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Stroke Rehabilitation in Low- and Middle-Income Countries

Original Editor - Antonia Abraham Top Contributors - Oshomoji Olawale, Alexandra Stead, Anthonia Abraham and Candace Goh

Page Summary

  • Post-stroke rehabilitation is potentially the best available recovery intervention in low- and middle-income countries (LMICs), which bear 89% of stroke-related disability-adjusted life years.
  • Rehabilitation barriers in low- and middle-income countries include workforce shortages, out-of-pocket costs, weak referral pathways, poor infrastructure, transport difficulties and limited guidelines and registries.
  • Limited access to stroke rehabilitation causes persistent disability, dependency, depression, premature death, carer burnout and reduced workforce participation, compounding household poverty and national economic loss.
  • Self-directed programmes and technology-based upper limb interventions show benefit in low-resource settings, whereas caregiver-delivered task-shifting trials in China and India did not outperform usual care.

Introduction

Stroke is the second leading cause of death and a major cause of disability among non-communicable disorder (NCDs) worldwide, with 89% of stroke-related disability-adjusted life years occurring in low- and middle-income countries (LMICs).[1] In LMICs, access to acute stroke interventions is often limited, making effective post-stroke rehabilitation potentially the best available intervention to promote post-stroke recovery.[2] LMIC are countries classified by the World Bank based on their Gross National Income (GNI) per capita, and this includes 5 major regions including Africa, Asia, Americas, Europe and Oceania.[3] According to the 2027 World Bank fiscal year, low-income countries make a GNI per capita of $1,175, lower middle-income countries make between $1,176 and $4,635, whilst upper middle-income economies make between $4,636 and $14,375.[3]

This article classifies low-income, lower middle-income, and upper middle-income countries under the framework of LMIC. The current state of stroke rehabilitation services in LMICs is examined here, including barriers to rehabilitation, consequences of limited access, opportunities for improvement and rehabilitative approaches that are effective.

Stroke rehabilitation in Africa

Stroke Rehabilitation in Africa is a very important area for research. Africa is known as the continent with the highest number of LMIC countries (53 out of 54 African countries).[3] Current evidence on stroke rehabilitation in Africa focuses primarily on Nigeria, Zambia, Egypt, South Africa, Ghana, Uganda, Rwanda, and Benin.

Barriers to stroke rehabilitation in Africa

Barriers to stroke rehabilitation in Africa can be grouped into five interrelated categories, drawing on recent reviews of the literature:[4]

  • Health systems factors: African countries often have weak health systems that are unable to provide adequate rehabilitation services. This can be due to a lack of funding, trained professionals, and rehabilitation facilities.[2] Inadequate infrastructure, fragmented care pathways, limited service availability, weak referral systems, fragmented governance also poses a major limitation.[5]
  • Individual factors: Patients in Africa may also face barriers to rehabilitation, such as poverty, lack of transport, low health literacy, use of traditional medications as an option instead of conventional therapies, and lack of formal carers.[2] Cognitive impairments, lack of social support, carer burden, cultural and language barriers are also associated.[4][6]
  • Financial factors: Patients in Africa often experience high cost of therapy sessions, imaging, assistive devices which can demotivate patients, especially when they do not have the required funds for treatment.[4]
  • Rehabilitation workforce factors: There is a shortage of skilled rehabilitation professionals, including physiotherapists, occupational therapists, and speech and language therapists, which contributes to overwork and burnout among clinicians. [5][4]
  • Knowledge and resource factors: There is also a lack of guidelines to support clinicians,[7] inadequate training of existing professionals, poor infrastructure, lack of policies for stroke rehabilitation, and lack of reliable epidemiological information on stroke.[8]
[9]
[10]
[11]

Consequences of limited access to stroke rehabilitation

Limited access to stroke rehabilitation has significant consequences that extend across individual, carer, and population levels. At the individual level, stroke survivors without access to rehabilitation experience poor functional outcomes and persistent disability, often resulting in dependency on others for daily activities, and are also more likely to die prematurely.[12] Depression and reduced quality of life are frequently reported among this population, alongside low rates of return to work and difficulties with social reintegration.[2] Financial hardship and unemployment further compound the burden of disability, creating a cycle of impoverishment and social isolation.[5]

