PRE2016 4 Groep2

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Project Robots Everywhere 2016/2017 Group 2

Group members

  • Joris Dalderup 0942945
  • Frouke Hekker 0897373
  • Ellen Vugts 0892371
  • Bram Wieringa 0893231
  • Mireille Moonen unknown

Planning

Week Dates What Whom
1 24-30 April Problem definition All
Context All
Planning M & E
Presentation J & F
Research about state of the art
* Computer Vision (CV) J & B
* Appearance M & F
* Behaviour E & F
Make appointment with secondary users TBD
Brainstorm: what to put in interview/questionnaire? TBD
27/4 deadline planning M & E
24/4 meeting 1 M & E
25/4 meeting 2 M & E
2 1-7 May First presentation J & F
Computer Vision (CV)
  • Recognition of humans
  • Recognition of faces
J & B
Appearance of the robot
  • Prepare interview/questionnaire with nurses in home care

Literature study on human robot interaction

E & F
3 8-14 May Computer Vision (CV)
  • Recognise people in different positions

Appearance

  • Conduct interview with team of nurses
  • Process results of interview

Behaviour

  • Come up with features based on interview and literature study
J & B

E & F
M

4 15-21 May Implementation results interview:

Decide upon features of robot

All
5 22-28 May Bring all the components together

Preliminary design Seek flaws

All
6 29 May to 4th of June Decide upon final design,

give descriptions and make diagrams

All
7 5-11 June final design Discussion Conclusion

Extra time if necessary

All
8 12th of June Final presentation All ex J and F

Minutes

Monday, 24 April

Ellen and Mireille looking for what is needed in healthcare, asking nurses, looking in the feeld where the problems occur with caring for people and people caring for themselves. Everyone will look what is state of the art about lifting people autonomously, what can we improve about this technology and what will be the future challenges
Next meeting: 25/4 12:30
Fixed meetings: every monday 9:00-12:30

Tuesday, 25 April

What subject do we want to choose concretely?
The “robear” is very similar to what we had in vision, it can lift up people.
This robear doesn’t have robot vision yet, so we can see if we can improve this aspect so that we can lift up a person in every position. Is this not a too small concept?
What can our end goal be? Making an autonomous robot that can lift people.
What do we need to accomplish?
Who are the users? first, secondary users.
Knowing what is state of the art, what do people think of the current lift possibilities?
What does it need to look like?

Decision making

We take the RoBear as state of the art, we want to create a lifting robot that can operate autonomously without supervision and has an appearance which people appreciate.
Points to do:

  • specify how the robear exactly operates
  • what are the points to improve, what is missing
  • doing field research with the secondary users (week 2)
  • doing field research about our final concept
  • designing the appearance
  • simulating the navigation
  • value sensitive design
  • computer vision


With every point we

  • search the state of the art
  • identify what is missing or can be improved
  • design a better solution

combining every component to create our final robot on paper.

Tasks

  • Joris and Frouke will make the presentation and will present on Monday
  • Ellen and Mireille will make the planning specific and in detail

Thursday, May 4

Present: Frouke, Ellen, Bram (first half), Mireille (second half), Joris (second half)

Interviews

Discussed:

  • What questions are relevant?
  • Take out double questions, don’t spend too long on nurses’ complaints/physical injuries.
  • What questions should be added?
    • More questions about emotions of client and how to reassure them while moving. Questions about improvement of RoBear: user interface with touch screen/sound.
    • What functions does the nurse think should be added?
  • What values are important?
    • How can we directly link norms, rules of conduct or the robot’s behaviour to these values?

User interface on robot

Search for articles on communicating with client. How a robot should approach a person, give information, use sounds and commands.
An extra which we will not use: robot that takes initiative in lifting person, e.g. wake up function.

Computer vision

Detect person and its body parts

Currently the program can recognize a person’s face and its body in standing position

Tasks

  • To put on the wiki: Preliminary interview, minutes, progress on computer vision (short description)
  • Computer vision: body in other positions (lie down, kneeling, …) and small demo
  • Think of concrete questions to ask the supervisors.
  • Discuss interview, are there any improvements?

Monday, May 15th

Joris and Mirrille were absent. The teachers expressed their concerns about never having seen Mirielle.
Because the wiki wasn’t updated the meeting started of with explaining what we had done this week. The biggest problem right now is that our problem statement is still too broad.

A few options were suggested but we are encouraged to think of our own:

  • changing the sheats
  • getting in to a wheel chair
  • fluffing pillows

We have to chose how healthy the person is and why we want to lift him (where does the person need to go, it is difficult to put someone in a chair). We have to make a scenario explain why we have chosen that.
It would also be fine if our end result is a prototype that lifts a potato sack, if we can explain why it is relevant. The deadline for a more confined goal on the wiki page is tomorrow.

