In today’s technological era, the research ecosystem around digital services is getting richer. There is curiosity-driven literature around the assistive role of digital rehabilitative interventions (DR) being developed across the globe. The National Center for Biotechnology Information, USA, in 2023 defined DR as a part of the rehabilitation process that utilises technology as a means of target-correcting a person’s mental or physical ailment, and improving their functioning in society. These services can be mapped on a broad spectrum, which include medical, educational, and occupational rehabilitation. The goal of utilising technology to assist in rehabilitation is to break down societal stigmas surrounding the physical and psychological well-being of people coming from different strata of society. Looking at India’s commitment to resolving the multifaceted challenges faced by individuals dealing with physical, mental, or social adversities, one can trace the exponential need for developing an extensive network of smart rehabilitative services and its allied legal framework to holistically address the unique challenges the rising digital civilization faces. Today we see the utilisation of DRs in sports injuries, substance abuse rehabilitation, medical recoveries, vocational training, social reintegration, and other community-based initiatives.
However, with the increasing usage of DRs, there also arises a need for framing an extensive framework in place to check and regulate the reach of these rehabilitation services. The introduction of innovative rehabilitative techniques, such as the use of simulation rooms, audio-visual programs, digital medical wearables, etc., has been done to escalate and catalyse the neuro-interventions and to effectively rehabilitate individuals by catering to their unique needs. While globalization has significantly affected this new era of ‘smart rehabilitation’, it also sparks the conflicting debate about whether persuasive technologies (PT) attack the right to mental liberty of such individuals. Lighthart et. al. (2021) have explained the design of PTs to mean “digital technologies, such as mobile apps, video games and virtual reality systems, that are deployed for the explicit purpose of changing attitudes and/or behaviours, without using coercion, deception or extreme forms of psychological manipulation (such as hypnosis or indoctrination), and without exerting a direct (not psychologically mediated) physical effect on the brain”. However, the inherent legal and ethical questions around autonomy and privacy are invoked at the core of the usage of technology as a means of rehabilitation. The question of the moral right to mental liberty also needs to be explored vis-à-vis the informed consent of individuals to use of persuasive technologies as an aid to corrective rehabilitation. At the moment, there remains an inconsistency in the utilisation of DRs, weaving the way for a more robust, policy-driven approach that bridges the gap between the idealistic aim of DRs with the social reality of its effect on the rights of individuals.
From an Indian context, the extent of rights affected in this couture of smart rehabilitation is far more layered than what meets the standing legislative framework. Much like the leading nations of the world, Indian economy too is cognizant of the age of Internet of Things (IoT). Thus, it is not too far-fetched to offer IoT-based smart rehabilitation systems as a promising solution to mitigate issues such as the shortage of health professionals and vocational training experts, and to address the needs of the cyber civilisation. These systems leverage IoT to create an interconnected platform that facilitates immediate information interaction and resource reconfiguration.
One could argue against DRs citing the infrastructural gaps, economic strains and a general resource depletion. However, it is ascribed theoretical justification on the foundational ground that humans end up in need of rehabilitation due to their deteriorated social circumstances or situations beyond their control. It is thus seen as the responsibility of the State to intervene and conciliate, as much as it is the individual’s right to ask for support and assistance from the administration as well as his or her community. There can also be found supporters of Bentham’s theory of utilitarianism who support such a rehabilitative design. He provided that we should adapt such a way that would generate the ‘greatest happiness of the greatest number of people’ which seems to come alive when exercising the facility of rehabilitation, a notion which also advances the scriptures of justice.
To harness the full potential of DRs, it is imperative to align these technological advancements with national policies and flagship schemes such as Digital India. The integration of smart rehabilitation systems with Digital India can facilitate the widespread adoption of these technologies, ensuring that rehabilitation services reach even the most remote and underserved populations. The fabric of Article 21 of the Constitution of India, 1950 gives way to effective health care. One could stretch the argument that access to DRs for qualified cases ensures a fair chance of being socially re-integrated, having physical or mental impairment/ailment restored, etc. What constitutes a qualified case remains for the legislature to define and categorise based on different industries of DR application. This also pulls at the strings of Article 41 of the Constitution of India, 1950 which requires the State to make effective provisions for ‘securing the right to work, education, and public assistance’. These can be achieved by the implementation of programs like Virtual Campus, BreakingFree Online, Virtual Rehab, the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), Therapeutic Education System (TES) and Motivational Assessment Program to InitiateTreatment (MAPIT), etc.
