Enhancing safety-critical procedural training for battery energy storage systems using immersive virtual reality

ObjectivesTo assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms.Materials and MethodsCare homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach.ResultsForty-eight care staff completed AR training (n = 19), immersive VR training (n = 21), or non-immersive VR training (n = 8). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset.ConclusionsAR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.

Immersive virtual reality can expose humans to novel training and sensory environments, but motor training with virtual reality has not been able to improve motor performance as much as motor training in real-world conditions. An advantage of immersive virtual reality that has not been fully leveraged is that it can introduce transient visual perturbations on top of the visual environment being displayed. The goal of this study was to determine whether transient visual perturbations introduced in immersive virtual reality modify electrocortical activity and behavioral outcomes in human subjects practicing a novel balancing task during walking. We studied three groups of healthy young adults (5 male and 5 female for each) while they learned a balance beam walking task for 30 min under different conditions. Two groups trained while wearing a virtual reality headset, and one of those groups also had half-second visual rotation perturbations lasting ~10% of the training time. The third group trained without virtual reality. We recorded high-density electroencephalography (EEG) and movement kinematics. We hypothesized that virtual reality training with perturbations would increase electrocortical activity and improve balance performance compared with virtual reality training without perturbations. Our results confirmed the hypothesis. Brief visual perturbations induced increased theta spectral power and decreased alpha spectral power in parietal and occipital regions and improved balance performance in posttesting. Our findings indicate that transient visual perturbations during immersive virtual reality training can boost short-term motor learning by inducing a cognitive change, minimizing the negative effects of virtual reality on motor training. NEW & NOTEWORTHY We found that transient visual perturbations in virtual reality during balance training can boost short-term motor learning by inducing a cognitive change, overcoming the negative effects of immersive virtual reality. As a result, subjects training in immersive virtual reality with visual perturbations have equivalent performance improvement as training in real-world conditions. Visual perturbations elicited cortical responses in occipital and parietal regions and may have improved the brain's ability to adapt to variations in sensory input.

Virtual reality (VR) experiences are receiving increasing attention in education and training. Some VR setups can deliver immersive VR training (e.g., on multiple projected screens), while others can deliver nonimmersive VR training (e.g., on standard desktop monitors). Recently, consumer VR headsets make it possible to deliver immersive VR training with six-degrees-of-freedom tracking of trainees' head as well as hand controllers, while most smartphones can deliver nonimmersive VR training without the need for additional hardware. Previous studies compared immersive and nonimmersive VR setups for training, highlighting effects on performance, learning, presence, and engagement, but no study focused on contrasting procedural training with (immersive) VR headsets and (nonimmersive) smartphones. This article conducts a comparison of these two VR setups in the aviation safety domain. The considered training concerned door opening procedures in different aircraft and included a virtual instructor. In addition, we compared the two VR setups with the traditional printed materials used in the considered domain, i.e., safety cards. Results show that both VR setups allowed gaining and retaining more procedural knowledge than printed materials, and led to higher confidence in performing procedures. However, only the VR headset was considered to be significantly more usable than the printed materials, and presence was higher with the VR headset than the smartphone. The VR headset turned out to be important also for engagement and satisfaction, which were higher with the VR headset than both the printed materials and the smartphone. We discuss the implications of these results.

In Japan, task shifting and sharing are promoted to reduce the workload of physicians. Radiological technologists have been assigned new responsibilities, such as securing venous access for radiopharmaceutical administration. This study aimed to develop a prototype Virtual Reality (VR) training system that allows safe and repeatable training for radiological technologists. Additionally, the educational effectiveness of VR training was evaluated, and the concentration levels of the participants were assessed using multiple physiological indicators. Overall, 17 male and 12 female participants (mean age 20.1 ± 0.9 years) were enrolled in this study and classified into two groups-video-based and immersive VR system groups-both of which simulated radiopharmaceutical administration. Concentration and tension levels were evaluated using electroencephalography (EEG) data, salivary amylase levels, and mood assessments. The educational effectiveness was evaluated using a multiple-choice cognitive test. Compared with the resting levels, the alpha/beta ratio of EEG (indicating relaxed concentration) was significantly decreased by 19% in the video-based VR and increased by 40% in the immersive VR groups (both p < 0.05). No significant difference was observed in salivary amylase levels between the two groups. The cognitive test scores, increased by 2.0 and 3.4 points in the video-based VR and immersive VR groups, respectively; a significant difference was observed between both groups (p < 0.05). However, no correlation was found between the EEG ratio and test performance. Thus, immersive VR promotes a more relaxed and concentrated state and was found to have higher educational effectiveness than video-based VR. This suggests that participatory VR training may be more effective than observational VR training. Further research should explore the relationship between educational effectiveness and the evaluation of medical skills.

Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training. A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance. Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics. Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.

Cataract surgery is the most common incisional surgical procedure in ophthalmology and is important in ophthalmic graduate medical education. Although most ophthalmology training programs in the United States (US) include virtual reality (VR) training for cataract surgery, comprehensive reviews that detail the impact of VR training on ophthalmology trainee performance are lacking. To assess the impact of VR training for cataract surgery on the operating performance of postgraduate ophthalmology trainees, measured by operating time, intraoperative complications, postoperative complications, supervising physician ratings, and VR simulator task ratings. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 14 June 2021. We included randomized controlled trials (RCTs) comparing VR training to any other method of training, including non-VR simulation training (e.g., wet laboratory training), didactics training, or no supplementary training in postgraduate ophthalmology trainees. We used standard Cochrane methodology. Primary outcomes were operating times in the operating room and intraoperative complications. Secondary outcomes were operating times in simulated settings, simulator task ratings, and supervising physician ratings, either in the operating room or simulated settings. We included six RCTs with a total of 151 postgraduate ophthalmology trainees ranging from 12 to 60 participants in each study. The included studies varied widely in terms of geography: two in the US, and one study each in China, Germany, India, and Morocco. Three studies compared VR training for phacoemulsification cataract surgery on the Eyesi simulator (VRmagic, Mannheim, Germany) with wet laboratory training and two studies compared VR training with no supplementary training. One study compared trainees who received VR training with those who received conventional training for manual small incision cataract surgery on the HelpMeSee simulator (HelpMeSee, New York, NY). Industry financially supported two studies. All studies had at least three domains judged at high or unclear risks of bias. We did not conduct a meta-analysis due to insufficient data (i.e., lack of precision measurements, or studies reported only P values). All evidence was very low-certainty, meaning that any estimates were unreliable. The evidence for the benefits of VR training for trainees was very uncertain for primary outcomes. VR-trained trainees relative to those without supplementary training had shorter operating times (mean difference [MD] -17 minutes, 95% confidence interval [CI] -21.62 to -12.38; 1 study, n = 12; very low-certainty evidence). Results for operating time were inconsistent when comparing VR and wet laboratorytraining: one study found that VR relative to wet laboratory training was associated with longer operating times (P = 0.038); the other reported that two training groups had similar operating times (P = 0.14).One study reported that VR-trained trainees relative to those without supplementary training had fewer intraoperative complications (P < 0.001); in another study, VR and conventionally trained trainees had similar intraoperative complication rates (MD -8.31, 95% CI -22.78 to 6.16; 1 study, n = 19; very low-certainty evidence). For secondary outcomes, VR training may have similar impact on trainee performance compared to wet laboratoryand greaterimpact compared to no supplementary training, but the evidence was very uncertain. One study reported VR-trained trainees relative to those without supplementary training had significantly reduced operating time in simulated settings (P = 0.0013). Another study reported that VR-trained relative to wet laboratory-trained trainees had shorter operating times in VR settings (MD -1.40 minutes, 95% CI -1.96 to -0.84; 1 study, n = 60) and similar times in wet laboratory settings (MD 0.16 minutes, 95% CI -0.50 to 0.82; 1 study, n = 60). This study also found the VR-trained trainees had higher VR simulator ratings (MD 5.17, 95% CI 0.61 to 9.73; 1 study, n = 60). Results for supervising physician ratings in the operating room were inconsistent: one study reported that VR- and wet laboratory-trained trainees received similar supervising physician ratings for cataract surgery (P = 0.608); another study reported that VR-trained trainees relative to those without supplementary training were less likely to receive poor ratings by supervising physicians for capsulorhexis construction (RR 0.29, 95% CI 0.15 to 0.57). In wet laboratory settings, VR-trained trainees received similar supervising physician ratings compared with wet laboratory-trained trainees (MD -1.50, 95% CI -6.77 to 3.77; n = 60) and higher supervising physician ratings compared with trainees without supplementary training (P < 0.0001). However, the results for all secondary outcomes should be interpreted with caution because of very low-certainty evidence. AUTHORS' CONCLUSIONS: Current research suggests that VR training may be more effective than no supplementary training in improving trainee performance in the operating room and simulated settings for postgraduate ophthalmology trainees, but the evidence is uncertain. The evidence comparing VR with conventional or wet laboratory training was less consistent.

