# Telerehabilitation--A Viable Option for the Recovery of Post-Stroke Patients
###### Abstract  
As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients' acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists' constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy. teterehabilitation; post-stroke recovery; robotic therapy; virtual reality; serious games +
Footnote †: journal:as pathological motor pattern development, non-use of the affected limb, spasticity enhancement, joint rigidity, increased pain and disability [12; 13; 14]. In addition, rehabilitation programs initiated in the clinic and continued at patients' homes represent a therapeutic alternative to hepatotoxic and nephrotoxic medications administered to relieve pain and trophic effects [15; 16]. Rehabilitation therapy has proven its efficacy when task-oriented and applied in large doses, intensively, with many repetitions and continuously, in order to facilitate relearning [7; 12; 17]. The results seem to be directly proportional to the training period [7; 17]. For example, improvements of arm function have been obtained after sessions summing 3 h or more per week [10]. Traditional exercises provided for patients upon discharge in order to be practiced at home have low adherence because of motivation loss, lack of pleasure while exercising and tasks that are either too hard or too easy [9]. Stroke rehabilitation represents a complex field that brings together physiotherapy, occupational therapy, speech and language therapy and neuropsychology [10]. As a result of the high costs of individual therapy sessions provided by a specialist, this is not the standard approach to chronic post-stroke patients. Teletherapy represents an alternative in the form of a variety of communication technologies, robotic devices or computer games used at home under the remote guidance of the therapist, and is a promising option that can stimulate motivation and prevent boredom [6; 8]. Telerehabilitation (TR) implies access anytime and anywhere, through the Internet and technology, to qualitative rehabilitation services of any kind: physiotherapy, occupational therapy, speech and language therapy and neuropsychology [3]. It allows patients to have continuity in the rehabilitation of their acute or chronic conditions in cases of shortage of healthcare staff and medical resources, difficult transport, living in rural areas with difficult access to rehabilitation centers or mobility and interpersonal contact restrictions in the case of a pandemic [18]. The purpose of this literature review was to identify in the literature the main challenges that may be faced when trying to initiate post-stroke telerehabilitation with the help of technology, and to contribute to the decision-making process in this emerging field.