# Making Best Use of Home-Based Rehabilitation Robots
## 1 Introduction  
Complications from neurological disorders may leave patients with physical and/or mental impairments which affect their function in daily activities and quality of life. A consequence of these neurological disorders is often physical weakness, both in the upper and lower limbs. Physiotherapy in the acute stage can be less focused on upper-limb rehabilitation [1] as the use of the lower limbs for mobility is considered of greater importance. Conventional therapy services are resource limited and can be a source of disappointment to participants [2; 3]. This is a problem for the patients who are discharged from hospital wards and need to continue to undertake rehabilitation. Since the early 1990s the use of rehabilitation robotics to aid and administer therapy to participants has been developed [4; 5]. Robots can help a patient to complete a task and have been seen to motivate patients using computerised interfaces. Studies have shown that after robot training participants can improve arm function and ability in Activities of Daily Living (ADL) [6; 7]. There is a wide range of neurological conditions, but the research described in this paper will focus on adults with stroke. In adulthood, stroke is one of the major causes of disability [8; 9]. In the UK alone more than 100,000 people have a stroke each year (currently 1.3 million survivors in the UK) [10] at an estimated cost that exceeds \(\epsilon\)26 billion per year [11]. The success of rehabilitation can vary on the type of stroke. After hemispheric infarction (obstruction of blood to the brain) about 75% of survivors report weakness in their affected hand making it difficult to perform ADL [12]. Rehabilitation plays a large part in the recovery of stroke participants. However, the type of rehabilitation and choice of intervention play an important role in terms of impact on participant outcomes. Conventional therapy generally involves one-on-one interaction between patient and therapist. The therapist assists and encourages the patient through a number of repetitive movements. The therapy aims at reduction of impairment and improvement of functions for ADL [13]. Novel technologies which assist a person to undertake arm exercise can provide a means of supplementing physical treatments provided through conventional therapy. Increasing the intensity of practice is an important component of recovery, particularly for functionally useful movements [13; 14]. There are several devices currently being developed with varying degrees of complexity. Many of these require the system to be used and supervised in a clinical or hospital setting. These devices are intended to be used for patients with moderate to severe arm weakness. However, patients with some good residual function could benefit from using devices which are less complex and allow independent use. There have been a number of rehabilitation robots that have been developed over the last 30 years, and studies have shown that they have their place [15]. But the devices found in research studies are not suitable for home-based rehabilitation [16], and there are few commercial offerings available. With the COVID-19 pandemic, the impact on the NHS and patients was devastating. Across Europe, over 50% of patients in the later stages of recovery were refused in-house therapy [17]. Although rehabilitation from stroke is focused on many areas [18], rehabilitation robotics could have played an important factor in home-based rehabilitation. However, the cost-benefit ratio is yet to be explored for robotic therapy en masse. Since 2019, the rehabilitation landscape has changed [19], and this is an opportunity for robots to make a difference--if the price is right [20]. In a recent large-scale study with 770 participants called RATLUS [21], the key findings were that robot therapy is just as useful as conventional therapy but using expensive rehabilitation robotic devices is not a cost-effective solution.