Neuromotor Rehabilitation Research Articles

The Impact of Virtual Reality as a Rehabilitation Method Using TRAVEE System on Functional Outcomes and Disability in Stroke Patients: A Pilot Study

Background: Stroke is the third leading cause of disability. Virtual reality (VR) has shown promising results in post-stroke rehabilitation. The VR TRAVEE system was designed for the neuromotor rehabilitation of the upper limb after a stroke and offers the ability to track limb movements by providing auditory feedback and visual augmentation. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), aligned with the International Classification of Functioning, Disability, and Health (ICF) principles, is a valid tool for measuring disability regardless of its cause. This study aimed to investigate the feasibility of the VR TRAVEE system in upper limb rehabilitation for stroke patients. Methods: A total of 14 stroke patients with residual hemiparesis were enrolled in the study. They underwent a 10-day program combining conventional therapy (CnvT) with VR rehabilitation. At baseline (T0), the upper limb was assessed using the Modified Ashworth Scale (MAS), active range of motion (AROM), and the Numeric Rating Scale (NRS) for pain. These assessments were repeated after the 10-day rehabilitation program (T1). Additionally, disability was measured using WHODAS 2.0 at T0 and again 30 days after completing the program. Results: Significant improvements were observed in AROM and MAS scores for the shoulder, elbow, wrist, and metacarpophalangeal joints, as well as in the reduction in shoulder pain (p ˂ 0.001). WHODAS scores decreased across all six domains, with a statistically significant improvement in the Cognition domain (p = 0.011). Conclusions: Combining CnvT with VR as a rehabilitation approach enhances motor function in the upper limb. This method has the potential to reduce disability scores and promote neuroplasticity.

Effectiveness Of Visual Feedback Balance Training On Equiboard Versus Traditional Balance Training In Post Stroke Patients- A Comparative Study

Background: A Stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause and is a major cause of disability and death worldwide.(1) Balance problems are thought to be common after stroke and they have been implicated in the poor recovery of activities of daily living and mobility and increased risk of falls.(2) Postural sway for patients with hemiplegia can be twice that of their age matched peers. Many balance training are used but No general physiotherapy approach has proven to be superior for promoting balance recovery from stroke.(3)Novel biofeedback devices based on Virtual reality (VR)technology are now being used for neuromotor rehabilitation. Traditional balance training is based on the automatic repetition of specific movements. These methods can become repetitive and thus reduce the motivation of the patient and adherence to treatment. So the need of my study is to compare the effectiveness of visual feedback balance training on equiboard and traditional balance training in post stroke patients. Aims and objectives-To study and compare the effectiveness of visual feedback balance training on equiboard versus traditional balance training in post stroke patients. Methodology- 30 patients with stroke were equally divided into two groups. patients in group A received the conventional physiotherapy while the patients in group B received visual feedback balance training on equiboard. All the subjects were treated for 1 month, 5 days a week. BBS-Berg Balance Scale and step test was used as the outcome measure at the beginning and end of study. Results-Results showed significant improvement within both the groups for both the outcome measure(p,0.05), while there was no significant difference between two groups in BBS(p>0.5), but there was significant difference in the step test of experimental group(p<0.5) Conclusion-It can be concluded that visual feedback balance training is more effective than the traditional balance training alone in stroke patients.

Urgent hybrid repair of a symptomatic dissection-related type ii thoracoabdominal aortic aneurysms.

Emergency repair of type II thoraco-abdominal aortic aneurysms is burdened by high perioperative morbidity and mortality. We report the case of a symptomatic type II post-dissection thoraco-abdominal aortic aneurysm that was treated by mean of a hybrid technique. The repair was carried out through two stages. In the first stage, we deployed two imbricated stent grafts in the descending thoracic aorta. A left carotid to left subclavian artery by-pass was preemptively performed in order to obtain a proper proximal landing zone and as part of the spinal cord protective maneuvers. The endovascular first stage was effective in obtaining proximal sealing but, as expected, did not prevent distal reperfusion of the aneurysmatic false lumen. Few hours later, we moved on to the second stage in which we repaired the aneurysmal distal thoracic and abdominal aortic segment by mean of a multibranched synthetic graft. The repair was carried out through a left thoracophrenolaparotomy in the VII intercostal space. A left passive arterial by-pass and selective cold renal and warm visceral perfusion were adopted in order to provide organ protection. Technical success was achieved and radiologically confirmed. The patient experienced a mild postoperative paraplegia, which almost completely regressed after a neuro-motor rehabilitation program.