Beyond the individual, the burden of stroke extends to family members and carers who provide informal care in the absence of formal rehabilitation services. These carers frequently experience poor physical and mental health outcomes themselves, including depression, burnout, and stress-related illness.[4] The financial strain of providing unpaid care whilst managing reduced household income creates substantial economic hardship for families, particularly in low- and middle-income countries where social support systems are limited.[5]

At the population and national level, inadequate rehabilitation contributes to prolonged dependency among stroke survivors, reducing overall economic productivity and resulting in loss of gross domestic product (GDP).[2] In low- and middle-income countries, where healthcare financing is already constrained and competing health priorities abound, these economic costs compound the burden of stroke as a public health crisis. The accumulating effects of poor individual outcomes, carer stress, and reduced workforce participation create a significant drag on national economic development and healthcare systems already straining under limited resources.

Opportunities to improve stroke rehabilitation

There are a number of opportunities to improve stroke rehabilitation in LMICs. These include:

  • Strengthening health systems: Countries in Africa can strengthen their health systems by increasing funding for rehabilitation, training more professionals, and building more rehabilitation facilities.[2]
  • Addressing individual barriers: Countries in Africa can also address individual barriers to rehabilitation by providing financial assistance, transport, and education about stroke and rehabilitation.[4]
  • Innovative approaches: Countries in Africa can also use innovative approaches to deliver rehabilitation, such as telerehabilitation and community-based rehabilitation.[13][14] Telerehabilitation has been shown to reduce travel time and cost, ultimately improving patient outcomes.[15]

Stroke rehabilitation in Asia

Stroke Rehabilitation in Asia is another important area for research. Asia is known as the continent with the largest total population living within LMICs, driven by massive economies like India and Bangladesh.[3] Current evidence on stroke rehabilitation in Asia focuses primarily on the Philippines, India, Malaysia, Singapore, Thailand, Bangladesh, Bhutan, Indonesia, the Maldives, Myanmar, Nepal, Sri Lanka, North Korea, and Timor-Leste.

Barriers to stroke rehabilitation in Asia

Evidence on stroke rehabilitation in Asia identifies three interrelated categories of barriers:[16][17][18][19][20][21][22]

  • Health system gaps: Many countries face a shortage of neurologists and limited neuroimaging capacity, few stroke-ready hospitals or dedicated stroke units, and a scarcity of rehabilitation facilities.[17] [18] [20] Emergency medical services are often underdeveloped, delaying hospital arrival, and standardised stroke protocols are rare.[17] Access is markedly worse in rural areas than urban ones, and weak intensive care infrastructure for severe stroke affects the rehabilitation that follows.[17][21]
  • Patient and financial barriers: Reliance on traditional and complementary medicine as an alternative to conventional rehabilitation is common, alongside low public awareness of stroke symptoms and risk factors that delays care-seeking.[16] [17] [18][19] Out-of-pocket costs for therapy, imaging, and medication are consistently cited as prohibitive, worsened by low insurance coverage and, for rural patients, long travel distances.[17] Depression, fatigue, cognitive impairment, and low motivation further limit patients' engagement once in treatment.[19]
  • Workforce and system gaps: Rehabilitation professionals are scarce and concentrated in urban areas, with limited specialised training in stroke care.[16] [19] [21] Few countries maintain a national stroke registry or collect outcome data such as caregiver burden, and clinical guidelines, rehabilitation curricula, and supportive policy remain underdeveloped.[16][17][22]
[23]
[24]

Consequences of limited access to stroke rehabilitation

Limited access to rehabilitation contributes to higher years lived with disability (YLDs) and greater rates of recurrent stroke, exacerbating the long-term burden on survivors.[16] In the Philippines, stroke imposes a substantial economic burden through high out-of-pocket medical costs for both patient and family.[17] [20] There is also a reduced workforce participation, particularly given the higher incidence of stroke among younger adults, though the full scale of this burden remains unclear due to the absence of a national registry and community-level data.[17] Across the South-East Asia Region, high stroke-related mortality and disability persist, with up to one-third of survivors experiencing severe disability, a high risk of recurrence, and limited attention to community reintegration.[18] Limited access to critical and rehabilitation care across LMICs ultimately contributes to the global burden of stroke-related disability and mortality.[21]

