Virtual Reality Stroke Rehabilitation: Does VR Therapy Work?
NeuroRehab Team
Tuesday, November 18th, 2025
Stroke impacts more than 17 million people worldwide each year. It remains a leading cause of death and disability. VR stroke rehabilitation brings new hope to the 80% of patients who struggle with movement after having a stroke. The numbers tell a sobering story – only 25% of stroke patients can handle daily activities without help.
Research shows that VR rehabilitation works well and stays safe to use, especially when combined with traditional therapy methods. Patients wear headsets and motion sensors to play therapeutic “games” that help them recover movement in their limbs. This technology helps adult stroke patients recover movement in their upper body, lower body, walking ability, and balance.
This piece looks at how VR helps rehabilitation work better, what systems you can use, and the growing proof that it really works. We’ll get into what affects patient outcomes and the hurdles teams face when using VR. The technology’s ability to adapt and stay user-friendly makes it a great option for patients of any age.
Understanding Stroke and the Need for Rehabilitation
Blood supply disruption to the brain causes a cerebrovascular accident or stroke. This condition leads to immediate neurological impairment that varies in severity [1]. Stroke stands as the leading cause of disability worldwide, and its occurrence will likely increase as the global population ages [1].
What happens to the brain after a stroke
Two main categories of strokes exist based on their underlying mechanisms. Ischemic strokes make up about 80% of all cases and happen due to vessel occlusion from thrombosis or embolism [2]. Blood vessel rupture causes hemorrhagic strokes that leak inside or around the brain [2].
An ischemic event creates two distinct damage zones in the affected brain area. Cells die within minutes of blood flow interruption in the “core,” while the surrounding “ischemic penumbra” contains marginally perfused tissue that doctors can save for a limited time [3]. Quick emergency treatment becomes vital because brain injury is time-sensitive.
The brain responds to injury through complex neuroplastic processes. Research shows that “the cerebral cortex exhibits spontaneous phenomena of brain plasticity in response to damage” [1]. Various inhibitors of neural regeneration and sprouting, including myelin components and guidance molecules, can limit recovery after a stroke [1].
Common physical and cognitive impairments
Stroke patients often face multiple impairments that affect their daily functioning. About two-thirds of stroke survivors develop sensorimotor deficits [4] that affect their ability to stand, walk, or use their upper limbs properly [1].
Motor dysfunction remains the most common after-effect of stroke [4]. The brain’s damaged side determines specific patterns of impairment:
- Right-sided weakness, speech problems, and analytical thinking difficulties typically result from left hemisphere damage [5]
- Left-sided weakness, spatial perception issues, and attention deficits usually come from right hemisphere damage [5]
- Both sides of the body can suffer from brainstem strokes, potentially creating a “locked-in” state [5]
Recovery becomes more challenging due to cognitive issues. Cognitive impairment affects up to 60% of survivors within the first year after stroke [3]. These problems often involve attention, memory, language, and orientation [3]. About 40% of survivors experience cognitive impairment that doesn’t qualify as dementia but still affects their quality of life [3]. One-third might develop dementia within five years [3].
Why traditional rehab has limitations
Several factors limit how well conventional stroke rehabilitation approaches work. Experts disagree on which rehabilitation method works best for specific patient categories [1]. Local facilities offer available treatments and assume they will help improve outcomes [1].
Rehabilitation timing creates another challenge. The first three months serve as the “golden period” when 48-91% of recovery happens [1]. Many patients face delays in getting appropriate care. Some regions lack standardized evaluation processes for rehabilitation unit admission [1]. This gap might exclude patients who could benefit from treatment.
Current approaches don’t deal very well with personalization. Research suggests that clinicians need better markers of treatment response “to improve the personalization of neurorehabilitation pathways” [1]. Existing methods might not address the wide variation in post-stroke recovery patterns.
Getting rehabilitation services presents another big barrier. Stroke survivors and their families often struggle financially [6]. High-quality rehabilitation services remain out of reach for many patients, while government-funded facilities are scarce [6]. This situation creates a gap between evidence-based best practices and the actual care most stroke survivors receive.
These limitations show why we need innovative rehabilitation approaches. New methods must overcome accessibility issues, enable personalization, and maximize recovery potential. This need explains the growing interest in virtual reality stroke rehabilitation technologies.
