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When Are Rehabilitation and Assistive Technology Provided

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 and Rachael Lowe  

Introduction

Rehabilitation and assistive technology can play a significant role in optimising outcomes for many individuals with acute or long-term health conditions or disabilities. Together, these services enable people to complete daily activities that might otherwise be difficult or impossible to achieve.

"Rehabilitation can reduce the impact of a broad range of health conditions, including diseases (acute or chronic), illnesses or injuries."[1] Rehabilitation is a fundamental right and vital health service that must be accessible when any person experiences limitations in their daily functioning - whether from a sudden injury, ongoing health condition, or any impairment. This essential care should be provided based on individual needs, without barriers or restrictions.[1]

There is a worldwide need for assistive technology. The World Health Organization's initiative to increase access to assistive technology, called the Global Cooperation on Assistive Technology (GATE), has a vision that everyone in need can obtain high-quality, affordable assistive products to live productive lives.[2]

This article discusses the need for rehabilitation interventions and assistive products across the lifespan. It also reviews how rehabilitation interventions and assistive products are adapted to meet the needs of individuals during different phases of healthcare and explores why early identification and timely access to services are essential for optimal outcomes. Finally, it introduces common misconceptions that can limit access to these services.

The Need for Rehabilitation and Assistive Products Across the Lifespan

The need for rehabilitation services and / or assistive products can arise at any stage of life—from birth to adulthood.

Bilateral clubfoot

Early intervention and assistive technology are critical for premature infants and newborns with health conditions, with each group requiring specialised approaches to support optimal development. For premature infants, rehabilitation integrates multiple sensory and motor interventions. Healthcare professionals work on supporting respiratory function through positioning and gentle handling, promoting oral motor skills for feeding, and providing appropriate visual and auditory stimulation to support sensory development.[3] For high-risk newborns, rehabilitation support should begin immediately after birth. These early interventions are designed to address potential delays across multiple domains—from motor skills and sensory processing to cognitive development and communication. Diagnosing specific conditions in newborns presents unique challenges due to their rapidly evolving developmental status, but the benefits of early intervention are well-documented.[4] Neonatal rehabilitation must be comprehensive and individualised. It must consider each infant's specific needs and aim to effectively involve the family or caregiver.

The benefits of early intervention are clear when we consider the management of congenital clubfoot. The rehabilitation of children born with clubfoot follows a systematic approach, combining gentle stretching exercises with a progressive series of casting techniques. Lower limb braces are also fitted to maintain the corrected position and prevent recurrence.[5] It is essential to carefully time and integrate these interventions to promote normal development patterns while addressing any specific challenges during this early period of life.

Speech therapy

During the school-age years, rehabilitation and assistive technology interventions are designed to help create an inclusive home, play and educational environment that maximises a child's potential to learn, play and engage with their peers and family. They help improve access to academic and leisure materials, facilitate social engagement and foster independence in the home and school environments.

Rehabilitation focuses on enhancing functional abilities through therapeutic interventions, while assistive technology provides practical solutions, allowing students to participate fully in academic activities.[6] Therapeutic interventions in a school setting often include exercises to improve handwriting skills through fine motor control activities, stretching and strengthening exercises to help posture during prolonged sitting and balance training to navigate stairs and playgrounds safely. Assistive technology, like mobility aids and supportive seating systems, helps students move around the school and maintain proper positioning for learning. Screen readers or large print materials facilitate reading for students with visual impairments. Communication devices also help students with speech or hearing issues express themselves and participate actively in classroom discussions and family gatherings.[6]

Transfer training

During adulthood, many people establish and build their careers and may have their own families. For individuals living with disabilities, these life experiences may feel more challenging.[7] The role of rehabilitation and assistive technology during adulthood and the working years often focuses on maintaining function and supporting workplace and social participation.

For people with a physical disability, assistive technology can increase choice, autonomy and participation.[8] Healthcare professionals work closely with each person to determine what they need to thrive in their workplace and community. It may include helping them find the right mobility device that lets them move around easily or communication tools that help them participate fully in meetings, workplace discussions and social events.

