TELEREHAB: Bringing rehabilitation into the real world

For many patients, rehabilitation does not begin and end in the hospital or clinic. It continues quietly and often inconsistently at home, in daily routines designed to rebuild confidence and mobility gradually and sustainably. This is particularly true in areas where rehabilitation depends on consistency and gradual improvement over time. Nowhere is this more apparent than in balance rehabilitation.

Whether linked to ageing, neurological conditions or musculoskeletal recovery, impaired balance is one of the leading causes of falls, hospitalisation and long-term loss of independence. Yet despite its importance, rehabilitation remains difficult to monitor and personalise and for patients to sustain over time.

“What makes balance disorders particularly challenging is that fall risk rarely has a single cause,” explains Prof. George Matsopoulos, Director Biomedical Engineering Laboratory, Institute of Communication and Computer Systems in Greece and project coordinator.

“It can be related to movement, symptoms, cognition, comorbidities or the way someone responds to therapy. That is why fall prevention needs a more rounded and more personalised rehabilitation approach.”

This complexity has consequences far beyond the individual. Falls place a significant burden on healthcare systems, driving hospital admissions, extending recovery times and increasing long-term care needs. Yet despite this, the way rehabilitation is delivered has changed relatively little.

Beyond the clinic
Traditional rehabilitation pathways, however, are not well equipped to provide the level of continuity or personalisation needed to address this problem. “Traditional rehabilitation still depends a lot on face-to-face sessions and on what the clinician can observe during those appointments,” says Matsopoulos. “Between visits, it is often difficult to know whether the patient is following the programme, whether symptoms are changing or whether the exercises are being done correctly and consistently.”

The result is a fragmented view of recovery, where clinicians see isolated snapshots rather than how a patient is progressing over time. In a field where consistency and sustained engagement with rehabilitation programmes are critical, this makes it harder to identify problems early and adjust treatment effectively.

At the same time, there are increasing pressures on healthcare delivery. Ageing populations, rising demand for rehabilitation services and limited access to specialist treatments are making it increasingly difficult to rely solely on clinic-based care. “In recent years it has become very clear that rehabilitation cannot depend only on what happens inside the clinic,” Matsopoulos says. “Patients need support that extends beyond occasional appointments.”

A connected model of care
The TELEREHAB DSS project is designed to address this challenge by rethinking rehabilitation as a continuous, connected process, rather than a series of isolated interventions. At its core is a digital platform that brings together assessment, treatment planning, exercise delivery and monitoring into a single, integrated system.

“The core idea behind TELEREHAB DSS is to bring the whole rehabilitation pathway together instead of treating it as a series of separate steps,” says Matsopoulos. “In many cases, these elements are still handled in a fairly disconnected way. What we are trying to do is create a more coherent model of care that supports both clinicians and patients throughout the rehabilitation process.”

This is achieved through a combination of technologies: a cloud-based decision support system, a clinician dashboard, a patient-facing mobile environment, a virtual coach and a network of connected sensors. Together, these components allow rehabilitation to move beyond periodic assessment towards continuous monitoring and adaptive support, where treatment can be adjusted in response to how patients are progressing in their daily lives.

What sets TELEREHAB DSS apart is not any single technology, but the way they are combined. “A lot of digital rehabilitation tools concentrate on a single layer,” Matsopoulos explains. “TELEREHAB DSS is trying to support the whole pathway, from initial assessment and intervention planning to exercise execution, adherence support and outcome tracking.”

Making rehabilitation visible
A key enabler of this connected approach is the ability to capture detailed, continuous data on patient activity and performance. Wearable devices and connected sensors track movement, exercise execution and broader indicators such as activity levels, heart rate and sleep patterns. This information is transmitted to the platform, where it can be analysed and used to support clinical decisions.

“Wearable devices and IoT sensors are basically how the platform sees what is happening outside the clinic,” explains Dr. Vasilis Tsakanikas, Technical co-ordinator, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina. “They capture movement and performance data while patients carry out their exercises at home.”

This transforms rehabilitation from a largely subjective process into one that can be measured, monitored and understood over time. “Clinicians get a much richer view of the patient than they would from a standard follow-up appointment alone,” Tsakanikas adds.

Artificial intelligence plays a central role in making sense of the data this technology collects. Rather than simply gathering information, the platform uses AI models to assess fall risk, evaluate treatment effectiveness and support decisions around therapy planning and progression.

These models draw on both baseline clinical data and continuous inputs from sensors and patient interaction, building a more dynamic picture of each individual’s rehabilitation journey. “AI is really at the centre of TELEREHAB DSS,” says Tsakanikas. “It is what turns the platform from a monitoring tool into a decision support system.”

At the heart of this approach is the platform’s decision support system (DSS), which combines data analysis with predictive modelling to guide rehabilitation strategies.

