Aging is a gradual, multifactorial and continuous process characterized by the progressive loss of biological function and degeneration associated with the onset of age-related diseases. In Portugal, the aging of the population is particularly noticeable, with the population projected to fall from 10.3 to 7.5 million by 2080, while the number of elderly people will increase from 2.1 to 2.8 million. Among the health problems associated with aging, dementia/neurocognitive impairment major stands out as a disabling progressive neurological condition. It is characterized by deterioration in cognitive domains such as attention, memory, language, and social cognition, as well as being associated with neuropsychiatric symptoms (SNP) such as aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition, and communication difficulties. In 2018, it was estimated that 50 million people in the world were living with dementia, a figure that could triple by 2050. PARO
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Home / Publications / Publication
IMPACT OF ROBOTHERAPY-PARO ON ELDERLY PEOPLE WITH DEMENTIA IN PORTUGAL
Publication type: Article Summary
Original title: Roboterapia-PARO em pessoas idosas com perturbação neurocognitiva
Article publication date: November 2019
Source: Repositório Institucional da Universidade Católica Portuguesa
Author: Rita Gomes
Supervisors: João Amado & Rosa Silva
What is the goal, target audience, and areas of digital health it addresses?
The aim of the study was to evaluate the effectiveness of Robotherapy-PARO as a non-pharmacological intervention to improve the well-being of elderly people with dementia. The target audience includes elderly people diagnosed with dementia, formal and informal carers, social workers, healthcare professionals, sociologists, and socio-cultural animators. This research is part of digital health, exploring the use of advanced technologies such as therapeutic robots.
What is the context?
Aging is a gradual, multifactorial and continuous process characterized by the progressive loss of biological function and degeneration associated with the onset of age-related diseases. In Portugal, the aging of the population is particularly noticeable, with the population projected to fall from 10.3 to 7.5 million by 2080, while the number of elderly people will increase from 2.1 to 2.8 million.
Among the health problems associated with aging, dementia/neurocognitive impairment major stands out as a disabling progressive neurological condition. It is characterized by deterioration in cognitive domains such as attention, memory, language, and social cognition, as well as being associated with neuropsychiatric symptoms (SNP) such as aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition, and communication difficulties. In 2018, it was estimated that 50 million people in the world were living with dementia, a figure that could triple by 2050.
In residential facilities for the elderly, people with dementia often remain inactive for half the time they are awake. In addition, while some live in low-stimulation environments, others are exposed to excessive stimuli, such as too much light and noise at night. These circumstances aggravate SNP and contribute to depressed mood, making it essential to balance periods of sensory stimulation and relaxation.
Multisensory stimulation is an effective non-pharmacological approach to reduce SNP at any stage of dementia. This therapy, based on individualized attention, uses sensory stimuli such as hearing, sight and touch, adjusting to the specific needs of everyone. It provides a balance between relaxation and active stimulation, promoting well-being and increasing self-confidence. Despite its recognized benefits, its implementation faces significant challenges, such as the high level of inactivity among the elderly, the excessive use of sedation and the lack of specialized training for health professionals.
What are the current approaches?
Conventional interventions to manage SNP generally involve isolating elderly people with dementia and/or using medication such as analgesics and antipsychotics. Although these drugs offer quick and convenient results, they are associated with serious adverse effects, such as an increased risk of cardiovascular disease and worsening cognitive deterioration, which makes it even more difficult for these elderly people to get involved in activities.
Alternatives such as multisensory stimulation, cognitive exercises (such as word games), and simplified routines slow cognitive decline, reduce SNP, and improve the quality of life of elderly people with dementia, as well as reducing the risk of carer burnout.
Social robots stand out as a form of multisensory stimulation therapy, promoting interaction and communication with the elderly. These robots promote positive emotions, reduce feelings of loneliness, and improve mood and social interaction. Studies indicate that elderly people appreciate the presence of robots, with acceptance and therapeutic effect being influenced by the design and materials of the robots. In addition, interaction with robots has been associated with activation of the immune system and a reduction in SNP. Another benefit is the gradual replacement of pet therapy (animal therapy), which presents challenges such as the risk of allergic reactions, the unpredictability of animal behavior and the costs associated with animal care.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consists of evaluating the impact of Robotherapy-PARO in Portugal, using the PARO social robot, developed in Japan, to promote physical, emotional, cognitive and social improvements in elderly people with dementia.
PARO is a therapeutic robot in the shape of a baby seal, designed with a zoomorphic design to convey comfort and stimulate positive interactions. The choice of a seal, an animal little associated with everyday life, was intentional, avoiding possible negative associations or traumas related to domestic animals. Each device is coated with antibacterial, dirt-resistant fur that is safe for people with medical devices such as pacemakers.