Opportunities to improve stroke rehabilitation

  • Strengthening health systems: Countries in Asia can strengthen stroke care by investing in workforce training, expanding stroke-ready units and specialist capacity, and establishing unified national stroke registries to guide quality improvement.[16][25] Rehabilitation services could also be integrated into primary, secondary, and tertiary levels of health care systems. [26]
  • Addressing individual barriers: Multilingual public awareness campaigns, integration of traditional and complementary medicine with biomedical care, and government subsidies for treatment and insurance coverage can improve access for underserved communities.[17][19][20]
  • Innovative approaches: Technology-based solutions such as telemedicine, telerehabilitation, and mobile stroke units, alongside community-based rehabilitation and task-shifting to non-specialist health workers, are being used to extend rehabilitation access.[27]

Stroke rehabilitation in Latin America and the Caribbean

Stroke Rehabilitation in Latin America and the Caribbean is another important area for research. Latin America and the Caribbean is unique within all LMICs, because it does not have any low income countries, all countries are classified as lower middle-income and upper middle-income.[3] Current evidence on stroke rehabilitation in Latin America and the Caribbean focuses primarily on Argentina, Belize, Bolivia, Brazil, Colombia, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, Nicaragua, Paraguay, Peru, Suriname, and Venezuela.

Barriers to stroke rehabilitation in Latin America and the Caribbean

Reviews of stroke rehabilitation in Latin America and the Caribbean identify four interrelated categories of barriers:[28][29][30][31]

  • Health System and Resource Shortages gaps: Latin America and the Caribbean countries often present with health-system inequities and underinvestment, insufficient rehabilitation infrastructure and facilities, shortage of rehabilitation personnel, limited access to rehabilitation technologies, high cost and limited adoption of rehabilitation robotics.[28][30]
  • Access and Financial Barriers: Inadequate financial coverage, geographical and transportation barriers, long waiting lists and limited treatment sessions, public–private inequalities in rehabilitation services.[30]
  • Guidelines and Clinical Standards: Limited awareness of rehabilitation guidelines, few national rehabilitation guidelines, poor methodological quality and applicability of existing guidelines, incomplete rehabilitation guidance.[29]
  • Care Coordination and Delivery Gaps: Limited multidisciplinary rehabilitation, weak continuity between hospital and community care, insufficient caregiver preparation and home adaptation.[30]
[32]
[33]

Consequences of limited access to stroke rehabilitation

Restricted access to rehabilitation worsens long-term outcomes, causes persistent disability, and reduces independence, while limited rehabilitation reduces quality of life and social reintegration.[5] [30] Persistent disability lowers workforce participation and income, and poor financial coverage increases out-of-pocket costs for patients and families.[30] Disparities between public and private services, and between urban and rural areas, widen health inequalities.[5] Rising survivor numbers ultimately strain rehabilitation systems.[31]

Opportunities to improve stroke rehabilitation

  • Strengthening health systems: National, evidence-based guidelines can be developed with input from professionals, patients, and caregivers can help address gaps in rehabilitation guideline access.[29] Expanding multidisciplinary teams covering physical, occupational, speech, cognitive, and psychological care can help close this gap in multidisciplinary care.[30] In addition, greater investment in infrastructure and robotics outside major cities, alongside stronger public–private partnerships, can narrow disparities in the health system.[28]
  • Addressing financial and workforce barriers: Expanding public financing and insurance coverage eases the burden of out-of-pocket costs.[30] Strengthening the rehabilitation workforce through training, recruitment, and retention of therapists and neuropsychologists addresses workforce shortages.[30]
  • Innovative service delivery approaches: Telehealth, mobile technologies, and community and home-based rehabilitation can extend capacity and reach.[34] Clearer referral pathways from acute care to community and home services, affordable and locally developed rehabilitation technologies, improved caregiver training and home adaptation, and stronger data systems to monitor access, quality, and outcomes can improve the overall system.[31]

Stroke rehabilitation in Europe

Stroke Rehabilitation in Europe is another important area for research. Europe is unique as the continent with the highest concentration of high-income economies, leaving it with the lowest share of low- and middle-income countries (LMICs) globally.[3] Current evidence on stroke rehabilitation in European LMICs is limited to Armenia, Bosnia and Herzegovina, and Moldova.[35] [36] [37] [38] Although the evidence is a bit fragmented and unlike other regions on this page, most available evidence for European LMICs is not stroke-specific. It is extracted from broader government workforce evaluations and general stroke-care registries rather than dedicated stroke rehabilitation studies, so findings here are inferred rather than directly reported.

