Profiling Robot-Mediated Play for Children with Disabilities through ICF-CY: The Example of the European Project IROMEC Serenella Besio, Francesca Caprino, and Elena Laudanna Università della Valle d’Aosta, Strada Cappuccini, 2A 11100 Aosta, Italy
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Abstract. This paper, from the description of the research activities of the ongoing European project IROMEC, discusses the potential role of the brand new version Children and Youth of ICF (International Classification of Functioning and Disability) as an useful resource in the design development and outcomes evaluation of robotic toys used as play mediators in educational and therapy settings with children with physical and/or cognitive impairments. ICF-CY has been used as a methodological framework in users’ needs assessment, in building appropriate task analysis of play activities, in robot requirements definition and in outcomes analysis will be examined. Further and deeper researches are needed to better understand strengths and weaknesses of such an approach. Keywords: ICF-CY, robotic toys, play mediators, play scenarios.
1 Introduction This paper, from the description of the research activities of the ongoing European project IROMEC, discusses the potential role of the brand new version Children and Youth of ICF (International Classification of Functioning and Disability) as resource in the design development and outcomes evaluation of robotic toys used as play mediators in educational and therapy settings with children with physical and/or cognitive impairments. A possible application of the ICF-CY as a methodological framework in users’ needs assessment, in building appropriate task analysis of play activities, in robot requirements definition and in outcomes analysis will be examined. The ICF has been selected and applied as a methodological tool within the IROMEC project for the following reasons: • it offers a holistic, bio-psychosocial framework [16] [18] which takes in account all the aspects related to the individuals and their life environments; • it adopts a language that is common to multiple disciplines; • it examines many aspects related to technology as an important mean for activity and participation; • the ICF-CY [18] directly addresses specific issues related to child and youth’s development such as, for the aims of this study, play stages and functions [15]. K. Miesenberger et al. (Eds.): ICCHP 2008, LNCS 5105, pp. 545 – 552, 2008. © Springer-Verlag Berlin Heidelberg 2008
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The first results have confirmed the heuristic potential of the ICF as a methodological framework in robot mediated play, but further and deeper researches are needed to better understand strengths and weaknesses of such an approach.
2 ICF and Its Use in AT Development and Outcomes Assessment WHO’s ICF, first presented in 2001, describes human functioning as an indispensable relationship between the health conditions of an individual and his or her ability to take actions and participate to the environment and to the psycho-social contexts. Overcoming both the medical and the social model of disability and adopting a more comprehensive bio-psycho-social one, the ICF assumes that disability is a natural experience in human life not necessarily depending on illness and that the individual functioning should be measured on the basis of activity and participation criteria; thus, it provides a taxonomy for coding all health-related experiences. To better assist professionals in its application, the WHO developed checklists with specific qualifiers to identify the degree of the impairment and the extent of activity limitations and participation restrictions, as well as the role played by environmental factors. Since its first introduction, some researches [11] tried to apply ICF as a framework to evaluate the user needs as regards Assistive Technologies (AT) and to analyse the impact of AT together with other environmental modifications on the Quality of Life (QoL) – as a multi-dimensional concept describing overall comfort with life [3] – of persons with disabilities. AT falls into the environmental factors domain (Products and Technology), and its use, enabling people to carry on daily life tasks by removing or mitigating environmental barriers, may have a positive influence on almost every activity and participation domain as described in ICF [14]. Due to its high degree of descriptiveness, and its holistic nature, ICF has been proposed as a powerful tool in AT assessment, and also as a unique model to plan and measure outcomes in AT intervention, in terms of quality of life and independent living [1]. Furthermore, ICF has been proposed as a potential framework to describe and include all the multidisciplinary aspects of AT practice and theory [1].
3 Design and Assessment of Robotics Artefacts for Paediatric Rehabilitation and Education Robotics artefacts used in children’s rehabilitation and education can rely on AT research results, thanks to the strict relationship between the two technological fields, mainly in the cases when robots are the mean through which the child interacts with standard toys or objects. For example, making use of the knowledge matured in the bio-medical field, robotic prosthetic arms were developed as assistive robots [4] or complex robotic artefacts, like PlayRob, were employed to let motor impaired children play with LEGO bricks [10]. These examples include robots that assist people with physical disabilities through physical interaction. They are, for this reason, really different from Socially Interactive Robots (SIR), defined , by Fong et al., [7] as robots whose main task was some form of social interaction, thus making a distinction
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with teleoperation as the form of control typical of Human Computer Interaction. Feil-Seifer and Matarić [6] suggested that the term Assistive Robotics (AR) is no longer sufficient to define the category of robots that give support to a human user. They defined Socially Assistive Robotics (SAR) as the intersection between AR and SIR: SAR must create close interaction with users with the aim of giving assistance and achieving measurable progress in convalescence and learning without appealing to any physical contact. Usually a strong emphasis is given to design and technological issues, like robot functionalities and human-robot interface. Regarding outcome assessment, SIR and SAR researches – such as robotic toys or robotic play mediators – both qualitative and quantitative methodologies have been used, investigating social and behavioural dimensions through laboratory experiments jointly with observations conducted in ecological settings. The obtained data, mostly collected through videotaped trials [5] [12] or direct observation, are based on the measurement of behavioural variables such as visual contact, physical proximity, vocalization, gesture and facial expressions. Unlike in the case of Assistive Robotics [8], the social robots impact on QoL is still unexplored due to the fact that social robots are still expensive and not largely widespread yet in educational or therapeutic settings; for these purposes, when developing new robot toys, a consistent framework should be anyway found and used.
