How robots can assist patients

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How can robots be used to assist patients?

To develop the ideal robot for patients, their needs and expectations must be understood. There
are three common considerations which need to be taken into account; ergonomics, physical
assistance and mental simulation.

Ergonomics is applying the knowledge of human behaviour, abilities, limitations and other
characteristics into the design of medical devices, systems and tasks, to achieve the desired
usability.

Physical assistance is ensuring that the robot can process sensory information and perform
physical actions to benefit the user, helping them to perform physical tasks with greater ease.

Mental Stimulation is required to improve the functioning of a person’s thinking and memory.
This is achieved by performing cognitive programs such as memory tasks, problem solving and
attention tasks. Mental stimulation is needed so that a patient is actively engaged with the robot
and it can also help to keep an ageing mind sharp.

Rehabilitation

Robotic systems have been widely applied to the rehabilitation of patients. They can provide
physical assistance and be used as a caregiver, promoting independence for the patient.

There are many ways in which a robot can assist a patient such as physical therapy, personal
assistant and disability aid, assistive mobility and social integration

 Robots for physical therapy are more efficient in delivering a physical and

occupational activity as they are able to monitor the patient’s movement to ensure the
correct movement is made. They can also provide rich data to assist in patient
diagnosis, customisation of the therapy and maintenance of patient records.
Rehabilitation robots guide the patient through the required movements with control over
resistance, speed and number of repetitions. In Step 1.6 you saw how exoskeletons
assist in guiding a patient to perform the required movements.
 Robots as personal assistants and disability aids aim to support patients with motor
impairments or an intellectual disability with everyday functions such as eating or
personal hygiene. A personal assistant robot can be a standalone assistive technology
such as a robotic arm or it can be integrated into a wheelchair.
 Robots assist in mobility by being used to develop power wheelchairs. These are
incorporated with sensors and control systems to allow a wheelchair to move more
autonomously.
  Robots for social integration can be used to interact and work with patients. These
systems are designed to learn and adapt to changing circumstances and interact with
people in a socially appropriate way by interpreting human needs and intentions. With
the development of AI, there will be more robots showing aspects of human-style
intelligence.

Summary

The patient’s needs and expectations as well as ergonomics, physical assistance and mental
stimulation all need to be considered when designing a robot. This can lead to it becoming a
useful tool in aiding a patient’s rehabilitation and independence, as well as providing physical
assistance.

What are exoskeletons?

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Robots can now be designed to mirror the joints and movements of the human body. As
discussed in step 1.8, these robots can be worn by people to facilitate their movement
and assist them with their rehabilitation. These robots are called exoskeletons.

An exoskeleton is a wearable machine which is powered by electric motors, pneumatics, levers,

hydraulics or a combination of technologies which assist limb movement with increased strength
and endurance. Exoskeletons are an external structure with joints and links that go around the
user’s body to aid in movement.

At the University of Leeds two exoskeletons are under development, these are the wrist and
ankle exoskeleton. The wrist exoskeleton is used for targeted and coordinated hand and wrist
therapy, which is often overlooked in rehabilitation robotics. The wrist exoskeleton can help to
regain the ability of the user to perform activities of daily living.
The ankle exoskeleton can be widely used among elderly people, those with impaired lower-leg
muscle strength and workers whose jobs require substantial walking or running.

How an exoskeleton is classified is often dependent on how the end user will use it, but there
are a few exceptions. B. Rupal (2017) classified exoskeletons into two categories: non-medical
and medical.

Non-medical exoskeletons are for soldiers, workers, healthy elderly and for general purposes.
Non-medical exoskeletons are used to support the user and to perform a desired motion in a
natural manner. For example, exoskeletons are used in the military to carry heavy objects (up to
300 kg) whilst running or climbing stairs. Using an exoskeleton to assist can decrease fatigue
and increase the productivity of a soldier. The control and interface of non-medical exoskeletons
need to be generic enough for efficient use by lay users. This means non-medical exoskeletons
have mass appeal and are adaptive to a wide range of movement patterns and individuals.

