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Study: Social robots can benefit hospitalized children
A robotic teddy bear could improve physical and emotional outcomes in pediatric patients.
A new study demonstrates, for the first time, that "social robots" used in support sessions held in pediatric units at hospitals can lead to more positive emotions in sick children.
Many hospitals host interventions in pediatric units, where child life specialists will provide clinical interventions to hospitalized children for developmental and coping support. This involves play, preparation, education, and behavioral distraction for both routine medical care, as well as before, during, and after difficult procedures. Traditional interventions include therapeutic medical play and normalizing the environment through activities such as arts and crafts, games, and celebrations.
For the study, published today in the journal Pediatrics, researchers from the MIT Media Lab, Boston Children's Hospital, and Northeastern University deployed a robotic teddy bear, "Huggable," across several pediatric units at Boston Children's Hospital. More than 50 hospitalized children were randomly split into three groups of interventions that involved Huggable, a tablet-based virtual Huggable, or a traditional plush teddy bear. In general, Huggable improved various patient outcomes over those other two options.
The study primarily demonstrated the feasibility of integrating Huggable into the interventions. But results also indicated that children playing with Huggable experienced more positive emotions overall. They also got out of bed and moved around more, and emotionally connected with the robot, asking it personal questions and inviting it to come back later to meet their families. "Such improved emotional, physical, and verbal outcomes are all positive factors that could contribute to better and faster recovery in hospitalized children," the researchers write in their study.
Although it is a small study, it is the first to explore social robotics in a real-world inpatient pediatric setting with ill children, the researchers say. Other studies have been conducted in labs, have studied very few children, or were conducted in public settings without any patient identification.
But Huggable is designed only to assist health care specialists — not replace them, the researchers stress. "It's a companion," says co-author Cynthia Breazeal, an associate professor of media arts and sciences and founding director of the Personal Robots group. "Our group designs technologies with the mindset that they're teammates. We don't just look at the child-robot interaction. It's about [helping] specialists and parents, because we want technology to support everyone who's invested in the quality care of a child."
"Child life staff provide a lot of human interaction to help normalize the hospital experience, but they can't be with every kid, all the time. Social robots create a more consistent presence throughout the day," adds first author Deirdre Logan, a pediatric psychologist at Boston Children's Hospital. "There may also be kids who don't always want to talk to people, and respond better to having a robotic stuffed animal with them. It's exciting knowing what types of support we can provide kids who may feel isolated or scared about what they're going through."
Joining Breazeal and Logan on the paper are: Sooyeon Jeong, a PhD student in the Personal Robots group; Brianna O'Connell, Duncan Smith-Freedman, and Peter Weinstock, all of Boston Children's Hospital; and Matthew Goodwin and James Heathers, both of Northeastern University.
First prototyped in 2006, Huggable is a plush teddy bear with a screen depicting animated eyes. While the eventual goal is to make the robot fully autonomous, it is currently operated remotely by a specialist in the hall outside a child's room. Through custom software, a specialist can control the robot's facial expressions and body actions, and direct its gaze. The specialists could also talk through a speaker — with their voice automatically shifted to a higher pitch to sound more childlike — and monitor the participants via camera feed. The tablet-based avatar of the bear had identical gestures and was also remotely operated.
During the interventions involving Huggable — involving kids ages 3 to 10 years — a specialist would sing nursery rhymes to younger children through robot and move the arms during the song. Older kids would play the I Spy game, where they have to guess an object in the room described by the specialist through Huggable.
Through self-reports and questionnaires, the researchers recorded how much the patients and families liked interacting with Huggable. Additional questionnaires assessed patient's positive moods, as well as anxiety and perceived pain levels. The researchers also used cameras mounted in the child's room to capture and analyze speech patterns, characterizing them as joyful or sad, using software.
A greater percentage of children and their parents reported that the children enjoyed playing with Huggable more than with the avatar or traditional teddy bear. Speech analysis backed up that result, detecting significantly more joyful expressions among the children during robotic interventions. Additionally, parents noted lower levels of perceived pain among their children.
