Immersive virtual reality to improve balance and gait after stroke: a pilot randomized controlled trial

Immersive virtual reality therapy (VRT) is emerging as a promising tool for stroke rehabilitation, with evidence suggesting benefits for motor recovery. However, its specific impact on balance and gait, particularly in the subacute phase of stroke in clinical setting, remains insufficiently explored. The primary objective was to determine whether integrating a VRT program into conventional therapy improves balance more effectively than conventional therapy alone in persons with subacute stroke. Balance was assessed using the Berg Balance Scale, complemented by the Sensory Organization Test to explore changes in sensory contributions to postural control. Secondary objectives were to evaluate the effects of VRT on gait performance and to assess usability, patient satisfaction, and potential adverse effects, such as cybersickness, associated with VRT. This pilot pragmatic randomized controlled trial included thirty-four participants who were equally randomized to a CT-only group and to a group in which 20% of daily CT was replaced by VRT. Both groups received the same total therapy time over a 2-weeks intervention. Functional ambulation classification, 2-min walking test, 10-m walking test, Berg Balance Scale (BBS) were assessed at baseline (T0) and post-intervention (T1). Sensory reweighting in the VRT group was evaluated with the Sensory Organization Test (SOT) at T0 and T1. Group, time and interaction effects were analyzed using ANOVA with post-hoc tests when appropriate. Spearman correlations were performed to assess relationships between improvements in gait and balance and sensory scores. Both groups improved significantly over time on all outcomes ( p < 0.001), with no main group effect ( p > 0.05). A significant group × time interaction was found for the BBS ( p = 0.023), with greater improvement in VRT than in CT group. In VRT group, BBS improvement significantly correlated with the visual score of the SOT ( r = 0.544, p = 0.030). Adding VRT to CT in the subacute phase after stroke appears as an adjuvant to CT for improving functional balance, as reflected by greater gains in the Berg Balance Scale, and inducing changes in sensory integration processes. Trail registration : ClinicalTrials.gov, TRN: NCT07409116, Registration date: 06 February 2026.