Virtual solutions get real-world results
Virtual reality and augmented reality emerge as useful tools in aiding recovery from stroke.
In the aftermath of stroke, when challenges to recovery are myriad, immersive technologies are proving valuable in supplementing traditional rehabilitation therapy. Gisele Sampaio, MD, PhD, professor of neurology at the Federal University of São Paulo in Sao Paulo, Brazil, says virtual reality (VR) and augmented reality (AR) can play a critical role in post-stroke rehabilitation in patients with attention, memory, visuospatial or behavioral deficits.
Sampaio, who is also head clinical trialist in neurology at the Albert Einstein Hospital in São Paulo, is one of a panel of experts speaking Wednesday at the session, “Technology-Enhanced Psychosocial Support for Stroke Recovery.”
VR systems can immerse patients in interactive environments that stimulate attention, memory and executive functions. Navigating a virtual kitchen, for example, could help retrain patients in planning and sequencing. AR, by contrast, overlays digital cues onto the real world — for example, guiding hand movements or providing step-by-step visual prompts during everyday tasks. The interactive and goal-oriented nature of these technologies enhances motivation and attention, reduces apathy and promotes active participation, Sampaio said.
“By engaging multiple sensory modalities and emphasizing implicit, embodied learning, these technologies leverage preserved procedural learning pathways even when explicit memory or executive function is impaired,” she said. “Repeated, meaningful practice within safe, simulated scenarios drives experience-dependent neuroplasticity across distributed cognitive networks critical for recovery.”
Cognitive and behavioral recovery for stroke patients requires active, engaging, feedback-driven therapy. Sampaio said VR and AR can deliver this effectively, leveraging neuroplasticity by combining:
- Multisensory — primarily visual and auditory — stimulation
- Goal-directed action
- Real-time feedback — such as visual cues, performance scores and adaptive tasks — that reinforces successful strategies and provides for error correction
- Sustained engagement in ways that closely resemble everyday life
“These tools repeatedly activate distributed neural networks involved in attention, memory, executive function and visuospatial processing,” she said.
In areas of visuospatial neglect, Sampaio said VR can place patients in immersive environments where important stimuli consistently appear in the neglected visual field. Graded cues and increasing complexity to retrain attentional orienting and spatial exploration. For executive function and memory, Sampaio said that in simulated everyday tasks that require planning, recall and adaptation (such as navigating a kitchen or supermarket) real-time feedback enforces effective strategies.
“Together, these examples show how immersive practice promotes neural recognition while directly improving everyday function skills,” Sampaio said.
Although VR and AR represent a great step forward in post-stroke recovery, Sampaio cautioned that these technologies complement — but do not replace — conventional rehabilitation methods.
A patient with post-stroke visuospatial neglect, for example, may receive traditional occupational therapy. This might be focused on scanning strategies and functional tasks such as dressing or tabletop activities. Sampaio said VR can be used alongside this therapy to intensively retrain attentional orienting in a controlled, immersive environment. This will allow the therapist to systematically increase spatial demands and provide immediate feedback.
“The gains achieved in VR — improved attention and spatial awareness — are then applied and reinforced during conventional therapy and daily activities such as navigating a hallway or preparing a meal,” she said. “In this complementary process, traditional rehabilitation provides hands-on guidance, clinical judgment and real-world functional practice, while immersive technologies add a high-dose, engaging and precisely controlled training that is difficult to achieve otherwise.”
Immersive technologies are not without drawbacks, which can include motion sickness in some users, variability in device calibration and the need for clinician training to ensure the proper use and interpretation of results. Despite these, Sampaio said she sees a bright future for the role these technologies will continue to play in supporting stroke recovery.
“Cognitive and behavioral recovery requires active, engaging, feedback-driven therapy, which VR/AR can deliver effectively,” she said. “Digital health innovations can democratize rehabilitation, especially in low- and middle-income countries. And the future lies in integrating those tools with artificial intelligence and wearable sensors to create adaptive, patient-centered rehabilitation ecosystems.”
