RADIC Handbook - 8. Frequently asked questions (FAQ)

In East Africa, where access to healthcare facilities may be limited in remote areas, Digital Rehabilitation offers an alternative to traditional in-person therapy sessions. It allows clients to receive rehabilitation services without needing to travel long distances, thereby increasing accessibility to care. To learn more about the concept and potentials of Digital Rehabilitation, go to chapter 1. 

Accessibility: Digital Rehabilitation increases access to rehabilitation services, particularly in remote or underserved areas where traditional healthcare infrastructure may be lacking. Clients in East Africa can access therapy sessions and support resources remotely, overcoming geographical barriers and reducing the need for travel to healthcare facilities. 

Lower stigmatization: Digital Rehabilitation platforms offer clients in East Africa a level of privacy and confidentiality that may not be available in traditional in-person settings. Clients can access therapy sessions and support resources from the privacy of their own homes/communities, reducing the risk of being stigmatized or judged by others.

Lower costs: Digital Rehabilitation can be cost-effective for clients in East Africa, where traditional healthcare services may be limited or costly. Clients save time and money associated with travel to healthcare facilities, as well as expenses related to transportation, accommodation, and lost wages.

Personalization: Digital Rehabilitation platforms can be personalized to meet the unique needs, preferences, and cultural backgrounds of clients in East Africa. Therapy programs can be tailored to address specific conditions, language preferences, and socioeconomic factors, improving engagement and adherence to treatment.

Engagement: Digital Rehabilitation utilizes interactive technologies, gamification elements, and multimedia content to enhance client engagement and motivation. Clients are more likely to actively participate in therapy sessions, adhere to treatment plans, and achieve better outcomes as a result.

Empowerment: Digital Rehabilitation empowers clients in East Africa to take an active role in their own care and rehabilitation journey. Clients have access to educational resources, self-management tools, and peer support networks, empowering them to make informed decisions and manage their condition effectively.

For more information about the benefits of Digital Rehabilitation for rehabilitation professionals, health care providers and the health care system, go to chapter 1. 

In East Africa, Digital Rehabilitation may utilize text-messaging interventions, mobile applications, and web-based platforms. These technologies cater to the region's infrastructure and connectivity constraints. Switch to chapter 6 to learn more about other technologies used in Digital Rehabilitation. 

Artificial Intelligence can be utilized in Digital Rehabilitation to analyze client data, personalize treatment plans, and provide decision support to healthcare providers. AI-powered applications can help optimize resource allocation and improve the efficiency of rehabilitation programs in resource-constrained settings, see for more information in chapter 6.

While more research is needed, Digital Rehabilitation has the potential to be as effective as traditional in-person rehabilitation in East Africa. Its effectiveness may vary depending on factors such as the type of intervention, client engagement, and the availability of resources.

HIV: Digital tools and platforms can be used to provide holistic support to individuals living with HIV in several ways: For example, digital applications can include medication reminder features to help individuals adhere to their antiretroviral therapy (ART) schedules. These reminders can be sent via SMS, mobile apps, or interactive voice response systems. Digital platforms can offer educational resources, counseling sessions, and peer support groups to empower individuals living with HIV to manage their condition effectively. This includes information on medication management, healthy living, stigma reduction, and coping strategies. Living with HIV can have significant psychological impacts. Digital Rehabilitation programs can provide mental health support through virtual counseling sessions, mindfulness exercises, and self-help tools to address depression, anxiety, and other mental health challenges.

Stroke: Stroke survivors often require ongoing rehabilitation to regain mobility, strength, and function. Digital Rehabilitation tools can offer personalized exercise programs, virtual therapy sessions, and home-based support for stroke clients in East Africa.

Musculoskeletal Disorders: Digital Rehabilitation platforms can provide exercises, instructional videos, and remote monitoring for individuals with musculoskeletal conditions such as low back pain.

Pediatric Disabilities: Children with disabilities, such as cerebral palsy or developmental delays, can benefit from Digital Rehabilitation interventions tailored to their specific needs. These may include interactive games, assistive technologies, and teletherapy services.

Mental Health Disorders: Digital Rehabilitation platforms may include mental health support services such as counseling, psychoeducation, and self-help tools for conditions like depression, anxiety, and post-traumatic stress disorder (PTSD).

Note: The conditions mentioned above are examples of diseases that can be supported with Digital Rehabilitation in East Africa. The results are based on the experiences of relevant stakeholders from East Africa and published literature as part of a scoping review we conducted in this project; of course, other diseases could also be treated with the help of Digital Rehabilitation. Furthermore, the list above does not reflect the order of prevalence of the diseases in East Africa. In Chapter 2, you will find best practice examples of how Digital Rehabilitation is used for clients with stroke, HIV and tuberculosis.

Limited Infrastructure: Many regions in East Africa lack reliable internet connectivity and electricity, hindering access to Digital Rehabilitation services.

Low Digital Literacy: A significant portion of the population may lack the necessary skills to navigate digital platforms effectively, limiting their ability to benefit from Digital Rehabilitation.

Financial Constraints: High costs associated with internet access, smartphones, and digital devices can pose barriers to accessing Digital Rehabilitation services, particularly for low-income individuals.

Language and Cultural Barriers: Digital Rehabilitation platforms may not be available in local languages or may not be culturally sensitive, making them less accessible to diverse populations in East Africa.

Healthcare Infrastructure: Inadequate healthcare infrastructure and workforce shortages may limit the integration of Digital Rehabilitation into existing healthcare systems.

For more information, look at chapter 4 and 5. 

Investment in Infrastructure: Governments and private organizations can invest in improving internet connectivity and electricity access in underserved areas to ensure reliable access to Digital Rehabilitation services.

