121tAking CAre oF our PArents
designprocess. is will increase the acceptance of robots by elderly
people (Frennert & Östlund, 2014).
Sorell and Draper (2014) propose an ethical framework for the
design of care robots. e framework denes the values that should
be promoted or at least respected by care robot designers. ese values
are as follows:
• Autonomy (being able to set goals in life and choose the means
of achieving them)
• Independence (being able to implement one’s goals without the
permission, assistance, or material resources of others)
• Enablement (having or having access to means of realizing
goals and choices)
• Safety (being able to readily avoid pain or harm)
• Privacy (being able to pursue and realize one’s goals and
implement one’s choices unobserved)
• Social connectedness (having regular contact with friends and
loved ones and safe access to strangers one can choose to
meet)
It is nearly impossible to avoid conicts between these values in a
design, and trade-os are necessary. In such trade-os, a balance must
always be sought between increasing the quality of life—by allowing
older people to remain at home longer—and protecting the individual
rights of people and their physical and mental well-being (Sharkey &
Sharkey, 2012).
Interview with Hans Rietman (Professor of Physical Medicine
and Rehabilitation, University of Twente, the Netherlands)
“e work will change, but personal contact is irreplaceable.”
Hans Rietman is not an engineer working in health care, but a doc-
tor turned technology expert—which makes a dierence. He admires
sophisticated exoskeletons that allow “the inrmed to walk,” but won-
ders if the designers will think of preventing bedsores.
“New robotic devices are best designed in a collaborative eort of
patients who know what they want, medical experts who know what’s
needed, and engineers who know what’s feasible,” Hans Rietman
says. “at’s my favorite take-home message.”
122 Just ordinAry robots
His triple professional position makes him see perhaps more clearly
than others how important all three parties are. At the University of
Twente (UT) in the Netherlands, he teaches future engineers about
rehabilitation technology. As a medical practitioner, he sees patients
at Roessingh, a specialized rehabilitation center in Enschede. Finally,
he is the director of Roessingh’s separate R&D division. ey cooper-
ate not only with the rehabilitation center but also with UT, which is
located within easy cycling distance.
Coaching Role
Among the projects that Roessingh R&D participates in is the devel-
opment of therapeutic robots. ese are feats of engineering and will
potentially benet both patients and doctors. “After a stroke, people need
intensive exercise to recover their motor skills, especially those of the
limbs, so that after some time they can return home. Ideally, they should
exercise several times a day, preferably doing useful and motivational
activities and getting direct feedback. But there is a personnel problem:
walking exercises on a treadmill, for instance, require the presence of two
therapists, and it’s such a strain on them that they can’t do this for more
than fteen minutes at a time—no more than thirty minutes a day, if we
follow workplace legislation to the letter. erefore, together with UT
and other partners, we have considered whether robots might take over
this job, and perhaps even be better at it. e result has been LOPES, an
exoskeleton full of sensors, which supports the patient’s weight and will
correct their walking movements where needed. Something similar has
been developed for arms. Hands are too complex at this stage, but there
is an international project working on them too.
My vision for the future is that in say ten years we’ll have exercise
areas with some two or three leg-exercise robots and ve arm-exercise
robots. ey will oer the users mostly game-like activities, some in
2D with touchscreens, others in 3D with a console similar to a Wii.
People will exercise there under the supervision of a therapist, who
will divide their attention among a number of patients. eirs will
be more of a coaching role than at present. So the day-to-day work
will change, but it will remain vital: only the therapist can assess how
well the recovery is going. Also, they will still be the most accurate
observer of a patient’s movements, and can tell best what corrections
are needed.”
123tAking CAre oF our PArents
Subjective Perception
“We are evaluating the quality of this innovation with conventional
therapy. e results so far indicate that they’re pretty close when it
comes to walking speed, endurance, quality of gait, and so on. e
robot is not yet superior, but it is just as good.
