Robots in Healthcare
'Bots are back. It's a while since I wrote about them--for example, see here for a collection of musings--and in the interim they seem to be moving into the mainstream.
'Bots are back. It's a while since I wrote about them--for example, see here for a collection of musings--and in the interim they seem to be moving into the mainstream.
A month or so ago in a stupor before heading off to bed, I watched part of an episode of Holby City, a UK TV series which relates the quotodien of a fictional acute hospital. In that particularly overacted episode, two surgeons squabble over who will take the lead in robotic surgery. Many of you have have worked with real surgeons will know few of them are shrinking violets, probably a good thing, because they may have to take life and death decisions in seconds. It may come as a surprise then that in the future some surgeons may actually be invisible.
The entomological metaphors in the article strike you: many of the devices are like centipedes or small spiders that are guided by humans through the heart, eye and other inaccessible parts of human anatomy. At this, some of you may think of that bug-thing that the Agents insert into Neo's navel in The Matrix, and it may be like that, though the ones described in the article are good guys.
Some of you may also recollect I posted about a discussion on BBC Radio 4 in which Professor Robert Winston took part. Prof. Winston was of the opinion that patients needed the human touch, and suggested robots were good but would never catch on. This is nonesense, of course. Healthcare in the future will apply robot and human touch.
* 21 November 2009 pp50-51
I’m still riding high from the Yes concert tonight. I confess, after a day’s work, after getting up at tweet-tweet time to catch a train, I went wearily to Birmingham Symphony Hall to join the other fans. But after the first chords of “Siberian Khatru” (No I won’t. Look the meaning up yourself.) I was reinvigorated.
I sat bang in the centre of the front row, so I noted the veteran band members are looking a bit older these days (unlike me who hasn’t aged a day) but their fingers still fly nimbly over those arpeggios and scales. A night to remember!
I have a fascination for robots, probably stemming from trying to make one as a child from a shoebox, flashlight bulbs and odd bits and pieces from my Father’s workshop, So perhaps it’s not surprising I spotted an article in the BBC’s Focus magazine which made me hope when I do age a few days, I may even have one as a carer.
The Japanese are way ahead in the field of robotics, fortunate since they are short of nurses and have the most rapidly aging population in the world. Perhaps supporting a phenomenon named uncanny valley Japanese researchers found people warier of human-like robots. Robo bears are their solution. Cute…or what??
This is Susan Jacobs' first guest posting for FHIT. You can find out more about her at the end.
People with mobility issues may soon have a more convenient alternative to helper monkeys and dogs. Georgia Tech's Center for Healthcare Robotics has just developed a robot prototype that can assist disabled people in their home. The robot's name is El-E and it is over 5-feet-tall, featuring a large mechanical arm. Though the robot may not have a friendly aesthetic, it could easily become a disabled person's best friend around the house.
The operator of El-E uses a laser pointer to guide the machine. When the laser is pointed at something the person wants, a button can be clicked and El-E moves to the object. There, a mechanical arm extends from El-E's body and the robot literally fetches whatever its operator has selected.
Though El-E was designed with the disabled in mind, this device could have a more widespread appeal eventually. In a Web 2.0 society, people of all kinds may be interested in what the project's director, Charlie Kemp, calls "…a clickable world." Indeed, that is what the El-E creates; a clickable world where anything is available to a person from the seat of their couch.
This robot isn't just convenient, mind you. As I mentioned, many disabled people have found success with the use of helper monkeys and dogs. However, a big draw to that situation is also the companionship. Georgia Tech obviously kept this in mind, as El-E has been programmed to say catchy phrases. It really has its own light-hearted personality, saying things like "Bob's your uncle" when it hands something to you.
Still in a beta phase with this project, the robot's creators will be testing El-E with a large group of disabled patients this summer. No word yet on the cost of this machine for mainstream use, so that could certainly be a big factor in whether people opt to use the El-E in everyday situations. The machine can't be too cheap, as it uses many sensors, cameras and high-tech laser technology.
