Stroke and Hemispatial Neglect: How Virtual Reality Rehabilitation Stimulates Neuroplasticity in 80% of Survivors
Stroke affects approximately 17 million people each year worldwide, of whom 80% present with upper limb motor disorders [1].
Visuospatial neglect (VSN) is one of the most common post-stroke disorders: it is characterised by impaired attention toward the hemispace contralateral to the lesion, profoundly affecting the patient's interactions with their environment.
Approximately one third of stroke survivors present with unilateral spatial neglect (USN), which significantly compromises rehabilitation outcomes.
Emerging evidence shows that virtual reality (VR) training generates measurable neuroplasticity, opening a concrete clinical pathway for physiotherapists.
The Clinical Challenge of Post-Stroke Hemispatial Neglect
You see it regularly in your practice or rehabilitation unit: your post-stroke patient turns their head the wrong way, misses obstacles on the left, only eats half their plate.
This behaviour is not a lack of willpower. It is hemispatial neglect — a profound disorganisation of spatial attention resulting from brain injury, most often in the right hemisphere.
Visuospatial neglect is a post-stroke cognitive disorder in which the patient does not perceive or respond to stimuli on the side contralateral to the lesion. Visual scanning training (VST) remains the recommended treatment in current clinical guidelines.
This is precisely where stroke rehabilitation with virtual reality comes in. Not as a gadget, but as a clinical tool capable of reproducing the complexity of the real world in a controlled and quantifiable environment.
💡 Discover what KineQuantum can change in your practice.
What Science Says About Stroke Rehabilitation with Virtual Reality
The level of evidence has progressed considerably in recent years. Meta-analyses converge on a clear finding: VR is effective, especially as a complement to usual care.
The latest update of the Cochrane review on VR in post-stroke rehabilitation includes 190 randomised controlled trials (RCTs) involving 7,188 participants, making it one of the most robust evidence bases in neurorehabilitation.
When VR is used as a complement to usual care — thereby increasing the therapeutic dose — a statistically significant difference between groups is observed (SMD 0.49; 95% CI: 0.21–0.77; 10 studies, 210 participants).
A network meta-analysis published in Frontiers in Neurology in 2025, including 34 RCTs and 1,704 participants, confirms that all VR modalities evaluated are superior to conventional therapy alone for improving upper limb function.
Regarding neglect specifically, the evidence is also progressing. A study published in Brain Communications (2024) demonstrates that immersive VR is more sensitive than traditional tests for detecting neglect — the latter correctly identifying it in only 53.8% of cases, particularly in mild forms or right-sided inattention. VR, on the other hand, reveals the various dimensions of neglect with superior accuracy and level of detail.
Neuroplasticity and VR: The Mechanisms at Work
Understanding why VR works enables better prescription. Three main mechanisms are currently documented in the literature.
1. Practice intensity: The repetition of targeted movements is the main driver of brain plasticity. Rehabilitation plays a pivotal role by harnessing neuroplasticity and facilitating cortical reorganisation — essential mechanisms for helping the patient recover lost skills. The evidence is robust: early intervention is strongly correlated with better functional outcomes in post-stroke patients. Immersive VR makes it possible to increase this practice dose without proportionally increasing the burden on the therapist.
2. Real-time feedback: In VR, the patient receives immediate visual and auditory information about their performance. This real-time feedback enhances performance and improves motor learning. Furthermore, the engaging nature of the exercises involves and motivates patients in their rehabilitation.
3. Active visuospatial exploration: For hemispatial neglect, VR immerses the patient in scenarios where they are compelled — in an ecological manner — to actively scan the neglected space. The VR-VET (Virtual Reality-Visual Exploration Therapy) protocol combines active visual exploration and attentional guidance via immersive headset. Patients complete 20 VR-VET programme sessions, with measurements on the CBS (Catherine Bergego Scale), the LBT (Line Bisection Test) and the SCT (Star Cancellation Test).
Patient Profile and Standard Clinical Protocol
Not all of your post-stroke patients are candidates for the same protocol. Here are the practical benchmarks for targeting the right profiles and building a coherent programme.
