***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT Objectives : We undertook a cluster-r and omised controlled trial exploring the effect of a therapeutic companion robot ( PARO ) compared to a look-alike plush toy and usual care on  dementia symptoms of long-term care residents . Complementing the reported quantitative outcomes , this paper provides critical reflection and commentary on individual participant responses to PARO , observed through video recordings , with a view to informing clinical practice and research . Method : A descriptive , qualitative design with five participants selected from the PARO intervention arm of the trial . The trial is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12614000508673 ) . Results : The five participants and their responses to PARO are presented in terms of three issues : i. ) Different pre-intervention clinical presentations and different responses ; ii . ) Same individual , different response – the need for continual assessment and review ; and iii . ) The ethics of giving and retrieving PARO .  Implication s for clinical practice and future research are discussed in relation to each issue . Conclusion : The findings suggest that one approach does not fit all , and that there is considerable variation in responses to PARO . A number of recommendations are discussed to aid the delivery of psychosocial interventions with PARO in practice , as well as to guide future research Background : Behavioral problems may affect individuals with dementia , increasing the cost and burden of care . Pet therapy has been known to be emotionally beneficial for many years . Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets . Robotic pet therapy offers an alternative to traditional pet therapy . Objective : The study rigorously assesses the effectiveness of the PARO robotic pet , an FDA approved biofeedback device , in treating dementia-related symptoms . Methods : A r and omized block design with repeated measurements guided the study . Before and after measures included reliable , valid tools such as : RAID , CSDD , GDS , pulse rate , pulse oximetry , and GSR .  Participants interacted with the PARO robotic pet , and the control group received st and ard activity programs .  Five urban secure dementia units comprised the setting . Results : 61 patients , with 77 % females , average 83.4 years in age , were r and omized into control and treatment groups . Compared to the control group , RAID , CSDD , GSR , and pulse oximetry were increased in the treatment group , while pulse rate , pain medication , and psychoactive medication use were decreased . The changes in GSR , pulse oximetry , and pulse rate over time were plotted for both groups . The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate , while GSR had several weeks when changes were similar between groups . Conclusions : Treatment with the PARO robot decreased stress and anxiety in the treatment group and result ed in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia Background and Objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia , and many show promising potential . In this study , we sought to explore family members ' perceptions of the Japanese-developed baby harp seal , Paro ( version 9 ) , and a look-alike , nonrobotic Plush Toy , when used by their relative with dementia for 15 min , 3 afternoons per week for 10 weeks . Research Design and Method The study employed a descriptive qualitative approach , which was nested within a larger cluster r and omized controlled trial . A convenience sample of 20 family members ( n = 10 each from the Paro and Plush Toy conditions ) with relatives in 9 long-term care facilities in Queensl and , Australia , completed individual semi-structured interviews ( telephone or face-to-face ) . Inductive , data -driven thematic analysis of the data was undertaken with the assistance of the qualitative management software , ATLAS.ti ® . Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro  , perceiving that it improved mood , reduced agitation , and provided opportunity for communication for their relative . Negative perceptions of the Plush Toy were given by family members , primarily because of its lack of movement and engagement . Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them , and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life . However , the current cost of Paro was identified by family members as a major limitation to use OBJECTIVES The robotic seal , PARO , has been used as an alternative to animal-assisted therapies with residents with dementia in long-term care , yet underst and ing of its efficacy is limited by a paucity of research . We explored the effects of PARO on motor activity and sleep patterns , as measured by a wearable triaxial accelerometer . STUDY DESIGN Cluster-r and omised controlled trial , involving 28 facilities in Queensl and , Australia . Nine facilities were r and omised to the PARO group ( individual , non-facilitated , 15-min sessions three afternoons per week for 10 weeks ) , 10 to a plush toy ( PARO with robotic features disabled ) and nine to usual care . MAIN OUTCOME MEASURES Changes in day- and nighttime motor activity and sleep after the 10-week intervention , as measured by SenseWear ® armb and s , worn by participants continuously for 24 h at baseline , during two single intervention days in weeks 5 and 10 respectively , and post-intervention ( week 15 ) . Analyses followed intention-to-treat , using repeated- measures mixed-effects models . RESULTS After 10 weeks , the PARO group showed a greater reduction in daytime step count than usual care ( p = 0.023 ) , and in nighttime step count ( p = 0.028 ) and daytime physical activity ( p = 0.026 ) compared with the plush toy group . At post-intervention , the PARO group showed a greater reduction in daytime step count than the plush toy group ( p = 0.028 ) , and at nighttime compared with both the plush toy group ( p = 0.019 ) and the usual-care group ( p = 0.046 ) . The PARO group also had a greater reduction in nighttime physical activity than the usual-care group ( p = 0.015 ) . CONCLUSIONS PARO may have some effect on motor activity of older people with dementia in long-term care , but not on sleep patterns . Australian New Zeal and Clinical Trials Registry ( ACTRN12614000508673 ) AIM The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia . BACKGROUND Nursing home residents with severe dementia often experience social withdrawal and lower quality of life , which are suggested to be enhanced by non-pharmacological interventions . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to robot-assisted intervention or control group ( treatment as usual ) .  METHODS Data were collected between March 2013-September 2014 . 