{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:31:58Z","timestamp":1786527118604,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurol. Int.","Neurology International"],"abstract":"<jats:p>In recent years, the application of virtual reality (VR) in rehabilitation medicine has gained increasing attention. VR is generally classified into two types: non-immersive and immersive systems. Non-immersive VR allows patients to interact with virtual environments through screens while maintaining a connection with the real world. Several studies have reported that the combined application of non-immersive VR and adjunctive technologies such as transcranial direct current stimulation and hand exoskeleton devices could facilitate functional recovery of hemiparetic limbs after stroke. In contrast, immersive VR is applied with the use of head-mounted displays to encompass the user\u2019s visual field, providing a high level of immersion and an enhanced sense of presence. This enhanced experience has been shown to promote patients\u2019 attention and motivation, which are important factors in motor learning. Emerging evidence suggests that immersive VR is effective for improving upper limb motor function in post-stroke hemiparetic patients. Furthermore, rehabilitative training performed in immersive virtual environments may facilitate the transfer of acquired motor skills to real activities of daily living. Future research should aim to generate high-quality evidence through large-scale, multicenter randomized controlled trials to better establish the clinical efficacy and optimal implementation of VR-based interventions in stroke rehabilitation.<\/jats:p>","DOI":"10.3390\/neurolint18080149","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T07:57:26Z","timestamp":1786521446000},"page":"149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Virtual Reality Training for Post-Stroke Upper Limb Hemiparesis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7019-2922","authenticated-orcid":false,"given":"Kanta","family":"Kitabayashi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, International University of Health and\u00a0Welfare Ichikawa Medical Center, Chiba 272-0827, Japan"},{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, International University of Health and Welfare, Chiba 286-8686, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2615-3374","authenticated-orcid":false,"given":"Naoki","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Radiology, International University of Health and Welfare Narita Hospital, Chiba 286-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","first-page":"707","article-title":"Understanding upper limb recovery after stroke","volume":"31","author":"Buma","year":"2013","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S1474-4422(09)70150-4","article-title":"Motor recovery after stroke: A systematic review","volume":"8","author":"Langhorne","year":"2009","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1080\/10749357.2020.1738662","article-title":"Does upper limb strength play a prominent role in health-related quality of life in stroke patients discharged from inpatient rehabilitation?","volume":"27","author":"Lieshout","year":"2020","journal-title":"Top. Stroke Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.wneu.2022.08.042","article-title":"History of virtual reality and augmented reality in neurosurgical training","volume":"167","author":"Paro","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10278-018-0122-7","article-title":"Applying Modern Virtual and Augmented Reality Technologies to Medical Images and Models","volume":"32","author":"Sutherland","year":"2019","journal-title":"J. Digit. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1007\/s11701-026-03230-x","article-title":"Extended reality and emerging artificial intelligence in orthopedic surgical training: A scoping review of educational outcomes","volume":"20","author":"Molina","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_7","first-page":"e202537","article-title":"Shaping the future of cardiac interventions and cardiac surgeries: The impact of virtual reality and artificial intelligence","volume":"2025","author":"AbdelMassih","year":"2025","journal-title":"Glob. Cardiol. Sci. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"240","DOI":"10.9758\/cpn.25.1382","article-title":"Digital Psychiatry with Virtual Reality and Augmented Reality: Recent Advances and Limitations","volume":"24","author":"Chang","year":"2026","journal-title":"Clin. Psychopharmacol. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"106311","DOI":"10.1016\/j.ijmedinf.2026.106311","article-title":"Navigating illness in a virtual world: The role of immersive technology across chronic care continuum\u2014A scoping review","volume":"211","author":"Dantu","year":"2026","journal-title":"Int. J. Med. Inform."},{"key":"ref_10","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_11","doi-asserted-by":"crossref","first-page":"102146","DOI":"10.1016\/j.arr.2023.102146","article-title":"Virtual reality and cognitive rehabilitation for older adults with mild cognitive impairment: A systematic review","volume":"93","author":"Tortora","year":"2024","journal-title":"Ageing Res. Rev."},{"key":"ref_12","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_13","doi-asserted-by":"crossref","first-page":"105248","DOI":"10.1016\/j.neubiorev.2023.105248","article-title":"Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques","volume":"152","author":"Salatino","year":"2023","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1177\/1545968314553031","article-title":"Training intensity affects motor rehabilitation efficacy following unilateral ischemic insult of the sensorimotor cortex in C57BL\/6 mice","volume":"29","author":"Bell","year":"2015","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.ijpsycho.2014.11.003","article-title":"Modulation of cortical activity in 2D versus 3D virtual reality environments: An EEG study","volume":"95","author":"Slobounov","year":"2014","journal-title":"Int. J. Psychophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vecchiato, G., Tieri, G., Jelic, A., De Matteis, F., Maglione, A.G., and Babiloni, F. (2015). Electroencephalographic correlates of sensorimotor integration and embodiment during the appreciation of virtual architectural environments. Front. Psychol., 6.","DOI":"10.3389\/fpsyg.2015.01944"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Saredakis, D., Szpak, A., Birckhead, B., Keage, H.A.D., Rizzo, A., and Loetscher, T. (2020). Factors associated with virtual reality sickness in head-mounted displays: A systematic