加藤 健治

Gait disturbance in individuals with spinal cord injury (SCI) at levels rostral to the lumbar locomotor centre results from disconnection between the supraspinal system and the spinal locomotor centre. Here, we present a non-invasive volition-controlled spinal stimulation paradigm that empowers paraplegic individuals to regain stepping control in their impaired legs. Using hand muscle-controlled magnetic stimulation targeting the lumbar spinal motor circuits in the preserved lumber cord, individuals with chronic SCI achieved control of start-stop motion, step length and cadence of bilateral cyclic stepping in paralysed legs. Stimulus-induced cyclic stepping with leg muscle EMG activity was evoked in all participants with complete or incomplete SCI, regardless of the lesion site between the thoracic and lumbar spinal cord. Combining voluntary gait effort with closed-loop stimulation further enhanced leg movements. Repeated application of this closed-loop stimulation led to progressive improvement in stimulus-induced stepping and muscle responses, particularly in participants with thoracic SCI, and in stimulus-free stepping, particularly in participants with incomplete SCI. Our findings indicate that the preserved lumbar spinal motor circuit plays a crucial role in improving stimulus-induced stepping, whereas the preserved descending pathway is required for improving stimulus-free stepping. This non-invasive closed-loop spinal stimulation paradigm bypasses the lesion site on the spinal cord and strengthens both the preserved spinal circuits and the descending pathways to allow bilateral stepping control to be regained after SCI. This approach holds great promise for SCI-related gait rehabilitation because it has the potential to lead to functional recovery. Furthermore, this approach offers a viable alternative for individuals with contraindications to invasive procedures or those who do not consent to surgical treatments.

This study aims to verify the feasibility of measuring the living space of elderly people living alone. The system uses a low risk of identifying personal information by using motion sensors indoors and a smartwatch's GPS (Global Positioning System) records when going out. On the first day of the demonstration, the motion detection sensor system was installed in the home, and the subjects were instructed on using and charging the smartwatch. The participants continued their daily lives for 8 weeks. The indoor system recorded activities such as moving between rooms, using the toilet, and sleeping, while the smartwatch tracked outdoor living spaces using GPS. In the future, we are investigating about how the living space of elderly people living alone is related to their medical characteristics, cognitive function, and physical function, and how it affects their activities of daily living by using our system.Clinical Relevance- The system is expected to enable the monitoring of indoor and outdoor activities of daily living for community-dwelling older adults living alone, and to assess real life-space environments from the perspective of Preventing leakage of personal information and enhancing participant adherence by using human-detection techniques that place minimal burden on older adults.

Sleep disorders affect one-third of the general population, with prevalence significantly increasing among the elderly. Rocking beds utilizing vestibular stimulation have shown promise as non-pharmaceutical interventions for improving sleep quality. However, existing designs lack the necessary features for retirement facilities, such as protective handles and reclining backrests, limiting their accessibility for elderly individuals who often experience markedly reduced sleep quality. In this work, we introduce Somnomat Care, an evolution of the long-running Somnomat sleep intervention project. While Somnomat Casa was designed for home use, Somnomat Care extends this concept to nursing homes and clinical environments, offering hospital-style functionality. Key enhancements include adjustable headrests, leg rests, and safety side rails, ensuring usability and safety for elderly residents. Preliminary feasibility testing with Somnomat Care demonstrated its viability and ease of integration into elderly care facilities or nursing homes. Combining innovative sleep robotics with tailored design for vulnerable populations, the newly designed robotic bed aims to enhance sleep quality, improving overall health and well-being in institutionalized elderly individuals. Future studies will validate its efficacy and assess long-term benefits, positioning Somnomat Care as a practical tool for improving sleep in geriatric care environments. Video: https://youtu.be/OfjqR86ORLI.

The growing prevalence of chronic health conditions in aging populations highlights the need for innovative solutions in rehabilitation and long-term care. We propose a multimodal system designed to automatically classify Activities of Daily Living (ADLs) and, in the future, support the prevention of secondary health conditions in institutionalized elderly individuals. This system continuously integrates six commercially available wearable and nearable sensors to monitor ADLs over two weeks, ensuring data completeness and maintaining high data quality throughout the trial. In this study, we present pilot data from two residents of a Japanese elderly care facility, demonstrating the proposed system's feasibility and usability. The collected data was comprehensive and robust, with residents showing strong acceptance of the wearable and nearable technologies for long-term use. These findings underscore the potential of multimodal sensory systems to enhance rehabilitation strategies by enabling continuous health monitoring. Integrating ADLs monitoring into rehabilitation programs may facilitate early detection of health changes and support personalized interventions, building on the success of digital health tracking in other clinical domains.

