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What is Rehabilitation and Assistive Technology

Original Editor - Ewa Jaraczewska based on the Creating Awareness of Rehabilitation and Assistive Technology course

Top Contributors - Ewa Jaraczewska, Jess Bell, Tarina van der Stockt, Kim Jackson and Rachael Lowe  


Introduction

Rehabilitation has been identified by the World Health Organization (WHO) as an essential health service. It has many benefits for individuals with acute or chronic health conditions, including decreased recovery time after injury or illness, reduced complications, and improved physical and mental functioning and well-being.

The WHO defines rehabilitation as: "a set of interventions designed to optimize functioning [...] in individuals with health conditions in interaction with their environment".[1] This article highlights the global need for rehabilitation and assistive technology before discussing each component of the WHO's definition of rehabilitation. It then explores assistive technology provision and the link between assistive technology and rehabilitation.

Global Need for Rehabilitation

Recent data reveals a significant global need for rehabilitation services and assistive technology. Approximately 2.4 billion people, or around one-third of the global population, require rehabilitation services.[1] Similarly, one in three people globally could benefit from assistive products.[2] However, access remains limited—only 10% of those needing assistive products can obtain them.[1]

Population ageing is a primary driver of the increased need for rehabilitation.[3] As life expectancy increases globally, more individuals experience age-related conditions requiring rehabilitation.[4][5]

Modern medical advances have also significantly improved survival rates from severe illness and injury.[6] While this progress represents a tremendous achievement, it has increased the number of individuals living with chronic conditions that require ongoing rehabilitation support and assistive technology.[4]

Similarly, the rising prevalence of non-communicable diseases, including cardiovascular conditions, diabetes, and respiratory disorders, has expanded rehabilitation needs.[7] These conditions often result in long-term functional limitations that require sustained intervention and assistive technology support.[4]

Improved screening and diagnostic capabilities have enhanced the recognition of developmental conditions. This increased awareness has led to earlier intervention and greater demand for specialised rehabilitation services and adaptive technology solutions.[4]

Rehabilitation Interventions

WHO PIR Health Conditions

The WHO’s Rehabilitation 2030 Initiative aims to help decrease unmet rehabilitation needs.[8] The Package of Interventions for Rehabilitation (PIR) was developed to help countries incorporate rehabilitation into their health systems. It provides a comprehensive framework for “essential” rehabilitation interventions, focusing on 20 health conditions.[9]

Functioning interventions in the PIR can be pharmacological and non-pharmacological.[9] This page focuses on non-pharmacological interventions. These interventions should be preventive, promotive, restorative, or compensatory, and they are divided into five categories:[9]

  • therapeutic techniques and procedures, exercises and training
  • physical modalities
  • assistive products
  • environmental modifications
  • self-management interventions

These five interconnected approaches enable clinicians to develop holistic rehabilitation programmes that address an individual’s immediate needs and long-term recovery goals.[10]

Therapeutic techniques and procedures, exercises and training are key components of a rehabilitation plan. This category includes interventions such as manual therapy, range of motion exercises and cognitive behavioural therapy.

Physical modalities, such as heat, cold, and electrical stimulation, can help manage pain and promote healing.

Appropriate assistive technology provision and training enable individuals to maintain or improve their functional capabilities through various devices and tools.

Environmental modifications can help create accessible spaces that accommodate individual needs and promote independence.

Self-management interventions empower patients to take an active role in their rehabilitation journey, providing them with the knowledge and skills to manage their conditions effectively. This intervention category includes education, advice, and carer and family training and support.

Optimising Functioning

Rehabilitation aims to optimise an individual's function to improve their overall capabilities and quality of life. Functioning, as defined by the WHO, encompasses multiple interconnected dimensions that shape a person's ability to engage with their environment and participate in daily life.[11]

The International Classification of Functioning, Disability and Health (ICF) is an important framework as it recognises the relationship between an individual's functioning and their health condition.

In the ICF, body functions and structures, activities and participation (i.e. health domains), and environmental and personal factors (i.e. health-related domains) determine functioning.[11] These domains are described below. Rehabilitation aims to help people achieve optimal performance across all these dimensions.[1]

Body functions are the physiological functions of body systems, such as muscle strength, joint mobility, and sensory processing. Body structures are the anatomical parts of the body, such as organs, limbs and their components.[11]

Activities are specific tasks that a person performs each day. They range from essential self-care tasks to complex skill-based actions.[11]

Participation is a broader concept, focusing on an individual’s ability to engage in meaningful social, occupational, and recreational activities.[11]

Environmental factors are the physical, social, and attitudinal environment in which people live and conduct their lives. They can either facilitate or hinder an individual's functioning.[11]

Personal factors, such as age, gender, education level, and coping strategies, influence how individuals navigate their rehabilitation journey and adapt to challenges.[11]

Applying the ICF in clinical practice can enhance decision-making among healthcare and social care professionals. It can help them develop targeted interventions that address all aspects of an individual's life and promote maximum independence and well-being.

