GERONTECHNOLOGY

Robot Therapy for Elders Affected by Dementia

DIGITAL STOCK & EYEWIRE

Using Personal Robots for Pleasure and Relaxation

BY KAZUYOSHI WADA, TAKANORI SHIBATA, TOSHIMITSU MUSHA, AND SHIN KIMURA

ementia is one of the most important issues in the care of the elderly. According to Alzheimers Disease International (ADI), an estimated 24.4 million people suffer from dementia worldwide, and the number will increase to 82 million by 2040. Dementia is a progressive disabling neurological condition that occurs in a wide variety of diseases. The most common cause of dementia is Alzheimers disease (AD), which accounts for approximately half of the people with dementia. Other causes include vascular disease, Lewy body dementia, and many other diseases [1]. Psychiatric and behavioral disturbances such as personality change, hallucinations, paranoid ideas, aggression, wandering, and incontinence are common features of dementia and are leading causes of the need for long-term care [2]. Unfortunately, there is no permanent cure for dementia at this time. Recent data suggest that art, music, and learning, which stimulate the patients emotions and brain, can help prevent the development of dementia [3][5]. However, there is room for improvement in all such treatments. Interaction with animals has long been known to benefit people emotionally. The effects of animals on humans have been applied to medical treatment. Especially in the United States, animal-assisted therapy (AAT) and animal-assisted activities (AAAs) are becoming widely used in hospitals and nursing homes [6], [7]. AAT has particular therapeutic goals designed by doctors, nurses, or social workers, in cooperation with volunteers. In contrast, AAA refers to patients interacting with animals without particular therapeutic goals and depends on volunteers. AAT and AAA generally have three effects: 1) psychological effects (e.g., relaxation and motivation), 2) physiological effects (e.g., improvement of vital signs), and 3) social effects (e.g., stimulation of communication among inpatients and caregivers). However, most hospitals and nursing homes, especially in Japan, do not accept animals, even though they acknowledge the positive effects of AAT and AAA. They fear the negative effects of animals on humans, such as allergy, infection, bites, and scratches. We proposed robot therapy, which uses robots as substitutes for animals in AAT and AAA [8][26]. To that end, we have

studied and developed mental commitment robotspersonal robots that aim to engender mental effects such as pleasure and relaxation. Robot therapy has two aspects: robot-assisted therapy, which has therapy programs designed by doctors, nurses, or social workers; and robot-assisted activity, which has patients interacting with robots without particular therapeutic goals. However, unlike AAA, robot-assisted activity does not depend on volunteers but is conducted by the staff of the facility. Paro, a seal-type mental commitment robot, was designed for therapy. She is covered with soft white artificial antibacterial fur, and her artificial intelligence allows genuine animallike behavior using tactile, visual, auditory, and posture sensors as well as several actuators. Robot therapy using Paro was conducted at pediatric wards and elderly institutions in several countries [13][22]. The results showed that interaction with Paro improved patients and elderly peoples moods, making them more active and communicative with each other and their caregivers. Results of urine tests revealed that interaction with Paro reduced stress among the elderly [17], [20]. In addition, we investigated long-term interaction between Paro and the elderly and found that the effects of interaction with Paro lasted for more than a year [19]. In this study, we discuss the application of seal robots in the therapy of patients with dementia and observe their neuropsychological effects through electroencephalogram (EEG) analysis. The next section describes mental commitment robots, which is followed by the section describing the real robot that was used for robot therapy. The Diagnosis Method of Neuronal Dysfunction section explains the evaluation methods used for assessing the brain activity of patients with dementia, and the Robot Therapy for Patients with Dementia section discusses the experimental methods and explains the effects of robot therapy. The Discussion section presents the current results of robot therapy as well as future work.
Mental Commitment Robots

