Neurorehabilitation From a Distance: Can Intelligent Technology Support Decentralized Access to Quality Therapy?

Abstract

Current neurorehabilitation models primarily rely on extended hospital stays and regular therapy sessions requiring close physical interactions between rehabilitation professionals and patients. The current COVID-19 pandemic has challenged this model, as strict physical distancing rules and a shift in the allocation of hospital resources resulted in many neurological patients not receiving essential therapy. Accordingly, a recent survey revealed that the majority of European healthcare professionals involved in stroke care are concerned that this lack of care will have a noticeable negative impact on functional outcomes. COVID-19 highlights an urgent need to rethink conventional neurorehabilitation and develop alternative approaches to provide high-quality therapy while minimizing hospital stays and visits. Technology-based solutions, such as, robotics bear high potential to enable such a paradigm shift. While robot-assisted therapy is already established in clinics, the future challenge is to enable physically assisted therapy and assessments in a minimally supervized and decentralized manner, ideally at the patient’s home. Key enablers are new rehabilitation devices that are portable, scalable and equipped with clinical intelligence, remote monitoring and coaching capabilities. In this perspective article, we discuss clinical and technological requirements for the development and deployment of minimally supervized, robot-assisted neurorehabilitation technologies in patient’s homes. We elaborate on key principles to ensure feasibility and acceptance, and on how artificial intelligence can be leveraged for embedding clinical knowledge for safe use and personalized therapy adaptation. Such new models are likely to impact neurorehabilitation beyond COVID-19, by providing broad access to sustained, high-quality and high-dose therapy maximizing long-term functional outcomes.

The Application of Technological Intervention for Stroke Rehabilitation in Southeast Asia: A Scoping Review With Stakeholders' Consultation

“…Traveling from home to the hospitals regularly for continuous therapy sessions could be burdensome, especially for rural areas (118). More importantly, the current coronavirus (COVID-19) pandemic outbreak causes an urgent need to reduce hospital stays and visits (119). At this crucial time, stroke clients have been forced to be catered to as a lower priority to avoid overburdening the healthcare system (119,120).…”

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

“…Moreover, when developing such games for rehabilitation, the programmer, by respecting the relearning process and constant feedback necessities [19], may create an intelligent application that can be in some cases a better substitute of human guidance because the equipment such as video camera and sensors can become flawless assessors and tireless helpers. Furthermore, the permanent online storage of acquired data permits previously written algorithms to process and analyze information based on current experience [13]. The programmed artificial intelligence being able to analyze hundreds of data inputs from multiple sources at the same time could provide the specialist with a quicker and more informed therapy solution.…”

“…The causes were the reluctance to visit the emergency department, various medical system limitations, patients' will to avoid prolonged contact with the health system or family reluctant to accommodate the visiting restrictions imposed by the epidemiological situation [39]. The fact that neurorehabilitation was not of high priority during the pandemic in order to decrease the overload of the medical system negatively impacted stroke patients and responsible health professionals [13,40]. Medical resources were preferentially concentrated in treating COVID-19 patients.…”

“…The presence of fear that the devices are too fragile and that they may get damaged during exercises can decrease acceptability for patients unfamiliar with technology [9]. The teletherapy system should fulfill some basic requirements such as assuring user safety, being user-friendly, not needing frequent technical maintenance, and requiring minimal home reorganization and investment [13].…”

“…However, there is evidence that also supports an intense recovery program during the chronic phase of the disease [6,12]. Thereby, post-stroke rehabilitation has an important role when applied in any stage of the disease, with its absence having consequences such as pathological motor pattern development, non-use of the affected limb, spasticity enhancement, joint rigidity, increased pain and disability [12][13][14]. In addition, rehabilitation programs initiated in the clinic and continued at patients' homes represent a therapeutic alternative to hepatotoxic and nephrotoxic medications administered to relieve pain and trophic effects [15,16].…”