Feasibility of a culturally adapted virtual reality cognitive rehabilitation program (COVERT) delivered via a hybrid model for stroke survivors in Singapore: A pilot study
Aug 2026· British Journal of Occupational Therapy· 0 citations· 20 references
TL;DR
A single-arm feasibility pilot study found that VR-based cognitive rehabilitation delivered through an experienced occupational therapy-led hybrid model is feasible and potentially effective for post-stroke cognitive impairment in Singapore.
Abstract
Virtual reality (VR) is an emerging modality for cognitive rehabilitation, but evidence in Singapore is limited. This pilot study examined the feasibility and preliminary effectiveness of a localized cognitive VR-based training program (COVERT) for individuals with post-stroke cognitive impairment, delivered using a hybrid model.
Nine participants (mean age = 54.0, SD = 10.0) were recruited from Hospital A and Hospital B over 19 months. Participants completed a 4-week VR program through tele-rehabilitation and conventional therapy. This single-arm feasibility pilot study assessed feasibility, cognitive function (Montreal Cognitive Assessment, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT)), health-related quality of life (EuroQol Five-Dimension Questionnaire), usability (System Usability Scale), and motivation (Intrinsic Motivation Inventory, Virtual Reality Neuroscience Questionnaire).
Feasibility was high with 100% retention. RBANS total scores improved significantly (73.4–78.9,
p
= 0.020), with all participants showing delayed memory gains. Processing speed improved (TMT-A) and there was a trend toward better executive function (TMT-B). EuroQuol-5D scores increased. Usability was moderate and declined with age, while motivation remained high. Recruitment was challenging.
VR-based cognitive rehabilitation delivered through an experienced occupational therapy-led hybrid model is feasible and potentially effective for post-stroke cognitive impairment in Singapore. Larger trials are warranted to establish efficacy.
Virtual Reality (VR) is a candidate for Post-Intensive Care Syndrome (PICS) rehabilitation, but the isolate effect remains unquantified. This study evaluates how the gains are driven. Methods: Healthy adults (n = 40) were assigned to: VR Dual-Task (VRCP); VR Cognitive (VRC); Tablet Cognitive (TC); and Tablet Placebo (TP). Protocols involved four sessions; outcomes included Montreal Cognitive Assessment (MoCA) scores, digital performance, and heart rate (HR). Results: VRC and TC showed significant MoCA gains (2.90 ± 0.74 and 2.70 ± 1.77, p < 0.001); TP showed none. VRCP demonstrated a near-perfect cognitive-physical gain correlation (r = 0.985) with a mean HR of 105.6 bpm. Within the VRC group, lower education levels correlated with higher VR gains (r = −0.707). Conclusion: While VR and tablets show clinical parity, VR offers superior multi-domain synergy and performance resolution. VRCP may be the most appropriate model for PICS rehabilitation.
Inês Oliveira, Bruna Reis, M. Portela et al.· International Conference on...· 0 citations
Abstract With the global population rapidly aging, cognitive decline, including mild cognitive impairment (MCI), is becoming increasingly common. MCI impacts essential cognitive functions like memory and attention, significantly reducing the quality of life for those affected and increasing the burden on healthcare systems. Virtual reality (VR) has emerged as a promising tool for enhancing cognitive rehabilitation by creating immersive and engaging environments. This pilot study aimed to evaluate the usability, acceptability, and preliminary cognitive benefits of VR-based cognitive stimulation exercises for older adults with MCI. The intervention consisted of eight VR and augmented reality sessions over 4 weeks, integrating interactive tasks and 360-degree videos tailored to enhance cognitive flexibility, visuospatial processing, and memory. Forty-five participants enrolled, with 40 completing the full intervention and final postevaluation, and usability feedback was collected from 42 participants, including two who completed partial sessions. Usability was assessed using an adapted System Usability Scale (SUS). Patients rated the VR content (81.9) and headset usability (86.5) highly reflecting strong engagement and comfort. Four healthcare professionals also provided a high SUS score (85.2), emphasizing the program’s clinical relevance and feasibility for integration into rehabilitation workflows. Cognitive assessments indicated a modest improvement in Trail Making Test A scores (p = 0.037), which may suggest enhanced cognitive flexibility. Other measures, including Mini-Mental State Examination, Montreal Cognitive Assessment, Digit Span, and Symbol Digit Modalities Test, showed trends toward improvement but did not reach statistical significance. These exploratory findings align with the short duration of the intervention and the study’s feasibility focus. The iterative, user-centered design process ensured the intervention was accessible, safe, and adaptable to participants’ needs and clinical workflow. These findings suggest that VR-based cognitive stimulation programs are highly usable and acceptable and show potential for improving cognitive performance in older adults with MCI. Further research with larger sample sizes and longer intervention periods is warranted to evaluate clinical impact and functional outcomes.
