A Case Study of a Robot-Assisted Speech Therapy for Children with Language Disorders
- To study if the results of the intervention with a social robot fits the expectations of the therapist.
- To analyse the response of the children while having a robot in their sessions.
2. Background and Related Works
3. Materials and Methodology
3.2. Cases Description
3.3. Enviromental Setup
3.4. Data Gathering and Analysis
- Two semi-structured interviews conducted to the therapist;
- Therapist and programmer personal diaries of each session;
- Video recording of the sessions.
- A professional service verbatim transcribed the content of the audio-recorded interviews and reflective diaries of the sessions.
- First round of data analysis consisted in reading the transcribed material and viewing videos of the sessions to triangulate the findings of the transcribed material. An inductive thematic analytic approach was used in order to identify content units and emerging themes and patterns in the data. This served to establish the initial categories, which were related in meaning. Each coded unit could have more than one category. This analysis was done independently.
- Then, we had successive meetings to establish the dynamics of coding, discuss the differences in the excerpts selected and the categories chosen.
- The material was reviewed, and the discrepancies were resolved through analytic conversations until reaching a consensus regarding the excerpts, the observational categories and the emerging themes.
- Based on a data-reduction process, we started with a “book of categories” previously agreed, with a brief description of each one that was expanded during the process. From these initial dimensions, an inductive process was carried out and some other categories emerged (Table 1).
- In the second round of analysis, we used a deductive thematic approach. The process was completed by saturating the information and with new interpretations of meanings being developed.
- The most important quotes to describe the results were extracted and grouped to organize all the information found, looking for correlations between them.
- Finally, a narrative connecting the findings was written from the triangulation of all the data analysed.
- Videos were identified using the following codes C1, C2, C3, C4 and C5 for each child, followed by the date of the recording.
4. Sessions with EBA
- Reading comprehension: short/medium- and long-term memory.
- Phonological awareness.
- Articulation and phonetical–phonological pronunciation.
- Phonetic segmentation.
- Oral and written comprehension.
- Reading and writing.
5. Results and Discussion
5.1. About the Intervention
“So, if you notice in C3, the child begins to better understand longer sentences. Yes, and applies it. I think it has helped in their learning, in their reading.”[Second interview with the speech therapist]
“Well, C1 is always glad a lot to see EBA, I think she is the one who is most happy and we will work with mostly vocal mobility as she is the one who has had a jaw surgery and phonetize and raise her voice for EBA being able of listening to her. It is the way to encourage her, tell her that EBA does not listen well and that she needs her to raise her voice, something that she is not normally doing. Because in this way we begin to help her open more phonetically the words you need to hear, I mean, say, so that EBA will listen to her whenever she tells it a story or something.”[Programmer’s diary (13 December 2017)]
“… It was a moment that ‘EBA’ said ‘Speaks me higher’ and the child saw that EBA didn’t respond because he could not hear. She started up inadvertently, i.e., not gave the command “turn up the volume of your voice” because she has fully retracted that order. But she needed EBA listening to her, then there appeared the volume. So, there has been a significant change and from there it is true that parents have spoken with me and they say they have noticed that she speaks a little higher….”[Second interview with the speech therapist]
“… in learning the multiplication tables, for example, I think he’s learned thanks to EBA, as there was no way until it appeared. I told David: ‘Please, put the tables in the software, and let’s see’. Hey, it was wonderful!”[Second interview with the speech therapist]
5.2. Willingness to Learn
“She tells it to her friends in class and had to send a photo of the robot…. She told me that she is one of the few children in the school who has a robot. She says so and therefore she does her best to work or play with EBA.”[Second interview with the speech therapist]
“EBA helped her a lot with the questions/answers, because it understands her and immediately says ‘very good, very good’ and for her, having a robot saying ‘very good’ is much better. I used to tell her, why do you get so happy? And she says: ‘Because it is a robot.’ Sure, I can say ‘good, you have done it very well’ and I give her a big kiss, but I… she knows that I love her and that there is an affective part and not in the robot. She knows whether she is doing well or not, I will always love her. But if the robot tells her that she has done it well, she knows it is because she really has done it well, and she is aware that she has done it well. And that is what is helping her in that aspect: she is talking to EBA more, constructs the sentences better and understands at a comprehensive level the way EBA constructs sentences.”[Second interview with the speech therapist]
“Yes, they keep sustained attention more because it is indeed curious, sustained attention both at the level of learning and focusing of attention, such as movement. This child, when EBA is not going from room to room, he stays here, he rises, stands up, moves around the chair, but not out of here, and that’s mean body control because what interests him is here.”[Second interview with the speech therapist]
“Then, in all the cases a greater sustained attention has been achieved, well, there are children who doesn’t have an attention and we don’t work it, but with all there is a greater sustained attention”[Second interview with the speech therapist]
“In the case of EBA, it is a robot, at first, of course they pay more attention, as if…, you know, the novelty, but not sustained attention, is the surface or physical sustained attention that we all have to something new, but they focus sustained attention when it intervenes in the integration of learning. From this novelty, the sustained attention appeared, the focused one has been appearing throughout the sessions. And this is very important. Look, when I talk about it, I also realize that things come out.”[Second Interview with the speech therapist]
