Patient satisfaction and tolerance of virtual reality rehabilitation in subacute ischemic stroke: a pilot study

If you're not measuring satisfaction against 100% recovery you're using the tyranny of low expectations to disguise the fact YOU'RE A COMPLETTE FUCKING FAILURE AT STROKE RECOVERY!

 Patient satisfaction and tolerance of virtual reality rehabilitation in subacute ischemic stroke: a pilot study

Sarka Banikova^1,2,3Alice Najsrova²István Szegedi^2,4,5Kateřina Vitová¹Iva Fiedorová^1,3Jana Trdá⁶Ondrej Volny^2,4*

• ¹Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
• ²Centre for Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
• ³Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
• ⁴Department of Neurology, University Hospital Ostrava, Ostrava, Czechia
• ⁵Department of Neurology, University of Debrecen, Debrecen, Debrecen, Hungary
• ⁶VR LIFE Ltd., Ostrava, Czechia

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Background: Virtual reality (VR) rehabilitation represents a promising technological approach in post-stroke neurorehabilitation, offering immersive, engaging therapy environments. However, limited data exist on patient satisfaction and tolerance in clinical practice, particularly during the subacute phase of stroke recovery. Objective: To evaluate patient satisfaction and tolerance of VR rehabilitation in patients with subacute ischemic stroke and assess physiotherapist perceptions of treatment outcomes compared to conventional rehabilitation. Methods: A prospective pilot study was conducted from January 1-December 31, 2024, at University Hospital Ostrava, Czech Republic. Patients in the subacute phase of ischemic stroke (≤2 weeks post-stroke) underwent VR rehabilitation using the MDR-certified VR Vitalis® Pro system. Patient satisfaction was measured using the User Satisfaction Evaluation Questionnaire (USEQ). Physiotherapists assessed treatment outcomes on a 5-point scale compared to conventional rehabilitation. Vital signs were monitored pre- and post-intervention. Results: Nineteen patients (mean age 67.7 ± 11.2 years, 52.6% female) completed VR rehabilitation. The mean USEQ satisfaction score was 25.0 ± 6.8 points (range 7-30). High satisfaction (≥25 points) was achieved in 68.4% of patients, with only 5.3% reporting low satisfaction. Individual question analysis revealed highest ratings for information clarity (4.63 ± 0.96) and perceived rehabilitation benefit (4.37 ± 1.12), with 63.2% reporting no discomfort. Physiotherapists rated 31.6% of patients as showing better outcomes than expected with conventional therapy, while 52.6% showed similar outcomes. No serious adverse events were recorded. Conclusions: VR rehabilitation demonstrated high patient satisfaction and excellent tolerance in subacute stroke patients. Individual USEQ analysis revealed strong acceptance for system clarity and rehabilitation benefit. These findings support VR rehabilitation feasibility in clinical stroke care.

Keywords: virtual reality, stroke rehabilitation, Patient Satisfaction, Neurorehabilitation, subacute stroke

Received: 06 Jul 2025; Accepted: 31 Jul 2025.

Copyright: © 2025 Banikova, Najsrova, Szegedi, Vitová, Fiedorová, Trdá and Volny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ondrej Volny, Centre for Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czechia

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

The bigger the problem, the smaller it seems

 When  1 in 4 per WHO that has a stroke and there is nothing for 100% recovery, that is a big problem. And every single fucking failure of a stroke association IS RUNNING AWAY! COWARDS!

10 million yearly stroke survivors is the size of the problem

The bigger the problem, the smaller it seems

Perceiving issues as severe or widespread can lead people to disengage from finding solutions, a recent study finds.

On the whole, we like to think of ourselves as making a difference in the world. At the same time, though, as a group we also manage to avoid addressing working together to mitigate massive, sometimes existential threats — acting like climate change isn't happening, for example, or looking the other way when it comes to racism, transphobia, or gender-based violence. These two things are hard to square: how can we claim to care about others on a grand scale, whilst also looking the other way?

It could be, a team writes in the Journal of Personality and Social Psychology, because of the "big problem paradox". Across six studies, Lauren Eskreis-Winkler and colleagues find that from poverty to drunk driving — and even severe chest pain — the bigger a problem seems, the less concerning it feels.