Digital Object Identifier 10.1109/MEMB.2008.919496

Industrial robots have been widely used in manufacturing industries since the early 1960s. Typical tasks for industrial robots include welding, assembly, painting, packaging, and palletizing in automotive manufacturing and other industries.
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Industrial robots accomplish their tasks very quickly and accurately. They must be taught by a human operator and a specific environment must be designed for them to accomplish their tasks. Most industrial robots are considered potentially dangerous to humans, and so they are kept isolated from people. On the other hand, the rapid development of high technology has produced robots not only for factories but also for homes, hospitals, museums, etc. In particular, human interactive robots for psychological enrichment are one of the new applications of robotics, and this field of application has research and commercial potential [26]. Human interactive robots are designed for entertainment, communication (social activity), guides, education, welfare and mental therapy, and other purposes. Various types of robots, such as humanoids, animals, and those with a unique appearance, have been developed. These robots are more interactive with humans than industrial robots. They are evaluated not only in terms of objective measures, such as speed and accuracy, but also in terms of subjective measures for interacting with humans, such as joy and comfort. Entertainment robots are good examples of the importance of their subjective value (Figure 1). There are four categories of human interactive robots for psychological enrichment in terms of their relationship with humans: 1) performance robots; 2) teleoperated performance robots; 3) operation, building, programming, and control robots; and 4) interactive autonomous robots.
Performance Robots

complexity is important in performance robots to keep humans amused.

Teleoperated Performance Robots

Teleoperated performance robots are controlled remotely by a hidden operator. Their movements can appear reactive to their audience or to the humans who interact with them because the operator senses their current actions and sends commands to the robot to simulate reactive behavior. At exhibitions or amusement parks, for example, human-type robots are used as teleoperated performance robots.
Operating, Building, Programming, and Controlling Robots

Humans derive much fun and joy from operating, building, programming, and controlling robots. Moreover, we can watch the performance of the robot that we are operating. A simple example of this is the UFO Catcher, a stuffed animal game machine, at amusement centers. Building and programming a robot is also included in this category. Contests between robots, such as Micro-mouse, RoboCup, and RoboOne, are popular examples [29], [30]. LEGO, Mindstorms, and I-Blocks are some other examples. Because building and programming robots can stimulate childrens creativity, this activity combines entertainment with education and is often referred to as edutainment [31], [32].
Interactive Autonomous Robots

Performance robots have a long history and are able to perform movements that express meanings to humans, mostly for fun. Mechanical puppets that could play an organ, make pictures, and write letters were developed in Switzerland in the 18th century. Karakuri dolls were developed to perform dances, magic, and so on in Japan during the same era. Recently, many performance robots have been used at exhibitions, museums, movies, and amusement parks such as Disney Land and Universal Studios. Recent humanoid robots such as Hondas ASIMO and Sonys QRIO can be included in this category [27], [28]. A performance robot can amuse a sizeable audience at any time. However, their movements will probably be preprogrammed and mostly repetitive, and so they are not usually very interactive with humans. A high degree of

Interactive autonomous robots interact with humans in the physical world. They use verbal and nonverbal communication depending on the functions of the robots. Contrary to robots in the other categories, the interactions between humans and these robots are mostly personal. For example, Sonys dog robot, AIBO, which is designed for entertainment, has a mechanical appearance and attracts peoples interest by using nonverbal communication [33]. The communication robot, ifbot, produces conversation by using facial expressions and a huge data of prepared conversation scenes [34]. The human-friendly information terminal, PaPeRo, can control home electric appliances, collect information via the Internet by voice command, and entertain people by dancing and playing games [35]. Guide robots in museums and exhibitions [36] the and mental commitment robots discussed in this article belong to this category. Mental commitment robots Medical Robot are not intended for offering Welfare Robot people physical work or service. Industrial Robot Their function is to engender Aesthetic Objects Working with Automatic Machine mental effects, such as pleasure Human Entertainment and relaxation, in their role as personal robots. These robots act independently with purpose and Home Appliance motives while receiving stimulation from the environment, mimicking living organisms. Actions that manifest during interactions Objective Evaluation Subjective Evaluation with people can be interpreted as Fast Interesting if the robots have feelings. Accurate Beautiful A basic psychological experiCheap Comfortable ment was conducted on the subjective interpretation and Fig. 1. Objective and subjective measures for evaluating artifacts. evaluation of robot behavior
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following interactions between robots and people [12]. This showed the importance of appropriately stimulating the human senses and extracting associations. Sensor systems, such as visual, aural, and tactile senses for robots, were studied and developed. A plane tactile sensor using an air bag was developed to cover the robot to enhance bodily contact between people and robots. It detects the position and calculates the force when there is contact, and at the same time, provides a soft texture. Dog, cat, and seal robots were developed using these sensors.
Paro the Seal Robot

