Virtual reality intervention protocols for upper limb rehabilitation afterneurological injuries: an integrative review
DOI:
https://doi.org/10.11606/issn.2238-6149.v36e242402Keywords:
Occupational Therapy, Neurological injuries, Virtual reality, RehabilitationAbstract
Introduction: Neurological injuries often impair upper limb (UL) function, negatively affecting functionality, occupational performance, and social participation. Virtual reality (VR) has emerged as a complementary strategy for rehabilitation; however, gaps remain regarding the standardization of intervention protocols. Objective: To analyze VR protocols used for upper limb functional recovery in adults and older adults with neurological injuries, characterizing interventions, assessment instruments, and clinical outcomes. Methods: An integrative literature review was conducted between December 2023 and March 2026 through searches in the CAPES Journal Portal and PubMed/MEDLINE. Results: Of the 1,426 articles identified, 16 met the eligibility criteria, comprising a total of 422 participants, with 86.49% included with group controlled studies. Most studies combined VR with conventional rehabilitation and demonstrated considerable variability in intervention frequency, session duration, and technologies employed. Outcome measures primarily focused on body structure and function, whereas motivation, participation, satisfaction, and user experience were rarely assessed. Conclusion: VR shows promise as a complementary resource for upper limb functional rehabilitation. Task personalization, real-time feedback, and progressive difficulty appear to have a greater influence on engagement and therapeutic outcomes than session duration.
Downloads
References
Brouwer VHEW, Schuijt HJ, Visser-Meily JMA, Achterberg WP, Van Dam Van Isselt EF. Rehabilitation outcomes of older persons within the context of the International Classification of Functioning, Disability and Health (ICF): a systematic review. Eur Geriatr Med. 21 de janeiro de 2026;17(1):261–72. https://doi.org/10.1007/s41999-026-01406-0.
Feigin VL, Owolabi MO, Feigin VL, Abd-Allah F, Akinyemi RO, Bhattacharjee NV et al. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission. Lancet Neurol. 2023;22(12):1160–206. https://doi.org/10.1016/S1474-4422(23)00277-6
Ding Y, Li G, Zhang P, Zhang W. Editorial: New advances in functional rehabilitation after central and peripheral nervous system injury. Front Neurol. 2023;14:1160382. https://doi.org/10.3389/fneur.2023.1160382
World Health Organization. Rehabilitation [Internet]. Geneva: World Health Organization; 2024.
Gomes MD, Teixeira L, Ribeiro J. Enquadramento da Prática da Terapia Ocupacional: Domínio & Processo 4ª Edição [Internet]. Escola Superior de Saúde, Politécnico de Leiria; 2021. Disponível em: http://hdl.handle.net/10400.8/6370. https://doi.org/10.25766/671R-0C18
Brunner I, Skouen JS, Hofstad H, Aßmus J, Becker F, Sanders AMet al. Virtual reality training for upper extremity in subacute stroke (VIRTUES): a multicenter RCT. Neurol. 12 de dezembro de 2017;89(24):2413–21. https://doi.org/10.1212/WNL.0000000000004744. PubMed PMID: 29142090.
Zilli F, Lima CBAD, Kohler MC. Neuroplasticidade na reabilitação de pacientes acometidos por AVC espástico. Rev Ter Ocup Univ São Paulo (Online). 2014;25(3):317-322. https://doi.org/10.11606/issn.2238-6149.v25i3p317-322
Khokale R, S. Mathew G, Ahmed S, Maheen S, Fawad M, Bandaru Pet al. Virtual and augmented reality in post-stroke rehabilitation: a narrative review. Cureus. 2023. https://doi.org/10.7759/Cureus.37559
Caiana TL, Nogueira DDL, Lima ACDD. A realidade virtual e seu uso como recurso terapêutico ocupacional: revisão integrativa. Cad Ter Ocup UFSCar. 2016;24(3):575–89. https://doi.org/10.4322/0104-4931.ctoAR061910
Olana DD, Abessa TG, Lamba D, Triccas LT, Bonnechere B. 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. J Neuroeng Rehabil. 2025;22(1):92. https://doi.org/10.1186/s12984-025-01603-1
Santana CMFD, Lins OG, Sanguinetti DCDM, Silva FPD, Angelo TDDA, Coriolano MDGWDSet al. Efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com Parkinson. Rev Bras Geriatr Gerontol. 2015;18(1):49–58. https://doi.org/10.1590/1809-9823.2015.14004
Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation: an abridged version of a Cochrane review. Eur J Phys Rehabil Med. 2015;51(4):497-506.