Investigations of motor performance with neuromodulation and exoskeleton using leader-follower modality: a tDCS study.

This study investigates how the combination of robot-mediated haptic interaction and cerebellar neuromodulation can improve task performance and promote motor skill development in healthy individuals using a robotic exoskeleton worn on the index finger. The authors propose a leader-follower type of mirror game where participants can follow a leader in a two-dimensional virtual reality environment while the exoskeleton tracks the index finger motion using an admittance filter. The game requires two primary learning phases: the initial phase focuses on mastering the pinching interface, while the second phase centers on predicting the leader's movements. Cerebral transcranial direct current stimulation (tDCS) with anodal polarity is applied to the subjects during the game. It is shown that the subjects' performance improves as they play the game. The combination of tDCS with finger exoskeleton significantly enhances task performance. Our research indicates that modulation of the cerebellum during the mirror game improves the motor skills of healthy individuals. The results also indicate potential uses for motor neurorehabilitation in hemiplegia patients.

Evaluation of Rehabilitation Outcomes in Patients with Chronic Neurological Health Conditions Using a Machine Learning Approach.

Background: Over one billion people worldwide suffer from neurological conditions that cause mobility impairments, often persisting despite rehabilitation. Chronic neurological disease (CND) patients who lack access to continuous rehabilitation face gradual functional decline. The International Classification of Functioning, Disability, and Health (ICF) provides a comprehensive framework for assessing these patients. Objective: This study aims to evaluate the outcomes of a non-hospitalized neuromotor rehabilitation project for CND patients in Italy using the Barthel Index (BI) as the primary outcome measure. The rehabilitation was administered through an Individual Rehabilitation Plan (IRP), tailored by a multidisciplinary team and coordinated by a physiatrist. The IRP involved an initial comprehensive assessment, individualized therapy administered five days a week, and continuous adjustments based on patient progress. The secondary objectives include assessing mental status and sensory and communication functions, and identifying predictive factors for BI improvement using an artificial neural network (ANN). Methods: A retrospective observational study of 128 CND patients undergoing a rehabilitation program between 2018 and 2023 was conducted. Variables included demographic data, clinical assessments (BI, SPMSQ, and SVaMAsc), and ICF codes. Data were analyzed using descriptive statistics, linear regressions, and ANN to identify predictors of BI improvement. Results: Significant improvements in the mean BI score were observed from admission (40.28 ± 29.08) to discharge (42.53 ± 30.02, p < 0.001). Patients with severe mobility issues showed the most difficulty in transfers and walking, as indicated by the ICF E codes. Females, especially older women, experienced more cognitive decline, affecting rehabilitation outcomes. ANN achieved 86.4% accuracy in predicting BI improvement, with key factors including ICF mobility codes and the number of past rehabilitation projects. Conclusions: The ICF mobility codes are strong predictors of BI improvement in CND patients. More rehabilitation sessions and targeted support, especially for elderly women and patients with lower initial BI scores, can enhance outcomes and reduce complications. Continuous rehabilitation is essential for maintaining progress in CND patients.

Optimizing Real-Time MI-BCI Performance in Post-Stroke Patients: Impact of Time Window Duration on Classification Accuracy and Responsiveness.

