# Digital Health Technologies to Support At-Home Recovery of People with Stroke: A Scoping Review
## 1 Introduction  
Stroke remains one of the leading causes of death and disability worldwide, imposing a significant burden on individuals, families, and healthcare systems [1, 2]. The economic impact of stroke rehabilitation is also substantial, as long-term care costs are often required, placing a strain on healthcare systems worldwide [3]. According to recent estimates, approximately 6.5 to 6.6 million stroke-related deaths occur annually, a number that reflects the growing impact of this condition globally [4]. Stroke incidence continues to rise, largely due to the increasing aging population and the rising prevalence of risk factors such as hypertension, diabetes, and a sedentary lifestyle [5, 6]. Following a stroke, disability is highly prevalent, and patients often face a range of physical and cognitive challenges, including upper extremity (UE) dysfunction, balance disorders, aphasia, dysphagia, andcognitive impairments [7]. The aftermath of a stroke can significantly impact a person's ability to return to work and perform daily activities, ultimately affecting their quality of life [8]. Approximately 25-74% of stroke survivors require assistance with daily activities, placing a substantial burden on caregivers and healthcare facilities [9]. Early and effective rehabilitation is crucial in the first two months following a stroke, as this period is essential for minimizing the risk of permanent disability and improving recovery outcomes [10]. Also, stroke rehabilitation is no longer confined to hospital settings; a significant component of recovery can take place in the home environment. Home-based rehabilitation allows for continuous monitoring, evaluation, and intervention, which is particularly important for stroke patients who live alone or suffer from cognitive disorders [11]. Home-based digital health tools can support self-management, track progress, and provide ongoing feedback to both patients and healthcare providers [12; 13]. This approach offers the potential to reduce the burden on hospitals and outpatient services while ensuring that patients receive the necessary care in the comfort of their homes [14]. As technological advancements continue to reshape healthcare, DHTs are emerging as powerful tools in stroke rehabilitation [15]. DHTs not only improve the efficiency and outcomes of rehabilitation, but they also provide more accessible options for patients [16]. For example, DHT can facilitate remote rehabilitation services, making it possible to reach individuals in rural or underserved areas who may not have access to specialized rehabilitation facilities [17; 18]. Moreover, the use of DHT has proven beneficial in uncommon circumstances, such as during the COVID-19 pandemic, when in-person rehabilitation sessions were disrupted by lockdowns and social distancing measures [19]. The field of DHT requires further clarification, not only in terms of the technology itself but also in evaluating its efficacy, effectiveness, and implementation ability. Recent literature reviews have shown that home-based technologies are widely used in stroke rehabilitation, with each technology offering specific benefits and limitations. Additionally, designing for motivation and considering the home environment are crucial factors in developing effective home-based stroke rehabilitation technologies [11]. The most influential research on this topic occurred between 1994 and 2012, with a strong emphasis on randomized clinical trials. Virtual reality technology, in particular, has become a prominent area of research within DHT for stroke rehabilitation [20]. Furthermore, self-monitoring interventions using DHT, which provide feedback and enable self-observation, have proven to be particularly effective in supporting behavior change among stroke patients [21]. However, there is a gap in the literature regarding the specific types of technologies used for home-based rehabilitation monitoring and evaluating patient performance.