Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery.

PURPOSE It is estimated that 50% to 75% of individuals who experience a stroke have persistent impairment of the affected upper limb (UL). There is a need to identify the best training strategies for retraining motor function of the UL. One intervention showing promise is virtual reality (VR), using either immersive or nonimmersive technology. Before recommending VR for use in clinical practice, it is important to understand the evidence regarding its effectiveness. METHOD Two questions about the effectiveness of VR for UL rehabilitation in stroke were posed: (1) Is the use of immersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? (2) Is the use of nonimmersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? RESULTS There is level 1b evidence suggesting an advantage to training in immersive VR environments versus no therapy in UL rehabilitation, and level 5 evidence for training in immersive VR versus conventional therapy. There is level 4 evidence showing conflicting results for training in nonimmersive VR versus no therapy, and level 2b evidence for training in nonimmersive VR versus conventional therapy. CONCLUSION The current evidence on the effectiveness of using VR in the rehabilitation of the UL in patients with stroke is limited but sufficiently encouraging to justify additional clinical trials in this population.