{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:24:47Z","timestamp":1789611887865,"version":"build-2803163510"},"reference-count":15,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministero delle Impese e del Made in Italy","award":["F\/360107\/01-03\/X75"],"award-info":[{"award-number":["F\/360107\/01-03\/X75"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Telerehabilitation\u2014the remote delivery of rehabilitation services\u2014is undergoing a paradigm shift with the convergence of immersive virtual reality (VR) and wearable biosensor technologies. This perspective article outlines a vision for home-based motor and cognitive rehabilitation that is engaging, personalized, and data-driven. We describe how immersive VR environments (for example, simulations of home settings or supermarkets) coupled with wearable sensors can address current challenges in rehabilitation by increasing patient motivation, enabling real-time biofeedback, and supporting remote clinician supervision. Gamification mechanisms and rich sensory feedback in VR are highlighted as key strategies to enhance user engagement and adherence to therapy. We discuss conceptual innovations such as multi-sensor data integration, dynamic difficulty adaptation, and AI-driven personalization of exercises, derived from recent research and our development experience, and consider their potential benefits for patients with neuro-cognitive-motor impairments (e.g., stroke, Parkinson\u2019s disease, and multiple sclerosis). Implementation scenarios for home-based therapy are presented, emphasizing scalability, standardized digital metrics for monitoring progress, and seamless involvement of clinicians via telehealth platforms. We also critically examine the current limitations of VR and telehealth rehabilitation and how an integrative model could overcome these barriers. More specifically, this perspective defines the engineering requirements of a closed-loop VR-based telerehabilitation framework, including multimodal data synchronization, calibration, signal-quality management, interpretable adaptive control, digital biomarker validation, and practical strategies to improve accessibility, privacy, and scalability in home-based neurological rehabilitation.<\/jats:p>","DOI":"10.3390\/bioengineering13040439","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T07:48:07Z","timestamp":1775720887000},"page":"439","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Towards a Closed-Loop Bioengineering Framework for Immersive VR-Based Telerehabilitation Integrating Wearable Biosensing and Adaptive Feedback"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5518-7805","authenticated-orcid":false,"given":"Gaia","family":"Roccaforte","sequence":"first","affiliation":[{"name":"Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"},{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Sinardi","sequence":"additional","affiliation":[{"name":"Foresight Consulting, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Ruello","sequence":"additional","affiliation":[{"name":"Foresight Consulting, 98122 Messina, Italy"},{"name":"Euro-Mediterranean Institute of Science and Technology, 90139 Palermo, Italy"},{"name":"Department of Economics, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Lipari","sequence":"additional","affiliation":[{"name":"Foresight Consulting, 98122 Messina, Italy"},{"name":"Research Unit of Artificial Intelligence and Computer Systems, Department of Engineering, Universit\u00e0 Campus Bio-Medico di Roma, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2036-2298","authenticated-orcid":false,"given":"Flavio","family":"Corpina","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy"},{"name":"Foresight Consulting, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Epifanio","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Servizi Riabilitativi, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Isgr\u00f2","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Servizi Riabilitativi, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Davide","family":"Russo","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Servizi Riabilitativi, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfio","family":"Puglisi","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8089-7449","authenticated-orcid":false,"given":"Giovanni","family":"Pioggia","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Marino","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Shariat, A., Najafabadi, M.G., Nakhostin Ansari, N., Anastasio, A.T., Bagheri, K., Hassanzadeh, G., and Farghadan, M. (2023). Outcome Measures Utilized to Assess the Efficacy of Telerehabilitation for Post-Stroke Rehabilitation: A Scoping Review. Brain Sci., 13.","DOI":"10.20944\/preprints202311.0571.v1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e68358","DOI":"10.2196\/68358","article-title":"An Integrated Virtual Reality\u2013Based Telerehabilitation Platform to Support Recovery and Maintenance of Functional Abilities Among Older Adults: Protocol for a Usability and Acceptability Study","volume":"14","author":"Benadduci","year":"2025","journal-title":"JMIR Res. Protoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s10055-024-00970-9","article-title":"A Systematic Review of Wearable Biosensor Usage in Immersive Virtual Reality Experiences","volume":"28","author":"Checa","year":"2024","journal-title":"Virtual Real."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Nartea, R., Poenaru, D., Constantinovici, M.I., Potcovaru, C.G., and Cinteza, D. (2025). Exploring the Effectiveness of Immersive Virtual Reality Rehabilitation for Parkinson\u2019s Disease: A Narrative Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14196858"},{"key":"ref_5","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_6","doi-asserted-by":"crossref","first-page":"101011","DOI":"10.1016\/j.entcom.2025.101011","article-title":"Integrating Artificial Intelligence and Gamification in Rehabilitation: A Scoping Review","volume":"45","author":"Wang","year":"2025","journal-title":"Entertain. Comput."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e7511","DOI":"10.2196\/rehab.7511","article-title":"Telerehabilitation: Review of the State-of-the-Art and Areas of Application","volume":"4","author":"Peretti","year":"2017","journal-title":"JMIR Rehabil. Assist. Technol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e69660","DOI":"10.2196\/69660","article-title":"Ethics and Equity Challenges in Telerehabilitation for Older Adults: Rapid Review","volume":"8","author":"Veras","year":"2025","journal-title":"JMIR Aging"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ca\u00f1a-Pino, A., and Holgado-L\u00f3pez, P. (2025). Wearable-Sensor and Virtual Reality-Based Interventions for Gait and Balance Rehabilitation in Stroke Survivors: A Systematic Review. Signals, 6.","DOI":"10.3390\/signals6030048"},{"key":"ref_10","unstructured":"(2026, January 12). Gamification in VR Therapy with CUREO. Available online: https:\/\/www.cureosity.com\/blogposts\/gamification."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Garofano, M., Del Sorbo, R., Calabrese, M., Giordano, M., Di Palo, M.P., Bartolomeo, M., Ragusa, C.M., Ungaro, G., Fimiani, G., and Di Spirito, F. (2025). Remote Rehabilitation and Virtual Reality Interventions Using Motion Sensors for Chronic Low Back Pain: A Systematic Review of Biomechanical, Pain, Quality of Life, and Adherence Outcomes. Technologies, 13.","DOI":"10.3390\/technologies13050186"},{"key":"ref_12","unstructured":"(2026, January 12). Remote Therapeutic Monitoring Neurological Recovery. Available online: https:\/\/www.tenovi.com\/remote-therapeutic-monitoring-neurological-recovery\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jphys.2024.06.001","article-title":"Real-Time Video Telerehabilitation Shows Comparable Satisfaction and Similar or Better Attendance and Adherence Compared with In-Person Physiotherapy: A Systematic Review","volume":"70","author":"Simmich","year":"2024","journal-title":"J. Physiother."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Herrera-Rojas, A., Moreno-Molina, A., Garc\u00eda-Garc\u00eda, E., Molina-Rodr\u00edguez, N., and Cano-de-la-Cuerda, R. (2025). Effects of Telerehabilitation Platforms on Quality of Life in People with Multiple Sclerosis: A Systematic Review of Randomized Clinical Trials. NeuroSci, 6.","DOI":"10.3390\/neurosci6040103"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Veras, M., Labb\u00e9, D.R., Furlano, J., Zakus, D., Rutherford, D., Pendergast, B., and Kairy, D. (2023). A Framework for Equitable Virtual Rehabilitation in the Metaverse Era: Challenges and Opportunities. Front. Rehabil. Sci., 4.","DOI":"10.3389\/fresc.2023.1241020"}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/439\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:53:08Z","timestamp":1775724788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["bioengineering13040439"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13040439","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}