed Field Testing 2. Participant approval increased significantly over successive iterations of the system across all categories (Wilcoxon signed rank test, p = 0.00003). Five LTC staff members successfully set up the system with minimal help from the researchers, demonstrating the usability of the system for caregivers. Iterative design changes incorporated hardware, software, and activity domains.

Conclusions:

These initial results demonstrate that LTC older adults and staff are capable and critical to the development and implementation of SAR-VR activities.