# Telerehabilitation--A Viable Option for the Recovery of Post-Stroke Patients
## 6 Telemehabilitation during COVID-19  
Efficient ways to substitute hands-on physical examinations and physiotherapy have to be found by making use of novel technology, robots, sensors or informal caregivers [5]. [PERSON] et al. adapted their study protocol [6] during the COVID-19 pandemic in order to be able to measure impaired arm functionality after the intervention and to comply with the prevention of SARS-CoV-2 transmission. They delivered the needed equipment to every patient and, together with a family member, made a video call. During the call, with the help of the caregiver, they performed the tests and completed the final evaluation and study protocol.  
During the COVID-19 pandemic, a significant decline was observed in cases in stroke units [38] and post-stroke patients referred to rehabilitation clinics [39]. The causes were the reluctance to visit the emergency department, various medical system limitations, patients' will to avoid prolonged contact with the health system or family reluctant to accommodate the visiting restrictions imposed by the epidemiological situation [39]. The fact that neurorehabilitation was not of high priority during the pandemic in order to decrease the overload of the medical system negatively impacted stroke patients and responsible health professionals [13; 40]. Medical resources were preferentially concentrated in treating COVID-19 patients. The number of beds available in rehabilitation clinics was drastically decreased in order to assure social distancing, patients with COVID-like symptoms were not eligible for any rehabilitation treatment, some rehabilitation activities were temporarily stopped and patients were prematurely discharged for epidemiological reasons [36].  
Telemedicine is probably the medical field with the most rapid and complex development during the COVID-19 pandemic. For many health services, it became a necessity in order to maintain social distancing and decrease the risk of viral transmission while meeting the constant demands of healthcare [40; 41; 42]. During the COVID-19 pandemic, telemehabilitation is a solution to continue the recovery of post-stroke patients without the consumption of protective equipment, while limiting viral transmission risk in a group that is already vulnerable [43; 44].  
Lately, TR implementation has been performed in a stressful period and has been a challenge for the health professionals without experience. Previous contact with telemedicine, a well-prepared IT department and management involvement have made TR implementation easier [36].  
[PERSON] et al. explored patients' and professionals' perception of a TR intervention during COVID-19 lockdown through questionnaires. Remotely delivered therapy was  
Figure 4: TR network setup.  
introduced in order to substitute traditional rehabilitation during the period of travel restrictions and social distancing requirements. Patients received it with a high level of skepticism and low adherence. Healthcare professionals also had a moderate level of trust in the benefits of TR and reported the lack of physical contact as an important limitation to their work. However, rehabilitation specialists with previous experience with remotely delivered therapy trusted its efficacy more than those without experience [41]. These results make it clear that TR is a field that needs more practiced and trained medical personnel to manage the implementation of any level of this new therapy option.