Another kink that Georgia Tech must work out is the fact that the current prototype only lifts up to 1.2 pounds. It is assumed that this will be improved later. I wouldn't be surprised if every household had a machine like this in the near future, particularly one that is programmed to rummage around the refrigerator.
Susan Jacobs is a part-time teacher, as well as a regular contributor for NOEDb, a site for learning about and selecting an online nursing degree program. Susan invites your comments and freelancing job inquiries at her email address firstname.lastname@example.org
At a recent conference a woman studying Health Informatics in London told me she'd seen this blog: "Oh yes, its about robots, isn't it?" Which probably means I have to make my intention clearer. Nonetheless, I can't deny a passion for them since reading about them as a child in old copies of the Eagle Annual I bought at a church jumble sale. So, at the risk of missing my intention, here are a couple of articles I spotted.
Professor Rodney Brooks talked about domestic and military robots in his RSI lecture for the British Computer Society. Prof. Brooks reckons that we are at the beginning of an exponential growth in the use of robots, partly driven by an aging Western population and our likely need for replacement body parts.
I also remember as a child reading a satirical SF book which somehow remains in my mind called Bill the Galactic Hero. Bill becomes a hapless hero when he accidentally destroys a Chinger command ship in a space battle. The Chingers are vilified by the humans who post questions on the decks of their space vessels like: "Would you let your sister marry one?" But another robot article I spotted in London's Metro might cause you to ask: "Would I be married by one?"
"Yes" is the answer of robot designer Seok Gyeong-Jae. Tiro the robot recently officiated at his wedding in South Korea.
A hospital is to cut heart surgery waiting times with robot surgeons reports the Daily Telegraph. British doctors are pioneering the use of a robotic arm to carry out a life-saving heart procedure. Cardiologists at St Mary's Hospital in London are using the technology to navigate inside the heart when treating patients for a fast or irregular heartbeat. Dr Wyn Davies, consultant cardiologist, said: "With further development, this robot will enable complex procedures to be carried out almost automatically, increasing the opportunities to treat more patients and ultimately reducing clinical risk."
A study conducted at Sinai Hospital of Baltimore published in the Journal of the American College of Surgeons found that robotic telerounding as a supplement to standard post-operative visits may reduce the length of stay of patients undergoing laparoscopic gastric bypass surgery.
On the first post-operative day 77 percent of patients in the group using robotic rounds were discharged compared with none in the group using exclusively bedside rounds. The mean length of stay was reduced from 2.33 days for the group assessed exclusively by bedside rounds to 1.26 days for the group assessed by robotic telerounding. Consequent early discharge from 54 beds created 71 patient-days of additional capacity, representing a total financial benefit of more than $200K.
Touch Bionics announced last week its i-LIMB Hand and ProDigits partial hand prostheses are available and have been successfully fitted in the United States and Europe. The i-LIMB Hand looks and acts like a real human hand and is the world's first widely available prosthetic device with five individually powered digits.
Touch Bionics says the i-LIMB Hand offers an intuitive control system that uses a traditional myoelectric signal input to open and close the hand's life-like fingers. Myoelectric controls utilize the electrical signal generated by muscles in the remaining portion of a patient's limb. This signal is picked up by electrodes that sit on the surface of the skin.
A nail-pierced hand catches a man falling from a rooftop and hoists him to safety: just one potent image from Ridley Scott's Blade Runner which I recently watched again. The hand is that of the fearsome genetically engineered replicant Roy Batty who mercifully saves Rick Deckard—the blade runner who has been pursuing him through a rain-sodden Los Angeles in a 2019 dystopia. After the encounter Deckard looks as though he could do with the services of a physiotherapist—but even in 2007 s/he may not be human.
New Scientist reports the use of robots in helping patients to recover from strokes. In the US 700 000 and in the UK 130 000 a year suffer a stroke making it the biggest cause of severe disability in both countries.
The US Department of Veterans Affairs (often ahead of the rest of healthcare) is running a clinical trial of MIT's wrist robot. Studies have shown patients prefer robotic therapy to home-based exercise, which could make them more likely to complete programmes of rehabilitation.