Safety training is an important factor in preventing and reducing work-related accidents. As workplaces look for ways to improve safety outcomes, increasing the effectiveness of safety training continues to be an important factor. Interest in virtual reality (VR) training has grown substantially in recent years due to the emergence of affordable, consumer-grade VR technologies. The ability to simulate hazardous and difficult-to-access scenarios and environments provides the opportunity for practical hands-on training otherwise difficult to achieve. VR also provides the opportunity for trainees to fail safely increasing the appeal for safety–critical sectors. This study investigates the preliminary effectiveness of VR training for ozone generator isolation training compared to traditional training methods. Measures included are reaction, learning (i.e., knowledge gain and knowledge retention), and training duration. A mixed design was used with between-groups cross-sectional comparisons (N = 33) and a longitudinal evaluation on knowledge retention (N = 29). The VR training group reported significantly higher reaction results and took significantly less time to complete the training when compared with the traditional training group with no significant differences in learning outcomes. Overall, the results suggest that VR training can be a viable tool for delivering ozone generator isolation training. Further investigation is needed to evaluate the effectiveness of VR safety training in influencing behavioral change and reducing work-related accidents.

Immersive Virtual Reality (IVR) technology has been shown to effectively facilitate fire safety training. However, the current discourse on immersive safety training provides scarce knowledge on the quality of immersive safety training from the perspective of safe spaces. In turn, the general notion of a safe space – being an environment that is characterized by the freedom to move, share, talk, and act freely without risk for physical or mental damage – needs further elaboration in an IVR training context where the experience of safety is highly interrelated with embodiment and immersion. This study employed thus a phenomenological approach to explore and conceptualize characteristics of immersive safe spaces. This was done through phenomenological interviews with employees at Sweden’s largest train operating company, which undertook fire safety training in IVR by using an IVR application known as the “Fire Trainer”. The interview material was then analyzed through an Interpretative Phenomenological Analysis (IPA) that conceptualized four themes for characterizing immersive safe spaces: Sense of Authentic Hazard Recognition, Sense of Behavioral Responsiveness, Sense of Intersubjective Risk Perception, and Sense of Embodied Atmosphere. Implications of conceptualizing the themes are targeted towards understanding the quality of being/feeling safe during safety training in IVR, and how the design of future immersive fire safety environments might benefit from employing the proposed themes.

