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2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and

Networks (CAMAD)

Key challenges for developing a Socially Assistive


Robotic (SAR) solution for the health sector
Keven T. Kearney, Domenico Presenza, Federica Saccà, Philip Wright
Research and Development Laboratory
Engineering Ingegneria Informatica S.p.A.
Rome, Italy
{Keven.Kearney & Domenico.Presenza & Federica.Sacca & Philip.Wright}@eng.it

Abstract — To help meet the health and caregiving needs of an their autonomy longer and delay the need for social/health
increasingly ageing population, Engineering is developing SARA, service interventions [11]. Advances in artificial intelligence
a “Socially Assistive Robotic Solution for Ambient assisted (AI) and IoT technologies are rapidly converging to make such
living”, as an extension of its commercial AREAS Enterprise solutions both technically and economically feasible. In this
Resource Planning suite for the Health sector. SARA is a complex light, Engineering [12] is extending its current commercial
distributed home automation and robotics system providing AREAS® suite - an Enterprise Resource Planning solution for
health monitoring and (socially interactive) assistance in daily the Health sector - with SARA (Socially Assistive Robotic
living tasks to the elderly (and their caregivers) at home – with Solution for Ambient assisted living), a robotic system aimed
the aim to prolong their autonomy and delay their
at providing automated health/incident monitoring and home
institutionalization. While advances in artificial intelligence and
internet-of-things technologies are converging to make SARA
assistance to elderly people with mild cognitive impairments.
(and similar automated solutions) ever more technically feasible This paper describes some of the key challenges entailed in the
and economically viable, there nevertheless remain significant development of SARA and highlights areas where smart end-
technological challenges to overcome. This paper introduces to-end IoT interoperability, connectivity and security –
SARA, describes some of the key challenges faced in its technologies at the heart of the EU funded SEMIOTICS
development, and explains how smart end-to-end IoT project [13] - can play a critical role.
interoperability, connectivity and security can help tackle these
The remainder of this paper comprises the following
challenges.
sections: Section II provides an overview of the system;
Keywords— IoT, Cloud, SAR, AAL, MIC, Alzheimer disease, Section III presents an application scenario and lists some key
robotic, HRI assistive tasks supported by SARA; Section IV describes
significant technological challenges in developing SARA; and
Section V provides a summary conclusion.
I. INTRODUCTION
The global trend for increased life expectancy [1] is II. OVERVIEW OF THE SARA SYSTEM
expected to be accompanied by a rapid rise in the number of
people affected by Mild Cognitive Impairment (MIC) [2] or As its name indicates, SARA is a Socially Assistive
mild Alzheimer’s disease (AD) [3] [4]. Aging and dementia Robotics (SAR) solution, which [14] define as the intersection
lead to a significant chronic loss in physical/cognitive of Assistive Robotics (AR) - typically robots that provide
capacities and a decline in functional ability, resulting in physical assistance (e.g. rehabilitation robots, wheelchair
increased dependency and need for caregiving [5], with robots, mobility aids, manipulator arms) - and Socially
substantial medical, social, psychological, and financial Interactive Robotics (SIR) - whose main task is some form of
burdens placed on patients, their families, and their social interaction with humans (e.g. engaging in conversation,
communities [6]. Indeed, the kind of continuous, holistic and understanding gestures, role taking, task collaboration). SAR
integrated care required by people with dementia cannot be aims to assist humans through social interaction – an ambitious
satisfied by the current ‘specialist’ model [7], and the gap goal given that social interaction is arguably the most complex
between the number of people in need of care and those able of all human behaviours. A socially competent robot, for
to provide it is expected to grow [8]. People also prefer to live example, according to [15], should be able to: communicate
in their own homes for as long as possible rather than being with high-level dialog; use natural cues (gaze, gesture, etc.);
institutionalized in sheltered/nursery homes when age-related express and/or perceive emotions; learn/recognise models of
problems appear [9]. Leading, for example, [10] to propose other agents; exhibit distinctive personality and character;
“Aging in place” - allowing older adults to age in the least establish and maintain social relationships; (possibly)
restrictive environment of their choice - as a more desirable learn/develop social competences.
and viable care model. Achieving human level competence in these areas is well
Home automation and robotics systems can help relieve the beyond even the best of contemporary AI technologies, so
caregiving burden and make ‘ageing in place’ a reality by with SARA our goal is more pragmatic. We aim to develop an
providing physical and cognitive assistance to the elderly in expandable platform that initially exhibits only trivial social
the common tasks of daily home living, helping them maintain capabilities (well within current technological limits), while