Will mechanical physios replace human ones? With 4000 unemployed and many of them heading for Canada, Australia and New Zealand to find jobs and experience, let's hope so.
Is it because, according to a study carried out on behalf of the UK Office of Science and Innovation's Horizon Scanning Centre, Robots could demand legal rights that I have experienced a sudden surge of interest in the possible use of robots in healthcare?
I guess you have also endured presentations where a speaker reads a hail of bullet points on a projected Microsoft PowerPoint slide, usually with their back to the audience. Edward R. Tufte puts it beautifully: "Power corrupts. PowerPoint corrupts absolutely". So much can standardised PC software constrain our ideas and our behaviour.
So, I was concerned when I read Bill Gates in January 2007 Scientific American: A Robot in Every Home. Mr. Gates talks about robots as though they were mobile PCs. Robotics, he says, is a highly fragmented industry with few common standards or platforms—and it needs some.
If he's right, let’s hope the robots make better use of standard software than some humans.
The US Defense Advanced Research Projects Agency (DARPA) seeks to investigate and exploit promising technologies for use in the defence industry. Its Trauma Pod program (see article and animation at bottom of the page)--an outgrowth of earlier telepresence surgery R&D--seeks to meet the military’s need for trauma care and autonomous surgery by 2025. It is part of the Army’s goal to remove medical personnel and all hospitals from battlefields.
This program supports immediate diagnosis, therapy and evacuation of casualties. Deliverables include advances in teleoperation and surgical procedures, mechanical movements, directed energy, software development, miniaturization and the automatic management of medical supplies in theatre.
Since 2004, DARPA principal investigators have designed and prototyped novel systems. Commercial use of Trauma Pod technologies could lead to greater medical efficiency and the better use of specialist staff.
Thanks to Lance Manning for this entry. Lance is a business consultant providing client support in research, development and implementation of emerging health care technologies.
Former Marine Claudia Mitchell may be the first person in the world to have a set of acrylic nails fitted to a bionic arm. Claudia lost her arm in a motorbike accident and has been fitted with a state-of-the-art prosthesis.
The bionic device costs about £32 000 and takes a five-hour operation to install. The nerves needed to operate the arm then regrow in about five months. Claudia can control the prosthesis by thought using nerve impulses from the muscles in her chest--and she clearly has priorities about the way it looks!
For some procedures robotic surgery is less invasive than open surgery. Its use in prostatectomies, for example, may result in less pain, less bleeding and a quicker recovery. A surgical robot's lenses may also give surgeons a 3D view deep into incisions making it easier to avoid damaging the ureter and the complex of nerves.
A mobile phone carrying a breathalyser is about to be launched in the UK the Sunday Times on 9 July 2006 reported. The Samsung LP4100 tests drinkers's fitness to drive and may also lock out certain numbers to prevent embarrassing drunken calls to bosses, former partners or the local takeaway. The phone is multifunctional, even offering a remote control for karaoke machines.
I also spotted this article about a breath test for metabolites asssociate with breast cancer.
Lack of testing and diagnostic devices not needing specialist intervention have limited remote monitoring and the development of carebots, but that's changing fast with breath testing a promising area.
Back to one of my favourite topics.
A short article in the UK's Financial Times: How humanoids won the hearts of Japanese industry covers familiar ground but introduces me to a robotic baby seal Paro that uses sensors to react to the way that it is treated by humans. It apparently reduces stress levels in the elderly and is popular, despite costing several thousand dollars.
Still, walking robots are even more expensive--about the same price as a Ferrari--though costs would fall with volume to about that of a cheap car.
The article makes an interesting inference about why Japanese are less suspicious of robots than Westerners. The Shinto religion allows for a living spirit to inhabit inanimate objects, whereas Christianity has found the notion of man creating an image of himself sacriligeous. Hmmm.
In a recent interview for an article, Honda Motor Europe’s William de Braekeleer told me: “The long term objective of our engineers is to create a robot able to help people in their daily lives. So that is why ASIMO has been designed to walk and move just like us.”