The researchers noted that 93 percent of patients completed the Huggable-based interventions, and found few barriers to practical implementation, as determined by comments from the specialists.
A previous paper based on the same study found that the robot also seemed to facilitate greater family involvement in the interventions, compared to the other two methods, which improved the intervention overall. "Those are findings we didn't necessarily expect in the beginning," says Jeong, also a co-author on the previous paper. "We didn't tell family to join any of the play sessions — it just happened naturally. When the robot came in, the child and robot and parents all interacted more, playing games or in introducing the robot."
An automated, take-home bot
The study also generated valuable insights for developing a fully autonomous Huggable robot, which is the researchers' ultimate goal. They were able to determine which physical gestures are used most and least often, and which features specialists may want for future iterations. Huggable, for instance, could introduce doctors before they enter a child's room or learn a child's interests and share that information with specialists. The researchers may also equip the robot with computer vision, so it can detect certain objects in a room to talk about those with children.
"In these early studies, we capture data … to wrap our heads around an authentic use-case scenario where, if the bear was automated, what does it need to do to provide high-quality standard of care," Breazeal says.
In the future, that automated robot could be used to improve continuity of care. A child would take home a robot after a hospital visit to further support engagement, adherence to care regimens, and monitoring well-being.
"We want to continue thinking about how robots can become part of the whole clinical team and help everyone," Jeong says. "When the robot goes home, we want to see the robot monitor a child's progress. … If there's something clinicians need to know earlier, the robot can let the clinicians know, so [they're not] surprised at the next appointment that the child hasn't been doing well."
Next, the researchers are hoping to zero in on which specific patient populations may benefit the most from the Huggable interventions. "We want to find the sweet spot for the children who need this type of of extra support," Logan says.
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Scientists are using bioelectronic medicine to treat inflammatory diseases, an approach that capitalizes on the ancient "hardwiring" of the nervous system.
- Bioelectronic medicine is an emerging field that focuses on manipulating the nervous system to treat diseases.
- Clinical studies show that using electronic devices to stimulate the vagus nerve is effective at treating inflammatory diseases like rheumatoid arthritis.
- Although it's not yet approved by the US Food and Drug Administration, vagus nerve stimulation may also prove effective at treating other diseases like cancer, diabetes and depression.
The nervous system’s ancient reflexes<p>You accidentally place your hand on a hot stove. Almost instantaneously, your hand withdraws.</p><p>What triggered your hand to move? The answer is <em>not</em> that you consciously decided the stove was hot and you should move your hand. Rather, it was a reflex: Skin receptors on your hand sent nerve impulses to the spinal cord, which ultimately sent back motor neurons that caused your hand to move away. This all occurred before your "conscious brain" realized what happened.</p><p>Similarly, the nervous system has reflexes that protect individual cells in the body.</p><p>"The nervous system evolved because we need to respond to stimuli in the environment," said Dr. Tracey. "Neural signals don't come from the brain down first. Instead, when something happens in the environment, our peripheral nervous system senses it and sends a signal to the central nervous system, which comprises the brain and spinal cord. And then the nervous system responds to correct the problem."</p><p>So, what if scientists could "hack" into the nervous system, manipulating the electrical activity in the nervous system to control molecular processes and produce desirable outcomes? That's the chief goal of bioelectronic medicine.</p><p>"There are billions of neurons in the body that interact with almost every cell in the body, and at each of those nerve endings, molecular signals control molecular mechanisms that can be defined and mapped, and potentially put under control," Dr. Tracey said in a <a href="https://www.youtube.com/watch?v=AJH9KsMKi5M" target="_blank">TED Talk</a>.</p><p>"Many of these mechanisms are also involved in important diseases, like cancer, Alzheimer's, diabetes, hypertension and shock. It's very plausible that finding neural signals to control those mechanisms will hold promises for devices replacing some of today's medication for those diseases."</p><p>How can scientists hack the nervous system? For years, researchers in the field of bioelectronic medicine have zeroed in on the longest cranial nerve in the body: the vagus nerve.</p>
The vagus nerve<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTYyOTM5OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NTIwNzk0NX0.UCy-3UNpomb3DQZMhyOw_SQG4ThwACXW_rMnc9mLAe8/img.jpg?width=1245&coordinates=0%2C0%2C0%2C0&height=700" id="09add" class="rm-shortcode" data-rm-shortcode-id="f38dbfbbfe470ad85a3b023dd5083557" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />
Electrical signals, seen here in a synapse, travel along the vagus nerve to trigger an inflammatory response.