27 participants participated in group activity for 30 minutes twice a week over 12 weeks , 26 participated in the control group .  Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline , after end of intervention and at 3 months follow-up . The scale and regular psychotropic medication were analysed stratified by dementia severity . Analysis using mixed model , one-way anova and linear regression were performed . RESULTS An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group . The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia . The intervention group used significantly less psychotropic medication compared with the control group after end of intervention . CONCLUSION Pleasant and engaging activities facilitated by nursing staff , such as group activity with Paro , could improve quality of life in people with severe dementia . The trial is in adherence with the CONSORT statement and is registered at www . clinical trials.gov ( study ID number : NCT01998490 ) [ corrected ] OBJECTIVES To investigate the affective , social , behavioral , and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting . DESIGN A pilot block r and omized controlled trial over 12 weeks . Participants were r and omized to the intervention ( Paro ) or control condition  ( st and ard care ) . SETTING Two dementia day care centers and participants ' homes in Auckl and , New Zeal and . PARTICIPANTS Thirty dyads ( consisting of a care recipient with dementia and their caregiver ) took part in this study . All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia . INTERVENTION Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks . Participants also had Paro at home for 6 weeks . MEASUREMENTS At the day care centers , observations of the care recipients ' behavior , affect , and social responses were recorded using a time sampling method . Observations of interactions with Paro for participants in the intervention were also recorded . Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care . In the home setting , level of cognition , depressive symptoms , neuropsychiatric symptoms , behavioral agitation , and blood pressure were measured at baseline , 6 weeks , and 12 weeks . Hair cortisol measures were collected at baseline and at 6 weeks . RESULTS Observations showed that Paro significantly improved facial expressions ( affect ) and communication with staff ( social interaction ) at the day care centers . Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro . There were no significant differences in care recipient dementia symptoms , nor physiological measures between the intervention and control group . CONCLUSION Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context . Larger r and omized controlled trials in community setting s , with longer time frames , are needed to further specify the context s and characteristics for which Paro is most beneficial OBJECTIVES To explore whether severity of cognitive impairment and agitation of older people with dementia predict outcomes in engagement , mood states , and agitation after a 10-week intervention with the robotic seal , PARO . DESIGN Data from the PARO intervention-arm of a cluster-r and omized controlled trial was used , which involved individual , nonfacilitated , 15-minute sessions with PARO 3 afternoons per week for 10 weeks . SAMPLE AND PARTICIPANTS One hundred thirty-eight residents-aged ≥60 years , with dementia-from 9 long-term care facilities . MEASURES A series of stepwise multiple linear regressions were conducted . Dependent variables were participants ' levels of engagement , mood states , and agitation at week 10 [ assessed by video observation and Cohen Mansfield Agitation Inventory-Short Form ( CMAI-SF ) ] . Predictor variables were baseline levels of cognitive impairment [ assessed by Rowl and Universal Dementia Assessment Scale ( RUDAS ) ] and agitation ( CMAI-SF ) . RESULTS Five models were produced . The strongest finding was that participants with more severe agitation at baseline had higher levels of agitation at week 10 ( R2 = .82 , P < .001 ) . Predictors of positive response were less significant . Low levels of agitation at baseline predicted greater positive behavioral engagement with PARO ( R2 = .054 , P = .009 ) and fewer observed instances of agitation ( R2 = .033 , P = .045 ) at week 10 , whereas greater visual engagement was predicted by both lower levels of agitation and cognitive impairment ( R2 = .082 , P = .006 ) . Less severe cognitive impairment predicted greater pleasure at week 10 ( R2 = .067 , P = .004 ) . CONCLUSIONS / IMPLICATION S Participants with severe agitation had poor response to PARO . Lower levels of agitation and higher cognitive functioning were associated with better responses . In clinical practice , we recommend PARO should be restricted to people with low-moderate severity of agitation . Further research is needed to determine the optimal participant characteristics for response to PARO We recently reported that a companion robot reduced residents ' loneliness  in a r and omised controlled trial at an aged‐care facility . This report aims to provide additional , previously unpublished data about how the sessions were run , residents ' interactions with the robot and staff perspectives Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To examine effects on symptoms of agitation and depression in nursing home residents with moderate to severe dementia participating in a robot-assisted group activity with the robot seal Paro . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to either robot-assisted intervention or a control group with treatment as usual during 3 intervention periods from 2013 to 2014 . SETTING Ten adapted units in nursing homes in 3 counties in eastern Norway . PARTICIPANTS Sixty residents ( 67 % women , age range 62 - 95 years ) in adapted nursing home units with a dementia diagnosis or cognitive impairment ( Mini-Mental State Examination score lower than 25/30 ) . INTERVENTION Group sessions with Paro took place in a separate room at nursing homes for 30 
    Output:
    
Interactions with robopets were described as having a positive impact on aspects of well-being including loneliness , depression and quality of life by residents and staff , although there was no corresponding statistically significant evidence from meta- analysis for these outcomes .
Not everyone had a positive experience of robopets .
Engagement with robopets appears to have beneficial effects on the health and well-being of older adults living in care homes , but not all chose to engage .
IMPLICATION S FOR PRACTICE Robopets have the potential to benefit people living in care homes , through increasing engagement and interaction .
With the robopet acting as a catalyst , this engagement and interaction may afford comfort and help reduce agitation and loneliness