Barriers to stroke rehabilitation in Europe

Evidence extracted from broader government workforce evaluations and general stroke-care registries points to three interrelated categories of barriers in Armenia, Bosnia and Herzegovina, and Moldova:

  • Health system gaps: Stroke care quality across Europe is related strongly with GDP and healthcare spending, with rehabilitation and stroke unit access identified among the areas most in need of improvement region-wide.[35]
  • Care Coordination and Delivery Gaps: In Moldova, a hospital registry found limited CT access delaying diagnosis and treatment pathways.[36] In Bosnia and Herzegovina, a clinical trial found standard care often leaves post-stroke depressive symptoms unaddressed.[38]
  • Workforce and system gaps: In Armenia, a WHO workforce evaluation found shortages and inconsistent professional recognition for rehabilitation roles.[37]

Consequences of limited access to stroke rehabilitation

Stroke unit and rehabilitation bed availability remains insufficient in most European countries, a gap the Christensen et al. audit links to worse outcomes in lower-income countries specifically.[35] Diagnostic gaps in Moldova, including limited CT access, delay accurate triage toward rehabilitation.[36] Untreated depression in Bosnia and Herzegovina is linked to poorer rehabilitation engagement.[38]

Opportunities to improve stroke rehabilitation

  • Strengthening health systems: National stroke plans and quality-audit programmes are linked to better outcomes region-wide, so should be developed.[35] Bosnia and Herzegovina's trial supports integrating psychoeducation into standard rehabilitation.[38]
  • Addressing workforce barriers: Armenia's evaluation recommends formalising rehabilitation roles within national strategy.[37]

Stroke rehabilitation in Oceania

Stroke Rehabilitation in Oceania is another important area for research. Oceania is unique as the global region characterised by isolated, small-island LMICs that face extreme economic vulnerability despite having zero nations in the lowest-income bracket.[3] Unlike Africa, Asia, and Latin America and the Caribbean, there is currently no recent, peer-reviewed, systematic body of evidence on stroke rehabilitation barriers, consequences, or opportunities specific to Pacific Island LMICs. Of the ten Pacific Island LMICs recognised by the World Bank[3] (Fiji, Kiribati, the Marshall Islands, the Federated States of Micronesia, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu, and Vanuatu), stroke-rehabilitation-specific evidence exists only for Fiji and Papua New Guinea, and even there it is limited to a single dated study and anecdotal accounts respectively. This does not provide sufficient breadth to characterise the region in the same depth as the sections above.

Rehabilitation approaches and emerging evidence in LMIC

There has been a growing evidence in rehabilitation approach across the globe. While most are effective generally, their feasibility in LMIC population requires a more evidence. The following summarises current literature on this evidence, considering the barriers, consequences, and opportunities outlined above.

Low-cost, self-directed stroke rehabilitation

Self-directed stroke rehabilitation has been shown to be effective in LMIC. A 2021 randomised controlled trial in developing countries for individuals with chronic stroke found that a structured self-rehabilitation programme, in which patients performed guided upper-extremity exercises independently between formal therapy sessions, improved motor function outcomes without requiring additional therapist time.[39] Similarly, a 2022 randomised controlled pilot study in Suriname (the SunRISe study) tested a home-based, semi-supervised physiotherapy intervention explicitly designed to require fewer resources than centre-based programmes, and found it feasible in a low-resource setting.[40] A 2025 qualitative descriptive study of Pakistani physiotherapists found that physiotherapists perceived task-oriented training as valuable when adapted to local constraints., with therapists reporting home-based modifications and caregiver involvement as practical approach to addressing resource limitations, time constraints, and cultural factors affecting implementation.[41]

Task-shifting and caregiver-delivered rehabilitation

Given the family-centred, culturally-based model of care common in LMIC, shifting rehabilitation tasks to trained caregivers or community-level workers has been directly tested in LMIC settings, with mixed but instructive results.