BackgroundIt appears that active video games (AVGs) and training apps that allow for physical activity (PA) in immersive virtual reality (VR) may be useful for sports, health-enhancing PA, and physical education (PE). Therefore, research is needed to identify their potential.ObjectiveThe study aimed to evaluate the intensity and attractiveness of exercise during table tennis (TT) training in VR in arcade and simulation modes and to assess the potential for using such exercises in health-enhancing PA, sport, and PE.MethodsThe research used the Racket Fury: Table Tennis VR. Exercise intensity during TT training in VR was evaluated by heart rate (HR) monitoring and rating of perceived exertion (RPE 6–20). The effectiveness of short-term TT training in VR was estimated based on the user’s performance in playing against an opponent with artificial intelligence (AI), satisfaction with playing TT was measured using the Physical Activity Enjoyment Scale (PACES), and the potential usefulness of the tested app in PA, sport, and PE was assessed based on a questionnaire for participating PE teachers (30 participants).ResultsPA intensity during TT training in VR expressed as a percentage of maximum heart rate (HRmax) was moderate but was significantly (p < 0.001; d=-0.830) higher in the easier arcade mode (69.50 ± 12.58%HRmax) than in the simulation mode (64.10 ± 9.67%HRmax). Despite the greater fatigue of respondents, user satisfaction was significantly higher in arcade mode. Users’ performance when playing with AI was significantly better after 20 min of training in VR than before training. PE teachers recognize the great potential of the app.ConclusionsThe application tested is characterized by a beneficial PA intensity, with its level depending on the game mode. Facilitating strokes during a game of virtual TT promotes increased intensity of exercise and increased enjoyment of the PA. Short-term TT training in VR improves playing skills in a virtual environment. PE teachers spoke highly of the app and recognized the potential for using VR technology in PA, sports, and school PE.

PurposeThis study evaluated the effectiveness of virtual reality (VR) training versus traditional methods in enhancing radiation safety practices among cardiologists and scrub nurses. Developed by Virtual Medical Coaching, VR training simulates radiation safety scenarios in cardiac catheterization laboratories (Cath Labs). MethodsA three-year crossover study was conducted with 150 healthcare professionals (in this study, healthcare professionals are defined as cardiologists and scrub nurses who work in Cath Labs) at five urban hospitals. These professionals are key personnel in fluoroscopy-guided interventional procedures, where radiation safety is a critical concern.Participants, stratified by profession, were randomly assigned to initially receive either VR (virtual medical coaching) or traditional training, followed by a year-long washout period before switching training modalities. Primary outcomes measured changes in radiation exposure via dosimeters, whereas secondary outcomes assessed knowledge retention. ResultsVR training significantly reduced radiation exposure, resulting in a 30% greater decrease in radiation dose than traditional methods do. Cardiologists in Group A (VR training) experienced a mean reduction of 3.37 (p < 0.001), whereas scrub nurses experienced a mean reduction of 2.89 (p < 0.001). In contrast, participants in Group B (traditional training) exhibited a smaller reduction of 1.75 for cardiologists (p < 0.001) and 1.49 for scrub nurses (p < 0.001). The participants transitioning from traditional to VR training demonstrated enhanced retention and application of safety protocols, as reflected by improved knowledge and observed structured clinical examinations (OSCE) scores. The integration of VR into training notably improved procedural knowledge and skills without the risk of radiation exposure, making VR an effective tool for radiation safety education. ConclusionThis study highlights the superiority of VR training in reducing radiation exposure and enhancing practical skills among medical professionals. Virtual medical coaching’s specialized VR modules effectively simulate real-world scenarios, making them valuable components in radiation safety training. The findings advocate the integration of VR into medical education curricula to improve safety standards and training efficacy.

Cognitive frailty-defined as the coexistence of physical frailty and mild cognitive impairment without dementia-has gained attention as a potentially reversible condition linked to functional decline, disability, and future dementia. Traditional motor-cognitive or physical training programs can be beneficial, yet they often suffer from low engagement and limited ecological relevance. Immersive virtual reality (VR) has emerged as a promising alternative because it provides interactive, multisensory environments capable of simultaneously stimulating cognitive and motor processes. Although several trials have evaluated VR in older adults with cognitive frailty, the overall effect remains uncertain. Recent meta-analyses have generally been broad in scope, combining heterogeneous populations or non-immersive VR systems, and no review has specifically focused on immersive motor-cognitive VR in individuals formally diagnosed with cognitive frailty. To evaluate whether immersive motor-cognitive VR improves global cognition and physical frailty in adults with cognitive frailty. Five databases were searched through March 09, 2026, for randomized controlled trials using immersive or semi-immersive motor-cognitive VR in adults diagnosed with cognitive frailty. Global cognition was the primary outcome and physical frailty the secondary. Pooled effect sizes were calculated using SMDs or MDs with 95% CIs. Risk of bias was assessed with Cochrane criteria, and certainty of evidence with GRADE. Three randomized controlled trials (n = 344) comparing VR-based interventions with non-VR control conditions demonstrated a significant improvement in global cognitive function (SMD = 0.50; 95% CI 0.14-0.85; I 2 = 39%). Two trials (n = 278) that used whole-body VR reported reductions in frailty severity (MD = -0.26; 95% CI -0.47 to -0.04; I 2 = 0%). Immersive motor-cognitive VR may improve both cognitive function and frailty severity in adults with cognitive frailty. Evidence remains limited by the small number of trials and variation in VR systems and intervention protocols. Larger, high-quality studies are needed to confirm these findings. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251234169, PROSPERO database CRD420251234169.