In the first study, 328 participants read scenarios about a local problem in Chicago: either a failed restaurant health inspection, a building code violation, or a child not being vaccinated. Crucially, only some participants were told how common the problem was after reading the vignette. All participants then rated how likely the problem was to cause serious harm. Those who had learned that something had high prevalence consistently rated its likelihood of causing harm as lower.

Subsequent studies suggested that the big problem paradox seems to exert its effects across many different fields, making situations that participants were already aware are likely to be harmful seem less of a threat. Probed topics in these studies included drink driving, dropping out of college, and even particular genetic mutations that could lead to cancer.

The next set of studies looked to understand exactly why this happens. Firstly, 201 participants read about a U.S. family whose tap water contained microplastics. One group was told the contamination is extremely common (present in 99.99% of U.S. households), while the other was not. Both groups then rated how likely it was that the contaminated water would cause harm, and whether they believed the problem had been dealt with safely.

As before, participants who learned the contamination was common were significantly more likely to believe the family would not get sick, in part because they were more likely to think such a notable problem will have received attention and safely solved. As the team puts it, "the more pervasive the problem, the more people assume it has already been addressed, and the less likely they may be to see the need to address it." This, of course, has the potential to lead to dangerous outcomes where issues remain unseen to.

The next two studies looked at whether the big problem paradox actually undermines helping behaviour. In both, participants imagined that a friend was experiencing a life-threatening problem — either chest pain or suicidal ideation. Again, only the participants who were told the problems were highly prevalent rated the situation as less likely to result in serious harm. Crucially, here, the team found that this reduced perception of harm also drove significantly lower motivation to seek urgent help for the person in need — meaning that the big problem paradox may be inhibiting people's desires to help others, even when they need it.

This also held in the final study, where 303 participants were asked to select someone to receive a donation: a woman needing what they were told was a rare surgery, or a woman needing a more common surgery. Again, learning the prevalence of a problem reduced participants' beliefs about its severity, which in turn reduced their likelihood to donate.

This could go some way to explain why people look the other way when faced with big social issues, and why climate change, poverty, or war can feel oddly abstract even when they touch millions. When a problem becomes 'normal', it also becomes easier to dismiss, and the scale that should inspire action instead inhibits a genuine sense of urgency.

These findings pose clear practical implications here for public messaging: organisations that emphasise just how widespread a problem is may inadvertently weaken public concern and reduce action at the individual level.

Read the paper in full:
Eskreis-Winkler, L., Troncoso Peres, L. T., & Fishbach, A. (2025). The bigger the problem the littler: When the scope of a problem makes it seem less dangerous. Journal of Personality and Social Psychology, 128(4), 790–806. https://doi.org/10.1037/pspa0000409

Are Carbs Healthy? A 30-Year Study Reveals the Truth

 Apply the science to your diet. Or you could allow your competent? doctor to tell you what to do. I'd rather trust the science even if I have to decipher it myself.  While MIND and Mediterranean diets are science backed, there is nothing specific in them that makes their benefits repeatable.

Carbohydrates (6 posts to November 2014)

carbohydrate intake (2 posts to September 2017)

Low-carb diet (1 post to Nevember 2018)

Are Carbs Healthy? A 30-Year Study Reveals the Truth

How to Become a Super Ager: 4 Research-Backed Habits for Sharpness, Strength, and Longevity

 I will easily get there.

How to Become a Super Ager: 4 Research-Backed Habits for Sharpness, Strength, and Longevity

Super agers stay mentally sharp, physically strong, and socially connected well into their 80s and beyond. Here’s how to start building that kind of future now.Super ager is a scientific designation for adults, typically over 80, who maintain the memory, strength, and 

moh-bil-i-tee] noun

The ability to move freely and easily through a full range of motion.

Learn More

mobility of someone decades younger. But you don’t have to wait until your 80s to take action. Most of what we know about super agers comes from clinical research studies, so while the term has become aspirational, it’s rooted in a very specific scientific framework. The habits that help people become Super Agers are accessible now, and they’re rooted in both research and real life.

The term was coined by neuroscientist Emily Rogalski, PhD, at Northwestern University’s Feinberg School of Medicine, to describe people whose memory performance rivals that of much younger individuals. Since then, the research has expanded. Super Agers have great recall, greater emotional 

[ri-zil-yuhns] noun

The ability to recover quickly from stress or setbacks.

