North America and Caribbean region: Costa Rica

Costa Rica, a country in Central America with a population of 5,163,038 in an area of 51,100 km2, has an epidemiological profile characterized by a predominance of morbimortality related to noncommunicable diseases, particularly cardiovascular diseases including stroke. This profile presents a challenge to its universal public social security system, which covers 95% of the population but has relatively limited resources.The Costa Rican healthcare network is organized in an ascending complexity structure covering the national territory, with health establishments that range from small clinics to a specialized rehabilitation hospital. Stroke rehabilitation in particular faces many barriers, including the lack of a national stroke rehabilitation protocol, which forces each rehabilitation facility to provide the care it can according to its resources. The system continuously struggles with demands exceeding its capacity, insufficient infrastructure, and technological gaps with few commercial mechatronic solutions implemented in the public system.Alliances with academic institutions have been the predominant means of developing technological solutions. The Instituto Tecnológico de Costa Rica (National Technology Institute of Costa Rica, henceforth ITCR) is currently working on robotic rehabilitation devices for upper- and lower-limb stroke rehabilitation, and haptic devices, improving clinicians’ remote access and the incorporation of Internet of Things (IoT) capabilities into rehabilitation devices. These will eventually reduce waiting lists and increase system capacity. However, at this point, multiple barriers block the implementation of robotic solutions, such as geographical barriers, lack of training in technological rehabilitation solutions, and a complex bureaucratic, bioethical, and legal framework.After COVID-19, new spaces have opened for technology, including more opportunities for telerehab and a growing interest in rehabilitation, but funding cuts and the demand for rehabilitation have taken a toll on the quality of care and timely rehab services, and have made it even clearer that there are gaps in care that might be filled with robotic technology.