24 They are also used extensively
in clinical training, as discussed earlier.
Robots are also being explored in mental and behavioral healthcare applications. Robots are being used to support
people with autism spectrum disorder
and cognitive impairments, to encourage
wellness, and to provide companionship.
(See Riek29 for a detailed review of
For physical task support, robots
can provide external manipulation and
sensing capabilities to DRUs. For example, wheelchair mounted robot arms
can provide reach, smart wheelchairs
can help facilitate safe navigation and
control, and telepresence robot surrogates can enable people with severe
motor impairments the ability to fly,
give TED talks, and make coffee.
6, 7, 38
There are other examples of external
robots that are outside the scope of this
paper, but could prove highly pertinent
in healthcare. For example, autonomous
vehicles may provide new opportunities
for DRUs to locomote, or may enable
EMTs to focus on treating patients rather
than driving ambulances. Telepresence
may also have unforeseen applications
in healthcare, such as through aerial
manipulation, drone delivery of medical supplies, among others.
Healthcare Robotics Adoption:
Challenges and Opportunities
While there are exciting advances in
healthcare robotics, it is important to
carefully consider some of the challenges inherent in healthcare robotics,
and discuss ways to overcome them.
Robots have the ability to enact physical change in the world, but in health-care that world is inherently safety
critical, populated by people who may
be particularly vulnerable to harm due
to their disability, disorder, injury, or
illness. Stakeholders face five major
considerations when considering deploying robots in healthcare: Usability
and acceptability, safety and reliability, capability and function, clinical
effectiveness, and cost effectiveness.
Each is explored here.
Usability and acceptability. Robots
that are difficult for primary stakehold-
ers to use have a high likelihood of be-
ing abandoned. This phenomenon has
been well documented in the Assistive
5, 9, 20 For exam-
ple, a 2010 study reported that as many
as 75% of hand rehabilitation robots
were never actually tested with end us-
ers, rendering them completely unus-
able in practice and abandoned.
One the major challenges is that
clinicians, even those who are well-educated and accomplished in their disciplines, often have low technology literacy levels.
19 Thus, if they themselves
find a robot unusable, the likelihood of
them successfully training a direct robot user or caregiver to use the robot is
Another challenge is that DRUs are
often excluded from the robot design
process, which leads to unusable and
unsuitable technology. Robots with
multiple degrees of freedom, such as
wearable prostheses or wheelchair-mounted arms, require a high level of
cognitive function to control.
However, many people needing such robots
often have co-morbidities (that is, other conditions), which can make control
a further exhausting process.
There are several ways to address
this issue. One approach is for robot
makers to reduce robot complexity.
Balasubramanian et al.
2 argue for functional simplicity in therapeutic robot
design, which will lead to robots that
are easier for all primary stakeholders to use, control, and maintain. This
concept is echoed in much of the reliability and fault tolerance literature;
lower-complexity robots are more likely to be longitudinally reliable and fault
Forlizzi and Zimmerman propose
the idea of a service-centered design
process, wherein rather than only
think about a single user and a system, designers consider including
the broader ecosystem surrounding
10 This is a particularly
beneficial idea in healthcare robotics.
Rarely will there be one DRU and one
robot; rather, there is a complex social structure surrounding caregiving
that should be considered carefully in
Another important barrier to health-care robot adoption is its acceptability.
The morphology, behavior, and func-
tionality of a robot play a major role in
its adoption and use. When a DRU uses
a robot in public, they are immediately
calling attention to their disability, dis-
order, or illness. DRUs already face sig-
nificant societal stigma, so frequently
avoid using anything which further
advertises their differences, even if it
provides a health benefit.
27, 32, 33
Shinohara and Wobbrock argue that
in addition to designers considering
the functional accessibility of system,
they also consider its social accessi-
bility, and employ a “Design for Social
Acceptance” (DSA) approach.
means going beyond purely functional
designs, which may be “awkward and
34 Robot makers are usually
primarily concerned about a robot’s
functional capabilities; for example,
can the robot perform its task safely
and reliably given workspace, envi-
ronmental, and platform constraints.
However, the aforementioned litera-
ture suggests that there may be great
value in also considering a robot’s ap-
pearance and behavior to help enable
Safety and reliability. When robots
and people are proximately located,
safety and reliability are incredibly
important. This is even more critical
for DRUs who may rely extensively on
robots to help them accomplish physi-
cal or cognitive tasks, and who may not
have the same ability to recover from
robot failures as easily as non-DRUs.
There has been a fair bit of work
on safe physical human-robot inter-
action, particularly with regard to im-
proving collision avoidance, passive
compliance control methods, and new
advances in soft robotics to facilitate
37 There also have
been recent advances on algorithmic
verifiability for robots operating in par-
tially unknown workspaces,
may prove fruitful in the future.
However, there has been little work
to date on safe cognitive human-robot
interaction. People with cognitive dis-
abilities and children are particularly
prone to being deceived by robots.
This is an important and under-ex-
plored question in the robotics com-
munity, though a few efforts have been
made recently with regard to encourag-
ing robot makers to employ value-cen-
tered design principles. For example,
ensuring the appearance of the robot
is well-aligned with its function (for ex-
ample, avoiding false-advertising), en-
abling transparency into how a robot
makes decisions, and maintaining the
privacy and dignity of DRUs.
Another way to help bridge the