{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T22:57:16Z","timestamp":1789426636138,"version":"build-2803163510"},"reference-count":69,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005802","name":"Ministerul Cercet\u0103rii \u0219i Inov\u0103rii","doi-asserted-by":"publisher","award":["PN-IV-P7-7.1-PTE-2024-0764"],"award-info":[{"award-number":["PN-IV-P7-7.1-PTE-2024-0764"]}],"id":[{"id":"10.13039\/501100005802","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Immersive virtual reality (VR) has emerged as a promising tool to enhance neuroplasticity, motivation, and engagement during post-stroke motor rehabilitation. However, evidence on its feasibility and data-driven integration into clinical practice remains limited. Objective: This pilot study aimed to evaluate the feasibility, usability, and short-term motor outcomes of an immersive VR-assisted rehabilitation program using the Travee-VR system. Methods: Fourteen adults with post-stroke upper-limb paresis completed a 10-day hybrid rehabilitation program combining conventional therapy with immersive VR sessions. Feasibility and tolerability were assessed through adherence, adverse events, the System Usability Scale (SUS), and the Simulator Sickness Questionnaire (SSQ). Motor outcomes included active and passive range of motion (AROM, PROM) and a derived GAP index (PROM\u2013AROM). Correlations between clinical changes and in-game performance metrics were explored to identify potential digital performance metrics of recovery. Results: All participants completed the program without adverse events. Usability was rated as high (mean SUS = 79 \u00b1 11.3), and cybersickness remained mild (SSQ &lt; 40). Significant improvements were observed in shoulder abduction (+7.3\u00b0, p &lt; 0.01) and elbow flexion (+5.8\u00b0, p &lt; 0.05), with moderate-to-large effect sizes. Performance gains in the Fire and Fruits games correlated with clinical improvement in shoulder AROM (\u03c1 = 0.45, p = 0.041). Cluster analysis identified distinct responder profiles, reflecting individual variability in neuroplastic adaptation. Conclusions: The Travee-VR system proved feasible, well tolerated, and associated with measurable short-term improvements in upper-limb function. By linking clinical outcomes with real-time kinematic data, this study supports the role of immersive, feedback-driven VR as a catalyst for data-informed neuroplastic recovery. These results lay the groundwork for adaptive, clinic-to-home rehabilitation models integrating clinical and exploratory digital performance metrics.<\/jats:p>","DOI":"10.3390\/bioengineering13010059","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:35:47Z","timestamp":1767620147000},"page":"59","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Immersive Virtual Reality for Stroke Rehabilitation: Linking Clinical and Digital Measures of Motor Recovery\u2014A Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9170-5016","authenticated-orcid":false,"given":"Livia-Alexandra","family":"Ion","sequence":"first","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"},{"name":"Doctoral School, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miruna Ioana","family":"S\u0103ndulescu","sequence":"additional","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"},{"name":"Physical Medicine and Rehabilitation, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5801-5416","authenticated-orcid":false,"given":"Claudia-Gabriela","family":"Potcovaru","sequence":"additional","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"},{"name":"Physical Medicine and Rehabilitation, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4135-5695","authenticated-orcid":false,"given":"Daniela","family":"Poenaru","sequence":"additional","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"},{"name":"Physical Medicine and Rehabilitation, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7946-7734","authenticated-orcid":false,"given":"Andrei Doru","family":"Comi\u0219el","sequence":"additional","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9719-1788","authenticated-orcid":false,"given":"\u0218tefan","family":"\u0218tefureac","sequence":"additional","affiliation":[{"name":"National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3168-9969","authenticated-orcid":false,"given":"Andrei Cristian","family":"Lambru","sequence":"additional","affiliation":[{"name":"Computers Department, Faculty of Automatic Control and Computers, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1368-7249","authenticated-orcid":false,"given":"Alin","family":"Moldoveanu","sequence":"additional","affiliation":[{"name":"Computers Department, Faculty of Automatic 