José Ferrer Costa, M. J. Ciudad, Maribel González Abad et al.· Journal of medical extended...· 3 citations
Background Cognitive symptoms represent a major determinant of long-term disability in chronic schizophrenia and only partially respond to pharmacotherapy. Evidence is growing about the potential effect of cognitive interventions to promote functional recovery. Immersive virtual reality (IVR) offers a simulated, adaptive, and ecologically valid real-world-like scenarios in safe and controlled environments. The present study aimed to evaluate the feasibility, acceptability, and efficacy of IVR-based cognitive rehabilitation in schizophrenia. Methods We performed a single-blind, randomized, waiting list (WL) controlled trial (Clinicaltrials.gov:NCT07427485). Forty clinically stable outpatients with schizophrenia were allocated (1:1) to IVR or WL. The intervention consisted of 12 weekly IVR-sessions through the CEREBRUM-VR tool. Primary outcome was the change in psychotic symptoms (Positive and Negative Symptoms Scale/PANSS). Secondary outcomes included global functioning (GAF), Digital Symbol Substitution Test (DSST), Animal Naming Test (ANT), Trail-Making Test A (TMT-A). Simple Reaction Choice (SRT) and Choice Reaction Time (CRT) evaluated psychomotor speed. Results Drop-out rate was 15% per group, attrition rate was 4.9%. Most IVR-assigned participants (77.8%) reported willingness to continue. IVR did not worsen overall or positive psychotic symptoms. A significant IVR between-group improvement emerged for negative symptoms (p < 0.01), psychomotor speed (SRT p = 0.01, CRT p = 0.01), DSST (p = 0.02), and ANT (p = 0.04). GAF and TMT-A changes were nonsignificant. Adverse effects were mostly mild and transient, decreasing over repeated sessions. Conclusion IVR-based cognitive rehabilitation appears feasible and tolerated in stable outpatients with schizophrenia. Our findings suggest improvement in psychomotor speed and modest improvement in negative symptoms. Larger and longer trials are warranted to confirm clinical relevance.
Claudio Caiazza, Alessia Aletto, Luigi Franzese et al.· Schizophrenia Research: Cogn...· 0 citations
Objective: To evaluate the feasibility, safety, and usability of a novel fully immersive virtual reality (VR) exergame, designed to incorporate cognitive-motor dual-task training for patients with Parkinson’s disease (PD).Methods: We developed a specialized fully immersive VR exergame program, featuring seven cognitive-motor dual-task games. Prior to the pilot study, we refined the system through two successive usability evaluations involving 17 and 15 rehabilitation experts, respectively, to optimize safety and interface design. Subsequently, four patients with idiopathic PD completed a 30-minute VR exergame session using the finalized system under therapist supervision. We assessed cybersickness using the Simulator Sickness Questionnaire (SSQ) and evaluated usability via the User Experience Questionnaire (UEQ) and a self-developed Custom Usability and Satisfaction Survey.Results: All participants completed the session without adverse events. Mean SSQ total scores decreased from 14.75±9.43 to 4.75±1.89 without statistical significance (p>0.05). UEQ demonstrated positive experiences, with Attractiveness (1.167), Efficiency (1.063), and Stimulation (1.500) exceeding benchmarks. Custom Usability and Satisfaction Survey scores for interest (6.00/7) and overall satisfaction (6.25/7) were high; however, physical comfort was rated relatively lower (4.25/7) due to the headset weight and safety harness.Conclusion: The developed fully immersive VR exergame system is feasible, safe, and engaging in patients with PD. Limitations include the small sample size and single-session design. Future research should focus on large-scale randomized controlled trials and hardware improvements to enhance physical comfort for long-term clinical application.
