THE field of rehabilitation is undergoing a revolution. According to the World Health Organisation, rehabilitation is ‘a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment.’ Therefore, it is not only about medical treatment; it focuses on improving functioning, participation, and quality of life. Globally, one in three people benefits from rehabilitation.
The concept of robotic rehabilitation in Bangladesh first emerged in 2021, when I, as a physiotherapist, proposed the startup idea ‘robo re1hab’ during the Bangabandhu Innovation Grant (BIG 2021) under the Information and Communication Technology Division’s iDEA project, marking the country’s earliest integration of robotics into healthcare rehabilitation. Around the same time, universities such as Bangladesh University of Engineering and Technology and Bangladesh Army University of Science and Technology developed robotic-rehab prototypes (eg, IEOM 2021; Khan 2022). The vision materialised in 2025, when Bangladesh Medical University launched the nation’s first Robotic Rehabilitation Centre.Ìý
In rehabilitation management, practices have evolved from traditional manual approaches to the integration of artificial intelligence and robotics in Bangladesh. Within rehabilitation, the manual–artificial binary blurs the boundary between human touch (manual therapy and body movement) and artificial touch (AI- or robot-assisted systems), where ethical questions come in front. For instance, what does rehabilitation or therapy truly mean when performed by a machine? Can healing remain natural when driven by algorithms? These questions highlight the need to develop an ethical rehabilitation framework grounded in conceptual engineering, aimed at redefining and rethinking care, recovery, and human touch in this AI-assisted era. According to Hopster, this conceptual disruption may manifest as (i) conceptual gaps, (ii) conceptual overlaps, and (iii) conceptual misalignments.
Most rehabilitation technologies focus on engineering efficiency and regulatory frameworks emphasise safety and effectiveness, but what about autonomy, consent and justice? For example, if a robotic arm malfunctions while assisting a stroke patient, who would be responsible for the error or harm caused? How can safeguards ensure that patient data are not shared with third parties, protecting privacy and dignity?
While we are fascinated and sometimes fearful of the auxiliary power of AI-based robotics, important questions arise: Does this technology make humans more vulnerable? In the therapist–patient relationship, the philosophical question of what it means to be human comes to the forefront, along with concerns about power distribution between AI-driven robots and human caregivers. Technology can be a tool of liberation, but not a tool of human enslavement.
Furthermore, can a machine or algorithm truly feel emotions, empathy, or compassion? Can it foster a genuine doctor–patient relationship or make fair and culturally sensitive decisions? There is an urgent need to address these issues without reproducing biases such as Eurocentrism, Americentrism, or Sinocentrism. These are not merely hypothetical concerns, they are supported by growing real-world evidence.
If AI-based robots think and generate algorithms using existing data, the question of their cognitive ability and metacognition remains unclear. There is a high risk of ableism and algorithmic unconscious bias. The ongoing debate over the definition of personhood and the identity of a human being is now being reignited by AI itself.
These concerns highlight why we urgently need to redefine ethical frameworks and conduct further research through bioethical lenses. As Hopster asks, ‘Who has the legitimacy to decide which concepts should be revised, and how?’
More than 54 years after Bangladesh’s Liberation War in 1971, rehabilitation practitioners and professionals remain outside the mainstream healthcare and rehabilitation system, reflecting persistent ethical bias and tokenism. To move forward, we must strengthen research efforts and integrate rehabilitation teams to achieve the WHO Rehabilitation 2030 Initiative, thereby enhancing our capacity within the modern healthcare system.
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Md Gausul Azam is physiotherapist and rehabilitation officer.