If you want to learn more about the ICF, please read this article.

Various interventions can optimise a person's functioning, such as skill development and strategy implementation, using assistive technology, environmental modification, building confidence and capabilities, and addressing social and attitudinal barriers. The following sections provide examples of these interventions.

Skill Development and Strategy Implementation

Rehabilitation professionals focus on teaching new skills and strategies to enhance an individual's capabilities. This process may involve systematic training in alternative methods for performing daily activities. For instance, occupational therapists might work with stroke survivors to develop new movement patterns for self-care tasks. In contrast, speech and language therapists may introduce alternative communication techniques for individuals with speech impairments.[12]

Assistive Technology

Integrating assistive products into an individual’s daily life is key to optimising functioning.[13] Assistive technology solutions range from basic mobility aids to sophisticated communication devices.[12] These tools serve as bridges, helping individuals overcome specific functional limitations and participate more fully in daily activities. The selection and implementation of assistive technology must be carefully matched to each individual's needs, capabilities, and life circumstances.

Environmental Modification Strategies

Rehabilitation professionals assess and adapt physical spaces to enhance accessibility and usability. They might recommend home modifications, such as ramps or grab bars, or suggest workplace adaptations to improve ergonomics and accessibility.[12] The goal is to create environments that support rather than hinder individual function.

Building Confidence and Capability

Rehabilitation professionals employ various techniques to enhance self-efficacy and motivation.[12] This psychological support helps individuals develop resilience and remain engaged in rehabilitation. Through supportive practices and guided experiences of success, individuals develop the confidence to tackle increasingly challenging activities.

Addressing Social and Attitudinal Barriers

Optimising functioning involves addressing broader social and attitudinal barriers. Rehabilitation professionals work to promote inclusivity through education and advocacy. This might include working with families, employers, or community groups to foster understanding and support. Additionally, practitioners help individuals develop self-advocacy skills to navigate social situations effectively.[12]

Health Conditions

While the WHO Package of Interventions for Rehabilitation identifies 20 specific health conditions, rehabilitation interventions can benefit people with various conditions that affect functioning.

Health conditions and rehabilitation needs vary across the lifespan.[9] In early life, conditions such as cerebral palsy, developmental delays, and congenital disorders may require rehabilitation interventions to optimise development and function. In adulthood, rehabilitation is often required for conditions related to trauma, such as spinal cord and traumatic brain injuries, and progressive neurological conditions, like multiple sclerosis, as well as cardiovascular conditions, like stroke and heart disease. Musculoskeletal conditions, particularly low back pain and arthritis, are also major sources of disability that can benefit from rehabilitation services. As individuals age, conditions such as dementia, Parkinson's, and age-related sensory impairments become more prevalent. These conditions often require specialised rehabilitation to help people maintain independence and quality of life. Rehabilitation must be carefully planned in older individuals with multiple comorbidities.[9]

The WHO emphasises that functional limitations should drive rehabilitation interventions. Thus, an individual's need for rehabilitation depends on how their health condition affects their ability to function and participate in daily activities. For instance, two individuals with the same diagnosis may require different rehabilitation approaches based on their circumstances, environmental factors, and participation goals.[12]

It is important to remember that establishing the impact of a health condition on an individual’s daily life and participation is not a diagnosis, but it determines a person’s need for rehabilitation.[14]

Functioning includes various domains, such as mobility, self-care, communication, cognition, and social interaction. Limitations in these areas can affect an individual's ability to participate in work, education, family life, and community activities. The severity of functional limitations, rather than the underlying diagnosis, often determines the intensity and duration of rehabilitation needed.[12]

Environmental Interaction

The complex interactions between physical spaces, social support networks, attitudinal contexts, and systemic structures can influence rehabilitation outcomes. Understanding and addressing these environmental dimensions enables more effective rehabilitation planning and implementation.[12]

Physical Environment

Physical spaces are the built and natural spaces that individuals must navigate. Accessibility remains a fundamental consideration in rehabilitation planning. Healthcare facilities must provide adequate space for therapeutic activities, appropriate lighting, and necessary equipment. Beyond clinical settings, home and community environments should be assessed and modified to support recovery.[12]

Physical infrastructure considerations include doorway widths, surface textures, lighting conditions, and acoustic properties. These elements directly impact mobility, safety, and independent function. Rehabilitation professionals must assess these factors when developing treatment plans and making recommendations for environmental modifications.[12]

