Preface

This book examines recent developments in assistive technology and explores new trends in this rapidly evolving and multidisciplinary field. Assistive technology has gained prominence in recent years due to several factors. One of them is the aging population, which has increased the demand for technologies that help elderly people remain independent and communicate better [1]. Assistive technologies have also been increasingly used by people with physical, sensory, or cognitive disabilities, allowing them to perform daily tasks and participate more fully in society [2]. Another important factor is technological advancement, which has made it possible to create increasingly sophisticated and accessible devices and solutions to enhance independence [3].

Assistive technologies (AT) refer to devices, software, or equipment designed to support people with disabilities. Assistive technologies can be used to support individuals with physical, sensory, cognitive, or developmental disabilities in their daily activities, and can be customized to meet their specific needs and abilities [2]. AT can range from simple solutions such as wheelchair ramps, hearing aids and closed captioning, for example, to more advanced equipment such as speech recognition software, hightech alternative communication aids, prostheses, voice-activated virtual assistants, and smart wearables, among others.

Assistive technologies are amazingly important for individuals with disabilities, as they enable greater independence, autonomy, and participation in daily life. By promoting accessibility and inclusivity, assistive technologies benefit not only individuals with disabilities but also the broader community [4]. The ability to participate in activities and roles makes an important contribution to people's sense of well-being, social connectedness, and quality of life. Overall, assistive technologies can help people with disabilities to remove barriers to full engagement in society.

Assistive technology also has a significant economic impact, as it can reduce dependence on caregivers and healthcare professionals, increase opportunities for employment and education, and contribute to the inclusion and equal opportunities of people with disabilities or functional limitations [5]. For these reasons, assistive technology is an important area of research and development that has the potential to transform the lives of millions of people around the world.

This collection consists of five chapters. Chapter 1, entitled "Introductory Chapter: Trends in Assistive Technology", discusses the relevance, purpose, trends, and challenges of assistive technology. As assistive technologies become more advanced, there is a potential for greater integration with mainstream technology, allowing individuals with disabilities to use the same technologies as everyone else.

Chapter 2, entitled "Perspective Chapter: Service Robots in Healthcare Settings", looks at several applications of healthcare-oriented robots in acute, ambulatory, and at-home settings. In addition, it describes critical problems for the future when such technology will be ubiquitous.

Chapter 3, entitled "Understanding the Assistive Potential of Consumer Technologies: A Case Example of Smartphones, Smart Speakers, and Internet of Things Technologies", examines the assistive potential of a range of consumer digital technologies and explores how they can benefit people with disabilities and older people. Issues pertaining to risks to personal information, autonomy and consent while using these technologies are also outlined.

In Chapter 4, entitled "Perspective Chapter: Vocational Rehabilitation, Information, Communication Technology, and Assistive Technology Devices for Employment", the authors present a literature review analyzing the present and future of information and communications technology and assistive technology devices in the field of vocational rehabilitation in Japan.

Chapter 5, entitled "Perspective Chapter: Assistive Technology Ecosystem for Effective Self-Care – Application to Alzheimer's and Related Dementia", approaches the challenges of self-care and assistive living, including equitable access to assistive technology and care, the right to choose where to live, protection of privacy and security in people who live with Alzheimer's disease and related dementias. It presents an assistive technology ecosystem that enables autonomy, independence, and interdependence in these complex cases.

Thank you for your interest in this book. It is our hope that the content within these pages will provide you with valuable insights and information that can help you in your personal or professional life. We appreciate your time and attention, and we invite you to continue reading to discover the ideas and concepts that we have compiled to present in this book. We believe that you will find the chapters informative, engaging, and thought-provoking. Thank you again for choosing to read this book, and we hope that it exceeds your expectations.

**Alejandro Rafael Garcia Ramirez**

Department of Computing, University of Vale de Itajai Itajai, Brazil

#### **References**

[1] Yusif S, Soar J, Hafeez-Baig A. Older people, assistive technologies, and the barriers to adoption: A systematic review. International Journal of Medical Informatics. Oct 2016;**94**:112-116. DOI: 10.1016/j.ijmedinf.2016.07.004. Epub 2016 Jul 7. PMID: 27573318

[2] Albert M. Cook, Janice Miller Polgar, Pedro Encarnação. Assistive Technologies: Principles and Practice. 5th Edition - November 8, 2019. eBook ISBN: 9780323523370. Hardcover ISBN: 9780323523387

[3] Agree EM. The potential for technology to enhance independence for those aging with a disability. Disability and Health Journal. Jan 2014;**7**(1 Suppl): S33-S39. DOI: 10.1016/j. dhjo.2013.09.004. Epub 2013 Oct 7. PMID: 24456682; PMCID: PMC4154228

