Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-inone robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.

Research Objectives: Assess change in balance, balance-confidence, and fall risk factor management after the Merging Yoga and Occupational Therapy (MY-OT) intervention. Design: Primary analyses of a non-controlled before-after pilot study. Setting: University lab. Participants: Convenience sample of 13 people with chronic stroke (>6 months) completed the study. Inclusion criteria: >59 years old; falls history or current fear of falling; completion of stroke rehabilitation; able to stand; impaired balance (4 out of 6 on the short Mini Mental Status Exam. Interventions: One hour each of group yoga and group OT delivered twice a week for 8 weeks (32 total hours). Yoga included modified physical poses, breath work, and meditation. OT addressed behaviors and attitudes, activities, stroke-effects, and environment. Main Outcome Measure(s): Outcome measures were completed before and after the intervention and included the: Berg Balance Scale (BBS) for balance; the Activities Balance Confidence scale (ABC) for balance-confidence; and 5 fall risk factor management assessments (Falls Control Scale, Falls Management Scale, Fall Prevention and Management Questionnaire, Fall Management Behavior Questionnaire (FMBQ), and the Fall Prevention Strategy Survey (FPSS)). Wilcoxon signed-rank tests were used to compare data from before and after the 8-week intervention. Results: Average age was 73 years, 7 participants were female, and 98% were >1 year post-stroke. Significant improvements occurred in: BBS (32.77 vs 42.66, p<.001); ABC (53.34 vs. 62.06, pZ.036); FMBQ (32 vs 41.38, pZ.001); and FPSS (12.08 vs 17.15, pZ.008). The other fall management scores improved, but not significantly. Conclusions: Preliminary results indicate that MY-OT may improve balance and fall risk factor management in people with chronic stroke.