Community-based neurorehabilitation in underserved populations

Abstract

Despite the fact that stroke is the leading cause of long-term adult disability and a primary cause of death, one of the major problems in national healthcare systems is the inability to provide quality post-stroke rehabilitation. Geographical barriers, socioeconomic position, race, education, and cost all contribute to health care disparities. These disparities may not only obstruct access to the most appropriate rehabilitative care, but may contribute to psychological problems, reduced quality of life, and unsuccessful return to meaningful community participation. Information and communications technology (ICT) when combined with robotic technology can enhance the accessibility of rehabilitation in low-resource, capacity-constrained settings. In this paper we introduce a low cost, limited supervision, portable robot (H-Man) designed for upper extremity rehabilitation. A usability and feasibility study indicates that out-patient robotic treatment with the H-Man leads to positive improvements in arm movement, and that the system is usable and well accepted by key stakeholders. This paper also introduces an implementation strategy to assess the effectiveness, benefits and barriers of using the H-Man robot for community-based neurorehabilitation in underserved populations, such as those that live in low income neighborhoods or in rural areas.