Virtual Reality Associated with Functional Electrical Stimulation for Upper Extremity in Post-Stroke Rehabilitation: A Systematic Review

Background: This systematic literature review aims to explore the impact of rehabilitation in post-stroke patients, particularly highlighting the roles of virtual reality (VR) technology and functional electrical stimulation (FES). Methods: To ensure all relevant studies were included, a thorough search was conducted in PubMed and Web of Science databases using keywords such as 'post-stroke', 'FES', 'functional electrical stimulation', 'virtual reality', and 'VR'. Studies on rehabilitating upper limb function through VR and FES in post-stroke patients were included, regardless of publication year. Studies had to compare this combination therapy with conventional methods and report outcomes related to upper limb coordination, functional mobility, and daily activities. Studies not meeting these criteria were excluded. The selection process involved screening titles, abstracts, and full texts by four independent reviewers. The quality and risk of bias of the included studies were assessed using the PEDro scale and Robvis tool. Results: The review included four studies involving 135 post-stroke patients. Two articles examined the effectiveness of an approach involving virtual reality, robotic therapy, and functional electrical stimulation in rehabilitating upper limbs in post-stroke patients, showing significant improvements in motor function and quality of life. The other two studies explored the effects of rehabilitation therapy using virtual reality combined with functional electrical stimulation on upper limb function in stroke patients, finding that combined therapy (FES with VR) was superior to functional electrical stimulation or robotic therapy. Discussion: The review was limited by the small number of studies and participants, which may affect the generalizability of the results. Variations in intervention protocols and outcome measures across studies posed challenges in synthesis. Integrating these technologies brings benefits and increases the potential for personalizing and optimizing the rehabilitation process, enhancing patient engagement and satisfaction, and promoting a holistic approach to post-stroke management. Future research should focus on larger, more standardized trials to confirm these findings and optimize intervention protocols.