Souza MTD, Silva MDD, Carvalho RD. Integrative review: what is it? How to do it? Einstein (São Paulo). 2010;8(1):102–6. https://doi.org/10.1590/s1679-45082010rw1134
Huang Q, Wu W, Chen X, Wu B, Wu L, Huang Xet al. 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. Trials. 2019;20(1):104. https://doi.org/10.1186/s13063-019-3177-y
Phan HL, Kim JP, Kim K, Hwang CH, Koo K in. Wrist rehabilitation system using augmented reality for hemiplegic stroke patient rehabilitation: a feasibility study. Appl Sci. 2019;9(14):2892. https://doi.org/10.3390/app9142892
Cuesta-Gómez A, Sánchez-Herrera-Baeza P, Oña-Simbaña ED, Martínez-Medina A, Ortiz-Comino C, Balaguer-Bernaldo-de-Quirós Cet al. Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial. J Neuroeng Rehabil. 2020;17(1):90. https://doi.org/10.1186/s12984-020-00718-x
Mekbib DB, Zhao Z, Wang J, Xu B, Zhang L, Cheng Ret al. Proactive motor functional recovery following immersive virtual reality–based limb mirroring therapy in patients with subacute stroke. Neurotherapeutics. 2020;17(4):1919–30. https://doi.org/10.1007/s13311-020-00882-x
Song YH, Lee HM. Effect of immersive virtual reality-based bilateral arm training in patients with chronic stroke. Brain Sci. 2021;11(8):1032. https://doi.org/10.3390/brainsci11081032
Aguilera-Rubio Á, Cuesta-Gómez A, Mallo-López A, Jardón-Huete A, Oña-Simbaña ED, Alguacil-Diego IM. Feasibility and efficacy of a virtual reality game-based upper extremity motor function rehabilitation therapy in patients with chronic stroke: a pilot study. Int J Environ Res Public Health. 2022;19(6):3381. https://doi.org/10.3390/ijerph19063381
Cemim JA, Corrêa PS, Pereira BS, Souza JS, Cechetti F. Virtual reality as an intervention tool for upper limbs in Parkinson’s disease: a case series. Fisioter Pesqui. 2022;29(2):128–37. https://doi.org/10.1590/1809-2950/20022329022022en
Cuesta-Gómez A, Martín-Díaz P, Sánchez-Herrera Baeza P, Martínez-Medina A, Ortiz-Comino C, Cano-de-la-Cuerda R. Nintendo Switch Joy-Cons’ infrared motion camera sensor for training manual dexterity in people with multiple sclerosis: a randomized controlled trial. J Clin Med. 2022;11(12):3261. https://doi.org/10.3390/jcm11123261
Heinrich C, Morkisch N, Langlotz T, Regenbrecht H, Dohle C. Feasibility and psychophysical effects of immersive virtual reality-based mirror therapy. J Neuroeng Rehabil. 2022;19(1):107. https://doi.org/10.1186/s12984-022-01086-4
Marques IA, Alves CM, Rezende AR, Mendes LC, Paiva TS, Cyrino GFet al. Virtual reality and serious game therapy for post-stroke individuals: a preliminary study with humanized rehabilitation approach protocol. Complement Ther Clin Pract. 2022;49:101681. https://doi.org/10.1016/j.ctcp.2022.101681
Huang Q, Jiang X, Jin Y, Wu B, Vigotsky AD, Fan Let al. Immersive virtual reality-based rehabilitation for subacute stroke: a randomized controlled trial. J Neurol. 2024;271(3):1256–66. https://doi.org/10.1007/s00415-023-12060-y
Chen J, Or CK, Li Z, Yeung EHK, Zhou Y, Hao T. Effectiveness, safety and patients’ perceptions of an immersive virtual reality–based exercise system for poststroke upper limb motor rehabilitation: a proof-of-concept and feasibility randomized controlled trial. Digit Health. 2023;9:20552076231203599. https://doi.org/10.1177/20552076231203599
Aguilera-Rubio Á, Alguacil-Diego IM, Mallo-López A, Jardón Huete A, Oña ED, Cuesta-Gómez A. Use of low-cost virtual reality in the treatment of the upper extremity in chronic stroke: a randomized clinical trial. J Neuroeng Rehabil. 2024;21(1):12. https://doi.org/10.1186/s12984-024-01303-2
De Pasquale P, De Bartolo D, Russo M, Berger DJ, Maselli A, Borzelli Det al. User-centered development of a personalized adaptive mirror therapy for upper-limb post-stroke rehabilitation using virtual reality and myoelectric control. Front Bioeng Biotechnol. 2025;13:1655416. https://doi.org/10.3389/fbioe.2025.1655416
Heinzle K, Habig J, Pröglhöf M, Diwald A, Mildner S, Haslinger Met al. Immersive virtual reality upper-limb exercises in people with Parkinson’s disease: an observer-blinded randomised controlled trial. J Neuroeng Rehabil. 2026;23(1):9. https://doi.org/10.1186/s12984-025-01851-1
