Virtual Reality-Based Telerehabilitation for Upper Limb Recovery Post-Stroke: A Systematic Review of Design Principles, Monitoring, Safety, and Engagement Strategies

TL;DR

This systematic review investigates VR-based telerehabilitation for upper-limb recovery after stroke, addressing accessibility and engagement challenges inherent in conventional care. Using PRISMA 2020 guidelines, it analyzes design principles, monitoring/communication, safety, and engagement strategies across five studies, most of which are clinical or pilot in nature and only a subset conducted at home. The review identifies gaps in early human-centered design involvement, heterogeneous monitoring approaches, sparse standardized safety protocols, and limited quantitative assessment of physical capabilities in home settings, while highlighting potential advantages of VR for at-home, personalized rehab and improved adherence through gamification and adaptive difficulty. The findings suggest VR telerehabilitation can enhance access and motivation but require robust guidelines, enhanced stakeholder involvement, and comprehensive safety/monitoring frameworks to enable broader, long-term clinical adoption and improved patient outcomes.

Abstract

Stroke rehabilitation continues to face challenges in accessibility and patient engagement, where traditional approaches often fall short. Virtual reality (VR)-based telerehabilitation offers a promising avenue, by enabling home-based recovery through immersive environments and gamification. This systematic review evaluates current VR solutions for upper-limb post-stroke recovery, focusing on design principles, safety measures, patient-therapist communication, and strategies to promote motivation and adherence. Following PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed, IEEE Xplore, and ScienceDirect. The review reveals a scarcity of studies meeting the inclusion criteria, possibly reflecting the challenges inherent in the current paradigm of VR telerehabilitation systems. Although these systems have potential to enhance accessibility and patient autonomy, they often lack standardized safety protocols and reliable real-time monitoring. Human-centered design principles are evident in some solutions, but inconsistent patient involvement during the development process limits their usability and clinical relevance. Furthermore, communication between patients and therapists remains constrained by technological barriers, although advancements in real-time feedback and adaptive systems offer promising solutions. This review underscores the potential of VR telerehabilitation to address critical needs in upper-limb stroke recovery while highlighting the importance of addressing existing limitations to ensure broader clinical implementation and improved patient outcomes.

Figures (1)

• Figure 1: PRISMA 2020 flow diagram.