behavior planning layer sends basic behavioral patterns to the behavior generation layer. The basic behavioral patterns include several poses and movements. Here, although the term proactive is used, the proactive behavior is very primitive compared with that of humans. We programmed Paro such that its behavior (blinking eyes, movement of neck and flippers, etc.) was similar to that of a real seal. We visited the harp seals habitat in Canada and observed its behavior. In particular, the noises made by Paro are based on actual seal vocalizations. Behavior Generation Layer This layer generates control references for each actuator to perform the determined behavior. The control reference depends on the magnitude of the internal states and their variations. For example, various parameters can change the motion speed and number of instances of the same behavior. Therefore, although the number of basic patterns is finite, the number of emerging behaviors is infinite because of the varying number of parameters. This creates life-like behavior. In addition, to gain attention, the behavior-generation layer adjusts the parameters according to the priority of reactive and proactive behaviors based on the magnitude of the internal states. This function allows the behavioral situation of Paro to be unpredictable to a subject.

Paro, a seal robot, is shown in Figure 2. Its appearance resembles a baby harp seal, a nonfamiliar animal. Therefore, people can accept Paro easily without preconceptions. The fur has a soft, natural feel, and the newly developed soft tactile sensors, named ubiquitous surface tactile sensors, were inserted between the hard inner skeleton and the fur over the whole body surface to permit measurement of human contact [23]. Paro is equipped with four primary senses, i.e., sight (light sensor), auditory (determination of sound source direction and speech recognition), balance, and the tactile sense mentioned previously. Its moving parts are designed to provide vertical and horizontal neck movements, front and rear paddle movements, and independent movements of each eyelid, which is important for creating facial expressions. Paro weighs approximately 2.8 kg. Its operating time with the installed battery is approximately 1 h. However, a charger, which resembles a dummy (pacifier), can be used for continuous operation of Paro. For therapy use, its artificial fur is hygienic with an antibacterial, soil-resistant finish, and hair loss is prevented. Paro has an electromagnetic shield, and so it can be used by people with a pacemaker. Paros reliability and durability have been improved through voltage, drop, and stroking tests over 10,000 times, and a long-term commissioning test in a nursing home. Paro has a behavior generation system (Figure 3) consisting of two hierarchical layers of processes: proactive and reactive. These two layers generate three types of behavior: proactive, reactive, and physiological.
Proactive Behavior

Fig. 2. Paro, the seal robot.

Paro has two layers to generate proactive behavior: a behavior planning layer and a behavior generation layer. By addressing its internal states of stimulation, desires, and rhythm, Paro generates proactive behavior. Behavior Planning Layer This has a state transition network based on Paros internal states and desire, produced by its internal rhythm. Paro has internal states that can be described with words indicating emotions. Each state has a numerical level, which changes according to the stimulation. Moreover, each state decays with time. Interaction changes its internal states and creates the character of Paro. The

Proactive Processes Evaluation of Value State Transition Network Internal States Internal Rhythm Desire

Behavior Planning Layer Basic Behavior Pattern 1 Basic Behavior Pattern N Behavior Generation Layer

Stimulation Light Auditory Tactile Posture

Control Reference Speed Number of Behavior

Behavior Reactive Behavior 1 Reactive Behavior M Reactive Processes

Fig. 3. The behavior generation system of Paro.

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Long-Term Memory Paro has the property of reinforcement learning, and it assigns values to the relationship between stimulation and behavior. It places a positive value on preferred stimulation, such as stroking, and a negative value on undesired stimulation, such as beating. Users are prevented from changing its behavior program manually; however, Paro can be gradually tuned to the preferred behavior of its owner. (Paro is not tuned to be obedient to its owner when it is beaten frequently. In such a case, Paro would be a prickly character.) In addition, Paro can memorize a frequently articulated word as its new name. The user can give Paro his or her preferred name during natural interaction.
Reactive Behavior

Paro reacts to sudden stimulation. For example, when it hears a sudden loud sound, Paro pays attention to it and looks in the direction of the sound. There are several patterns of combination of stimulation and reaction. These patterns emulate the unconditioned reflex of animals.
Physiological Behavior

