A doctor checks in on a patient via the RP7 remote presence robot. The device allows physicians to do telerounds, as long as the robot and doctor have access to a high-speed wireless network. (Photo courtesy of InTouch Health)

It's cute and cuddly and makes a great pet. Except you don't have to clean up after him. Paro's a robot — and one of several examples of how the field of robotics is changing the way health care is delivered.

Paro was developed in Japan in 1998 to be used as a therapeutic device for people who often need institutional care — the elderly, Alzheimer's patients and children with autism. Paro is billed as the world's most therapeutic robot.

Paro has sensors under its fur, can respond to human touch and is capable of learning limited behaviour depending how you react to its actions. The robot's inventor, Takanori Shibata, designed a device to improve the quality of people's lives. He settled on a pet-like robot after studying the interplay between animals and humans and seeing how pets can have positive psychological and social effects on people.

Shibata says Paro may help people with dementia. Preliminary tests have shown an improvement in the brain activity of people with dementia after exposure to the robot. The World Health Organization has estimated that 84 million people around the world will have some form of dementia by 2040.

Alan Mackworth, a professor in the department of computer science at the University of British Columbia and Canada's foremost authority on artificial intelligence, sees tremendous potential in robots as our population ages. He says robotic companions are fine, but the technology needs to go beyond that.

"People want to stay in their houses but their kids have trouble looking after them," Mackworth told CBCNews.ca. "If you have a long-term care type of companion which … would keep an eye on the person and talk to the person … family members could talk to the person through the robot. The robot would keep track of where the person is actually moving or if they're lying on the floor in the bathroom, has taken their drugs, has followed their normal routine."

Right now, Mackworth says, the cost for this kind of at home robot would be prohibitive. But it might be feasible for an institution.

"It's $10,000 or so — you wouldn't pay that for your house but you might in a long-term care facility if it relieved the nurses of some of their burden of monitoring patients or even escorting patients to the dining room or the lounge or wherever."

Cardiac patient Eugene Bem, left, is shown the console portion of an early model da Vinci surgical robot on July 20, 2000, at Beth Israel Medical Center in New York, four days before he was scheduled to undergo "robotic" or computer-enhanced coronary bypass surgery. (Kathy Willens/Associated Press)

And there is some evidence that using robotics to relieve health care professionals of some their burden can improve the quality of health care. A study published in the July 2007 issue of the Journal of the American College of Surgeons shows that using robots to check in on patients may significantly cut the time patients undergoing laparoscopic gastric bypass surgery spend in hospital — if it's used to supplement standard postoperative rounds, made by surgeons.

The robotic assessment included real-time audio and visual communication between doctor and patient, electronic chart review and discussion with nurses about treatment.

The physician operated the robot from a control station that could either be in the hospital or kilometres away.

A similar device has been used at the Dalhousie Medical Centre in Halifax.

The RP-7 Remote Presence robot looks like a flat screen TV plunked atop a 1960s B-movie version of a robot. It's built by Intouch Health — a California-based company — and retails for about $200,000 US. It can work anywhere that's equipped with a high-speed wireless network.

It's equipped with high definition cameras to allow the physician to see the patient or health-care worker. The flat-screen TV projects a real-time image of the doctor. While the robot is not cheap, it is far cheaper than wiring every room in a hospital with camera and audio capability.

The Nursing Institute of West Central Ohio recently acquired one of the units as part of a pilot project to see if it could help faculty members interact with students in remote locations. It's the first test of this technology at a nurse education centre in the United States.

The focus of robotic technology in the field of health care in North America is to improve the ability and efficiency of health-care workers. On May 4, 2007, physicians in London, Ont., used robotic technology to perform coronary artery bypass surgery — without opening up the patient's chest.

Instead, the surgeons made four one-centimetre incisions and used a daVinci Robot — the only device approved by the U.S. Food and Drug Administration as a surgical aid — to get inside and do the work. The robot, which is guided by surgeons, allows the surgeons to see much greater detail than they could with the naked eye. It also eliminates hand tremors that can be hard to control because of the long surgical instruments normally used in these procedures.

The so-called minimally invasive surgery (MIS) reduces the amount of time patients need to stay in hospital from five or six days to one or two. It also substantially cuts the time needed for recuperation from a few months to as little as a week or so.

Dr. Rajni Patel, chair of the Department of Electrical and Computer Engineering at the University of Western Ontario, says besides the obvious savings to the health-care system, robotic surgery has major implications.

"The robotic systems currently used for surgery are teleoperated or 'master-slave' systems where the surgeon sits at a console and manipulates the surgical robot located near the patient via appropriate computer control. The slave and the master can be in different places many kilometres apart… It is possible to use these robotic systems to perform surgery at a distance – telesurgery…This has obvious advantages for a large country like Canada."

Patel, who holds the Canada Research Chair in Advanced Robotics and Control, is working on taking robotic surgery a big step further. He is heavily involved in research in the field of haptics in robotics — enhancing the surgical sense of touch.

"One of the major drawbacks of using robotics in MIS is that the surgeon does not have any feedback of the force of contact with tissue. Our research is exploring ways of providing this feedback."

At the Mays and Schnapp Pain Clinic and Rehabilitation Center, in Memphis, Tennessee, Dr. Moacir Schnapp is looking at ways to use robotics to help patients who are dealing with severe pain.

"The role of a rehab therapist goes far beyond what gadgets can do," Schnapp told CBCNews.ca. "However, good rehabilitation is usually time-intensive and therefore costly. When a limb is paralyzed due to a stroke or nerve damage, it can only regain its maximum function with intensive and daily rehabilitation, not with fifteen minute sessions, three times a week."

He says devices have been used in physiotherapy for years that slowly and rhythmically flex and extend a patient's knee. All the physiotherapist has to do is set it up.

"What it lacks is the flexibility to learn and adjust to an individual's specific needs such as pain, the amount of joint and muscle stiffness, and the rate of improvement," Schnapp said.

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He envisions an alternative device that not only moves the knee but can also sense the person's changing pattern of breathing, pupillary dilation, and sweating — all indicators of stress and pain. It could "learn" how much pain the patient was feeling and automatically adjust the exercise.

"Robotic devices that can learn from a patient's behavior, giving him or her the choice of how much to hurt and how far to push, would immediately increase compliance and consequently the chances for improvement."

Schnapp is looking forward to the day that robotic-assisted devices make purely passive exercises a thing of the past.

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