Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

Abstract

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Evaluation of the Impact of the First Wave of COVID-19 and Associated Lockdown Restrictions on Persons with Disabilities in 14 States of India

“…This makes it particularly challenging for rural dwelling PwD with respect to accessibility, availability, and utilization of rehabilitation services [ 19 ]. Although telerehabilitation and teleconsultations emerged as a response to support PwD, the evidence for safe, effective and good quality service was lacking [ 20 ].…”

Telerehabilitation in Low- and Middle-income Countries

“…A clinical provider's role is to deliver TR services [18]. They may either be physicians, AHPs [17] such as nurses, therapists, counselors, social workers, dietitians, pharmacists or traditional and complementary practitioners, or even caregivers [11]. TR providers may be stationed at hospitals, clinics, health centers, homes [5], or online.…”

“…Sub-acute cases requiring rehabilitation and monitoring can no longer be managed in acute or rehabilitation hospitals due to competing health priorities and shortened length of stay (LOS). Telerehabilitation (TR) may be a key innovation to ensure continuity of care post-hospital discharge and reduce the global burden of disability [11][12][13].…”

“…The needs of its people and healthcare system will steer the direction of telemedicine in LMIC [13]. The success or failure of TR will depend on the dynamic relationships between human, organizational, and technical factors [10,11]. Vulnerable groups such as people with disabilities (PWDs) and the elderly in LMIC face additional challenges in accessing TR.…”

Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India

“…ReWin innovation targets a continuum of care for stroke survivors that is effective, safe, and of good quality. Patients who seek treatment for stroke in a hospital get comprehensive treatment for acute stroke, and they get discharged home as soon as they are medically stable [21]. Poststroke disability is poorly understood and managed because we do not have a continuum of care outside the hospital setting in a country such as India [22].…”