ROBO-PAWS: Robot-Dog-Assisted Walking

ROBO-PAWS: A Pilot Randomized Controlled Trial of Robot-Dog-Assisted Walking to Improve Sleep Quality, Fatigue, and Quality of Life in Pediatric Oncology Patients

Childhood cancers affect approximately 400,000 children and adolescents worldwide each year. Although advances in treatment have significantly improved survival rates, children undergoing cancer treatment continue to experience a wide range of treatment-related symptoms and complications. Among these, fatigue and sleep disturbances are particularly common and may persist throughout treatment and survivorship, negatively affecting psychological well-being, cognitive functioning, and overall quality of life. Reduced physical activity during treatment is strongly associated with worsening fatigue, impaired sleep, and decreased quality of life in pediatric oncology patients. However, treatment side effects, prolonged hospitalization, infection risk, and lack of motivating play-based activities often limit children's participation in physical activity during treatment. Recent evidence suggests that physical activity interventions may help reduce fatigue and improve well-being in children with cancer, yet engaging and age-appropriate non-pharmacological interventions remain limited, especially for younger children.

This pilot randomized controlled trial aims to evaluate the feasibility and potential effects of a robot-dog-assisted walking intervention on sleep quality, fatigue, and quality of life among children aged 2-7 years undergoing cancer treatment.

This pilot randomized controlled trial will evaluate the feasibility and preliminary effects of a robot-dog-assisted walking intervention for children aged 2-7 years receiving active cancer treatment. The intervention is designed to promote physical activity through interactive and play-based walking sessions supported by a robotic dog companion.

Children undergoing cancer treatment frequently experience fatigue, sleep disturbances, reduced physical activity, and decreased quality of life during treatment. Hospitalization, treatment-related side effects, infection precautions, and limited access to motivating activities may contribute to sedentary behaviors in this population. Previous studies have suggested that physical activity interventions may improve symptom management and well-being in pediatric oncology patients; however, engaging and developmentally appropriate interventions for young children remain limited.

Participants will be randomly assigned to either the robot-dog-assisted walking intervention group or the control group receiving standard care. The intervention will consist of structured walking activities integrated into the child's routine during hospitalization or outpatient treatment visits. Feasibility outcomes will include recruitment, retention, adherence, acceptability, and safety of the intervention. Preliminary clinical outcomes will include sleep quality, fatigue, and quality of life.

The findings of this study will provide preliminary evidence regarding the feasibility and potential benefits of integrating robot-assisted play and movement interventions into supportive pediatric oncology care.

Inclusion Criteria:

• Aged between 2 and 7 years,
• Diagnosed with cancer and currently receiving active treatment,
• Pain level not severe enough to interfere with mobilization (FLACC or Wong-Baker FACES score ≤ 4),
• Diagnosed within the previous 1 month,
• Medically stable and approved by the physician to participate in light-intensity walking activities,
• Expected to remain hospitalized for at least 1 month to allow completion of the study protocol,
• Not scheduled for hematopoietic stem cell transplantation (HSCT) and not currently undergoing HSCT,
• Hemoglobin level adequate for participation in walking activities (>10 g/dL),
• No significant impairment in consciousness, balance, or motor functions due to heavy analgesic or sedative medication use.

Exclusion Criteria:

• Resting SpO₂ <94%, requirement for ≥2 L/min oxygen support, or recurrent desaturation episodes within the last 24 hours,
• Heart rate or respiratory rate significantly elevated or irregular for age,
• Hemodynamic instability,
• Visual, hearing, or severe cognitive impairment that would prevent interaction with the robotic dog,
• Increased mobilization risk due to high-dose corticosteroid treatment or medications associated with neurotoxicity,
• Motor function limitations that would interfere with safe walking,
• Concurrent severe infection or serious treatment-related complications (e.g., grade 3-4 mucositis or severe neutropenia requiring isolation),
• Children receiving end-of-life care.