Paro has a diurnal rhythm. It has several spontaneous needs, such as sleep, based on this rhythm. For investigating how people evaluate the robot, studies were conducted using questionnaires at exhibitions held in six countries: Japan, United Kingdom, Sweden, Italy, Korea, and Brunei. The results showed that the seal robot was widely accepted, regardless of cultural differences [24][26].
Diagnosis Method of Neuronal Dysfunction

There are various methods for the assessment of cognitive function. Neuropsychological tests, such as minimental state (MMSE) and clinical dementia rating (CDR), are handy and useful [37], [38], although their sensitivity depends on the measuring procedure and their time resolution is low. Functional neuroimaging techniques [single photon emission computed tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI)] are useful for the early diagnosis of dementia [39]. However, they are prohibitively expensive and require huge measuring equipment and/or injection of radioactive tracer compounds. On the other hand, electrophysiological tests, such as the EEG and event-related potential (ERP), directly measure the cortical
100,000 (s) 15
Fp1 F7 Fp2 Fp3 Fz F3 F4

activity of specific neuronal populations [40], [41] and have high time resolution. However, these methods are difficult to quantify. In addition, ERP requires a well-designed test battery. Diagnosis method of neuronal dysfunction (DIMENSION), an EEG analysis method, has high time resolution and quantifiability and does not require a test battery [42]. It can detect lack of smoothness of the scalp potential distribution due to cortical neuronal impairment by analyzing spontaneous EEG alpha components recorded with 21 electrodes. This technique is applicable for the mass screening of people with early stage dementia. When neurons within a specific cortical area are depolarized, electric currents flow perpendicularly to the cortical surface, producing a scalp potential. In a normal brain, the active current generators produce the distributions of neurons that are approximately equally activated. This activation produces 1) uniform electric current density at the cortical surface, 2) electric currents within cortical sulci that cancel each other, and 3) a uniform distribution of the resulting scalp potential [43]. However, when cortical (and possibly subcortical) damage exists, randomly oriented electric current sources arise because sulcal currents do not cancel each other, and the scalp potential becomes less uniform [44] (Figure 4). Musha et al. defined mean alpha diporality (Da) to determine the loss of uniformity of an observed scalp EEG alpha potential distribution. Da approaches unity without cortical sulcal lesions, whereas a brain with randomly distributed cortical sulcal lesions has Da values well below unity. Especially, as shown by the results from SPECT analysis, Da has a strong correlation with a decreasing regional cerebral blood flow (RCBF), which is a particular symptom of the early stage of AD. A basic experiment showed that the rough criterion Da @ 0.95 separates normal subjects and AD patients. Reproducibility of this result was examined in normal subjects, and the error is 0.005 in repeated measurements after 1 h. Therefore, positive efficacy is observed when an increment d of the Da value after treatment is larger than 0.005.
Robot Therapy for Patients with Dementia

As for the interaction between Paro and patients with dementia in nursing homes, behavioral improvements were observed in several cases. For example, a patient who moaned continuously was able to relax and then started to talk with the therapist [22]. Moreover, on playing with Paro, another patient who often tried to return home stopped doing so, and her wandering decreased. In this study, we 100,160 (s) aimed to investigate the neuropsy10 chological influence of Paro. Fp2 Fp3 Fp1
Fz F3 F4 F2

10
F2 F7

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T3 C3 Cz C4 T2

0 5 10 15

T3

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P3 T5 Pz O1 O2

P4 T6

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Methods of Robot Therapy

(a)
Fig. 4. a-waves of the scalp electrical potential distribution.

(b)

Seal robots named Paro were used at Kimura Clinic, a cranial nerve clinic in Japan, where patients with mild to moderately severe dementia were treated. After obtaining informed consent of patients and/or their families, a 20-min robot therapy was conducted in accordance with the ethical committee of the National Institute of Advanced Industrial Science and Technology (AIST).

