Virtual Reality Rehabilitation for Cognitive, Emotional, and Motor Recovery in Neurological Disorders

This randomized controlled trial (RCT) aims to evaluate the effectiveness of virtual reality (VR) rehabilitation in improving cognitive, emotional, social, and motor functions in patients with neurological and neurodegenerative disorders (Acquired Brain Injuries, Spinal Cord Injuries, Multiple Sclerosis, and Parkinson's Disease). The study also explores neurophysiological changes and the potential benefits of combining VR with non-invasive brain stimulation (NIBS) and telerehabilitation. Objectives: Primary Objectives: Assess the effectiveness of VR-based rehabilitation in enhancing cognitive and motor functions. Identify neurophysiological changes (EEG, fNIRS, MRI) associated with functional recovery. Secondary Objectives: Identify behavioral and neurophysiological biomarkers predictive of rehabilitation outcomes. Compare the effectiveness of different VR devices for rehabilitation. Evaluate the impact of VR telerehabilitation on recovery and continuity of care. Explore the synergistic effects of VR combined with NIBS. Methods: Study Site: IRCCS Centro Neurolesi Bonino Pulejo. Duration: 3 years. Participants: 328 individuals with neurological disorders (18-75 years old). Design: Participants will be randomized into two groups: VR Training Group: Engages in immersive VR-based rehabilitation. Active Control Group: Receives conventional therapy. Sessions: 20 sessions over 8 weeks (3 times per week). Assessments at 3 time points: T0 (Baseline): Neurological, neuropsychological, motor, and neurophysiological evaluations. T1 (Post-intervention): Repeat assessments to measure immediate effects. T2 (Follow-up at 3 months): Evaluate the maintenance of improvements. Assessments \& Outcome Measures: Cognitive Function: MoCA, MMSE, ACE-R, Rao's Battery. Motor Function: Functional Independence Measure (FIM), TUG, Tinetti Scale, Berg Balance Scale. Neurophysiological Changes: EEG, fNIRS, MRI, eye-tracking, motion analysis, sEMG. Emotional \& Social Function: Short Empathy Quotient (EQ-short), Faux Pas Test, Hamilton Depression Scale. Usability \& Acceptance: System Usability Scale (SUS). Expected Impact: This study aims to advance personalized rehabilitation strategies, improve accessibility to innovative therapies (e.g., telerehabilitation), and optimize the use of VR-based interventions in clinical practice.