978-1-5386-6151-2/18/$31.00 ©2018 IEEE


2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and
Networks (CAMAD)

yet providing a solid foundation for future expansion to more With the exception of the ACS and RR (both developed in
sophisticated human-like interactions. house by Engineering) these components are all off-the-shelf
devices that are not specifically designed to work together.
In line with previous work on ‘intelligent environments’
The different devices consume and produce different kinds and
suited to the elderly [11][16], the design of SARA integrates a
quantities of data, in diverse formats, and support different
number of assistive technologies to address the diverse
modes of network communication (Bluetooth, Wi-Fi, wired
problems that older people face when living independently
ethernet, can-bus, etc.). Moreover: for reliability, critical data
with the support of their community. More specifically, it
is collated from multiple redundant sources (several
comprises multiple mobile (mobotic) and static (domotic, or
components monitoring the same features) and shared through
home automation) robotic elements working in tandem with
multiple redundant channels; to ensure timely responses of
wearable health monitors, personal smart devices (phones and
robotic elements, AI intense computations (described in
tablets) and various (proprietary and third party)
Section IV below) are executed concurrently throughout the
computational and information services, to continuously
system, with operations dynamically dispatched to the nearest
monitor and assist elderly subjects (and their caregivers) in
available computing resources (including edge devices);
their normal daily activities in and around the home. The
network configurations are not static: mobile devices move
technical components of SARA are as follows:
around and may temporarily go out of range of Wi-Fi; mains
• backend AREAS Cloud Services (ACS): serving powered devices (e.g. Wi-Fi base stations, domotic servers)
primarily as a repository of medical records and an are lost during power outages, while battery powered devices
offline store for monitored bio-medical data; (e.g. robots and phones) will need periodic recharging; and
wearable health monitors (BAN devices) can be removed (e.g.
• a Body Area Network (BAN) comprising wearable when taking a bath).
health monitors (e.g. for heart-rate, blood pressure,
breathing rate, stress levels, balance and fall detection) In short, solely in terms of hardware, software, network
worn by the elderly subject and communicating via structure and network communications, SARA is a highly
Bluetooth to their personal device (phone or tablet); heterogeneous and dynamic distributed system, which of itself
raises a number of significant technical challenges (described
• a Robotic Rollator (RR): a smart wheeled walking further in Section IV). Additional challenges derive from the
frame providing physical support for standing, sitting application scenario, which is described in the next section.
and walking, and capable of monitoring its user’s
posture and gait, and of (limited) autonomous
III. APPLICATION SCENARIO: ASSISTING THE ELDERLY AT
navigation;
HOME
• a Robotic Assistant (RA): a mobile humanoid robot - As already stated, SARA is a robotic solution aimed at
specifically Softbank’s humanoid “Pepper” robot [17] - providing automated health/incident monitoring and home
capable of autonomous navigation, face recognition, assistance to elderly people with mild cognitive impairments.
scripted dialog and adopting life-like human poses (e.g. The solution is intended to be provided ‘as a service’, under
to perform arm/hand gestures); controlled supervision, by local health authorities, to eligible
• various AI Services: computational resources citizens. The following narrative (a hypothetical case study)
providing machine learning (ML), mapping, route illustrates some of the ways SARA could impact the daily lives
planning and reasoning capabilities (among others); of the elderly and their caregivers.