For older adults, rehabilitation interventions and assistive products become increasingly important for maintaining independence and preventing decline. Older adults without a health condition or injury-specific disability may start to require rehabilitation and assistive technology as they aim to maintain independent living. They may need physiotherapy for strength and mobility issues, balance problems and preventing falls. Occupational therapy can help with home modifications to make the environment safer. Occupational therapists can also teach alternative or compensatory strategies.[9] Speech and language therapists can help older adults communicate more effectively with their families, friends, and caregivers. The use of assistive technology can help address problems experienced by older adults. For example, mobility aids can enhance the movement of older persons with mobility and balance problems, and hearing devices can allow people with hearing impairments to continue to enjoy conversations, listen to music, watch movies and more.[10]

Rehabilitation and Assistive Technology Across the Continuum of Care

Rehabilitation and assistive technology can be provided at any stage in a person's healthcare journey, from acute hospital care to rehabilitation in the community.

Acute care focuses on immediate health needs during a sudden illness, injury, or health crisis.[11] Rehabilitation interventions in acute care settings can be provided by an interdisciplinary team specialised in rehabilitation care or by healthcare professionals who do not have specialised rehabilitation training.[12] For example, in an intensive care unit (ICU), a specialised rehabilitation team might provide early mobilisation interventions to help mitigate the effects of long-term immobilisation. Other healthcare professionals without specific rehabilitation training might be involved in optimising a patient's positioning. Healthcare professionals in acute care settings will also utilise patient handling equipment, like hoists, slings, and stand assist devices, to help patients with limited mobility move from one place to another.

In rehabilitation hospitals, healthcare professionals work with patients to optimise their functioning through targeted interventions while also addressing ongoing medical needs. For instance, a patient recovering from a stroke may require ongoing cardiovascular monitoring while participating in mobility training. Healthcare professionals may teach this patient how to effectively utilise assistive technology, ranging from simple devices like modified eating utensils to more complex equipment, such as powered mobility aids or communication devices. As this patient progresses through their rehabilitation journey, healthcare providers will adjust interventions and modify assistive technology recommendations to meet the patient's evolving needs and capabilities.

In long-term care settings, rehabilitation and assistive technology serve essential roles in maintaining residents' quality of life and functional abilities.[13] Physiotherapists, occupational therapists, and other rehabilitation professionals implement maintenance programmes that help residents sustain their mobility, strength, and ability to perform daily activities. Assistive technology, such as walkers, wheelchairs, or adaptive equipment for personal care, eating, and communication, enables residents in long-term care settings to maximise their independence despite chronic conditions or age-related limitations.[13]

Timely and appropriate provision of rehabilitation services and assistive technology can support people receiving palliative care. [14] They aim to prevent and relieve suffering, maintain a person's comfort and dignity, enable participation in meaningful activities, promote independence, and reduce caregiver burden.[15] The rehabilitation approach integrates physical interventions, including therapeutic exercises, passive mobilisations and relaxation techniques,[16] with practical support for daily living. Appropriate positioning techniques are applied to manage pain, control swelling, and prevent complications like pressure injuries and joint contractures. Occupational therapy may focus on choosing and providing training on appropriate adaptive techniques and environmental modifications.[17]

Referral Pathways for Rehabilitation and Assistive Technology Services

“Referral can be defined as a process in which a health worker at one level of the health system, having insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of, the client's case.”[18]

Referral systems play a fundamental role in connecting different levels of healthcare services, ensuring patients receive optimal care at the right time and place. A well-functioning referral system operates seamlessly across local, provincial, and national healthcare levels, creating a comprehensive framework that supports patient care continuity.[19]

Referral system

Identifying and referring patients for rehabilitation and assistive technology services requires careful consideration and planning. Healthcare providers must establish efficient and appropriate selection criteria for sustainable service delivery. This approach helps create a robust framework that can effectively meet the diverse needs of patients who require specialised rehabilitation services.[20]

Referrals can originate from various healthcare professionals and stakeholders. While physicians often initiate these referrals, other professionals, such as nurses, hospital discharge planners, social workers, community health workers, insurance case managers, and even teachers or family members, can also make referrals.[11]

The success of referral pathways heavily depends on effective communication between referring physicians and rehabilitation service providers. We can achieve effective communication through mutual understanding, respect and shared objectives. Regular, accurate and timely communication between healthcare providers helps to ensure optimal patient care.