AIM: This study aimed to explore differences in the emotions of patients with mild cognitive impairment (MCI) and Alzheimer's dementia (AD) in group rehabilitation using facial analysis. METHOD: We conducted rehabilitation consisting of aerobic exercise, cognitive training, dual tasks (a combination of exercise and cognitive training), and creative activities in a group format with patients with MCI and dementia. The faces of the 30 patients (MCI: n=14; mild/moderate AD: n=16) who participated were filmed from the front with a small camera during the four tasks. Then, we used the Kokoro Sensor (CAC Corporation, Japan), a device which estimates emotion scores (anger, contempt, disgust, fear, joy, sadness, surprise) based on different parts of the face using artificial intelligence, to calculate emotion scores for each activity, and compared them between the MCI and AD groups. RESULTS: Emotion scores for fear and surprise were significantly higher for the AD group than for the MCI group during dual tasks (p=0.016), while emotion scores for joy were significantly higher for the MCI group than for the AD group during creative activities (p=0.012). CONCLUSION: Creative activities and dual tasks, which require simultaneous physical activity and cognitive thinking, were difficult for patients with AD. On the other hand, tasks which used a range of cognitive functions, such as creative activities, evoked joy in patients with MCI. It may be beneficial to provide tasks and support to patients with respect to their unique emotions based on these results.

In this study, we assessed the physical burden on professional caregivers when using a transfer support robot, "Hug," to transfer and move a care recipient. We compared heart rate (HR), heart rate variability (HRV), and the time-series synchronization between HRV and respiration in caregivers using the robot or a normal wheelchair as control. Under both conditions, a commercial wearable device was used to simultaneously obtain electrocardiogram and respiration signals while performing care tasks, which comprised transfer from a bed to a wheelchair or to the robot, movement to a remote location, and transfer to a chair. We found that HR was significantly higher and HRV and wavelet coherence were significantly lower in the control than with Hug during at least the first 30 seconds of rest after the task (p < 0.05). This suggests that Hug could reduce the increase in HR and thereby maintain a more constant rhythm between HRV and respiration during care tasks. A post-task questionnaire also revealed that caregivers felt the physical burden of the tasks was reduced using Hug. Our results suggest that the introduction of transfer support robots can reduce the physical burden for caregivers of daily transfer assistance tasks.

BACKGROUND: Interventions and care that can evoke positive emotions and reduce apathy or agitation are important for people with dementia. In recent years, socially assistive robots used for better dementia care have been found to be feasible. However, the immediate responses of people with dementia when they are given multiple sensory modalities from socially assistive robots have not yet been sufficiently elucidated. OBJECTIVE: This study aimed to quantitatively examine the immediate emotional responses of people with dementia to stimuli presented by socially assistive robots using facial expression analysis in order to determine whether they elicited positive emotions. METHODS: This pilot study adopted a single-arm interventional design. Socially assistive robots were presented to nursing home residents in a three-step procedure: (1) the robot was placed in front of participants (visual stimulus), (2) the robot was manipulated to produce sound (visual and auditory stimuli), and (3) participants held the robot in their hands (visual, auditory, and tactile stimuli). Expression intensity values for "happy," "sad," "angry," "surprised," "scared," and "disgusted" were calculated continuously using facial expression analysis with FaceReader. Additionally, self-reported feelings were assessed using a 5-point Likert scale. In addition to the comparison between the subjective and objective emotional assessments, expression intensity values were compared across the aforementioned 3 stimuli patterns within each session. Finally, the expression intensity value for "happy" was compared between the different types of robots. RESULTS: A total of 29 participants (mean age 88.7, SD 6.2 years; n=27 female; Japanese version of Mini-Mental State Examination mean score 18.2, SD 5.1) were recruited. The expression intensity value for "happy" was the largest in both the subjective and objective assessments and increased significantly when all sensory modalities (visual, auditory, and tactile) were presented (median expression intensity 0.21, IQR 0.09-0.35) compared to the other 2 patterns (visual alone: median expression intensity 0.10, IQR 0.03-0.22; P<.001; visual and auditory: median expression intensity 0.10, IQR 0.04-0.23; P<.001). The comparison of different types of robots revealed a significant increase when all stimuli were presented by doll-type and animal-type robots, but not humanoid-type robots. CONCLUSIONS: By quantifying the emotional responses of people with dementia, this study highlighted that socially assistive robots may be more effective in eliciting positive emotions when multiple sensory stimuli, including tactile stimuli, are involved. More studies, including randomized controlled trials, are required to further explore the effectiveness of using socially assistive robots in dementia care.