By integrating information on patient performance, symptoms and behavioural patterns, the DSS can support clinicians in selecting appropriate interventions, adjusting exercise intensity and identifying when progress is slowing or risks are increasing. In this way, rehabilitation becomes a more adaptive process, shaped by ongoing feedback rather than fixed treatment plans.

Importantly, the aim is not to replace clinical judgement, but to support it. “The point is to support clinical judgement in a more structured way,” Tsakanikas continues. “AI can help bring together different factors that clinicians already think about, and do so in a way that is more consistent, more scalable and more personalised.”

Rehabilitation in the real world
Alongside monitoring and analysis, TELEREHAB also rethinks how rehabilitation exercises are delivered. Through the use of Augmented Reality (AR), patients can perform exercises in interactive, guided environments designed to improve both understanding and engagement. “AR is used to make rehabilitation more guided, more engaging and easier to follow at home,” says Tsakanikas. “Instead of just handing the patient written instructions, the platform creates a more interactive training experience.”

As part of this experience, a virtual physiotherapist provides real-time guidance, helping patients perform exercises correctly and maintain consistency, two factors that are critical for successful rehabilitation. For patients, this represents a shift from the more traditional periodic care to continuous support at home. “The biggest advantage is continuity,” Tsakanikas explains. “Rehabilitation does not stop when patients leave the clinic, and support does not depend only on the next appointment.”

Personalisation
Also central to TELEREHAB’s approach is the idea that rehabilitation should be tailored to the individual, rather than delivered as a standardised programme. By combining clinical data, sensor inputs and contextual factors, the platform supports more nuanced decisions about treatment type, intensity and progression.

These decisions are informed not only by clinical indicators, but also by how patients engage with their rehabilitation in practice – how consistently they follow the programme, how they respond to different exercises and how they progress over time. This allows treatment plans to be adapted in a more responsive and realistic way, reflecting the conditions in which rehabilitation actually takes place.

“The main idea is that rehabilitation should not be prescribed in exactly the same way for everyone,” says Matsopoulos. “The system helps clinicians adjust rehabilitation in a more structured way, based on what is actually happening over time.”

But personalisation in itself is not enough. Its effectiveness depends on how patients engage with rehabilitation in their daily lives. Even the most advanced system will fail without patient engagement. TELEREHAB therefore places strong emphasis on adherence, usability and digital literacy as core components of effective rehabilitation. “Adherence is critical because even the best rehabilitation plan does very little if it is not followed consistently,” Matsopoulos notes.

The platform actively monitors engagement, tracking exercise completion, activity patterns and user interaction, while also incorporating tools to assess usability and patient experience.

“Engagement is not just about asking a patient whether they liked the system,” says Tsakanikas. “It is about whether they actually used it and whether the platform supported the rehabilitation process instead of getting in its way.”

Recognising the diversity of patient needs, the system also takes into account levels of digital confidence and familiarity with technology. “Digital literacy plays a bigger role than people sometimes think,” Matsopoulos adds. “The system recognises that successful tele-rehabilitation depends not only on medical need, but also on whether the technology actually fits the person using it.”

A new model of care
As the project moves through its validation phase, the focus now is on demonstrating not only its technical feasibility, but also its real-world clinical value. “The aim is to show that the platform can improve both subjective and objective rehabilitation outcomes and strengthen patient compliance,” says Matsopoulos.

If successful, TELEREHAB could contribute to a broader shift in how rehabilitation is delivered. “It could help move rehabilitation away from a mainly episodic model and towards something more continuous and patient-centred,” Tsakanikas explains.

This shift also has implications at the system level, offering a more scalable approach to delivering specialist care, one that will help healthcare systems address some of the many challenges they face. “By combining remote assessment, AI-assisted decision support and monitoring in one environment, the platform can help extend specialist expertise beyond the physical clinic,” adds Tsakanikas.

Looking ahead
Despite its promise, the path to widespread adoption for TELEREHAB is not without its challenges. Clinical validation, integration into healthcare systems and user acceptance will all play critical roles. “One of the biggest challenges is not just building the technology, but getting it adopted in real healthcare settings,” Matsopoulos acknowledges.

Nevertheless, the direction of travel is clear. As digital tools become more sophisticated and more embedded in healthcare delivery, they offer the potential to reshape not only how rehabilitation is delivered, but how it is experienced by patients.

“AI and AR can make rehabilitation more adaptive and less dependent on static treatment plans,” Matsopoulos concludes. “Used properly, they can help clinicians extend their reach and support patients more consistently.”

In doing so, projects like TELEREHAB are not simply introducing new technologies; they are redefining what rehabilitation can be: continuous, personalised and connected to the realities of how people live their lives.