Digital Literacy Programs: Implementing digital literacy training programs to empower individuals with the skills needed to navigate digital platforms effectively and participate in Digital Rehabilitation programs.

Subsidized Access: Providing subsidized or low-cost internet access and digital devices to individuals with limited financial means to reduce barriers related to affordability.

Localization and Cultural Sensitivity: Developing Digital Rehabilitation platforms in local languages and incorporating cultural considerations into design and content to ensure relevance and accessibility to diverse populations.

Capacity Building: Investing in training healthcare professionals to effectively utilize Digital Rehabilitation tools and integrating Digital Rehabilitation into healthcare training curricula.

Partnerships and Collaboration: Forming partnerships between governments, healthcare providers, technology companies, and non-profit organizations to leverage resources and expertise in expanding access to Digital Rehabilitation services.

For more information, look at chapter 4 and 5. 

Digital accessibility refers to the practice of designing and developing digital content, websites, applications, and technologies in a way that ensures equal access and usability for people with disabilities. This includes individuals who may have visual, auditory, motor, cognitive, or other impairments that affect their ability to perceive, understand, navigate, and interact with digital content. Digital accessibility is important because it ensures that everyone, regardless of their abilities or disabilities, has equal access to information, services, and opportunities online. It promotes inclusivity, independence, and participation in the digital world, and it is supported by various laws, standards, and guidelines around the world. Digital accessibility is essential for ensuring that Digital Rehabilitation services are inclusive, effective, and equitable for all individuals, regardless of their abilities or disabilities. By prioritizing accessibility in the design and development of Digital Rehabilitation platforms, healthcare providers can maximize the potential benefits of technology-enabled rehabilitation for their clients.

Key principles of digital accessibility include:

1. Perceivable: Digital content should be presented in ways that are perceivable to all users, regardless of their sensory abilities. This may involve providing alternatives for non-text content (such as images or videos), ensuring sufficient color contrast for readability, and offering text alternatives for audio content.
2. Operable: Users should be able to operate and interact with digital content using a variety of input methods, such as keyboards, mice, touchscreens, and assistive technologies like screen readers or voice recognition software. This requires ensuring that navigation is intuitive, controls are accessible, and functionality is operable through different input devices.
3. Understandable: Digital content should be presented in a clear and understandable manner to facilitate comprehension for all users. This may involve using plain language, organizing content logically, providing clear instructions and cues, and avoiding overly complex or confusing design elements.
4. Robust: Digital content should be developed using technologies that are robust and compatible with a wide range of user agents, assistive technologies, and platforms. This ensures that the content remains accessible as technology evolves and new devices and software are introduced.

Yes, there are various accessibility evaluation tools and software available. These tools can automatically test web pages, documents, and multimedia for accessibility issues and provide guidance on how to fix them. 

Automated Accessibility Testing Tools: These tools automatically scan web pages or digital documents to identify accessibility issues based on predefined criteria. Examples include:

• WAVE Web Accessibility Evaluation Tool: A browser extension that provides visual feedback about the accessibility of web content.
• axe Browser Extensions: Browser extensions that analyze web pages for accessibility issues and provide detailed reports.
• Accessibility Insights for Web: A tool that helps developers identify and fix accessibility issues in web applications during development.

Accessibility Checkers for Documents: These tools assess the accessibility of documents such as PDFs, Word documents, and PowerPoint presentations. Examples include:

• Adobe Acrobat Pro Accessibility Checker: A feature of Adobe Acrobat Pro that checks PDF documents for accessibility issues and provides guidance on how to fix them.
• Microsoft Office Accessibility Checker: Built-in accessibility checker in Microsoft Office applications (Word, PowerPoint, Excel) that identifies accessibility issues in documents and offers suggestions for improvement.
• Screen Reader Testing Tools: Screen readers simulate how individuals with visual impairments interact with digital content by converting text to speech or braille output. Examples include:
  
  • NVDA (NonVisual Desktop Access): A free, open-source screen reader for Windows that provides access to web content, documents, and applications.
  • VoiceOver: Built-in screen reader for macOS and iOS devices that provides spoken feedback and navigation assistance.
• Color Contrast Checkers: These tools assess the color contrast of text and background elements to ensure readability for users with low vision. Examples include:
  
  • WebAIM Color Contrast Checker: A tool that evaluates color combinations to determine if they meet WCAG color contrast requirements.
  • Contrast Checker: A feature available in some design tools and web development environments that allows users to check color contrast directly within their design or code.

To ensure accessibility, Digital Rehabilitation platforms typically adhere to established web accessibility guidelines such as the Web Content Accessibility Guidelines (WCAG). They may offer features like screen reader support, alternative text for images, voice navigation, and adjustable font sizes. Developers also incorporate user feedback, especially from individuals with disabilities, to continuously improve accessibility.

The primary ethical principles to consider in Digital Rehabilitation include autonomy, beneficence, non-maleficence, justice, and maintaining a professional-client relationship. Autonomy emphasizes the client's ability to make choices and exercise self-determination. Beneficence involves acting for the benefit of others to promote their well-being. Non-maleficence stands for preventing harm to the clients. Justice concerns ensuring fairness and equal access to technology. The professional-client relationship principle addresses maintaining trust and communication in digital settings.

Key aspects include data classification, access controls, data encryption, handling and disposal of data, and data backup and recovery. These elements are critical for ensuring responsible, ethical, and legally compliant data management. Policies and regulations aim to protect individual privacy and ensure the integrity and security of organizational data, emphasizing lawfulness, fairness, transparency, purpose limitation, data minimization, accuracy, storage limitation, integrity, and confidentiality.