[4] Marion Hersh, Marcelo G. Gomes Ferreira, Alejandro R. Garcia-Ramirez. In: Garcia-Ramirez AR, Marcelo G, Ferreira G, editors. Introductory Chapter: The Role of Assistive Technologies in Smart Cities. InTech; 2018. p. 1-3. DOI: 10.5772/intechopen.81820

[5] World Health Organization (WHO). Assistive Technology. 2018. Available from: https://www.who.int/news-room/ fact-sheets/detail/assistive-technology [Accessed: 08 March 2023]

#### **Chapter 1**

## Introductory Chapter: Trends in Assistive Technology

*Alejandro Rafael Garcia Ramirez*

#### **1. Introduction**

People may present at any age some type of disability, lack or deficiency of one or more abilities that affects their performance in carrying out tasks appropriate to their level of development, such as walking, speaking, hearing, seeing, among others. Disability is a term used to refer to any physical, sensory, cognitive, or intellectual impairment that significantly affects a person's ability to perform daily activities or participate in society on an equal basis with others [1]. It is a broad and complex concept that comprises a wide range of conditions and limitations, temporary and permanent, and can result from various factors, like genetics, illness, injury, and environmental factors. The definition of disability may vary depending on the context, cultural beliefs, and legal frameworks in different societies [1].

Disabled individuals are prevalent within most extended families, and it is common for non-disabled individuals to provide support and care for their disabled loved ones. As a result, throughout human history, societies have grappled with the ethical and political dilemma of how to effectively incorporate and assist individuals with disabilities. The distress of people with some kind of disability depends more on the environment in which they are inserted than necessarily on the problem they have. The World Report on Disability, jointly produced by the World Health Organization (WHO) and the World Bank, suggests that more than one billion people worldwide suffer from disabilities and reports that people with disabilities generally have poorer health, lower educational attainment, fewer economic opportunities, and higher poverty rates than people without disabilities [2]. This can be attributed in large part to the insufficient availability of services and the numerous obstacles that individuals with disabilities encounter daily. In this scenario, assistive technology (AT) emerges.

Assistive technologies (AT) are devices, tools, and services that help individuals with disabilities to perform everyday tasks and participate fully in society. The goal of AT is to provide support and facilitate independence, while also improving the quality of life for those who use it [3]. As technology continues to advance, so do the possibilities for assistive technologies. In recent years, we have seen a rapid increase in the development and use of new AT devices and services that have the potential to transform the way we assist and support individuals with disabilities. This chapter introduces the new trends in assistive technologies, their benefits, and the challenges that come with them.

#### **1.1 Definition of assistive technology**

Assistive technology refers to devices, software, or equipment designed to support people with disabilities, enabling them to participate in various activities and improve their overall quality of life [3]. AT solutions can range from a simple white cane to a complex computerized system controlled by gaze or bioelectric signals. Included in the range of items that can enhance the quality of life for people with disabilities are adapted toys and clothing, computers with special software and hardware that meet accessibility requirements, alternative communication devices, special keys, and triggers, assisted listening devices, visual aids, prosthetic materials, and countless other products.

#### **1.2 Purpose of assistive technologies**

The primary aim of assistive technologies is to empower individuals with disabilities to achieve independence, autonomy, and participation in society. AT seeks to enable individuals to overcome the various barriers that they may encounter in their daily lives, such as mobility limitations, sensory impairments, lack of information, or challenges in processing information. Assistive technologies can aid people with disabilities in multiple ways, including improving communication abilities, facilitating access to education and information, performing daily tasks, and participating in the labor force. Furthermore, they can help individuals achieve greater social inclusion, develop their skills, and improve their overall quality of life. Assistive technologies can also generate broader societal benefits, such as promoting diversity and inclusion, reducing healthcare expenditures, and enhancing productivity and economic outcomes [4].

#### **1.3 Relevance of assistive technologies**

Assistive technologies are incredibly important for people with disabilities because they provide a means of overcoming barriers and promoting independence, autonomy, and participation. Assistive technologies make it possible for people with disabilities to access and interact with various environments, such as workplaces, schools, public spaces, and the Internet. This sort of technologies enables people with disabilities to perform tasks and activities independently, such as mobility aids that help people to move around and prosthetic limbs that allow people to engage in activities such as sports and recreation [3].

Assistive technologies have the potential to enhance the quality of life for people with disabilities by assisting their engagement in social activities, accessing education and information, and completing daily living tasks. Inclusion is crucial, and assistive technologies can promote diversity and inclusion by enabling individuals with disabilities to fully participate in society and be recognized for their unique skills and perspectives. They can also lessen the economic impact of disability by supporting individuals to enter the workforce, increasing their earning potential, and decreasing their dependence on social welfare programs. All in all, assistive technologies are essential for protecting the rights and well-being of people with disabilities and advancing the goal of building a more equitable and inclusive society [4].