Ideal profile for stroke rehabilitation with virtual reality in hemispatial neglect:
Parameter | Indicative Value |
|---|---|
Post-stroke phase | Subacute or chronic (> 2 weeks) |
Side of lesion | Right hemisphere (predominantly left-sided neglect) |
Motor autonomy | Partial control of at least one upper limb |
Visual acuity | Correctable, tolerated under headset |
Cognition | Absence of associated severe dementia |
Motivation | Patient aware of their deficit or guidable |
1. Initial assessment: Before any VR session, objectify VSN (visuospatial neglect) using validated tools: CBS, LBT, SCT. Immersive VR with eye-tracking allows you to go further, characterising visual search behaviour in peripersonal and extrapersonal spaces — something no paper-based test can achieve.
2. Scenario progression: Start with simple visual scanning tasks in a streamlined environment. Progressively increase the spatial and cognitive complexity of the scenes. Parameters such as target position, spatial context and difficulty level significantly influence visual search behaviours. Adjust these according to your patient's progress.
3. Objective data monitoring: VR generates quantified data (response times, success rates, amplitude of head movements) that you cannot obtain through conventional therapy. These metrics allow session-by-session readjustments.
Reference protocol for VR rehabilitation of hemispatial neglect:
Parameter | Recommended Value |
|---|---|
Number of sessions | 15 to 20 sessions |
Duration per session | 20 to 30 minutes in VR |
Frequency | 3 to 5 times per week |
Supervision | Therapist presence mandatory |
Combination | As a complement to conventional rehabilitation |
Intermediate assessment | At mid-course (week 2–3) |
💡 Key takeaway: The efficacy of stroke rehabilitation with virtual reality is dose-dependent. VR is increasingly used to improve upper limb rehabilitation after stroke, and the acute and subacute phases — critical windows of neuroplasticity — represent the most promising intervention periods. The earlier and more intensively you begin, the more the brain plasticity window is exploited.
Visuospatial Exploration in VR: What Concretely Changes for Your Patient
Stroke rehabilitation with virtual reality is not simply a "game". It is a reconfiguration of the patient's attentional working environment.
In a real clinical setting, the patient can compensate. They rotate their trunk, avert their gaze, anticipate blind spots. In a 360° immersive VR environment, these compensatory strategies are identified and quantified.
Protocols such as the immersive "virtual road-crossing task" have been developed to identify and quantify discrete neglect symptoms in chronic stroke patients — including persistent forms that impede activities of daily living but remain clinically difficult to detect.
The VR approach adds a bottom-up stimulus component — attentional guidance via central cue — which does not require the patient to be aware of their deficit. This utility is supported by work describing the segregation of directed (top-down) and reflexive (bottom-up) attention in the dorsal and ventral fronto-parietal cortices.
⚠️ Key point: Immersive VR should be used with caution in patients with photosensitive epilepsy, uncorrected severe visual impairment, or a marked history of cybersickness. A short test session (5 to 10 minutes) at the beginning of management allows individual tolerance to be assessed before moving on to more intensive protocols.
How KineQuantum Transforms This Science into Concrete Results
From research to your daily practice.
Studies show what is possible. KineQuantum puts these protocols in your hands, in your practice, from the very first session.
1. Clinically calibrated neurology exercises — KineQuantum's VR neurology exercise library integrates scenarios specifically designed for stroke, spatial attention work and visuospatial exploration, with dynamic difficulty adjustment.
2. Objective assessments integrated into every session — Each session automatically generates actionable clinical data: attentional latency time, scanning amplitude, detection rate of targets on the neglected side. Your assessment reports are produced without any additional administrative work. Discover how VR assessments work.
3. A platform adapted to upper limb rehabilitation — Hemispatial neglect is often accompanied by upper limb motor deficits. KineQuantum allows both to be worked on simultaneously, with upper limb and spatial attention modules that can be combined within a single session protocol.
4. Complete autonomy for the independent physiotherapist — The KineQuantum Liberté device requires no fixed installation. It adapts to the practice, the home or a facility, to follow your post-stroke patients throughout their complete rehabilitation pathway.
5. A tool that enhances your expertise — KineQuantum does not replace your clinical judgement. It documents, reinforces and makes it visible: for your patients, for referring physicians, and for the facilities that call upon you.
Conclusion: VR, a Clinical Tool in the Service of Neurology
Post-stroke hemispatial neglect remains one of the most complex challenges in neurological physiotherapy. It is common, under-detected and often resistant to conventional approaches alone.
Stroke rehabilitation with virtual reality is no longer a promise for the future. With 34 RCTs and 1,704 participants confirming the superiority of VR over conventional therapy for the post-stroke upper limb, and specific protocols validated for visuospatial exploration and neglect, VR is establishing itself as a fully-fledged clinical tool.
As a physiotherapist, you are at the heart of the therapeutic window where neuroplasticity is most accessible. Thanks to its capacity to increase motivation, stimulate neuroplasticity and reproduce functional tasks in controlled environments, VR represents a major advance in the neurological care pathway.
KineQuantum gives you the clinical means to fully exploit this window — session after session, patient after patient.
FAQ
Is virtual reality rehabilitation effective for all post-stroke patients?
The majority of studies evaluate VR interventions targeting motor deficits. Studies on cognitive rehabilitation or improvements at the participation level remain less numerous. VR is particularly indicated for patients presenting with upper limb deficits and spatial attention impairments, but an individual assessment remains essential before any protocol.
How many sessions are needed to observe results with VR after a stroke?
Protocols validated in the literature generally use between 15 and 20 immersive headset VR training sessions. Improvements on CBS (Catherine Bergego Scale) scores and line bisection tests have been observed from the first few weeks. Progression depends on initial severity, the post-stroke phase and training frequency.
Can virtual reality detect hemispatial neglect that classic tests have missed?
Yes, this is one of the most well-documented contributions. Traditional methods correctly detect neglect in only 53.8% of cases, particularly for mild forms or right-sided inattention. Immersive VR reveals the various dimensions of neglect with superior sensitivity and level of detail, operating independently of classic tools.
Can stroke rehabilitation with virtual reality be used at home?
RCTs on home-based VR post-stroke do exist: 8 randomised trials involving 392 participants show that home-based VR positively improves functional upper limb recovery, particularly for motor control. Autonomous and portable devices — such as the KineQuantum Liberté — make this type of follow-up possible, under therapist supervision.
Is VR in neurology suitable for elderly patients or those uncomfortable with technology?
Results from the System Usability Scale (SUS) show good acceptability of immersive VR, including among elderly patients and those with neurological deficits. A short acclimatisation session of 5 to 10 minutes is generally sufficient to put the patient at ease. Immersion reduces technological apprehension by focusing attention on the task, not the tool.
💡 Would you like to integrate stroke rehabilitation with virtual reality into your practice or centre?
📚 References
[1] Zhang J., Liu M., Yue J. et al. (2025). Effects of virtual reality with different modalities on upper limb recovery: a systematic review and network meta-analysis on optimizing stroke rehabilitation. Frontiers in Neurology, 16:1544135. Voir l'article →
[2] Laver K.E. et al. (2025). Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews (mise à jour 2025). Voir l'article →
[3] Soleimani M., Ghazisaeedi M., Heydari S. (2024). The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 24:135. Voir l'article →
[4] Painter D.R., Norwood M.F. et al. (2024). Virtual reality gameplay classification illustrates the multidimensionality of visuospatial neglect. Brain Communications, 6(4):fcae145. Voir l'article →
[5] Saeys W. et al. (2025). Use of immersive virtual reality to explore visual search behaviour in individuals with visuospatial neglect after stroke. Neuropsychological Rehabilitation, 36(2):442-469. Voir l'article →
[6] Panzini C. et al. (2024). Immersive Virtual Reality for Treatment of Unilateral Spatial Neglect via Eye-Tracking Biofeedback: RCT Protocol and Usability Testing. Brain Sciences, 14(3):283. Voir l'article →
[7] Kim T.L. et al. (2023). Feasibility of hemispatial neglect rehabilitation with virtual reality-based visual exploration therapy among patients with stroke: randomised controlled trial. PMC10157074. Voir l'article →
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