Abstract
Background: Patients with stroke sequelae experience motor impairments that make it difficult to perform many activities of daily living, resulting in reduced social participation. Immersive virtual reality (VR) provides the necessary conditions for motor learning, such as repetitiveness, intensity, and task meaningfulness, and it could be a promising rehabilitation tool for upper limb recovery in individuals with stroke sequelae. Objective: The objectives of this study are to summarize the current scientific evidence on the use of immersive VR for upper limb rehabilitation in patients with subacute stroke and to identify clinical and instrumental criteria that may inform the development of a standardized VR treatment protocol. Materials and Methods: Bibliographic research on primary and secondary studies was conducted using the keywords "subacute stroke", "immersive virtual reality/head-mounted display (HMD)", and "upper extremity/arm/hand" in the following electronic databases: CINAHL, PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, PEDro, and Google Scholar. Then, we performed the selection of studies and the assessment of the methodological quality of such studies using the PEDro scale. Finally, the qualitative synthesis of the data extracted from the selected studies was carried out. This systematic review was conducted according to the PRISMA 2020 guidelines. Results: After the selection process, five studies were included in this systematic review (two RCTs, two controlled clinical studies, one study protocol). Four studies reported significant improvements in some main outcomes after the VR intervention, including a significant increase in the Fugl-Meyer Upper Extremity total score, in favor of the virtual rehabilitation group. Conclusions: VR appears to be a promising rehabilitation tool for upper limb motor recovery. However, further research is needed to determine the intervention methods and long-term effects of VR on the stroke population.