Brain-computer interfaces (BCIs) are promising tools for motor neurorehabilitation. Achieving a balance between classification accuracy and system responsiveness is crucial for real-time applications. This study aimed to assess how the duration of time windows affects performance, specifically classification accuracy and the false positive rate, to optimize the temporal parameters of MI-BCI systems. We investigated the impact of time window duration on classification accuracy and false positive rate, employing Linear Discriminant Analysis (LDA), Multilayer Perceptron (MLP), and Support Vector Machine (SVM) on data acquired from six post-stroke patients and on the external BCI IVa dataset. EEG signals were recorded and processed using the Common Spatial Patterns (CSP) algorithm for feature extraction. Our results indicate that longer time windows generally enhance classification accuracy and reduce false positives across all classifiers, with LDA performing the best. However, to maintain the real-time responsiveness, crucial for practical applications, a balance must be struck. The results suggest an optimal time window of 1-2 s, offering a trade-off between classification performance and excessive delay to guarantee the system responsiveness. These findings underscore the importance of temporal optimization in MI-BCI systems to improve usability in real rehabilitation scenarios.

Neuromotor rehabilitation and virtual reality: A review

Neuromotor rehabilitation and virtual reality: A review

EEG-based sensorimotor neurofeedback for motor neurorehabilitation in children and adults: a scoping review

ObjectiveTherapeutic interventions for children and young people with dystonia and dystonic/dyskinetic cerebral palsy are limited. EEG-based neurofeedback is emerging as a neurorehabilitation tool. This scoping review maps research investigating EEG-based sensorimotor neurofeedback in adults and children with neurological motor impairments, including augmentative strategies. MethodsMEDLINE, CINAHL and Web of Science databases were searched up to 2023 for relevant studies. Study selection and data extraction were conducted independently by at least two reviewers. ResultsOf 4380 identified studies, 133 were included, only three enrolling children. The most common diagnosis was adult-onset stroke (77%). Paradigms mostly involved upper limb motor imagery or motor attempt. Common neurofeedback modes included visual, haptic and/or electrical stimulation. EEG parameters varied widely and were often incompletely described. Two studies applied augmentative strategies. Outcome measures varied widely and included classification accuracy of the Brain-Computer Interface, degree of enhancement of mu rhythm modulation or other neurophysiological parameters, and clinical/motor outcome scores. Few studies investigated whether functional outcomes related specifically to the EEG-based neurofeedback. ConclusionsThere is limited evidence exploring EEG-based sensorimotor neurofeedback in individuals with movement disorders, especially in children. Further clarity of neurophysiological parameters is required to develop optimal paradigms for evaluating sensorimotor neurofeedback. SignificanceThe expanding field of sensorimotor neurofeedback offers exciting potential as a non-invasive therapy. However, this needs to be balanced by robust study design and detailed methodological reporting to ensure reproducibility and validation that clinical improvements relate to induced neurophysiological changes.

Care Pathways in Rehabilitation for Children and Adolescents with Cerebral Palsy: Distinctiveness of the Adaptation to the Italian Context.

In 2020, a multiprofessional panel was set up in collaboration with the Italian FightTheStroke Foundation family association to produce evidence-based recommendations for the management and neuromotor rehabilitation of persons with cerebral palsy aged 2-18 years to implement in clinical practice in Italy. The recommendations of these care pathways were developed according to the American Academy for Cerebral Palsy and Developmental Medicine guidelines for Care Pathways Development and the Grading of Recommendations Assessment Development and Evaluation working group for adoption, adaptation, or de novo development of recommendations from high-quality guidelines (GRADE-ADOLOPMENT). Four strong positive recommendations were developed regarding comprehensive management, and twenty-four addressed neuromotor treatment. A holistic, individualized approach was affirmed in terms of both multidimensional patient profile and interdisciplinary management in a network with the school where children and adolescents are integrated. It was defined that all motor rehabilitation approaches must be individually tailored considering age and developmentally appropriate activities as interventions and goals, in light of the reference curves addressing prognosis for Gross Motor Function and Manual Ability Classification Systems. Intervention must be structured with adaptations of the task and/or of the context (objects and environment) based on the analysis of the child's skills to support motivation and avoid frustration.

