The challenges facing rehabilitation care are enormous. Due to population ageing and the growing number of people living with chronic conditions, the demand for rehabilitation is rising, while the sector is already under financial and workforce pressure. Traditionally, rehabilitation care is expensive and labour-intensive. Collaboration between EUR, Erasmus MC, TU Delft and Rijndam Rehabilitation is essential to develop smart, simple and affordable solutions for home rehabilitation and remote monitoring, enabling a much larger group of people to access (rehabilitation) care in the future.
Remote treatment using technology is still not very common in rehabilitation care, but it offers many advantages. It is much more affordable, as fewer highly specialised care professionals are needed per patient. When patients can rehabilitate in their own environment, care providers can coach more patients remotely while simultaneously monitoring their progress. Patients also gain more control over their own recovery process. Despite these benefits, such technologies are rarely implemented structurally, as they do not yet fit well within existing care pathways or reimbursement models. Implementation within rehabilitation centres is often challenging as well. The Convergence Human Mobility Center (CHMC) flagship aims to change this.
"To ensure that rehabilitation care remains sustainable and affordable in the future, we need a vision that is broader than what can emerge from a single scientific discipline. That vision can be formulated within this collaboration."
Gerard Ribbers
Gerard Ribbers, Professor of Rehabilitation Medicine, Erasmus MC
Gerard Ribbers
Gerard Ribbers is Professor and Head of the Department of Rehabilitation Medicine at Erasmus MC and Scientific Lead of the CHMC flagship.
Gerard, you initiated the Flagship Convergence Human Mobility Center. Why did this flagship have to be created?
"We are facing an ageing population, an increase in people living with multiple conditions, and people are living longer with conditions that typically fall within the domain of rehabilitation. The resources to support these people are not increasing at the same rate. A group is emerging that cannot—or cannot sufficiently—be helped within the current system."
The scale of the challenge in numbers: by 2040, a 50% increase in stroke patients is expected, and a 70% increase in people with Parkinson’s disease. The WHO states that rehabilitation will become ‘the profession of the future’, as a wave of people will be living longer with the consequences of disease.
"Traditionally, innovation in this field has focused on increasingly complex treatment methods. But that will not help us in the future. We want to address a different question: how can we treat the very large group of patients that is coming our way at all? That also means shifting towards non-inferiority research: achieving more by doing less."
Why is TU Delft essential for this?
"Collaborating with Delft is both an opportunity and a necessity. I don’t believe technology alone is the answer, but it can at least solve part of the problem. Within our flagship, we are exploring how to move from one-to-one treatments in rehabilitation centres to self-training at home, with remote coaching and monitoring. In such a scenario, one (physio)therapist might be able to follow fifty patients instead of ten.”
“But technology alone is not enough; it must also be accepted and used by patients and embraced by professionals. That is why the contribution of social and medical researchers from Erasmus University and the clinical professionals from Rijndam is just as important. Collaboration between many parties creates cross-pollination."
What do you see as the main challenges or tasks for this flagship?
"There is already a care gap: people with language barriers or lower socioeconomic status have more difficulty accessing adequate care. With the introduction of technology, there is a risk that this gap will widen. So first and foremost, we must ensure that vulnerable groups are not left behind. The challenge for future rehabilitation technology is therefore: simpler, simpler, simpler—and, of course, affordable.
That immediately brings us to the second challenge: a device that is cheap to produce can become expensive due to European regulatory requirements. Is there a viable business model for companies to bring such devices to market, for example at limited scale? There must also be adequate reimbursement mechanisms for rehabilitation centres to treat patients remotely, and room to experiment."
How does the flagship contribute to solutions?
"It is an illusion to think we will have solved this once the funding period of our flagship ends. But we have built an ecosystem where people meet: physicians, engineers, social scientists, rehabilitation clinics, companies and health insurers. That is incredibly valuable.
Engineer Laura Marchal Crespo is fully embedded in our scientific staff, and we submit grant applications together. Engineers benefit from seeing how patient care works and are able to spend time at Rijndam. At the same time, we are still learning to understand each other. When I read a Delft paper full of equations, I tend to drop out. But through projects such as the Fizzy robot ball or the P-Mate, we have learned to connect.
We face a societal challenge: how do we ensure rehabilitation remains sustainable and affordable in the future? That requires a vision that goes beyond a single scientific discipline, and we can develop that vision within this collaboration."