Medical exoskeletons are suitable for users who have paraplegia, for rehabilitation assistance,
amputee and disabled patients. Medical exoskeletons are designed to provide mobility to
someone who is physically disabled, injured or weak where their functionality is limited in terms
of their mobility and strength. Unlike a non-medical exoskeleton, movement of a medical
exoskeleton isn’t provided by the movement of the wearer. Instead, control strategies and
mechanical interfaces are specifically designed for the user. Medical exoskeletons require
assistance from specialist medical professionals. This is to ensure the patient will receive
maximum clinical benefit with limited chances of harm.

Gopura and Kiguchi classified exoskeletons into the four categories below:

Category Types

Rehabilitation, motion assist, human power, amplifier, haptics

By Function
interaction, teleoperation, prosthesis, etc.

Part of the human body where the exoskeleton is attached:

By Applied Segment upper and lower extremities (main classification), arm,
forearm, hand, combined segments

Electric motors, pneumatic muscles, hydraulic actuators,

By Actuators
mechanical, etc.

By Power Transmission Gear-driven, cable-driven, linkage mechanisms, combined, etc.

In this step, you have understood that exoskeletons have both a medical and non-medical
purpose and how exoskeletons can be categorised depending on their function, applied
segment, actuators and power transmission. You have also been introduced to the possible
uses of exoskeletons and the two types of exoskeletons that are under development at the
University of Leeds. This step aims to provide you with a broad overview of exoskeletons and
their potential applications.

Building exoskeletons
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Exoskeletons are a framework which aim to mirror the wearer’s internal skeletal structure
and multiply the wearer’s strength.

The framework of an exoskeleton is located around the user’s body. For a user to comfortably
interact with an exoskeleton it must be designed to meet wearability requirements and be
designed using suitable materials. The frame of an exoskeleton can be made from either hard
materials (metals) or soft materials (fabric).

Baniqued et al. (2015) adapted a design criterion for wearability from Gemperle et al. (1998) to
exoskeletons. Baniqued’s design criteria to ensure wearability of a design includes the following
elements:

 Placement – Refers to where the device is placed on the human body. Factors to
consider are sizing, areas of the body that must remain uninterrupted and large surface
areas. When designing an exoskeleton, the designer must also consider the attachment
systems of the exoskeleton to the body this includes straps, belts, hand grips and other
fasteners as they must accommodate various users (such as adults and children).
 Humanistic Form – The exoskeleton should be designed to ergonomically fit the form of
the human body.
 Kinesics – Refers to the movement of the human body. To ensure free and seamless
movement of the human body an exoskeleton must be designed considering the
movement of joint mechanisms, skin elasticity and muscles and tendons.
 Proxemics – Relates to the human perception of space and size.
 Size Variations – The design of an exoskeleton must consider the various users, and
the body size and anatomical profiles of individuals. Previous exoskeletons have
addressed this by developing adjustable frames.
 Containment – The design of the exoskeleton needs to consider the components that
contribute to the outer form of an exoskeleton, such as the size and weight of motors.
 Accessibility and Sensory Interaction – Refers to how the human body will interact
with the exoskeleton, which could be passive or active interactions. A successful design
of an exoskeleton should consider visual, tactile, auditory and kinaesthetic factors and
consider the functionality of the body alongside biological and perceptual heat factors.
 Aesthetics – Refers to the overall design of an exoskeleton and how appropriate the
design is for the user. The design also needs to consider the environment the
 exoskeleton will be used in. This includes how the exoskeleton looks (shapes and
colours), to the materials and textures used.

If all of these design considerations have been met the user will be relaxed and happy when
using the exoskeleton.

Can AI and robots be used as caregivers?

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By now, you’ve seen how robots can be used to assist in surgeons performing complex
and delicate surgical procedures, as well as providing physical assistance to patients as
a tool for rehabilitation. But would it ever be possible for a robot to do something
previously considered very human, and actually care for people?

Healthcare extends beyond surgery and medical interventions to include providing care for
those who require additional help and support. Those who provide this service as known as
care givers.

Care givers do not work under the direction of a doctor or nurse and are not typically considered
as a healthcare professional. The aim of a care giver is to make day to day life easier for the
individual requiring support. This can include tasks such as driving, housekeeping and
companionship.

Up until now, this has been a solely human domain, but advancements in AI and robotics
means that we are beginning to see the creation of robots specifically designed to provide care
to people.

