Balance of Autonomic Nervous Activity, Exercise, and Sleep Status in Older Adults : A Review of the Literature

While older people are frequently known to experience sleep disturbances, there are also many older people who have a good quality of sleep. However, little is known about the balance of autonomic nervous activity, exercise habits, and sleep status in healthy older adults. This study reviews the literature regarding balance of the autonomic nervous activity, exercise, and sleep in healthy older adults. Relevant articles were searched from electronic databases using the combination of the following keywords: “Autonomic nervous activity”, “sleep status”, “sleep”, “healthy older adults”, “aging”, “heart rate variability (HRV)” and “exercise”. Articles were included if they met inclusion criteria: (1) Published in English, (2) Article types: research and review articles, (3) Main outcome was related to the autonomic nervous activity, lifestyle, sleep, and/or healthy aging, and (4) Fully accessed. From 877 articles that were identified, 16 articles were included for review. Results showed that the autonomic nervous activity changes with increasing age, particularly a constant decline in cardiac vagal modulation due to the significant decrease in the nocturnal parasympathetic activity. In addition, the autonomic nervous activity was also related to sleep status and lifestyle, particularly the capability to exercise. In preparing older people toward a healthy aging, maintaining good sleep quality and exercise is suggested

Examining Factors Associated with Dynapenia/Sarcopenia in Patients with Schizophrenia : A Pilot Case-Control Study

Sedentary behavior in patients with schizophrenia causes muscle weakness, is associated with a higher risk of metabolic syndrome, and contributes to mortality risk. This pilot case-control study aims to examine the associated factors for dynapenia/sarcopenia in patients with schizophrenia. The participants were 30 healthy individuals (healthy group) and 30 patients with schizophrenia (patient group), who were matched for age and sex. Descriptive statistics, Welch’s t-test, cross-tabulations, adjusted residuals, Fisher’s exact probability test (extended), and/or odds ratios (ORs) were calculated. In this study, dynapenia was significantly more prevalent in patients with schizophrenia than in healthy individuals. Regarding body water, Pearson’s chi-square value was 4.41 (p = 0.04), and significantly more patients with dynapenia were below the normal range. In particular, body water and dynapenia showed a significant association, with an OR = 3.42 and 95% confidence interval [1.06, 11.09]. Notably, compared with participants of the healthy group, patients with schizophrenia were overweight, had less body water, and were at a higher risk for dynapenia. The impedance method and the digital grip dynamometer used in this study were simple and useful tools for evaluating muscle quality. To improve health conditions for patients with schizophrenia, additional attention should be paid to muscle weakness, nutritional status, and physical rehabilitation

2D Video Analysis for Active shoulder ROM

Aging and its associated problems related to movement impacts the care of people with psychiatric disorders. This study sought to clarify the usefulness of 2D video analysis for evaluating shoulder range of motion (ROM) during upper limb exercises in patients with psychiatric disorders. Subjects (N=54) were patients with psychiatric disorders categorized as the following : having either a high or low activities of daily living (ADL) score using the Barthel Index ; experiencing shoulder ROM limitation, and whether or not compensatory movements were exhibited. Compensatory movement was also considered in patients with Parkinsonism, cerebrovascular disease, and cognitive dysfunction. Shoulder joint ROM was measured using a goniometer and active ROM was captured using ImageJ. No significant difference between passive ROM measured by a goniometer and active ROM measured by ImageJ considering disease groups, ADL level, and shoulder ROM limitation was found. Factoring in compensatory movements, however, significant differences were found between passive and active ROM : existence compensatory movement group, left side (z=-2.30, p=0.02) ; nonexistence compensatory movement group, right side (z=-2.63, p<0.001). Image-evaluating devices help assess ROM in patients with psychiatric disorders, enhancing the development of physical rehabilitation programs to regain critical ADL, sustaining self-care capabilities

Evaluation of a Remote-Controlled Drone System for Bedridden Patients Using Their Eyes Based on Clinical Experiment