Conclusions

Senario

  • Lying down to standing up
  • Healthy but weak person
  • Deliverables:
    • Series of movements to lift a person
    • General design (shape and amount of arms)
    • Results with explanations


Preparations for interview

Identify the context, user and tasks of the robot.
What are important values for the care givers?
What are important values for the care receivers?
Can there be linked concrete norms to these values?

Work done beforehand

Care robot:
Care for persons
“Designed for use in home, hospital, or other settings to assist in, support, or provide care for the sick, disabled, young, elderly or otherwise vulnerable persons” (Vallor 2011)
Tasks

  • Assisting in caregiving tasks
  • Monitoring a patient’s health status
  • Providing social care or companionships
  • Some level of autonomy
  • Require minimal human input, but are still human-operated
  • “interpretive flexibility”: a robot is defined by its context, users and task for use

Three dimensions to ethics of robots:

  • Ethical systems built in robots
  • Ethical systems of people who design robots
  • Ethics of how people treat robots

Care (4 stages, Toronto)

  • Caring about (recognizing one is in need and what those needs are)
  • Care taking (taking responsibility for the meeting of said needs)
  • Care giving (fulfilling an action to meet the needs of an individual)
  • Care receiving (recognition of a change in function of the individual in need)

Moral elements (corresponding)

  • Attentiveness
  • Responsibility
  • Competence
  • Responsiveness
  • Needs of care receiver vs. needs of care giver

Context

Nursing home (e.g. critical care ward for people with dementia)

Values

  • Safety (of the care receiver and care giver)
    • care receiver: prevent injury from falling, being squished, choking, being trapped, …
    • care giver: prevent injury from being run over, being trapped, catching care receiver, …
  • Trust
  • Touch
  • Hands-on care, warm and seemingly “safe” hands/arms
    • Respect
    • Intimacy
    • Human dignity
  • Patient satisfaction
  • Nurse satisfaction
  • Physical wellbeing patient
  • Psychological wellbeing patient
  • Compassion
  • Empathy
  • Patient-nurse relationship
  • Competence

Monday, 29 May

Present: Ellen and Joris

Joris has been working on the Computer Vision “segment” of the project. So far, it’s been going swimmingly. Last week, there was a demo that showed the progress so far and included overlaying multiple Common Objects in Context (COCO) models on pictures from a single webcam. Joris is now working on the conversion from a single two dimensional image feed to a three dimensional model of the situation using OpenCV disparity maps. Another choice would be to use a Kinect, but there are some problems with it’s range and field of vision that make alternative approaches more appropriate.

Our deliverables were again discussed. According to the planning, we should now be in the final stages of the project (having finished preliminary designs, having thought of most of the improvements already). Our deliverables stay the same: current RoBear method, our improvements on observation and the method of lifting. In the interviews, problems were found that currently do not have a solution, the goal of the project is to see which of these problems we can solve with improvements to the RoBear.

It was made clear that we need a clearer link between the Computer Vision and Value Sensitive Design “segments” of the project. Both the teachers and us agree that this should not be at difficult; the improved ‘vision’ capabilities of the robot will be very useful and allow a more personal and ‘active’ interaction between the robot and the patient. This interaction and its autonomy is a central part of our project.

In order to finish the problem in time, we will need to make massive progress in the following week. Some things that need to be done include:

  • We need to choose a very specific scenario, both to make the autonomy part of the project easier/better and to make our impovements to the RoBear more specific and detailed.
  • Generate a final answer to the question: what are the values (in a VSD context) of the chosen scenario, why do(es) RoBear, passive lifts exist?
  • Describe the ideal behaviour of the RoBear
    • Details of an ‘ideal’ lifting process
  • Describe in detail what we want to change about the RoBear
    • Values: what do we want to change about the RoBear in order to support our identified values better?
    • ‘Strategy’: What do we want to change about the RoBear to make it lift people better?
    • Some (very slight) ‘Implementation’: What improvements can we do on the hardware/implementation level to improve the RoBear design (e.g. make sure it has a way to detect when the patient does not cooperate, what sensors do we need?)

Important in these tasks is to remove ambiguity and make things explicit.

Tasks for following week:
Joris

  • Work on computer vision and the description of the ‘Strategy’ and ‘Implementation’

Frouke

  • Analysis of what the RoBear does now (coupling this with relevant Values, some of which are already identified). Especially describe its lifting strategy.

Ellen

  • Finish elaborating the interviews, identify important values and how these are respected.

Bram

  • What are improvements to the RoBear, what would need to change about it to make the RoBear respect these values? (How does a person feel safe, respected whilst keeping initiative with the client)

Challenge for next week: we guide the meeting!

Interview

Content

Goals

Find out

  • The context, user and tasks of the robot
  • Important values for the care givers
  • Important values for the care receivers?
  • Can there be linked concrete norms to these values?

Context

verzorgingsinstelling waar ouderen zelfstandig wonen in een appartement met eigen keukentje en badkamer, ingericht door de zorginstelling. (aanleunwoningen)

Questions

General questions

  • Wat is uw functie? (Verzorgende in thuiszorg, verzorgende in de instelling)
  • Op welke afdeling werkt u?
  • Wat is uw leeftijd?

