Oct. 19, 2011 -- Residents at Mount Macrina Manor, a long-term care facility in Uniontown, Pa., have many furry companions to keep them company: dogs, cats, bunnies, birds, and a couple of robotic white baby seals. Residents and staff call one of the seals Sarah, but to its manufacturers and researchers, it's known as Paro.
Patti Benford, Mount Macrina's administrator, said therapists caring for patients with dementia use Paro to help them work through problems with communication and social interaction. She said most residents react to the robot the same way they respond to therapy with live animals. But the seals don't make a mess, which is a big win for the staff, Benford said.
"Some of these patients had no facial expressions, offered no verbal communication before their therapy," Benford said. "But with Paro, some of them came back out of that shell, and their eyes would light up. It's wonderful."
Paro is a soft, fuzzy robot, built to look and sound like a baby seal. It's also a $6,000 machine, classified by the U.S. Food and Drug Administration as a Class II medical device.
Stroke its fur, and Paro squirms delightedly at the loving touch. Hit or punish it, and it will learn not to repeat what it did to cause displeasure. With the help of audio sensors, Paro can even learn its name and respond to greetings.
"It has really big dark eyes and big long eyelashes, so it really is endearing," Benford said. "The residents think it's something real, something that's alive."
That feeling makes elder care experts and medical ethicists a little uneasy. Social robots like Paro create a number of ethical quandaries, particularly when it comes to older people who may be physically and mentally impaired. For instance, is it ethical to let older people believe that a robot is alive?
"We get concerned about whether these devices promote detachment from reality," said Ron Arkin, regent's professor and director of the mobile robot laboratory at the Georgia Institute of Technology. "Also, are we abrogating our responsibilities to our fellow human beings by suddenly saying, the robot can take care of you?"
Other elder care experts see Paro and his robotic brethren as useful tools in combating debilitating mental health woes in older adults. Nearly 2 million U.S. adults age 65 and older suffer from some form of depression, according to Mental Health America, a nonprofit organization dedicated to raising mental health awareness. Many studies have shown that interaction goes a long way in helping older adults cope with feelings of anxiety, isolation and agitation that can come as they face declining health, dwindling circles of friends, and increased financial or personal troubles.
As a social robot, Paro is designed to help people with precisely those problems. On its website, Paro Robots U.S. Inc., the device's manufacturer, says the baby seal can improve the psychological well-being in patients in hospitals and extended care facilities.
Rosamond Rhodes, director of bioethics education at Mount Sinai School of Medicine, said she doesn't see anything wrong with using a robot like Paro to help older people lessen their anxiety or depression. Of course, the robot won't replace a relationship with a grandchild, Rhodes said, but it still can be a useful tool in alleviating mental anguish.
"They may prefer a visit from a grandchild, but the child cannot be there 24/7 and the robot can," she said. "And not everyone has a grandchild or a son and daughter. So for those people it sounds like a robot could be a huge advantage."
Richard Nix, executive vice president of AgingCare.com, said technology certainly has a place in care for the elderly. Robots can help older people and their caregivers by giving reminders about medication, sensing when a person falls and calling for help, and turning off appliances when they are not in use. But when it comes to robots providing social interaction, Nix is skeptical.
"A robot's a good thing as long as it's used as an aid and not a companion," Nix said. "There's no substitute for a caring human relationship."
Some scientific data shows that playing with Paro actually does help older people. Researchers at Japan's National Institute of Advanced Industrial Science and Technology, the group that developed Paro, have published a few studies that documented the positive effects of the robots.
In one study, elderly residents at a day service center played with Paro for five weeks while AIST researchers evaluated their moods using face scales and questionnaire,s and also testing their urine for stress hormones. At the end of the study, researchers reported that the residents' moods improved and their urine showed lower levels of stress hormones.
Another AIST study followed 10 elderly people who played with Paro for two hours a week for a year, and found that their feelings improved and their depression was reduced. The researchers noted that the facility's caregivers said that interaction with Paro made the residents laugh and become more active, and caused them to communicate more with one another.
These studies are small and, as scientific standards go, not terribly rigorous. Experts say much larger, more controlled trials are needed before researchers can really understand Paro's effects on people and whether the fuzzball robot can be used to meet psychological needs.
But for medical ethicists, the more important question isn't can robots help but should they. Nix said he fears the technology could serve as a temptation for overwhelmed family members and caregivers to neglect their elderly relatives.
"My concern would be that people who used to check in on mom every day instead say, I'll come every few days. Mom's with the robot, so she's OK," Nix said. "It's that unconditional love that people really can bond with, and I'm not sure a robot can show love."
Arkin said the developers who create these technologies need to ask key questions about how their products will be used in the real world.
"Who benefits from the development of this technology? Is it the young or the old?" Arkin said. "Many in our field tend to create solutions without fully understanding the issues attached to them."
Arkin said he's much more encouraged by research that investigates how robots can assist humans in providing therapy for older adults.
At Mount Macrina Manor, Benford said the staff have been so pleased with the responses they get from their two seals that they're thinking of buying a third one. She said the robot has been a tremendous aid in rehabilitating patients.
"The Paro seal helps them ... express themselves and stimulates a response ... we can't elicit that kind of response from them anymore," Benford said.