#### **2. New trends in assistive technologies**

In this section are described emerging trends in the field of assistive technologies (AT) that have the potential to revolutionary transform the lives of people with disabilities.

#### **2.1 Artificial intelligence**

AI has the potential to transform the field of assistive technology by empowering individuals with disabilities to live more independently and actively participate in society. Examples of AI-powered assistive technology is the integration of voice assistants such as Amazon Alexa, Google Assistant, and Apple Siri, which enable individuals with disabilities to manage their home environment, make phone calls, send messages, and access information, among other functionalities [5]. Another example is the Oura Ring that has sensors to capture biological signals and provides reports on the user's health [6]. Personalized assistive technology is also a field of application for AI, where AI-powered prosthetics can learn and adapt to an individual's movements and preferences [7].

The potential of AI-powered assistive technologies is vast, and as technology continues to progress, we can expect to witness more innovative uses of AI in assistive technology. The UN Convention on the Rights of Persons with Disabilities, held in June 2019, recognized that AI "has the potential to enhance inclusion, participation, and independence for people with disabilities" [8]. Numerous organizations are exploring the uses of AI in assistive technologies as a means of improving accessibility. Among them are AI-based visual aids, smarter glasses, cognitive hearing aids, new opportunities for education, and equal opportunities for employment.

#### **2.2 Wearable devices**

The use of wearables, such as smartwatches, fitness trackers, and other body-worn devices, has been on the rise in recent years as assistive technology for individuals with disabilities or other specific requirements. These devices offer numerous advantages, including health monitoring capabilities that can track vital signs like heart rate, blood pressure, and oxygen levels, which can be especially beneficial for those with chronic conditions or disabilities [6, 9]. Wearables can also aid communication for people with hearing or speech impairments by pairing with a smartphone app that converts speech to text or vice versa, allowing for more effortless communication [10]. Additionally, wearables can facilitate navigation for people with visual impairments, where smart glasses come equipped with built-in cameras and software that can recognize objects and provide audio feedback to help users navigate their surroundings [11].

Furthermore, wearables can enhance safety for people with disabilities, where some smartwatches offer emergency features that enable users to call for help or share their location in case of an emergency [12].

Wearables possess immense potential to deliver significant benefits for individuals with disabilities or other specific needs. As technology continues to progress, we can anticipate more groundbreaking applications of wearables as assistive technology devices.

#### **2.3 Robotics**

Robotics has emerged as a promising technology for assisting people with disabilities in performing daily tasks, achieving greater independence, and improving their quality of life. Robotic assistive technologies can be customized to meet individual needs and can provide support for a wide ranging of disabilities, including mobility impairments, sensory impairments, and cognitive impairments [13].

Robotics can be used to create prosthetic limbs that are controlled by the user's myoelectric signals, enabling greater mobility and independence [7]. Exoskeletons are wearable robotic devices that can help people with mobility impairments walk or stand. They are particularly useful for people with spinal cord injuries or other conditions that affect their ability to move [14]. Robots can be used to assist with a range of everyday tasks, such as cooking, cleaning, and personal care. These robots can help people with disabilities or older adults live independently in their own homes [15].

#### **2.4 Internet of things (IoT)**

The field of assistive technology stands to be revolutionized by the potential of the Internet of things (IoT), which allows devices to communicate with each other and gather data in real time. IoT refers to a connected network of devices that can exchange information and perform tasks without human intervention. For instance, IoT sensors can detect falls and automatically alert caregivers or emergency services as necessary [16].

Assistive technology can take advantage of IoT to create customized environments for people with disabilities, such as smart homes. Furthermore, IoT can help monitor health indicators, like heart rate and blood pressure, allowing healthcare professionals and caregivers to provide more personalized and targeted care to individuals with disabilities [17].

Another example of the use of IoT in assistive technology is the development of smart prosthetics. These prosthetics can be connected to the Internet and other devices, enabling users to control them through their smartphones and receive feedback on their movements and other data [18].

IoT can also be used to create more efficient and effective transportation systems for individuals with disabilities. Connected vehicles can be equipped with sensors and other technologies to provide real-time traffic updates, monitor road conditions, and optimize routes to ensure that individuals with disabilities can travel safely and efficiently.

In conclusion, the application of IoT in assistive technology can enhance the quality of life for people with disabilities by offering customized and adaptable solutions that cater to their specific requirements.

#### **3. Challenges**

Although assistive technology can offer numerous benefits for individuals with disabilities, there exist various challenges and concerns that need to be addressed when designing, implementing, and utilizing assistive technology. One of the primary challenges is ensuring that assistive technology is accessible by people with diverse types of disabilities, considering factors such as vision, hearing, motor skills, and cognitive abilities to maximize its usability by as many people as possible [19].