How Virtual Reality Works in Rehabilitation
Virtual reality technology brings a fresh approach to stroke rehabilitation. It uses computer-generated simulations that create interactive therapy environments. VR helps patients take part in personalized, goal-focused activities and gives them immediate feedback from multiple senses [1].
Immersive vs non-immersive VR
VR systems in rehabilitation can be grouped by how immersive they are. The level of immersion directly affects therapy experience and possible outcomes. These systems come in three distinct types:
Immersive VR systems use head-mounted displays (HMDs) that fill the user’s entire field of view with virtual content [5]. These track head and body movements through accelerometers, gyroscopes, and external cameras. They create a complete 3D environment that keeps patients away from distracting clinical surroundings [5]. Research shows immersive VR works best at improving upper extremity function, with 1.39 standard mean differences in improvements compared to Nintendo Wii intervention [3].
Semi-immersive VR shows users virtual content through large computer monitors, screen projectors, or multiple television systems [5]. This gives a moderate level of realism and immersion that sits between fully immersive and non-immersive environments [6].
Non-immersive VR lets users interact with a virtual 3D environment through regular devices like monitors, keyboards, and mice [5]. Though less immersive, these systems are valuable, especially for patients with condition-related limitations [3]. Studies reveal both immersive and non-immersive VR conditions boost oxygenated hemoglobin in the motor cortex and nearby brain regions [3].
Interaction and feedback mechanisms
VR stroke rehabilitation works through advanced interaction and feedback systems that aid motor learning through multiple sensory inputs. Patients interact with VR environments through:
- Motion tracking sensors that capture limb movements
- Touch screens or specialized magnetic tracking sensors
- Wearable devices that enable 3D position tracking [5]
VR stands out because of its complete feedback system. These systems give immediate visual, auditory, and often haptic feedback on performance [1]. The best results come when movement and visual response happen within 20 milliseconds. This prevents motion sickness and needs high-refresh-rate displays (90–120 Hz) [7].
This immediate feedback serves many therapy purposes. It helps correct movements right away [1]. It also boosts neuroplasticity through constant sensory input [1]. Game-like elements in VR rehabilitation—such as scoring systems and leaderboards—help patients see their progress and stay motivated [8].
Role of mirror neurons and neuroplasticity
VR rehabilitation works because it activates specific neural pathways that help recovery. Mirror neurons play a central role—these specialized neural networks fire both when performing and watching actions [9].
VR rehabilitation triggers mirror neurons through visual feedback. Patients see themselves as avatars on screen, much like looking in a mirror [6]. This visual trick can make the brain think the affected limb moves normally, which might stimulate motor input areas in the cortex [9].
Brain imaging studies show several changes after VR therapy:
- Better interhemispheric balance [1]
- Stronger cortical connectivity [6]
- Bigger cortical mapping of affected limb muscles [6]
- More activation in frontal cortex regions [6]
These changes show how the brain restores and compensates for functional deficits [1]. Research has found clear links between neural plasticity changes and functional recovery, which explains how VR therapy affects the brain [1].
The best results happen with therapy lasting 5-8 weeks, with sessions over 30 minutes, at least three times weekly [3]. Longer therapy periods might not give better results, so each patient needs a carefully planned training schedule [3].
Types of VR Systems Used in Stroke Recovery
The field of virtual reality stroke rehabilitation now uses a variety of technological approaches. Each approach gives unique advantages for recovery. These systems range from readily available consumer gaming platforms to advanced medical-grade equipment designed for clinical settings.
Game-based VR platforms
Commercial gaming platforms like Nintendo Wii and Xbox Kinect became popular as budget-friendly virtual reality rehabilitation options. The Wii system works with a console, adapter, infrared sensor bar, wireless nunchucks, remote with wrist straps, and balance board. This setup creates an environment where patients can practice therapeutic movements [10]. Games like Wii Sports (tennis and boxing), Wii balance board activities, and Cooking Mama work well for rehabilitation [10].
These gaming platforms recreate real-life situations that encourage high-intensity repetitive movements similar to daily activities [4]. Research shows these systems lead to significant improvements in joint range of motion. VR groups achieved post-treatment mean values of 18.18 compared to 14.56 in routine physical therapy groups [10].
