Immersive vs. Non-Immersive Virtual Reality in Upper Limb Rehabilitation Post-Stroke: A Systematic Review

Abstract

Background: Virtual reality (VR) has become a commonly used adjunct in post-stroke upper-limb rehabilitation. VR systems are typically categorized as immersive (head-mounted displays [HMDs], 360° virtual environments) or non-immersive (screen-based systems, motion sensors, gaming consoles). Direct comparisons of immersive vs non-immersive VR for upper-limb motor impairment, function and participation are limited.

Objective: To systematically review randomized and controlled studies comparing immersive and non-immersive VR interventions (or comparing each to conventional therapy) for upper-limb recovery after stroke, and to synthesize evidence on motor impairment (FM-UE), dexterity, functional measures (ARAT/BI/FIM), participation and safety.

Methods: PRISMA 2020 methodology was used. We searched PubMed/MEDLINE, Embase, Scopus, PEDro, Cochrane CENTRAL and Google Scholar through September 2025. Included: adults’ post-stroke; immersive or non-immersive VR targeting upper limb; RCTs, controlled clinical trials, and high-quality quasi-experimental studies; outcomes including impairment, dexterity, function, participation. Risk of bias was assessed using RoB-2 (RCTs) and ROBINS-I (non-randomized). Two reviewers performed selection and extraction. Due to heterogeneity, we present a narrative synthesis and study-level data tables.

Results: Twelve primary studies (8 RCTs, 4 controlled/quasi-experimental) with 615 participants were included. Both immersive and non-immersive VR produced improvements over conventional therapy in motor impairment and function across multiple studies. Immersive VR showed relatively larger improvements in gross motor impairment (Fugl-Meyer Upper Extremity; consistent clinically meaningful changes in several trials). Non-immersive VR produced equivalent or superior gains for fine dexterity tasks (Box & Block, NHPT), and was used more frequently in home-based programs. Adherence was high and adverse events were few; immersive systems reported transient simulator sickness in a small minority. Studies had moderate risk of bias (common issues: lack of blinding, small samples, variable dosing).

Conclusions: VR is an effective adjunct to physiotherapy for post-stroke upper-limb rehabilitation. Immersive VR may offer greater gains for proximal/gross motor recovery, while non-immersive systems are practical, accessible, and effective for fine motor/dexterity training. Larger head-to-head RCTs with standardized dosing, longer follow-up and participation-level outcomes are required.