Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.

Only 18 patients were studied, nine in each group, so chance findings cannot be ruled out. The assessor also delivered the virtual reality intervention, so expectations could have influenced the results. The total dose was 4 hours, which the authors say may have been too low to produce larger measurable improvements. The groups were heterogeneous, especially in months post-stroke, with medians of 7 in the virtual reality group and 4 in the control group. No corrections for multiple comparisons were performed. The study excluded patients with hemi-spatial neglect and moderate or severe language comprehension deficits, so it does not speak to those groups. The authors did not test transfer to real supermarket, pharmacy, post office or bank tasks, so real-world daily living improvement was not shown. Learning effects on repeated cognitive tests were possible because no parallel versions were used.

Funded by the European Commission, Fundação para a Ciência e a Tecnologia, and Agência Regional para o Desenvolvimento da Investigação, Tecnologia e Inovação. No author conflicts of interest are reported.

Do not conclude that virtual reality cognitive training is proven to restore real-world daily living. This was a small, unblinded trial of 18 patients, and the authors did not assess transfer to actual supermarket, pharmacy, post office or bank tasks.