Abstract
Stroke is the second leading cause of disability in Europe, generating a broad spectrum of physical, cognitive, and psychological sequelae. Among the most functionally disabling consequences are upper-limb sensorimotor impairments, which compromise coordination, reaching movements, grip control, and object manipulation. 1 Poststroke motor deficits arise not only from direct damage to the motor cortex and corticospinal pathways but also from disruption of parietal regions subserving praxis, proprioception, and body representation. 2 As a result, patients frequently develop distorted body representations, altered perception of peripersonal space, and disruptions in the sense of embodiment—encompassing body ownership, agency, and self-location. 3 Somatosensory impairments further compound these difficulties, impairing the perception of touch, temperature, pressure, and pain on the affected side. In severe cases, patients may fail to recognize the affected limb as part of their own body. Taken together, these alterations negatively affect movement coordination, motor awareness, and the capacity to adapt to poststroke bodily changes. 4
IN THIS FEATURE, we aim to describe the characteristics of current cyberpsychology research in Europe. In particular, CyberEurope aims to describe the leading research groups and projects running on the other side of the Ocean.
Body Perception and Body Illusion After Stroke
Recent advances in neurorehabilitation highlight that interventions targeting body representation and embodiment may foster motor recovery by capitalizing on neural plasticity. Following stroke, neuroplasticity enables surviving brain regions to reorganize and form new connections, partially compensating for injured areas through repeated practice and targeted rehabilitation. This adaptive process supports the recovery of motor, cognitive, and language functions, making early and intensive intervention essential for optimizing functional outcomes. 5
Virtual reality (VR) has emerged as a particularly effective tool for eliciting body ownership illusions in both healthy individuals and clinical populations. A growing body of evidence suggests that combining VR with embodiment-based paradigms can further enhance motor rehabilitation outcomes by restoring coherent sensorimotor integration and correcting distorted body representations. 6 Embodied VR systems leverage motion-capture technologies to track patients’ movements in real time and deliver multisensory feedback about motor performance. The resulting body ownership illusions may induce changes in patients’ internal body representation, strengthen neural networks involved in motor planning and execution, and ultimately accelerate the rehabilitation process. 7
The StrokeVR Project
StrokeVR is a rehabilitation project designed to address upper-limb sensorimotor and proprioceptive deficits in stroke patients through immersive and nonimmersive VR. The project pursues three interrelated objectives: enhancing body perception and proprioceptive awareness, improving motor control and sensorimotor integration, and increasing patient engagement during rehabilitation. Central to the project is the hypothesis that restoring a coherent sense of body ownership and agency may facilitate motor recovery. Because stroke-related impairments frequently involve disruptions in body representation and embodiment, body illusion paradigms delivered through VR may help patients reintegrate the affected limb into their body schema and normalize sensorimotor processing. 8
To investigate these mechanisms, StrokeVR employs a randomized controlled trial comparing a VR-based rehabilitation program with traditional treatment over a 4-week intervention period. Assessments of neuropsychological, physical, and body perception measures are conducted before treatment, immediately after the intervention, and at 6 and 12 months of follow-up, enabling evaluation of both short- and long-term effects. Eligible participants are adults aged 18–85 years with ischemic or hemorrhagic stroke occurring 2–18 months before recruitment, presenting with moderate to severe upper-limb motor impairment and altered proprioceptive abilities. 8
The rehabilitation program integrates immersive three-dimensional and nonimmersive two-dimensional VR technologies. During immersive sessions, patients wear a head-mounted display and interact with virtual objects via hand-tracking systems while performing exercises targeting fine motor skills, visuomotor coordination, and spatial interaction. Nonimmersive sessions employ the Handbox VR rehabilitation system, through which patients perform customized hand and wrist exercises using interactive exergames targeting grasping, pinching, finger coordination, and wrist movements. Throughout all sessions, physiotherapists and researchers supervise patients to maintain motivation, attention, and active participation. By integrating body illusion mechanisms, personalized exercise protocols, and engaging exergames, StrokeVR aims not only to promote motor recovery and neuroplasticity but also to improve patients’ awareness and perception of the affected limb.