4 ICF-CY as a Methodological Framework in the IROMEC Project IROMEC (Interactive RObotic MEdiators as Companions, 2006 IST-2005-2.6.1) is an European project, involving research centres and institutions of six different countries, which investigates how robotic toys can help children who are prevented from playing, either due to cognitive, developmental or physical impairments. The project aims at designing and developing a prototype robot able to facilitate and implement the play of children with disabilities thus improving their learning abilities, social inclusion and quality of life. Children with autism, children with mental retardation and children with severe motor impairment, have been identified as the main target groups. Following a user centred perspective, the robot prototype development focused on a detailed user needs assessment; this has been carried out by considering both the group of primary users as well as the group of secondary users (teachers, therapists, medical doctors, caregivers) who have been involved since the early stages of the project. Through an iterative process, a first selection of robot requirements – based on the collected user needs – and a set of play scenarios, describing possible play activities in specific contexts, have been finalized. Current experimentation on the selected play scenarios with market pre-existing robotic systems is going to evaluate the scenarios’ validity among the target groups to finally address the robot prototype development. During the preliminary phase of the project, the main variables – Critical Factors (CF) – involved in robot assisted play in learning and therapy have been studied, with the aim to develop a background study on the possible use and effects of IROMEC [2]. To better examine the CF, ICF-CY has been chosen as a methodological framework in order to include the variety of aspects of the human life, giving the research a
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clear participative and inclusive perspective [13] and adopting a universally shared language. Five main clusters of CF have been singled out, related to the play of children with disabilities, mediated by robotic technology [2]: • factors related to the individual, as detailed in ICF-CY; • factors related to the context, as detailed in ICF-CY and including the following on-purpose personal factors: sex, age, nationality and culture, family relationships, cognitive styles and adaptability, previous experiences, social background, education styles; • factors related to technology and robotics; • factors related to methodology; • factors related to play. CF related to the use of robotics in the field of children’s play, as well as those related to technology and play and methodology in the field have been studied in-depth, and separately, through a specific and comprehensive literature investigation.
5 First Results and Ongoing Research At this stage a set of user requirements to be considered in the robot design and a first group of play scenarios have been developed, thanks to an iterative process which has involved – through several rounds - secondary user panels (professionals, teachers, caregivers). The CF analysis based on ICF-CY has been used by researchers of the University of Valle d’Aosta both in the concept design phase and in the development of suitable play scenarios for the selected target user groups. During the phases of concept generation, a process still running which will lead to the realization of the first prototype, the adoption of this user-centred methodology brought to consider the functional impairments of the target user groups as a priority to decide the robot’s functionalities. In this sense, the use of ICF-CY proved to be a comprehensive and exhaustive instrument. In fact, both the type and the severity of any functional impairment (ICF body functions component) have a direct impact on the child’s capacities and performances. For this reason, specific attention was focused on analysing functions that may be involved in play activities, such as motor, sensory, voice and speech, mental functions. Just to give some examples: children with severe motor impairments can usually be described using items of Cluster Body Functions, Neuromusculoskeletal and movement related functions (ICF-CY chapter 7) regarding functions of movement and mobility, including functions of joints, bones, reflexes and muscles. These items were analysed to decide the requirements of the prototype, to avoid tasks that may lead to collateral damages, to stimulate appropriate movements and postures and to select appropriate interfaces devices. But severe motor impairment also limits functionalities in activities, clustered under the ICF-CY chapter Mobility (4th of Activity and Participation), that are important for playing such as: gripping, lifting and carrying objects (ICF-CY d430-d449). As a consequence, the user requirements analysis clearly pointed out the need for robot to provide help for symbolic or exercise play that use these functionalities. Impairments in speech and voice functions (ICF-CY b310-b340), frequently occurring in neuro-motor pathologies, should be also considered in the robot interface
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design in the case that speech recognition could be implemented. Furthermore, impairments in attention functions (ICF-CY b140) are elements to be considered in the robot appearance, expressiveness, quality and typology of feedbacks. The functionalities and activities described above have been considered in relation to one of the most significant activity in a child’s development, that is learning, which, of course, includes play; this activity is described in the ICF-CY on the basis of the most recent studies in psychology and pedagogy. Environmental factors have been also taken into account since the robot is intended to be used in educational inclusive settings, where many children can act as coplayers with their unexpected behaviours, and noise and confusion can make difficult interaction with the robot through voice and sounds. Finally, Personal factors such as gender, age and culture have to be taken in account when planning the robot functionalities and appearance. As regards functionality, age affects independence in using a robotic toy and the ability to manage complex interfaces and as regards appearance the possible choice between zoomorphic, anthropomorphic, or machine-like appearance can’t leave out of consideration gender, age