Additionally, the cost of assistive technology can be a barrier for individuals with disabilities, and it is essential to consider ways to increase affordability and accessibility, such as through government subsidies or insurance coverage. Moreover, assistive technology typically requires customization to meet the specific needs of each user, which can be time-consuming and costly, and may necessitate specialized knowledge and skills [3].

Much assistive technologies require training to be used effectively. It is important to provide adequate support to ensure that users can use the technology effectively

and safely [4]. Maintaining and repairing assistive technology is also essential to ensure its proper functioning, and it is essential to have efficient systems in place to provide timely maintenance and repair services. In addition, privacy and security are significant concerns when using assistive technology that collects and stores sensitive personal data. Developers must consider privacy and security issues and implement appropriate measures to safeguard user data. Moreover, ethical considerations need to be addressed when designing and utilizing assistive technology, including ensuring that it respects the autonomy and dignity of the individual user [20].

#### **4. Conclusion**

Assistive technology has the potential to transform the lives of people with disabilities. Tendencies in assistive technology provide more personalized, adaptable, and accessible solutions that can enhance their independence, mobility, and quality of life.

The capability for growth and future developments of assistive technologies is significant, as these technologies continue to evolve and become more sophisticated. As technology becomes more advanced, there is a growing potential for greater personalization in assistive technology solutions. This could involve the use of sensors, artificial intelligence, and other technologies to develop more customized solutions that meet the unique needs of each individual user.

Accessibility is a key in the expansion of assistive technologies, and there is an increasing recognition of the need to ensure that these technologies will be accessible to as many people as possible. This may involve developing more affordable solutions, as well as solutions adaptable and customizable to meet the needs of diverse users.

As assistive technologies become more advanced, there is potential for greater integration with mainstream technology, allowing individuals with disabilities to use the same technologies as everyone else. This could involve the development of assistive technologies that can be used with devices such as smartphones and tablets, as well as greater compatibility with existing technologies. For example, assistive technologies could be used to improve accessibility in public spaces or to enhance learning and education for individuals with disabilities using mobile devices.

Collaboration between technology companies, disability organizations, and individuals with disabilities is essential for the development of effective and user-friendly assistive technologies. By working together, these stakeholders can identify areas of need and develop solutions that are truly responsive to the needs of individuals with disabilities.

Overall, the potential for growth and future developments in assistive technologies is remarkable, and there is great potential for these technologies to enhance the lives of people with disabilities in many ways.

#### **Acknowledgements**

Thanks to the Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina (FAPESC), the National Council for Scientific and Technological Development (CNPq), and the National Institute on Minority Health and Health Disparities, from the National Institutes of Health, who support several studies in this field.

*Trends in Assistive Technologies*

### **Author details**

Alejandro Rafael Garcia Ramirez Department of Computing, University of Vale de Itajai, Itajai, Brazil

\*Address all correspondence to: ramirez@univali.br

© 2023 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Introductory Chapter: Trends in Assistive Technology DOI: http://dx.doi.org/10.5772/intechopen.111413*

#### **References**

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[2] World Health Organization (WHO). World report on disability. 2011. Available from: https://www.who.int/ teams/noncommunicable-diseases/ sensory-functions-disability-andrehabilitation/world-report-on-disability [Accessed: 2023-03-08]

[3] Cook AM, Polgar JM, Encarnação P. Assistive Technologies: Principles and Practice. 5th Edition. St. Louis: Elsevier; 8 Nov, 2019. eBook ISBN: 9780323523370. Hardcover ISBN: 9780323523387

[4] Hersh M, Gomes Ferreira MG, Garcia-Ramirez AR. In: Garcia-Ramirez AR, Gomes Ferreira MG, editors. Introductory Chapter: The Role of Assistive Technologies in Smart Cities. London, UK, London: InTech; 2018. pp. 1-3. DOI: 10.5772/intechopen.81820

[5] Gonzalez W. Three Ways AI is Improving Assistive Technology. Jersey City: Forbes; 2021. Available from: https://www.forbes.com/ sites/ forbesbusinesscouncil/2021/09/21/ three-ways-ai-is-improving-assistive technology/?sh=3312a8df419d [Accessed: 2023-03-08]

[6] Oura. 2023. Available from: https:// ouraring.com/ [Accessed: 2023-03-08]

[7] Guizzo E. Dean Kamen's "Luke arm" prosthesis receives FDA approval this advanced bionic arm for amputees has been approved for commercialization. In: IEEE Spectrum for the Technology

Insider Dean Kamen's "Luke Arm" Prosthesis Receives FDA Approval. New York: IEEE Spectrum; 2014. Available from: https://spectrum.ieee.org/deankamen-luke-arm-prosthesis-receivesfda-approval [Accessed: 2023-03-08]

[8] Magic EdTech. How AI is making assistive technologies more powerful. Available from: How AI is making assistive technologies more powerful — by Magic EdTech — MagicBox — Medium. Nov 8, 2019 [Accessed: 2023-03-08]

