Precision Rehabilitation: Can Neurorehabilitation Technology Help Make It a Realistic Target?

A major theme that has emerged in medicine over the last 10–15 years is “precision medicine”, in which therapeutic interventions are tailored toward the specific biological makeup and clinical needs of a given patient. This chapter briefly introduces the concept of precision medicine, exemplified by recent successes in oncology. Then, we summarize attempts at developing precision medicine approaches for stroke rehabilitation with a focus on upper extremity movement recovery. These attempts have mainly focused on predicting long-term outcomes rather than on predicting who can benefit from rehabilitation therapy, or, more importantly, who can benefit from what type of therapy. The most promising results have come from using early voluntary movement ability as a predictor, supplemented by motor evoked potential status, rather than genetic or brain structure factors. Of all the components that could further a clinically viable precision rehabilitation, we argue that precision measurement of impairment with neurorehabilitation technology is most directly within our reach and will have the greatest impact.