Credit: Adobe Stock via solvod<p>The vagus nerve ("vagus" meaning "wandering" in Latin) comprises two nerve branches that stretch from the brainstem down to the chest and abdomen, where nerve fibers connect to organs. Electrical signals constantly travel up and down the vagus nerve, facilitating communication between the brain and other parts of the body.</p><p>One aspect of this back-and-forth communication is inflammation. When the immune system detects injury or attack, it automatically triggers an inflammatory response, which helps heal injuries and fend off invaders. But when not deployed properly, inflammation can become excessive, exacerbating the original problem and potentially contributing to diseases.</p><p>In 2002, Dr. Tracey and his colleagues discovered that the nervous system plays a key role in monitoring and modifying inflammation. This occurs through a process called the <a href="https://www.nature.com/articles/nature01321" target="_blank" rel="noopener noreferrer">inflammatory reflex</a>. In simple terms, it works like this: When the nervous system detects inflammatory stimuli, it reflexively (and subconsciously) deploys electrical signals through the vagus nerve that trigger anti-inflammatory molecular processes.</p><p>In rodent experiments, Dr. Tracey and his colleagues observed that electrical signals traveling through the vagus nerve control TNF, a protein that, in excess, causes inflammation. These electrical signals travel through the vagus nerve to the spleen. There, electrical signals are converted to chemical signals, triggering a molecular process that ultimately makes TNF, which exacerbates conditions like rheumatoid arthritis.</p><p>The incredible chain reaction of the inflammatory reflex was observed by Dr. Tracey and his colleagues in greater detail through rodent experiments. When inflammatory stimuli are detected, the nervous system sends electrical signals that travel through the vagus nerve to the spleen. There, the electrical signals are converted to chemical signals, which trigger the spleen to create a white blood cell called a T cell, which then creates a neurotransmitter called acetylcholine. The acetylcholine interacts with macrophages, which are a specific type of white blood cell that creates TNF, a protein that, in excess, causes inflammation. At that point, the acetylcholine triggers the macrophages to stop overproducing TNF – or inflammation.</p><p>Experiments showed that when a specific part of the body is inflamed, specific fibers within the vagus nerve start firing. Dr. Tracey and his colleagues were able to map these relationships. More importantly, they were able to stimulate specific parts of the vagus nerve to "shut off" inflammation.</p><p>What's more, clinical trials show that vagus nerve stimulation not only "shuts off" inflammation, but also triggers the production of cells that promote healing.</p><p>"In animal experiments, we understand how this works," Dr. Tracey said. "And now we have clinical trials showing that the human response is what's predicted by the lab experiments. Many scientific thresholds have been crossed in the clinic and the lab. We're literally at the point of regulatory steps and stages, and then marketing and distribution before this idea takes off."<br></p>
The future of bioelectronic medicine<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTYxMDYxMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjQwOTExNH0.uBY1TnEs_kv9Dal7zmA_i9L7T0wnIuf9gGtdRXcNNxo/img.jpg?width=980" id="8b5b2" class="rm-shortcode" data-rm-shortcode-id="c005e615e5f23c2817483862354d2cc4" data-rm-shortcode-name="rebelmouse-image" data-width="2000" data-height="1125" />
Vagus nerve stimulation can already treat Crohn's disease and other inflammatory diseases. In the future, it may also be used to treat cancer, diabetes, and depression.