Psychomotric Perspectives of Rehabilitation in Chronic Brachial Plexus Palsies

Background. The perspective of ongoing electric signals within the motor cortex, conditioned by continuous rehabilitation strategies (doubled by adherence to the treatment protocol), is of interest related to understanding how cerebral plasticity is being modulated in adult traumatic brachial plexus (BP) lesions. Very often, patients with chronic BP lesions tend to be less compliant to rehabilitation therapy over time, since multiple reconstructive microsurgery interventions may not always offer a proper upper limb functionality, especially in severe, complex BP cases. Material and methods. In order to asses the ongoing psychomotric projection of the limb’s representation among the motor cortex, in relation with long term rehabilitation protocol we followed up a group of 11 chronic patients, by transcranial magnetic stimulation (TMS) during a time-lapse of two years. Results. Although modest in relation with amelioration of the deficit on the MRC scale, the patients had mild improvements of the parameter latency, but more important, by assessing the amplitude of the motor evoked potential (MEP), we observed a dynamism of the motor area. This we consider suggestive for ongoing psychomotor components stimulated by rehabilitation: ideomotricity, perceptual-motor coordination, laterality and body representation, as a foundation in maintaining a proven measurable potential of continuous neuroplasticity. Conclusion. From clinical perspective, since psychomotricity actually means interdisciplinarity, this is the common denominator found in the collaboration between medical specialties: plastic surgery and reconstructive microsurgery, clinical neurology, electrodiagnostic and neuromotor rehabilitation.

Transferring Sensor-Based Assessments to Clinical Practice: The Case of Muscle Synergies.

Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.

Synchronization of Neurophysiological and Biomechanical Data in a Real-Time Virtual Gait Analysis System (GRAIL): A Proof-of-Principle Study.

The investigation of gait and its neuronal correlates under more ecologically valid conditions as well as real-time feedback visualization is becoming increasingly important in neuro-motor rehabilitation research. The Gait Real-time Analysis Interactive Lab (GRAIL) offers advanced opportunities for gait and gait-related research by creating more naturalistic yet controlled environments through immersive virtual reality. Investigating the neuronal aspects of gait requires parallel recording of brain activity, such as through mobile electroencephalography (EEG) and/or mobile functional near-infrared spectroscopy (fNIRS), which must be synchronized with the kinetic and /or kinematic data recorded while walking. This proof-of-concept study outlines the required setup by use of the lab streaming layer (LSL) ecosystem for real-time, simultaneous data collection of two independently operating multi-channel EEG and fNIRS measurement devices and gait kinetics. In this context, a customized approach using a photodiode to synchronize the systems is described. This study demonstrates the achievable temporal accuracy of synchronous data acquisition of neurophysiological and kinematic and kinetic data collection in the GRAIL. By using event-related cerebral hemodynamic activity and visually evoked potentials during a start-to-go task and a checkerboard test, we were able to confirm that our measurement system can replicate known physiological phenomena with latencies in the millisecond range and relate neurophysiological and kinetic data to each other with sufficient accuracy.

Influence of Temporal and Frequency Selective Patterns Combined with CSP Layers on Performance in Exoskeleton-Assisted Motor Imagery Tasks.

Common Spatial Pattern (CSP) has been recognized as a standard and powerful method for the identification of Electroencephalography (EEG)-based Motor Imagery (MI) tasks when implementing brain-computer interface (BCI) systems towards the motor rehabilitation of lost movements. The combination of BCI systems with robotic systems, such as upper limb exoskeletons, has proven to be a reliable tool for neuromotor rehabilitation. Therefore, in this study, the effects of temporal and frequency segmentation combined with layer increase for spatial filtering were evaluated, using three variations of the CSP method for the identification of passive movement vs. MI+passive movement. The passive movements were generated using a left upper-limb exoskeleton to assist flexion/extension tasks at two speeds (high-85 rpm and low-30 rpm). Ten healthy subjects were evaluated in two recording sessions using Linear Discriminant Analysis (LDA) as a classifier, and accuracy (ACC) and False Positive Rate (FPR) as metrics. The results allow concluding that the use of temporal, frequency or spatial selective information does not significantly ( 0.05) improve task identification performance. Furthermore, dynamic temporal segmentation strategies may perform better than static segmentation tasks. The findings of this study are a starting point for the exploration of complex MI tasks and their application to neurorehabilitation, as well as the study of brain effects during exoskeleton-assisted MI tasks.