• a Smart Home: a home incorporating intelligent Piero is 70 years old and lives in a ‘smart’ apartment in
objects, utilizing wired or wireless networks and having Rome with his daughter who looks after his daily needs. Piero
the capacity to analyse patterns of activities to manage suffers mild Alzheimer’s disease and has problems walking
appliances in anticipation of human needs or to provide due to a recent hip replacement. As such, his General
adaptive cues for human occupants. Practitioner (GP) has registered him as eligible for SARA,
and the necessary technical components – Robotic Assistant
(RA), Robotic Rollator (RR) and wearable Body Area Network
(BAN) health monitors - have been delivered and configured
to his specific needs. His ‘smart’ apartment was already fitted
with various domotic (home automation) devices - including a
smart armchair and smart medicine box - all now integrated
into the SARA system.
One afternoon, while his daughter is out at the
supermarket, Piero sits dozing in front of the television -
which he has been watching for some time. The SARA system
notices this and (following ‘daily activity’ rules configured by
Piero’s GP) decides that Piero should instead perform one of
Fig. 1 SARA communication system his prescribed cognitive rehabilitation exercises. Accordingly,
the RA approaches Piero, calls him by name a few times to get
2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and
Networks (CAMAD)

his attention, and suggests the exercise. Piero agrees, and detects a change in his facial expression); Notifying assigned
they begin. For this particular exercise, the RA displays a caregivers of possible problems and incidents (e.g. SARA
sequence of pictures and symbols (on its chest-mounted tablet) alerts Piero’s daughter when Piero shows signs of distress);
which Piero has to correctly (verbally) identify. Enabling doctors/caregivers and family members to remotely
check in on a patient (e.g. on request, SARA initiates a remote
With the exercise done, the RA reminds Piero that it is time
audio/video link); Performing cognitive and physical
for him to take his medicine. Piero looks around but can’t find
rehabilitation exercises; Reminding patients to take prescribed
his tablets. He asks the RA where they are, and the RA informs
medication at allotted times; Access to and persistent storage
him that his ‘smart’ medicine box is in the kitchen. Piero asks
of detailed monitored health data (e.g. SARA maintains an
the RA to call the rollator (RR), which wakes, and
offline record of the historical data collected by the BAN,
autonomously steers itself from its rest position in the corner
which in the narrative is later accessed by the medic, but can
of the room to Piero. Using the RR for support, Piero stands,
also be used for general analytical/research purposes).
and walks to the kitchen - all the while being escorted and
monitored by the RA. This application scenario makes apparent the intimate and
critical role that SARA plays in the life of the elderly. The
On the way, however, Piero feels faint and staggers. His
system is embedded in the home and is an intimate part of an
BAN health monitors detect the loss of balance and reduction
elderly person’s daily life, with continuous access to highly
in blood pressure, the RR notices a change in his gait and
personal and sensitive data about their ongoing activities and
increased pressure on the handles, while the RA sees his
state of health. This naturally raises strong security and
expression change to a grimace. All of which is sufficient to
privacy concerns, which SARA must address. The role of the
raise an alert.
SARA system is also health-critical: it matters if the system
The SARA system duly notifies Piero’s daughter (as his fails to detect a health-related incident, or to remind a patient
assigned caregiver) of the situation. His daughter receives the to take their medicine. So SARA must also be robust and
