Professor Wendy Moyle leads a multidisciplinary team researching the use of PARO, a robotic harp seal, as a non-pharmaceutical dementia therapy. Previous pilot studies found PARO reduced anxiety and increased pleasure in dementia patients compared to a reading group. Moyle's comprehensive new study aims to definitively establish PARO's effectiveness through a randomized controlled trial comparing PARO therapy to usual care alone and to a plush toy. The goal is to replicate pilot study results on a larger scale and provide a solid evidence base on PARO's impacts on behaviors, mood, and medication use for dementia patients.

1. Can you outline how your background has
led to your interest in using the robotic
baby harp seal called PARO (comPAnion
RObot) as a dementia therapy?
I lead evidence-based ageing research
at Griffith University and am a research
leader in the Australian National Dementia
Collaborative Research Centre – Carers and
Consumers. My work focuses on finding
evidence for managing behavioural and
psychological symptoms of dementia, which
include agitation, aggression and wandering.
These symptoms are common, occurring in
over 60 per cent of people with this condition,
and are difficult to manage. They can be
responsible for caregiver stress, the regular use
of antipsychotic medication and people being
placed into institutional care. Simple changes
in environment are known to have a positive
impact, and one such change is interaction
with robotic animals.
Several years ago I found that a number of
long-term care facilities had purchased robotic
animals as a means of reducing symptoms of
dementia. However, without clear protocols
on their use and maintenance, they were
more likely to be found in cupboards than
in use. The first time I saw PARO I realised
its potential for engaging people with
dementia, and the descriptive evidence for
its use encouraged me to develop a proposal
and look for funds to definitively establish
whether robotic animals were suitable as non-
pharmaceutical interventions.
A furry friend
A multidisciplinary team led by researchers at Griffith University, Australia, is conducting the world’s most
comprehensive study on the use of robotic animals as a therapeutic tool for those affected by dementia
Professor Wendy Moyle offers an introduction to her research into the potential use of a therapeutic
robot seal as an effective, non-pharmaceutical method to support people living with dementia
Robotic dementia therapy
PROFESSORWENDYMOYLE
78 INTERNATIONAL INNOVATION
DISEASES RELATED TO ageing are among
the greatest challenges public health systems
currently face, with the burden likely to
continue, or even worsen, over the coming
years.Amongthis groupof conditions,dementia
– a syndrome associated with an irreversible
decline in brain activity – poses a particular
burden. The World Health Organization (WHO)
estimates that 35.6 million people across the
world have dementia and, at the current rate
the global population is ageing, this figure is
estimated to double every 20 years.
Dementia refers to a range of cognitive,
behavioural and psychological symptoms,
which often cause distress among people
with the disease and their families. These
include issues with memory, impaired mental
agility, agitation, aggression and a tendency
to wander. Since most forms of dementia are
progressive and cannot be cured, treatment
mostly focuses on ensuring patients are
comfortable and safe, with many going into
residential homes to receive care. However,
the nature of dementia means that those living
with symptoms can also experience apathy,
loneliness and depression, which can make it
difficult for care professionals to provide the
level of support needed.
CAN ROBOTS HELP?
Given the scale and urgency of the dementia
challenge, researchers around the world are
working hard to find ways of improving quality
of life for patients. A particularly innovative
example of this is the development of therapeutic
robotic animals that can be used to engage
lonely older people and other individuals with
cognitive deterioration. The rationale for this
type of therapy is based on a wealth of research
suggesting that regularly interacting with animals
can have a positive impact on social behaviour,
and encourage individuals with dementia to
verbally communicate. However, as it is not
alwaysfeasible or practicalfor care homes to keep
pets, a life-like robot could be a viable alternative.
PARO (comPAnion RObot), a baby harp seal
invented by Dr Takanori Shibita in Japan, is a
notable realisation of this type of therapeutic
robot. Beneath its cute, toy-like appearance,
PARO is a highly sophisticated device that
can respond to touch and the human voice
through its movements and sounds, show a
range of emotions, and ‘learn’ which aspects of
its behavior will encourage humans to respond
positively so it can repeat them. Since its
invention, PARO has been introduced to a range
of long-term care facilities around the world.
