Advanced robotic rehabilitation in Bangladesh Medical University

Authors

DOI:

Keywords

rehabilitation, robotic, neurorehabilitation

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Correspondence

Md. Abdus Shakoor
Email: shakoorma@bmu.edu.bd


Publication history

Received: 3 Nov 2025
Accepted: 11 Dec 2025
Published online: 28 Dec 2025

Funding

None

Ethical approval

The study received approval from DGDA under the ref. no. (DGDA/Misc-07/966, dated: 2 Nov 2025) 

Trial registration number

Not applicable

Copyright

© The Author(s) 2025; all rights reserved. 
Published by Bangladesh Medical University (former Bangabandhu Sheikh Mujib Medical University).
Key messages
Bangladesh Medical University’s Robotic Rehabilitation Centre introduces advanced robotic systems for neurological and musculoskeletal care. Robotic therapy delivers high-intensity, precise treatment that can improve patient outcomes. The centre builds research and training capacity and advances Bangladesh toward excellence in rehabilitation despite cost and access challenges.
Robotic rehabilitation is an emerging field within physical medicine and rehabilitation that provides high-intensity, repetitive, and precise rehabilitation to enhance neuroplasticity and promote functional recovery. The global evidence base for robotic rehabilitation in post-stroke and spinal cord injury populations shows improvements in gait parameters, mobility, and training although there is heterogeneity in functional outcomes has been comprehensively reviewed elsewhere [1, 2, 3]. This perspective therefore focuses on implementation experience, early outputs, and unresolved challenges in Bangladesh.
 
Bangladesh Medical University, a national centre of excellence for postgraduate medical education and tertiary care, has recently established a Robotic Rehabilitation Centre to support patients with complex disabilities. The robotic systems deployed at the centre were provided as a governmental gift from the People’s Republic of China for humanitarian rehabilitation purposes, rather than procured through direct institutional or public financial investment. Regulatory requirements of national authorities are being followed and approved temporarily by Directorate General of Drug Administration of Bangladesh. This initiative, therefore, lies in the responsible, ethical, and effective utilisation of this advanced medical technology within a public-sector health system. Since inception, approximately 220 patients with neurological and musculoskeletal conditions have received robot-assisted therapy. It is assumed that 60% more improvement was found in the robotic rehabilitation than that of conventional therapy. No serious device-related adverse events have been observed so far. The programme has demonstrated operational feasibility in a public university hospital, including staff training, routine maintenance, and integration with conventional therapy pathways. However, systematic outcome analysis and health-economic evaluation are ongoing. These advantages relate primarily to therapy delivery and monitoring rather than proven superiority in functional outcomes, which remains to be established through comparative studies. At present, the centre lacks systematically analysed outcome data comparing robotic-assisted and conventional rehabilitation. Cost-effectiveness, long-term functional outcomes, and patient-reported measures will be evaluated. 
 
Bangladesh is a country with a growing burden of disability together with unmet rehabilitation needs and a shortage of physical medicine and rehabilitation specialists [4, 5]. National surveys consistently report fragmented service delivery, urban-rural disparities, and limited access to modern rehabilitation technologies. At this context, the Robotic Rehabilitation Centre at Bangladesh Medical University took an attempt to introduce structured, task-specific, and data-driven rehabilitation within a public sector setting. In this stage robotic systems are used as adjuncts to drug therapy and allow objective monitoring through parameters such as range of motion and muscle strength, in line with global evidence suggesting potential benefits of integrated robotic rehabilitation. Clinically, robotics help to extend therapist capacity by reducing physical workload during repetitive training and facilitating delivery of higher-intensity, standardised rehabilitation. Academically, integration of robotic systems provides trainees with exposure to contemporary rehabilitation technologies. Research initiatives, including prospective registries and pragmatic studies, are planned to generate local evidence on feasibility, safety, and cost-benefit in a Bangladesh context.

Categories

Number (%)

Sex

 

   Male

36 (60.0)

   Female

24 (40.0)

Age in yearsa

8.8 (4.2)

   Education

 

   Pre-school

20 (33.3)

   Elementary school

24 (40.0)

   Junior high school

16 (26.7)

Cancer diagnoses

 

   Acute lymphoblastic leukemia

33 (55)

   Retinoblastoma

5 (8.3)

   Acute myeloid leukemia

4 (6.7)

   Non-Hodgkins lymphoma

4 (6.7)

   Osteosarcoma

3 (5)

   Hepatoblastoma

2 (3.3)

   Lymphoma

2 (3.3)

   Neuroblastoma

2 (3.3)

   Medulloblastoma

1 (1.7)

   Neurofibroma

1 (1.7)

   Ovarian tumour

1 (1.7)

   Pancreatic cancer

1 (1.7)

   Rhabdomyosarcoma

1 (1.7)

aMean (standard deviation)

Categories

Number (%)

Sex

 

   Male

36 (60.0)

   Female

24 (40.0)

Age in yearsa

8.8 (4.2)

Education

 

   Pre-school

20 (33.3)

