outREACH system

outREACH system for the delivery of personalized upper extremity assessment and rehabilitation management for stroke patients in sub-Saharan Africa

The Issue

80 percent of stroke burden occurs in low and middle-income countries. In sub-Saharan Africa stroke prevalence has doubled in the past four decades causing serious, long-term physical disabilities, and has pervasive negative influences on an individual’s quality of life, participation in society and independence. Evidence shows post-stroke rehabilitation facilitates recovery and improves quality of life and independence.  However, in sub-Saharan Africa there is a scarcity of rehabilitation professionals and access to healthcare is limited by geographical distances.


This study

This study will leverage mHealth technologies to develop a community-based stroke management system in order to enhance access to healthcare. Using an iterative user-centered design approach we developed a community-based tool for the personalized delivery of upper extremity stroke assessment and rehabilitation.

Aim 1: Evaluate the usability and acceptability of the outREACH system in Gondar, Ethiopia

Aim 2: Establish the extent to which the outREACH system leads to improvements in post-stroke upper limb function




Figure 1. outREACH system graphical user interfaces (GUIs)

outREACH system features

  • The creation and modification of tailored rehabilitation programs
  • Tracking patient progress based on performance
  • Visual feedback about psychological and physiological progress
  • Asynchronous patient and clinician communication

Figure 2. outREACH system architecture


  • The outREACH system will provide an innovative and entirely new approach to stroke management. If successful, our community-based mHealth application may lead to a shift in the way that patients with physical disabilities are treated
  • Community-based mHealth solutions can serve as a model for rehabilitation during stroke recovery improving access to healthcare across sub-Saharan Africa and in other areas with limited access to quality rehabilitation services


Project Team

Principal Investigator
Charmayne Mary Lee Hughes, Ph.D
Health Equity Institute NeuroTech Lab



Binyam Tilahun, PhD
Department of Health Informatics
University of Gondar


Kedir Sany, MSc
Department of Physiotherapy
University of Gondar


Paul Cunningham, MSc
IST-Africa Institute