Contents I. Introduction
Tele-rehabilitation has flourished in recent years. With the advancement of information and communication technology (ICT), the gap between urban and rural medical resources has narrowed, and the quality of rehabilitation has also improved. Stroke is one of the leading causes of death and disability in the world [1], [2]. Approximately 1.1 million European residents have a stroke every year [3]. In Asia, stroke mortality is higher than in Europe and North America [4]. Strokes cause physical and functional limitations in individuals and diminish their quality of life (QoL) [5], [6]. More than 50% of stroke survivors suffer from locomotion difficulties, while up to 20% of stroke survivors cannot be independent in terms of self-care [5]. For years, the development of tele-rehabilitation systems for stroke was focused on different dimensions, such as fine motor training [7], upper arm training [8], [9], ambulation training [10], QoL improvement [11], robotic-assisted therapy [11], [12], treatment for aphasia [13], resolution of depression [11], [14] etc. However, the aim of this study was to develop a remote rehabilitation program adapted to regional needs. According to national health insurance policies, Taiwan can be regarded as one of the countries with the highest density of medical resources. This enables people to easily enter medical institutions, but it also causes medical institutions to be overcrowded. Patients must wait in line for appointments to obtain rehabilitation services. The quality of therapy is also limited due to the large number of patients. In this study, we designed a tele-rehabilitation system intended to enhance the quality of rehabilitation in clinics, to alleviate the burden of therapists, and to facilitate home-based rehabilitation with remote monitoring. Upper extremity impairments after stroke result in functional limitations that impinge on daily life [16] that include issues with personal hygiene, eating, dressing, and housekeeping tasks. The tele-rehabilitation system proposed in this study was focused on a comprehensive evaluation and home program called TOT@home intended to provide home-based task-oriented training (TOT) for the upper limbs, the details for which are described in the following discussion.