The convergence of smart rehabilitation with other flagship schemes such as Digital India can significantly enhance the reach and impact of these services. For instance, the use of telepsychiatry, e-healthservices, and smartphone applications can facilitate remote consultations and continuous monitoring of patients, reducing the burden on healthcare facilities and improving patient outcomes. Further, healthcare professionals and vocational trainers must be equipped with the skills and knowledge to utilize DR technologies effectively. This can be achieved through targeted training programs and continuous professional development initiatives. A robust regulatory framework is essential to address issues related to data privacy, security, and ethical considerations in the use of smart rehabilitation technologies. Policies should be formulated to protect user data and ensure the responsible use of technology. The Digital India initiative aims to transform the country into a digitally empowered society and knowledge economy. By integrating smart rehabilitation systems with this initiative, the government can ensure that advanced rehabilitation services are accessible to all, regardless of geographical location. This can also promote social networking and peer support, providing individuals with the necessary social and emotional support for their recovery journey.
The Digital LifeCare, under the Ayushman Bharat program, is a staggering example of integrating technology into healthcare. It focuses on comprehensive primary healthcare services, including preventive and rehabilitative care, utilizing digital platforms to track patient health records and ensure continuity of care. Similarly, eSanjeevani is a telemedicine service initiated by the Ministry of Health and Family Welfare, which provides remote consultation services. This initiative has proved significant in providing mental health support and rehabilitation services to individuals in remote areas, especially during the COVID-19 pandemic.
While different industries utilise DR programs best suited to their needs, a policy-driven approach should overall focus on select key areas. At the outset, it needs to be recognised that establishing the necessary infrastructure to support IoT-based rehabilitation systems is crucial in India to even take this conversation forward. This includes investment in high-speed internet connectivity, data storage solutions, and secure communication networks to ensure seamless interaction between devices and systems. DRs must not be looked at independently of emerging technologies such as artificial intelligence (AI), machine learning (ML), and blockchain technologies. AI and ML can effectuate predictive analytics, to assist healthcare providers in anticipating and resolving potential issues before they become critical. Blockchain technology is best utilised for ensuring the security and integrity of data, fostering trust in the use of digital rehabilitation services. Currently, the briefest examination of the cyber security infrastructure of the nation would strike at the anvil of the right to data protection, privacy and autonomy. It would raise questions on the legal leverage of State interest being weighed against the right to mental liberty as a charter to the right to freedom from interference with one’s mind. These are legislative gaps that need to be worked out in tandem with the established international framework around these rights including aligning the Indian policy standards with the Universal Declaration of Human Rights (UDHR), 1948, the International Covenant on Civil and Political Rights, 1966 (ICCPR), the International Covenant on Economic, Social and Cultural Rights, 1966 (ICESR), ITU’s Connect 2030, in alignment to the United Nations Sustainable Development Goals 2030 (SDGs 2030), etc.
To sum up, the DR framework in India will be nothing short of a pragmatic explosion contingent upon the dedication and commitment with which the State devotes its time, energy, and resources to making this technologically-infused rehabilitative regime a triumphant story. The need for policy-driven smart rehabilitation in India is evident. By leveraging IoT and other emerging technologies, and aligning these advancements with national policies and flagship schemes, the country can significantly improve the accessibility, efficiency, and effectiveness of rehabilitation services. A comprehensive, policy-driven approach can ensure that all individuals, regardless of their physical, mental, or social challenges, have access to the rehabilitation services they need to lead fulfilling lives. Through a combination of the legal framework, robust infrastructure, and innovative technology, India can set a global example in providing holistic and inclusive rehabilitation services.
Anamika Shukla is an Assistant Professor of Law at Gujarat National Law University, Gandhinagar, and Tarun is an Assistant Professor (Research) at Gujarat National Law University, Gandhinagar. The views expressed are personal.
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