Lifting methods

  • In welke situaties moet een cliënt worden verplaatst door middel van

optillen? Van welke naar welke houding?

Wanneer een cliënt moet worden verplaatst van een liggende naar staande positie,

  • welke methode gebruikt u het meest? Beschrijf de methode stap voor stap. (Serie van handelingen)
  • zijn er ook andere veel gebruikte methoden?
  • hoe bepaalt u welke methode het beste kan worden gebruikt?

User experience

Als een cliënt (het aangeeft dat hij) zich niet op zijn gemak voelt bij het optillen, hoe stelt u deze dan gerust?

Ervaart u regelmatig klachten die veroorzaakt worden door het optillen van een persoon? Welke?

Ervaart de cliënt geregeld angst door getild te worden?

Ervaart de cliënt geregeld irritatie door getild te worden?

Ervaart de cliënt geregeld ongemak door getild te worden?

Hoe gaat u met deze emoties om?

The Tillift

Hoe verandert de reactie van cliënten op getild worden als er een tillift wordt gebruikt? Denk aan angst, zich veilig voelen, ongemakken, irritaties.

Hoe gaat u hiermee om?

Reageert u hier zelf ook anders op en zo ja hoe dan?

Relation caregiver/patient

In hoeverre is vertrouwen een belangrijk onderdeel in het verplaatsen van een cliënt?

Hoe is uw relatie/band met de gemiddelde cliënt?

Draagt deze relatie bij in het vertrouwen in het til-proces?

Zijn er nog vragen die ik niet heb gesteld die volgens u nog van belang zijn?

Questions and answers

In welke situaties moet een cliënt worden verplaatst door middel van optillen? Van welke naar welke houding?
Een aantal cliënten wordt ‘s ochtends vroeg uit bed gehaald alvorens het aankleden of wassen. Soms wordt er dan gebruik gemaakt van een tillift of van een draaischrijf. Vanochtend ben ik nog bij mevrouw Adams uit [Lage] Mierd[e] geweest en die wil ook vaak ‘s middags naar bed. ‘s Ochtends gebruiken wij de tillift eigenlijk niet, mevrouw wordt met de hand uit bed getild. Dan haal ik haar uit bed als volgt: dan liet ik ze vasthouden, en zette ik mijn knieën tegen haar knieën en instrueerde ik haar heel goed: en nu staan. En dan gaat ze mee staan, draaiden we en dan zette ik ze zo weer terug [op bed].

Dus dan haal je echt iemand uit bed of help je iemand er weer in? Dus dan begeleid je echt iemand vanuit liggende positie uit bed om ‘s ochtends op te staan?
Ja. Bijvoorbeeld mevrouw Beckers. Deze ochtend had ze toevallig de kracht om zelf op de rand van het bed te zitten toen wij er waren, maar meestal help ik die ook vanuit liggende positie omhoog, want ze kan dat vaak ook niet (ja ze kan het wel, maar...). Die geef ik dan een hand en die draai ik dan vanuit liggende positie naar een zittende, voordat ik haar help opstaan.

Dus dit zijn allerlei verschillende mensen die geholpen moeten worden met een transfer?
Ja. Maar dit is hoeft niet perse altijd zwaar te zijn. Soms is het voldoende om een hand aan te bieden en in de onderrug te steunen om mensen het vertrouwen geven om op te staan, maar dit kunnen ze dan vanuit eigen kracht. Maar die begeleiding/dat vertrouwen hebben ze dan nodig. Maar in Lage Mierde moet je mevrouw echt om het hoofd heen [vastpakken] en mee rechtzetten. Voor je rug is dat wel echt heel belastend.

Ervaren mensen angst bij dit optillen? En hoe gaat u daar dan mee om?
De meeste mensen vinden tilliften echt super eng, en willen er dan ook absoluut niet in.

En het tillen zelf, wat u als verpleegsters doet (met de hand)?
Dat optillen vindt ze minder eng, en dan wordt ze ook wel ondersteund. Ja, maar volgens mij vertrouwt ze gewoon op de mensen die dat doen. En dat verschilt ook echt per persoon. Want als ze iemand niet vertrouwt, dan gaat ze ook minder goed staan.

Maar dan moet ze eerst een relatie opbouwen met de verpleegkundige, en dan pas durft ze geholpen te worden met opstaan?
Bij haar is dat heel sterk. Want bij de een vertrouwt je beter, en dan is het hup! en dan hoef je niks te doen, en bij de ander, die vertrouwt je niet en dan gaat het veel moeilijker ook. Het scheelt wel dat hoe meer dat je er komt, dat merk ik nou wel, hoe vertrouwder dat ze ook met jou wordt.