PARO AS A DEMENTIA SUPPORT TOOL
Professor Wendy Moyle of Griffith University
leads research that aims to improve the quality
of life among older people through evidence-
based solutions. She became interested in
PARO’s potential as a dementia-support tool
through her work on the management of the
behavioural and psychological symptoms of
the syndrome, including agitation, aggression
and apathy.
Now, together with an interdisciplinary team
of experts in dementia, neuropsychology,

2. What are the PARO’s key features?
Robotic animals, also called emotional or
therapeutic robots, have recently been
introduced as companions for people with
cognitive impairment and other physical
problems. The advantages of robotic pets
have been listed as: highly imitative, lifelike
behaviour; the ability to model emotional
states usually experienced by humans; and
the capacity to provide interaction without a
carer present. This means that robotic animals
can fill those inevitable gaps in the day when
the resident is alone because the carer is
otherwise occupied.
Descriptive studies have reported
improvements in relationships, loneliness,
relaxation, motivation and socialisation in older
people who have interacted with such tools. It
remains unclear, however, whether therapeutic
robots such as PARO have significantly more
benefits compared to non-robotic interventions
or the usual care for dementia.
How do the reactions of people with
dementia to the seal vary? Is there a
specific patient profile that is most
responsive to the therapy?
Our pilot research demonstrated that there
are people who always react positively to the
animal robot, whereas there are others whose
responses vary. The majority of reactions
are positive, where the individual appears
to enjoy the opportunity to interact with
the robot. These are not related to gender,
age, or type or stage of dementia. However,
people who have previously had an emotional
attachment to a real animal appear to react
more quickly to the robot. Our current
research will help us to understand if there is
indeed a specific patient profile that is more
responsive to PARO.
By which methods do you measure
engagement, mood states and agitation?
It is very challenging to collect self-reported
data from individuals with dementia –
particularly those in the late stages of
the disease. Therefore, we make video
observations using a small camera and Noldus
Observer XT software to code and describe
agitation, mood and engagement. We also
measure agitation using the Cohen-Mansfield
Agitation Inventory, which is completed by
facility staff for each participant.
We record and compare an individual’s specific
behaviours, such as restlessness, agitation and
sleep disturbances, with their physiological
responsiveness as indicated by changes in
physical activity and sleep patterns following
introduction of PARO. The short-term effects
of daily experiences, such as engagement
with the tool, are established by comparing
physiological measures on stressor days versus
intervention days, and by establishing within-
person associations over time between daily
stressors and wellbeing. We measure such
changes via SenseWear arm monitors – a slim,
nonintrusive armband.
What motivates you in your work?
I am motivated by the comfort and pleasure I
see displayed by people with dementia when
they are provided with a robotic animal;
the knowledge that our work is making a
difference in the lives of people with dementia;
and the development and evaluation of non-
pharmacological interventions that aim to
enhance engagement and mood, and reduce
agitated behaviours.
PROFESSOR WENDY MOYLE
WWW.INTERNATIONALINNOVATION.COM 79
psychiatry, nursing, human movement,
biostatistics and health economics, Moyle
is driving the most comprehensive research
project to date on PARO’s effectiveness as a
non-pharmaceutical treatment for dementia.
ESTABLISHING AN EVIDENCE BASE
Until now, small numbers of participants,
as well as a lack of appropriate samples and
control groups, have hampered the reliability
of research into PARO and other therapeutic
robots. Moyle’s project aims to create the
solid evidence base that previous studies have
been unable to do. Specifically, she and her
colleagues are hoping to compare how patients
react to having PARO introduced alongside
their usual care plans, versus their usual care
alone. In addition, they will consider whether
a plush toy, which looks similar to PARO but
does not have its artificial intelligence, will
have similar effects on a person’s behavioural
and psychological symptoms. They will also
investigate the relationship between these
three different types of intervention and the
patients’ physical activities, sleep duration and
agitation levels.
Another key aspect of the study is to find out
how care staff and family members respond
to PARO as a form of therapy. Finally, the
researchers will analyse and compare the cost-
effectiveness of using the robotic tool and/or
the plush toy as a non-pharmacological method
to manage agitation, and improve engagement
and mood in people with dementia.
BUILDING ON THE PILOT STUDY
Moyle’s trial – which has a cluster, randomised,
control design – follows a pilot study that
generated promising results. This initial project
involved 18 people in long-term care for
dementia and set out to compare the effect of
interacting with PARO versus participating in a
reading group on participants’ behavioural and
psychological symptoms.