P-Mate
The robot designed to rehabilitate leg movements offers many adjustment options but is costly and requires time and expertise to use. Using elastic cables, Marchal Crespo devised a smart alternative.
''After a stroke, paralysis always occurs on one side of the body. By connecting the legs with elastic bands, the healthy leg can support the paralysed leg,'' she explains. Think of it like a marionette: when the functioning leg moves, elastic bands cause the paralysed leg to move as well—without the need for a motor.
Marchal Crespo: ''It doesn’t have to be a sophisticated high-tech robot. As long as it helps patients move forward in an intuitive and sustainable way—quite literally. That’s what ultimately motivates me.''
Can you already describe that vision?
"Within the Health and Technology convergence, physicians, researchers, companies, health insurers and patients collaborate on the rehabilitation medicine of the future. The idea is simple yet powerful: smart technology enables many more people to recover at home, without repeatedly travelling to the hospital.
For patients, this means greater freedom, less travel time and care that fits their daily lives. For healthcare professionals, it offers the opportunity to intervene more quickly when problems arise and to use their time more efficiently. This ecosystem only works if all parties can find one another and speak the same language. It is precisely this collaboration that enables innovations to be tested, improved and scaled more rapidly. In this way, rehabilitation care becomes something that takes place not only in clinics, but at the heart of society. Our Convergence Human Mobility Center flagship is a key driver of this development."
Laura Marchal Crespo
Laura Marchal Crespo is Associate Professor of Human–Robot Interaction and Scientific Lead of the CHMC flagship.
Laura, where does the flagship stand today?
"When we started, everyone still had their own ambitions. Even when we wrote proposals together, each party had its own perspective on needs or the market. Over the past three years, we have grown closer. We have learned how other disciplines view the challenges and how we can work towards solutions together.”
As Gerard mentioned, it was extremely valuable for us at TU Delft to spend many hours in the rehabilitation clinic. Collaborating with EUR researchers who view the problem from sociological and economic perspectives was equally important. We had to learn how to communicate with one another. But after three years, we are much more of a unified team. We remain distinct disciplines, each strong in our own field, but we now share a vision."
Why is such a shared vision necessary?
"The urgency is increasing. People are living longer, and the current healthcare system will not be able to cope with the growing demand. This is the challenge we must address now. We cannot clone physiotherapists, nurses or physicians, but we can develop technology to at least partially solve the problem. Technology allows us to move rehabilitation programmes from hospitals into people’s homes. Even the European Union is calling for this. For rehabilitation technology to succeed in the home environment, it must be intuitive, extremely simple and very safe."
"The trend in rehabilitation technology is that it is becoming increasingly complex and advanced. I think that is precisely why, within this flagship, we are working in a disruptive way: by developing and deploying ultra-simple, low-cost technology."
Laura Marchal Crespo
Associate Professor of Human–Robot Interaction, TU Delft
What obstacles do you face?
"The current financing structure remains a challenge. Insurance companies are only interested once we have demonstrated effectiveness, but we are still at the beginning of development. Another issue is that clinics are not reimbursed when patients rehabilitate at home."
Do you see similar collaborations emerging internationally?
"What we are working on—simple, safe, affordable rehabilitation technology for home use—is still fairly revolutionary. In Switzerland and the US, there are also initiatives focused on more accessible, intuitive and home-based technology. However, the overall trend in rehabilitation technology is toward increasing complexity and sophistication. I believe this flagship is disruptive in that sense. Our vision goes against the institutions that fund us. That sometimes makes it harder to secure research funding, because funders do not always recognise the groundbreaking nature of ultra-simple, low-cost technology.”
Is this form of transdisciplinary collaboration between universities, clinics and insurers also revolutionary?
"At a conference in Spain last week, I believe there was only one other group discussing what we call a human-centred design approach: involving both patients and clinics in the development of rehabilitation devices."
Impact
Ultimately, Laura Marchal Crespo’s team (TU Delft) aims to improve the quality of life for as many people as possible. ''We want to make rehabilitation more enjoyable, more personal and more effective for everyone—and, above all, easier and more affordable for therapists."
Read in Dutch: Revalideren met een robot | NEMO Kennislink (Rehabilitation using a robot)
Laura, what is your dream?
