AI-Enhanced Extended Reality for Rehabilitation in Africa: A Perspective on Explainable Agents, Co-Creation, and Generative Worlds

Abstract

The burden of disability is rising rapidly in Africa, where a severe shortage of rehabilitation professionals and limited infrastructure create a major treatment gap. Immersive virtual reality and serious games have shown promise for upper limb rehabilitation, but current extended reality (XR) solutions lack personalization, cultural adaptability, real-time feedback, and scalability. This perspective paper proposes a conceptual AI-enhanced XR framework tailored to African low- and middle-income countries. We identify how generative AI, large language models, multiagent systems, and explainable AI can address specific rehabilitation barriers. The framework integrates these four pillars into a three-layer architecture covering content creation, interaction, and decision support. We analyze implementation considerations specific to African contexts-infrastructure, capacity building, cultural adaptation, ethics, and financing-and outline a detailed research agenda with near, medium, and longer term priorities. Realizing this vision requires co-design with African communities, investment in local capacity, adaptation to infrastructure constraints, and development of ethical frameworks. AI-enhanced XR has the potential to democratize access to quality rehabilitation across Africa, but this potential must be validated through rigorous, context-sensitive research.