Potential for new technologies in clinical practice.
OBJECTIVE
Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice.


RESULTS
Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects.


CONCLUSIONS
Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.
Burridge
Jane H
JH
Faculty of Health Sciences, University of Southampton, Southampton, UK. jhb1@soton.ac.uk
Hughes
Ann-Marie
AM
D000203:Activities of Daily Living; D002493:Central Nervous System Diseases / Q000191:economics / Q000534:rehabilitation*; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000295:instrumentation* / Q000639:trends*; D003362:Cost-Benefit Analysis / Q000191:economics; D004599:Electric Stimulation Therapy / Q000191:economics / Q000295:instrumentation / Q000379:methods; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D026741:Physical Therapy Modalities / Q000191:economics / Q000295:instrumentation* / Q000639:trends*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends; D012371:Robotics / Q000191:economics / Q000295:instrumentation / Q000639:trends