Virtual Reality for Upper Limb Recovery Post-traumatic Brain Injury

Zaibak Dai^*
*Correspondence: Zaibak Dai, Department of Occupational Therapy or Digital Health & Rehabilitation, National Taiwan University, Taipei, Taiwan, Email:

Introduction

Upper limb impairment is one of the most prevalent and functionally disabling consequences following traumatic brain injury (TBI), often affecting a personâ??s ability to perform everyday activities and reducing overall independence. Recovery is often complicated by spasticity, muscle weakness, ataxia and impaired coordination or sensation, especially in the affected hand and arm. Traditional rehabilitation approaches such as occupational therapy, constraint-induced movement therapy (CIMT) and neuromuscular stimulation have long been standard. However, in recent years, virtual reality (VR) has emerged as a promising adjunct or alternative for upper limb motor recovery. VR systems provide immersive, interactive environments that promote repetitive, task-specific movement key elements in motor relearning and neuroplasticity. These systems are designed to simulate real-world tasks, enhancing engagement and motivation while offering real-time feedback. For individuals with TBI, who may also suffer from attention deficits and cognitive fatigue, VRâ??s gamified experience encourages participation more effectively than conventional methods alone [1].

Description

VR-based rehabilitation allows for the customization of exercise difficulty, timing and sensory input to match patient needs, which is critical in a population known for its variability in functional and cognitive profiles. Notably, VR also reduces the monotony of repetitive exercises by introducing variety, virtual challenges and visual rewards, thereby increasing adherence and satisfaction. As a result, VR-based training has been shown to accelerate recovery timelines, improve quality of life and in some cases, enhance cognitive function alongside motor outcomes. The underlying mechanisms behind VRâ??s effectiveness in post-TBI upper limb recovery are rooted in its ability to engage brain plasticity through multisensory stimulation and motor learning principles. Functional MRI studies have shown that VR training activates motor and premotor areas, as well as parietal regions responsible for spatial awareness and sensorimotor integration. When users engage in virtual tasks such as reaching, grasping, or stacking objects, the brain processes these movements similarly to real-life interactions. The immersive nature of VR elicits visuomotor coordination and bilateral upper limb activation, which is particularly useful for patients with unilateral deficits [2].

VR also enables graded exposure to complex tasks, allowing the user to progress from gross to fine motor challenges in a structured manner. Importantly, many systems incorporate motion tracking sensors or gloves, which capture subtle wrist and finger movements that are difficult to quantify with traditional therapy. This allows for more precise measurement of improvements and better calibration of exercise intensity. VRâ??s role in enhancing proprioception and movement symmetry has been noted in trials where patients performed mirror therapy-inspired activities, visually reinforcing correct limb use. In systems utilizing augmented feedback, patients receive visual, auditory, or haptic cues in real time, supporting error correction and improving motor planning. Additionally, adaptive algorithms within some VR platforms modify task difficulty automatically based on performance, keeping the patient in an optimal challenge zone. These factors combined contribute to both motor gains and improved confidence in using the affected upper limb in daily activities, which is a major determinant of long-term rehabilitation success. Clinical evidence supporting VR for upper limb rehabilitation post-TBI is growing, with multiple Randomized Controlled Trials (RCTs), pilot studies and systematic reviews highlighting positive outcomes. Studies have reported significant improvements in Fugl-Meyer Assessment (FMA) upper extremity scores, Box and Block Test (BBT) performance and functional independence measures after VR-based therapy. In a multicenter study involving 120 patients with moderate TBI, VR users showed greater gains in both gross and fine motor skills compared to controls receiving standard occupational therapy alone [3].

Moreover, patients reported higher motivation levels, decreased boredom and greater satisfaction with their therapy regimen. Pediatric TBI populations, who often struggle with engagement in repetitive therapy, have shown particularly strong responses to VR interventions due to the inherently playful and interactive nature of these systems. Importantly, home-based VR solutions are expanding the accessibility of upper limb therapy for patients with transportation challenges or those living in rural areas. Telerehabilitation using VR also enables therapists to monitor performance remotely and adjust tasks accordingly. While VR should not entirely replace hands-on therapy, it has been shown to complement it effectively, particularly when integrated into structured, multidisciplinary rehabilitation programs. Concerns such as cybersickness, visual fatigue, or overstimulation can be mitigated by adjusting session duration and using low-latency, user-friendly systems. Additionally, VRâ??s capacity for standardized protocol delivery ensures consistency across treatment sessions, which is especially beneficial in multi-provider care models. Overall, evidence supports VRâ??s safety, feasibility and efficacy in enhancing upper limb recovery, warranting broader implementation in neurorehabilitation centers. Despite its promise, the integration of VR into standard post-TBI rehabilitation still faces several implementation challenges and research gaps. The initial cost of VR hardware and software, limited training among rehabilitation professionals and variable reimbursement policies are notable barriers to widespread adoption. Moreover, patient selection criteria for VR interventions are still being refined, as individuals with severe cognitive impairments, visuospatial neglect, or epilepsy may require modified protocols or alternative interventions. More longitudinal studies are needed to evaluate the sustainability of VR-related functional gains and to determine optimal intervention frequency and duration. Customization remains a critical factor VR programs must be adaptable not only to motor ability but also to cognitive load, fatigue thresholds and motivational factors [4-5].

Conclusion

Cross-disciplinary collaboration between clinicians, engineers and patients is essential to design effective, accessible and intuitive platforms. The emergence of AI-integrated VR platforms holds potential for even more personalized, predictive therapy planning in the near future. Additionally, integrating biosensors and real-time physiological monitoring into VR sessions may help therapists detect fatigue, emotional state, or pain, allowing for responsive adjustments to therapy. On a systems level, healthcare providers must invest in staff training, infrastructure and outcome tracking tools to successfully implement VR in clinical settings. Furthermore, policy changes supporting insurance reimbursement for digital therapies would facilitate equitable access. In conclusion, virtual reality represents a transformative tool in the rehabilitation of upper limb function post-TBI. As evidence builds and technology evolves, VR has the potential to become a mainstream modality that enhances patient engagement, accelerates recovery and ultimately contributes to a more holistic and effective rehabilitation experience.

Acknowledgement

None.

Conflict of Interest

None.

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