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We designed two seal robots and placed them in the center of tables. Five to ten patients were arranged around the tables (Figure 5). They interacted with the seal robots freely during the robot therapy. Before and after the robot therapy, a 5-min EEG recording was performed with the patient at rest with closed eyes. The recorded EEG was analyzed by DIMENSION. In addition, a questionnaire about their impressions of Paro was conducted after the 20-min interaction. The questionnaire consisted of four items evaluated in five grades (Table 1). All the answers to the questions were scored as follows: most positive answer 2, positive 1, no opinion 0, negative 1, and most negative 2. The impression of Paro was evaluated by the total score of the questionnaire. The examiner heard each question to the subject.
Results of Robot Therapy

Cortical neuron activity of two patients, F and G, who achieved the same total scores on the impression questionnaire, was opposite after the robot therapy. In response to the question about their lives, we found that patient F had owned pets, but G had not. Patient G felt that animals were fearful, dirty, and stinky, but commented Paro never bit me, and its very clean. I want this one! I feel as if Paro is alive. On the other hand, patient F said this was well made, even though she was dandling Paro on her knee during the robot therapy. To clarify the effects, we inactivated Paro so that it appeared to be a stuffed toy and applied it to subjects whose neuronal activities had been improved by Paro. We obtained data from

Table 1. Questionnaire of the impression of the seal robot. 1. Is Paro cute/ugly? a) very b) cute c) no cute opinion 2. Do you like/dislike Paro? b) like c) no a) like it opinion very much

D: SD of Smoothness Fluctuation

We examined 29 patients (including 11 men, 6290 years). Some of these patients were rejected because they were subnormal or normal according to the DIMENSION analysis. In such cases, no improvement was expected by robot therapy. In some other cases, the patients were rejected because they were unable to close their eyes during the EEG recording. The number of available subjects was reduced to 14. Their basic attributes are shown in Table 2. Figure 6 presents the results. The Y-axis, Dr, denotes the standard deviation of fluctuations of Da. The fan beam area denotes the rough standard of levels of neuronal activity. Arrows indicate displacements after the 20-min robot therapy. The green arrows indicate positive displacements. The robot therapy was effective for seven patients. In particular, one patient improved from impaired to normal, and two other patients improved to subnormal. As for the questionnaire on the impressions of Paro, we were able to obtain data from 11 of the 14 available subjects. Figure 7 shows the scores of their questionnaires and changes of Da. Four patients whose total score was eight showed improvement. In contrast, no improvement was observed in patients whose score was lower than seven (except for patient B). As for their interactions with Paro, for example, patient K treated Paro like her grandchild. She hugged and spoke to it while smiling during the robot therapy (Figure 8). She felt Paro was so cute that she recommended it to a patient seated at her side. She said, I want to sleep with Paro, and Im never tired of Paro. On the other hand, patient A did not try to interact with Paro, and said, It seems to be alive, but it is not a real animal.

d) ugly

e) very ugly

d) dislike

e) dislike it very much

3. Is playing with Paro fun or boring? a) very b) fun c) no d) boring fun opinion 4. Do you want to play more with Paro? a) more b) a little c) no d) not too more opinion eager

e) very boring

e) no more

Table 2. Basic attributes of the 14 subjects. Sex Male Female Age (avg. SD) MMSE (avg. SD)

4 10 79.2 4.5 16.6 2.9

0.0350 0.0300 0.0250 0.0200 0.0150 0.0100 0.0050 0.8000 0.0000 Before After 0.8400 0.8600 0.8800 0.9000 0.8200 0.9200 0.9400 0.9600 Subnormal Normal 0.9800 1.0000
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D: Smoothness of Scalp Electrical Potential Distribution

Fig. 6. The change of cortical neuron activity of 14 patients before and after robot therapy.

Fig. 5. A scene of robot therapy.

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0.0500 0.0400 0.0300 0.0200 D of D 0.0100 0.0000 0.0100 0.0200 K I J H G E F D C B A Subject (F, 81) (F, 81) (F, 79) (F, 81) (F, 82) (F, 74) (M, 76) (F, 80) (M, 84) (M, 72) (M, 80) (Gender, Age) [16] [16] [17] [18] [18] [18] [13] [15] [14] [14] [MMSE Score] [20] Score of 8 5 6 7 4 0 Impression of 3 Paro
Fig. 7. The relationship between the impression of seal robot, patients.

five subjects: B, G, I, J, and K (Figure 9). Neuronal activities of subjects K and I, whose impressions of Paro were relatively high, were improved by the interaction with the inactivated Paro. However, the changes of Da were smaller than when they interacted with the activated Paro. In fact, their interactions with the inactivated Paro were quite different from those with the activated Paro. They rarely touched it, and never spoke to it. In addition, none of them said, I want to play more with Paro.
Discussion

Fig. 8. Patient K holding a seal robot. She treated it like her grandchild.