The Pencil Exercise

Background: Voluntary posterior shoulder instability is a rare condition, with a prevalence of 0.5% to 2.6% in young adults, in which the patient is able to provoke a dislocation or subluxation through voluntary activation of the muscles. Studies have shown results that highlight the importance of abnormal cortical activation in this population and suggest physiotherapeutic treatment as first line. Indications: Currently, there are a wide range of options of physiotherapeutic treatment for this condition, such as muscle reinforcement, scapulohumeral coordination, and/or muscle activation with electrodes, all with acceptable results. Simple, low-cost neuromotor rehabilitation is based on the simplicity of a different approach. We believe that with distal-proximal neuromotor rehabilitation we can improve a physiological muscle function. Technique Description: The goal of the pencil exercise is to stimulate the cerebral cortex by making circular movements with a pen between the fingers, bridging abnormal voluntary stimulation and activation of the shoulder muscles, allowing the patient to focus, by the view, only on hand movements. Results: In this case, we have achieved the bypass of the abnormal voluntary stimulation and activation of the shoulder muscles and improve the patient's physiological shoulder function with the implementation of the pencil exercise. Conclusion: This technique may be an effective option for the treatment of voluntary posterior shoulder dislocation because it is based on the stimulation of the cerebral cortex and not on traditional physiotherapeutic or surgical interventions. It is important to note that more research is needed to validate the results of this technique and determine its long-term efficacy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A Versatile Embedded Platform for Implementation of Bio Cooperative Control in Upper-Limb Neuro Motor Rehabilitation Scenario ,

This paper presents a versatile embedded platform designed for the implementation of bio-cooperative control in upper-limb neuromotor rehabilitation scenarios. With an increasing demand for effective rehabilitation techniques, particularly in cases of upper-limb impairments, there is a growing need for innovative technologies that can seamlessly integrate with existing rehabilitation protocols. The proposed platform leverages embedded systems technology to offer real-time feedback and control, facilitating personalized and interactive rehabilitation exercises. By incorporating bio- cooperative control strategies, which enable seamless collaboration between the user and the rehabilitation system, the platform aims to enhance engagement and effectiveness of rehabilitation sessions. The platform's versatility allows it to be easily customized and adapted to different rehabilitation scenarios, making it a promising tool for improving outcomes in upper-limb neuromotor rehabilitation.

Wrist EMG Monitoring Using Neural Networks Techniques

In rehabilitation, the correct performance of the exercises the specialist prescribes wrist movement is crucial. However, this may have the disadvantage of the patient’s subjectivity. Moreover, recent studies show that feedback through electrostimulation devices is beneficial during the process that leads to neuromotor rehabilitation. Besides, the electromyographic (EMG) signals give information about the actual degree of rehabilitation. This work examines whether temporal features can be used to classify wrist movements using back-propagation artificial neural networks and superficial EMG (sEMG) signals. The data for the evaluation were based on the information acquired from sEMG signals of two forearm muscles: the flexor carpi ulnaris (FCU) and the brachioradialis (B). These sEMG signals were analyzed to find the most critical parameters for classifying the wrist’s movement and to configure a multilayer perceptron (MLP) capable of classifying such movements.

Human movement modifications induced by different levels of transparency of an active upper limb exoskeleton.