When considering referrals, healthcare providers must take a comprehensive approach that addresses a patient's immediate and future needs. Patients often require multiple services simultaneously—they might need immediate rehabilitation and to be assessed for assistive technology. Careful coordination between providers is essential to ensure all aspects of care are adequately addressed.[11]

Establishing clear referral pathways improves patient outcomes and enhances the efficiency of healthcare delivery. It ensures patients receive appropriate interventions at the right time, maximising their potential for recovery and functional improvement while effectively using healthcare resources.[11]

Impact of Delayed Access to Rehabilitation and Assistive Technology Services

People with disabilities or health conditions may require access to healthcare services and specialised care for their specific impairments and functional needs. Unfortunately, one of the most pressing challenges in healthcare delivery is the tendency to delay referrals until patients show substantial functional decline. This approach contradicts the fundamental principle of early intervention and preventive care.[21]

The potential impact of delayed referrals to rehabilitation services

The timing of rehabilitation interventions is crucial for optimal recovery. For instance, when patients receive early occupational therapy at the first signs of functional or cognitive decline, they have a better chance of preventing further deterioration. Early initiation of physiotherapy services can also improve outcomes and be more cost-effective in the long run.

Research and clinical experience demonstrate that delayed access to rehabilitation can significantly impact recovery potential. The human body and brain demonstrate enhanced plasticity and recovery potential during the initial phase following an injury or illness.[22] Missing this critical window of opportunity due to delayed referrals can result in suboptimal outcomes and longer recovery periods.

The impact of delayed access becomes particularly evident during emergencies and crises. Events such as conflicts, the COVID-19 pandemic, or natural disasters like earthquakes create sudden and massive demands for rehabilitation and assistive technology services. In these situations, prompt access to rehabilitation and assistive technology is essential if optimal health outcomes and functional recovery for those affected are to be achieved.[23]

The psychological consequences of delayed access to rehabilitation and assistive technology services cannot be underestimated. Patients often experience a loss of confidence in their abilities, developing anxiety about their prospects. This psychological impact can lead to social withdrawal and isolation. Furthermore, family dynamics can become strained as caregivers attempt to provide support without proper guidance or appropriate assistive devices, potentially leading to caregiver burnout and deteriorating family relationships.[11]

Perhaps most concerning is the cyclical nature of these delays. When individuals do not receive timely intervention, their condition becomes more complex and challenging to manage. What might have been effectively addressed through early rehabilitation and appropriate assistive technology can escalate into complicated issues requiring more intensive, time-consuming, and expensive interventions. This pattern affects the person's health outcomes and places an additional burden on healthcare resources and systems.[11]

The compounding effect of delayed access creates a situation where the individual and the healthcare system face increased challenges and costs. Early intervention through proper rehabilitation and assistive technology services is evidence-based and results in more efficient use of healthcare resources, ultimately leading to better outcomes for patients and their families.[11]

Common Misunderstandings Affecting Access to Care

Several misconceptions can create barriers to accessing rehabilitation and assistive technology services. These misunderstandings can significantly impact patient care and outcomes.

