wo years ago, nurse Wendy Fello allowed some robotics experts to follow her through her daily routine in the suburban Pittsburgh nursing home where she works. She visited with patients, filled medicine containers and escorted people to physical therapy appointments.
Recently, the experts paid several return trips, bringing with them a 4-foot-tall robot named Pearl.
Pearl, who has silver grab bars in lieu of arms, greeted people and dispensed candy. She entered residents' rooms and told them they should follow her to physical therapy. When they agreed, Pearl's screen and voice said, ''Lets go! Chop chop!''
The ''nursebot'' is a marvel of robotics, and her creators hope she represents the future of nursing.
''I came out to get a look at who's replacing me,'' Fello joked, after watching Pearl at work.
When fully developed, Pearl and her progeny will be able to assist elderly people in their homes, allowing them to live independently longer before they need the round-the-clock care of a nursing home. Pearl can perform such routine tasks as opening a jar, reminding people to take their medication or calling for help if they fall. Trouble with basic tasks is the main reason elderly people give up independent living.
With nursing home care ranging from $30,000 to $70,000 or more a year, helping people live longer at home is cost-effective, not to mention more comfortable and dignified, said Sebastian Thrun, Pearl's 34-year-old inventor.
''We have succeeded in helping people to live longer,'' he said. ''Now, we need to help them to live better.''
Together with the School of Nursing at the University of Pittsburgh, Thrun and other scientists at Carnegie Mellon University are creating a home helper who can not only assist with the basics but can check the Web for TV listings, monitor vital signs and allow a doctor to make a remote house call by transmitting video and audio information via the camera lenses that are Pearl's eyes and the screen that is her stomach. The robot will be able to access medical information - teaching people how to take care of a surgical wound at home, for example - and will collect health data, such as measuring a diabetic's blood sugar.
Nursebot researchers are not venturing guesses as to how much a commercial version of Pearl would cost or when it might be ready, but the project has ''unlimited'' potential, said Penny Milanovich, executive director of a home health care agency, UPMC-South Hills Health System Home Health.
''With the nurse shortage, the Nursebot can be used in a way that would not affect the quality of care but would enhance the professional nursing staff,'' Milanovich said. ''I see this [technology] being interspersed with nurse visits.''
The dream is that nursebots like Pearl some day will be able to remind people to take their medicine, go to the bathroom and do their exercises. She will remember and monitor daily routines, access medical information, alert for anything out-of-the-ordinary that could signal an accident or other problems. She might even be able to recommend when to call the doctor, when her human companion reports troubling symptoms.
Milanovich said home health is already attempting to automate many nursing functions. Elderly people wear emergency call buttons on necklaces, for example, and use a Hoyer Lift to rise out of bed or chairs. Computerized services telephone them with reminders about medication and bathroom visits.
Nursebot researchers have even suggested that Pearl could provide companionship for older people living alone.
But Fello thinks that idea can only go so far. Asked if the robot can truly replace a nurse, she said: ''I don't believe that. I don't believe the compassion can be there. Sometimes all somebody needs is a hug and to talk a little bit.''
Elizabeth Scheid, 74, a Longwood resident who volunteered to participate in the Pearl experiment, said she believes Pearl could be helpful to overworked nursing home staff. But she would not want Pearl in her home as her only care giver. ''It's just that I wouldn't want to be stuck with the thing all the time,'' Scheid said. ''I would feel isolated. It's a machine, and I'm a person who likes some kind of give and take.''
The scientists are doing what they can to make Pearl seem less machinelike.
Pearl, a second-generation prototype, is more humanoid than the first Nursebot, who was named Flo, after Florence Nightingale. Pearl's name comes from the pearly sheen of her skull. Her electronic mouth displays four settings, from a big smile to sticking out her tongue. She has eyebrows to enhance her expressions, she blinks and every five seconds her eyes twitch slightly to give a more natural look. It sounds odd but it works.
Since Pearl's visit to the Longwood Assisted Living Center, where she met nurse Fello, scientists have decided to install spinning ears to signal to people that she is thinking. Greg Armstrong, who maintains eight robots for Carnegie Mellon, is working on the ears.
''We want people to realize she's doing something,'' he said, ''rather than standing there silent while they're waiting for a response.''
While health care has ventured into many areas with robots - using them as surgical assistants, physical therapists, pharmacy aides and janitors - involving them directly in patient care is a new field of study. Thrun said he believes that's a major reason why the Nursebot Project qualified for a National Science Foundation grant of $1.4 million last year and is a contender again for a new round of funding. Of 1,400 proposals, only 15 percent qualified for Information Technology Research grants.
''Bringing technology in general to people, most robotics people don't do this,'' Thrun said.
Through robotic advancements, Pearl can navigate a single floor by traveling it once and creating a two-dimensional reference map. Humans then add significant locations on the grid of her memory. Power supply, speed, voice recognition - each of these is practically a whole field of robotic science.
''For the first time we actually have the technology together to develop robots that exhibit the necessary robustness, reliability and level of capability,'' Thrun said.
It's a ''no-brainer,'' he said, that robots will work in homes in the future and the elderly have the most to gain. By the time Pearl moves out of the laboratory and into a real job, baby boomers will be swelling the ranks of senior citizens. Today, about 6.5 million elderly Americans need assistance in their daily living, according to the Assisted Living Federation of America, a figure that is expected to double by 2020.
Judy Matthews, a Nursebot Project member who teaches nursing at the University of Pittsburgh, said Pearl is having mixed success dealing with humans. In a recent experiment, a robot - trying to provide some exercise and test the limits of a patient's willingness to follow orders from a 4-foot pile of metal - asked an elderly gentleman to stand up out of his chair five times. The chair was low, Matthews said, and the man had an arthritic hip.
He stood up three times, pushing with difficulty on the chair arms. Then he faked the last couple of times and told the robot he had done it. Unknown to the man, a researcher was watching the experiment from another room. Matthews said the robot, to increase compliance, should have called the man on his faked stands.
''I would have said, `I've counted three, let's do it again,''' Matthews said. ''And to begin with, I would have started with a taller chair that he could have gotten out of more easily.''
As a result, the Nursebot people are planning to shadow a nurse again - this time as the nurse makes home visits - in an attempt to discover what works in communication aimed at getting people to comply. ''As nurses, we bring an understanding of the problems,'' Matthews said.
Even so, patients seem to be warming up to Pearl.
Since her first visit to the Longwood nursing home last December, associate executive director Pam Leibensperger said she has had no trouble signing up new volunteers to work with the robot. ''Every resident who has gone through the process has come and thanked me and said it was eye-opening.''