Seung Hwan Lee, Seo Jung Yun, Minjung Kim et al.· Annals of Rehabilitation Med...· 0 citations
Background Suicide risk is disproportionately higher for rural veterans who often lack access to specialty-trained health professionals equipped to deliver effective prevention interventions. Virtual reality offers a scalable training solution to address these gaps. This mixed-methods feasibility study systematically developed and evaluated a prototype virtual reality simulation for a training module in suicide risk identification and lethal means safety counseling during rural veteran home visits. Methods Thirty participants (10 nursing/social work students, 10 health professionals, and 10 rural community members) completed the veteran suicide prevention simulation using Meta Quest 2 headsets. Sense of presence (including negative effects) was assessed with the ITC-Sense of Presence Inventory; additional outcomes included representativeness, acceptability, and cue recall. Results Participants reported high engagement, with moderate spatial presence, and ecological validity, and low negative effects (e.g., nausea). Prominent lethal means cues were highly recalled (firearms: 93.3%; alcohol: 83.3%), while subtler cues (e.g., isolation) were less frequently noted. Most endorsed representational accuracy, with qualitative feedback praising authenticity and suggesting improvements in interactivity and navigation. Conclusions Findings support the preliminary feasibility and acceptability of the VET-SAVR prototype for suicide risk identification and lethal means counseling training. Refinements to navigation, cue salience, and mitigation of negative VR effects are warranted before future efficacy testing.
Donna L. Schuman, Micki Washburn, Regina T. Praetorius et al.· PLoS ONE· 0 citations
Abstract Background Patients with chronic stroke commonly experience motor and cognitive impairments, with diminished quality of life. Their participation in rehabilitation is often limited by long travel distances and low motivation. Given the health benefits of multimodal exercise, with the accessibility and engagement offered by interactive exergames, delivering such interventions in a remote format may help overcome common barriers, and enhance health outcomes. Objective This study aimed to assess the content validity and feasibility of a prototype home-based multimodal exergame for patients with chronic stroke. Methods This study comprised a cross-sectional study for content validity and preliminary usability evaluation (part 1), and a prospective single-arm feasibility study with blinded assessors (part 2). In part 1, the content validity of a prototype home-based multimodal exergame was evaluated by 5 experts. Moreover, 5 patients with chronic stroke were enrolled to evaluate the preliminary usage of the game prototype. Enjoyment, rating of perceived exertion, user feedback, satisfaction, and safety were assessed. In part 2, 9 patients with chronic stroke were enrolled to evaluate the feasibility of home-based multimodal exergame (mean age 53.67, SD 11.70 years, and mean time post stroke onset 75.00, SD 101.99 months). Participants performed the intervention for 60 min/day, 3 days/week, for 6 weeks. Feasibility outcomes, including adherence, adverse events, motor function, cognitive function, and enjoyment of the program, were determined. Results In part 1, the content validity index for the overall program was 0.82. The average total enjoyment score was 47.80 out of 56 (SD 7.50), the rating of perceived exertion was 13.40 out of 20 (SD 0.55), the satisfaction score was 8.60 out of 10 (SD 1.34), and no adverse events were reported. In part 2, after the 6-week intervention, positive changes were observed in global cognition (mean difference=−3.44, 95% CI −5.66 to −1.23; P=.007) and executive function (mean difference=38.43, 95% CI 3.78-73.08; P=.03) compared with baseline. Participants reported a consistently high level of exercise enjoyment throughout the training period. The average exercise adherence rate was 85.19%, and no adverse events were reported throughout the training. Conclusions These findings suggest that the prototype home-based multimodal exergame was a valid, enjoyable, accessible, and user-friendly rehabilitation approach. Unlike conventional home exercise programs, this multimodal exergame integrates physical and cognitive training into an interactive remote rehabilitation platform for individuals with chronic stroke. The intervention showed potential benefits for cognitive outcomes, maintained enjoyment, and promoted exercise adherence, and reported no adverse events throughout the intervention period. These findings provide preliminary evidence that home-based multimodal exergame may support long-term rehabilitation participation. Importantly, the program may address barriers to stroke rehabilitation, including transportation limitations, restricted access to rehabilitation services, and low long-term adherence, particularly among individuals living in underserved or remote areas.
P. Keawtep, C. Sittichoke, Phattharakon Nitsaphawanit et al.· JMIR Serious Games· 0 citations