alert on her mobile phone, and initiates a telepresence session dependable, which raises further technical challenges -
- a live two-way audio/visual stream from her phone to the especially in light of the system’s heterogeneous, dynamic and
RA’s built-in chest tablet – to assess the situation (avoiding distributed nature (Section III). Finally, as for any machinery
any need for her father to locate and answer his phone). His deployed in the home, and even more so in the homes of the
daughter quickly ascertains that Piero is not in any immediate elderly, SARA must be safe.
trouble, but she tells him that she’ll be home soon, and just to
In sum, even if we limit SARA (for now) to displaying
make sure everything is ok, also sends a request (through
only trivial social capabilities (Section II), it should be clear
SARA) for a remote medical check.
that there are nevertheless significant foundational technical
After the call, and feeling somewhat better, Piero challenges. We review these challenges in more detail in the
continues to the kitchen. The smart apartment automatically next section.
turns off the lights in the lounge, and turns on those in the
kitchen. The RA visually detects, and informs Piero, that his IV. TECHNICAL CHALLENGES
smart medicine box is over by the sink. Piero sits down at the
kitchen table and takes his pills, while the RR autonomously This section describes key technical challenges in the
parks itself in the corner of the room out of the way. design and development of SARA, with particular emphasis on
those aspects where SEMIOTICS innovations in smart end-to-
A short while later his daughter arrives home and, having end IoT interoperability, connectivity and security can play a
received notification that a medic is available and waiting, key role in providing a solution.
initiates a new telepresence session between the RA and the
medic - who has already accessed Piero’s medical records A. Challenges in Security, Privacy, Dependability and Safety
and recent BAN data. After walking Piero and his daughter
In section III (above) we highlighted a strong need for
through a few physical checks (e.g. taking his blood pressure),
addressing security, privacy, dependability and safety
the medic asks Piero’s daughter to hook up a heart and
concerns. This cannot be overstated. SARA, to re-iterate, is a
breathing monitor to the BAN and then remotely monitors the
technology aimed at a specific sector of the health domain. It
readings as Piero performs some simple RA-guided physical
is intended to provide real benefits to elderly citizens and their
exercises. In this case, the RA performs a series of pre-
caregivers and to relieve pressure on overstrained health and
orchestrated movements, which Piero has to copy as best he
social services. This overarching goal should not be
can (with the RA giving performance feedback). The exam is
compromised by the technology itself. In particular, the system
soon over, with the medic confirming that all seems ok.
must be secure from malicious intrusion, must respect a
As evidenced in the narrative, the assistive roles played by citizen’s privacy – especially w.r.t. the exchange and storage
SARA include (among other things): Keeping track of the of sensitive health-related data - and must (to be of actual
location of significant objects (e.g. Piero’s medicine box); benefit) reliably and safely perform its function.
Escorting and providing mobility support for the elderly as
Key security, privacy, dependability and safety
they move through their environment; Monitoring a subject’s
requirements for SARA include the following: all stored
health conditions (e.g. the BAN detects a Piero’s loss of
personal data (e.g. medical records, monitored BAN data)
balance, the RR detects a change in his gate, and the RA
must be securely encrypted with protected access only by
2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and
Networks (CAMAD)