   Elementary school

24 (40.0)

   Junior high school

16 (26.7)

Cancer diagnoses

 

Acute lymphoblastic leukemia

33 (55)

Retinoblastoma

5 (8.3)

Acute myeloid leukemia

4 (6.7)

Non-Hodgkins lymphoma

4 (6.7)

Osteosarcoma

3 (5)

Hepatoblastoma

2 (3.3)

Lymphoma

2 (3.3)

Neuroblastoma

2 (3.3)

Medulloblastoma

1 (1.7)

Neurofibroma

1 (1.7)

Ovarian tumour

1 (1.7)

Pancreatic cancer

1 (1.7)

Rhabdomyosarcoma

1 (1.7)

aMean (standard deviation)

Category

Key Factors

Weight

Strengths

Strong management support, skilled workforce, compliance with legal regulations

0.338

Weaknesses

Logistical complexity, inadequate segregation, financial constraints

0.13

Opportunities

Industry collaboration, environmental policies, new technology

0.094

Threats

Limited space, lack of coordination, high investment risk

0.329

Pain level

Number (%)

P

Pre

Post 1

Post 2

Mean (SD)a pain score

4.7 (1.9)

2.7 (1.6)

0.8 (1.1)

<0.001

Pain categories

    

   No pain (0)

-

1 (1.7)

31 (51.7)

<0.001

   Mild pain (1-3)

15 (25.0)

43 (70.0)

27 (45.0)

 

   Moderete pain (4-6)

37 (61.7)

15 (25.0)

2 (3.3)

 

   Severe pain (7-10)

8 (13.3)

2 (3.3)

-

 

aPain scores according to the visual analogue scale ranging from 0 to 10; SD indicates standard deviation

Aspect

Conventional dichotomous model

Emerging continuum model

Disease Classification

Dementia with lewy bodies (DLB): Cognitive decline manifests prior to or within 12 months of motor symptom onset.

Disease is conceptualised as a spectrum with overlapping onset of cognitive, motor, psychiatric, and sleep disturbances. No distinct temporal order governs the presentation of symptoms.

Parkinson’s disease dementia (PDD): Dementia emerges after at least one year of established Parkinsonism.

Neuropathology

Predominantly characterised by α-synuclein deposits. DLB often demonstrates more prominent cortical involvement, while PDD predominantly affects subcortical structures.

Extensive cortical and subcortical involvement of α-synuclein pathology in both DLB and PDD. Coexistent Alzheimer-type pathologies (β-amyloid plaques, tau tangles) observed across both entities, suggesting shared neurodegenerative processes.

Clinical Features

Cognitive impairment follows motor symptom onset in PDD, whereas DLB exhibits early cognitive symptoms. Both conditions feature Parkinsonism, visual hallucinations, fluctuating cognition, and REM sleep behaviour disorder (RBD).

A broader clinical continuum of cognitive, motor, psychiatric, and sleep disturbances with no rigid sequence, indicating that cognitive and motor symptoms may emerge simultaneously or in varying order. Common pathophysiological markers overlap between both forms of LBD.

Diagnostic Thresholds

Clear temporal distinction based on the onset of dementia relative to motor features, specifically the one-year cutoff rule for PDD.

Diagnostic boundaries are fluid, guided by clinical, pathological, and molecular markers rather than an arbitrary time frame. Both phenotypes represent variations within a spectrum.

Therapeutic Implications

Cholinesterase inhibitors and dopaminergic therapies are commonly employed, but treatment regimens are often stratified based on the temporal progression of symptoms, without regard for underlying pathophysiology.

A unified therapeutic approach tailored to individual patient profiles using biomarkers. Both cholinesterase inhibitors and dopaminergic agents are employed but with careful consideration of the individual patient's symptomatology and the risk of treatment-related side effects.

Clinical Trial Design

Clinical trials often restrict inclusion based on rigid diagnostic criteria, such as the one-year temporal cutoff, potentially excluding individuals with early cognitive or psychiatric symptoms and misclassifying patients.

Clinical trials are designed to accommodate the full spectrum of disease, focusing on biomarker-based phenotyping rather than rigid temporal criteria, allowing for more inclusive patient selection and better representation of disease variability.

Bangladesh Medical University’s initiative demonstrates that advanced rehabilitation techno-logies can be introduced in a resource-constrained setting. Future work should focus on publishing patient-reported and programme outcome data, comparing robotic-assisted versus conventional therapy. With strategic investment, policy support, and attention to equity, this centre could be a regional hub for innovation in rehabilitation in Bangladesh.
Acknowledgements
We thank the authority of Bangladesh Medical University for establishing the advanced robotic rehabilitation centre.
Author contributions
Manuscript drafting and revising it critically: MAS, MAKA, MIH. Approval of the final version of the manuscript: MAS, MAKA, MIH. Guarantor of accuracy and integrity of the work: MAS, MAKA, MIH.
Conflict of interest
All the robotic devices were donated by the Government of the People’s Republic of China.
Data availability statement
Not applicable
Supplementary file
None
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