5.3. Emotional Aspects
“I remember one day in a session were EBA had a broken finger,… Well, the parents had to phone me! Their child was scared because we had put an electrical tape on EBA finger, and he thought it was a cast. He had normalized EBA as if it were human. When the parents phone me they said that their child had slept badly, that ‘poor EBA’… that ‘Daddy please, phone EBA to see how she is, because she is in the hospital for sure….’ But of course, you have to get to know this child. That this child says that and sees a fellow man as his fellow man…, because his equals… well, he has many behaviour problems because he has an oppositional defiant disorder. So, normally, he attacks his peers. His greatest communication is to attack…. And suddenly, being so worried about EBA? It was a great leap that has also taken him out. That is very nice, it moves me.”[Second interview with the speech therapist]
“They brag in the school that they have a robot. We are talking about children with difficulties, with disorders, who have always felt different in the group…, who have always been treated as different, they are taken out of the classroom because they go to support classes because they are different. And it turns out that they now have a robot that no one else has. And brag about it… And they feel important for once in their life. I think it is very important.”[Second interview with the speech therapist]
In another session with this child, EBA calmed his hyper-activity in an effective way. […] He came angry about something with his father, a coin or something he lost in the car, he brought something to show me. Another child, many children, they get angry and you, in two minutes, have calmed them down, ‘come on, your brain, so and so’, we change, and we start working, and that’s it. But not like this child, no, because he has an oppositional disorder. Then he came angry, stood there, he tried to attack me, he began to bite himself. This child, I’ve been working with him for three years: the first year there were attacks, he practically escaped me, tried to attack me, I had to slow him down a lot, I had to do physical restraint, and that’s over. But last year, that day he attacked himself, he begins to bite, he begins to pinch, he begins to hit his head on the table and I, because I was next to him, sitting on the floor, ready to intervene contention because the next step is to attack me or the one next to him. So, David went super-fast and programmed EBA, and EBA started talking to C2, C2 didn’t even look at it. He entered and did not look at them, there was his problem and his aggression and his coin…Suddenly, EBA began to speak to him with what David was introducing: “Hello C2! How are you? What’s wrong? Don’t be like that, you’ll find the coin when you go out”, or something like that. And in less than 3 min, he approached EBA, started talking to her, told her about the problem. That this child tells you?… May be, he would tell the psychologist about it later. If I had spent the whole session with him lying on the ground, I wouldn’t have succeeded, because it has already happened to me, because he also gives himself feedback. This kid what he didn’t do with the robot is feedback on the problem.”[Second interview with the speech therapist]
No prejudice, no value judgments, and that makes children raise their self-esteem.[Second interview with the speech therapist]
“That’s one of the things I have mentioned it to David. The non-verbal language does not come out and it is essential for communication and nonverbal communication, and in EBA it does not appear, but children don’t miss it.”[Second interview with the speech therapist]
“Using this form that comes spontaneously, because I could not work otherwise, then comes spontaneously, children adopt this affective form and transmitted, and have taken from EBA, have made a transmission, they give it and take it to EBA as if EBA really gives that affection. So, what happens when that emotional part? Integration of learning occurs better, it stays, it is not only learnt, but it integrates because there is a part that they have to show or not or learn just because EBA says so.”[Second Interview with the speech therapist]
“So, sometimes it’s very complicated to program the computer… that is, the robot, while we are speaking as the software needs time to load and today this has happened and C4 wanted immediate results, and I couldn’t give them. So, I’ve seen the child, mmm, ‘frustrated?’… Until everything was working again, but then it was difficult for me to catch his attention.”[Programmer’s diary (28 May 2018)]
5.4. Relationship with EBA
“He, at first, was afraid of EBA and did not approach it. If it moved, he got scared. But he went getting used to it, he normalized it.”[Second interview with the speech therapist]
“‘If I kick EBA and throw it out the window, will I break it?’ And I say ‘yes, you break EBA, and if you do the same to me maybe you will hurt me too. And we will stop functioning, me and EBA’. And he said, ‘I will not do it because she’s my friend’. But he says so loudly, and I thought that it could have happened. Do you remember? At the beginning I told you, this child, you must be careful with EBA because he is able to catch it and release it from the balcony.”[Second interview with the speech therapist]
“EBA facilitates inclusion inside and outside the classroom because its support and reinforce the learning of speech and consequently of oral language and communication. It seems that it has also stimulated the emotionality of individual and group social language process. It helps children to recognize the differences through EBA, which is different, and learns and teaches at the same time. So, I would say that EBA facilitates the inclusion objective of achieving equality and equity. Finally, the originality of EBA invites curiosity and reinforces the students’ strengths and capabilities. I see a lot of possibilities incorporating EBA in the classrooms.”[Second interview with the speech therapist]
“One day I said, ‘Hey, you know, EBA is going to teach reading?’ And he said ‘Well, I already know. I’m going to teach her because EBA is a robot and robots do not know, you have to shove things in those circuits.’ So, I said, let’s flip it…. This is the goal now, he is the teacher of EBA.”[Second interview with the speech therapist]
“Then, he has been teaching EBA, the NAO, how that game works so that the next day we meet, EBA has learned and we can work with it.”[Programmer’s diary (12 November 2017)]
“C5 looks all the time trying to be the protagonist in this session, nor the speech therapist, nor EBA, showing the robot what it should be learnt.”