authorized and authenticated individuals and/or system B. Challenges in Interoperability


processes; all communications with personal data as content In addition to the interoperability mechanisms required for
must be securely encrypted with authenticated endpoints – this SPDI (previous section), the SARA system also raises
also extends to notifications (e.g. incident alerts and interoperability challenges of a more traditional nature.
reminders) and the audio/video streams transmitted during
telepresence sessions; the treatment of patient health data As described in Section II, the SARA system relies on a
must comply with healthcare domain standards (e.g. [18]) and distributed network of sensors and actuators, employing
national and international regulations concerning security and diverse wired and wireless communications technologies. The
privacy (e.g. [19]); all actuator control signals (whether nodes in the network are highly heterogenous, ranging from
originating ‘on device’ or ‘over the network’) must be basic inertial measurement units (IMU - e.g. for balance and
protected from malicious interference – e.g. we do not want fall detection), presence sensors (e.g. cameras equipped with
hackers taking remote control of the RA or RR; system motion detection and face/object recognition), to sophisticated
components and technologies must be configured on a reliable robotic devices with their own internal sensor/actuator systems
network to avoid service interruptions; high-priority and onboard computers. The sensor/actuator network also
communications, e.g. incident alerts, must be transmitted by communicates with backend cloud services to access and store
reliable means (e.g. multiple identical transmissions over events (e.g. ‘fall detected’, ‘telepresence session initiated’) and
multiple channels) and given network priority; the SARA monitored health data (e.g. detailed time-sequenced
system (in particular, its robotic components) must include measurements from BAN devices).
failsafe measures to ensure that no harm can come to the Accordingly, the system must deal with a wide range of
Patient (or anyone else); system components and device semantics (different kinds of devices with different
communications technologies must not interfere with or functions), data formats (syntactic representations),
disrupt medical equipment (and reciprocally, for reliability, measurement unit conventions (for sensor readings), and
should not be negatively affected by medical equipment). communications protocols (e.g. wifi, zigbee, bluetooth – see
As described in Section II, SARA is complex Fig.1). Various key aspects of SARA functionality, moreover,
heterogeneous and dynamic distributed system comprising require that data from multiple sources is collated, aggregated
many diverse components, both fixed and mobile, connected and/or analyzed in a coherent collective fashion. The reliable
to both local and global networks, and communicating in many detection of ‘fall incidents’, for example, may involve the
ways. Ensuring end-to-end security, privacy, dependability and continuous comparative evaluation of data from wearable IMU
safety for such a complex system is a major challenge. In a devices, RR handle-mounted pressure sensors and wall-
nutshell, we need a means to accurately assess the impact of mounted video cameras (among others). In short, SARA must
varying system configurations on the security, privacy, tackle the problem of IoT device and data interoperability.
dependability and safety properties of the system: to verifiably These interoperability issues impact all points in the life-
ascertain, for example, if using a particular device for a cycle of the SARA system, with sound and efficient
particular purpose, or a particular configuration of devices, mechanisms for syntactic and semantic interoperability
exposes the system to an unacceptable level of risk. required at: design-time: to handle heterogeneous
SEMIOTICS offers a viable, albeit partial, solution to this communication and application protocols brought into the
challenge in the form of “SPDI patterns” which model system by off-the-shelf actuators/sensors and other devices,
dependencies between security, privacy, dependability and including differences at the IoT platform level - e.g. between
interoperability (SPDI) properties of smart objects and the standard robotics platforms (such as ROS [20]) and
corresponding properties of orchestrations/compositions built proprietary home automation systems; deploy-time: to map
over these objects. Based on such patterns, the system can then high-level, patient-specific system requirements/configurations
formally verify whether or not a given device configuration as defined by medics (e.g. “the patient requires a heart monitor
satisfies some set of SPDI properties. It can also, in principle, with certain properties”), to specific proprietary devices -
generate (or adapt) device configurations guaranteed to satisfy including new and perhaps special-need devices, unforeseen at
SPDI properties – which has further implications for network design-time, that have to be individually procured and
management (discussed in Section IV.D below). integrated within the system; run-time: to enable the
The degree to which SPDI patterns can in practice resolve opportunistic integration of third-party services (e.g. on
the particular security, privacy, dependability and safety demand computing and AI services) and IoT elements (e.g. an
challenges of SARA remains to be determined. Ostensibly, for on-site paramedic, called to an incident, may need to
example, SPDI patterns do not explicitly cover safety temporarily hook specialized medical equipment into the
requirements. We can, however, identify a strong need for an system to transmit data to an offsite ‘telepresent’ medic).
IoT infrastructure that supports the kind of formal, verifiable As a particular example, interoperability mechanisms
end-to-end security, privacy, dependability analytics that SPDI (comprising semantic annotation schemes and their associated
offers. validation technologies) could be used to i) model the
semantics/capabilities of devices on board an RR, ii) describe
requirements for a patient-specific health monitoring
application (e.g. for gait analysis) using a standardized
semantic format - which would then iii) enable the deployment
2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and
Networks (CAMAD)