Others have in mind resemblances beyond movement. Android Science in May 2006’s Scientific American describes an honest-to-goddess android called Repliee Q1Expo that looks like a thirty-something woman. To create it, Hiroshi Ishiguro used silicon rubber and polyurethane to cover the metal armature and Japanese newscaster Ayako Fujii as his model.
Before Christmas I went for lunch in London with my wife and my father and mother in law. We were looking at some ideas for designs that will soon adorn this blog. As a consquence, my mother in law said that if she were having surgery she would prefer it to be carried out with robotic precision.
In a recent article published on the E-Health-Insider website I present a straw man that robots will be better than humans at caring:
“Humans compare unfavourably with robots, tiring easily, taking longer to train, needing special fuel, being expensive to maintain, becoming easily bored by repetitive tasks—and—you just can not get the spare parts for them.”As Alasdair asked in a comment to a previous article: even if machines can care, should we let them? I think that machines will free clinicians and carers from the heavy, boring and repetitive tasks; but they can never give patients what we can--our humanity.
Image: Honda Motor Europe.
I am reading an excellent book: “Jacquard's Web” by James Essinger.
Joseph-Marie Jacquard was a master silk-weaver in Napoleonic France. Jacquard invented a loom that accelerated the rate at which master weavers could create their exquisite fabric by 25 times. The loom stored patterns and instructions for the beautiful designs on punched cards, which were in turn used by Charles Babbage to programme his Analytical Engine--the world's first computer.
The precursor of Jacquard's loom was the drawloom. Individual threads of the warp were lifted by it to create a path through which the shuttle was passed by a draw boy. The drawloom allowed patterns to be weaved at the unprecedented rate of two rows a minute (!)
This book is an excellent read and this caught my eye:
“The real problem was that the drawloom was not a machine at all. Instead, it was only a device for facilitating the manual weaving of patterns or images in the fabric...”
Facilitating the manual weaving. It seems to me that is what healthcare IT does: it's an aid to care rather than an integral part of care--still somewhere between the condition of an abacus and a calculator.
The picture is of the da Vinci operational robot which is used by surgeons to achieve unprecedented precision in minimally invasive surgery. It eliminates a surgeon's hand tremor, which is magnified by the lever effect of the long keyhole surgery instruments, and further improves visibility by the stereoscopic view of the site that its twin lenses provide.
Sure, it needs a surgeon to operate it remotely but how much longer before IT and tools are further integrated creating the medical equivalent of Jacquard's loom and freeing professionals to weave even better patterns of care?
Picture of the da VInci copyrighted property of Intuitive Surgical.
I'm writing a couple of articles on the use of robots in healthcare and yesterday I spoke to a UK researcher in the field who is researching In Touch Health's RP7 robot. RP stands for remote presence.
The RP7 resembles a monitor and camera on a large vacuum cleaner base and is navigated remotely at a console by using a joystick. It's like telemedicine on castors.
The robot is already deployed in the Accident and Emergency Department and on one of the Surgical wards of the researcher's hospital. One of the areas he thinks is very suitable for robot use is Intensive Care wards.
At first this seemed odd to me because patients on these wards are normally under constant supervision anyway and often unconscious or too ill to talk.
However, many IC wards outside of large hospitals in the UK are managed by Anaethetists who sometimes need a second opinion from a specialist Intensivist. Such opinions could often be more easily given remotely using a remote presence-type robot.
Here is a US article that describes the use of RP robots in ICU. The best written section is at the end of the page: Robots In the ICU.
This PDF sent to me by In Touch Health is a more detailed description of the same application of RP robots written by Paul Vespa.
Picture of the RP6 in action by kind permission of In Touch Health.
This month, Honda has unveiled its new, 1.3m tall version of ASIMO (advanced step in innovative mobility) one of the worlds most advanced bipedal robots.
ASIMO has been enhanced with a new selection of sensors--the key to future robot development. Using its visual, ultrasonic and floor sensors it recognises its environment, and steps out with the aid of its eye camera. Using wrist kinaesthetic sensors, it gives and takes objects.