The use of robotic nursing care equipment is an important option for solving the shortage of nursing care personnel, but the effects of its introduction have not been fully quantified. Hence, we aimed to verify that face-to-face care is still provided by caregivers in transfer situations when using robotic nursing care equipment. This study was conducted at a nursing home where the bed-release assist robot "Resyone Plus" is installed on a long-term basis. Caregiver gaze was analyzed quantitatively for one user of the equipment during transfer situations, and communication time, which involved looking at the face of the care recipient, as well as face-to-face vocalization, was measured. The caregiver spent 7.9 times longer looking at the face of and talking to the care recipient when using Resyone than when performing a manual transfer. In addition, the recipient was observed to smile during Resyone separation, which takes about 30 s. The results indicate a possible improvement in the QOL of care recipients through the use of robotic nursing care equipment as a personal care intervention. The ongoing development of robot technology is thus expected to continue to reduce the burden of caregiving as well as to improve the QOL of care recipients.

Many haptic guidance systems have been studied over the years; however, most of them have been limited to predefined guidance methods. Calculating guidance according to the operator's motion is important for efficient human motor adaptation and learning. In this study, we developed a system that haptically provides guidance trajectory by sequential weighting between the operator's trajectory and the ideal trajectory calculated from a predictive-vision system. We investigated whether motion completion with a predictive-vision system affects human motor accuracy and adaptation in time-constrained goal-directed reaching and ball-hitting tasks through subject experiments. The experiment was conducted with 12 healthy participants, and all participants performed ball-hitting tasks. Half of the participants get forceful guidance from the proposed system in the middle of the experiment. We found that the use of the proposed system improved the operator's motor performance. Furthermore, we observed a trend in which the improvement in motor performance using this system correlated with that after the washout of this system. These results suggest that the predictive-vision system effectively enhances motor accuracy to the target error in dynamic and time-constrained reaching and hitting tasks and may contribute to facilitating motor learning.

Assistive robots and technologies can play a key role in supporting the independence and social participation of older people, helping them living healthy lives and reducing the burden on caregivers. To support the effective development of assistive robots and technologies, it is important to develop a “living laboratory” to verify and adapt technology in real-life living spaces. The purpose of this study is to validate assistive robots using a living laboratory that simulates typical indoor and outdoor real-life situations. The rationale is to enable evaluation of daily living activities of older people in a simulated living space. To minimize the risk of trauma after falls, a ceiling suspension system was installed in the living laboratory. Six different commercially available mobility and transfer support robots were introduced and tested. We demonstrated that effective scenarios could be implemented using these assistive robots within the living laboratory. We implemented a 3D markerless motion capturing system in the outdoor space and showed that outdoor activities, including walking up and down a ramp, could be verified with sufficient accuracy in three cases: (i) normal use without a robot, (ii) use of the ceiling suspension system, and (iii) use of a mobility support robot on three healthy subjects. These results suggest that the proposed living laboratory can support testing and verification of assistive robots in simulated living environments.

INTRODUCTION: Emotional contagion is achieved by inferring and emotionally resonating with other persons' feelings. It is unclear whether age-related changes in emotional contagion for infant sounds are modulated by the experience of childbirth or childcare. This study aims to evaluate changes in inference and emotional resonance for positive and negative infant sounds (laughter and crying) among women, based on age and parous experience. METHODS: A total of 241 women (60 young nulliparous, 60 young parous, 60 old nulliparous, and 61 old parous) completed a web-based questionnaire. After listening to three types of infant sounds (laughter, cooing, and crying), participants responded with their valence for hearing infant sounds and estimated infant valence on an 11-point Likert scale. RESULTS: The analysis for emotional resonance revealed that the correlation coefficient between self and estimated infant valences was greater in young parous and old nulliparous women than in young nulliparous women, in laughter and cooing sounds. However, correlation coefficients for crying did not differ among any of the four groups. CONCLUSION: The degree of emotional resonance for infant valence increased depending on age and parous-experience for positive infant sounds.