One common misconception is that only medical doctors can deliver rehabilitation services. While physicians play a crucial leadership role in healthcare teams, rehabilitation services involve diverse healthcare professionals working collaboratively. Each team member brings unique expertise to provide comprehensive care that addresses both the medical and physical aspects of patient conditions.[11]

Another significant misunderstanding is the belief that rehabilitation and assistive products are only for persons with disabilities. Rehabilitation services are essential for anyone experiencing functional limitations due to acute or chronic health conditions, injuries, or impairments. The need for assistive products extends to various populations, including older adults, individuals with noncommunicable diseases, people with conditions like dementia and autism, and those experiencing gradual functional decline. The COVID-19 pandemic has further highlighted the extent of this need, as many individuals recovering from COVID-19 require assistive technology to address long-term functional impairments.[24]

The perception that rehabilitation and assistive products are luxury items rather than necessities is another harmful misconception. The World Health Organization has emphasised that rehabilitation is not an optional service reserved for those who can afford it. Instead, it is a fundamental component of healthcare—one that is particularly relevant in our current context of increasing multi-morbidity, chronic disease, and disability. The importance of rehabilitation and assistive technology is recognised in the United Nations' Sustainable Development Goals, particularly in areas related to health and wellbeing, poverty eradication, education, economic growth, and reducing inequalities.[25]

A dangerous myth suggests that rehabilitation should only begin after medical treatment concludes and that assistive products should only be considered as a last resort. Evidence demonstrates that early intervention is essential. Extended bed rest can lead to muscle atrophy and joint contractures, making movement more difficult. Early rehabilitation complements other medical interventions, enhancing recovery outcomes and helping prevent or manage complications associated with various health conditions such as spinal cord injuries, strokes, or fractures.[26]

The misconception that rehabilitation and assistive technology are social services rather than healthcare services can confuse service provision and access. This misunderstanding can result in fragmented care delivery and barriers to accessing necessary services.[11]

Finally, there's a problematic belief that using assistive products represents giving up or admitting defeat. This could not be further from the truth. Assistive technology represents a commitment to maximising independence and participation. While some impairments or differences may be lifelong and resistant to change, assistive technology is a powerful tool for immediate and sustained independent involvement in daily activities, much like how prescription glasses enable better interaction with one's environment.[11]

These misconceptions can create significant barriers to accessing timely and appropriate care. Addressing these misunderstandings will help ensure that individuals receive the rehabilitation and assistive technology services they need to optimise their function and participation in daily life.