These robots can be pre-programmed to provide a care giving role. They can also use AI and
machine learning to provide a more personal and human touch. Examples include being used
as therapy aids for children dealing with grief and loss, or as companions in nursing homes and
elementary schools.

Robots and Artificial intelligence can assist individuals by:

 Providing physical therapy – Robots can provide a variety of gamification methods or

pre-programmed activities to assist the patient in meeting their rehabilitative aims.
 Assisting with daily life tasks – Robots can provide physical and cognitive assistance.
This can range from planning and scheduling appointments to providing engaging
cognitive aides to stimulate thinking, concentration and memory.
 Emotional expression – Robots can encourage individuals to be emotionally
expressive by interacting with users through phrases and gestures
For a robot to be able to effectively assist an individual it must be able to engage with the user,
be responsive to the user’s needs and requirements, be easy to use so that it can be used
without any expertise or training and a robot must be able to translate the input by the user
correctly and efficiently.

Using AI to tackle anxiety and depression

One way in which AI can be used as a care giver is in the provision of emotional support to
people who suffer from anxiety and depression. Advancements in AI mean that programs can
now be created which are able to mimic human responses and even engage in stimulating two-
way conversations with people. These programs are called Chatbots.

Chatbots are currently available either in web-based applications or standalone apps.

One example of a Chatbot app which uses artificial intelligence to interact with humans is Wysa.

Wysa is a stress, depression and anxiety therapy chatbot that uses AI to react to the emotions
expressed by the user. Wysa aims to help and support a user by having anonymous,
empathetic and non-judgemental conversations with the user. The user can also access
additional support and guidance from a qualified skilled mental health professional. The app
also uses cognitive behavioural therapies. The aim of Wysa is to help users build mental
resilience and improve their emotional health.

What are the benefits to the NHS?

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So far you’ve seen how AI and Robotics can provide both physical assistance and
support to patients and also be used to provide mental stimulation and emotional
support. But how could these technologies support healthcare services and the NHS?

The main challenges that the NHS is currently facing are a growing and ageing population, a
staffing crisis as well as the closure of local services which limit access to healthcare. There are
also the evolving and ever-changing healthcare needs of the population. These include the
increase of obesity, diabetes and the rise of antibiotic resistance.

AI and Robotics could benefit the NHS by reducing the workload on healthcare workers by:

 Helping patients to eat their meals, perform tasks such as bathing and assisting with
movement around the hospital.
 Diagnosing serious illnesses by using digital pathology.
 Assisting in patient recovery from trauma, accidents or operations such as rehabilitation
robots.
  Assisting with rehabilitative exercises and improve recovery time for patients by
monitoring using AI. This can be used to monitor the patient’s rehabilitative exercises. It
can also be used to guide the patient through the entire rehabilitation process rather
than a therapist. Therapists can also track and monitor the patient rehabilitation remotely
to identify if the patient is performing the correct movements, if not the therapist can
intervene.
 Assisting with administrative tasks such as; appointment bookings, processing
prescriptions and communicating patient notes.

As populations increase and grow older there will be a growing demand for alternative
healthcare options such as robotics and artificial intelligence. Robots have the ability to operate
continuously without tiring while AI has the ability to replace human interaction. When both of
these technologies are used together they could help provide access to healthcare at any time.

How can robotics and AI benefit clinicians?

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In the last activity, you looked at how AI and robotics could support healthcare services
and the NHS. But what is the potential for using these new technologies to benefit
clinicians?

There are several different technologies in AI and robotics that can benefit clinicians. These
include surgical robots, using AI for screening and diagnosis of common illnesses and
performing precise diagnostics of medical imagery.

 Surgical robots can provide greater visualisation, with enhanced dexterity allowing

surgeons to operate in tight spaces of the body with increased precision. This can
minimise pain and scarring for the patient. Robots can be pre-programmed to aid in the
positioning and manipulation of the surgical instruments in use. This improves the
accuracy, flexibility and control for the surgeon.

 Screening and diagnosis of common illnesses to improve accuracy. AI can be used

to diagnose patients quickly by using deep learning algorithms, whereas a clinician
would have to review many cases which is a time-consuming process. AI can also
predict future health events better than humans. This means that alternative methods
can be introduced to limit the risk of the patient being readmitted back into the hospital.

