Putting patient health into their own hands

That was the question that has spawned a multidisciplinary collaborative study, led by University of Cincinnati researchers, that is looking into how a self-guided art therapy app and robotic pets affect the mood of patients.

UC’s Soma Sengupta, MD, PhD, said the idea for the study began during shutdown periods of the COVID-19 pandemic. Certain patients — like those with brain tumors — were unable to come into medical facilities for art therapy sessions, and therapy dogs and their trainers were not permitted inside hospitals. 

“You know it’s really depressing that all these people that depended on these therapies during the pandemic couldn’t get anything in person,” said Sengupta, associate professor and Harold C. Schott Endowed Chair of Molecular Therapeutics in the Department of Neurology. “Why don’t we develop something that is independent of people physically having to be there or an animal physically having to visit a home?”

Specifically, Sengupta focused this research on patients with vestibular schwannoma, or acoustic neuromas, which are benign tumors on nerves leading from the inner ear to the brain. Sengupta said these patients often experience some form of hearing loss.

For example, patient Sankhya Jejurikar experiences single-sided deafness as a result of a vestibular schwannoma, which was removed by Mario Zuccarello, MD, UC Brain Tumor Center Director at the UC Gardner Neuroscience Institute, in September 2020. She said she experienced feelings of depression and isolation as a result of her single-sided deafness.

“In a big crowd when everybody’s laughing at a joke and you’ve not heard it, you feel frustration, anger and realize that sometimes your friends forget,” Jejurikar said.

To get the study started, Sengupta reached out to Claudia B. Rebola, PhD, associate dean for research, associate professor and director of the new Center for DAAP Research and Innovation (CDRI) on Health and Wellbeing in the College of Design, Architecture, Art, and Planning. 

Sengupta and Rebola had previously collaborated on projects including a music therapy app and began work on a similar art therapy app. Rebola has also done extensive work improving the capabilities of robotic pets to act as companions for populations like older adults, with work ongoing to include functions where the pets could monitor vital signs or provide other care to patients.

Meera Rastogi, PhD, a psychologist, art therapist, program coordinator for the pre-art therapy certificate program and professor at University of Cincinnati, Clermont College, was recruited into the study to help design the art therapy prompts featured in the app.

It may seem like a logical progression to bring in experts from different disciplines into a research study, but Sengupta said often researchers stay in their individual silos and do not have as great an impact as they could if they worked together. She recalled a challenge from UC President Neville Pinto for more collaboration across different colleges and departments within the university and said this research is an example of that charge in action.

Health and Wellbeing is one of the strategic areas for the CDRI, a new platform to UC designed for the intersection of disciplines and collaborative efforts to generate new information. Through these efforts, CDRI participants will also connect with partners and communities to jointly address issues concerning health and well-being.

The CDRI is centered around collaboration, research and innovation, all of which are demonstrated within this research study.

“We can generate the most impact in health and well-being when integrating the creative disciplines in transdisciplinary research and innovation,” Rebola said. 

Rebola said some projects focus on research and others focus on design, but this study combines into what she calls “research through design practice.”

“It’s not about giving patients a survey to understand what they need, but developing design interventions for impact while understanding needs,” Rebola said. “We’re merging research and design together. It’s something we need to do more in research and the sciences.”

The collaborative study also included the work of:

• Diego Gomez Enriquez, DAAP master of design candidate
• Iris Lachnit, visiting scholar and clinical psychologist
• Abigail Koehler, clinical research professional
• Jamie Denlinger, UC Brain Tumor Center nurse navigator
• Yehudit Rothman, neuro-oncology physician assistant
• Peirce Johnston, MD, UC Department of Psychiatry

The team developed a 12-week pilot study that will analyze how the moods of patients are affected by working through the art therapy prompts and questions on the app. The patients’ mood and well-being will be measured using self-assessments analyzed both by psychologist Rastogi and Johnston.

“It’s more than just interacting with art materials. They’re specifically designed art activities to help people think about whatever issues they’re facing in a different way,” Rastogi said. “So it’s interactive through the app and would be similar to the type of art activities an art therapist would ask their clients to do, as well as reflection questions to think and write about after they do the artwork.”

Participants in the study will have one consultation with an art therapist to learn about how they will be using the tools they are given: a sketchbook and a 24-pack of colored pencils. The participants will also meet with medical staff to be trained on how to use the app to work through the art therapy prompts. 

Half of the patients will additionally be provided with robotic therapy dogs. 

“Each pet will have a smart bandana, with sensors that help us monitor the number and length of interactions that the user has with the pet,” Rebola said. “So our hope is to quantify and correlate how much they interact with the pet and how their well-being performs through a 12-week study.”

While ongoing work into the treatment of vestibular schwannoma is important, the researchers said it is also critical to engage in this line of research looking at patients’ mental health.

“It’s not so much about cure, but treatment,” Rebola said. “How can we elevate the health and well-being of our patients through alternative interventions?”

Patient and artist Jejurikar said from her perspective it is exciting to see the whole patient being considered through this study.

“The fact that Dr. Sengupta and her team have actually thought beyond just the physical correction of the surgery but also the emotional problems that come after, I think that’s the future of medicine,” Jejurikar said. “For them to work on it and think about the patients after the surgery really made me feel like I was at the right place. I’ve come to the right place and the right team.”

Sengupta noted the study could have wide-ranging implications for others: the hearing loss population, cancer or immunocompromised patients who can’t interact with therapy dogs or attend art therapy classes, patients with neurodegenerative diseases who cannot take care of animals and members of the general public experiencing feelings of anxiety, depression or isolation.

“There are a lot of things that you can’t cure, but if the quality of life is improved, then you know it makes the day-to-day lifestyle much better,” she said. “I think that piloting something like this has a bigger impact on improving quality-of-life metrics.”

These art and pet robot therapy interventions also are a step forward in giving patients the tools to take personal control of their well-being.

“It is important to design technologies that allow people to take care of their health with their own hands,” Rebola said. “And in an indirect way, it’s kind of responding to the needs of having more equitable access to health and distributing and having the users have control of their health.”

Researchers are currently enrolling patients into the pilot study, with plans to publish initial findings and then apply for funding for a larger-scale study. Rebola said future studies may also look into how mood is affected when patients complete the art on tablets rather than through conventional art supplies or could include robot pets with increased capabilities.

“We’re designing things as ways of understanding,” Rebola said. “It’s something we don’t do much in the sciences. We’re learning through this iteration, having an impact, generating the second generation.”

The study is being funded by the Jejurikar Fund for Vestibular Schwannoma Research and the Harold C. Schott Chair.

Featured photo at top: Sankhya Jejurikar discusses the study with UC researchers. Photo/Ravenna Rutledge/University of Cincinnati