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Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s11883-022-01067-x","article-title":"A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Prem-ature Stroke","volume":"24","author":"Potter","year":"2022","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart Disease and Stroke Statistics\u20142023 Update: A Report From the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Colamarino, E., Morone, G., Toppi, J., Riccio, A., Cincotti, F., Mattia, D., and Pichiorri, F. (2024). A Scoping Review of Technology-Based Approaches for Upper Limb Motor Rehabilitation after Stroke: Are We Really Targeting Severe Impairment?. J. Clin. Med., 13.","DOI":"10.20944\/preprints202408.1124.v1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1038\/nrneurol.2017.34","article-title":"Restoring brain function after stroke\u2014Bridging the gap between animals and humans","volume":"13","author":"Ward","year":"2017","journal-title":"Nat. Rev. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/S1474-4422(17)30283-1","article-title":"Prediction of motor recovery after stroke: Advances in biomarkers","volume":"16","author":"Stinear","year":"2017","journal-title":"Lancet Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10072-023-07012-3","article-title":"New approaches to recovery after stroke","volume":"45","year":"2024","journal-title":"Neurol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1161\/01.STR.0000238594.91938.1e","article-title":"Impact of Time on Improvement of Outcome After Stroke","volume":"37","author":"Kwakkel","year":"2006","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(11)60325-5","article-title":"Stroke rehabilitation","volume":"377","author":"Langhorne","year":"2011","journal-title":"Lancet"},{"key":"ref_10","first-page":"CD008349","article-title":"Virtual reality for stroke rehabilitation","volume":"2","author":"Laver","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1146\/annurev-neuro-061010-113731","article-title":"Spatial Neglect and Attention Networks","volume":"34","author":"Corbetta","year":"2011","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1212\/CON.0000000000001076","article-title":"Spatial Neglect and Anosognosia After Right Brain Stroke","volume":"27","author":"Barrett","year":"2021","journal-title":"Contin. Lifelong Learn. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1016\/j.cortex.2012.11.006","article-title":"Time course of visuospatial neglect early after stroke: A longitudinal cohort study","volume":"49","author":"Nijboer","year":"2013","journal-title":"Cortex"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jcomdis.2013.04.001","article-title":"The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke","volume":"46","author":"Flowers","year":"2013","journal-title":"J. Commun. Disord."},{"key":"ref_15","first-page":"128641","article-title":"Rehabilitation with poststroke motor recovery: A review with a focus on neural plasticity","volume":"2013","author":"Takeuchi","year":"2013","journal-title":"Stroke Res. Treat."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12984-024-01367-0","article-title":"Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: A scoping review","volume":"21","author":"Ceradini","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e24111","DOI":"10.2196\/24111","article-title":"Effectiveness of Using Virtual Reality\u2013Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"24","author":"Chen","year":"2022","journal-title":"J. Med Internet Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kenea, C.D., Abessa, T.G., Lamba, D., and Bonnech\u00e8re, B. (2025). Immersive Virtual Reality in Stroke Rehabilitation: A Systematic Review and Meta-Analysis of Its Efficacy in Upper Limb Recovery. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061783"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2285907","DOI":"10.1080\/07853890.2023.2285907","article-title":"Exploring the efficacy of virtual reality-based rehabilitation in stroke: A narrative review of current evidence","volume":"55","author":"Aderinto","year":"2023","journal-title":"Ann. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s42234-024-00150-9","article-title":"Virtual reality in stroke recovery: A meta-review of systematic reviews","volume":"10","author":"Khan","year":"2024","journal-title":"Bioelectron. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cardile, D., Arena, C., Corallo, F., Giuffrida, G.M., Giustiniani, A., Maggio, M.G., Rifici, C., Quartarone, A., Tomaiuolo, F., and Calabr\u00f2, R.S. (2025). A systematic review on the use of virtual reality in post-stroke patients: Exploring when modalities make the difference in executive and motor recovery. Front. Virtual Real., 6.","DOI":"10.3389\/frvir.2025.1653968"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"225","DOI":"10.31083\/j.jin2312225","article-title":"Effect of Virtual Reality-Based Training on Upper Limb Dysfunction during Post-Stroke Rehabilitation: A Meta-Analysis Combined with Meta-Regression","volume":"23","author":"Zhang","year":"2024","journal-title":"J. Integr. Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ferche, O., Moldoveanu, A., Cinteza, D., Toader, C., Moldoveanu, F., Voinea, A., and Taslitchi, C. (2015, January 19\u201321). From neuromotor command to feedback: A survey of techniques for rehabilitation through altered perception. Proceedings of the 2015 E-Health and Bioengineering Conference (EHB), Iasi, Romania.","DOI":"10.1109\/EHB.2015.7391454"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"8151","DOI":"10.1109\/ACCESS.2018.2886271","article-title":"The TRAVEE System for a Mul-timodal Neuromotor Rehabilitation","volume":"7","author":"Moldoveanu","year":"2019","journal-title":"IEEE Access"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"145","DOI":"10.5334\/pb.1033","article-title":"The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary","volume":"61","author":"Huygelier","year":"2021","journal-title":"Psychol. Belg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Potcovaru, C.-G., Cintez\u0103, D., S\u0103ndulescu, M.I., Poenaru, D., Chiriac, O., Lambru, C., Moldoveanu, A., Anghel, A.M., and Berteanu, M. (2024). The Impact of Virtual Reality as a Rehabilitation Method Using TRAVEE System on Functional Outcomes and Disability in Stroke Patients: A Pilot Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12112450"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Demeco, A., Zola, L., Frizziero, A., Martini, C., Palumbo, A., Foresti, R., Buccino, G., and Costantino, C. (2023). Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review. Sensors, 23.","DOI":"10.3390\/s23031712"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Pojala, C.V., and Roman, N. (2023). Realitatea virtual\u0103 \u00een reabilitarea membrului superior la pacien\u021bii cu sechele post AVC-revizuire de lit-eratura|[Upper extremity virtual reality rehabilitation in post-stroke patients-a literature review]. J. Med. Bras., 12\u201317.","DOI":"10.31926\/jmb.2022.2.4"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Caraiman, S., Stan, A., Botezatu, N., Herghelegiu, P., Lupu, R.G., and Moldoveanu, A. (2015, January 27\u201329). Architectural Design of a Real-Time Augmented Feedback System for Neuromotor Rehabilitation. Proceedings of the 2015 20th International Conference on Control Systems and Computer Science (CSCS), Bucharest, Romania.","DOI":"10.1109\/CSCS.2015.106"},{"key":"ref_30","unstructured":"Norkin, C.C., and WDJ (2016). Measurement of Joint Motion: A Guide to Goniometry, F.A. Davis Company. [5th ed.]."},{"key":"ref_31","first-page":"137","article-title":"The Effectiveness of Range of Motion (ROM) on Increasing Muscle Strength in Stroke Patients: Literature Review","volume":"2","author":"Faridah","year":"2022","journal-title":"Nurs. Heal. Sci. J."},{"key":"ref_32","unstructured":"(2025). Modified Ashworth Scale. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/psyg.13069","article-title":"Examining the validity of the Mini-Mental State Examination ( MMSE ) and its domains using network analysis","volume":"24","author":"Truong","year":"2024","journal-title":"Psychogeriatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/1541931213571043","article-title":"Validation of the System Usability Scale (SUS)","volume":"57","author":"Peres","year":"2013","journal-title":"Proc. Hum. Factors Ergon. Soc. Annu. Meet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"57","DOI":"10.7874\/jao.2024.00444","article-title":"Novel Approach to the Simulator Sickness Questionnaire","volume":"29","author":"Kurter","year":"2025","journal-title":"J. Audiol. Otol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Garro, F., Chiappalone, M., Buccelli, S., De Michieli, L., and Semprini, M. (2021). Neuromechanical Biomarkers for Robotic Neurorehabilitation. Front. Neurorobotics, 15, Available online: https:\/\/www.frontiersin.org\/journals\/neurorobotics\/articles\/10.3389\/fnbot.2021.742163.","DOI":"10.3389\/fnbot.2021.742163"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1177\/0271678X18800589","article-title":"The importance of comorbidities in ischemic stroke: Impact of hypertension on the cerebral circulation","volume":"38","author":"Cipolla","year":"2018","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Wang, C., Liu, D., Zhou, Z., Gu, S., and Zuo, H. (2021). Association of total pre-existing comorbidities with