How the Swiss assistance robot Lio supports nursing care

Robots can take over repetitive and monotonous tasks in the care of sick and elderly people and thus relieve the nursing staff. A Zurich-based company has developed the mobile assistant Lio. In an interview, CEO and company co-founder Michael Früh describes what Lio can already do, what it will be able to do in the future and why it cannot replace humans Mr Früh, you developed the robot Lio.

Who is Lio and what special features does he have?

Lio is the product of an interdisciplinary team of engineers, psychologists, neuroscientists, health professionals and other experts. “He” is a mobile assistance robot that is being developed and manufactured at our facility in Zurich. Lio was designed for use in retirement and nursing homes, clinics and home environments of people in need of care, where it supports professionals and cared-for people in their everyday lives. Lio does not look human, but has an animal or comic inspired character. He has an autonomously moving platform and a robotic gripper arm with which he can fetch, transport and offer objects. In addition, it has a variety of sensors such as cameras, distance sensors and a microphone to perceive its environment and communicate with it via speech. The combination of mobility, sensor technology and intelligent software allows Lio to be used multifunctionally. In the facilities, he has fixed goals: On the one hand, to relieve the specialist staff of repetitive tasks and thus give them more time to devote directly to the people being cared for. On the other hand, Lio contributes to increasing the quality of life of patients and residents. Here, for example, it also plays a role in offering people more independence again and motivating them to be physically active. Lio can also contribute to hygiene and safety, which is even more important at the moment.

Among the people cared for, adjectives such as “funny, hearty and a nice companion” probably come up most often. They often relate to it as if it were a pet.

Why is he called Lio? When it came to naming Lio, countless ideas arose in our office. We wanted to agree on something short and catchy. Because a deep voice is easier to understand, we were looking for a male or gender-neutral name. A name that is easy to remember and pronounce, even for people from other language regions. The result is the name Lio, which has no specific meaning. One of our clients thought about what “Lio” could stand for. They came up with “Kind, intelligent and organised”, which of course we can only agree with!

How would carers and residents describe Lio?

So far, the staff have accepted Lio as a team member quite quickly. Lio’s design and movements give him a friendly appearance that is not threatening. Since the staff has a very intensive daily routine, acceptance can be achieved in particular through concrete work relief. This is already the case for Lio’s first functions, such as transport or entertainment, and will increase greatly with further functions in the coming years. However, it is nice to see that the design concept of Lio is well received. Among the people cared for, adjectives like “funny, hearty and a nice companion” probably come up most often. They often relate to him as if he were a pet. After all, Lio is also designed as a character and intentionally does not look human.

Lio is better than other robots. Why and how is that recognisable?

Lio combines learning ability, social interaction and mobile packaging, which is so far unique in the context of robotics in care and nursing. Specifically, this means that Lio can not only perceive and react to its environment and people, but also physically interact with them. This is essential for many functions, such as personally handing a glass or opening a door. With this “basic equipment”, Lio is able to learn countless more functions in the future. With our background at the AI Lab of the University of Zurich, Lio has always been developed to work directly with humans. The result is a multitude of useful features, such as the soft outer shell or the touch-sensitive head, which enable the robot to be used in everyday life.

You say that Lio was developed in close cooperation with users, i.e. care professionals and older people or people with care and support needs. What exactly did you do and how did you involve the users and implement their requirements?

A user-centred development is indispensable, especially for an assistance robot like Lio. This is the only way to ensure that it can provide the best possible assistance to the people concerned. Institutions such as the Zihlschlacht rehabilitation clinic, Caritas Konstanz and Agaplesion Berlin have helped us to put early product versions into practical use. Through surveys of the user groups, workshops, early field testing of the prototypes in the right environment or with the help of usability tests, we were able to constantly do the reality check. The results are continuously integrated into the development process and Lio’s functionality is adapted accordingly. For example, Lio’s design, his voice pitch, the height of his head and the shape of his eyes is a well thought-out concept based on user input and literature research. After all, no one knows better what is needed than the people who work or live in Lio’s field of application every day.

What does Lio actually do in reality, what can it do theoretically and what will it be able to do in the future, and what development is needed for this?

Currently, fifteen Lios are in use in various facilities in Switzerland and Germany. In the facilities, Lio takes on a wide variety of tasks and functions in the areas of physical support, well-being, activation and safety & hygiene. For example, Lio is responsible for transporting mail or blood samples, disinfecting door handles, reminding and entertaining residents (including physical and cognitive activation), giving tours of the facility to new residents or guests, etc. Current projects and new developments are lift driving and night watch (driving through the corridors at night, recognising people if necessary and informing staff in case of abnormalities). In addition, Lio can be controlled remotely and thus be useful to people with severe physical disabilities and give them more independence again. This has already been used in the home of a quadriplegic and in a rehabilitation centre in German-speaking Switzerland. Lio also has facial recognition capabilities, which would theoretically allow for a wide range of functionalities. However, there are factors such as data protection or ethical factors that need to be taken into account and that still set some limits to the functions. All of these functions have the common goal of relieving professionals and offering the people being cared for a better quality of life. Of course, this is within the bounds of what is technically possible and ethically desirable. In the future, further functions are conceivable, such as collecting and distributing laundry, help with administrative tasks or functions that give residents and patients more independence again (accompanying them to the toilet, putting on support stockings, etc).

Where do people still need help and why?

People will always be needed for care, interpersonal relationships and emotional work. No robot can or should replace that. On the contrary, by taking over routine tasks, our Lio should give nursing more time for this human contact.