 AI to perform precise diagnostics of medical imagery. AI can identify patterns and

detect irregularities better than a human. Using AI to diagnose disease leaves clinicians
with more time to perform value-added tasks such as being more visible to patients.

Robotics and AI can affect the efficiency and productivity within the healthcare sector by:

 Performing repetitive tasks such as checking the blood pressure of a patient or attaching
a patient to a drip.
  Collaborating with other workers within the healthcare system. They can assist many
departments relieving the workload for many individuals.

This step has identified that robots and AI have the capability to perform tasks which are difficult
for a human to do. These include controlling the motion of a robot to improve the accuracy and
minimise potential risks, using algorithms to diagnose patients and spotting irregularities and
patterns better than a human.

The robot doctor will see you now

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Robotics and AI are rapidly advancing. There are many readily available technologies
that users can use in the comfort of their own home.

An example of this is the Babylon health app. The app aims to provide an affordable health
service worldwide. Babylon is made up from a team of scientists, clinicians, mathematicians and
engineers. The aim is to deliver personalised health assessments, treatment advice and face to
face appointments with a doctor at any time.

As the demand for medical care increases with the ageing UK population, doctors are limited in
the amount of time that they can spend with patients. There is more pressure on doctors to
manage their time and provide the care and support that patients require. This is why there is a
need for apps such as Babylon Health. However, if robots could be used to perform the tasks
required of a doctor, it may reduce the doctor’s workload.

In the scenarios below you will see two different situations of a patient visiting a Robot Doctor.
Think about how you would feel if you were in Angeline or Yosi’s position.
Scenario 1

Angeline has been for a biopsy to check if she has breast cancer. Angeline has visited many
people such as nurses and clinicians through the process of her diagnosis. She received a
phone call from the doctor to come into the clinic. When Angeline arrived, she was greeted by a
robotic doctor. It was three feet in height and was manoeuvring around the clinic on wheels.

The robot doctor took Angeline into a private room. When walking to the room the robot
engaged in preprogrammed discussions with Angeline such as how did you get to the clinic
today? And what do you think about today’s weather?

When Angeline and the robot were in the room together the Robot Doctor advised Angeline that
she has breast cancer. This was followed by a detailed description of the treatment that she can
have. Angeline took in the information whilst the robot doctor was stationary and unresponsive.
A few minutes passed and the robot doctor left the room prompting Angeline to leave without
receiving any emotional support or consolidation.

Scenario 2

Yosi has had a bad cough and temperature for a few days. He has become concerned so has
booked an appointment to see the GP. Arriving at the surgery Yosi is greeted by the Robot
Doctor who performs a routine check-up on Yosi. The robot checks his heart rate, temperature
and blood pressure. The robot doctor then prescribes Yosi with some medication to receive
from the pharmacy. It also tells him that if he doesn’t feel well in a weeks’ time he can return.

Improving precision diagnostics through AI

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Precision Medicine is the customisation of healthcare with medical decisions,

treatments, practices or products being tailored to the individual patient.

Roy Ruddle is a Professor of Computing at the University of Leeds. Dr Darren Treanor is a

Consultant Liver and Gastrointestinal Pathologist at Leeds Teaching Hospitals NHS Trust.

In this video, Roy and Darren discuss their work on the Leeds Virtual Microscope (LVM).

Traditional Diagnosis

Diagnosis is the traditional method for classifying and deciding if a patient has a condition in
clinical practice. A diagnosis results in a guide to treatment and possible future implications for
the patient.

There can be several different approaches in diagnosing diseases such as cancer, such as
physical examinations, laboratory testing, imaging testing and a biopsy. Laboratory testing of
cancer cells consists of a clinician observing the variation between a normal cell and a cancer
cell.

Cancer cells appear in an unorderly fashion with a variation in size and no apparent
organisation. Normal cells are uniform and of similar size in an orderly organisation.

Precision diagnostics

Precision diagnostics is a customised form of healthcare. Medical decisions, treatments or

diagnosis are customised for the patient. Some of the tools used in precision medicine are
molecular diagnostics, imaging and analytics.