Dus als je twee, drie keer in de week bij iemand langsgaat, dan vertrouwt ze ook alles wat je met haar doet?
Ja, ja zeker wel. En dan is het vaak ook de instructies die je ze geeft, want je moet constant tegen haar zeggen: goed blijven staan, knieën recht, goed gaan staan, je blijft gewoon constant herhalen.

Maar dan moet ze zelf gaan zitten vanuit liggende positie en dan help je haar opstaan?
[Demonstratie] Ze ligt in bed, en dan moet je haar wel helpen mee recht komen zitten op de bedrand, en dan pak je haar bij de benen en de andere hand bij de schouders. Dan zeg je 1, 2, en dan draai je haar in een beweging op de bedrand [in zittende positie]. En dan laat je haar je vastpakken om de nek, en dan plaats je haar benen tegen de knieën, en wederom 1, 2, staan en draaien. Zelf moet ze haar knieën dus mee buigen.

Zo werkt het ook met de postoel. ‘s Middags zit zij dan in de rolstoel, pakt ze de tafelrand vast, dan zeg ik dus: blijven staan, knieën recht. Dan laat je de rolstoel ergens staan, zeg: “blijven staan” en schuif je de stoel bij. Meestal probeer je dan met 1 hand contact te houden. Dat is voor de veiligheid: het is voor jouzelf dat je voelt wat dat zij doet, en voor haar om te weten dat ze moet blijven staan. En als ze dan klaar is, dan hou je haar vast in de onderrug, en pak je de rolstoel (die heel zwaar is). Intussen hou je haar dus vast. Dan geef je een high five en zeg je “goed zo!” en dan glundert ze helemaal. Dat enthousiasme is ook heel belangrijk.

Dat contact is dus voor jou heel belangrijk, om te voelen dat ze nergens naartoe gaat, en voor haar om te voelen dat je nog niet klaar bent en ze moet blijven staan?
Ja, precies. We hebben nog een cliënt waarbij we de stalift wel gebruiken, genaamd Dirks, en die maakt er goed gebruik van. Die vindt het ook niet eng. Ze heeft ook een betere stafunctie dan anderen.

Werkt de stalift soortgelijk als wat jullie doen wanneer een persoon vanuit zittende positie wordt geholpen op te staan?
Ja, die ondersteuning die jij normaal doet, doet nu de lift. Helemaal zelfstandig. Jijzelf staat aan de andere kant de knoppen te bedienen, dus je kunt niet met een hand op de onderrug contact houden. De cliënt moet dat dus helemaal zelfstandig durven.

Dat verschilt van persoon tot persoon dat ze dat durven?
Ja, echt wel. Sommigen durven dat echt niet.

Ook niet als je het zelf eerst voordoet? Vaak is het eerst zien, dan zelf proberen.
Nee, ja, dat hebben we nog niet geprobeerd. Dat is serieus een best goed idee.

Dat je eerst een demonstratie geeft, en dan dat de oudere het misschien ook durft?
Meneer Dirks heeft nog een actieve stafunctie. Daarbij werkte zo’n demonstratie helemaal niet, vond hij helemaal niks, en dat riep alleen nog maar meer weerstand op. Met hulpmiddelen voor steunkousen laat ik wel ooit een filmpje op youtube zien. We hebben wel eens een demonstratrice gehad, waar we met een heel stel bij zijn geweest, met een lift en een postoel om ‘s avonds te gebruiken, en meneer Adams had zoiets van ja daag, dat gaan we niet doen. Dat riep alleen maar meer weerstand op.

Dat was voor mijn tijd. Hoe hebben jullie dat toen gedaan dan, het vertrouwen van meneer Adams inwinnen?
Op een gegeven moment moest het gewoon, het kon bijna niet anders. Hij had zelf helemaal geen balans ofzo meer, hij moest zichzelf er aan over geven. Maar wel met heel veel schrik en heel veel weerstand. Hij heeft ook een actieve lift gehad, toch? Ja, maar die is meteen weer de gang in gebonjourd want hij had gewoon niet genoeg steun meer. Hij vond zelf wel dat hij een hele actieve stafunctie had, maar hij had geen kracht meer in zijn benen, dus zijn knieën konden zomaar onder hem vandaan schieten. Opstaan van de wc was ook een groot probleem, daar had hij de kracht gewoon niet voor. Hij had een ziekte waardoor je spierweefsel wordt omgezet in vet. Dat verslapt allemaal, en hij heeft geen kracht meer over.

Dan doen jullie veel met de hand tillen?
Bij hem niet dus. Tillen doen we het liefst zo min mogelijk, zelf of met behulp van liften. Het duurt altijd erg lang voordat we eenmaal de grens over stappen om een apparaat in te zetten. Dat komt ook omdat mensen het liefst zo lang mogelijk hun eigen functies willen behouden. Zo lang mogelijk, want mensen willen zo lang mogelijk alles zelf willen blijven doen, met behulp van, terwijl het vaak toch een kwestie is van pluk- en trekwerk aan zo’n persoon. Bovendien moet je de techniek echt echt echt heel goed beheersen, wil je een mens op tillen. En als ze eenmaal bedlegerig worden, dan worden ze overgeplaatst naar een verpleegtehuis. En terminale cliënten blijven toch wel vaak. En dan heb je nog glijzeilen die je kunnen helpen.