[9] Alam MM, Hamida EB. Surveying wearable human assistive technology for life and safety critical applications: Standards, challenges and opportunities. Sensors. 2014;**14**:9153-9209. DOI: 10.3390/s140509153

[10] Hey Google. Available from: https://assistant.google.com [Accessed: 2023-03-08]

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[13] Park KH, Bien Z, Lee JJ, Kim BK, Lim JT, Kim JO, et al. Robotic smart house to assist people with movement disabilities. Autonomous Robots. 2007;**22**(2):183-198

[14] Secciani N et al. Wearable robots: An original mechatronic design of a hand exoskeleton for assistive and rehabilitative purposes. Neurorobotics. 2021;**15**:1-15. DOI: 10.3389/ fnbot.2021.750385

[15] Hersh M. Overcoming barriers and increasing independence – Service robots for elderly and disabled people. International Journal of Advanced Robotic Systems. 2015;**12**(8):1-33. DOI: 10.5772/59230

[16] Nuñez TO, Ghizoni Teive RC, Garcia-Ramirez AR. In: Habib MK, editor. A Robotics-Based Machine Learning Approach for Fall Detection of People. Cognitive and Adaptive Behaviors. London, UK: InTech; 2022. pp. 1-15. DOI: 10.5772/ intechopen.106799

[17] Chapman K, McCartney K. Smart homes for people with restricted mobility. Property Management. 2002;**20**(2):153-166

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[19] Punchoojit L, Hongwarittorrn N. Usability studies on mobile user interface design patterns: A systematic literature review. In: Mandl T, editor. Advances in Human-Computer Interaction. London: Hindawi; 2017. pp. 1-22. Article ID 6787504. DOI: 10.1155/2017/6787504

[20] Rebello BC, Garcia-Ramirez AR, Heredia-Negron F, Roche-Lima A. A machine learning-based approach to epileptic seizure prediction using electroencephalographic signals. Journal of Engineering Research. 2022;**2**(8):1-9. DOI: 10.22533/at.ed.317282219056

#### **Chapter 2**

## Perspective Chapter: Service Robots in Healthcare Settings

*Rohit Singla and Christopher Nguan*

#### **Abstract**

Robots will play a part in all aspects of healthcare. The presence of service robots in healthcare demands special attention, whether it is in the automation of menial labour, prescription distribution, or offering comfort. In this chapter, we examine the several applications of healthcare-oriented robots in the acute, ambulatory and at-home settings. We discuss the role of robotics in reducing environmental dangers, as well as at the patient's bedside and in the operating room, in the acute setting. We examine how robotics can protect and scale up healthcare services in the ambulatory setting. Finally, in the at-home scenario, we look at how robots can be employed for both rural/ remote healthcare delivery and home-based care. In addition to assessing the current state of robotics at the interface of healthcare delivery, we describe critical problems for the future where such technology will be ubiquitous. Patients, health care workers, institutions, insurance companies, and governments will realize that service robots will deliver significant benefits in the future in terms of leverage and cost savings, while maintaining or improving access, equity, and high-quality health care.

**Keywords:** Healthcare, acute care, ambulatory care, surgical robotics, at-home robotics

#### **1. Introduction**

With the introduction of robots into industrial domains, the exploration of remote controlled, semi-autonomous and fully autonomous surface robots within the field of healthcare is an area of increasing interest. Robotics has been considered across the major verticals of the healthcare continuum of prevention, screening, diagnosis, treatment, and homecare [1]. However, service robots could potentially fill the roles of typical industrial robots in the management of menial or laborious tasks such as supply chain management and logistics, stocking and inventory control, back-end support as well as delivery within the context of patient care. For example, consider delivery of medication or supplies [2]. With the use of robotics such as autonomous vehicle or drone fleets, a routine one-to-one delivery could be simplified; a high priority urgent delivery during acute care events could be made feasible; or broader community-based delivery could be made autonomous for an entire region [2]. Service robots in healthcare can also serve in direct patient interaction roles including as direct assistance to healthcare workers such as nurses, physicians, imaging technicians, and more [3–5]. In a patient-centered view, service robots may serve the role of comfort care or as personal assistance to the patient for mobilization, feeding or

activities of daily life [6, 7]. The breadth of applications is vast. This chapter focuses on the application of service robots at the interface of health care delivery, highlighting advances in acute care settings, such as the hospital or surgical settings; in ambulatory settings such as clinics; and in at-home settings where we consider comfort and health. The detailed discussion of supply-chain and logistics-based service robotics are left to other chapters to discuss.

#### **2. Service robots in acute care settings**

Acute care refers to the delivery of short-term diagnosis and treatment of a patient for a medical condition. These settings may require an emergency department visits where patients are rapidly assessed and provided with initial treatment, an admission into hospitals whereby patients are overseen by multidisciplinary healthcare workers, a surgical operation including the post-operative recovery, and any number of related services (imaging or laboratory services for example) required to provide optimal diagnosis and treatment.

