Francesco Rundo

Virtual reality (VR) is evolving from a platform for cognitive exercises into an instrumented rehabilitation environment capable of simultaneously delivering treatment and quantifying behavior. This critical narrative review examines how behavioral, ocular, kinematic, physiological, and neurophysiological signals can be transformed into clinically meaningful digital measures, candidate biomarkers, adaptive interventions, and real-world functional outcomes. PubMed/MEDLINE, Scopus, and IEEE Xplore were searched from database inception to 20 September 2026, supplemented by backward and forward citation searching and targeted searches. Clinical, methodological, validation, and directly relevant technical studies were considered, including studies in healthy participants when methodologically informative. Of 690 records identified, 145 duplicates were removed; 545 unique records were screened and 303 formed the candidate evidence pool for critical narrative appraisal. Behavioral and interaction-derived measures are the most established, while eye tracking, kinematic sensing, autonomic monitoring, EEG, and fNIRS provide complementary information on attention, strategy, workload, and engagement. Quantitatively, combined hand- and eye-tracking features distinguished mild cognitive impairment from healthy controls with 93.3% accuracy, 100% sensitivity, and 83.3% specificity, while immersive VR life-skills training produced real-world functional gains of d = 1.00 post-training and d = 1.12 at 1-week follow-up. However, most sensor-derived variables remain digital measures or candidate biomarkers rather than clinically validated biomarkers; physiology-informed closed-loop adaptation is uncommon, and evidence that such adaptation produces sustained ADL or assisted-living benefits is lacking. Progress now depends on standardized reporting, external and multicenter validation, clinically interpretable adaptive models, and objective demonstration of real-world transfer.

Extended reality (XR) platforms may support cognitive and functional interventions in mild cognitive impairment (MCI), but their clinical feasibility depends on perceived usability, comfort, and user acceptance. This exploratory pilot study examined subjective acceptability of three integrated XR device–task configurations: a non-immersive Touch TV configuration, a semi-immersive Cave Automatic Virtual Environment (CAVE) configuration, and a fully immersive head-mounted display (HMD) configuration. The study included 21 individuals with MCI and 10 cognitively healthy controls. Participants experienced all three device–task configurations in randomized order and completed the Digital Immersion Satisfaction Questionnaire (Qu.G.I.D.), an ad hoc instrument assessing digital literacy, perceived ease of use, preference, and willingness to use the configurations for future applications. Perceived ease of use scores were generally high and did not differ significantly between groups. Repeated-measures exploratory analyses showed no statistically robust configuration effect for perceived ease of use or preference scores. CAVE was numerically the most frequently selected device–task configuration for future applications, but this difference was not statistically significant when non-mutually exclusive selections were analyzed using Cochran’s Q. Digital literacy was not positively associated with Touch TV preference. Because device type, level of immersion, interaction modality, and task content were not experimentally separable, these findings cannot determine whether ratings reflected hardware characteristics or the specific activities performed. The results should therefore be interpreted as preliminary descriptive self-report acceptability and acceptability data, not as evidence of comparative device–task configurations effectiveness. Larger, balanced, counterbalanced studies using validated usability scales, objective performance metrics, interaction-quality measures, and cybersickness assessment are required before hypotheses for future controlled studies can be formulated.

Background: Cognitive decline across the mild cognitive impairment (MCI)–dementia continuum is a major driver of loss of independence and growing health- and social-care burden. Immersive technologies, such as virtual reality (VR), augmented reality (AR), and Cave Automatic Virtual Environment (CAVE) systems, are increasingly explored as tools to enhance engagement, personalization, and ecological validity in cognitive rehabilitation. Objective: This systematic review synthesizes current evidence on the usability, therapeutic effects, and implementation challenges of immersive technologies for cognitive rehabilitation in MCI and dementia. Methods: A systematic search of Scopus and Web of Science was conducted for peer-reviewed journal articles published between 2021 and 2026. Eligible studies investigated VR, AR, or CAVE interventions targeting cognitive rehabilitation outcomes in MCI and/or dementia and reported measures related to usability or acceptability, or cognitive, functional, or behavioral outcomes. Due to heterogeneity in technologies, intervention content, and outcome measures, findings were synthesized narratively with comparisons across modalities and study designs. Results: In total, 119 studies met the inclusion criteria. Across immersive VR interventions, signals of benefit were most consistently reported for memory, attention, and executive functioning, with several studies also targeting outcomes with higher ecological relevance (eg, everyday task performance and functional skills). AR approaches primarily support context-aware cueing and task guidance in real-world settings, aiming to strengthen daily functioning and independence. CAVE-based systems were frequently used for spatial navigation and embodied interaction, offering advantages for supervised clinical deployment. Key barriers included cybersickness and comfort issues, interface complexity, and onboarding demands in cognitively impaired users, limited accessibility and standardization of outcome measures, small samples and short follow-up periods, and practical constraints related to cost, space, staffing, and caregiver involvement. Conclusions: Immersive VR, AR, and CAVE systems are feasible and often engaging for cognitive rehabilitation in MCI and dementia, with promising therapeutic signals but substantial uncertainty driven by methodological and implementation heterogeneity. Future work should prioritize standardized reporting (intervention components, dose, and adverse events), clinically meaningful outcomes (including functional end points), adequately powered comparative trials, and explicit evaluation of scalability and real-world deployment pathways.

