Virtual-reality and exergame rehabilitation

Domain IX · Biomedical, neuro & digital

What it is

What it is. Virtual-reality (VR) and exergame rehabilitation uses computer-generated environments and motion-controlled games to let people practise movement, balance and everyday tasks. Cochrane defines VR broadly as computer-based programs that simulate real-life objects and events, and includes…

Format

• There is no single published protocol; programmes are designed by the treating rehabilitation team and vary by system, condition and setting. The phases below describe the typical course as the sources imply it, with the psychotherapist's parallel tasks. Session counts, durations and progression…
• Referral and rehabilitation assessment. Goal: the team decides whether VR or gaming fits the person's goals (arm function, balance, walking, daily activities, cognition) and the setting (inpatient, outpatient, home). Cochrane frames VR as an add-on to usual care that raises therapy volume, not a…

Who practises it, and how they are trained or regulated

• Graded training. Goal: repeated task practice with progression decided by the therapist from performance and tolerance. Cochrane reports benefits may be greatest when people use the programme for many hours and that larger arm-function gains were seen when VR was added to usual care.
• Version followed: VR and interactive video gaming as defined in the Cochrane review Virtual reality for stroke rehabilitation (Laver et al.; 2017 version and the June 2025 update), with the Cochrane Parkinson's review (2016) for balance and gait, the FDA AR/VR medical-device list (as of October 2026; page content dated 4 September 2026) for regulatory status, and manufacturer health-and-safety warnings and…
• Purpose of design: off-the-shelf commercial consoles and games (e.g. Nintendo Wii and Wii Fit, used in most Parkinson's trials) versus specialised rehabilitation systems built and, in some cases, regulated as medical devices.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• hopelessness after poor progress or discharge. Working: a current, shared plan.
• unsupervised use, online contact with strangers, sleep disruption. Working: supervised, plan-linked use.
• minimising symptoms to keep access to the programme. Working: the team receives timely, specific reports.
• clients avoiding use from privacy fears (explore and refer for answers); unclear data flows. Working: the client knows where data goes.
• a sense of abandonment at discharge; unsupervised continuation with unsuitable consumer games. Working: a clear post-rehab plan agreed with the team.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.