New ASIMO displays a greater ability to work harmoniously with humans. It can walk while holding a hand and carry objects using a trolley or cart.
It has also doubled its running speed to 6km/hr with both feet off the ground during the gliding phase. For that it balances centrifugal force by tilting its centre of gravity.
"ASIMO has been created as a new form of mobility. In the long term, it should allow you to execute a task without having to move yourself," explains William de Braekeleer of Honda Motor Europe Ltd. "We see ASIMO as an aid to the nurse, taking care of the heavy aspects of their tasks, allowing them to spend more time with the patient."
Now ASIMO is capable of more grunt work, Honda says that future development will concentrate on its intelligence to enable it to make judgements in various situations.
Pictures of ASIMO by kind permission of Honda Motor Europe Ltd
Now, it has been known for some time that having a pet can improve your health. But what having about a robodog?
A study by the US Department of Health concluded that pets increased the survival rate of heart attack victims. The study revealed that 28% of heart patients with pets survived serious heart attacks, compared to only 6% of heart patients without pets.
Owning a pet it seems can lower blood pressure and cholesterol levels. In the US a study of elderly patients showed that those with pets sought the services of their doctor less frequently. This seems to be supported by another study in nursing homes that showed an animal companion reduced significantly the use of prescription drugs.
But pets are not welcome everywhere: enter robodog.
A recent study at the University of Missouri-Columbia, found levels of the stress hormone cortisol dropped among adults who petted Sony's robodog AIBO. AIBO responds when stroked, chases a ball and perks up when it hears a familiar voice.
Unfortunately, unlike the real thing, AIBO did not prompt an increase in feel good chemicals like oxytocin and endorphins.
In the dog house or paws for thought?
At the International Robot Exhibition in Tokyo, the world's biggest robofest, Japansese researchers demonstrated a robot designed to train doctors to operate inside blood vessels.
Researchers showed the Micro Surgery Robot operating on the veins of a transparent human dummy. By guiding the robot, a medical student or a doctor can learn about endovascular treatment, or operations in which patients are treated through tubes inserted into their veins. Endovascular treatment is popular for victims of a stroke because it places less stress on them.
Robots in healthcare seem to be developing in three main ways: operational (like this one), anthropomorphic (like ASIMO: see "Robots in healthcare") and miniature (sometimes called nanobots)...
I have loved robots since I was a child and saw Robbie in "Forbidden Planet" at the Saturday morning pictures. But my attempts to make one from old shoe boxes, torch bulbs and a couple of batteries ended in failure.
So, it was a great pleasure for me when I went eyeball to lens with the RP (remote presence) 6 robot being piloted at Imperial College Medical School at St. Mary's Hospital, Paddington, London. You can read more about my encounter with the RP6 in an article that I wrote Carebots in the Community.
The RP6 looks like a vacuum cleaner base carrying a flat screen monitor. A doctor consults a patient remotely, steering with a joystick and the help of an on board camera. It is also handy if a doctor in Birmingham needs a second opinion from a colleague in London, or in New York for that matter.
The advantage of remote presence robots like the RP6 over conventional telemedicine is that they can move to the patient, rather than the patient having to move to a telemedicine suite. In addition, they respect privacy, so there would be no need for a person at home to be subjected to 24 hour surveillance. Mind you, how would the RP6 make it upstairs unless it developed Dalek-like levitation skills?
Humanoid robots can climb stairs and will operate in our world. They will do the heavy work—like lifting patients, moving equipment and working gadgets like the washing machine and microwave—remember, many people give up living independently because of arthritis.
Here is a nice brochure about anthropomorphic robots from the University of Waseda in Japan. The University plans for its robots to use "multimedia such as speech, facial expression and body movement" (!) Robots like these could make carers' jobs less physically demanding and help the elderly and infirm to stay independent.
My wife says she wants one now (I say she already has one). Honda’s ASIMO (see pic) is an example of a bipedal humanoid robot, which unfortunately for my wife (and me) is still about ten years away from general deployment. Now where did I put those shoe boxes?
Picture of ASIMO by kind permission of Honda Motor (Europe) Ltd.