North America and Caribbean region: USA

Stroke is the leading cause of significant long-term disability in the United States of America (USA). Stroke survivors receive medical and rehabilitation interventions across a continuum of settings from physiatrists, rehabilitation nurses, occupational and physical therapists, and social workers. Evidence indicates that the current health infrastructure in the United States is not prepared to address the rapidly increasing numbers of adults with stroke. With the current limitations in health insurance coverage, shortage of rehabilitation practitioners, and decreased time allocated for rehabilitation, stroke survivors do not receive the needed care, and thus the functional outcomes are not optimal. Recently, there has been an increase in the use of mobile health technologies, artificial intelligence, and robotics as adjunctive techniques to extend rehabilitation care; however, the penetration of robotics in healthcare settings is still problematic. Technological, clinical, practical, financial, and social barriers hinder the widespread adoption of robotic devices and limit their accessibility to large hospitals and rehabilitation centers in urban areas. In this chapter, we provide a brief overview of healthcare for stroke survivors in the United States. We then discuss some of the technological advances seen in the last decade, ranging from enabling technologies to new design solutions, that can facilitate the paradigm shift of robots from clinic-based to community-based rehabilitation. We end with some challenges and potential research/development directions needed to promote the growth of rehabilitation robotics in the United States.