Is there an amusing application situation of Lio that made the people involved laugh heartily? Or does Lio not have a sense of humour?

In fact, Lio makes staff and residents laugh more often than not. It is always amusing when people try Lio’s “tickle” function for the first time. With this you can tickle Lio, whereupon he emits a laugh that actually never fails to put a grin on people’s faces. Lio also actually has plenty of jokes ready to tell when asked. One specific situation that comes to mind is a conversation between two residents. One of them wanted to offer Lio a chocolate bar. Her colleague jumped in and said that she wanted to bribe him to come to her more often, but that wouldn’t work. Lio should not fall for it.

There are a variety of support functions that can be performed by robots. Lio currently performs tasks in the area of transport (lab samples, mail), disinfection of doors, night watch in the corridors, activation through movement exercises and entertainment such as storytelling or music.

Imagine if robotics to support humans in health and physical matters had to be reinvented all over again. Should something be done differently and if so, what?

Robotics builds on technologies from many other fields. Examples include processors, cameras, sensors, gears and motors that come from the computer or automotive industries. Software building blocks such as speech recognition, object recognition algorithms, etc. are also adapted from other applications. All of these technologies are evolving rapidly. Bringing these complex technologies together is already a challenge in and of itself, yet many helpful robots have been developed in recent years. I don’t believe that a completely different approach would make much better robots available for the health sector today. In fact, technical limitations are often the reason why more robots are not already in use. However, the integration of practice must come first. This could certainly have been done more intensively in recent years.

Let’s think for a moment about robotics in principle in everyday nursing and care in the various care settings, i.e. hospital, long-term setting, outpatient or home care. Which specific application situations can also be supported by robotics in the future?

There is a wide range of support functions that can be provided by robots. Lio currently takes over tasks in the area of transport (laboratory samples, mail), disinfection of doors, night watch in the corridors, activation through movement exercises and entertainment such as storytelling or music. Lio is designed in such a way that countless new functions can be learned in the future. For example, reminders and accompanying residents in the facility are frequently mentioned topics. Or the integration into the communication system, so that Lio can automatically receive and perform certain tasks and report them to its human colleagues. Robots can also help people with a physical limitation to live more independently again, for example through a robot that can be operated via wheelchair control.

If you had to name disadvantages of robotics, what would they be?

Robots have no empathy and are not suitable to replace interpersonal relationships. One disadvantage that we hear a lot but is not true is the loss of jobs. Interestingly, countries with the most robots per capita have the lowest unemployment. This is due to the higher competitiveness of these countries and the jobs created by robotics.

Where does Switzerland stand in international comparison with regard to robotics in healthcare?

Switzerland is first class in the development of robotics and the ecosystem of researchers and manufacturers is also impressive in international comparison. In healthcare, we have an above-average density of surgical and rehabilitation robots. In nursing and care, there are simply not yet as many robots commercially available – Lio is an exception. Therefore, we are probably average in this area at a low level in an international comparison.

Are there any hard-to-imagine developments in robotics that might still take a few decades, and what would they be?

In my view, there are two major challenges that will take some time to master. The first relates to the sensitivity of robots. We humans have hundreds of thousands of sensors in our fingers, eyes and ears and can use them to gather enormous amounts of information. This information is used by our “mechanics” to reliably grasp objects and handle different materials. Robots lack this wealth of information. The second challenge is to react to spontaneity or unforeseen situations. The human brain processes countless pieces of information within fractions of a second and sometimes even decides too quickly for our own perception, for example in the case of a reflex. Robots like Lio also use neural networks, i.e. a “decision engine” that processes the collected information and sensor data and suggests a next sensible action to the robot. In this area, humans are still clearly superior to robots in everyday situations.

Assistance robots like Lio do not have the task of replacing human closeness and attention.

How sustainable is robotics in terms of resources, production, maintenance, etc.?

Robots are technical devices that need electronics, aluminium parts and other components to function. Whenever possible, we source the components from Swiss suppliers and keep the delivery routes short. Lio works with a modern battery, so it is powered by electricity. Lio is probably comparable to a very small electric car in terms of sustainability.

What are your wishes for health professionals who use robotics and those who do not yet use it, e.g. nurses?

To approach new technology with openness and curiosity. In studies, it is often criticised that manufacturers should cooperate more closely with the practice in order not to develop without taking into account the need. We have done this consistently since the first prototype and have had the privilege of working with enormously innovative and enthusiastic health professionals. Mutual understanding is needed. You have to be able to forgive a wrong operation or a technical error by Lio. And that can only be achieved in a cooperation based on trust.

What take-home message would you like to give to the readers of SocietyByte?

Assistance robots like Lio do not have the task of replacing human closeness and care. Rather, by taking over monotonous tasks, they can help free up more time for human work. Moreover, as tireless helpers, they provide additional services, such as activation or night watch, which could not be provided to this extent without them.

The person

Michael Früh is CEO and member of the board of directors of F&P Robotics AG. The high-tech company was founded in 2014 and develops assistance robots. Michael Früh is a trained electronics engineer, studied business administration and international financial management, and completed further training in health economics. He is currently expanding the field of assistance robotics at F&P Robotics AG. Further information on the Lio assistance robot can be found here.

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AUTHOR: Friederike J. S. Thilo

Prof. Dr Friederike Thilo is Head of Innovation Field "Digital Health", aF&E Nursing, BFH Health. Her research focuses are: Design collaboration human and machine; technology acceptance; need-driven development, testing and evaluation technologies in the context of health/disease; data-based care (artificial intelligence).

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