“Well then, this exchange of roles ‘student–teacher’, ‘teacher–student; children like C4 that… he has managed to connect to the robot because he is its teacher. He is not taught; he teaches the robot. What has happened with this? With this we can get to alleviate a little feedback that he has self-imposed himself. Because in order to teach, you must have certain trait of humility, even if the child does not know, takes it out, otherwise, he can’t teach. So, he can overcome this self-imposed rigorousness.”[Second interview with the speech therapist]
“For C5 EBA looks like a robot. C5 is older than the others. It is the only case that sees EBA as a robot. As a resource to learn. That is, C5 is not going to become a friend of EBA.”[Second interview with the speech therapist]
“In this case, with this girl, what has been achieved and I have seen a change with the activities that EBA has done with the girl, because for us it is EBA, the children do not see it as a robot,… At first yes, but later it is as… They ask when does EBA come? As if EBA were a friend of her.”[Second interview with the speech therapist]
“For C3, he spoke very softly out of absolute shyness, he respects her, it is difficult for him to approach see it there as… She sees it as a robot and I think she is beginning to open up and she is the one who asks the most about EBA, curiously, and asked ‘can you create a dog for her?’, because she has dogs.”[Second interview with the speech therapist]
“He has empathized with EBA, to such an extent that we have seen his maturation period with respect to the robot. He is the only child we are working with who differs, that is, he distinguishes. Suddenly, he gets to work with EBA and normalizes it as an equal, mind you that it is difficult for this child to see someone as an equal, and suddenly he needs to ask David something about EBA, about how EBA works, he gets up and stands next to David at the computer to see EBA networks. And in a matter of seconds he sits back down and has EBA as an equal again. For this child it is very difficult to do that, very complicated, it is something that the school is trying to do by all means and here he does it and nobody has said ‘do it’, it has come out because of the intervention that is being done.”[Second interview with the speech therapist]
5.5. Relationship with the Programmer
“Well, David is part of the furniture in the sessions. In mean, the children just greeted me and EBA. At the beginning I had to tell them, ‘Hey this is David, greets him’ … but then I gave up, because I realized that, for the children, he didn’t exist directly. Look! Not only did they not be aware that David was there, but they didn’t even realize there was a camera recording them”[Second interview with the speech therapist]
“The thing about C2 is that, if EBA doesn’t understand him, he stands up and goes to David, ‘Why doesn’t he understand me?’, ‘Let’s see, where is it? Where is his brain?’ That is, he tries to understand the head of EBA. He interacts less than the others because he is more aware of the process of what is happening, so I would like him to interact. He is the only one who has not asked about EBA, the only one, and when he comes, he is happy, but he has not asked, the others have. When does EBA come? When does EBA come? He does not, but the way he interacts with EBA is different, there is no hook, but there is a hook with the whole process and there is a hitch with the Dragon Ball…. Yes, he has not humanized EBA, for him it is the robot that comes and sometimes he doesn’t pay any attention, sometimes you’re here and I look at David and say ‘I’m going to start working with other things because no way.’”[Second interview with the speech therapist]
6. Conclusions, Limitations and Future Research
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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(observations related to the therapy itself and the objectives worked)
|Speech therapist||Formulation of questions and answers|
|Comprehension and construction of sentences|
|Articulation and pronunciation|
|Memorization||Through the multiplication tables|
|Readiness towards learning|
(children’s attitudes towards learning)
|Empathy||Creating a link with EBA|
|Other affective components||Absence of value judgments|
|Absence of non-verbal language|
|Relationship with EBA (established relationship between child and robot)||Behavioural changes|
|Relationship with the programmer (relationship of the children with the programmer)|
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Estévez, D.; Terrón-López, M.-J.; Velasco-Quintana, P.J.; Rodríguez-Jiménez, R.-M.; Álvarez-Manzano, V. A Case Study of a Robot-Assisted Speech Therapy for Children with Language Disorders. Sustainability 2021, 13, 2771. https://doi.org/10.3390/su13052771
Estévez D, Terrón-López M-J, Velasco-Quintana PJ, Rodríguez-Jiménez R-M, Álvarez-Manzano V. A Case Study of a Robot-Assisted Speech Therapy for Children with Language Disorders. Sustainability. 2021; 13(5):2771. https://doi.org/10.3390/su13052771Chicago/Turabian Style
Estévez, David, María-José Terrón-López, Paloma J. Velasco-Quintana, Rosa-María Rodríguez-Jiménez, and Valle Álvarez-Manzano. 2021. "A Case Study of a Robot-Assisted Speech Therapy for Children with Language Disorders" Sustainability 13, no. 5: 2771. https://doi.org/10.3390/su13052771