This review provides a critical analysis of the findings from studies that investigated the effects of virtual reality (VR) and augmented reality (AR) training on the cognitive and sensorimotor skills of soccer players. A systematic search was conducted to identify studies reporting pre-post intervention outcomes related to (1) cognitive performance measured in traditional laboratory tasks, (2) cognitive-motor skills assessed with on-pitch tasks (e.g., heading), and (3) various self-report measures. The search was conducted in PubMed, Web of Science and SPORTDiscus databases, using the keywords soccer OR football AND virtual reality OR augmented reality AND cognitive OR cognitive-motor OR self-report, along with equivalent entry terms. Article selection followed the PRISMA 2020 guidelines. Of 289 records identified, 7 studies met the inclusion criteria. All included studies reported significant improvements in the VR and AR training groups, particularly in cognitive variables measured with reaction time and accuracy; cognitive-motor skills such as heading, passing, and shooting; and self-reported outcomes including perceived efficiency, self-confidence and sports engagement. One study also reported structural and functional brain adaptations following VR training. In conclusion, the findings of this systematic review support the potential of VR and AR training as an effective approach to improve cognitive-motor performance in soccer players. These results highlight that VR and AR can serve as effective tools in soccer training programmes, complementing traditional training. Open questions relating to the topic of the review are identified and are proposed as targets for future research.

Virtual reality (VR)–based training has not yet fulfilled all expectations placed on it in the nuclear domain. Therefore, it is important to try to understand and identify possible causes of disappointments and difficulties in the adoption of VR technology in the training of nuclear operations. We conducted a case study, including expert interviews (on training and technological development points of view) and an explorative VR simulator test (involving field operators, i.e. user perspective), in one Finnish nuclear power plant that can be considered a pioneering agent in the field of VR training in the energy industry. A detailed examination of their participatory development approach for designing VR training for field operators revealed that a close collaboration between different stakeholder groups is required to optimize the VR training design process as well as the resulting outcomes. According to the interviews with technical developers, some technological advancements are needed before VR technology can be more extensively adopted in field operator training. However, they expect that further development of VR technology soon will pave the way for a more extensive application of VR in training of operative personnel. The trainers saw VR technologies as one possible option among many other tools and methods for learning. However, their main concern in the application of VR in training was about the added value and cost effectiveness of VR-based training. The usability of the VR training tools was another source of criticism. Even though the end users perceived the VR environment and training as positive, their opinions differed in terms of the value placed on VR training. Some participants thought that VR has a lot of potential for field operator training, whereas some of them were more skeptical and considered the less immersive alternatives as more viable.