We also set great store by the patients’ perception of the therapy. It
is particularly this subjective, emotional aspect that Roessingh want
to bring to the collaboration with the more technology- oriented
parties such as UT and several companies. We pay attention to appar-
ent details that matter greatly to patients. For instance, how long
does it take to strap on the device, sensors and all? It shouldn’t be
more than three minutes—we have it down to ve now. On the posi-
tive side, it turns out that patients positively enjoy the arm- exercise
robot. Today’s patients, including the elderly, are comfortable with
computer games. eir main complaint is that they would like more
variety.
ose with misgivings about the devices are not so much the
patients, but rather the therapists and nurses, probably for two rea-
sons. First, as professionals, they often have to work with prototypes,
which tend to have teething troubles. is frustrates them no end, and
I understand that completely. Second, it is often claimed that robots
will replace therapists and nurses. Personally, I think that these pro-
fessionals will remain of vital importance. e emotional value of per-
sonal contact is irreplaceable. I do expect that contacts with therapists
will become less frequent, as patients will be able to exercise with a
robot in between. Importantly, patients tend to be happy about that.”
Preferring the Wheelchair
Other robotic devices that Roessingh R&D are developing include
smart prostheses and orthoses—articial body parts and external
body supports, in everyday language. anks to their sensors, they
can predict the user’s next movement and adjust their action accord-
ingly. But yet again, there are some snags.
“We now have leg prostheses with very advanced computers in the
knees. e need for them is greatest among the elderly, but the benets
will mostly go to young people, because insurance companies consider
them too expensive for elderly patients. In the future, these prostheses
will be motorized, so as to support the legs even more. But many elderly
124 Just ordinAry robots
patients will have trouble controlling such a powerful device. eir motor
intelligence is no longer up to it, so accidents are bound to happen. I believe
they will benet more from nonrobotic improvements in prostheses.”
Orthoses pose their own problems. Some of them are technical:
how to enable the user to control them if their nerve signals are either
absent, as in paraplegics, or inadequate, as in people with spasticity.
Others result from “these developments being technology-driven,”
Rietman says. “Designers realize insuciently that the patient will
be within a device that grates against the skin, irritating it. You get
pressure sores, comparable to bedsores and wheelchair sores. Perhaps
these can be avoided by using innovative materials, but this is not the
priority I think it ought to be, in line with the patients’ preferences.
Actually, I expect that 10 years from now, most patients will still nd
a wheelchair preferable.”
Betrayed by a Bot
Will health care see an invasion of service robots over the next decade?
Rietman strongly doubts it. “We are doing work on a patient lift that
is so smart you might well call it a robot. But it will be mostly for
professional settings, as it is way too expensive for home use. Besides,
the legal requirements for home use are even more stringent, as there
is no professional around to intervene when things go pear-shaped.
Yet another development in this eld, though not here at Roessingh,
are social robots to keep people company and chat with them. Personally,
they make me a bit uneasy. Of course, they will get increasingly sophis-
ticated, responding correctly to emotions andquestions. It is conceiv-
able that at some point it will be hard to tell their conversations apart
from talking with humans. Interestingly, it doesn’t even matter when
the robot doesn’t look human. I remember seeing a research presenta-
tion from Canada about a robot of only 1.30 meters (or 4.27 feet) tall.
Its head was the classical tin aair, but it was endowed with human
speech. When they let a patient talk with it, he started treating it as if it
were a sentient being within 5 minutes. He even tried to pull the robot’s
leg! Afterward, when the robot told the therapists that the patient had
failed to do some of his exercises, the patient felt let down. Betrayed.
Obviously, this gets you into all sorts of ethical discussions.
erefore, I’ve been very happy to notice that engineering students,
when I teach them about the relationship between health care and
125tAking CAre oF our PArents
rehabilitation technology, often spontaneously bring up the ethical
questions. What will these technologies mean for individual patients
and for society? I think it is very good and important that they think
about these questions right from the start.”
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