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A team comprising members of the Stroke Research and Prevention Group (HKU Stroke), Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine of the University of Hong Kong (HKUMed); Sport AI Laboratory (SAIL), Department of Electrical and Electronic Engineering, HKU; and The Hong Kong Society for Rehabilitation (HKSR) developed SmartRehab – a mobile platform that uses artificial intelligence (AI) technologies to help facilitate stroke rehabilitation in the home setting. This team recently received support from the World Stroke Organization (WSO) to test the platform’s feasibility in seven countries beyond Hong Kong to improve the accessibility of post-stroke rehabilitation, especially in low- and middle-income countries.

Background
Stroke is the second most common cause of death and a leading cause of disability in the world. ¹ Timely and adequate rehabilitation is critical in facilitating post-stroke recovery.² With an ageing population and the increasing prevalence of stroke, there is strong and rising demand for rehabilitation services globally.³ However, organising and delivering rehabilitation are resource-demanding, and currently only approximately 25% of stroke survivors in low- and middle-income countries have access to such services.⁴ Improving access to stroke rehabilitation services to facilitate timely and accessible rehabilitation in the community setting is important to reduce the burden on public healthcare facilities.

Although there has been an increasing use of telemedicine and telerehabilitation services, current solutions rely heavily on subjective reporting through video conferences or phone interviews. Other solutions attempt to use various sensor- and camera-based devices to capture a stroke victim’s exercise performance, but fall short in the real-life application of home-based tele-rehabilitation, given the relatively high cost per unit and spatial requirements. 

About the SmartRehab Platform
SmartRehab is a mobile application that is accessible from a tablet or mobile phone and aims to facilitate personalised stroke rehabilitation in the community setting. SmartRehab was developed and validated by a multidisciplinary team comprising neurologists, engineers, translational neuroscientists, physiotherapists and occupational therapists from HKU Stroke, HKU SAIL and HKSR. SmartRehab currently encompasses 10 gross movement exercises. These exercises are recommended and designed by therapists from the HKSR and are tailored specifically for stroke patients to improve upper limb function, weight shifts and balance. In contrast to traditional telerehabilitation platforms, SmartRehab utilises the built-in RGB camera of a tablet or mobile phone, for which the team has developed a computer vision-based pose-estimation algorithm to predict the precise body framework and segment key joint locations. The system allows SmartRehab to compute movement-related features, including changes in joint angles, velocity, and the presence of spastic movement, all of which can be used to evaluate the quality of a patient’s movement and provide immediate feedback. SmartRehab also includes a portal system, in which therapists can assess the stroke patient and prescribe exercises (including the type of exercise, frequency and number of repetitions) tailored to the needs of each patient, and remotely monitor the patient’s functional and motor performance, progress and compliance.

Significance and Impact 
‘We are very excited to launch this platform and to have the support of the World Stroke Organization to further test the feasibility of our platform in seven countries beyond Hong Kong,’ said Dr Gary Lau Kui-kai, Clinical Associate Professor, Division of Neurology, Department of Medicine, School of Clinical Medicine, HKUMed, and Director of HKU Stroke. ‘We do hope our platform will not only be of use for the local Hong Kong stroke population, but also benefit low- and middle-income countries outside of Hong Kong, where rehabilitation services are limited due to severe shortages of physiotherapists and occupational therapists.’ 

‘With advances in AI technologies, there is a lot of potential for our platform,’ said Dr Wilton Fok Wai-tung, Director of SAIL, HKU. ‘We will incorporate more movements to facilitate rehabilitation of fine motor functions, augmented and virtual reality and gamification functions, and various biometric monitoring functions very soon. We will also modify our platform in due course to suit other patients and older adults who require rehabilitation,’ Dr Fok said.

‘HKSR is privileged to be able to collaborate in this exciting project,’ said Ng Yuk-mun, Head of Allied Health & Primary Healthcare, HKSR. ‘SmartRehab has the potential to benefit not only stroke patients, but also probably older adults and patients with other neurological conditions, such as Parkinson’s disease and dementia. HKSR is committed to continuously enhancing our rehabilitation services with the application of advances in technology, and we look forward to incorporating SmartRehab into our stroke services, by extension of rehabilitation to the patients’ home setting, to maximise the rehabilitation potential of our patients.’ 

About the Team
SmartRehab was developed by a team comprising members of HKU Stroke and SAIL from HKU, in collaboration with HKSR. The mission of HKU Stroke is to better understand what causes stroke, and how to better prevent and manage it. HKU Stroke also strives to improve the well-being of stroke patients and their caregivers, and over the years has developed a number of platforms and initiatives to facilitate this. For details, please refer to the HKU Stroke website: http://stroke.hku.hk.

SAIL was established in 2019 by Dr Wilton Fok Wai-tung. The lab concentrates primarily on leveraging AI to analyse human posture, enhance sports performance and understand video context. Dr Fok’s team has been working on publicly funded projects, such as the ITF Better Living Fund, Smart Traffic Fund, and Sports Science and Research Fund, for projects related to drowning detection, stroke rehabilitation exercise, transport safety and sports performance analysis. For more details, please refer to the SAIL website: https://www.sail.hku.hk/.

The HKSR was established in 1959 and is a pioneer in rehabilitation services in Hong Kong. It is also the longest-standing charity in Hong Kong that specialises in rehabilitation. Through rehabilitation innovations and by empowering persons with disabilities or health conditions, HKSR advocates holistic well-being, social participation, and an inclusive and enabling environment. For details, please refer to the HKSR website: https://www.rehabsociety.org.hk/.

Acknowledgements
The team acknowledges the support from the Innovation and Technology Fund for Better Living (Ref: ITB/FBL/8032/20/P) to develop SmartRehab and also from the WSO to launch studies to explore the feasibility of SmartRehab in seven countries outside Hong Kong: India, Malaysia, Romania, Argentina, Brazil, the United States and Italy.

Raise Awareness and Prevent Stroke
In response to World Stroke Day (29 October), HKU Stroke, The HKSR, and The Hong Kong Stroke Association, will jointly launch the ‘Together We Care for Stroke’ Exhibition at the ground floor of Cityplaza from 27-29 October. The three-day exhibition will provide free health check-ups and consultation services for the public. It aims to help the general public understand the signs and prevention of stroke, while providing comprehensive information on the community support available for stroke patients and their carers in combating stroke. SmartRehab will also be showcased at the exhibition, where the general public can experience this new platform.

Media enquiries
Please contact LKS Faculty of Medicine of The University of Hong Kong by email (medmedia@hku.hk).

¹ Stroke, Cerebrovascular accident, World Health Organization (https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html).
² Van Peppen RPS, Kwakkel G, Wood-Dauphinee S, Hendriks HJM, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: What's the evidence? Clinical Rehabilitation 2004; 18(8):833–62.
³ World Health Organization. Access to rehabilitation in primary health care. In: Global Conference on Primary Health Care, 2018; Geneva.
⁴ Owolabi MO, Thrift AG, Martins S, et al. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int J Stroke. 2021;16(8):889-901.