Maar je probeert mensen zo min mogelijk te tillen terwijl ze zelf nog kunnen opstaan?
Ja, dat klopt. Verder kun je ook denken aan een sta-op stoel. Als mensen moeite hebben met opstaan uit een lagere stoel, dan is een sta-op stoel geschikt voor hun.

Ervaart u regelmatig klachten die veroorzaakt worden door het optillen van een persoon? Welke?
Nou, wel regelmatig rugklachten. We proberen daar wel iets aan te doen, om te overleggen met elkaar. “Hoe doe jij dat? Heb jij een makkelijkere manier?”

Hebben jullie dan allemaal een eigen manier van een cliënt helpen opstaan?
Nou nee, dat toch niet. We proberen daar toch wel een lijn in te trekken. Dat is ook heel erg afhankelijk van de persoon. Maar per persoon organiseren we wel een bijeenkomst om te overleggen hoe dat we die persoon het beste op kunnen tillen. Dat is voor de cliënt wel het fijnste, om het iedere keer hetzelfde te doen, hè. Dan weet hij ook wat hij te wachten staat, en hoe zij tegenover ons als verpleegkundigen staan. Want anders is de ene de goeie en de ander de kwaaie.

Oke, dus een cliënt kan angstig worden door het vooruitzicht om opgetild te worden door jullie of met behulp van een lift. Ervaart de cliënt geregeld irritatie door getild te worden? Hoe gaan jullie daar mee om?
Nou nee, ik denk niet zo zeer irritatie, maar een vorm van verlies, afscheid, weer een stap terug uit, dat is eigenlijk een rouwproces. Dat begint dan met autorijden, een heel groot stuk zelfstandigheid, je bent niet meer mobiel. Dan moet je altijd iemand opbellen, en bent niet meer onafhankelijk. Zo is het ook met opgetild worden. Het feit alleen al: ik krijg een prikkel: ik moet naar de wc. Dan sta je op en loop je naar de wc. Het idee dat je daar zit, en dat je denkt oh jee, mijn prikkel komt dat ik naar de wc moet, maarja dan moet ik weer eerst iemand gaan bellen, want er moet eerst iemand komen. Eigenlijk moet je die prikkel wel heel vroegtijdig voelen want anders dan kan ik het misschien wel niet ophouden en misschien zijn ze wel te laat. Dat zijn zoveel dingen veroorzaakt door die ene prikkel dat je moet gaan plassen. En het alternatief is zo’n ding in je broek.

Zijn er dan cliënten die jullie ieder moment van de dag kunnen opbellen om naar de wc te gaan?
Ja. Maar als je toevallig bij een ander staat en je bent die al aan het helpen, ben je een half uur te laat. Dan spelen er wel irritaties.

Hoe ga je hiermee om?
Je kunt dan alleen aangeven dat het nog een half uur gaat duren dat je er bent. Niet dat ze er rekening mee houden dat je er binnen 5 minuten bent. Soms kan dat wel, maar dat is maar net waar je mee bezig bent. Maar als je het aangeeft is dat minder erg. Als ze het maar weten. Maar we voelen allemaal met de cliënten mee. Als we onszelf in die situatie zien, dan denken we soms dat we er nog erger door geïrriteerd zouden zijn.

Verschilt het heel erg per persoon dat ze ongemak of angst ervaren bij het optillen? Of dat ze de voorkeur geven aan door jullie geholpen te worden of met behulp van de tillift?
Dat verschilt inderdaad heel erg per persoon, maar ze geven echt allemaal, stuk voor stuk, de voorkeur aan dat wij ze zelf helpen met opstaan.

En waarom is dat zo, denk je?
Ze hebben dan meer het gevoel dat ze zelf opstaan, en niet dat ze zich volledig moeten overgeven aan een apparaat. Daarbij komt dat ze ons meer vertrouwen dan een apparaat. Zoals we al eerder hebben gezegd: vertrouwen is het belangrijkst in de zorg.

Summary of results

To lift someone out of bed a lift or a “turntable” can be used but most times by hand. Most people are afraid of the lifts, people are seen as more trustworthy but it depends on the relation between the caregiver and the client. For example if the client gets familiar with the caregiver they trust them more easily. Giving clear instruction also helps.

There are stand-up lifting systems, but only people who have relatively good functioning standing capabilities and trust in that ability can use them for the client is not comforted when using it.

People want to be autonomous for as long as the can be. They will won’t like a tool because it means they can’t do certain things without help. If a caregiver helps with standing up it feels like you still do something, with technology this isn’t the case. It also doesn’t help that most people don’t like change.