Social Support

Family members often serve as primary caregivers. Community support includes friends, neighbours, and local organisations. Effective rehabilitation programmes incorporate family education and training. This includes teaching proper assistance techniques, understanding recovery expectations, and recognising signs of complications. Community resources, such as support groups and volunteer organisations, can supplement professional care and provide additional social engagement opportunities.[12]

Attitudinal Environment

Negative attitudes and misconceptions about disability can create barriers to participation and recovery. Positive attitudes promote social inclusion and improve an individual’s self-esteem.[15] Healthcare providers must understand and address attitudinal barriers and discrimination affecting patient care. Rehabilitation professionals should recognise how cultural beliefs and values influence perceptions of disability and recovery.[15] Educational initiatives, including cultural competency training for healthcare staff, family members, and community stakeholders, can help create more supportive attitudinal environments.

Systems and Policies

Healthcare systems and policies create the framework within which rehabilitation services operate. Insurance coverage, service accessibility, and healthcare regulations impact treatment options and duration.[16] Understanding these systemic factors helps practitioners advocate effectively for patient needs.

Understanding Assistive Technology

Assistive technology is a comprehensive system with three main components: products, services, and systems. Each component is essential in ensuring successful implementation and outcomes.

Products are external devices that maintain or improve functioning and independence. Product categories include mobility devices, communication aids, sensory aids, and adaptive equipment for daily activities.[12] An appropriate assistive technology product must meet the user's needs and environmental context. It must provide a proper fit and postural support when required. It must be safe, durable and available. Finally, there must be affordable options to maintain and service the product locally.[12]

Specific services must be in place to ensure the successful implementation of assistive technology products. Rehabilitation professionals must first comprehensively assess the user's needs, functional capabilities, and environmental factors. This assessment guides product selection and customisation. Service delivery also includes user training and education, ongoing monitoring and support, maintenance and repair coordination.[12]

A broader infrastructure or system supports the implementation of assistive technology. This includes the policies, funding, and infrastructure that make assistive technology available. Effective systems ensure equitable access to appropriate assistive technology. System components include health insurance policies, funding mechanisms, reimbursement structures, professional training programmes, product procurement and distribution channels, quality control and regulatory frameworks.[12]

When selecting an assistive product, the healthcare professional must consider:

  • functional requirements and user capabilities, including the user's knowledge and lived experiences[17]
  • environmental conditions and constraints, such as the weather and other environmental conditions that the assistive product should be able to withstand[18]
  • availability of local support services so parts can be repaired, maintained and replaced locally[19]
  • cost and funding options, because "having predictable, stable, and adequate financial resources is essential for achieving universal coverage of essential health products and services"[20]
  • the supplier's maintenance requirements, including time frame and frequency[18]

The Interdependence of Rehabilitation and Assistive Technology

Rehabilitation and assistive technology often work together to maximise patient recovery and independence. Understanding the link between rehabilitation and assistive technology enables practitioners to optimise intervention strategies and improve patient outcomes.

Rehabilitation can help individuals develop skills that enable them to use assistive technology effectively. For example, physiotherapy can increase a person's strength and coordination, enabling them to successfully operate a mobility device. Occupational therapy can help them develop the fine motor skills to manipulate adaptive equipment. Speech and language therapy helps people build the skills to use communication devices.[21]

Assistive technology can extend and maintain functional gains achieved through rehabilitation. For instance, mobility devices preserve energy and increase independence after gait training, and adaptive equipment maintains participation in daily activities following upper extremity rehabilitation. Communication devices sustain social interaction after speech therapy interventions.[22]

As a patient’s needs change, rehabilitation approaches and assistive technology solutions must evolve. Interventions may need to be modified to meet changing needs, particularly for individuals with progressive conditions. People who experience an improvement in function also need to have their assistive technology needs reassessed. Regular reassessment ensures that rehabilitation goals remain aligned with assistive technological support.[12]

Rehabilitation and assistive technology "solutions go beyond a functioning piece of equipment and become a reflection of the specific user, not unlike a unique style of fashion."[23]

Conclusions

The WHO defines rehabilitation as a range of interventions that aim to enhance a person's function while considering their environment. Evidence-based rehabilitation interventions range from therapeutic techniques to environmental modifications. These interventions should be adapted to reflect a person's specific context. Rehabilitation and assistive technology can work together to enhance overall outcomes.