The first application of robotics in this setting is with regards to environmental hazards. This mimics the notion of industrial robotics to protect workers from workplace hazards. As underscored by the global COVID-19 pandemic, there is heightened interest in the use of robotics to protect valued healthcare workers and patients from dangerous environmental scenarios including preventable infections, ionizing radiation, or combative and violent scenarios. As a key example, the routine care of patients infected with COVID-19 requires significant investment of time and resources on the healthcare delivery system, while continuing to put healthcare workers at risk, and leading to reallocation of resources and cumbersome delivery of patientcare. For two examples of robots created in response to this pandemic, we refer to two companies based in Denmark. First, consider how the nasopharyngeal swab, required for collection of respiratory mucosa to diagnosis COVID-19, inherently places the worker performing the swab at risk. Lifeline Robotics (Odense, Denmark) developed the CAREEBO system, the first of its kind to perform a fully automatic swab analysis [8]. The robotic system is designed to interact with patients and perform the swab itself, obviating the need for a healthcare worker to be in proximity with a potentially infectious individual [8]. Likewise, disinfection and sterilization of the surrounding environment is a key step in the preventing infectious disease transmission. Existing procedures still rely on human staff to perform the cleaning, which may in turn be tedious, costly, and time consuming as well as an avoidable exposure. Towards prevention in hospital settings, ultraviolet light has been utilized in a touchless manner through mobile service robotics. This approach has been demonstrated superior results to manual cleaning when evaluating the number of microbes as well as reducing infection [9]. Commercial offerings exist, such as UVD Robots (Odense, Denmark) designed to disinfect patient wards and operating rooms in between admissions [10].

In a similar fashion, despite standard of care barrier methods, interventional radiologists and radiology technicians who work with and nearby to ionizing radiation continue to suffer increased rates of malignancies as compared to the general population. Mitigating the exposure risk for these individuals directly relates to their safety. Enhanced robotic imaging instrumentation may be the avenue to achieve this. However, to the best of our knowledge, there is not yet a fully autonomous commercial imaging system available for clinical usage. Researchers have explored the notion of a robotic imaging instrumentation. As an example, Haliburton *et al.* towards a service robot for a fluoroscopy machine by demonstrating their tracking system called On-board Position Tracking for Intraoperative X-rays (OPTIX), achieved clinically relevant accuracies through the addition of a single camera [11]. The end goal for OPTIX was to reduce the number of fluoroscopic images required in an operation [11]. This system is one step towards semi-autonomous and fully autonomous robotic systems. Environmental safety, as demonstrated by infection risk and ionizing radiation, can be ameliorated using service robots. In doing so, we consequently mitigated the overhead of anxiety and stress related to working in these potentially hazardous environments.

Moving beyond environment, service robots have a role to play at the patient's bedside. In the most literal example, service robots can assist patients with physical limitations such as reduced physical ability or a bariatric patient in mobility. For these patients, service robots enable patients to have fundamental needs such as having a robotic arm to mitigate the loss of mobility in one's natural arm. Japanese researchers at the RIKEN-TRI Collaboration Center for Human-Interactive Robot Research developed the world's first nursing-care robotic system that can transfer a patient from a bed to wheelchair, and vice versa [12]. However, more generally, service robots enable "contactless" approaches to techniques that would otherwise require an in-person human element. Researchers at Massachusetts Institute of Technology (MIT) repurposed the commercially available Spot™ from Boston Dynamics, a dog-like robot [13]. This robot was modified to include additional cameras, allowing contactless measurement of key vitals such as temperature, blood oxygen saturation and respiratory rate without human intervention. These tele-monitoring style systems may allow for workplace efficiencies as well, reducing undue burden on healthcare staff from frequent monitoring. A relatively easy extension to tele-monitoring is telepresence. Ava Robotics, a spin-off company of consume robotics company iRobot, offers telepresence robotic systems capable of spatially mapping and navigating environment [14]. This type of technology then enables a remotely placed clinician located in a risk-free environment to interact and engage with patients at the comfort of their own beds. This form of telepresence is useful to provide healthcare access from scarce experts, improving upon health inequities.