Sometimes demonstrating the “new” technology in form of a film give more resistance towards it than just using the technology.

Caregiver can oftentimes not get to patients in time to help the patients get up. This gives rise to irritation.

Methods for helping someone get up:

Getting up from a sitting position (in order of the client having a lot to little power ):

  1. Hand on the back to give them the faith they can do this (caregiver hardily lifts)
  2. Let the client grab the caregiver around the neck
  3. Caregiver puts knees against patient's knee
  4. Stand up together
  5. Grab patient around body and head
  6. Lift until they are upright

Sitting up from a lying position:

  1. The care giver gives the client a hand and lifts them up
  2. Grab shoulders and legs
  3. Turn them towards the edge of the bed and lift the shoulders at the same time

Context: verzorgingsinstelling waar ouderen zelfstandig wonen in een appartement met eigen keukentje en badkamer, ingericht door de zorginstelling. (aanleunwoningen)

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662860/ http://dmeforpeace.org/sites/default/files/Boyce_In%20Depth%20Interviews.pdf

Problem definition and setting

All around the world, robots are being introduced in daily life. In healthcare, the prospective is that robots will facilitate elderly or disabled persons to be more mobile and enable them to move around freely. Take for example the scenario where a person has to get up from his or her bed to get up and start the day. Where in earlier days the manual lifting of a person by two nurses was required, the goal is that with present day technology a robot could be used to lift a person for laying down to standing up in a safe and comfortable manner. For this we will improve designs like the RoBear.

The RoBear is a robot that can lift people out of bed. It moves around on wheels and has to big arms that are covered in cushions. its head looks like a bear's head in a cartoonish way hence the name.
However this robot is not yet perfect. A nurse has to help every step of the way and it cannot help to stand if the patient is lying down.

Information gathering

To see how in what degree lifting a person is a problem in healthcare and how it is coped with right now an interview will be held. A few nurses of the RSZK, which stands short for Regionale Stichting Zorgcentra de Kempen will be interviewed as they have more expertise on this subject. This institute facilitates home care and help at home, but also consists of several nursing homes. In the latter, the distinguishment is made between two types of nursing homes the first, where people live that cannot live independently due to old age, illness or a handicap, and the second, where intensive care is given to people that require heavy medical treatments because of severe physical or psychological handicaps, for example after cerebral hemorrhage or dementia.

For this project, we will consider the RoBear as a robot that could be integrated in the nursing homes of the first type. These home centres consist of several care apartments, that are mostly inhabited by elderly people.

Setting

Movie from RSZK Mariahof te Reusel (link).

This nursing home is inhabited by people that live semi-independently, but receive care they require with some daily tasks, such as help with showering, help with going to bed, medical stockings et cetera. The general lay out of the rooms is similar, all include a bed/living-room with bathroom and an own kitchenette. The room itself is not furnished, so each client is free to place furniture at his or her own liking. However, the arrangement of the furniture must be conform rules that are introduced so that nurses are not impeded in their movement while caring for their client.

Why introduce a lifting robot?

One of the tasks of the nurses is to help the clients out of bed in the morning. The lifting which is involved in this can cause physical injury for the nurses. Such as back-, hip- and knee wear.

Another problem is that there are not enough nurses and the clients cannot get up at the time they want. This lifting robot should give them more autonomy.

Goal

In particular, we aim for improvement of the care practice of lifting a patient in a safe and comfortable way with a certain degree of autonomy. The robot must be able to lift a client in a safe way, which entails that the client can under no condition fall off of the Robear when only one nurse is present to guide the client in the arms of the RoBear. In a later stadium, the RoBear should be able to lift a client safely without any supervision. However, this might be a bridge too far. In particular, we would like to examine and improve the way of lifting.

RoBear now

Values

Detailed description of the RoBear current values and how these are or are not respected. The Robear is made to help nurses lift a patient in and out of beds or chairs. This allows the nurses some extra time for more personalised care or to talk to the patient about unrelated things, for example in order to make the patients feel less lonely.

The RoBear is shaped like a bear with the intent to look less threatening. Most robots are in a smaller size or look more like lesser known animals to prevent falling into the uncanny valley. A robot is said to be in the uncanny valley when it accurately resembles something or people but just not enough to fool them (see the picture below). However, when the intention is to resemble a person or animal but one can clearly distinguish the robot from the real thing in size or shape, then this so-called uncanny valley effect is prevented, think for example of a plush stuffed animal. Mori-uncanny-valley-300x234.png

Seeing that the RoBear has to be human sized in order to lift a human being, it had to use other ways to look non threatening. However the cartoonish face it has now doesn’t seem very trustworthy. The bond between a patient and a nurse must be formed on trust. Most patients can do very little without adequate help from a nurse, if this nurse is to be helped by a robot, then the robot must be trustworthy too. This is extra important when lifting people as they are helpless in the process.