These platforms have become more available and offer:
- Exergaming activities that need purposeful body movements and show clear improvements in balance, lower limb mobility, and functional independence [4]
- Serious games designed specifically to help with rehabilitation rather than entertainment [4]
- Video games with rhythm components like Beat Saber that blend gaming with music therapy to improve arm functions [2]
Rehabilitation-specific virtual environments
Rehabilitation-specific VR environments differ from commercial platforms because they focus on therapeutic goals. Medical-grade systems like the MDR-certified VR Vitalis® Pro represent modern rehabilitation platforms created for neurological patients [11]. These specialized devices have modules for both upper and lower limb rehabilitation. The exercises adapt to different levels of motor impairment [11].
Research shows rehab-specific VR environments work better than commercial games [4]. These specialized platforms provide objective performance metrics and adapt to each patient’s needs and therapeutic goals [11].
Popular rehabilitation-specific systems include ARMEO Spring 1.1, Rehabilitation Gaming System, and ArmAble™[12]. Many systems feature 360° immersive environments that use movements like forearm rotations and tendon gliding exercises [13]. Clinical studies mainly use Oculus Quest (35%), Oculus Rift (30%), HTC Vive (30%), and Pico (5%) as VR headsets [13].
Mixed reality and haptic feedback systems
Mixed reality (MR) systems blend virtual reality with physical objects. Patients can interact with real items while staying immersed in a virtual environment. This helps them maintain their sense of reality [3]. Physical objects act as tangible interfaces that encourage more participation and learning [3].
Haptic feedback systems provide vital sensory information that helps control movements and task completion. Touch feedback plays a key role since sensory input from everyday tasks helps improve hand function [14]. Studies show that adding haptic feedback to VR systems lets users feel a realistic sense of touch while manipulating virtual objects [14].
Advanced haptic systems include the Novint Falcon™, a budget-friendly robot arm that creates forces with 3 degrees of freedom [14]. The MR-board 2 uses palm cameras (TapSix) for finger training and tracks fingers in real time. This allows natural interactions between humans and computers [3]. The system has improved upper limb function at impairment, activity, and participation levels [3].
Robotic devices with haptic feedback show great results when combined with gamified virtual training tasks. Some systems use haptic rendering to represent interaction forces with objects from virtual environments [15]. These advanced systems often include gamified training tasks for reaching, grasping, and releasing objects. This promotes both proximal and distal movements with focus on fine motor control [15].
Evidence of VR Effectiveness in Stroke Rehabilitation
Research shows that VR stroke rehabilitation works well in many functional areas. Clinical trials consistently reveal meaningful improvements in motor and cognitive recovery. This provides solid evidence of its therapeutic value.
Upper limb motor recovery
Studies of VR-based interventions for upper limb rehabilitation show substantial positive outcomes. A meta-analysis of 35 studies found that 11 of 12 studies showed significant benefits of VR for selected outcomes [6]. VR showed a strong effect on motor impairment with an odds ratio of 4.89 (95% CI, 1.31 to 18.3) in randomized controlled trials [6].
VR interventions produced these specific improvements for upper limb function:
- 14.7% improvement in motor impairment (95% CI, 8.7%–23.6%)
- 20.1% improvement in motor function (95% CI, 11.0%–33.8%) [6]
The validated Fugl-Meyer Upper Extremity scale showed VR interventions had a mean difference of 3.91 points (95% CI = 1.70–6.12, P = 0.0005) [8]. The level of immersion seems to influence outcomes. Full-immersive VR produced the greatest motor gains with a mean Fugl-Meyer improvement of 5.4 points (95% CI 5.02–5.77) over conventional therapy [7].
Non-immersive systems often work better than fully immersive options. Microsoft Kinect proved most effective in boosting upper limb motor function with a mean difference of 7.27 (95% CI: 0.59 to 13.77). Nintendo Wii followed with 4.53 (95% CI: 0.87 to 8.14) [16]. Both approaches can work well depending on patient needs.
Lower limb, gait, and balance improvements
VR interventions have shown promising results for lower extremity function. VR-based treadmill training improved walking speed substantially in the 10-meter walk test compared to conventional therapy (Δ 0.07 vs 0.04 m/s, p = 0.003) [17]. The 6-minute walk test distance also increased notably with VR intervention (Δ 19.79 vs 10.19 m, p = 0.005) [17].