The RECOVER trial NCT02247921 a 2019 multicenter prospective, randomised open, blinded outcome assessed, controlled trial conducted in 3 rural county hospitals in China tested a nurse-led, caregiver-delivered rehabilitation model supported by a smartphone application across three rural county hospitals, based on a task-shifting approach designed specifically for low-resource contexts.[42] The results found the intervention did not significantly improve physical functioning compared with usual care, despite the promising task-shifting design.[42] Similarly, the ATTEND 2017 trial in India, a large multi-hospital randomised controlled trial, tested family-led rehabilitation initiated in hospital and continued at home; results did not show family-led rehabilitation to be superior to usual care, illustrating that task-shifting models require careful design and are not universally effective simply because they are lower-cost.[43]

Community-based, gait and balance-specific rehabilitation

Community-based, gait and balance-specific rehabilitation shows promising but mixed evidence to be effective in LMIC. A 2026 scoping review of community-based stroke rehabilitation in low-resource settings in which existing studies included were LMIC countries (Brazil, Thailand, China, India, Uganda, Turkey, Benin, Vietnam, Nigeria, Iran, Malaysia), showed that physical rehabilitation programs were typically delivered at home by a single healthcare professional such as a physiotherapist or nurse. Over half of included randomised controlled trials showed statistically significant improvement over control groups, and none reported cost-effectiveness data, highlighting both the promise and the evidence gaps in this delivery model.[44] A separate 2026 scoping review focusing specifically on gait and balance rehabilitation interventions in LMICs in which 89 studies were included similarly mapped the scope and characteristics of published research, identifying where evidence is concentrated and where significant gaps remain.[45] There was a clear predominance of conventional, exercise-based approaches alongside an emerging interest in technology-assisted and adjunctive interventions. However, important gaps persist, as evidence is concentrated in a small number of countries, with very limited representation from low-income contexts, and the reporting of intervention content, intensity, and comparators is frequently incomplete.[45] A 2021 systematic review focused specifically on India found several gait training interventions, including treadmill-based and task-specific approaches, showing benefit for stroke survivors, though the evidence base remains limited in size.[46]

Technology-based interventions

A 2025 systematic review and meta-analysis which included 50 studies found that technology-based interventions for upper limb rehabilitation, including robotic and virtual reality-based tools, improved motor function, activities of daily living, and quality of life for stroke survivors in LMICs.[47] Although two earlier scoping reviews from Southeast Asia which examined the application of technological interventions for general stroke rehabilitation and for falls and fall-risk management specifically, both concluding that technology remains underused in LMIC compared to high-income countries.[48] [49] Similarly, a 2021 systematic review of affordable rehabilitation robotics for upper limb stroke recovery in developing countries identified specific engineering approaches used to reduce production costs, making robotic-assisted therapy more accessible in low-resource clinical settings.[50] In addition, a 2025 participatory co-creation study in Ethiopia developed and tested an immersive virtual reality system for upper limb stroke rehabilitation designed explicitly for LMIC contexts, addressing barriers common to conventional rehabilitation.[51] Overall, while older studies focused on the feasibility of technological interventions for stroke rehabilitation in LMIC, recent systematic review suggest that technology-based interventions for upper limb rehabilitation improved motor function, activities of daily living, and quality of life for stroke survivors in LMICs.[47]

Mobile health and telehealth solutions

A perspective article on mobile health (mhealth) solutions argues that mHealth technologies represent a significant opportunity to extend rehabilitation access in LMICs, particularly given the rapid growth of mobile phone even in settings with limited formal healthcare infrastructure, though the authors note that evidence on effectiveness and implementation remains at an early stage.[52] Consistent with this, a scoping review of mobile stroke units in low and lower-middle-income countries found current evidence still limited, with implementation examples reported in India and Nigeria, and identified utilisation, cost-effectiveness, and contextual suitability as priority areas for future research.[53]

[54]

Context-adapted public awareness messaging

A 2025 global review of stroke symptom messages found that widely used mnemonics such as FAST and BE-FAST, while effective in the settings where they were developed, may have limited effectiveness or cultural acceptability when applied without adaptation elsewhere.[55] CFAST, a stroke education tool specifically simplified and culturally adapted for Chinese communities, illustrates this principle in practice.[56] In some rural South African settings, similar locally-adapted awareness efforts have been reported in practice, including BE-FAST pamphlets distributed at weekly community hypertension clinics and school-based education on stroke signs and symptoms.

