Digital Health and Telerehabilitation in Amyotrophic Lateral Sclerosis: Current Evidence, Implementation Challenges, and Future Perspectives

Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressing neurodegenerative disease causing severe physical, bulbar, and respiratory disability, rendering traditional center-based care highly burdensome for patients and informal caregivers. To evaluate how digital health can bridge hospital-to-home management, this narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) quality criteria. A comprehensive search was performed across the PubMed/Medline, Web of Science, and Scopus databases to analyze telerehabilitation modalities, remote functional telemonitoring, and caregiver-centered tools. The evidence supports the feasibility of several home-based approaches and the measurement validity of selected motor, respiratory, and bulbar digital markers; however, improved detection of progression does not itself establish therapeutic benefit. Although selected respiratory telemonitoring pathways have reported favorable healthcare-utilization outcomes, current evidence does not consistently demonstrate reductions in hospital admissions or caregiver burden across the technologies reviewed; benefits for functional status and quality of life also remain uncertain for many interventions. Key technologies include wearable inertial sensors, non-invasive ventilation telemetry, markerless computer vision, eye-tracking systems, and mobile applications; however, significant limitations have been reported, particularly in clinical, technological, and evidence-based domains. Therefore, a cross-disease bridging framework is needed to translate and adapt validated digital solutions from higher-prevalence neurological populations to ALS patients. However, specific clinical trials are required to provide ALS-specific data, integrating telemedicine solutions within hybrid care models and providing sustainable solutions to optimize multidisciplinary ALS management.