The Effect of Virtual Reality Therapy on Functional Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Virtual reality (VR) therapy can potentially enhance upper extremity recovery and motivation in stroke rehabilitation. The BTS Nirvana system, equipped with infrared sensors and real-time audiovisual feedback, enables objective performance recording and supports task-oriented, intensive exercises. This study evaluates the combined effect of VR therapy using BTS Nirvana and conventional rehabilitation on upper extremity functions in subacute stroke patients. This randomized, controlled, single-masked study included 22 subacute hemiplegic patients divided into a virtual reality group (n = 11) and a control group (n = 11). Both groups received conventional therapy for three weeks, with the VR group undergoing additional sessions using the BTS Nirvana system. Upper extremity functions were assessed using the Fugl-Meyer upper extremity scale, Brunnstrom stage, Functional Reach Test, Chedoke Arm and Hand Activity tests, and range of motion measurements. Both groups showed significant improvements (p < 0.05) in most outcomes, except for shoulder adduction (p = 0.222) and shoulder external rotation (p = 0.113). Intergroup analysis favored the VR group for upper extremity Brunnstrom stage (p = 0.030), shoulder external rotation (p = 0.029), and Chedoke arm test scores (p = 0.039). Time-group interaction analysis also highlighted superior improvements in the VR group for these measures (p < 0.05). The BTS Nirvana system is a safe and effective complement to conventional therapy, offering intensive and repetitive training for upper extremity rehabilitation in subacute stroke patients. Further research with larger sample sizes and extended treatment durations is needed to confirm these findings and refine treatment protocols.