Learn More

resilience, stronger social ties, and healthier physical profiles than their peers.

What Is a Super Ager?

Interestingly, the research shows that the brains of super agers are structurally distinct in ways that scientists are just beginning to understand. These aren’t subtle shifts, either. Super agers appear to preserve the physical architecture that supports memory, decision-making, and connection well into their 80s and beyond.

Here are three things research reveals about how their brains are built to last:

1. Thicker Gray Matter: Gray matter is responsible for processing information and controlling functions like movement, memory, and emotions. According to a study published in Cerebral Cortex, super agers have thicker cortical brain regions, especially in the anterior cingulate cortex. This reflects preserved gray matter, specifically the outer layers of the brain involved in processing and higher cognitive functions. While this is a promising marker, it’s important to recognize that gray matter thickness is just one of several brain aging indicators and doesn’t capture the full complexity of cognitive resilience.
   
2. More Social Brain Cells: (Yes, those are a thing) The National Institute on Aging notes that some super agers’ brains contained a much higher density of a particular type of cell called von Economo neurons, which are linked to social intelligence and awareness.
   
3. Less White Matter Atrophy: White matter is the communication highway between different brain regions and between the brain and the spinal cord. A 2024 study in the Journal of Neuroscience found that super agers show significantly less white matter atrophy (thinning or shrinkage) over time compared to typical older adults. Preserving white matter supports better overall brain connectivity and coordination.

5 Science-Backed Habits That Support Super Aging

The good news? You don’t have to win the genetic lottery to become a super ager. In fact, lifestyle and mindset matter more than you think.

1. Deliberately Challenge Your Brain

Super Agers actively seek out cognitive effort. They don’t let their minds coast.

• Learning a new language or instrument
• Playing strategy games like chess or bridge
• Engaging in storytelling, writing, or public speaking

According to Northwestern researchers, super agers are often lifelong learners who embrace mental effort.(My efforts to stay up-to-date on research in stroke, Parkinsons and dementia requires hours of research every day) This is how you promote

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neuroplasticity, helping your brain build new pathways as you age.

2. Move with Intention

Building muscle and increasing your aerobic capacity not only strengthens your body but also fuels your brain. Physical activity improves blood flow, lowers inflammation, and boosts cognitive function. 

[in-fluh-mey-shuhn] noun

Your body’s response to an illness, injury or something that doesn’t belong in your body (like germs or toxic chemicals).

Learn More

According to Harvard Health, preserving your exercise capacity, especially your VO₂ max, is critical to aging well. How much you retain depends on the intensity, duration, and frequency of your workouts. (I'm not doing my 10,000 step walks much right now, just getting my new condo setup)

• For beginners, aim to elevate your heart rate to 50% of your max (calculated as 220 minus your age), and work up to 60–70% over time. At that level, you’ll be breathing heavily and unable to talk easily while exercising.
• Aim for 20 to 40 minutes of aerobic activity, 3 to 5 days a week. 
• Incorporate strength training to support mobility and metabolic health
• Check out our guide to building muscle safely after 40.

Your exercise plan should be tailored to your physical ability and health status, especially if you’re managing mobility limitations or chronic conditions. 

3. Find Your People

Super agers often maintain close relationships and meaningful interactions. Strong social connections are protective against cognitive decline and depression.

According to a study published in PLOS ONE, super agers reported higher psychological well-being, life satisfaction, and stronger social networks than typical older adults, suggesting that emotional resilience and interpersonal engagement play a significant role in memory preservation and quality of life.

• Schedule regular calls or walks with friends
• Play a racquet sport for fun (They’re linked to longevity)
• Join a club, class, or volunteer group
• Sign up for an art class
• Prioritize presence over perfection in your relationships

At a loss for how to find your people? Try something new, something you’re interested in but haven’t done before, maybe something that feels a little risky, so you need to stoke some courage (it’s good to flex your courage muscles with healthy risks).

(Sunday is music at Red Cedar, Tuesday is music at Moriarties, Thursday is trivia at Moriarties; all are bars, so alcohol is involved, there will be no condemnations of that.)

