Virtual Reality-Based Upper-Limb Rehabilitation after Stroke: Effects on Upper-Limb Function, Self-Hygiene Performance and Activities of Daily Living - A Literature Review

Stroke frequently results in persistent upper-limb dysfunction, which can limit self-care, activities of daily living (ADL), functional independence, and quality of life. Virtual reality (VR)-based rehabilitation has emerged as a promising approach for providing repetitive, task-oriented, interactive, and engaging upper-limb training. However, although previous studies have reported improvements in motor and functional outcomes, evidence specifically addressing self-care and self-hygiene remains limited. This review aimed to synthesize the available evidence regarding the effectiveness of VR-based upper-limb rehabilitation on upper-limb function, self-care and self-hygiene performance, ADL, functional independence, and quality of life among stroke survivors. A structured literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, supplemented by screening reference lists of relevant publications. Following the predefined screening process, 1,900 records were identified, 650 duplicates were removed, and 100 full-text articles were assessed for eligibility. After full-text screening, 11 studies were included in the qualitative synthesis. The reviewed evidence indicated that VR-based rehabilitation may improve upper-limb motor function, hand function, ADL performance, and quality of life, particularly when used alongside conventional rehabilitation. However, direct evidence regarding self-care and self-hygiene outcomes was comparatively limited. Considerable heterogeneity in VR technologies, intervention protocols, treatment duration, participant characteristics, and outcome measures was observed across studies. Overall, VR appears to be a promising adjunct to conventional stroke rehabilitation, but further high-quality research focusing on meaningful activity-level outcomes, particularly self-hygiene and functional independence, is warranted.

Stroke, Virtual reality, Upper-limb rehabilitation, Activities of daily living, Self-care, Self-hygiene, Functional independence

1. Masiero S, Armani M, Ferlini G, Rosati G, Rossi A. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2014;28(4):377–386. [Google Scholar] [Crossref]

2. Soleimani M, Ghazisaeedi M, Heydari S. The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis. BMC Med Inform Decis Mak. 2024;24:135. [Google Scholar] [Crossref]

3. Lamba D, et al. Effect of virtual reality-based upper limb training on activity of daily living and quality of life among stroke survivors: a systematic review and meta-analysis. J Neuroeng Rehabil. 2025;22:92. [Google Scholar] [Crossref]

4. Diriba K, et al. Immersive virtual reality in stroke rehabilitation: a systematic review and meta-analysis of its efficacy in upper limb recovery. J Clin Med. 2025;14(6):1783. [Google Scholar] [Crossref]

5. Chan WC, Au-Yeung SS. Recovery in the severely impaired arm post stroke after mirror therapy: a randomized controlled study. Am J Phys Med Rehabil. 2018;97(8):572–577. [Google Scholar] [Crossref]

6. Choo PL, Gallagher HL, Morris J, Pomeroy VM, Van Wijck F. Correlations between arm motor behavior and brain function following bilateral arm training after stroke: a systematic review. Brain Behav. 2015;5(12):e00411. [Google Scholar] [Crossref]

7. Mackey F, Ada L, Heard R, Adams R. Stroke rehabilitation: Are highly structured units more conducive to physical activity than less structured units? Arch Phys Med Rehabil. 1996;77:1066–1070. [Google Scholar] [Crossref]

8. Moreno JC, et al. Examining the effectiveness of virtual, augmented, and mixed reality therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis. J Neuroeng Rehabil. 2022;19:93. [Google Scholar] [Crossref]

9. Saposnik G, Levin M, Stroke Outcome Research Canada (SORCan) Working Group. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 2011;42(5):1380–1386. [Google Scholar] [Crossref]

10. Holden MK, Dyar T. Virtual environment training—A new tool for neurorehabilitation? Neurology Report. 2002;26(2):62–71. [Google Scholar] [Crossref]

11. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Stroke. 2018;49(4):e160–e161. [Google Scholar] [Crossref]

12. Levin MF, Weiss PL, Keshner EA. Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys Ther. 2015;95(3):415–425. [Google Scholar] [Crossref]

13. Leong SC, Tang YM, Toh FM, Fong KN. Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis. J Neuroeng Rehabil. 2022;19(1):93. [Google Scholar] [Crossref]

14. Mugisha S, Job M, Zoppi M, Testa M, Molfino R. Computer-mediated therapies for stroke rehabilitation: a systematic review and meta-analysis. arXiv. 2024;2409.20260. [Google Scholar] [Crossref]

15. Harjanto JP, Irawan AA, Ma’ruf I, Silakarma D. Utilization of virtual reality for upper limb motoric rehabilitation of post-stroke patients: a systematic review. Indones J Phys Med Rehabil. 2025;14(1):135–147. [Google Scholar] [Crossref]

16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. [Google Scholar] [Crossref]

17. Moreno JC, et al. Examining the effectiveness of virtual, augmented, and mixed reality therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis. J Neuroeng Rehabil. 2022;19:93. [Google Scholar] [Crossref]

18. Frost Y, Weingarden H, Zeilig G, Nota A, Rand D. Self-care self-efficacy correlates with independence in basic activities of daily living in individuals with chronic stroke. J Stroke Cerebrovasc Dis. 2015;24(7):1649–1655. [Google Scholar] [Crossref]

19. Bower K, Gustafsson L, Hoffmann T, Barker R. Self-management of upper limb recovery after stroke: how effectively do occupational therapists and physiotherapists train clients and carers? Br J Occup Ther. 2012;75(4):180–187. [Google Scholar] [Crossref]

20. Purton J, Sim J, Hunter SM. The experience of upper-limb dysfunction after stroke: a phenomenological study. Disabil Rehabil. 2021;43(23):3377–3386. [Google Scholar] [Crossref]

21. Kwon JS, Park MJ, Yoon IJ, Park SH. Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial. NeuroRehabilitation. 2012;31(4):379–385. [Google Scholar] [Crossref]

22. Kiper P, Godart N, Cavalier M, Berard C, Cieślik B, Federico S, et al. Effects of immersive virtual reality on upper-extremity stroke rehabilitation: a systematic review with meta-analysis. J Clin Med. 2023;13(1):146. [Google Scholar] [Crossref]

23. Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, et al. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial. J Neuroeng Rehabil. 2016;13(1):17. [Google Scholar] [Crossref]

24. Smith R, Burgess C, Sorinola I. The effect of a dysfunctional upper limb on community-dwelling stroke survivors and their carers: an interpretative phenomenological analysis. Physiother Res Int. 2018;23(4):e1726. [Google Scholar] [Crossref]

25. Lin RC, Chiang SL, Heitkemper MM, Weng SM, Lin CF, Yang FC, et al. Effectiveness of early rehabilitation combined with virtual reality training on muscle strength, mood state, and functional status in patients with acute stroke: a randomized controlled trial. Worldviews Evid Based Nurs. 2020;17(2):158–167. [Google Scholar] [Crossref]

26. Goldman-Gerber V, Schwartz I, Rand D. Upper extremity self-efficacy correlates with daily hand-use of individuals with high functional capacity post-stroke. Disabil Rehabil. 2023;45(14):2301–2306. [Google Scholar] [Crossref]

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