Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym

Abstract

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.

Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review

“…Although many of the trials show that these interventions despite their high cost are not more effective than conventional therapies, a likely advantage is that automated interventions like robotic therapies require minimal input from rehabilitation professionals in terms of time and efforts. Therefore, given the efficacy of robotic therapy and the fact that its utilization in stroke rehabilitation may mitigate the labor intensive and personnel tasking nature of many conventional therapies, affordable stroke rehabilitation robotics that are feasible for use in low-resource countries are being produced, and assessed for efficacy ( 361 ).…”

“…Translation of these budding opportunities and existing evidence-based interventions into pragmatic and cost-effective solutions in LMICs remains a huge challenge. Research efforts are needed to develop cost-effective robotic devices that can perform the above functions in harsher environments characterized by extreme economic hardship (per country), intermittent electricity supply and limited expert supervisors ( 361 ). Technology assisted rehabilitation as a viable option to task-shifting is the subject of current trials ( 392 ).…”

The Need for the Establishment of Biomedical Engineering (BME) as an Academic and Professional Discipline in the Philippines — A Quantitative Argument

“…The benefits that accompany the inclusion of biomedical engineering in nationwide rehabilitation efforts for PWDs form a strong argument that biomedical engineering can, for certain, improve the quality of life of millions in the Philippines. Biomedical engineering research that focuses on affordable assistive technology, such as the Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S), aims to improve the provision of therapy to persons with severe disabilities that arise from stroke in low-and middle-income countries [94]. The integration of these technologies across rehabilitation centers in the Philippines could benefit the ~12 percent of Filipinos [95], who suffer from severe disability.…”

Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke

“…We envision this system being based in primary care, tertiary care, or community centers. The current system is a compact robotic gym that provides affordable, game-based rehabilitation for the upper and lower limbs, based on concepts first tested in Mexico [ 130 , 140 ]. Unlike existing rehabilitation systems that are bulky, expensive, and serve a single patient at a time, our setup enables one rehabilitation professional to treat multiple patients at a time in a more efficient manner [ 130 ].…”

“…It promotes a community-based approach by creating a fun and social therapy environment where patients can interact with each other, increasing their motivation to exercise and receive treatment. The unique aspects of this system include its modularity and adaptation of rehabilitation technologies that can be implemented in low-resource settings [ 140 ].…”