[57]
[58]

Assistive device and wheelchair access

In LMIC, access to appropriate assistive devices remains a persistent barrier to stroke rehabilitation. An older but still-cited South African study examining wheelchair service delivery in a rural setting found gaps between national and international policy guidance and actual implementation on the ground, including challenges with repair access, travel distances, and shortages of trained service providers in rural areas.[59] More recently, some rural South African rehabilitation services have reported addressing this gap through monthly outreach drives providing wheelchairs and walking aids such as walkers and quadrupods to underserved areas, alongside occupational therapist-led caregiver training on safe mobilisation techniques and nurse training on bed mobility and positioning protocols.

Summary of the page

Stroke rehabilitation is essential for improving the lives of people affected by stroke. There are many challenges and consequences to providing rehabilitation in LMICs, but there are also a number of opportunities to improve access to these services. The majority of these challenges centre on a shortage of rehabilitation professionals, financial burden on patients, lack of funding, lack of transport, poor referral pathways, inadequate infrastructure, and a lack of guidelines and registries. By addressing these challenges and opportunities, LMICs can make significant progress in reducing the burden of stroke. Emerging evidence highlights promising but still-developing approaches, including context-adapted public awareness messaging, technology-based interventions, and community-based rehabilitation, alongside continued gaps in gait- and balance-specific programmes. Mobile health and telehealth solutions remain an area for ongoing and future research.