Sun Y, Shao S, Huo F, Zhang H, Ji Q, Zhou Ret al. Effects of self-directed game-based virtual reality program on upper-limb motor recovery in mild-to-moderate ischemic stroke: a randomized controlled trial. Eur J Phys Rehabil Med. 2026;62(1):11–23. https://doi.org/10.23736/S1973-9087.25.09129-4
Galvão CM. Níveis de evidência. Acta paul enferm. 2006;19(2):5–5. https://doi.org/10.1590/S0103-21002006000200001
Bargeri S, Baggio M, Guida S, Castellini G, Gianola S. Evolving trends in virtual reality rehabilitation for stroke in research publications. Arch Physioter. 2024;182–8. https://doi.org/10.33393/aop.2024.3155
Ministério da Saúde (BR), Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. Diretrizes metodológicas: elaboração de revisão sistemática e meta-análise de ensaios clínicos randomizados [Internet]. Brasília: Ministério da Saúde; 2021. Disponível em: https://www.gov.br/conitec/pt-br/midias/artigos_publicacoes/diretrizes/diretrizes_metodologicas_elabor acao_sistematica.pdf
Nascimento CO, Carvalho CRA. Terapia ocupacional e o uso dos jogos de realidade virtual no tratamento com pessoas idosas. Rev Chil Ter Ocup. 2022;23(2). https://doi.org/10.5354/0719-5346.2022.66857
Moraes VB, Andrade MMA, Toyoda CY, Araujo RCT. O uso do videogame Nintendo Wii como recurso terapêutico para idosos: uma análise da atividade na perspectiva da Terapia Ocupacional. Cad Ter Ocup UFSCar. 2016;24(4):705–14. https://doi.org/10.4322/0104-4931.ctoAO0640
Bui J, Luauté J, Farnè A. Enhancing upper limb rehabilitation of stroke patients with virtual reality: a mini review. Front Virtual Real. 2021;2:595771. https://doi.org/10.3389/frvir.2021.595771
Simón-Vicente L, Rodríguez-Cano S, Delgado-Benito V, Ausín-Villaverde V, Cubo Delgado E. Cybersickness: a systematic literature review of adverse effects related to virtual reality. Neurologia (Engl Ed). 2024;39(8):701–9. https://doi.org/10.1016/j.nrleng.2022.04.007
Chen X, Liu F, Lin S, Yu L, Lin R. Effects of virtual reality rehabilitation training on cognitive function and activities of daily living of patients with poststroke cognitive impairment: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2022;103(7):1422–35. https://doi.org/10.1016/j.apmr.2022.03.012
Gao Y, Ma L, Lin C, Zhu S, Yao L, Fan Het al. Effects of virtual reality-based intervention on cognition, motor function, mood, and activities of daily living in patients with chronic stroke: a systematic review and meta-analysis of randomized controlled trials. Front Aging Neurosci. 2021;13:766525. https://doi.org/10.3389/fnagi.2021.766525
Palma GCS, Freitas TB, Bonuzzi GMG, Soares MAA, Leite PHW, Mazzini NAet al. Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review. Top Stroke Rehabil. 2017;24(4):269–78. https://doi.org/10.1080/10749357.2016.1250373
Santos LM, Sampaio Neto EM, Barreto GCP, Oliveira MCA, Cavalcanti PAB, Câmara VMPet al. A eficácia da realidade virtual na reabilitação pós-AVC: uma revisão sistemática da literatura. Contrib Cienc Soc. 2024;17(10):e11224. https://doi.org/10.55905/revconv.17n.10-042
Castro BSHM, Raposo AB, Silva-Calpa GFM. Aprimorando a experiência do usuário em um jogo de Realidade Virtual para pessoas com comprometimento nos membros superiores. Em: Anais Estendidos do XXII Simpósio Brasileiro de Jogos e Entretenimento Digital (SBGames Estendido 2023) [Internet]. Brasil: Sociedade Brasileira de Computação; 2023. p. 1343–8. Disponível em: https://sol.sbc.org.br/index.php/sbgames_estendido/article/view/27928 https://doi.org/10.5753/sbgames_estendido.2023.234096
Souza CHR, Oliveira SS, Berretta LO, Carvalho ST. O uso de dados de saúde para o ajuste dinâmico de dificuldade em jogos sérios. Em: Anais do XXIII Simpósio Brasileiro de Computação Aplicada à Saúde (SBCAS 2023) [Internet]. Brasil: Sociedade Brasileira de Computação; 2023. p. 479–84. Disponível em: https://sol.sbc.org.br/index.php/sbcas/article/view/25314 https://doi.org/10.5753/sbcas.2023.229632
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Lara Malheiros de Melo, Débora Couto de Melo Carrijo
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