0.0550 0.0400 0.0300 0.0200 D of D 0.0100 0.0000

0.0100 0.0200 Subject B (M, 80) G (F, 74) J (F, 81) K (F, 81) K (F, 79) (Gender, Age) [18] [16] [16] [18] [MMSE Score] [14] Score of 4 3 5 6 7 Impression of Paro
Fig. 9. The relationship between the impression of Paro and the efficacy of inactivated Paro on five patients whose neuronal activities improved by the activated Paro.

Art therapy [3], music therapy, animal therapy, and so on are known to be effective in delaying the onset of dementia. However, Paro, and its efficacy on 11 these therapies require welltrained therapists. In addition, animal therapy has problems of safety and sanitation. Learning therapy requires patient effort for continuation. Pharmaceutical treatment is also available to prevent the progress of dementia but has side effects. In contrast, robot therapy using the seal robot Paro is safe, convenient, and does not require special skills, places, or other tools. In Figure 5, the four patients whose impression of Paro was most positive were all women. Women interacted with Paro willingly and treated it as if it was a real puppy or kitten. On the other hand, most males just watched Paros behavior and did not interact with it positively, even though they commented that it was cute. One man commented, It is boring because it is not a real animal. Moreover, males generally feel that playing with stuffed toys is girlish. We considered that these differences influenced the effects of Paro. Influences of robot therapy on patients F and G were opposite, even though their total scores of their impressions of Paro were the same. Patient G disliked animals but wanted to interact with Paro. This desire might enhance the effects of Paro, and she immediately accepted Paro as if it was a real animal. On the other hand, patient F felt Paro was an artificial thing in a part of her mind, even though she treated it like a child. We consider that this difference resulted in opposing influences on their cortical neuron activity. As for patient B, his cortical neuron activity improved by robot therapy despite his poor score on his impression of Paro. When the experimenter was listening to patient Bs impression of Paro, people around him laughed at his negative answer because he interacted with Paro very happily. His answers to the questionnaire might have been influenced by embarrassment. As for the inactivated Paro, neuronal activities improved in two subjects whose impression of Paro was relatively high. Harlow examined the reactions of a child monkey to two surrogate mother monkeys consisting of only hard wire or hard wire-covered with a soft blanket [45]. He found that the child monkey was more attracted to the soft surrogate mother monkey, and often hugged it. Softness brought the child monkey comfort and peace. This experiment showed us

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the importance of touch. Paro appears to be a baby harp seal, a very cute animal, and its surface is covered by soft bushy fur. In addition, ubiquitous surface tactile sensors also provide softness. The appearance and feel of Paro might bring neuropsychological improvements in patients. However, the extent of that improvement was smaller than when they interacted with the activated Paro. Moreover, their interaction with the inactivated Paro was passive. We consider that the reactions to the touch and speech from the patients were very important to attract their interest and brought about the effects of robot therapy. With regard to other research groups, Dautenhahn used mobile robots and Robins used robotic dolls for treating autistic children [46], [47]; and robot therapy using commercially available animal-type robots, such as AIBO and the cat robot named NeCoRo [48], has been attempted [49] [53]. For example, Yokoyama used AIBO in a pediatric ward and observed the interaction between children and the robot [49]. He pointed out that when people met AIBO for the first time, they were interested in it for a brief period. However, AIBO never produced relaxation effects, such as those obtained from petting a real dog. In other examples, Libin introduced NeCoRo to a nursing home and observed patient interaction with it [50]. Ohokubo used AIBO, NeCoRo, etc. at pediatric wards using volunteers and then investigated its influences by observation and with questionnaires [51]. Kanamori et al. examined the effects of AIBO on the elderly in a nursing home [52]. By measuring hormones in saliva, they found that stress decreased after a one-hour interaction with AIBO and patient loneliness improved after 20 sessions over a seven-week period. Tamura et al. compared the effects of a toy dog with those obtained when patients were exposed to AIBO [53]. They found that AIBO encouraged less interaction and required more intervention from the occupational therapist. Robots such as AIBO and NeCoRo break easily during interaction with people because they were not originally designed for therapy. Therefore, it is important to consider the robot as a system that includes its usage and design it specifically for therapeutic uses. In our first experiment, which investigated the neuropsychological effects on patients with dementia, we evaluated the subjects neuron activities before and after the robot therapy session and obtained data from 14 subjects. The number of subjects was very limited because of the restricted experimental environment. However, current results show that robot therapy has a high potential for improving the brain activity of patients with dementia and helping to prevent the development of such disorders in healthy people. A case study to investigate the effects more precisely will be performed in the future. Further experiments are needed to investigate the repeatability and durability of the effects and the relationship between the functions of the robots and their effects on patients suffering from dementia.
Conclusions