With the aging of the population in Japan, the number of bedridden patients who need long-term care is increasing. The Japanese government has been promoting the creation of an environment that enables everyone, including bedridden patients, to enjoy travel, based on the principle of normalization. However, it is difficult for bedridden patients to enjoy the scenery of distant places and to talk with the local people because they need support from helpers to travel to distant places using travel agencies. Therefore, to enhance their quality of life (QOL), we developed a remote-controlled drone system, which involves using only the eyes. We believe that bedridden patients are able to operate the system’s drone in a distant place, to easily view the scenery of the distant place with a camera installed on the drone, and to talk with the local people. However, we have never evaluated whether actual bedridden patients can operate the drone in a distant place, to see the scenery, and to talk with the local people. In this paper, we presented clinical experimental results to verify the effectiveness of this drone system. Findings showed that, not only subjects with relatively high levels of independence in activities of daily living, but also bedridden subjects, could operate the drone at a distant place with only their eyes and communicate with others

ケアロボットのもたらす法的問題点

Our research group studies on care and rehabilitation using Care Robots（CRs）. Legal issues arising from these CRs are diverse. In this paper, we examined legal issues that should be considered in each stage ; manufacturing, processing, installation, use, deterioration, and disposal of CRs, and especially the cases where CRs as medical devices cause damage to patients. Thus, this paper pointed out the subjects as below : “Product Liability Act mainly and secondary general tort law in the manufacturing stage’’, “Defect liability in the processing stage’’, “General tort law in the installation stage”, “Obligation of security or faulty performance responsibility in the use stage” and “Personal Information Protection Law at the disposal stage”. In addition, we suggested the presumed issues that should be examined and indicated the direction of the way of thinking. This study will contribute to creating safety guidelines for the future use of CRs

Healthy Lifestyle, Autonomic Nervous System Activity, and Sleep Status for Healthy Aging

With the super-aging society, it is important to pay attention to the quality of life of older people so that they can face healthy aging. Lifestyle, particularly exercise, autonomic nervous system activities, and sleep status are factors that affect the quality of aging. This chapter explores how those three variables are related and what strategies can be employed to maintain and enhance these variables to prepare. (1) The combination of healthy lifestyles, adequate physical activity, healthy dietary patterns, moderate alcohol consumption, and nonsmoking were related to the risk of cardiovascular diseases. (2) For older people, being physically active is important to the improvement of their physical and mental functions and keeping them independent and mobile. The increasing HRV after exercise might be caused by increasing vagal tone and decreasing sympathetic activity. (3) To reach healthy aging, people should maintain the proper function of autonomic balance activities. This is important because slowing down the decline in sympathetic status might delay many geriatric complaints. (4) To achieve healthy aging, maintaining a healthy sleep is essential. Thus, the key to a lifestyle that facilitates healthy aging is a balance of regular physical exercise and adequate sleep, which mediates and is mediated by autonomic nervous system activity

Remote-Controlled Drone System through Eye Movements of Patients Who Need Long-Term Care : An Intermediary’s Role

The use of a remote-controlled drone system (RDS) by eye movements was studied to assist patients in psychiatric long-term care (PLTC) to allow them to view the environment outside the hospital, hoping that this will bring them some enjoyment. However, successfully applying this system requires human intermediaries in facilitating the interactions between patients and RDS operators. The aim of the study was to describe the role of nurses as intermediaries in the application of an RDS through eye movements of patients PLTC. This study employed the Intentional Observational Clinical Research Design. Data collection was performed in November 2021 at a psychiatric hospital with selected patients in PLTC. Seventeen patients took part in the indoor experiment, whereas 23 patients took part in the outdoor experiment. Fifteen of the 23 patients in the outdoor experiment were the same patients who took part in the indoor experiment. Most of the patients in the indoor and outdoor test arenas could successfully, delightfully, and safely fly the drone. This study demonstrated that RDS using just eye movements could increase the quality of life in older patients with psychiatric problems in PLTC. For the successful use of this drone system, nurse intermediaries assumed critically significant roles

Development Issues of Healthcare Robots : Compassionate Communication for Older Adults with Dementia