"Have you ever heard of online communities that develop algorithms to train insulin pumps? You can find them on platforms like Reddit. It works a bit like Roblox: people develop games themselves and share them online. I would love to achieve something similar in rehabilitation care: an innovation you can 3D-print, take home, and connect to an online community. That is my real dream: an open and democratic way of developing technology—by the people, for the people. We as engineers, together with physicians and social scientists, can facilitate that."
Without collaboration, rehabilitation technology remains a nice idea: a plea for co-creation
Technology that enables home rehabilitation is no longer a luxury, but a necessity. Developing rehabilitation technology does not require a relay-race approach, but rather equal and simultaneous collaboration between (academic) researchers, commercial developers, healthcare professionals and patients from the very start. Our call to the sector: do not wait for perfect conditions, but set concrete medium-term goals so that more people can be helped with fewer resources. Build a culture that encourages collaboration, experimentation, risk-taking and creative ideas. An opinion piece by the involved researchers was published in the Dutch Journal of Rehabilitation Medicine (December 2025): Without collaboration, rehabilitation technology remains a nice idea: a plea for co-creation – Revalidatie.nl
Jane Murray Cramm
Jane Murray Cramm is Professor of Person-Centred Care at Erasmus University Rotterdam and Scientific Lead of CHMC.
What is the role of EUR within the CHMC flagship?
"While TU Delft and Erasmus MC primarily focus on technology and clinical application respectively, EUR concentrates on the human, organisational and societal conditions. Technology can be smart and affordable, but without attention to adoption, inclusion and embedding in daily life, its impact remains limited. We therefore study which factors determine whether technology is actually used by patients and healthcare professionals. How can we ensure that home rehabilitation is not only efficient, but also fair and inclusive? How do we include people with limited digital skills or lower socioeconomic status in design and implementation? These groups often benefit most from accessible home rehabilitation, yet in practice they are reached last."
Which factors determine adoption?
"We build on years of EUR research into person-centred care, implementation and sustainable healthcare innovation. This has resulted in a framework now known within the flagship as ‘Jane Murray Cramm’s ten factors’. In practice, innovations rarely fail because of the technology itself, but rather due to one or more of these factors. When we say technology must be ‘simple’ or ‘user-friendly’, we mean things like requiring minimal explanation and fitting into people’s daily routines."
Ten factors determining whether simple home-rehabilitation technology can be successfully implemented:
- Fit with daily life – Technology must align with routines, living conditions and energy levels.
- Simplicity and intuitiveness – The less explanation required, the higher the likelihood of use, especially among vulnerable groups.
- Perceived added value – Users must feel that it genuinely helps them progress physically and mentally.
- Person-centred flexibility – No one-size-fits-all solution; room for individual goals, pace and capabilities.
- Trust and safety – Confidence in the technology, data and support among patients and professionals.
- Professional support – Adoption improves when professionals view technology as an enhancement rather than a threat.
- Organisational embedding – Integration into workflows, responsibilities and care pathways.
- Financial and institutional feasibility – Without appropriate reimbursement and incentives, scaling remains difficult.
- Long-term user involvement – Co-creation is an ongoing process, not a one-off workshop.
- Attention to inclusion and health equity – Innovations should not increase inequality; inclusion must be designed and monitored explicitly.
How do you involve vulnerable groups in design?
"Within the flagship, we use participatory and inclusive research designs in which patients, informal caregivers and healthcare professionals are involved from the start—not as an after-the-fact test group, but as equal partners. Usability is tested in real home environments. As Gerard mentioned, we work closely with Rijndam and pay explicit attention to language, culture and digital skills."
Why is this essential for the future of healthcare?
''The core question is not ‘can we develop technology?’—of course we can. The real questions are: for whom does this technology work, under what conditions, and who might we unintentionally exclude?''
Convergence Health & Technology
Erasmus MC, TU Delft, and Erasmus University Rotterdam (EUR) work closely together in a leading national partnership: Convergence Health & Technology. We uniquely integrate technological, medical, and social sciences to address the greatest healthcare challenges of the 21st century — both in the Netherlands and internationally. We bring together open, transdisciplinary teams with a strong focus on implementation. This accelerates innovation, leads to tangible market outcomes, and generates new knowledge that continuously transforms healthcare.
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