{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:27:40Z","timestamp":1790702860851,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004271","name":"Sapienza University of Rome","doi-asserted-by":"publisher","award":["RM122181675BD4FF"],"award-info":[{"award-number":["RM122181675BD4FF"]}],"id":[{"id":"10.13039\/501100004271","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Art therapy was recently administered to stroke patients using immersive virtual reality technology, chosen to provide the illusion of being able to replicate an artistic masterpiece. This approach was effective in improving rehabilitative outcomes due to the so-called Michelangelo effect: patients\u2019 interaction with artistic stimuli reduced perceived fatigue and improved performance. The aim of the present study was to investigate which factors may influence those outcomes (e.g., type of artwork, esthetic valence, perceived fatigue, clinical conditions). Methods: An observational study was conducted on 25 patients with stroke who performed the protocol of virtual art therapy (VAT). In each trial, patients were asked to rate the esthetic valence of the artworks and their perceived fatigue, whereas therapists assessed patients\u2019 participation in the therapy (Pittsburgh Rehabilitation Participation Scale, PRPS). Moreover, before and after treatment, patients\u2019 independence in daily living activities (Barthel Index, BI), and their upper limb functioning (Manual Muscle Test, MMT) and spasticity (Ashworth Scale, AS) were measured. Results: The after-treatment BI scores depended on the before-treatment BI score (p &lt; 0.001) and on the PRPS score (p = 0.006), which, in turn, was increased by the subjective esthetic valence (p = 0.044). Perceived fatigue is a complex factor that may have influenced the outcomes (p = 0.049). Conclusions: There was a general effect of art in reducing fatigue and improving participation of patients during therapy. The variability observed among patients mainly depended on their clinical conditions, but also on the esthetic valence given to each artwork, that could also be intertwined with the difficulty of the task. Art therapy has a high potential to improve rehabilitation outcomes, especially if combined with new technologies, but psychometric investigation of the effects of each factor is needed to design the most effective protocols.<\/jats:p>","DOI":"10.3390\/brainsci15070736","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T13:44:19Z","timestamp":1752241459000},"page":"736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors Influencing Virtual Art Therapy in Patients with Stroke"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2434-3887","authenticated-orcid":false,"given":"Marco","family":"Iosa","sequence":"first","affiliation":[{"name":"Department of Psychology, Sapienza University of Rome, 00185 Roma, Italy"},{"name":"IRCCS Santa Lucia Foundation, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"De Giorgi","sequence":"additional","affiliation":[{"name":"Casa di Cura Nomentana Hospital, 00013 Fonte Nuova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Gentili","sequence":"additional","affiliation":[{"name":"Casa di Cura Nomentana Hospital, 00013 Fonte Nuova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ciotti","sequence":"additional","affiliation":[{"name":"Casa di Cura Nomentana Hospital, 00013 Fonte Nuova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano","family":"Rubeca","sequence":"additional","affiliation":[{"name":"Casa di Cura Nomentana Hospital, 00013 Fonte Nuova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Casolani","sequence":"additional","affiliation":[{"name":"Casa di Cura Nomentana Hospital, 00013 Fonte Nuova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5082-7130","authenticated-orcid":false,"given":"Claudia","family":"Salera","sequence":"additional","affiliation":[{"name":"IRCCS Santa Lucia Foundation, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Tieri","sequence":"additional","affiliation":[{"name":"IRCCS Santa Lucia Foundation, 00179 Rome, Italy"},{"name":"Virtual Reality & Digital Neuroscience Lab, Department of Law and Digital Society, Unitelma Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","unstructured":"Fancourt, D., and Finn, S. 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