VR therapy improves gait symmetry, which helps prevent falls. Studies show significant drops in asymmetry index values for both stance duration (Δ -8.6 vs -1.8, p = 0.049) and swing duration (Δ -24.3 vs -5.5, p = 0.036) [17].
Balance outcomes show even better improvements. VR groups had significantly higher Berg Balance Scale scores (Δ 4.33 vs 2.44, p = 0.005) [17]. A meta-analysis of 24 studies with 871 participants found a standardized mean difference of 0.26 (95% CI 0.12 to 0.40) favoring VR over other approaches [18]. Adding VR to usual care led to even better balance improvements (SMD 0.68, 95% CI 0.46 to 0.91) [18].
Cognitive and language function outcomes
VR helps address cognitive deficits after stroke effectively. Studies using the Montreal Cognitive Assessment (MoCA) show significant improvements after VR intervention. Seven out of nine studies reported significant post-intervention gains in MoCA scores in VR groups versus control groups, with cognitive improvement averaging 12.8% [9].
VR-based cognitive interventions showed moderate-to-large effects in these areas:
- Global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85])
- Executive function (SMD = 0.84; 95% CI [0.25, 1.43])
- Memory (SMD = 0.65; 95% CI [0.15, 1.16]) [5]
Treatment characteristics play a key role in outcomes. One-on-one coaching (SMD = 0.95, 95% CI [0.18, 1.71], p = 0.01) and individualized design (SMD = 1.72, 95% CI [0.82, 2.62], p < 0.01) produced better effects [5]. VR interventions lasting six weeks or longer showed superior results [5].
VR also boosts psychological well-being. Patients in VR studies expressed significant improvements in motivation, with notable increases in Achievement dimension scores (T0: 68.41 ± 15.81, T1: 68.93 ± 15.80; p < 0.001) and fewer depressive symptoms (T0: 41 ± 2.32, T1: 6 (4–8); p = 0.003) [19].
Factors That Influence VR Rehab Outcomes
VR stroke rehabilitation success rates vary based on several implementation factors. Clinicians need to understand these variables to create the best treatment plans for each patient.
Timing after stroke: acute vs chronic
The timing of VR therapy after a stroke plays a major role in rehabilitation outcomes. Research shows most clinical studies focus on patients in the chronic stage (more than 6 months post-stroke) [6]. Starting rehabilitation early, within two weeks after stroke, leads to better mobility and functional recovery [20].
Studies present mixed findings about the best time to start. Some research suggests rehabilitation works better during the subacute phase (1-6 months) compared to the chronic stage [4]. Other studies found that VR therapy helped patients who started more than 6 months after their stroke. These patients saw better improvements in their quality of life [1]. This contrast shows why each patient’s situation needs careful evaluation beyond just timing.
Session duration and frequency
The right “dosage” of virtual reality rehabilitation is vital for recovery. Successful VR programs typically include:
- Session durations ranging from 10-60 minutes [21]
- Total intervention sessions between 4-30 [21]
- Treatment periods spanning 3-12 weeks [1]
Research shows patients need at least 20 VR treatment sessions to see real improvements in balance and mobility. Fewer sessions didn’t make much difference [1]. Programs lasting 5-8 weeks seemed to help balance function the most [22].
Level of immersion and personalization
Immersion levels and personalization shape how well rehabilitation works. Studies show both immersive and non-immersive VR approaches can help, though each works better for different functions [4].
Patient-specific programs make a big difference. Studies found 68.4% of patients were happy with their customized VR therapy [11]. Patients did better when exercise challenges matched their progress [10]. Therapists can adjust difficulty levels as patients improve, keeping tasks challenging but achievable [10].
Physiotherapists’ evaluations back up these tailored VR approaches. About 84.2% of patients did as well as or better than with standard rehabilitation [11]. Most patients handled it well too – 63.2% reported no discomfort. These results show why matching VR programs to each patient’s abilities and goals matters so much [11].
Challenges and Considerations in VR Stroke Therapy
VR in stroke rehabilitation shows promise, but several big hurdles stand in the way of its adoption in healthcare settings. These challenges affect how widely hospitals and clinics can use this technology.
