A systematic review of techniques and clinical evidence to adopt virtual reality in post-stroke upper limb rehabilitation

Abstract Recognizing the limitations of traditional therapy can be tedious and demotivating, we explore VR’s dynamic and immersive environment to potentially improve patient engagement and motivation. This approach promises accelerated recovery by integrating real-time feedback and progress monitoring. This study aims to compare various VR training techniques employed for upper limb rehabilitation in stroke survivors. We have followed the PRISMA guidelines for systematic reviews. Articles were filtered with title words such as “virtual reality rehabilitation”, “rehabilitation”, “upper limb”, “lower limb”, “interactive gaming system”, and “VR based games” were searched in databases (LILACS, PUBMED, IEEE, WoS, and Scopus). Articles published between 2005 and 2021 were analyzed. There were 820 articles found, but only the most relevant 96 papers were analyzed. Most of the studies were randomised controlled trials (RCTs) that were submitted in 2014 or beyond. The sample size ranged from 5 to 96 persons with chronic stroke, or adults and seniors. There were no samples analyzed for those under the age of 18. Nintendo Wii® and Microsoft’s Kinect were the most popular video gaming systems. In most of the publications, the intervention took place 2–3 sessions per week, for about 2–12 weeks, with each session lasting 30 to 60 min. The most assessed outcomes were body steadiness, upper extremity motor capabilities, daily tasks, and quality of life. The Fugl–Meyer Assessment was one the commonly used tool for measuring outcomes. After VR therapy, the research found that quality of life, dynamic steadiness, and upper extremity movement function improved. To achieve dynamic equilibrium, VR proved more beneficial than traditional treatments. The most important outcomes, the researchers focused, were day-to-day activity and physical movements of the patients. Some studies investigated the early consequences of VR on daily activities and social involvement.