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Dorcas BC Gandhi: College of Physiotherapy & Dept of Neurology, Christian Medical College & Hospital Ludhiana & Manipal Academy
of health Education, India
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Rinita Mascarenhas: Dept iof Neurology, Christian Medical College & Hospital Ludhiana, India
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Vinicius Montanaro: Neurology, SARAH Network of Rehabilitation Hospitals, Brasilia, Brazil.
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Gerard Urimubenshi: Department of Physiotherapy, University of Rwanda, Kigali, Rwanda
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Kavinkumar Saravanan: Director, Palmtree Comprehensive Care Center, Namakkal, India
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Isha Tajane: K J Somaiya College of Physiotherapy, Mumbai, India
on behalf of The Global Consortium of Stroke Rehabilitation (GCSR)-serving low resource settings
Stroke rehabilitation varies from country to country. A group of researchers set out to examine the stroke rehabilitation services in India, Rwanda and Brazil, with the objective of identifying key challenges and opportunities for improvement. A further aim was to support efforts to enhance accessibility, affordability, and quality of stroke care, particularly in underserved regions.
GCSR board members (L to R, clockwise): Dorcas Gandhi, John Solomon, Gerard Urimubenshi, Sureshkumar Kamalakannan and Vinicius Montanaro
The researchers carried out a rapid literature review, analysis of peer-reviewed articles, government reports, and organizational data and synthesised this to put together their report. Their report examines the burden of stroke, access to rehabilitation services, costs, infrastructure, and guidelines, offering actionable insights for policymakers, healthcare providers, and other stakeholders
“For the analysis, local country champions conducted qualitative assessments to interpret region-specific nuances. We focused on key themes including disease burden, healthcare services and tiered care systems.” Explained Dr Montanaro “We categorised our findings into categories including, but not limited to, burden of stroke, Post-Stroke Return to Work, Access to Rehabilitation Services, telerehabilitation and education and training.”
Figure 1. Summary of findings from the review
The findings highlighted disparities in infrastructure, workforce availability, and affordability (Figure 1). Main findings showed that India demonstrated a mix of world-class urban facilities and limited rural services, highlighting a need for equitable resource distribution. Rwanda faces shortages in resources and financial barriers that hinder access to care, particularly in rural areas. Lastly, Brazil benefits from national guidelines and active stroke societies, but disparities between public and private sectors limit universal access to advanced care.
The report also identifies opportunities for policy enhancement and improved service delivery in each country separately, and overall recommendations. The main recommendations for each country are summarised in Figure 2, with recommendations varying from expanding rural coverage of rehabilitation centers, to implementation of telerehabilitation and reduction of financial barriers.
“Based on our findings we put together a list of the main areas that could be targeted to improve care, tailored to the needs of each country (Figure 2).” Explained Dr Suresh Kamalakannan, a board member of the GCSR “Similarly, we put together general recommendations that could be implemented across all three countries to improve services and care, including promotion of PPP, more education and fostering international collaboration (Figure 3).”
Figure 2. Recommendations per country
Through their report, the team hope that their findings and recommendations can be used to bridge gaps in stroke rehabilitation, inform policy and promote equitable, evidence-based care in India, Rwanda, and Brazil. Further leading to improvements in care and outcomes for stroke patients.
“By synthesizing data from diverse sources, the report aims to inform stakeholders and foster evidence-based decision-making” Explained Dr John Solomon, another board member of the GCSR “We hope this will strengthen stroke rehabilitation systems in these countries.”
Figure 3. General recommendations across all countries
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