4. Align With Your Purpose

Having a reason to get up in the morning matters. Whether it’s volunteering, mentoring, or pursuing creative projects, knowing your why is key.

A 2024 study published in Innovation in Aging found that older adults with a stronger sense of purpose in daily life had better cognitive function throughout the day, suggesting that purpose may help maintain attention, memory, and executive functioning even in advanced age. Additional research in Alzheimer’s Research & Therapy supports these findings, showing that a strong sense of purpose promotes resilience to brain aging by reducing the cognitive burden of structural brain changes in midlife.

Whether it’s mentoring, volunteering, caregiving, or activism, purpose supports:

• Attention
• Memory
• Executive functioning
• Motivation

It’s important to note that these findings are correlational, meaning that purpose is associated with better function, but causality is still being explored. New research suggests purpose may not extend your lifespan, but it does improve overall well-being.

(My purpose is to get stroke solved to 100% recovery. will have to convince supposedly smart Ph. D.s and doctors that it is possible, A challenge, but doable if their minds are not too closed off in listening to stroke-addled brains like mine!)

5. Tell Yourself A Good Story

If you want to live a long, healthy life, one tool people overlook: stories. Super Agers don’t just move more, think harder, or connect better; they also tell themselves a different story about what’s possible and about aging itself. Their secret? Mindset.

(I'm incredibly positive about myself. I have decades of exploring yet to do and I'm 69. If I have to get younger and younger friends that will be able to keep up with me, I'll get that done. Just bought a 4 level condo, 7 steps to each level. Absolutely do not believe in removing steps in living quarters. Don't do steps at home, won't be able to travel to step laden places like Machu Pichu or restrooms anywhere in Europe!)

We now know that how we perceive aging can directly affect how we experience it. In fact, multiple studies, including pioneering work from Yale researcher Becca Levy, PhD, have found that people with more positive beliefs about aging live significantly longer than those with negative views. The takeaway: the stories we tell ourselves about getting older shape our biology.

Instead of bracing for decline, super agers lean into growth. They expect meaning, vitality, and relevance, no matter the number on the calendar. This mindset shift rewires how we respond to challenges, how we care for our bodies, and even how our brains age.

At Super Age, we believe the future is shaped not just by what you do, but by what you believe is possible. Yes, exercise, nutrition, sleep, and purpose matter, but so does rejecting outdated narratives about aging and replacing them with something bolder, more empowering, and more true to who you are now.

Aerobic minutes and step number remain low in inpatient stroke rehabilitation

 And this useless research was because you missed this from many years ago! Solve the problem; DON'T JUST LAZILY TELL US IT EXISTS! I'd have you all fired for incompetence. 

78% of time in sedentary behaviors (1 post to August 2019)

sedentary behavior (38 posts to January 2014)

69 percent sedentary time (3 posts to August 2019)

Aerobic minutes and step number remain low in inpatient stroke rehabilitation

Yunyi Yan, Janice J. Eng, Stanley H. Hung, Mark T. Bayley, Krista L. Best, Louise A. Connell, Sarah J. Donkers, Sean P. Dukelow, Victor E. Ezeugwu, Marie-Hélène Milot, Brodie M. Sakakibara, Lisa Sheehy, Hubert Wong, Jennifer Yao, Sue Peters 

• Published: July 28, 2025

Abstract

Objective

Rehabilitation is important for regaining mobility poststroke. Clinical practice guidelines suggest a high number of repetitive stepping activities to optimize subacute recovery especially when undertaken at intensities that challenge cardiovascular fitness. However, adherence to these guidelines is unclear. The objective of this study was to quantify aerobic minutes and step number in usual care inpatient stroke rehabilitation unit physical therapy sessions across Canada and identify characteristics of participants who met guideline aerobic intensity minutes at a session midpoint in their rehabilitation.

Methods

To gain insight into usual care, we analyzed cross-sectional data from the usual care arm of the Walk ‘n Watch implementation trial; trial sites included Canadian rehabilitation units that were not typically involved in research studies. To be included, medically stable patients were admitted for inpatient stroke rehabilitation, and able to take > 5 steps with a maximum of one person assisting. We assessed a midpoint physical therapy session with a wrist-based heart monitor (aerobic minutes) and ankle-based step counter (step number). Means, histograms, and correlations between aerobic minutes (> 40% heart rate reserve) and steps were calculated.