Pathologists specialise in a specific area to diagnose, treat and prevent disease. They are either
doctors with specialist laboratory training or scientists with specialist clinical training who are
experts in disease detection.

It may always be difficult to confidently diagnose a patient. However, by using AI to support

physicians it is possible to increase the reliability of a diagnosis. AI is currently used in image
analysis in radiology, pathology and dermatology increasing the speed and accuracy of
diagnostics.

AI has the potential to revolutionise the speed and accuracy of medical diagnosis. AI can be
trained to recognise the patterns of disease. AI will then be able to support clinically-trained
pathologists to diagnose diseases faster, more accurately and at a lower cost.

IBM Watson and precision medicine

IBM’s Watson Health is an example of AI being used to enable smarter, more personalised
medicine. One of the aims of IBM Watson Health is to fight cancer using precision medicine and
AI.

A Beijing based company Hangzhou CognitiveCare have planned to install IBM’s artificial
intelligence platform ‘Watson for Oncology’ at 21 hospital sites within China. Watson for
Oncology is a system that will help to diagnose and treat cancer more efficiently. This is done by
analysing the patients’ medical information against a database with more than 300 medical
journals, 200 textbooks and nearly 15 million pages of text. This means that IBM Watson can
provide treatment recommendations and warnings for toxicities of certain drugs.

This provides physicians with informative treatment options to help customise therapeutic
recommendations specific to each individual based on their specific needs.

What does the future hold?

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As technology advances the future of healthcare may be very different from what it is
now. A few aspects of where AI and robotics will alter healthcare are:

 Analysis of medical laboratory results – The integration of robotics and automation

can alter procedures. This can be done by transforming manual processes to automated
liquid handling systems. One example of this is the miniaturisation of many laboratory
operations. Another example is the growing use of cloud computing and artificial
intelligence making it easier for individuals access, share and analyse data such as lab
results.
 Disease diagnostics – AI-based learning machines can utilize algorithms to visually
diagnose diseases.
 Medical Record Data Analysis – The emerging application of AI in predictive analytics,
diagnostic analytics and prescriptive analytics can be used with cloud computing. This
can result in an exchange of clinical information to provide insight into medical
conditions, symptoms and treatments from medical data worldwide. This can be used to
improve patient outcomes.
 Companion Robots – The purpose of a companion robot is to interact with an individual
by building relationships and providing assistance in the home. The ageing population in
the UK could be a potential market for companion robots in the near future.
 Live diagnostics – The development of machine learning algorithms can assist with
image analysis. This is by providing real-time assessments, which would be highly
advantageous for surgeons whilst operating.
 The shift from treatment towards prevention – The current increase in wearable
technology can provide individuals with real-time data about their health and wellbeing.
The collation of data can help to assist individuals in understanding the cause of a
particular condition earlier to track and monitor their health prior to the patient’s condition
worsening.

Key points revisited

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In this short article, Shane revisits some of the key points from this week.

By reflecting on these key points and completing the further steps in this revision activity, you
will be better placed to complete the test at the end of this course.

This week you covered:

 How robots can assist patients

 How robots can assist clinicians
 The future of robotics and whether it could lead to a loss of human care
How robots can assist patients

In Week 2, you were introduced to examples of how robots can assist patients. This can be
through rehabilitation, being personal assistants, disability aids and aiding in mobility and social
integration. You also saw that when designing a robot, the user scenario, user profile and user
environment must be considered to ensure that the end user can interact with the device
effectively and efficiently. You were also introduced to exoskeletons: wearable machines that
use a combination of technologies to assist users with limb movements.

How robots can assist clinicians

You were introduced to some of the ways that AI can benefit clinicians, and the implications this
may have on the design of robots. You saw how robots can be used in surgical applications in
an example of a capsule endoscopy robot. You also saw how AI could support clinicians by
using pattern recognition to revolutionise the speed and accuracy of medical diagnosis.

Future of robotics

In Week 2, you were taken through the developments of robots and AI and the possible future
for these technologies in healthcare. You were provided with current examples of healthcare
robots such as companion and therapy robots, as well as surgical robots. You also considered
the impact robotics and AI could have on caring for patients, and if this could lead to a loss of
human care in the healthcare sector.