Service robots are no stranger in surgery. Surgical assistive systems have been present in various applications for several decades now [15]. While surgical care itself spans pre-operative assessments, imaging and planning up to, and including, postoperative recovery, the most abundant example of surgical robotics is in the operating room itself. Medtronic, one of the largest medical technology companies in the world, has offerings of spine and orthopedic systems (MAZOR™) that fully integrate with pre-operative imaging, and allow surgeons to achieve highly precise movements within an accuracy of a few millimeters [16, 17]. Knee and hip replacements have seen significant benefit from robotic systems provided by Mako Surgical [18, 19]. One of the most common surgical robot systems is the da Vinci surgical system™ from Intuitive Surgical (Sunnyvale, USA) [1, 20]. This tele-operated system facilitates surgeons improved workflow and ergonomics, extended degrees of motion, tremor filtering, and enhanced visualizations [1, 20]. In this setup, the surgeon is not directly operating the surgical instruments, but instead is manipulating them in a one-way feedback manner. In more recent offerings of the da Vinci™, integrated table motion allows for additional ambient capabilities to manipulate the surgical environment to the benefit of the surgery at hand [21, 22]. This feature allows the surgeon to leverage gravity assistance to manipulate patient position and internal organs by motion of

the operating table, and the simultaneous movement of the robotic arms [21, 22]. The growth of commercially available products in surgical environments has simultaneously spurred an active area of research. Investigators now seek to add additional capabilities to these platforms. Examples of these pre-clinical abilities include task automation ranging from suturing, knot tying, and needle insertion in minimally invasive surgery, autonomous intra-operative ultrasound scanning, and automated camera control and motion as well as telerobotic capabilities [23–28]. However, while the first completely remote surgery was performed in the early 2000s, the ability to use this technology has remained elusive due to challenges in network bandwidth, latency, video communication.

Closely related are service robots in anesthesia which may provide oversight of patient management and procedures. This may include automated drug delivery of adequate anesthetic and analgesic medication through closed-loop control systems for monitoring and administration as well as management of medical devices such as adaptive ventilatory and circulatory support [29–31]. In the pharmaceutical delivery application, robotic systems which receive information directly from the patient by way of a suite of sensors could process such multi-dimensional high-resolution data in a manner human practitioners may be incapable of doing. In turn, there may be benefits to be seen through service robotics which respond in real-time to the patient needs with minimal guesswork required. In terms of circulatory support, the LUCAS robot system acts as an entirely mechanical and automated cardiopulmonary resuscitation device and has been shown to improve outcomes while obviating the need for manual chest compressions from support staff [32]. Beyond these applications, the use of robots to perform needle interventions for regional anesthesia and automatic intubation have been explored [33–35]. However, these systems remain largely preclinical in validation, with robust clinical benefit not yet shown.

#### **3. Service robots in ambulatory care settings**

While several of the applications (like sanitization, autonomous imaging, or robotic procedures) in acute care may extend into the ambulatory care setting, there are unique applications to consider. When applied to the ambulatory care setting, we consider service robots for the protection as well as empowerment and scaling up of the healthcare workforce.

In a similar fashion to environmental protection, service robots can protect the workforce from self-inflicted pitfalls such as fatigue risk. Chronic shortages of physicians and allied healthcare professionals leads to an overworked workforce, exacerbated by external stressors and cognitive overload, and resulting in a negative impact on attention, reaction, memory, and reasoning [36]. This in turn ultimately leads to inadvertent medical errors made by these well-intentioned individuals. It can also lead to increased psychological distress, insomnia, and depression [37–39]. Service robots in this roll could offload menial tasks and cognitive overhead so that healthcare workers could concentrate on more critical tasks related to direct patient care. In similar fashion, service robots could play the role of validation units in ensuring that health care workers are delivering the intended therapeutic to the patient in the right amount, at the right time, and in the right place. The notion of a robotic assistant has been well received by certain disciplines, such as nursing [40].

Leveraging of the workforce is another potential use of service robots in healthcare. Instead of one-to-one management between health care practitioner and

patients, service robots allow for one healthcare practitioner to oversee the care (or subset thereof) for multiple patients simultaneously. This would have implications for health care delivery on a global scale such that fewer workers could provide access to higher quality care to a broader population of patients.

#### **4. Service robots in At-home care settings**

In the final section of this chapter, we examine the role of service robots in athome care settings. In these settings, the patient is often not traveling to another institution to receive care. Instead, they either receive care from external providers in the comfort of their own home or are able self-administer care. In these diverse athome settings, service robots may play a role in both delivering and providing actual medical care to patients but also in providing companionship and reassurance to those in times of need.

The evident application of robots at home is the use of telepresence. To address geographic disparities in equitable health access, as well as to reduce patient burden such as time and travel expenses, the use of telepresence enables clinicians to serve populations otherwise inaccessible [41]. In the simplest form, telepresence uses video communication apps available on smart devices or computers. However, more advanced immersive versions provide a physical mobile platform, allowing the user to move around the environment. Researchers have sought to automate classical physical examination techniques such as palpation [42] as well as advanced techniques such as ultrasound [42, 43]. While these technologies have not seen widespread integration in telepresence, one recent example is remote medical imaging. Imaging in remote areas is an exciting opportunity, as many communities lack individuals with the expertise to acquire and interpret high-quality images, providing a barrier to care. Clinicians in Saskatchewan, Canada deployed the MELODY system from AdEchoTech in a small study, finding that 92% of organs displayed on conventional examination were seen on those performed remotely, demonstrating the clinical feasibility of such remote imaging [44].