Results

There were 166 participants (69 females, age 69 standard deviation (SD)12 years) with stroke (138 Ischemic/ 27 Hemorrhagic) included. Participants had a mean of 10(SD11) aerobic minutes and 985(SD579) steps. The relationship between step number and aerobic minutes was negligible (R2 = 0.003). More participants with ≥20 aerobic minutes in a session were male, with lower 6 Minute Walk Test distance, and have a subcortical stroke location.

Conclusion

The number of steps has increased, but aerobic minutes has not changed and remains extremely low compared to published reports in the past several years. Given that increasing activity levels are critical for stroke recovery, further investigation into the potential barriers to achieving targets set by guidelines is recommended.

Trial registration

ClinicalTrials.gov NCT04238260

Abstract

Objective

Rehabilitation is important for regaining mobility poststroke. Clinical practice guidelines suggest a high number of repetitive stepping activities to optimize subacute recovery especially when undertaken at intensities that challenge cardiovascular fitness. However, adherence to these guidelines is unclear. The objective of this study was to quantify aerobic minutes and step number in usual care inpatient stroke rehabilitation unit physical therapy sessions across Canada and identify characteristics of participants who met guideline aerobic intensity minutes at a session midpoint in their rehabilitation.

Methods

To gain insight into usual care, we analyzed cross-sectional data from the usual care arm of the Walk ‘n Watch implementation trial; trial sites included Canadian rehabilitation units that were not typically involved in research studies. To be included, medically stable patients were admitted for inpatient stroke rehabilitation, and able to take > 5 steps with a maximum of one person assisting. We assessed a midpoint physical therapy session with a wrist-based heart monitor (aerobic minutes) and ankle-based step counter (step number). Means, histograms, and correlations between aerobic minutes (> 40% heart rate reserve) and steps were calculated.

Results

There were 166 participants (69 females, age 69 standard deviation (SD)12 years) with stroke (138 Ischemic/ 27 Hemorrhagic) included. Participants had a mean of 10(SD11) aerobic minutes and 985(SD579) steps. The relationship between step number and aerobic minutes was negligible (R2 = 0.003). More participants with ≥20 aerobic minutes in a session were male, with lower 6 Minute Walk Test distance, and have a subcortical stroke location.

Conclusion

The number of steps has increased, but aerobic minutes has not changed and remains extremely low compared to published reports in the past several years. Given that increasing activity levels are critical for stroke recovery, further investigation into the potential barriers to achieving targets set by guidelines is recommended.

Trial registration

ClinicalTrials.gov NCT04238260

Figures

  

Citation: Yan Y, Eng JJ, Hung SH, Bayley MT, Best KL, Connell LA, et al. (2025) Aerobic minutes and step number remain low in inpatient stroke rehabilitation. PLoS One 20(7): e0328930. https://doi.org/10.1371/journal.pone.0328930

Editor: Leica S. Claydon-Mueller, Anglia Ruskin University UK, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND

Received: January 21, 2025; Accepted: July 8, 2025; Published: July 28, 2025

Copyright: © 2025 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data are now uploaded here: https://borealisdata.ca/dataverse/eng Eng, Janice, 2025, “Replication Data for: “Aerobic Minutes and Step Number Remain Low in Inpatient Stroke Rehabilitation””, https://doi.org/10.5683/SP3/LKMDHX, Borealis, V1, UNF:6:vqj6gdzUh2hj0esQ2f7OLQ== [fileUNF].

Funding: The authors gratefully acknowledge the support and collaboration of the CanStroke Recovery Trials Platform. Funding for the CanStroke Recovery Trials Platform has been made possible by the Canada Brain Research Fund (CBRF), an innovative arrangement between the Government of Canada (through Health Canada) and Brain Canada Foundation and the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, University of Calgary and the Sunnybrook Research Institute. Further funding is from the Canadian Institutes of Health Research (Operating Grant FDN 143340 JJE; Fellowship SP); Canada Research Chair Program (JJE); Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Operating Grant (JJE); Michael Smith Foundation for Health Research Fellowship (SP). Michael Smith Foundation for Health Research Scholar Award (BMS). No funders contributed to any aspect of the study.