References

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  37. ↑ 37.0 37.1 37.2 World Health Organization. Rehabilitation workforce in Armenia: evaluation report 2024–2025. InRehabilitation. 2025.
  38. ↑ 38.0 38.1 38.2 38.3 Glinac A, Sinanović O. Multicomponent Educational-Rehabilitation Treatment and Its Impact on Depressive Symptoms in Stroke Survivors. Psychiatria Danubina. 2024 Aug 23;36(2):219-24.
  39. ↑ Natta DD, Lejeune T, Detrembleur C, Yarou B, Sogbossi ES, Alagnide E, Kpadonou T, Selves C, Stoquart G. Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial. Annals of Physical and Rehabilitation Medicine. 2021 Jan 1;64(1):101413.
  40. ↑ Jarbandhan A, Toelsie J, Veeger D, Bipat R, Vanhees L, Buys R. Feasibility of a home-based physiotherapy intervention to promote post-stroke mobility: A randomized controlled pilot study. PLoS One. 2022 Mar 7;17(3):e0256455.
  41. ↑ Afridi A, Malik AN, Raheel N, Aiman U, Shahid F, Iftikhar A, Rehman M. Task-oriented training in stroke rehabilitation: Qualitative study on perspectives and challenges among Pakistani physiotherapists. PloS one. 2025 Aug 20;20(8):e0330634.
  42. ↑ 42.0 42.1 Zhou B, Zhang J, Zhao Y, Li X, Anderson CS, Xie B, Wang N, Zhang Y, Tang X, Prvu Bettger J, Chen S. Caregiver-delivered stroke rehabilitation in rural China: The RECOVER randomized controlled trial. Stroke. 2019 Jul;50(7):1825-30.
  43. ↑ Lindley RI, Anderson CS, Billot L, Forster A, Hackett ML, Harvey LA, Jan S, Li Q, Liu H, Langhorne P, Maulik PK. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. The Lancet. 2017 Aug 5;390(10094):588-99.
  44. ↑ Hardianto Y, Lynch E, Irwan AM, Kandasamy T, Purvis T, Callisaya ML, Lindley RI, Gandhi D, Liu N, Abd Aziz NA, Pandian J. A scoping review of community-based stroke rehabilitation in low-resource settings. International Journal of Stroke. 2026 Feb;21(2):164-76.
  45. ↑ 45.0 45.1 Urimubenshi G, Kumurenzi A, Kaseke F, de Oliveira Cacho R, de Oliveira Baggio JA. Recent research on rehabilitation interventions for post-stroke gait and balance in low-and middle-income countries: a scoping review. BMC Health Services Research. 2026 Apr 20.
  46. ↑ Shankaranarayana AM, Gururaj S, Natarajan M, Balasubramanian CK, Solomon JM. Gait training interventions for patients with stroke in India: A systematic review. Gait & posture. 2021 Jan 1;83:132-40.
  47. ↑ 47.0 47.1 Carbajal Galarza M, Chinchihualpa Paredes NO, Abanto Perez SA, Saposnik G, Lazo-Porras M. Effectiveness of technology-based stroke interventions to improve upper limb functioning in low-and middle-income countries: a systematic review and meta-analysis. Topics in stroke rehabilitation. 2025 Oct 3;32(7):723-43.
  48. ↑ Selamat SN, Che Me R, Ahmad Ainuddin H, Salim MS, Ramli HR, Romli MH. The application of technological intervention for stroke rehabilitation in Southeast Asia: a scoping review with stakeholders' consultation. Frontiers in public health. 2022 Feb 7;9:783565.
  49. ↑ Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MS, Mackenzie L. Stroke rehabilitation for falls and risk of falls in Southeast Asia: a scoping review with stakeholders' consultation. Frontiers in public health. 2021 Mar 3;9:611793.
  50. ↑ Demofonti A, Carpino G, Zollo L, Johnson MJ. Affordable robotics for upper limb stroke rehabilitation in developing countries: a systematic review. IEEE Transactions on Medical Robotics and Bionics. 2021 Jan 26;3(1):11-20.
  51. ↑ Kenea CD, Abessa TG, Lamba D, Bonnechère B. AdaptRehab VR: development of an immersive virtual reality system for upper limb stroke rehabilitation designed for low-and middle-income countries using a participatory co-creation approach. Bioengineering. 2025 May 28;12(6):581.
  52. ↑ Bonnechère B, Kossi O, Mapinduzi J, Panda J, Rintala A, Guidetti S, Spooren A, Feys P. Mobile health solutions: An opportunity for rehabilitation in low-and middle income countries?. Frontiers in Public Health. 2023 Jan 24;10:1072322.
  53. ↑ Opare-Addo PA, Tannor EK, Brennan E, Aikins M, Bediako SA, Herbert TL, Hutton-Mensah KA, Ofori E, Gyan KF, Gyabaah S, Acheamfour-Akowuah E. A scoping review of the utilization of mobile stroke units in low and lower middle-income countries: current evidence, implications and future direction. BMC Health Services Research. 2025 May 22;25(1):742.
  54. ↑ VJNeurology. Enhancing stroke rehabilitation in low-income countries with innovative technologies. Available from: https://www.youtube.com/watch?v=Yzs6UC-WUnU [last accessed 30/8/2026]
  55. ↑ Singh H, Belson S, Beauchamp JE, Nelson ML. Examining stroke symptom messages implemented globally: a need for contextually relevant stroke symptom messaging. Journal of Nursing Scholarship. 2026 Jan;58(1):e70059.
  56. ↑ Khan H, Wang Y, Ren CC, Chen J, Xie XB, Xu W, Li M, Huang DL, Xiao J. CFAST––a simplified and culturally adopted stroke education tool for the Chinese communities. Frontiers in Stroke. 2026;5:1845862.
  57. ↑ UW Medicine. Know the warning signs of stroke with BE FAST. Available from: https://www.youtube.com/watch?v=j8pvpdyGb7w [last accessed 30/8/2026]
  58. ↑ AllThingsParamedic. BE-FAST Stroke Assessment: Recognise a Stroke Fast | Paramedic Guide. Available from: https://www.youtube.com/watch?v=d-nYib9_Kzg [last accessed 30/8/2026]
  59. ↑ Visagie S, Scheffler E, Schneider M. Policy implementation in wheelchair service delivery in a rural South African setting. African journal of disability. 2013 Jan 1;2(1):1-9.
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