Equipped with artificial intelligence and 5 types of sensors, PARO allows for sophisticated interaction that is adapted to each user. The touch sensors, located under the fur and whiskers, react to human contact, while light sensors in the nose detect changes in brightness. Temperature and posture sensors, located in the center of the device, adjust the robot’s responses to heat and the user’s position. Microphones make it possible to localize sounds and respond to auditory stimuli. In addition, the robot emits simulated seal sounds, which can be interpreted as signs of pleasure or displeasure and combines movements, sounds and expressions to recreate emotional states and provide an engaging interaction.
Between March and May 2019, an experimental study was carried out with 10 elderly women institutionalized in a residential structure in the Porto region, aged over 78 years, diagnosed with dementia and moderate to very severe cognitive decline. Sixteen individual sessions of 30 minutes were held over 8 weeks, led by a multidisciplinary team composed of a psychologist, a sociologist, a social worker and a sociocultural animator. The participants interacted with the PARO robotic seal through touch, gaze, gestures and verbal communication, in controlled environments and with the same facilitator during all sessions.
The impact of the intervention was assessed before and after the sessions, using validated scales: the Global Deterioration Scale (GDS) to determine the degree of cognitive deterioration, the Neuropsychiatric Inventory (NPI) to analyze the SNPs and the Cornell Scale for Depression in Dementia (CSDD) to measure depression states. In some sessions, video recordings were also made to evaluate behaviors, and, in each session, an observational grid was used to record the participants’ interactions with the robot.
What are the main results? What is the impact of these results? What is the future of this technology?
Robotherapy-PARO revealed high acceptance, with 80% of the participants demonstrating satisfaction and active involvement during the sessions. Although two participants dropped out, which is recurrent in studies of people with dementia, the eight participants who completed the therapy showed significant improvements. Analyses carried out using video-recordings and observational grids revealed that the participants welcomed the PARO seal with enthusiasm, giving it affectionate names and often reacting with smiles. There was an increase in the frequency and duration of affective gestures, such as touches, hugs, glances, and grooming (e.g., brushing the fur). The intervention also promoted improvements in verbal communication, facial expression, and social interaction, as well as significantly reducing SNP, especially agitation, according to the INP scale.
Although the GDS and CSDD scales did not identify significant changes in cognitive performance or levels of depression, it was observed that elderly people with less cognitive deterioration responded better to therapy. In addition, previous affinity with animals also proved to be a relevant factor in the success of the intervention, with many participants associating PARO with companion animals.
The results of this study have a significant impact, suggesting that Robotherapy-PARO can be an effective and safe alternative to pharmacological treatments, contributing to reduction the drug burden and improving the quality of life of elderly people with dementia. Additionally, the intervention promoted a more meaningful interaction between carers and elderly people, creating opportunities for more human and empathetic relationships. The implementation of this technology in residential structures can represent a substantial advancement in long-term care.
The future of Robotherapy-PARO includes conducting studies with control groups and larger, more diverse samples to confirm and expand the results obtained. In addition, it will also be important to adjust the intervention, reducing the duration of sessions for participants with higher levels of cognitive deterioration. To effectively integrate Robotherapy-PARO into the institutional context, it will be crucial to invest in training of carers and health professionals, ensuring appropriate and sustainable use of technology.
Would you like to know all the details?
Autonomous Robotics System for Autism Therapy
Autism spectrum disorder is a neurodevelopmental condition with significant clinical, social and economic repercussions throughout life. According to the World Health Organization, it is estimated…
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Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with…
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COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious disease with the potential to cause serious complications, requiring the isolation of infected individuals and…
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Healthcare-associated infections pose a serious public health threat, as they are acquired during medical treatments or hospital stays, often leading to prolonged hospitalizations, high costs…
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Alzheimer’s disease is the most common form of dementia, affecting more than 55 million people globally and accounting for around 70 percent of dementia cases….
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Portugal has one of the highest aging populations in the world, placing increasing pressure on elderly care services, especially in nursing homes. Healthcare professionals in…
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Paroxysmal diseases are characterized by sudden, episodic conditions that cause temporary changes in the body. Among them, epilepsy stands out for causing synchronous and uncontrolled…
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Vascular diseases, such as carotid stenosis (narrowing of the carotid arteries, which connect the heart to the brain, caused by the accumulation of fatty atheroma…
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Home / Publications / Publication
IMPACT OF ROBOTHERAPY-PARO ON ELDERLY PEOPLE WITH DEMENTIA IN PORTUGAL
Publication type: Article Summary
Original title: Roboterapia-PARO em pessoas idosas com perturbação neurocognitiva
Article publication date: November 2019
Source: Repositório Institucional da Universidade Católica Portuguesa
Author: Rita Gomes
Supervisors: João Amado & Rosa Silva
What is the goal, target audience, and areas of digital health it addresses?
