Virtual Reality in the balance and the gait of post-stroke patients – an integrative review

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Abstract
Background: A cerebral vascular accident (CVA) is an event that compromises the central nervous system (CNS), leading to functional limitations. Virtual Reality (VR) has been proposed as a novel technological tool for rehabilitation, as it extends beyond treatment, providing motivation to patients. This study aims to evaluate the evidence of gait and balance rehabilitation using Virtual Reality (VR) in a population of adults and elderly individuals post-stroke in personalized virtual environments and commercially available gaming systems. Methods: The databases used in this study were selected as major research sources in the health and engineering fields. They include Pubmed, IEEE, PMC, Sciencedirect, Springer, and Bireme. Article searches were conducted, restricting the publication period to 2014-2024. The search descriptors followed the MESH/DECS terms: Stroke, Virtual Reality, Gait, Balance and Ecercise Therapy. Controlled trials comparing VR to conventional rehabilitation were included. Population criteria included adults and the elderly post-stroke, excluding children, cerebral palsy, and other neurological disorders associated with gait and balance disturbances. Results: The search in the established databases yielded 1,711 studies, of which 115 were excluded due to duplication, 1,403 after title and abstract screening, and 182 after full-text reading. Thus, 11 studies met the inclusion criteria. Conclusions: VR rehabilitation moderately improves outcomes compared to conventional rehabilitation in adults and the elderly post-stroke. However, current interventions have small sample sizes to precisely evaluate their overall benefits. Future research should analyze the activities performed, participation, and assessment measures, and investigate commercially available VR systems.

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