Although progress is being made in affective computing, issues remain in enabling the effective expression of compassionate communication by healthcare robots. Identifying, describing and reconciling these concerns are important in order to provide quality contemporary healthcare for older adults with dementia. The purpose of this case study was to explore the development issues of healthcare robots in expressing compassionate communication for older adults with dementia. An exploratory descriptive case study was conducted with the Pepper robot and older adults with dementia using high-tech digital cameras to document significant communication proceedings that occurred during the activities. Data were collected in December 2020. The application program for an intentional conversation using Pepper was jointly developed by Tanioka’s team and the Xing Company, allowing Pepper’s words and head movements to be remotely controlled. The analysis of the results revealed four development issues, namely, (1) accurate sensing behavior for “listening” to voices appropriately and accurately interacting with subjects; (2) inefficiency in “listening” and “gaze” activities; (3) fidelity of behavioral responses; and (4) deficiency in natural language processing AI development, i.e., the ability to respond actively to situations that were not pre-programmed by the developer. Conversational engagements between the Pepper robot and patients with dementia illustrated a practical usage of technologies with artificial intelligence and natural language processing. The development issues found in this study require reconciliation in order to enhance the potential for healthcare robot engagement in compassionate communication in the care of older adults with dementia

Investigation of Methods to Create Future Multimodal Emotional Data for Robot Interactions in Patients with Schizophrenia : A Case Study

Rapid progress in humanoid robot investigations offers possibilities for improving the competencies of people with social disorders, although this improvement of humanoid robots remains unexplored for schizophrenic people. Methods for creating future multimodal emotional data for robot interactions were studied in this case study of a 40-year-old male patient with disorganized schizophrenia without comorbidities. The qualitative data included heart rate variability (HRV), video-audio recordings, and field notes. HRV, Haar cascade classifier (HCC), and Empath API© were evaluated during conversations between the patient and robot. Two expert nurses and one psychiatrist evaluated facial expressions. The research hypothesis questioned whether HRV, HCC, and Empath API© are useful for creating future multimodal emotional data about robot–patient interactions. The HRV analysis showed persistent sympathetic dominance, matching the human–robot conversational situation. The result of HCC was in agreement with that of human observation, in the case of rough consensus. In the case of observed results disagreed upon by experts, the HCC result was also different. However, emotional assessments by experts using Empath API© were also found to be inconsistent. We believe that with further investigation, a clearer identification of methods for multimodal emotional data for robot interactions can be achieved for patients with schizophrenia

Characteristics of interactive communication between Pepper robot, patients with schizophrenia, and healthy persons

Background: Expressing enjoyment when conversing with healthcare robots is an opportunity to enhance the value of human robots with interactive capabilities. In clinical practice, it is common to find verbal dysfunctions in patients with schizophrenia. Thus, interactive communication characteristics may vary between Pepper robot, persons with schizophrenia, and healthy persons. Objective: Two case studies aimed to describe the characteristics of interactive communications, 1) between Pepper as a healthcare robot and two patients with schizophrenia, and 2) between Pepper as a healthcare robot and two healthy persons. Case Report: The “Intentional Observational Clinical Research Design” was used to collect data. Using audio-video technology, the conversational interactions between the four participants with the Pepper healthcare robot were recorded. Their interactions were observed, with significant events noted. After their interactions, the four participants were interviewed regarding their experience and impressions of interacting with the Pepper healthcare robot. Audio-video recordings were analyzed following the analysis and interpretation protocol, and the interview data were transcribed, analyzed, and interpreted. Discussion: There were similarities and differences in the interactive communication characteristics between the Pepper robot and the two participants with schizophrenia and between Pepper and the two healthy participants. The similarities were experiences of human enjoyment while interacting with the Pepper robot. This enjoyment was enhanced with the expectancy of the Pepper robot as able to entertain, and possessing interactive capabilities, indicating two-way conversational abilities. However, different communicating characteristics were found between the healthy participants’ impressions of the Pepper robot and the participants with schizophrenia. Healthy participants understood Pepper to be an automaton, with responses to questions often constrained and, on many occasions, displaying inaccurate gaze. Conclusion: Pepper robot showed capabilities for effective communication pertaining to expressing enjoyment. The accuracy and appropriateness of gaze remained a critical characteristic regardless of the situation or occasion with interactions between persons with schizophrenia, and between healthy persons. It is important to consider that in the future, for effective use of healthcare robots with multiple users, improvements in the areas of the appropriateness of gaze, response time during the conversation, and entertaining functions are critically observed