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Artificial Intelligence in Health Robotics and Vivaldi AI for ALS assessment

In terms of ALSFRS-R total score agreement, the Furthermore, ICC values of 0.77 (95% CI: 0.57 – 0.88)
Bland–Altman plot revealed a bias (mean difference) of for the bulbar domain, 0.92 (95% CI: 0.84 – 0.96) for
−0.18 points, with 95% LOA ranging from −4.35 to 3.99 the motor domain, and 0.97 (95% CI: 0.94 – 0.99) for
points (Figure 3A). In addition, the ICC of 0.95 (95% CI: the respiratory domain indicated moderate to excellent
0.90 – 0.98) indicated good to excellent agreement between agreement between the robotic- and human-administered
the robotic- and human-administered questionnaires questionnaires (Table 2).
(Table 2), consistent with the classification by Koo and Li. 34
Regarding longitudinal analysis, Table 3 displays
For ALSFRS-R subscores, separate Bland–Altman plots monthly rates of change for ALSFRS-R total scores
were generated for bulbar (Figure 3B), motor (Figure 3C), and subscores, along with CoVs. While all outcomes
and respiratory (Figure 3D) domains. The bulbar subscore demonstrated significant declining trends over time in
exhibited a bias of 0.14 points, with 95% LOA from −1.24 both administration methods, no significant bias between
to 1.53 points. Similarly, the motor subscore showed a bias human and robot-based administration was observed, as
of −0.57 points, with 95% LOA from −4.54 to 3.40 points, indicated by the mixed-effects linear regression interaction
while the respiratory subscore had a bias of 0.25 points, terms (P > 0.05 for all domains).
with 95% LOA from −1.02 to 1.52 points.
5.3. Impact of robotic device usage on patients’
anxiety and openness to experience dimension
Table 1. Descriptive characteristics of ALS patients (n=28)
Our findings revealed a statistically significant decrease in
Parameter Data state anxiety before and after the robotic administration
Age at evaluation 62.37 (53.88 – 68.43) of the ALSFRS-R questionnaire (35.50 [30.00 – 40.00] vs.
Sex, n (%) 31.00 [28.00 – 36.00]; P = 0.0218). Despite this decrease,
Male 19 (67.86) both pre- and post-administration levels of anxiety
Female 9 (32.14) remained below the clinical threshold of 41, indicating
Age at onset 59.97 (50.18 – 67.70) a general absence of clinical anxiety even before robotic
administration. Specifically, before the questionnaire’s
Site of onset, n (%) administration by the robot, 17 ALS patients (60.71%)
Bulbar 0 (0.00) showed no clinical state anxiety, while the remaining
Spinal 28 (100.00) 11 patients (39.29%) reported slightly elevated anxiety
Disease duration* 24.80 (16.87 – 33.60) levels. After robotic administration, five out of these
Diagnostic delay 10.13 (7.10 – 16.20) 11 patients (17.86%) experienced a decrease in anxiety
ALSFRS-R** total score 38.50 (35.00 – 41.00) levels below the clinical threshold.
ALSFRS-R bulbar subscore 12.00 (10.00 – 12.00) In a longitudinal analysis of 16 patients who underwent
ALSFRS-R motor subscore 16.00 (13.00 – 17.00) psychological evaluation at both baseline and follow-up,
ALSFRS-R respiratory subscore 12.00 (11.00 – 12.00) no significant differences in state anxiety before and after
Notes: *Time between onset and evaluation; **Measured by the human robotic administration were observed, neither at baseline
operator; all the values are expressed as median (interquartile range) nor at the end of the follow-up period. However, a trend
unless otherwise indicated. of anxiety reduction was more pronounced during the
initial evaluation (effect size = 0.42) compared to the final
Table 2. Agreement between operator and robotic device in assessment (effect size = 0.36). Furthermore, we found no
the ALSFRS‑R (total and subscores) administration significant correlations between the BFI score for openness
to experience and the magnitude of difference in ALSFRS-R
ICC (95% CI) Bias 95% LOA scores measured by human operators versus robotic
ALSFRS-R total score 0.95 (0.90 – 0.98) −0.18 −4.35 – 3.99 devices, for both total scores and individual domains.
ALSFRS-R bulbar subscore 0.77 (0.57 – 0.88) 0.14 −1.24 – 1.53 In the observational grid analysis, notable patterns
ALSFRS-R motor subscore 0.92 (0.84 – 0.96) −0.57 −4.54 – 3.40 emerged during various stages of the interaction between
ALSFRS-R AASS 0.89 (0.78 – 0.95) −0.07 −2.84 – 2.70 patients and the robotic device. During the initial training
ALSFRS-R AAII 0.89 (0.78 – 0.95) −0.50 −2.97 – 1.97 phase (T1), the majority of patients (67.85%) displayed
ALSFRS-R respiratory subscore 0.97 (0.94 – 0.99) 0.25 −1.02 – 1.52 curiosity and interest, indicating a high level of engagement
Abbreviations: ALSFRS-R: Amyotrophic lateral sclerosis Functional with the administration process. Conversely, 39.28% of
Rating Scale–Revised; CI: Confidence interval; LOA: Limits of patients expressed a recurring sense of puzzlement during
agreement. this phase. After the first question posed by the robotic

Volume 1 Issue 4 (2024) 79 doi: 10.36922/aih.3732