Immersive Virtual Reality in Neuropsychological Assessment of Acquired Brain Injury: a Systematic Review and Meta-Analysis

Acquired brain injury (ABI) often results in a range of cognitive, emotional, and behavioural impairments that compromise everyday functioning. Accurate neuropsychological assessment is essential for developing effective, individualized rehabilitation strategies. However, traditional paper-and-pencil tests frequently lack ecological validity and may underestimate deficits that emerge in complex, real-life contexts. Immersive virtual reality (VR) offers a promising complementary approach by creating interactive, realistic environments that more closely mirror daily cognitive demands. To examine the effectiveness of immersive VR in assessing neurocognitive impairments in ABI populations. Seventeen studies comparing the cognitive performance of ABI patients and healthy controls were analysed, focusing on executive functions, visuospatial abilities, and memory. Healthy controls outperformed ABI patients across all domains. The strongest effect sizes were observed in the visuospatial domain, although results were heterogeneous. Executive function tasks also revealed robust differences with less variability. Memory was the least assessed domain across studies. Moderator analyses indicated that error-based performance measures yielded the largest effect sizes, suggesting they may be particularly informative sensitive in detecting subtle cognitive deficits. In contrast, demographic factors and the inclusion of environmental distractors did not significantly influence outcomes. These findings support immersive VR as a sensitive and ecologically valid tool for neuropsychological assessment in ABI. While the current evidence is promising, further research is required to standardize VR protocols and optimize their clinical application, enabling more personalized and functionally relevant cognitive evaluations.