Individuals were regularly assessed against a
range of widely-used scales that indicate quality
of life. Through a combination of staff reports
and video analysis, the researchers found that
the group who was spending time with PARO
seemed to experience more pleasure and had
lower levels of anxiety than individuals in the

3. Beneath its cute, toy-like appearance, PARO is a highly sophisticated
device that can respond to touch and the human voice through its
movements and sounds
EFFECT OF AN INTERACTIVE
THERAPEUTIC ROBOTIC ANIMAL
ON ENGAGEMENT, MOOD STATES,
AGITATION AND ANTIPSYCHOTIC
DRUG USE IN PEOPLE WITH DEMENTIA
OBJECTIVES
To reduce the impact of dementia symptoms
and burden on the person with dementia,
family and staff, as well as potentially
reducing pharmaceutical usage through
an engaging activity using a robotic
animal called PARO. A cluster randomised
controlled trial will compare and evaluate
the relationship between physical activities,
sleep and agitation.
KEY COLLABORATORS
Professor David Shum; Dr Cindy Jones;
Dr Siobhan O’Dwyer; Dr Cindy Mervin;
Dr Marguerite Bramble, Griffith Health
Institute, Griffith University, Australia
Professor Elizabeth Beattie, Dementia
Collaborative Research Centre, Queensland
University of Technology, Australia
Professor Brian Draper, Dementia
Collaborative Research Centre, University of
New South Wales, Australia
Associate Professor Lukman Thalib,
Department of Community Medicine
(Biostatistics), Kuwait University
FUNDING
National Health and Medical Research
Council, Australia
Dementia Collaborative Research Centre –
Carers and Consumers
CONTACT
Professor Wendy Moyle
Griffith Health Institute
Centre for Health Practice Innovation
School of Nursing & Midwifery
Griffith University
Nathan Campus
Nathan 4111 Queensland
Australia
T +61 7 3735 5526
E w.moyle@griffith.edu.au
http://bit.ly/moyles_research
WENDY MOYLE is Director of the Centre
for Health Practice Innovation, a research
programme at the Griffith Health Institute.
Her expertise covers behavioural and
psychological symptoms of dementia,
quality of life for people with dementia
and families, assistive technologies, social
robots, and complementary and alternative
medicine; she has authored 157 peer-
reviewed publications on these areas.
80 INTERNATIONAL INNOVATION
INTELLIGENCE
reading group. This affect was irrespective
of factors such as age, gender and level of
cognitive impairment.
In their new study, Moyle and her colleagues
aim to replicate these findings on a larger scale,
as well as provide further insights into exactly
how and why PARO positively impacts upon
people with dementia. The researchers have
gained the backing of PARO’s inventor who, in
support of their work, loaned them some of the
robots and reduced the cost of others.
WINNING OVER THE CRITICS
Another important aim of Moyle’s work is
to provide reassurance regarding the use of
robots in a therapeutic setting to those who
are uncomfortable with the idea. A common
bugbear among critics is that the use of robots
in this way could lead to automated care;
shifting the emphasis away from personal,
human interaction and increasing levels of social
isolation and loneliness. “Where residents have
been using PARO, staff often see the person in a
more positive light and are reminded that they
are, foremost, a human being,” counters Moyle.
“This can result in much more constructive
interaction with staff.”
Moyle is keen to emphasise the importance of
introducing therapeutic robots such as PARO
with the psychological needs of the individual
in mind. She also asserts that the intervention
should not be seen as a replacement for other
types of care but as a complement: “We do not
advocate that robots are used in place of human
contact, but as an adjunctto human interaction”.
PREDICTING THE OUTCOMES
Basedonthepilotstudy,Moyleandhercolleagues
are hopeful that their trial will show PARO to be
an effective means of alleviating the behavioural
and psychological symptoms of dementia, thus
reducing the need for psychotropic medication.
They also predict that family members and care
staff will react positively towards PARO, and that
itwillbecost-neutralincomparisonwiththeusual
care. If they are successful, their results could
encourage a greater number of care providers
to consider using robots to improve the lives of
people with dementia and other conditions that
can cause loneliness in older people.