Rehabilitation Robots for Neurorehabilitation in High-, Low-, and Middle-Income Countries - Chapter 31: Toward inclusive rehabilitation robots

The World Health Organization in “Rehabilitation 2030: A Call for Action” describes a mismatch between the global need for rehabilitation, the growing issues seen in the numbers of patients that need care, and the availability of resources. The shortage of health professionals, rehabilitation therapists, nurses and doctors, and persons capable of taking care of the growing numbers of people with disabilities are major causes of this gap in healthcare. Evidence suggests that rehabilitation robots, which include therapeutic and assistive robots, can support neurorehabilitation of persons with neurological injuries and help bridge this care gap. Currently, the impact of rehabilitation robotics has not been inclusive, and access to the potential benefits of these technologies is unequal. Unfortunately, robot technology-assisted rehabilitation solutions are expensive, and as a result, they are primarily available in high-income countries (HICs). Solutions that are appropriate for low- and middle-income countries (LMICs) are rare and so their availability and impact in these countries are low. Given the potential of these solutions to bridge resource gaps, we must consider innovative ways to increase their inclusivity. This chapter raises general and ethical issues around access to rehabilitation robot technologies and discusses them in the context of inclusivity—a term that encompasses affordability and other common issues that may justify limiting or increasing use in low-resource settings in HICs and LMICs. We suggest that inclusivity can be increased if we address typical concerns and barriers to equal access for their rehabilitation use by diverse populations. The first section describes the motivation for this chapter. The second section briefly discusses these barriers from the lens of access, ethics—justice, privacy, safety, and autonomy; affordability; and finally, feasibility, usability, and acceptance. The third section details a potential practice framework for increasing inclusivity.