The aim of the study was to evaluate the effectiveness of Robotherapy-PARO as a non-pharmacological intervention to improve the well-being of elderly people with dementia. The target audience includes elderly people diagnosed with dementia, formal and informal carers, social workers, healthcare professionals, sociologists, and socio-cultural animators. This research is part of digital health, exploring the use of advanced technologies such as therapeutic robots.
What is the context?
Aging is a gradual, multifactorial and continuous process characterized by the progressive loss of biological function and degeneration associated with the onset of age-related diseases. In Portugal, the aging of the population is particularly noticeable, with the population projected to fall from 10.3 to 7.5 million by 2080, while the number of elderly people will increase from 2.1 to 2.8 million.
Among the health problems associated with aging, dementia/neurocognitive impairment major stands out as a disabling progressive neurological condition. It is characterized by deterioration in cognitive domains such as attention, memory, language, and social cognition, as well as being associated with neuropsychiatric symptoms (SNP) such as aggression, agitation, depression, anxiety, delusions, hallucinations, apathy, disinhibition, and communication difficulties. In 2018, it was estimated that 50 million people in the world were living with dementia, a figure that could triple by 2050.
In residential facilities for the elderly, people with dementia often remain inactive for half the time they are awake. In addition, while some live in low-stimulation environments, others are exposed to excessive stimuli, such as too much light and noise at night. These circumstances aggravate SNP and contribute to depressed mood, making it essential to balance periods of sensory stimulation and relaxation.
Multisensory stimulation is an effective non-pharmacological approach to reduce SNP at any stage of dementia. This therapy, based on individualized attention, uses sensory stimuli such as hearing, sight and touch, adjusting to the specific needs of everyone. It provides a balance between relaxation and active stimulation, promoting well-being and increasing self-confidence. Despite its recognized benefits, its implementation faces significant challenges, such as the high level of inactivity among the elderly, the excessive use of sedation and the lack of specialized training for health professionals.
What are the current approaches?
Conventional interventions to manage SNP generally involve isolating elderly people with dementia and/or using medication such as analgesics and antipsychotics. Although these drugs offer quick and convenient results, they are associated with serious adverse effects, such as an increased risk of cardiovascular disease and worsening cognitive deterioration, which makes it even more difficult for these elderly people to get involved in activities.
Alternatives such as multisensory stimulation, cognitive exercises (such as word games), and simplified routines slow cognitive decline, reduce SNP, and improve the quality of life of elderly people with dementia, as well as reducing the risk of carer burnout.
Social robots stand out as a form of multisensory stimulation therapy, promoting interaction and communication with the elderly. These robots promote positive emotions, reduce feelings of loneliness, and improve mood and social interaction. Studies indicate that elderly people appreciate the presence of robots, with acceptance and therapeutic effect being influenced by the design and materials of the robots. In addition, interaction with robots has been associated with activation of the immune system and a reduction in SNP. Another benefit is the gradual replacement of pet therapy (animal therapy), which presents challenges such as the risk of allergic reactions, the unpredictability of animal behavior and the costs associated with animal care.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consists of evaluating the impact of Robotherapy-PARO in Portugal, using the PARO social robot, developed in Japan, to promote physical, emotional, cognitive and social improvements in elderly people with dementia.
PARO is a therapeutic robot in the shape of a baby seal, designed with a zoomorphic design to convey comfort and stimulate positive interactions. The choice of a seal, an animal little associated with everyday life, was intentional, avoiding possible negative associations or traumas related to domestic animals. Each device is coated with antibacterial, dirt-resistant fur that is safe for people with medical devices such as pacemakers.
Equipped with artificial intelligence and 5 types of sensors, PARO allows for sophisticated interaction that is adapted to each user. The touch sensors, located under the fur and whiskers, react to human contact, while light sensors in the nose detect changes in brightness. Temperature and posture sensors, located in the center of the device, adjust the robot’s responses to heat and the user’s position. Microphones make it possible to localize sounds and respond to auditory stimuli. In addition, the robot emits simulated seal sounds, which can be interpreted as signs of pleasure or displeasure and combines movements, sounds and expressions to recreate emotional states and provide an engaging interaction.
