Translational Science Highlight
- Through its CTSA Program, NCATS enabled an early-stage investigator to assemble a multidisciplinary team of technology and child development experts to evaluate and advance the emerging field of telepresence, in which virtual inclusion and engagement potentially could have an impact on child health.
A four-foot-tall robot equipped with a video camera and screen rolls into a classroom on two wheels. It is remotely controlled by a child who is at home because she is too sick to attend school in person. The robot enables her to be “telepresent” and therefore a more active participant in class and with her classmates, viewing lessons, asking questions and contributing to discussions in real time.
These telepresence robots are increasingly making it possible for children with chronic illnesses to attend school virtually, sometimes for the first time in their lives. The robots also help children being treated for cancer or undergoing surgery to keep up with their classmates while recovering.
However, there is little information about how well the robots improve learning and keep kids socially connected or on the impact they have on the classroom. With support through the NCATS Clinical and Translational Science Awards (CTSA) Program, a multidisciplinary team of researchers in education, informatics, cognitive sciences and pediatrics at the University of California, Irvine (UCI), is advancing this emerging field.
Personal Experience Drives Professional Interest
The lead researcher on the project, Veronica Newhart, Ph.D., knows what it is like to take long breaks from school. As a child, she missed many days of school due to congenital heart defects. She found going back to class difficult for reasons far beyond catching up on her schoolwork.
“You feel isolated from your friends, and when you finally come back, it is awkward because they don’t know what to say,” said Newhart, who is supported through a postdoctoral training grant from the UCI Institute for Clinical and Translational Science (ICTS), a CTSA Program hub. “It can be a little scary when classmates go missing for long periods of time and no one talks about why.”
Fast forward a bit more than a decade: Newhart was working for the Department of Public Health and Human Services in Montana. There, she saw how telemedicine enabled rural patients to talk to a doctor and receive care virtually. Newhart was interested in how similar technologies could help sick children attend school. She began a Ph.D. program in the UCI School of Education and approached her mentor about studying this approach.
“He was not doing this kind of research and did not have funding for it, but he supported my idea and encouraged me to take classes and make the connections I needed for the project,” Newhart said.
This led to a first-of-its-kind case study, looking at why and how children with chronic health issues, ranging from suppressed immune systems to cancer, use telepresence robots. The study suggested that one of the most important aspects of the technology was helping kids feel more connected to their friends and teachers.
In one case, a child with a failing heart had been homebound for 18 months while he awaited a heart transplant. His parents attributed his exhaustion — so severe he had even stopped engaging in conversations — to his illness. But after receiving the robot, he participated through an entire first day of school virtually. He soon began talking again and had much to say about his friends, teachers and homework, leading his parents and medical team to realize his previous level of fatigue was caused by depression due to isolation.
Based on cases like this, Newhart predicts that virtual inclusion and engagement could improve pediatric health by providing the motivation children often need to take their medications and follow other treatment plans. She is building on her ongoing studies and working with a pediatrician at ICTS to determine how to measure health outcomes as part of a randomized clinical trial to test her theory.
Robots Present Unique Challenges
Newhart cautions that attending school virtually through telepresence robots is not for everyone. One child stopped using the robot and returned to homeschooling because other kids were bullying her. Newhart hopes to understand these kinds of issues further through her research, so that parents, teachers and doctors can make informed decisions about what is best for each child.
Since the technology has moved rapidly from companies to consumers without formal study, there are no guidelines or best practices. To understand what does and does not work with the technology, Newhart talks not only to the child but also to classmates and teachers who interact with the robot at school.
“You can place a robot in a classroom, but if no one is talking to it or selecting it for group work, then the child is not really fully immersed in the class,” Newhart said. “We need to study whether other children and teachers see and accept the robot as a traditional student and if the student participating by robot feels a sense of belonging in the classroom.”
A New Interdisciplinary Field Finds a Home
One of challenges in studying this emerging field, according to Newhart, is figuring out where her research fits more broadly. While completing her graduate work and looking to continue and expand it as a postdoctoral student, she realized it did not fit neatly into a specific area, which made it difficult to find the right job. But ICTS was a natural fit because she had connections through both the CTSA Program and the university. The postdoctoral TL1 training grant helped her continue and expand her case studies and assemble a team of experts, including her primary mentor for her postdoctoral training, Jacquelynne Eccles, Ph.D., a psychologist in the UCI School of Education.
“Veronica is at the cutting edge of linking educational issues into pediatrics,” Eccles said. “And through mentoring Veronica, I am now plugged into the CTSA Program, which is fantastic. It’s opened up a great opportunity to work with people in a clinical setting, which I would not have done otherwise.”
Newhart’s secondary mentor is a social roboticist who will help determine which aspects of the robot can enable the child to make the best use of the technology and have the best outcomes.
With the help of her mentors and collaborators, Newhart is building a national database of the services homebound children receive and use; no such database currently exists, and there is no consistency in the services children receive. She hopes the database will spur faster progress in this emerging field.
Newhart also thinks the use of these robots to attend school virtually might have far-reaching implications for society. “Historically, these children couldn’t attend school, so serious illness was easier to ignore. I am really interested to see how society’s views on health may change if illness doesn’t disappear from the classroom. I am excited to see where this field goes.”
Posted November 2018