Background/Objectives: Maintaining proper oral hygiene is particularly challenging for individuals with autism spectrum disorder (ASD) due to sensory sensitivities, communication difficulties, and anxiety. Traditional oral hygiene education methods may be ineffective for this population, thereby necessitating innovative solutions. This study evaluates the effectiveness of a virtual reality (VR)-based educational program in improving home oral hygiene practices among children and adolescents with ASD. Methods: Sixty-four children with ASD (Level 1) were recruited and divided into two groups. Group 1 received traditional oral hygiene education, while Group 2 used a VR-based intervention featuring a virtual domestic bathroom with an avatar demonstrating proper brushing and flossing techniques. The intervention lasted eight weeks, with two one-hour sessions per week. The oral health assessment tool (OHAT) was used to evaluate oral hygiene status before and after the intervention. An unpaired t-test compared outcomes between groups. Results: Both groups showed improvements in oral hygiene, but the VR intervention group exhibited a significantly greater reduction in OHAT scores compared to the traditional education group (p < 0.001) due to a greater improvement in oral health. The VR-based approach enhanced engagement and adherence to oral hygiene routines, particularly benefiting children with ASD who struggle with conventional methods. Conclusions: VR-based education appears to be a promising tool for improving oral hygiene habits in children with ASD by providing an interactive and immersive learning experience. Future research should explore long-term adherence and the broader application of VR in healthcare education.

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Virtual reality has gained attention as an effective tool for cognitive, motor, and daily activity rehabilitation in patients with major neurocognitive disorder (M-NCD). The first objective of this study was to check for differences between M-NCD caused by degenerative and non-degenerative conditions (DC and NDC, respectively) in terms of relearning four functional living skills (FLSs), by means of a non-immersive virtual reality training (VRT). The second purpose was to verify whether spontaneous transfer from the virtual environment to the real environment occurred. Four FLS apps were developed in our institute (Information, Suitcase, Medicine, and Supermarket). A nonrandomized interventional study was carried out, comparing experimental and control groups (EG and CG, respectively). The study included three phases: in vivo test at T1; VRT at T2 only for EG; in vivo test at T3. During the in vivo test, the four FLSs were assessed in their natural environments. Both EG-DC and EG-NDC significantly improved in all of the VRT variable scores (the EG-NDC group seemed to show better outcomes than the EG-DC group). Moderate-to-high satisfaction with the VRT was reported. EG-DC and EG-NDC also enhanced their performances in the in vivo test. No statistically significant differences between them were found. CG-DC and CG-NDC improved only in the execution time of Information in the in vivo test. These findings confirm the ecological validity of VRT for FLSs.

The loss of functional living skills (FLS) is an essential feature of major neurocognitive disorders (M-NCD); virtual reality training (VRT) offers many possibilities for improving FLS in people with M-NCD. The aim of our study was to verify the effectiveness of a non-immersive VRT on FLS for patients with M-NCD. VRT was carried out for 10 to 20 sessions, by means of four 3D apps developed in our institute and installed on a large touch screen. The experimental group (EG) and the control group (CG) included 24 and 18 patients with M-NCD, respectively. They were administered the in vivo test (in specific hospital places reproducing the natural environments) at T1 (pre-training) and T3 (post-training); at T2, only EG was administered VRT. Statistically significant differences between EG and CG in all the in vivo tests were found in the number of correct responses; during VRT, the number of correct responses increased, while the execution times and the number of clues decreased. The improvement in the in vivo tests appeared to be related to the specific VRT applied. The satisfaction of participants with the VRT was moderate to high.

Summary: The aim of this study was to define the time structure of leg movements during sleep occurring with an intermovement interval (onset‐to‐onset) shorter than 10 s in patients with restless legs syndrome and controls, and to compare it to the structure of movements with intervals of 10–90 s or >90 s. Polysomnographic recordings of 141 untreated patients and 68 age‐matched normal controls were analysed. All movements were detected and classified into three categories, separated by intervals of 90 s. The number of movements included in each category was significantly higher in patients than in controls. The movements with an interval of >90 s occurred steadily during the night, whereas the hourly distribution of movements with intervals of <10 or 10–90 s was decreasing or bell‐shaped in patients or controls, respectively. Movements with an interval of 90 s. The time structure features of the three categories of movements considered in this study were found to be clearly different. This, together with previous observations on the differential effects of dopamine agonists on movements with different intervals, suggests that movements with intervals of 90 s are regulated by neurotransmitter mechanisms different from those modulating movements with an interval of 10–90 s.