Immersive Technologies of Virtual and Augmented Reality (VR/AR) in Patient-Centered Neurorehabilitation.

Abstract

Neurological disorders affect more than three billion individuals worldwide. Conventional neurorehabilitation is constrained by therapist dependency, limited treatment intensity, poor patient adherence, and restricted accessibility. VR/AR technologies offer immersive, high-dose, and remotely-deliverable alternatives to address these challenges. To synthesize current evidence on VR/AR applications in major neurological disorders; to evaluate alignment with patient-centered care principals, to assess relevant technological aspects and clinical outcomes, and to identify economic considerations, research gaps, and future directions. A narrative review was conducted using searches from large databanks, encompassing clinical trials, systematic reviews, and meta-analyses of VR/AR interventions in stroke, traumatic brain injury (TBI), spinal cord injury (SCI), Parkinson's diseases (PD), and multiple sclerosis (MS). Evidence was synthesized against a neurobiological and patient-centered care framework. VR and AR demonstrated clinically relevant potential across the neurological conditions examined. In stroke, VR added to conventional therapy produced moderate-certainty improvements in upper-limb motor recovery and balance. AR cueing significantly reduced freezing-of-gait duration and incidence in PD. VR interventions improved balance results in MS beyond those achieved with conventional therapy. In incomplete SCI, a large effect size on balance was reported, although with high heterogeneity. Some evidences support VR-based cognitive rehabilitation in TBI. Economic analysis indicated acceptable incremental cost-effectiveness and reimbursement pathways are emerging in several healthcare systems. VR/AR technologies are promising patient-centered tools in neurorehabilitation. Key gaps including absence of standardized reporting protocols, insufficient large multicentre trials, long-term data lacking from low-resource-settings. Addressing these gaps is essential for equitable, evidence-based global implementation.