and culture issues [17]. In addition to the phase of concept generation, ICF-CY has been used also during the process of developing play scenarios reflecting the user requirements; also in this case individual, environmental, and personal factors have been considered, to plan a wide range of possible play activities and play settings For example, the presence of other actors – like parents, peers and friends – the degree of their involvement, their role and the possible amount of support coming from them, have been described, following both the Activities and participation / Interpersonal relationships and relations and the Support and Relationships ICF-CY domains. In the same way, ICF-CY codes about play have been taken into account in prospecting possible play activities from the simple sensory play, to more complex games with rules: to this scope, a great range of body functions (e.g., voice and speech, mental, musculoskeletal and sensory functions) have been analysed, as well as Activity and Participation components (e.g., general tasks and demands, communication, mobility). Finally, Environmental components (products and technology adapted or not for communication and play) have been an useful repertoire to plan artefacts and media (toys, assistive technology devices) to be introduced in the play setting. The outcomes of CF analysis led the Aosta research group to set up a methodological framework for the use of robotic toys as play mediators in rehabilitation and educational settings, which will be proposed for use and validation in the next experimental stages, both for preliminary user needs assessment and for the evaluation of intervention outcomes. The framework is exemplified in Fig. 1. The starting point of the process is “the child”, the particular child that is the object, and the subject, of the intervention. The first step is the analysis of his/her functioning and impairments. In this phase the ICF-CY is the fundamental tool to take into account not only body functions but also limitations in activities and participation as important features for describing the child. Obviously not all ICF-CY items have the same importance – this importance depends on the particular child, the context , the objectives, – and the first task is to select which items must be considered: items that need improvements, should be identified; functions and activities already possible that are the starting points for the play setting; items that are important to define robot interaction features.
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The impairment in Body Functions and the effectiveness of Activity and Participation must be evaluated through methods that could be related to ICF-CY qualifiers; on the other hand, the same methods will be used at the end of the rehabilitation and/or education intervention to the purpose of measuring its outcomes. At this point two features of the play activity can be defined: function and stage of play. As regards the Contextual Factors, they should be carefully analysed so that the more fruitful aspects and persons can be singled out to support the play activities.
Fig. 1. Concept map of a ICF-CY based methodological framework for robot mediated play
Consequently a scenario among the available ones will be selected: the robot features will be decided according to the requirements of the scenario and on the individual and environmental factors related to the child . This framework will be tested by some IROMEC partners as an instrument of analysis and evaluation of their experimental activities; its last validated version will be finally included in the Guidelines for teachers and rehabilitation professionals, one of the expected products of the project.
6 Conclusions The ICF approach revealed to be a powerful resource to describe individual and environmental factors relevant in planning interventions with robotic artefacts as play mediators. At the same time, play and technology factors described in ICF-CY don’t fully respond to the need of the research project purposes of an exhaustive analysis of
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these aspects. Play in the ICF-CY is in a not really significant position in the hierarchy, being basically described as one of the sub-codes of the basic learning cluster. Only two of the play types (symbolic and pretend play) described in literature are included and assembling and exercise play are labelled as “learning through actions with objects” activities. Play with rules is part of the community and civic life under the code recreation and leisure. The play stage classification contained in ICF-CY (solitary play, onlooker play, parallel play, shared cooperative play codes) seemed to be more suitable for the purposes of this research but it could be assigned higher evidence. The lack of an exhaustive description of play in the activities and participation domain together with the fragmentation of the different codes related to play caused the need to look for a more comprehensive approach to play, which was found in the ESAR system [9], set up by another partner of the project, AIJU (Instituto Tecnológico del Juguete, Spain). As regards technology, some codes of the environmental component are referred to play materials as Products and technology used to play. These products are described as equipment, products and technologies used by children in structured or unstructured play / objects, materials, toys, and other products that assist people to play. Further codes mention assistive or adapted products and technology for play and education but many other technological factors – such as robotics technologies for education and rehabilitation – aren’t fully included in the ICF-CY. In spite of these highlighted limitations, the close relationships found among the ICF-CY clusters and the needs of the project at its different steps, encouraged the effort to set up the above presented methodological framework. At this stage the presence of too many variables still represents a challenging task for the proposed experimental application of the ICF-CY. The future work will be to move from an analytical research approach to the development of a concrete and reliable assessment tool. This means to create “simple” and easy to use instructions for the use of robotic toys in the education and rehabilitation activities, addressed to the secondary end users, like teachers and rehabilitation professionals.
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