There are a few ways to help create trust that even robots can use. The first step is competence, the robot must be able to execute the task fluently and without stops that could be seen as hesitation. Secondly there is communication, by talking or more accurately by explaining what is going to happen and making sure it will, makes one reliable. At last but certainly not the least important thing is eye contact, thereby acknowledging the patient. If this is not done the process is dehumanizing. Especially when lifting people, else it would be as if the patient is a thing instead of a person.

The Robear only has the first step, it is up to the nurse to make the patients at ease. This doesn’t help since the Robear now isn’t trusted but the nurse also has less tools to gain trust (usually touching patients helps this bond) .

Lifting Strategy

Detailed descriptions of the RoBear current lifting strategy (try to include images). Possible discuss the associated values(?). Try to include (many) sources. The robear can lift people from the bed into a chair and backward and from a chair to a standup position with help of a nurse.

To get from the patient from the bed the robot will move towards it and extends its “legs” to be more balanced. The nurse will put the patient in a position see the first picture[1]. The Robear can now extend its arms, the will go under the knees and support the back of the patient. The nurse needs to fasten to straps that will connect the arms of the robot and support the patient so they cannot fall between the arms. The patient can now be lifted and moved to a place where the chair is. The robot will slowly lower the patient into the chair while the nurse holds the chair under the robot and pushes it in place. When the patient sits, the straps can be put removed and the arms retracted. The whole process is shown in the picture below. Riba-Lifting-a-Person-from-Bed-to-Wheel-chair.jpg

To get out of a chair and stand up, the robot will move in front of the patient while the nurse holds the chair in place as shown in the picture below[2]. This time not only the “legs” will extend but also a platform for the patient to stand on. The arms of the robot will close around the sides of the patient as they can hold on the the robot’s shoulders for support. The RoBear will slowly lift the patient, meanwhile the nurse moves the chair away to make room for the patient to stand. This can be seen in the last picture.

Robear-designboom05.jpg Robear-designboom06.jpg

Current implementation

Generally discuss the RoBear current implementation. What kind of sensors or other mechanics does the RoBear already have and how do these tie in to the values? The RoBear can be controlled by a tablet in its back. It uses three types of sensors, including torque sensors and Smart Rubber capacitance-type tactile sensors made entirely of rubber, which allow for gentle movements, ensuring that the robot can perform power-intensive tasks such as lifting patients without endangering them[3]. The last sensor is a kinect that should be able to detect bodies in front of it, but is at the moment blocked by its mouth [4].

Another flaw in this robot is its difficult operation and maintenance.

Possible Improvements

New Values

What values are important? Which do we want to improve? (Maybe discuss Computer Vision as a tool to improve interaction between the RoBear and patient?) In this chapter we will discuss the most important values in the care practice of lifting a client. The focus lays on the aspects that are definitely lacking in the act of being lifted by a machine compared to being assisted by a nurse. Since we only had access to a nursing home that uses person hoists on a daily base but does not own a RoBear, we use this technology as a basis and compare this to the functions of the RoBear. From this viewpoint, we define improvements to the RoBear based on the experiences of clients with person hoists. Note that we must fill in the gaps ourselves between the somewhat older technology of person hoists compared to the RoBear. However, we argue that the same problems hold to some extent for being lifted by any machine that operates quite similarly.

The first thing that we consider is lacking, is the trustworthiness. We want to improve the trust of the patient in the RoBear, for example by extra contact points of the RoBear with the client. We have seen that an extra contact point in the lower back is comforting and relaxing for the client although it might not practically be needed in the lifting process.

Another way to solve this problem is a more natural way of lifting a client. Based on the position of the client’s body, the RoBear must formulate an action plan and lift the client accordingly. Then, the RoBear must be able to detect the position of the body of the client. This way, the RoBear will behave more natural and not scare the client or make the client feel dehumanized. This leaves us at the next value.

Human dignity is an extremely important value in the act of lifting a person. We have seen that the client loses some independence when he needs help standing up. Then we must at least try to give the client the independence it can still have. One way of doing this, is to have eye contact with the client and treat him with great respect. When a nurse is present, he or she should be able to do this and not be distracted by the controls of the RoBear. Therefore, we want the RoBear to perform a string of actions autonomously. Whenever we want the RoBear in a home setting without a nurse present, it has to be able to look into the clients eyes before or during the lifting process.

Furthermore, to give a client back some independence, he or she should be the one to take initiative before being lifted. Then, the Robear should behave according to the commands of the client. We aim for a RoBear that can give audiovisual feedback, in the form of full sentences or an interactive display for the client to use. With this user interface, the client should feel in control.

