Doing this review DID NOTHING towards getting survivors recovered! You didn't put anything into a useable protocol format. Evaluation and 'assessments' don't get survivors recovered; or are you that blitheringly stupid?
Innovating Stroke Recovery: A Systematic Review of Virtual Reality in Cognitive Rehabilitation
Published: October 28, 2025
DOI:
10.7759/cureus.95573
Peer-Reviewed
Cite this article as: Anadachee A, Patil R, Gajadhur K, et al. (October 28, 2025) Innovating Stroke Recovery: A Systematic Review of Virtual Reality in Cognitive Rehabilitation. Cureus 17(10): e95573. doi:10.7759/cureus.95573
Virtual reality (VR), a surging therapeutic tool especially in stroke rehabilitation, has emerged as a powerhouse for VR-based rehabilitation in stroke patients, which is not only restricted to motor dysfunction but also encompasses cognitive impairment. Given the central role of cognition in activities of daily living, identifying effective interventions to address post-stroke cognitive impairment is critical. Hence, this systematic review aims to evaluate the effects of VR on cognitive function in stroke patients.
An extensive search was conducted on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Turning Research into Practice (TRIP), Google Scholar, Science Direct, Web of Science, and Scopus databases, with Medical Subject Headings (MeSH) terms “virtual reality”, “cognitive function”, and “stroke” for relevant articles. Eligible randomized controlled trials (RCTs) published from January 2019 to August 2025 were reviewed. The Cochrane risk-of-bias tool (RoB 2) was used for methodological appraisal. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and compliance with standard guidelines.
Out of 91,713 articles initially identified, 9 RCTs met the inclusion criteria and encompassed a total of 601 stroke patients, comprising 53% females. The primary outcome was global cognitive function assessed by the Montreal Cognitive Assessment, which was statistically significant in 78% of the articles following VR-based interventions compared to conventional therapy. The secondary outcomes measured included: mental health by Mini-Mental State Examination (n=2), Beck Depression Inventory-II (n=1), Hospital Anxiety and Depression Scale (n=1) or Hamilton Anxiety Rating Scale (n=1); disability and autonomy measured by Modified Barthel index (n=1) and Functional Independence Measure (n=2); and quality of life (QoL) assessed by Short form-12 Health Survey (n=1) and EuroQoL (n=1). Statistical improvement was observed in only two studies for mental health and in one for QoL.
VR-based cognitive rehabilitation is associated with meaningful improvements in global cognitive function. The findings of this review support integration of VR as a complementary tool in the multidisciplinary rehabilitation of stroke survivors with cognitive impairments.
Introduction & Background
Over the past few decades, stroke has emerged as a major contributor to long-term disability worldwide, clearly demonstrated by the Global Burden of Disease estimates, as stroke currently accounts for approximately 4-5% of global disability adjusted life years (DALYs)[1-2]. Disability is tackled by rehabilitation pathways that mostly cater to motor recovery, hence insufficiently addressing functions such as cognition, depression, and fatigue [3]. An oversight that proves devastating when non-motor impairments especially cognition can prove as socioeconomically debilitating as their motor counterparts, notably demonstrated by 40% of stroke patients who develop post-stroke cognitive impairment within 4 years of stroke, a condition associated with an increased number of visits to the general practitioner, and/or neurologist prolonged hospital stays and in many cases loss of employment [4-5].
In recent years, virtual reality(VR) based rehabilitation has emerged as a promising alternative with its engaging task-oriented environment that stimulates neuroplasticity while enhancing patient motivation [6-7]. Nevertheless, it is to be remarked that despite this dual improvement potential, most of the previous VR platforms were primarily designed to focus on motor function improvement and, it is only now that with increasing number of randomized controlled trials (RCTs) investigating cognitive gains via VR therapy, that a systematic review on the subject has become more viable [6, 8-10]. Previous systematic reviews and meta-analyses on the subject have, to date, largely relied on pilot studies or a limited pool of RCTs, which have precluded a comprehensive evaluation of cognitive outcomes or the influence of baseline characteristics, such as time since stroke or side of brain lesion [9-10]. The recent proliferation of high-quality RCTs featuring extended follow-up periods and detailed baseline data, including time post-stroke, lesion laterality, and lesion type, allows us to overcome these limitations and enables a more robust analysis of the topic.
Accordingly, this systematic review has as its main aim to evaluate the impact of VR-based interventions on global cognitive function in adult stroke survivors, as measured by the Montreal Cognitive Assessment (MoCA), which has been proven as an adequate tool used for assessment of general cognitive function, specifically in stroke patients [11]. This systematic review also compared the relative effectiveness of immersive versus non-immersive VR applications and examined secondary outcomes related to functional independence, mental health, and quality of life (QoL). All done, along with a methodological assessment of the RCTs that ensured a solid, evidence-based evaluation of our primary aim: the evaluation of the effectiveness of VR-based cognitive rehabilitation in stroke patients assessed by MoCA.
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