Stroke is a leading cause of long-term disability worldwide, yet access to sustained home-based rehabilitation in the chronic stage remains deeply unequal. Barriers are not simply a matter of resources, they are shaped by workforce distribution, insurance structures, caregiver availability, cultural context, and digital infrastructure, and they play out differently in a rural Cameroonian community, a physiotherapy clinic in Pune, a telerehabilitation trial in Chicago, and a home exercise programme in Santiago. This symposium brings together four physiotherapy experts: two PhD researchers and two senior clinicians: from South Asia, sub-Saharan Africa, the United States, and Latin America to examine these differences and draw practical lessons that cross borders.

Part 1: What Are the Real Barriers and Facilitators?

The session opens with a cross-regional synthesis of evidence on what enables and what blocks home-based chronic stroke rehabilitation. Structural barriers including limited physiotherapy workforce, absent reimbursement, poor assistive technology supply chains, and fragmented referral systems, sit alongside patient-level barriers including low health literacy, caregiver fatigue, depression, and poor self-efficacy. Facilitators differ by region: strong family networks in South Asia and Africa, community health worker integration in Cameroon, mobile technology penetration in Chile, and structured telerehabilitation infrastructure in the United States. Speakers draw on published evidence and 13 years of frontline clinical experience to make this comparison specific and grounded.

Part 2: Supervision Models: What the Evidence Actually Shows

The second segment examines how home rehabilitation is delivered and supervised across the four regions. Fully supervised models offer quality but are geographically and financially impractical in most settings. Minimally supervised and caregiver-mediated models show promise but demand careful design. Technology-assisted supervision, including front-loaded and intermittent therapist contact via smartphone platforms, is examined through a synthesis of clinical trial evidence, including data on adherence, safety, and functional outcomes in older adults with moderate-to-high stroke impairment. The evidence is clear that no single model works everywhere, and that matching supervision intensity to patient need, caregiver capacity, and local infrastructure is the critical implementation decision.

Part 3: Technology and Assistive Modalities in Practice

The third segment addresses what technology can realistically deliver across these settings. Evidence is synthesized on smartphone-based exercise platforms integrated with functional electrical stimulation, wearable sensors for movement monitoring, gait analysis tools, and community-based motor retraining approaches, including NDT/Bobath and motor relearning programs. The discussion is deliberately honest about limitations including digital divides, device costs, connectivity gaps, and the risk of technologies designed in high-income contexts failing in low-resource ones. Speakers share what has worked in their own settings and what has not.

Closing: A Practical Framework

The session closes with a regionally tailored implementation framework built from the synthesized evidence and clinical experience of all four speakers. Participants leave with concrete, adaptable guidance, not generalized recommendations, for advancing home-based chronic stroke rehabilitation in their own setting, whatever the resource context.

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