Between March and May 2019, an experimental study was carried out with 10 elderly women institutionalized in a residential structure in the Porto region, aged over 78 years, diagnosed with dementia and moderate to very severe cognitive decline. Sixteen individual sessions of 30 minutes were held over 8 weeks, led by a multidisciplinary team composed of a psychologist, a sociologist, a social worker and a sociocultural animator. The participants interacted with the PARO robotic seal through touch, gaze, gestures and verbal communication, in controlled environments and with the same facilitator during all sessions.
The impact of the intervention was assessed before and after the sessions, using validated scales: the Global Deterioration Scale (GDS) to determine the degree of cognitive deterioration, the Neuropsychiatric Inventory (NPI) to analyze the SNPs and the Cornell Scale for Depression in Dementia (CSDD) to measure depression states. In some sessions, video recordings were also made to evaluate behaviors, and, in each session, an observational grid was used to record the participants’ interactions with the robot.
What are the main results? What is the impact of these results? What is the future of this technology?
Robotherapy-PARO revealed high acceptance, with 80% of the participants demonstrating satisfaction and active involvement during the sessions. Although two participants dropped out, which is recurrent in studies of people with dementia, the eight participants who completed the therapy showed significant improvements. Analyses carried out using video-recordings and observational grids revealed that the participants welcomed the PARO seal with enthusiasm, giving it affectionate names and often reacting with smiles. There was an increase in the frequency and duration of affective gestures, such as touches, hugs, glances, and grooming (e.g., brushing the fur). The intervention also promoted improvements in verbal communication, facial expression, and social interaction, as well as significantly reducing SNP, especially agitation, according to the INP scale.
Although the GDS and CSDD scales did not identify significant changes in cognitive performance or levels of depression, it was observed that elderly people with less cognitive deterioration responded better to therapy. In addition, previous affinity with animals also proved to be a relevant factor in the success of the intervention, with many participants associating PARO with companion animals.
The results of this study have a significant impact, suggesting that Robotherapy-PARO can be an effective and safe alternative to pharmacological treatments, contributing to reduction the drug burden and improving the quality of life of elderly people with dementia. Additionally, the intervention promoted a more meaningful interaction between carers and elderly people, creating opportunities for more human and empathetic relationships. The implementation of this technology in residential structures can represent a substantial advancement in long-term care.
The future of Robotherapy-PARO includes conducting studies with control groups and larger, more diverse samples to confirm and expand the results obtained. In addition, it will also be important to adjust the intervention, reducing the duration of sessions for participants with higher levels of cognitive deterioration. To effectively integrate Robotherapy-PARO into the institutional context, it will be crucial to invest in training of carers and health professionals, ensuring appropriate and sustainable use of technology.
Would you like to know all the details?
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Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with various factors, such as demographic ageing, excessive use of digital…
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Vascular diseases, such as carotid stenosis (narrowing of the carotid arteries, which connect the heart to the brain, caused by the accumulation of fatty atheroma plaques), cerebrovascular accidents (CVA) (sudden interruption of blood flow to…
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Workers face growing challenges in the industrial environment. Among the most critical are fatigue and inappropriate postures, often associated with repetitive tasks and working conditions that lack ergonomic suitability. These factors represent significant risks for…
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PAD is a prevalent chronic condition, affecting approximately 200 million individuals globally, characterized by obstruction of the peripheral arteries, especially in the lower extremities, due to the formation of atherosclerotic plaques, which compromise blood flow…
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Poliempreende is a consolidated national network for encouraging entrepreneurship in higher education in Portugal, with two decades of existence. Focused on promoting innovation, the competition has had a significant impact on the national economy, with…
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Many patients face difficulties scheduling medical appointments in hospital units, and, when successful, they often endure long waiting times to be attended. This situation is aggravated by problems such as the incompatibility of schedules between…
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Innovative technology that subconsciously relieves anxiety through a scarf
The SCAARF technology aims to offer an alternative method to alleviate anxiety symptoms in a non-intrusive and subconscious way. This technology is an innovative idea in the field of digital health and wearable technology, designed…
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The radiology service of ARS Algarve has already performed nearly 29,000 exams using Artificial Intelligence (AI) technology. In recent years, there has been a significant investment in image digitization and data storage, as well as…
European Health Data Space: Unified Access To Health Data In The EU
The COVID-19 pandemic highlighted the importance of digital services in health, but complex rules and increasing cyberattacks make it difficult to share data across Member States; the EHDS, based on several regulations, provides tailor-made rules…
European Commission Amends Digital Europe Programme With an Investment of €762.7 Million
The European Commission has amended the Digital Europe Programme work programmes 2023-2024, investing an additional €762.7 million in Europe’s digital transition and cybersecurity. The digital transition is the main work programme with a budget of…
SPMS Integrates the TEF-Health Initiative
SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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