BACKGROUND: The introduction of nursing care-support devices using robotic technology is expected to reduce the task burden in long-term care facilities. OBJECTIVE: To investigate the use of the rise-assisting robot, Resyone, in extending and improving the life space of nursing home residents with severe care needs. METHODS: We performed a feasibility study in which Resyone was used to facilitate visits to additional sites in and around the nursing home as part of the care package of three residents. Two weeks before and four weeks after implementation of the new arrangements, the 30 caregivers involved were asked to record transfer times and destinations, while also checking the residents' facial expressions. RESULTS: Before implementation, participants had limited life spaces, but afterwards they regularly visited additional destinations including the garden, home entrance and corridors, which previously they had not visited frequently. The residents' facial expressions became more positive and less negative. This study demonstrates that Resyone can enrich care activities in severely disabled individuals. CONCLUSION: These findings suggest that the sustainable use of Resyone would improve the quality of care at care facilities. Moreover, the extension of otherwise limited life space has the potential to improve care receivers' quality of life. TRIAL REGISTRATION: UMIN Clinical Trials Registry No. UMIN000039204 (20/01/2020); retrospectively registered; interventional study; parallel, non-randomized, single blinded. URL of trial registry records: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044709 .

The long-term use of transfer support robots in nursing facilities is an important option for improving the efficiency of care work. The "Resyone" transfer support robot is a combination of an electric care bed and a wheelchair, and the wheelchair half of the bed can be detached at the touch of a button. The purpose of this study was to investigate how the long-term use of Resyone would improve the performance of transfer assists, such as reducing the need for multiple caregivers. One Resyone was installed in a nursing facility in Japan and 17 caregivers used it for more than 11 months. The time and number of caregivers required for each transfer assist were surveyed for three 1-week periods: 1 week before (Phase 1) and at 3 weeks (Phase 2) and 11 months (Phase 3) after the introduction of Resyone. In Phase 1, approximately 60% of all transfer assists were performed by two caregivers, but in Phase 2, this was reduced to approximately 20%, and finally, in Phase 3, all transfer assists were performed by a single caregiver. These results suggested that the long-term use of Resyone was associated with improved work efficiency in transfer assistance in a nursing facility.

OBJECTIVE: The aim of this study was to assess safety issues of self-controlled repetitive trans-vertebral magnetic stimulation (rTVMS) in humans. METHODS: We investigated effects of self-controlled rTVMS (≤20 Hz, ≤90% intensity) on vital signs and subjective sensations in 1690 trials of 30 healthy volunteers and 12 patients with spinal cord disorders. RESULTS: Healthy volunteers and the patients received 4595 ± 2345, and 4450 ± 2304 pulses in one day, respectively. No serious adverse events were observed in any participants, and only minor events were seen as follows. While blood pressure was unaffected in the patients, the diastolic blood pressure increased slightly after rTVMS in healthy volunteers. The peripheral capillary oxygen saturation increased after rTVMS in healthy volunteers. "Pain" or "Discomfort" was reported in approximately 10% of trials in both participants groups. Degree of the evoked sensation positively correlated with stimulus intensity and was affected by the site of stimulation. CONCLUSION: Self-controlled rTVMS (≤20 Hz and ≤90% intensity) did not induce any serious adverse effects in healthy volunteers and patients with spinal cord disorders. SIGNIFICANCE: Our results indicate that rTVMS can be used safely in physiological investigations in healthy volunteers and also as treatment for neurological disorders.

BACKGROUND: To reduce the physical burden of caregivers, wearable transfer support robots are highly desirable. Although these robots are reportedly effective for specific tasks in experimental environments, there is little information about their effectiveness at nursing care facilities. The aim of this study was to identify care tasks and operations suitable for the use of these robots among caregivers in nursing facilities where these robots have been in use on a daily basis. METHODS: A 1-min observational time-motion analysis was conducted to examine care tasks and operations in two nursing facilities where wearable transfer support robots, namely Muscle Suit or HAL® Lumbar Type for Care Support, have been used routinely on a daily basis for more than 24 months. RESULTS: Analysis of the care tasks and their time ratio while wearing the equipment revealed that both robots were used conspicuously for direct care in over 70% of transits, especially during transfer assistance and toileting care. Furthermore, these robots were used intensively in the morning along with wake-up calls to care recipients, where pre-assigned wearers used them as part of their "routine work." CONCLUSIONS: We found that these wearable transfer support robots enabled effective performance of care tasks and operations in nursing facilities where these robots have been used on a daily basis for an extended period of time. These results may lead to the effective implementation and sustained operation of other types of care robots in the future. TRIAL REGISTRATION: UMIN Clinical Trials Registry no. UMIN000039204 . Trial registration date: January 21, 2020. Interventional study. Parallel, non-randomized, single blinded.