The Moderating Role of the Embodied Virtual Arm
A central theoretical claim of StrokeVR is that the degree to which patients experience the virtual arm as their own—the sense of body ownership—functions as a key moderator of rehabilitation outcomes. Preliminary findings support this hypothesis: patients who develop a stronger sense of ownership over the virtual arm show greater improvements in motor performance compared with those who do not experience the virtual limb as part of their body. These results are consistent with the broader literature indicating that embodiment and body ownership illusions may facilitate motor recovery by enhancing sensorimotor integration and promoting adaptive neuroplastic changes. 7 Specifically, perceiving the virtual arm as one’s own appears to strengthen the activation of neural networks subserving motor planning and execution, thereby supporting more effective rehabilitation.
These findings carry meaningful implications for the clinical design of VR-based rehabilitation. They suggest that ensuring a robust sense of virtual embodiment—through factors such as synchronous visuomotor feedback, realistic avatar appearance, and individualized system calibration—is not merely an ergonomic concern but a therapeutically significant variable. Future iterations of the StrokeVR protocol may benefit from integrating real-time measures of body ownership as a dynamic guide for adapting VR parameters to each patient’s phenomenological response, thereby moving toward a genuinely individualized model of embodiment-informed neurorehabilitation.
Patient Compliance with the StrokeVR Program
Patients reported high levels of interest and motivation toward the treatment, indicating that the VR-based rehabilitation program was perceived as both engaging and acceptable. Their accounts underscore the capacity of immersive VR to reframe the rehabilitative experience in ways that conventional therapy cannot easily replicate:
“I appreciated and enjoyed all the sessions; the therapy was engaging and challenging, and less boring than traditional rehabilitation” (Patient 1); “The exergames in VR distracted me from the pain in my arm, allowing me to continue the exercises, whereas during traditional therapy I often needed to stop” (Patient 2).
These qualitative reports align with the broader literature demonstrating that immersive and interactive rehabilitation approaches increase patient engagement, adherence to therapy, and active participation during treatment—factors consistently associated with improved functional outcomes. The capacity of VR to recontextualize physical effort as play and to attenuate the perception of pain through immersive distraction may itself represent a therapeutic mechanism worthy of systematic investigation in future research.
Conclusions
The psychological condition of patients represents a critical and often underestimated variable in the success of poststroke rehabilitation. Poststroke depression and anxiety are highly prevalent, particularly during the early stages following the event, when patients must rapidly adapt to sudden physical, cognitive, and social changes. Such psychological difficulties can negatively affect rehabilitation outcomes by reducing participation, attention, and persistence during therapy. Despite the evident potential of VR-based approaches, it is therefore essential to integrate systematic psychological assessment into the rehabilitation process from the outset rather than treating mental health as secondary to physical recovery.
Alongside functional rehabilitation, patients may benefit substantially from psychological support targeting emotional distress, anxiety, depressive symptoms, and adaptation to poststroke changes. An interdisciplinary approach—combining motor and sensorimotor rehabilitation with evidence-based psychological interventions—holds promise for enhancing patient well-being, sustaining motivation and adherence, and ultimately improving rehabilitation outcomes.
Looking ahead, the StrokeVR project will pursue several converging research priorities. The ongoing randomized trial will allow for a more definitive evaluation of body ownership as a moderating variable, including an examination of individual differences in susceptibility to virtual embodiment and their relationship to neurological profile and lesion localization. Concurrently, the project will systematically assess psychological outcomes alongside motor and proprioceptive measures, enabling a more complete picture of rehabilitation efficacy across multiple dimensions of patient functioning. Future work will also explore the integration of biofeedback and adaptive VR technologies capable of personalizing the immersive experience in real time in response to each patient’s physiological and psychological state. Together, these directions position StrokeVR as a model for next-generation neurorehabilitation—one in which immersive technology, embodiment science, and psychological care converge to support the whole patient.