Cost and accessibility
Money remains the biggest roadblock to bringing VR into rehabilitation. A 15-session constraint-induced movement therapy protocol costs about $2,489 CAD (2024 adjusted) per patient. Standard care costs just $355 CAD [2]. High-quality VR systems need powerful and expensive hardware [23]. Location makes things even harder. Patients in rural areas struggle to reach rehabilitation facilities [2].
Technical limitations and side effects
Cybersickness creates real problems and can make patients less likely to participate [24]. Research shows that patients feel pain, get tired, and become mentally exhausted during long VR sessions. One patient said, “I felt extremely tired during the rehab, almost as if I had done heavy physical labor” [25]. Technical problems like frozen screens and delayed movements often interrupt training [25]. Some patients simply cannot use VR. This includes people with photosensitive epilepsy, severe cognitive impairment, and high intracranial pressure [23].
Need for therapist training and support
Today’s clinicians need special training to use VR rehabilitation well. They must learn about hardware, software, and therapeutic protocols [26]. We need more research to create guidelines that help physiotherapists use VR systems [24]. Proper assessment tools must be developed to measure how well VR works in rehabilitation settings [24].
Conclusion
VR technology opens up exciting possibilities in stroke rehabilitation by going beyond traditional therapy methods. Studies show that VR combined with regular rehabilitation helps improve arm function, leg movement, balance, and brain function. Therapists can tailor VR systems to each patient’s needs and abilities, which helps maximize their recovery.
The success of VR rehabilitation depends on several factors. Recovery patterns vary based on when patients start their treatment – right after stroke or months later. The length and frequency of sessions make a big difference too. Research points to best results with 20 or more sessions over 5-8 weeks. Patient engagement and treatment success also improve by a lot when VR systems are personalized and immersive.
Some roadblocks still exist in making VR widely available. The high cost limits access, especially when you have budget constraints. Side effects like cybersickness and technical issues need careful thought before starting treatment. The therapy’s success also depends on having clinicians who know both the technology and its healing applications.
Yet the future looks bright for VR stroke rehabilitation. These systems will likely become standard tools in complete rehabilitation programs as technology gets better and more affordable. While VR won’t replace human therapists, it’s a great addition that improves traditional methods through better engagement, accurate progress tracking, and personalized recovery paths.
VR offers stroke survivors a powerful tool alongside conventional rehabilitation methods. Growing evidence supports its effectiveness, and this technology will keep evolving as a vital part of modern stroke recovery programs.
References
[1] – https://www.jmir.org/2025/1/e72364
[2] – https://www.medrxiv.org/content/10.1101/2024.08.23.24312233v1.full-text
[3] – https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01418-6
[4] – https://bioelecmed.biomedcentral.com/articles/10.1186/s42234-024-00150-9
[5] – https://onlinelibrary.wiley.com/doi/10.1111/jocn.16986
[6] – https://www.ahajournals.org/doi/10.1161/strokeaha.110.605451
[7] – https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02534-y
[8] – https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-022-01071-x
[9] – https://www.cureus.com/articles/424075-innovating-stroke-recovery-a-systematic-review-of-virtual-reality-in-cognitive-rehabilitation
[10] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10836287/
[11] – https://www.frontiersin.org/journals/rehabilitation-sciences/articles/10.3389/fresc.2025.1660766/full
[12] – https://www.sciencedirect.com/science/article/pii/S0048712025000271
[13] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11943060/
[14] – https://pmc.ncbi.nlm.nih.gov/articles/PMC5694569/
[15] – https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01439-1
[16] – https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1544135/full
[17] – https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1603233/full
[18] – https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008349.pub5/full
[19] – https://www.nature.com/articles/s41598-025-08173-1
[20] – https://pmc.ncbi.nlm.nih.gov/articles/PMC11278423/
[21] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10164524/
[22] – https://journals.lww.com/ajpmr/fulltext/2023/04000/effects_of_virtual_reality_based_exercise_on.5.aspx
[23] – https://pmc.ncbi.nlm.nih.gov/articles/PMC12440349/
[24] – https://www.physio-pedia.com/Virtual_Reality_for_Individuals_Affected_by_Stroke?lang=en
[25] – https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-025-01641-9
[26] – https://www.apta.org/patient-care/interventions/virtual-reality
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