New Lifting Strategy

How do we want to improve the lifting strategy? What does the RoBear need for this (generally, like extra arms or legs/wheels). How does this tie into computer vision? To improve both the autonomy of the RoBear and the feeling of autonomy of the care receivers, the RoBear should not only be able to lift a person all by itself, but also give the client the chance to help the RoBear in this process. Already when the person is getting seated from the bed, there are many differences between activeness and passiveness from them. To ensure the physical safety from a client, the RoBear should feel the amount of strength the client can still use himself to become seated, by using torque sensors in the arms helping the client get seated. If little power is needed, because the client can do much of the lifting himself, the RoBear should not keep pushing very hard and risk injuring the client, whereas when the client has little to no power, the RoBear can use a little bit more power.

The main lifting strategy, in the case where a client needs to go from laying down to sitting up in bed, is to first check the position of the body, using the cameras to be attached to the body of RoBear. Then the first arm is to be inserted under the neck of the client, while at the same time also giving the client the possibility wrap their arm around something, to give them the possibility to pull themselves up. This needs to happen in a soft and safe way, and thus the head and shoulders also need to be supported by the arm during the lift. When the upper body is lifted far enough, the second arm of RoBear can be inserted under the middle of the back, to give a bit more support to the client while sitting up. With this arm, the possibility of rolling off the grip of RoBear should be prevented, so the end should be tilted towards RoBear.

When the client is started sitting up, the knees need to be located by RoBear, using its cameras. Then the knees need to be lifted, which can be done using only a small arm. After a little bit of support is also given to the upper legs, the client can either be rotated towards the side of the bed and relieved from their leg support if they are able to stand up themselves, or be lifted off the bed if they can not. On the side of the bed, the clients are given a little rest, after which the rest of the lifting procedure is started.

For getting from seated to standing, the arms of the current RoBear can be used. The client will hold their arms on top of RoBears arms, and lift up from the bed, with help from RoBear. If possible, RoBear then slowly releases the client, to still give the client the satisfaction of standing up on their own. From the interviews, we got the note that a hand on the lower back is a very important part in getting a client to trust you. In this case however, as the RoBear is positioned in front of the client, a soft hand below the arm should suffice. Because this hand should not only be there to touch the client, but also to feel if the client is about to fall, very sensitive touch sensors are important here. If the now standing, or almost standing, client begins to fall, the RoBear should use its two soft arms to catch the client underneath the armpits. Overall, the most important aspect is the safety of the client. That is also why the Robear should at all times keep his eyes on the position and movements of the client, to keep them from falling.

Computer Vision

Actual content coming soon! Demonstration using the disparity maps between to camera's to create 3D vision expected next week.

Our demonstration last week was based on openpose, which is based on a demo given at the European conference for Computer Vision (ECCV) 2016 in Amsterdam and inspired several papers, such as "Realtime Multi-Person 2D Pose Estimation using Part Affinity Fields" by Zhe Cao and Tomas Simon and Shih-En Wei and Yaser Sheikh on CVPR 2017.

Implementation

Generally discuss small (QOL) improvements to the RoBear that are too HW level or otherwise detailed to include in the strategy section. When a client needs to be lifted, it is important that they know exactly what needs to be done by them and what is going to be done with them. RoBear should thus be able to communicate by speech to the client. To give the client a feeling of trust in RoBear, and to keep their dignity up, these instructions should be given in a friendly manner, and not in a commanding way. Doing otherwise will result in the client not acting to their full potential, and maybe hurting themselves.

Conclusion

Discuss all possible conclusions from the project For example:

  • What values are important
  • Generally the situation now (from the interviews)
  • Our improvements
    • Importance of computer vision

The goal of this project was to make improvements on the RoBear. It was shown that the robot doesn’t act trustworthy and lifts people in a dehumanizing way. Furthermore to use the robot a nurse needs to do a lot of work. The lifting can only start when the patient is in a position most elderly cannot reach by themselves.

To solve the first problem the robot will adopt a more natural way to lift patients. The solution described in “New lifting strategy” is one that nurses use now. This was concluded in the interview. This strategy is better because patients feel they are more in control. Another new aspect is that the robot will now also give audible feedback, encouragement and explanation about what will happen next.

To help the nurses a program was made that detects the way the patient is lying. That way even if the patient isn’t in the exact right position the robot will still be able to find the point where it should lift. It also enables the robot to look in the patient's eyes before doing something, this feels more like natural interaction and might comfort the patient.

When the suggested improvements would be implemented in the RoBear it would be more practical and less scary to use. It is a step in the direction of giving patients their independence back.

Discussion

Generally tearing apart our own project. Before the RoBear can be used there are a lot of improvements that need to be made. Seeing that this is only an 8 week long project, the original goal of the patient being able and willing to use the robot without help of a nurse was too ambitious. This is why the project only focused on the most obvious flaws.

It also means that there was no way to test if this is actually a better design. The only information this project is based on are older papers and in interview with nurses that care for elderly on a daily basis. These papers are based on similar robots but there might be factors that were not taken into account when applying the theory to the RoBear.

If this project had more time a few things need to happen. First the patients and their next of kin needs to be asked what they think of the project and what they expect from it. On that basis the design needs to be re-evaluated and most importantly the latest version needs to be tested.


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