Resources

References

  1. ↑ 1.0 1.1 1.2 1.3 Rehabilitation. Available from https://www.who.int/news-room/fact-sheets/detail/rehabilitation [last access 30.11.2024]
  2. ↑ Danemayer J, Boggs D, Ramos VD, Smith E, Kular A, Bhot W, Ramos-Barajas F, Polack S, Holloway C. Estimating need and coverage for five priority assistive products: a systematic review of global population-based research. BMJ global health. 2022 Jan 1;7(1):e007662.
  3. ↑ de Araújo RO, Fernandes TG, Jesus TS. Rehabilitation Needs Across Heterogenous Brazilian Regions: Secondary Analysis of the Global Burden of Disease Study. Int J Environ Res Public Health. 2025 Mar 25;22(4):486.
  4. ↑ 4.0 4.1 4.2 4.3 Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021 Dec 19;396(10267):2006-2017.
  5. ↑ Gianfredi V, Nucci D, Pennisi F, Maggi S, Veronese N, Soysal P. Aging, longevity, and healthy aging: the public health approach. Aging Clin Exp Res. 2025 Apr 17;37(1):125.
  6. ↑ Berecki-Gisolf J, Fernando T, D'Elia A. Trends in mortality outcomes of hospital-admitted injury in Victoria, Australia 2001-2021. Sci Rep. 2023 May 3;13(1):7201.
  7. ↑ Taheri Soodejani M. Non-communicable diseases in the world over the past century: a secondary data analysis. Front Public Health. 2024 Oct 3;12:1436236.
  8. ↑ Douryang M, Pillay L, Mkumbuzi NS, Foti C. The World Health Organization's Rehabilitation 2030 vision: an African perspective. Front Rehabil Sci. 2024 Jul 16;5:1442626.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 Package of Interventions for Rehabilitation. Module 1. Introduction. Geneva: World Health Organization;2023. Available from https://www.google.pl/books/edition/Package_of_interventions_for_rehabilitat/qnsOEQAAQBAJ?hl=en&gbpv=1&printsec=frontcover [last access 16.12.2024]
  10. ↑ Rauch A, Negrini S, Cieza A. Toward Strengthening Rehabilitation in Health Systems: Methods Used to Develop a WHO Package of Rehabilitation Interventions. Arch Phys Med Rehabil. 2019 Nov;100(11):2205-2211.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001.
  12. ↑ 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 12.11 12.12 12.13 12.14 12.15 Xuan D. What is Rehabilitation and Assistive Technology. Plus course 2024
  13. ↑ Danemayer J, Holloway C, Cho Y, Berthouze N, Singh A, Bhot W, Dixon O, Grobelnik M, Shawe-Taylor J. Seeking information about assistive technology: Exploring current practices, challenges, and the need for smarter systems.International Journal of Human-Computer Studies 2023;177:103078
  14. ↑ Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clinical rehabilitation. 2020 May;34(5):571-83.
  15. ↑ 15.0 15.1 Babik I, Gardner ES. Factors affecting the perception of disability: A developmental perspective. Frontiers in Psychology. 2021 Jun 21;12:702166.
  16. ↑ Carvalho E, Bettger JP, Goode AP. Insurance Coverage, Costs, and Barriers to Care for Outpatient Musculoskeletal Therapy and Rehabilitation Services. N C Med J. 2017 Sep-Oct;78(5):312-314.
  17. ↑ Howard J, Fisher Z, Kemp AH, Lindsay S, Tasker LH, Tree JJ. Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review. Disability and Rehabilitation: Assistive technology. 2022 May 19;17(4):390-408.
  18. ↑ 18.0 18.1 Assistive product specifications and how to use them. Geneva: World Health Organization; 2021. Available from https://iris.who.int/bitstream/handle/10665/339851/9789240020283-eng.pdf [last access 3/12/2024]
  19. ↑ Improving access to assistive technology (2018) WHO Seventy-First World Health Assembly. Available from https://apps.who.int/gb/ebwha/pdf_files/wha71/a71_21-en.pdf [last access 3. 12.2024]
  20. ↑ Tay-Teo K, Bell D, Jowett M. Financing options for the provision of assistive products. Assist Technol. 2021 Dec 1;33(sup1):109-123.
  21. ↑ Aqel MO, Issa A, Elsharif AA, Ghaben S, Alajerami YS, Khalaf H, Alrayyes T, Bratanov D, Debeljak M, Brabazon D. Review of recent research trends in assistive technologies for rehabilitation. In 2019 International Conference on Promising Electronic Technologies (ICPET) 2019 Oct 23 (pp. 16-21). IEEE.
  22. ↑ Khasnabis C, Heinicke Motsch K, Achu K, et al., editors. Community-Based Rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010. Assistive devices. Available from https://www.ncbi.nlm.nih.gov/books/NBK310951/ [last access 4.12.2024]
  23. ↑ French J, Anderson KD, Welden J, Axelson P, Bayes B, Burkhart I. Inclusive rehabilitation and assistive technologies development: An exploration of considerations, principles, and stakeholder engagement. J Rehabil Assist Technol Eng. 2024 Oct 3;11:20556683241286517.
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