# Digital Health Technology for Stroke Rehabilitation in Canada: A Scoping Review
## 4 Discussion
### Interpretations of Study Characteristics on the Use of DHTs in Stroke Rehabilitation in Canada  
The studies reviewed had varied goals, including assessing intervention effectiveness, exploring client and clinician perceptions, and evaluating feasibility. These findings indicate that Canadian researchers are investigating these technologies comprehensively, reflecting the complex and multifaceted nature of technology use in stroke rehabilitation. Additionally, most studies in this review were qualitative research articles and RCTs. Qualitative studies provided in-depth insights into client and clinician experiences. Since healthcare providers and patients may have different perspectives, understanding these perceptions is crucial for successful implementation alongside standardized assessments of feasibility and effectiveness. However, the limited number of RCTs highlights a gap in rigorous interventional research. Conducting ideal RCTs in rehabilitation is challenging due to potential biases, which can impact effect estimates. While RCTs offer valuable evidence, a diverse methodological approach is essential for advancing the field, reinforcing the need for varied study designs in research [43]. Future research in Canada could strengthen the body of knowledge by conducting more high-quality RCTs to discover and validate new methods for stroke rehabilitation. In addition, it is important to continue using qualitative studies that capture the perspectives of culturally diverse populations, includingIndigenous peoples and immigrants, whose experiences and needs may differ from those of the general population. Various technologies are currently being explored in Canadian stroke rehabilitation research, including VR, robotic devices, gaming systems, sensors, and mobile apps. These findings suggest that technological advancements have already made their way into research, highlighting their potential for broader clinical adoption. As Canada continues to invest in digital health and innovation, expanding the use of available, evidence-based technologies presents a significant opportunity to improve patient outcomes. Integrating these tools into the healthcare system will ensure that stroke survivors have timely access to effective rehabilitation solutions and will promote the translation of research into clinical practice, ultimately enhancing the quality of care. Regarding clinical outcomes, the majority of studies focused on UE function. While UE rehabilitation is undoubtedly important, the narrow focus on UE function overlooks other critical areas where stroke survivors face challenges, such as walking, transferring, balance, cognition, and activities of daily living (ADLs). likely due to the prevalence of UE impairments in stroke survivors and their significant impact on daily activities and independence [44]. However, recent studies propose hypotheses suggesting potentially faster lower extremity (LE) recovery. One key factor that may explain this difference is the frequency of use or intensity of the rehabilitation intervention. The LE is used more frequently in daily activities, and when limbs are used frequently, it results in use-dependent plasticity and eventual recovery. Consequently, rehabilitation techniques that involve high-repetition task practice, such as robotic rehabilitation, Wii gaming, and constraint-induced movement therapy, should be incorporated into UE rehabilitation to facilitate recovery [45] However, many studies outside Canada exist that use technologies for non-upper extremity purposes. Multiple studies have demonstrated that VR-based rehabilitation can enhance walking speed, balance, and mobility compared to standard rehabilitation [46]. In addition, recent research highlights the potential of technology in enhancing cognitive rehabilitation for stroke patients.