of a new gait analysis functionality into an RR instance that These APIs, and other ML techniques suitable for mobile
was not initially engineered for that purpose - thanks to the phones (e.g. [33]) can be readily applied for simultaneous
ability to automatically match the semantic descriptions of on- localization and mapping (SLAM [34]): the computational
board devices against the patient-specific requirements. problem of mapping and tracking an agent’s location within an
unknown environment. Moving from perceptual to behavior
All in all, achieving a smooth functional integration of the
(action) generation systems, neural networks have long been
wide diversity of components and component interactions in
applied for controlling the motors of wheeled robots (e.g. [35]
SARA demands a high-level of syntactic and semantic
for a fairly recent example), and more recently also for the
interoperability.
simulation of more complex rigid body dynamics, such as the
coordinated movements required for the walking, trotting and
C. Challenges in Artificial Intelligence running gaits of the DARPA/Boston Dynamics ‘little dog’
SARA is an application of Socially Assistive Robotics quadruped robot [36]. Unsupervised networks based on
(SAR), and is thus fundamentally an artificial intelligence Prediction Error Minimization (PEM) [37] principles (e.g.
system. Achieving human-level social skills, as noted at the descendants of the Helmholtz machine [38]) also look
outset, is beyond current AI capabilities. But we can still hope promising (in the not-too-distant future) for the development
to effect some primitive social capabilities and go a fair way to of complex perception-action systems. Once again, however,
constructing a solid foundation for higher-level skills. In these perception and action tasks are all computationally
particular, recent advances in machine learning (ML) and the intensive with strong time constraints.
growing availability of large data sets for training ML systems
allow us to tackle some key problems of perceptual As stated at the outset, social interaction is arguably the
classification. most complex of all human behaviors, and the autonomous
robotics community as a whole is still a long way from
ML solutions for object, people/face and speech achieving human level social competence. Contemporary ML
recognition, for example, are readily available (and are techniques - as indicated by the brief survey above - have
incorporated into most modern mobile devices). Technologies made significant steps toward this goal, primarily in the area of
for recognizing human emotions (e.g. the Eyeris [21]) and perception: delivering the kinds of sensory input over which
hand gestures (e.g. the uSens FINGO [22]) are beginning to sophisticated social behaviors could in future be constructed.
appear on the market, and even older products like Microsoft’s Indeed, advances in neural network technologies (such as
Kinect [23] can provide coarse grained gesture/posture PEM) also look poised to tackle these wider behavioral
recognition [24]. The massive quantity of textual material on aspects of AI. The key point here, however, is just that SARA
the web has also driven ML-based advances in natural will minimally require the continuous operation of a range of
language processing (NLP) [245- as evidenced by Google perceptual systems. This means multiple AI/ML processes
Assistant [26], Apple’s Siri [27] and IBM’s Watson [28], all working concurrently to extract different features from the
of which combine NLP with domain knowledge/expertise to sensory input in a timely fashion - i.e. without any significant
provide semantically relevant answers to users’ natural network latency. We can thus identify a strong need for an IoT
language questions. State of the art NLP-knowledge systems infrastructure that supports computationally intensive,
are progressing (tentatively) towards more fully fledged distributed AI processing at the edge of the IoT network.
‘conversational agents’ [29], capable (at present only to a
degree) of sustained themed dialog. There are even D. Challenges in Network Management
conversational agents with distinct ‘personas’ [30], aiming to
SARA is a distributed application where different
deliver a yet more naturalistic conversational experience.
computing entities continuously communicate and synchronize
For sophisticated social interactions, we will eventually their activities to collectively generate the overall functionality
need to integrate all these approaches to simultaneously and of the system. Factors underlying the need for distributed
rapidly recognize objects and people, spoken and gestural computation in SARA include: the lack of adequate
natural language, posture and gait, to enrich these perceptual computational resources at edge nodes to execute the heavy
classifications with background domain knowledge, and to computational tasks indicated in the previous section (e.g.
then orchestrate the whole with conversation and dialog object/people recognition and autonomous navigation); the
management. This is a heavy computational load operating need to reduce the energy consumption of mobile edge nodes
under strong time constraints. (e.g. RR, RA) by reducing the number of computations they
execute; the need to share knowledge (e.g. events detected by
ML is also a key technology for autonomous navigation. home automation devices, that then need to be acted on by
Google’s Waymo [31] and Apple’s [32] driverless car robotic devices), or to access knowledge shared through the
technologies, for example, critically depend on deep learning cloud (i.e. remote data sources); the need for redundancy in
algorithms operating over 3D point cloud data from Light various aspects of system operation to meet requirements of
Detection and Ranging (Lidar) sensors to distinguish paths and dependability and safety.
obstacles, and to identify and track objects (e.g. other vehicles)
and people. Recently, both Google and Apple have also At the same time, many of these distributed computations,
released augmented reality APIs for mobile devices that due to their near real-time nature, are subject to strong time
include ML functions for identifying and tracking constraints – which can only be met by a network
horizontal/vertical surfaces and objects within video streams.
2018 IEEE 23rd International Workshop on Computer Aided Modeling and Design of Communication Links and
Networks (CAMAD)

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