Person’s immersion in computer virtual reality (VR) is accompanied by numerous distortions in his/her perception due to the replacement of sensory stimuli coming through visual, auditory and partially proprioceptive channels. In this case, the person’s own body becomes an immersion tool, since its movements indirectly affect the movement of the avatar in VR. Performing actions in VR on behalf of the avatar contributes to the appearance of distortions in the perception of one’s own body due to the diffuse effect of actualizing the operational image at the moment of purposeful activity (the subjective body image is modified in accordance with the need to adapt to VR conditions). There are various ways of immersing in VR, taking into account the different degree of involvement of individual parts of the recipient’s real body in controlling a digital character. Thus, the full-body tracking (FBT) technology is becoming widespread, allowing the use of almost all human gross motor skills for projection onto the movements of the avatar. The purpose of the study was to establish the specific features of the distortion of a person’s perception of the size of his/her own body, after its being immersed in computer virtual reality, and the control over the avatar using the FBT technology. The study was conducted in two stages (in 2020 and 2021) in order to compare the intensity and direction of body image distortions of the subjects when they were immersed with and without the FBT technology. The OhShape VR app for mobile immersion without FBT and a modification of the VR Chat app for mobile immersion with FBT were used as experimental exposures. Psychometric data on the subjects’ perception of their own bodies were obtained using the psychometric data on the subjects’ perception of their own bodies were obtained using Moshe Feldenkrais’ methods for physical measurements. According to the results of the study, the use of FBT during immersion in VR leads to distortions in the perception of various body sizes by the subjects, including the trunk and legs, while mobile immersion without the use of FBT only causes distortions in the perception of the dimensions of the upper shoulder girdle. It should be noted that this observation testifies to the connection of distortions with the facts of the involvement of the corresponding parts of the real body of the subjects in the process of controlling the avatar. It is concluded that there are specific distortions in the perception of a person’s own body when being immersed in VR using FBT. Finally, an assumption is made about the possible connection of these distortions with the success of performing intra-environment mobile tasks.

Neurological rehabilitation is technologically evolving rapidly, resulting in new treatments for patients. Stroke, one of the most prevalent conditions in neurorehabilitation, has been a particular focus in recent years. However, patients often need help with physical and cognitive constraints, whereby the cognitive domain in neurorehabilitation does not technologically exploit existing potential. Usually, cognitive rehabilitation is performed with pen and paper or on a computer, which leads to limitations in preparation for activities of daily living. Technologies such as virtual reality (VR) can bridge this gap. This pilot study investigated the use of immersive VR in cognitive rehabilitation for patients undergoing inpatient neurorehabilitation. The goal was to determine the difference in rehabilitation effectiveness between a VR serious game that combines everyday activities with cognitive paradigms and conventional computerized cognitive training. We hypothesized the superiority of the VR serious game regarding cognitive abilities and patient-reported outcomes as well as transfer to daily life. We recruited 42 patients with acute brain affection from a German neurorehabilitation clinic in inpatient care with a Mini Mental Status Test score >20 to participate in this randomized controlled trial. Participants were randomly assigned to 2 groups, with 1 receiving the experimental VR treatment (n=21). VR training consisted of daily life scenarios, for example, in a kitchen, focusing on treating executive functions such as planning and problem-solving. The control group (n=21) received conventional computerized cognitive training. Each participant received a minimum of 18 treatment sessions in their respective group. Patients were tested for cognitive status, subjective health, and quality of life before and after the intervention (Alters-Konzentrations-Test, Wechsler Memory Scale-Revised, Trail Making Test A and B, Tower of London-German version, Short Form 36, European Quality of Life 5 Dimensions visual analog scale, and Fragebogen zur Erfassung der Performance in VR). Repeated-measures ANOVA revealed several significant main effects in the cognitive tests: Tower of London-German version (P=.046), Trail Making Test A (P=.01), and Wechsler Memory Scale-Revised (P=.006). However, post hoc tests revealed that the VR group showed significant improvement in the planning, executive control, and problem-solving domains (P=.046, Bonferroni P=.02). In contrast, no significant improvement in the control group between t0 and t1 was detected (all P>.05). Furthermore, a nonsignificant trend was observed in visual speed in the VR group (P=.09, Bonferroni P=.02). The results of this pilot randomized controlled trial showed that immersive VR training in cognitive rehabilitation had greater effectiveness than the standard of care in treating patients experiencing stroke in some cognitive domains . These findings support the further use and study of VR training incorporating activities of daily living in other neurological disorders involving cognitive dysfunction. Federal Registry of Clinical Trials of Germany (DRKS) DRKS00023605; https://drks.de/search/de/trial/DRKS00023605.