Virtual Reality-Based Telerehabilitation for Upper Limb Recovery Post-Stroke: A Systematic Review of Design Principles, Monitoring, Safety, and Engagement Strategies

Stroke rehabilitation continues to face challenges in accessibility and patient engagement, where traditional approaches often fall short. Virtual reality (VR)-based telerehabilitation offers a promising avenue, by enabling home-based recovery through immersive environments and gamification. This systematic review evaluates current VR solutions for upper-limb post-stroke recovery, focusing on design principles, safety measures, patient-therapist communication, and strategies to promote motivation and adherence. Following PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed, IEEE Xplore, and ScienceDirect. The review reveals a scarcity of studies meeting the inclusion criteria, possibly reflecting the challenges inherent in the current paradigm of VR telerehabilitation systems. Although these systems have potential to enhance accessibility and patient autonomy, they often lack standardized safety protocols and reliable real-time monitoring. Human-centered design principles are evident in some solutions, but inconsistent patient involvement during the development process limits their usability and clinical relevance. Furthermore, communication between patients and therapists remains constrained by technological barriers, although advancements in real-time feedback and adaptive systems offer promising solutions. This review underscores the potential of VR telerehabilitation to address critical needs in upper-limb stroke recovery while highlighting the importance of addressing existing limitations to ensure broader clinical implementation and improved patient outcomes.