in patients suffering from dementia. This is especially true for patients who like Paro very much. In Japan, the cost of care for a patient with dementia is about US$33,000 per year, and their life expectancy is about eight years. This represents an enormous burden for those municipalities that provide longterm care insurance. Useful and convenient methods for the prevention of dementia are strongly needed. Several municipalities in Japan anticipate the effects of Paro and support its introduction. For example, Nanto city, Toyama, bought eight Paros and introduced them to day service centers in the city. In addition, Tsukuba city, Ibaraki, established a subsidy for purchasing Paro. We hope Paro will be widely used and provide help to people with dementia. Kazuyoshi Wada received his B.Eng. and M.Eng. degrees in mechanical and control engineering from the University of Electrocommunications, Tokyo, Japan, in 1998 and 2000, respectively, and he received his Ph.D. degree in engineering from the University of Tsukuba, Japan, in 2004. He was a research staff member at Intelligent Systems Research Institute, AIST, from 2004 to 2007. He has been an associate professor with the faculty of system design, Tokyo Metropolitan University since 2007. His current research interests include intelligent robotics, human-robot interaction, and robot-assisted therapy. He is a member of the Robotics Society of Japan and the Human Interface Society. Takanori Shibata received his B.S., M.S., and Ph.D. degrees in electromechanical engineering from Nagoya University in 1989, 1991, 1992, respectively. He was a visiting researcher at the Artificial Intelligence Lab, University of Zurich, in 1996 and at the Artificial Intelligence Lab, Massachusetts Institute of Technology, in 1998. From 1998 to 2001, he was a senior research scientist at the Mechanical Engineering Lab, AIST, and since 2007 he has been with the Intelligent Systems Research Institute, AIST. Concurrently, he has been a research scientist for the Interaction and Intelligence Project of Solution-Oriented Research Science and Technology, Japan Science and Technology Agency (SORST, JST). He is a Member of the IEEE as well as of other scientific and technical societies. His research interests include human-robot interaction, human interactive robot, emotional robot, robot therapy, and humanitarian demining. He has published many papers and books. He was certified as the inventor of a seal robot named Paro, the worlds most therapeutic robot, by the Guinness World Records in 2002. He has received many awards including the Outstanding Young Person (TOYP) of the World award in 2004 and the Japanese Prime Ministers award in 2003. Toshimitsu Musha graduated from the Department of Physics, University of Tokyo, in 1954, He worked for the Electrocommunication Lab of Nippon Telegraph and Telephone Corporation, Japan; the Research Lab of Electronics, MIT; the Royal Institute of Technology; and Tokyo Institute of Technology. After retirement,
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We used the seal robot, Paro, for therapy of patients suffering from dementia at a cortical neuron clinic. The efficacy of the robot therapy was evaluated by DIMENSION, which detects patients cortical neuron activity from a 21-channel EEG. The results from preliminary experiments show that robot therapy has a high potential to improve the condition of brain activity

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he established the Brain Functions Lab, Inc., where he has developed new diagnostic tools for numerical estimation of human emotional state (ESAM), which has been used in developing new industrial products, and the neuronal impairment in the human brain (DIMENSION), which allows early detection of dementia. Shin Kimura received his medical degree from Nihon University, Tokyo, Japan, in 1990. He was an instructor of neurosurgery at the Department of Neurosurgery, Nihon University, from 1989 to 2002. He has been the director of Kimura clinic and Art Brut in which people affected by dementia have been treated with art therapy since 2003. Address for Correspondence: Kazuyoshi Wada, National Institute of Advanced Industrial Science and Technology, 1-1-1 Umezono, Tsukuba, Ibaraki, 305-8561, Japan. E-mail: k-wada@ aist.go.jp.
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