Immersive Virtual Reality-Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study.

BACKGROUND AND PURPOSE: Immersive virtual reality (IVR)-based rehabilitation provides high-intensity, engaging, task-oriented training and motor exploration for upper limb (UL) recovery post-stroke. However, its feasibility and dose-response in acute and subacute stroke patients remain unclear. The purpose of this study was to evaluate the feasibility, safety and dose-response of IVR-based rehabilitation for post-stroke UL recovery.

METHODS

A pilot trial included 12 acute and subacute stroke patients (mean age 59.8 ± 14.2 years) with upper limb impairment randomized into two groups: Group A (10 IVR sessions + conventional rehabilitation [CR]) and Group B (20 IVR sessions + CR). Feasibility outcomes included adherence, usability (User Satisfaction Evaluation Questionnaire [USEQ], System Usability Scale [SUS]), system operability, and adverse effects. Motor outcomes, categorized by the International Classification of Functioning, Disability, and Health (ICF), assessed UL impairment (Fugl-Meyer Assessment, Medical Research Council scale), activity (Box and Block Test), and participation (Motor Activity Log 30). Blinded therapists conducted assessments at baseline, post-intervention, and 4-week follow-up. Dose-response was analyzed using Probability of Superiority (PS).

RESULTS

Feasibility was high, reporting 98% adherence, favorable usability scores (USEQ: 81.6 ± 15; SUS: 77.5 ± 7.4), efficient setup time (5.14 ± 1.57 min), system stability (77.86 ± 6.78%) and no severe adverse effects. Clinically meaningful motor improvements were observed across all ICF domains in both groups. Although the sample size was insufficient for inferential testing, descriptive trends and PS values above 75% suggested a potential dose-response trend favoring higher IVR exposure.

DISCUSSION: IVR-based rehabilitation showed high feasibility, safety, and improvements in motor recovery, with a dose-response trend favoring higher doses. These findings align with evidence that IVR enhances neuroplasticity-driven recovery through high-intensity, engaging, exploratory, and task-oriented upper limb training. Despite the small sample and brief follow-up, this study provides key data to guide larger trials on efficacy and optimal dosing.

TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT07086365, NCT07086365.