For individuals in rural and remote areas, or in emergent need such as in disaster relief, service robots can facilitate the delivery of medications and supplies. For example, drones themselves can travel fast and without geographical challenges. By leveraging these unnamed transport systems, drones could be used to distribute key medical resources to those in need. This is particularly advantageous in disaster settings whereby conventional transportation is not feasible [45, 46]. In commercial efforts of drone delivery, Zipline (San Francisco, USA) piloted blood distribution via drone delivery in Rwanda [47]. The use of service robotics for aerial transportation of medical resources resulted in a reduced transportation time of 4 hours to approximately 30 minutes [47]. Through coordinated efforts via fleets, drone delivery could extend to become an entire distribution network across entire communities.

Beyond the delivery of care, there is also the role of service robotics for self-care at-home. As exemplified by the COVID-19 pandemic, mental health including anxiety, depression and loneliness have increased significantly in the forefront of the general public's mind. As outbreaks occurred, entire long term care facilities were placed on "lockdown", restricting the movement of its patients and their visitors, for prolonged periods of time. In essence, these actions negatively impacted individuals' need for social interaction, a key component of one's mental health. How then can robots address this need? Through the patient-centered design of social robots designed

specifically to assist in the emotional and mental well-being of patients. BUDDY, a companion robot offered by the company of the same name, is one such example [48]. The small mobile esthetically pleasing robot can provide the social interaction needed for elderly patients isolated from others while aiding with activities of daily living and fall detection. Likewise, the use of the PARO robot was demonstrated to provide both social and physical interaction benefits, as well as a potential increase in activity levels, in a cohort of patients with dementia [49]. For children, these robot systems can assist in neurodevelopment and socialization skills. One example is Moxie™ from Embodied, developed in-part by child development experts, for customized learning and play [50].

#### **5. The challenges of service robots in healthcare**

While the growth of service robot applications in healthcare is rapid, there are significant barriers to widespread adoption that are worth noting. The first of these challenges is regulation. Unlike consumer technologies, healthcare is heavily regulated with a stringent review process. This inherently causes a longer development process dependent on the scope of functions expected of the robot. As expected, the regulatory approval duration increases with the complexity and risk of these robots. In a medical setting, such as surgery, there is minimal margin for error as the consequences are often grave. This regulation lends itself to the second issue of liability. If a service robot is deployed, who is to blame for when it fails to perform correctly? If used to disinfect a room, and subsequent someone is infected, who at fault? Liability from a legal perspective must be carefully considered, especially as systems become increasingly autonomous. Third is privacy and ethics. To excel at their function, these service robots often require knowledge, or the ability to gather it, about their patient and need to be able to process that knowledge. However, this may require processing of the patient's personally identifying information including voice and face or require transmission of data outside of the robot. The risk of an unwanted intruder accessing such information is non-trivial. How privacy concerns for patients, providers, and insurers are all addressed in robotic settings is an ongoing area of investigation.

The practical deployment of these robots also remains a barrier. While there is promise, significant portions of the core technology – particularly those that require interaction with healthcare workers or patients – remains experimental in nature. It remains to be seen, even with existing widely used medical service robots, whether the benefits promised by these systems is realized. These systems may vary in performance depending on environmental conditions such as network capabilities, audio noise, lighting conditions, battery life, and so on. This leads to the final remaining barrier to deployment: cost. The expense of manufacturing and equipping these robot systems often requires a large initial capital investment, as well as a barrage of consumables and maintenance requirements. It further requires additional training for staff, re-vamped workflows, and commonly institutional willpower to continue to support the systems. These fixed and variable expenses need to be sufficiently mitigated by the potential or realized gains of robotic system use.

#### **6. Conclusion**

In summary, service robots in healthcare are seen as potentially playing many roles within the patient care setting. In many ways, the health care industry could benefit

*Perspective Chapter: Service Robots in Healthcare Settings DOI: http://dx.doi.org/10.5772/intechopen.104640*

from increased automation which has been notably absent from this ever-important area. Patients, health care workers, institutions, insurance companies and governments will find that service robots bring significant benefits in terms of leverage and cost reductions in the future while maintaining or improving access, equity, and high-quality health care.

#### **Acknowledgements**

The authors acknowledge funding from the Vanier Canada Graduate Scholarship, the Natural Sciences and Engineering Research Council of Canada, and the Kidney Foundation of Canada.

#### **Conflict of interest**

The authors declare no conflict of interest.

#### **Author details**

Rohit Singla and Christopher Nguan\* Department of Urologic Sciences, University of British Columbia, Vancouver, Canada

\*Address all correspondence to: chris.nguan@ubcurology.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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### **Chapter 3**