stroke risk: A large-scale community-based cohort study from China. BMC Public Heal., 21.","DOI":"10.1186\/s12889-021-12002-1"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e70082","DOI":"10.1002\/hsr2.70082","article-title":"Effects of virtual reality on stroke rehabilitation: An umbrella review of systematic reviews","volume":"7","author":"Hao","year":"2024","journal-title":"Heal. Sci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e73142","DOI":"10.2196\/73142","article-title":"Combined Immersive and Nonimmersive Virtual Reality With Mirror Therapy for Patients With Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"27","author":"Gao","year":"2025","journal-title":"J. Med Internet Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Landim, S.F., L\u00f3pez, R., Caris, A., Castro, C., Castillo, R.D., Avello, D., Branco, B.H.M., Vald\u00e9s-Badilla, P., Carmine, F., and Sandoval, C. (2024). Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164615"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"193","DOI":"10.12681\/healthresj.34734","article-title":"Suitability, usability and safety of fully immersive Virtual Reality applications for motor and cognitive rehabilitation in stroke patients preliminary data","volume":"10","author":"Roussou","year":"2024","journal-title":"Heal. Res. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102220","DOI":"10.1016\/j.eclinm.2023.102220","article-title":"Effectiveness and safety of virtual reality rehabilitation after stroke: An overview of systematic reviews","volume":"64","author":"Bargeri","year":"2023","journal-title":"eClinicalMedicine"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Diriba Kenea, C., Gemechu Abessa, T., Lamba, D., and Bonnech\u00e8re, B. (2024). Technological Features of Immersive Virtual Reality Systems for Upper Limb Stroke Rehabilitation: A Systematic Review. Sensors, 24.","DOI":"10.3390\/s24113546"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Mares, K., Mas, M.d.R.H., Watt, A., Gregoriou, E., and Clark, A. (2025). Technical feasibility of the implementation of an intensive upper-limb rehabilitation system (NeuroVirt) intervention for stroke survivors. BMC Digit. Heal., 3.","DOI":"10.1186\/s44247-025-00169-1"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"5781","DOI":"10.1038\/s41598-025-90698-6","article-title":"Design and usability evaluation of an immersive virtual reality mirrored hand system for upper limb stroke rehabilitation","volume":"15","author":"Hsieh","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12984-025-01603-1","article-title":"Effect of virtual reality-based upper limb training on activity of daily living and quality of life among stroke survivors: A systematic review and meta-analysis","volume":"22","author":"Olana","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1177\/02692155251371435","article-title":"Validity, safety, usability, and user experience of virtual reality gamified home-based exercises in stroke","volume":"39","author":"Lazem","year":"2025","journal-title":"Clin. Rehabil."},{"key":"ref_49","first-page":"30","article-title":"Virtual Reality in Cognitive Rehabilitation: A Pilot Study on Usability and Preliminary Clinical Outcomes in Seniors with Mild Cognitive Impairment","volume":"2","author":"Ciudad","year":"2025","journal-title":"J. Med. Ext. Real."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Kiper, P., Godart, N., Cavalier, M., Berard, C., Cie\u015blik, B., Federico, S., Kiper, A., Pellicciari, L., and Meroni, R. (2023). Effects of Immersive Virtual Reality on Upper-Extremity Stroke Rehabilitation: A Systematic Review with Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010146"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Soleimani, M., Ghazisaeedi, M., and Heydari, S. (2024). The efficacy of virtual reality for upper limb rehabilitation in stroke patients: A systematic review and meta-analysis. BMC Med Inform. Decis. Mak., 24.","DOI":"10.1186\/s12911-024-02534-y"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e43505","DOI":"10.1097\/MD.0000000000043505","article-title":"Virtual reality combined with task-oriented circuit training for upper limb rehabilitation in subacute stroke patients: A randomized controlled trial","volume":"104","author":"Li","year":"2025","journal-title":"Medicine"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"7399995","DOI":"10.1155\/2022\/7399995","article-title":"The Effect of Virtual Reality on Motor Anticipation and Hand Function in Patients with Subacute Stroke: A Randomized Trial on Movement-Related Potential","volume":"2022","author":"Chen","year":"2022","journal-title":"Neural Plast."