review and meta-analysis. Front. Hum. Neurosci., 14.","DOI":"10.3389\/fnhum.2020.00096"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Du\u017cma\u0144ska, N., Strojny, P., and Strojny, A. (2018). Can Simulator Sickness Be Avoided? A Review on Temporal Aspects of Simulator Sickness. Front. Psychol., 9.","DOI":"10.3389\/fpsyg.2018.02132"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/nyas.14554","article-title":"A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke","volume":"1493","author":"Mekbib","year":"2021","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s13063-019-3177-y","article-title":"Evaluating the effect and mechanism of upper limb motor function recovery induced by immersive virtual-reality-based rehabilitation for subacute stroke subjects: Study protocol for a randomized controlled trial","volume":"20","author":"Huang","year":"2019","journal-title":"Trials"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e70151","DOI":"10.1002\/pri.70151","article-title":"Immersive Virtual Reality-Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study","volume":"31","author":"Yoma","year":"2026","journal-title":"Physiother. Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"George, A., Durairaj, S.K., Kandakurti, P.K., and Hazari, A. (2025). Immersive versus non-immersive virtual reality in improving upper limb function among individuals with subacute hemiplegia: A randomized controlled trial. BMC Neurol., 26.","DOI":"10.1186\/s12883-025-04588-5"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s00415-023-12060-y","article-title":"Immersive virtual reality-based rehabilitation for subacute stroke: A randomized controlled trial","volume":"271","author":"Huang","year":"2024","journal-title":"J. Neurol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1161\/STROKEAHA.125.054101","article-title":"Action Observation Combined with Virtual Reality Promotes Motor Recovery After Stroke: A Randomized Controlled Trial","volume":"57","author":"Errante","year":"2026","journal-title":"Stroke"},{"key":"ref_25","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_26","first-page":"e109404","article-title":"Safety, Feasibility and Efficacy of Immersive Virtual Reality Training with a Body Weight-Supporting System for Patients with Extrapyramidal Disorders: A Pilot Case Series Study","volume":"18","author":"Kitabayashi","year":"2026","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"542","DOI":"10.23736\/S1973-9087.19.05598-9","article-title":"Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: A randomized controlled single-blinded trial","volume":"55","author":"Hung","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e29830","DOI":"10.2196\/29830","article-title":"Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial","volume":"10","author":"Anwar","year":"2022","journal-title":"JMIR Serious Games"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.apmr.2013.10.027","article-title":"Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke","volume":"95","author":"Lee","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"8425060","DOI":"10.1155\/np\/8425060","article-title":"Effect of tDCS Concurrent with VR-Based Robotic Intervention on Hemiplegic Upper Limb Function After Subacute Ischemic Stroke: A Randomized Controlled Study","volume":"2025","author":"Guo","year":"2025","journal-title":"Neural Plast."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Abdullahi, A., Wong, T.W.L., and Ng, S.S.M. (2025). Effects of Combining Transcranial Direct Current Stimulation with Virtual Reality on Upper Limb Function in Patients with Stroke: A Systematic Review and Meta-Analysis. Bioengineering, 12.","DOI":"10.3390\/bioengineering12111205"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Shin, S., Lee, H.J., Chang, W.H., Ko, S.H., Shin, Y.I., and Kim, Y.H. (2022). A smart glove digital system promotes restoration of upper limb motor function and enhances cortical hemodynamic changes in subacute stroke patients with mild to moderate weakness: A randomized controlled trial. J. Clin. Med., 11.","DOI":"10.3390\/jcm11247343"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12984-025-01564-5","article-title":"Effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke: A randomized controlled trial","volume":"22","author":"Ase","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.apmr.2018.01.030","article-title":"Virtual reality rehabilitation with functional electrical stimulation improves upper extremity function in patients with chronic stroke: A pilot randomized controlled study","volume":"99","author":"Lee","year":"2018","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_35","first-page":"CD008349","article-title":"Virtual reality for stroke rehabilitation","volume":"20","author":"Laver","year":"2025","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1007\/s10072-023-06742-8","article-title":"Comparison of immersive and non-immersive virtual reality for upper extremity functional recovery in patients with stroke: A systematic review and network meta-analysis","volume":"44","author":"Hao","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_37","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_38","first-page":"20260020","article-title":"Exploring Usability and User Engagement in Fully Immersive Virtual Reality Systems for Upper Limb Stroke Rehabilitation: A Scoping Review","volume":"11","author":"Lygouras","year":"2026","journal-title":"Prog. Rehabil. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e66802","DOI":"10.2196\/66802","article-title":"Virtual reality enhanced exercise training in upper limb function of patients with stroke: Meta-analytic study","volume":"27","author":"Xu","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1207\/s15327108ijap0303_3","article-title":"Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness","volume":"3","author":"Kennedy","year":"1997","journal-title":"Int. J. Aviat. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Park, S., Ha, J., and Kim, L. (2022). Effect of Visually Induced Motion Sickness from Head-Mounted Display on Cardiac Activity. Sensors, 22.","DOI":"10.3390\/s22166213"}],"container-title":["Neurology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/8\/149\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:48:58Z","timestamp":1786524538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2035-8377\/18\/8\/149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["neurolint18080149"],"URL":"https:\/\/doi.org\/10.3390\/neurolint18080149","relation":{},"ISSN":["2035-8377"],"issn-type":[{"value":"2035-8377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}