Active upper limb exoskeletons are a potentially powerful tool for neuromotor rehabilitation. This potential depends on several basic control modes, one of them being transparency. In this control mode, the exoskeleton must follow the human movement without altering it, which theoretically implies null interaction efforts. Reaching high, albeit imperfect, levels of transparency requires both an adequate control method and an in-depth evaluation of the impacts of the exoskeleton on human movement. The present paper introduces such an evaluation for three different "transparent" controllers either based on an identification of the dynamics of the exoskeleton, or on force feedback control or on their combination. Therefore, these controllers are likely to induce clearly different levels of transparency by design. The conducted investigations could allow to better understand how humans adapt to transparent controllers, which are necessarily imperfect. A group of fourteen participants were subjected to these three controllers while performing reaching movements in a parasagittal plane. The subsequent analyses were conducted in terms of interaction efforts, kinematics, electromyographic signals and ergonomic feedback questionnaires. Results showed that, when subjected to less performing transparent controllers, participants strategies tended to induce relatively high interaction efforts, with higher muscle activity, which resulted in a small sensitivity of kinematic metrics. In other words, very different residual interaction efforts do not necessarily induce very different movement kinematics. Such a behavior could be explained by a natural human tendency to expend effort to preserve their preferred kinematics, which should be taken into account in future transparent controllers evaluation.

Characterization of Upper Extremity Kinematics Using Virtual Reality Movement Tasks and Wearable IMU Technology.

Task-specific training has been shown to be an effective neuromotor rehabilitation intervention, however, this repetitive approach is not always very engaging. Virtual reality (VR) systems are becoming increasingly popular in therapy due to their ability to encourage movement through customizable and immersive environments. Additionally, VR can allow for a standardization of tasks that is often lacking in upper extremity research. Here, 16 healthy participants performed upper extremity movement tasks synced to music, using a commercially available VR game known as Beat Saber. VR tasks were customized to characterize participants' joint angles with respect to each task's specified cardinal direction (inward, outward, upward, or downward) and relative task location (medial, lateral, high, and/or low). Movement levels were designed using three common therapeutic approaches: (1) one arm moving only (unilateral), (2) two arms moving in mirrored directions about the participant's midline (mirrored), or (3) two arms moving in opposing directions about the participant's midline (opposing). Movement was quantified using an XSens System, a wearable inertial measurement unit (IMU) technology. Results reveal a highly engaging and effective approach to quantifying movement strategies. Inward and outward (horizontal) tasks resulted in decreased wrist extension. Upward and downward (vertical) tasks resulted in increased shoulder flexion, wrist radial deviation, wrist ulnar deviation, and elbow flexion. Lastly, compared to opposing, mirrored, and unilateral movement levels often exaggerated joint angles. Virtual reality games, like Beat Saber, offer a repeatable and customizable upper extremity intervention that has the potential to increase motivation in therapeutic applications.

Aphasia improvement without logotherapy during motor neurorehabilitation of post-stroke hemiparesis using virtual reality or modified constraint-induced movement therapy: A retrospective cohort.

Some research suggests that post-stroke aphasia can recover "on its own", however, there is evidence of a common neural substrate for motor and language systems. We hypothesize, that motor neurorehabilitation of hemiparesis could be related to simultaneous improvement in aphasia. To measure changes in post-stroke aphasia and its relation with hemiparesis treated with different therapies. Database information (n = 32) on post-stroke hemiparesis (Fugl-Meyer Scale evaluated) managed with virtual reality (VR) versus modified constraint-induced movement therapy (mCIMT) or regular therapy (rPT/OT) was analyzed. None received logotherapy (LT) by appointment at four months. < 3 months after the stroke, aphasia severe (Boston Aphasia Intensity Scale), and all three evaluations. Twenty-one patient records met inclusion criteria (71,4% women and mean age 66,67±3,13 years) who received VR, mCIMT, or rPT/OT (n = 6, 8, and 7, respectively). There was continuous intra-groups improvement in aphasia (p < 0.05), but inter-groups the greater aphasia recovery (p = 0.05) and hemiparesis (p = 0.02) were in VR, with a high correlation in evolution between them (r = 0.73; p = 0.047). High clinical correlation between aphasia, without LT, and hemiparesis evolution during motor neurorehabilitation would support common neural connections stimulation. We will conduct a clinical trial, with a larger sample size to contrast our hypothesis.

A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation.

Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia -Virtual Reality Rehabilitation System, for treatment purposes. We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed and PubMed Central) for studies published until November 23, 2023. 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis.