University of Texas at Tyler associate nursing professor has launched the largest research project of its magnitude in the United States to assess effectiveness of personal robots in treating anxiety and depression in the elderly who have Alzheimer's, dementia or related disorders.

The robots are a replica of an appealing baby harp seal. Despite resembling a stuffed toy, PARO robotic seals are a therapedic medical device approved by the U.S. Food and Drug Administration.

One of the robots, named Oscar, has fluffy white hair, striking dark eyes, long black eyelashes, whiskers and flippers.

"His fur is treated with a special substance to keep him from spreading bacteria with people interacting with him. He's covered with sensors from his head to the tip of his flippers so he can feel you when you pat him," said Dr. Sandra Petersen, who teaches in the family nurse practitioner program at UT Tyler and is leading the research study.

"He's actually a biofeedback device. When someone has a nurturing or positive behavior toward him, then he will respond in that same way to elicit that calming response again," Dr. Petersen said, explaining that the PARO robots have "a degree of artificial intelligence."

"He does remember things, and if you do something that hurts him, he will remember and won't repeat whatever action he was doing right before that, because he thinks that would stimulate you to do it again," Dr. Petersen said. "He's pretty intelligent for a machine."

She is conducting a 12-week research study using the PARO robots with 60 patients in five identical assisted care/memory care facilities in the Dallas area. The research is funded with $30,000 from the Baylor Deerbrook Trust.

Dr. Petersen places a PARO robot on a small table with three seated patients and gives them the opportunity to interact.

"We introduce him and say something like, ‘would you help us take care of our pet,' and see what happens," Dr. Petersen said.

Oscar looks so real and sweet that almost no one can resist reaching over to pet him. He responds as if he was alive, moving his flippers and making endearing sounds like a baby harp seal.

Petting the robotic seal has a calming effect, increasing serotonin, a calming neurotransmitter produced by the brain that is lacking in many people who have dementia, Dr. Petersen said.

"PARO robots are very helpful in decreasing anxiety and depression in dementia. What they've found in using these in Europe and in Japan is that they can decrease the amount of medications that are utilized and the neurotransmitter, especially serotonin, is affected by interacting with the PARO seals," Dr. Petersen said.

Oscar has proven "really effective" in her practice, she said.

In one case, a patient with severe Alzheimer's had very violent behaviors, was nonverbal, would only grunt and was being treated by injection.

That patient has had a huge improvement with just treatment from the robot, she said.

"He first started talking to the robot, and then he talked to the nurse about the robot and now he's moved into a group, and we don't use injectables anymore with him," Dr. Petersen said.

The word PARO is Japanese for personal robot and is the brand name, Dr. Petersen said. The PARO robots are in 33 countries, but not many in the United States, where they are new - probably less than a hundred in this country and very few in Texas.

"We're hoping to change that. We are hoping to eventually get Medicare funding to pay for the biofeedback treatments because we've been able to reduce the number of medications that people take," Dr. Petersen said.

She has more PARO robots than anyone else in Texas – five in addition to Oscar.

"In Japan and European countries, the government actually buys them and places them in nursing homes and facilities that care for Alzheimer's/dementia patients because they have been so effective in decreasing anxiety and the cost of medications," Dr. Petersen said.

The patients in her research study, all 80 or older, will receive 20-minute treatments with a PARO robot three times a week.

Dr. Petersen used observational scales to assess the patients' level of anxiety and depression before the study began. She also used lie detector technology called the Galvanic Skin Response, which detects stress and tension in the skin.

The study will also report the number of medicines each patient was taking before the study started and the number after the study to see if there has been a reduction while patients are treated with the PARO robot.

The purpose of the study is to look at the impact of the PARO robot on the treatment of anxiety and depression in dementia, Alzheimer's or some type of related disorder, Dr. Petersen said.

Since she has been using the robots with her patients before the study started and because of results of multiple studies throughout Europe, Dr. Petersen said, she expects her research will show the PARO robot treatments are effective.

"I've enjoyed working with Oscar, just seeing the effect he has on my patients. It's amazing. Even the patients that don't have cognitive impairment are really disappointed if I don't bring him because they love Oscar," Dr. Petersen said.

"It's very similar to traditional pet therapy. It's to elicit nurturing responses from humans. That's how pet therapy works, and the result we see with the PARO robots is very similar to what we see with pet therapy."

A difference is that no one has to feed the PARO or take him to the bathroom. The PARO just needs his battery replaced every four or five years. Another feature is that the robot doesn't bite or scratch, while dogs and cats may scratch and bite and some people are afraid of them.

Dr. Petersen learned about the PARO robots during a seminar a couple of years ago in Dallas, which prompted her to study toward certification as a licensed robotic therapist.

The inventor in 1993, Dr. Takanori Shibata of Japan, went to Canada and studied harp seals there, recording their noises and actions, before coming back to Japan.

"He combined his knowledge of neuroscience and robotics to build the Paros specifically to work with people who have cognitive disorders," Dr. Petersen said. "They are programmed specifically to increase socialization and to treat anxiety and depression."

Oscar, who is 2, is the ninth generation of the PARO robots.

Oscar has a central processing unit that sits at his core. He is very sturdy and has a hard shell underneath the fur so that, if he gets dropped or thrown, he isn't hurt, Dr. Petersen said.

Although PARO robots were invented to treat people with cognitive disorders, people in Japan have them as pets, Dr. Petersen said. They are for sale on store shelves in Japan for $6,000 each. They come in different colors – white, which is the color of actual baby harp seals; and brown, gray and pink.

They are handcrafted at a factory in Japan. Each one is hand trimmed and hand covered.

"They all look different, and they all have their own personalities," Dr. Petersen said. "Somewhat like our pets, they take on the personality of the owner."


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