# Digital Health Technology for Stroke Rehabilitation in Canada: A Scoping Review
## 4 Discussion
### Findings on the Feasibility and Effectiveness of Technology Use in Stroke Rehabilitation in Canada  
Technologies such as VirTele [29], VR exergames [34; 36; 37], and H-GRASP [38] demonstrated high feasibility and adherence, particularly when training was personalized and user support was provided. These technologies helped patients feel more independent when exercising at home and motivated them to use their UE, which in turn improved UE strength, using the affected limb, and overall function [34; 36; 38]. The authors recommended that therapists provide behavioral support and motivation to ensure feasibility, as well as encourage family involvement [31; 36]. Additionally, it is important to raise awareness and provide information to patients about the technology being used, ensuring they are actively engaged in their therapy process [25]. Making the technology easy to use and prioritizing safety are also key considerations [25; 37; 38]. Personalized care enhances feasibility; therapists should tailor the technology to each patient's abilities, motivation, and autonomy [29]. These results in Canada align with recent studies worldwide that have explored the feasibility and acceptability of technology-based interventions in stroke rehabilitation [53]. Both internationally and in Canada, highly intensive technology-assisted training has shown promise for inpatients and outpatients in the subacute and chronic phases of stroke, leading to improvements in functional performance and efficiency [54]. In particular, VR-enabled telerehabilitation programs have been found feasible for rural stroke survivors in Canada, although some technological challenges were noted, especially regarding participants' hand function and comfort with the technology [55]. Additionally, technology-based mental health interventions have demonstrated low refusal rates and high levels of satisfaction and adherence among stroke patients globally; however, Canadian research has paid comparatively less attention to mental health interventions for stroke survivors [56]. Studies have demonstrated that DHTs improve motor function and increase the use of the affected limb in daily activities, showing good to high efficacy in supporting improvements for stroke rehabilitation [29; 31; 34; 36; 37; 38]. For example, the VirTele program led to meaningful improvements in the FMA-UE scores, maintained for months after intervention [37]. Similarly, H-GRASP participants surpassed clinically meaningful thresholds in motor performance and grip strength [38]. Gaming-based interventions, including commercial gaming systems [27] and VR-based interactive rehabilitation using Wii technology [35], have also demonstrated efficacy in improving UE function and overall motor recovery post-stroke. The included studies found that participants who engaged with gaming-based rehabilitation showed increased fine motor ability and confidence in performing activities of daily living [27] and highlighted the potential of interactive gaming (e.g., Wii) in stroke rehabilitation, suggesting that such systems could enhance engagement and motivation, leading to improved patient outcomes [35]. Some studies show a significant increase in self-efficacy, occupational performance, improvement in activities of daily living, and en -hanced quality of life after incorporating technology into rehabilitation plans [26; 32; 33]. Given the demonstrated effectiveness of DHTs in stroke rehabilitation, the next logical step is their integration into clinical practice. Hospital decision-makers and clinicians should prioritize the adoption of these technologies to ensure that rehabilitation services remain current and evidence-based. Consistent with global research, DHTs provide engaging and interactive environments that have the potential to transform traditional rehabilitation approaches [12].