Resources

References

  1. ↑ 1.0 1.1 Rehabilitation. World Health Organization. Geneva 2024. Available from https://www.who.int/news-room/fact-sheets/detail/rehabilitation [last access 7.01.2024]
  2. ↑ Elsaessler L-J. A global standard for assistive technology services. Available from https://committee.iso.org/files/live/sites/tc173/files/6.%20A%20Global%20Standard%20for%20Assistive%20Technology%20Services%2C%20Elsaesser.pdf [last access 3.01.2025]
  3. ↑ Liu Y, Li ZF, Zhong YH, Zhao ZH, Deng WX, Chen LL, Liu BB, Du TJ, Zhang Y. Early combined rehabilitation intervention to improve the short-term prognosis of premature infants. BMC Pediatr. 2021 Jun 9;21(1):269.
  4. ↑ Øberg GK, Girolami GL, Campbell SK, Ustad T, Heuch I, Jacobsen BK, Kaaresen PI, Aulie VS, Jørgensen L. Effects of a Parent-Administered Exercise Program in the Neonatal Intensive Care Unit: Dose Does Matter—A Randomized Controlled Trial. Physical Therapy. 2020 May 18;100(5):860-9.
  5. ↑ Deshmukh AA, Deshpande MS, Pushpa Dhote P. Club-foot deformity management in pediatric rehabilitation: Review article. Journal of Orthopaedic Reports, 2025; 4(1):100387
  6. ↑ 6.0 6.1 Fernández-Batanero JM, Montenegro-Rueda M, Fernández-Cerero J. García-Martínez I. Assistive technology for the inclusion of students with disabilities: a systematic review. Education Tech Research Dev 2022; 70: 1911–1930.
  7. ↑ Ripat JD, Woodgate RL. The importance of assistive technology in the productivity pursuits of young adults with disabilities. Work. 2017;57(4):455-468.
  8. ↑ van Dam K, Gielissen M, Bles R, van der Poel A, Boon B. The impact of assistive living technology on perceived independence of people with a physical disability in executing daily activities: a systematic literature review. Disabil Rehabil Assist Technol. 2024 May;19(4):1262-1271.
  9. ↑ De Coninck L, Declercq A, Bouckaert L, Döpp C, Graff MJL, Aertgeerts B. Promoting meaningful activities by occupational therapy in elderly care in Belgium: the ProMOTE intervention. BMC Geriatr. 2024 Mar 20;24(1):275.
  10. ↑ Yusif S, Soar J, Hafeez-Baig A. Older people, assistive technologies, and the barriers to adoption: A systematic review. International Journal of Medical Informatics 2016; 94: 112-116.
  11. ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 Xuan D. When Are Rehabilitation and Assistive Technology Provided Course. Plus, 2025.
  12. ↑ Stucki G, Stier-Jarmer M, Grill E, Melvin J. Rationale and principles of early rehabilitation care after an acute injury or illness. Disability and Rehabilitation 2005, 27 (7–8): 353–359.
  13. ↑ 13.0 13.1 Zheng K, Han F, Yang S, Li N. Building trust in long-term care settings using assistive technology: a systematic review. Front Rehabil Sci. 2024 Nov 22;5:1492104.
  14. ↑ Kelly R, Manning B, Broome K. Assistive technology in palliative medicine: equipment needs. BMJ Support Palliat Care. 2023 Jan 5:bmjspcare-2022-003723.
  15. ↑ Manning B, Kelly R, Broome K. Assistive technology in palliative care: a statewide equipment programme. BMJ Support Palliat Care. 2022 Nov 17:spcare-2022-004048.
  16. ↑ Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care. 2023 Jul 20;22(1):99.
  17. ↑ Policy brief on integrating rehabilitation into palliative care services. Copenhagen: WHO Regional Office for Europe; 2023. Available from https://iris.who.int/bitstream/handle/10665/366505/WHO-EURO-2023-5825-45590-68173-eng.pdf [last access 10.01.2025]
  18. ↑ WHO. Management of health facilities: Referral systems. World Health Organization. 2014
  19. ↑ Seyed-Nezhad M, Ahmadi B, Akbari-Sari A. Factors affecting the successful implementation of the referral system: A scoping review. J Family Med Prim Care. 2021 Dec;10(12):4364-4375.
  20. ↑ Agius Anastasi A, Zammit S. Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward. Journal of Orthopaedics, Trauma and Rehabilitation. 2022 Apr 11;29(1):22104917221092162.
  21. ↑ Bright T, Wallace S, Kuper H. A Systematic Review of Access to Rehabilitation for People with Disabilities in Low- and Middle-Income Countries. Int J Environ Res Public Health. 2018 Oct 2;15(10):2165.
  22. ↑ Salter K, Jutai J, Hartley M, Foley N, Bhogal S, Bayona N, Teasell R. Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. J Rehabil Med. 2006 Mar;38(2):113-7.
  23. ↑ Strengthening access to rehabilitation and assistive technology services in emergencies. World Health Organization. Europe. Available from https://www.who.int/europe/activities/strengthening-access-to-rehabilitation-and-assistive-technology-services-in-emergencies [last access 12.01.2025]
  24. ↑ Mishra S, Laplante-Lévesque A, Barbareschi G, Witte L, Abdi S, Spann A, Khasnabis C, Allen M. Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review. Disabil Rehabil Assist Technol. 2024 Feb;19(2):474-485.
  25. ↑ Scott A. Rehabilitation Rights: The Never-Ending Fight for Restoring Meaning and Purpose, Through True Holistic Management. 2023. Available from https://www.internationalhealthpolicies.org/blogs/rehabilitation-rights-the-never-ending-fight-for-restoring-meaning-and-purpose-through-true-holistic-management/[last access 12.01.2025]
  26. ↑ Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, Kean S, Mackenzie SJ, Krishan A, Lewis SC, Murray GD, Forbes JF, Smith J, Rattray JE, Hull AM, Ramsay P; RECOVER Investigators. Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial. JAMA Intern Med. 2015 Jun;175(6):901-10.
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