Credit: Adobe Stock via Maridav<p>Vagus nerve stimulation is currently awaiting approval by the US Food and Drug Administration, but so far, it's proven safe and effective in clinical trials on humans. Dr. Tracey said vagus nerve stimulation could become a common treatment for a wide range of diseases, including cancer, Alzheimer's, diabetes, hypertension, shock, depression and diabetes.</p><p>"To the extent that inflammation is the problem in the disease, then stopping inflammation or suppressing the inflammation with vagus nerve stimulation or bioelectronic approaches will be beneficial and therapeutic," he said.</p><p>Receiving vagus nerve stimulation would require having an electronic device, about the size of lima bean, surgically implanted in your neck during a 30-minute procedure. A couple of weeks later, you'd visit, say, your rheumatologist, who would activate the device and determine the right dosage. The stimulation would take a few minutes each day, and it'd likely be unnoticeable.</p><p>But the most revolutionary aspect of bioelectronic medicine, according to Dr. Tracey, is that approaches like vagus nerve stimulation wouldn't come with harmful and potentially deadly side effects, as many pharmaceutical drugs currently do.</p><p>"A device on a nerve is not going to have systemic side effects on the body like taking a steroid does," Dr. Tracey said. "It's a powerful concept that, frankly, scientists are quite accepting of—it's actually quite amazing. But the idea of adopting this into practice is going to take another 10 or 20 years, because it's hard for physicians, who've spent their lives writing prescriptions for pills or injections, that a computer chip can replace the drug."</p><p>But patients could also play a role in advancing bioelectronic medicine.</p><p>"There's a huge demand in this patient cohort for something better than they're taking now," Dr. Tracey said. "Patients don't want to take a drug with a black-box warning, costs $100,000 a year and works half the time."</p><p>Michael Dowling, president and CEO of Northwell Health, elaborated:</p><p>"Why would patients pursue a drug regimen when they could opt for a few electronic pulses? Is it possible that treatments like this, pulses through electronic devices, could replace some drugs in the coming years as preferred treatments? Tracey believes it is, and that is perhaps why the pharmaceutical industry closely follows his work."</p><p>Over the long term, bioelectronic approaches are unlikely to completely replace pharmaceutical drugs, but they could replace many, or at least be used as supplemental treatments.</p><p>Dr. Tracey is optimistic about the future of the field.</p><p>"It's going to spawn a huge new industry that will rival the pharmaceutical industry in the next 50 years," he said. "This is no longer just a startup industry. [...] It's going to be very interesting to see the explosive growth that's going to occur."</p>
The first rule of Vulture Club: stay out of Portugal.
So you're a vulture, riding the thermals that rise up over Iberia. Your way of life is ancient, ruled by needs and instincts that are way older than the human civilization that has overtaken the peninsula below, and the entire planet.
"The Expanse" is the best vision I've ever seen of a space-faring future that may be just a few generations away.
- Want three reasons why that headline is justified? Characters and acting, universe building, and science.
- For those who don't know, "The Expanse" is a series that's run on SyFy and Amazon Prime set about 200 years in the future in a mostly settled solar system with three waring factions: Earth, Mars, and Belters.
- No other show I know of manages to use real science so adeptly in the service of its story and its grand universe building.
Credit: "The Expanse" / Syfy<p>Now, I get it if you don't agree with me. I love "Star Trek" and I thought "Battlestar Galactica" (the new one) was amazing and I do adore "The Mandalorian". They are all fun and important and worth watching and thinking about. And maybe you love them more than anything else. But when you sum up the acting, the universe building, and the use of real science where it matters, I think nothing can beat "The Expanse". And with a <a href="https://www.rottentomatoes.com/tv/the_expanse" target="_blank">Rotten Tomato</a> average rating of 93%, I'm clearly not the only one who feels this way.</p><p>Best.</p><p>Show.</p><p>Ever. </p>
Contrary to what some might think, the brain is a very plastic organ.
As with many other physicians, recommending physical activity to patients was just a doctor chore for me – until a few years ago. That was because I myself was not very active.