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1080\/09638288.2023.2228690","article-title":"Clinical potential and neuroplastic effect of targeted virtual reality based intervention for distal upper limb in post-stroke rehabilitation: A pilot observational study","volume":"46","author":"Nath","year":"2024","journal-title":"Disabil. Rehabil."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.neuroscience.2024.04.011","article-title":"Virtual Reality Action Observation and Motor Imagery to Enhance Neuroplastic Capacity in the Human Motor Cortex: A Pilot Double-blind, Randomized Cross-over Trial","volume":"549","author":"Connelly","year":"2024","journal-title":"Neuroscience"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Alsubiheen, A.M., Choi, W., Yu, W., and Lee, H. (2022). The Effect of Task-Oriented Activities Training on Upper-Limb Function, Daily Activities, and Quality of Life in Chronic Stroke Patients: A Randomized Controlled Trial. Int. J. Environ. Res. Public Heal., 19.","DOI":"10.3390\/ijerph192114125"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.3109\/09638288.2013.854840","article-title":"Comparison of three instruments to assess changes of motor impairment in acute hemi-spheric stroke: The Stroke Impairment Assessment Set (SIAS), the National Institute of Health Stroke Scale (NIHSS) and the Canadian Neurological Scale (CNS)","volume":"36","author":"Seki","year":"2014","journal-title":"Disabil Rehabil."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1177\/15459683241237975","article-title":"Point of View on Outcome Prediction Models in Post-Stroke Motor Recovery","volume":"38","author":"Ghosh","year":"2024","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Georgiev, D.D., Georgieva, I., Gong, Z., Nanjappan, V., and Georgiev, G.V. (2021). Virtual Reality for Neurorehabilitation and Cognitive Enhancement. Brain Sci., 11.","DOI":"10.3390\/brainsci11020221"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Feitosa, J.A., Casseb, R.F., Camargo, A., Brandao, A.F., Li, L.M., and Castellano, G. (2023). Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: A pilot randomized study. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1241639"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12938-023-01124-9","article-title":"Virtual reality and motor imagery for early post-stroke rehabilitation","volume":"22","author":"Choy","year":"2023","journal-title":"Biomed. Eng. Online"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.neuron.2011.10.008","article-title":"Neuroplasticity Subserving Motor Skill Learning","volume":"72","author":"Dayan","year":"2011","journal-title":"Neuron"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Huang, C.-Y., Chiang, W.-C., Yeh, Y.-C., Fan, S.-C., Yang, W.-H., Kuo, H.-C., and Li, P.-C. (2022). Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: A randomized controlled trial. BMC Neurol., 22.","DOI":"10.1186\/s12883-021-02547-4"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Quan, W., Liu, S., Cao, M., and Zhao, J. (2024). A Comprehensive Review of Virtual Reality Technology for Cognitive Rehabilitation in Patients with Neurological Conditions. Appl. Sci., 14.","DOI":"10.3390\/app14146285"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1089\/g4h.2021.0197","article-title":"The Effect of Robot-Mediated Virtual Reality Gaming on Upper Limb Spasticity Poststroke: A Randomized-Controlled Trial","volume":"11","author":"Alshehri","year":"2022","journal-title":"Games Heal. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"17675","DOI":"10.1038\/s41598-024-64514-6","article-title":"Personalized rehabilitation approach for reaching movement using reinforcement learning","volume":"14","author":"Pelosi","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Maier, M., Ballester, B.R., and Verschure, P.F.M.J. (2019). Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front. Syst. Neurosci., 13, Available online: https:\/\/www.frontiersin.org\/journals\/systems-neuroscience\/articles\/10.3389\/fnsys.2019.00074.","DOI":"10.3389\/fnsys.2019.00074"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Zhao, J., Guo, J., Chen, Y., Li, W., Zhou, P., Zhu, G., Han, P., and Xu, D. (2024). Improving rehabilitation motivation and motor learning ability of stroke patients using different reward strategies: Study protocol for a single-center, randomized controlled trial. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1418247"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s12984-024-01413-x","article-title":"Influence of virtual reality and task complexity on digital health metrics assessing upper limb function","volume":"21","author":"Kanzler","year":"2024","journal-title":"J. Neuroeng. 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