RESEARCH Open Access Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial Andrea Turolla 1* , Mauro Dam 1 , Laura Ventura 2 , Paolo Tonin 1 , Michela Agostini 1 , Carla Zucconi 1 , Pawel Kiper 1 , Annachiara Cagnin 1,3 and Lamberto Piron 1 Abstract Background: Recent evidence has demonstrated the efficacy of Virtual Reality (VR) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied. Objectives: To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients. Methods: A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital. We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale (It-NIHSS) between 1 and 3 and without severe neuropsychological impairments interfering with recovery. Patients were allocated to two treatments groups, receiving combined VR and upper limb conventional (ULC) therapy or ULC therapy alone. The treatment programs consisted of 2 hours of daily therapy, delivered 5 days per week, for 4 weeks. The outcome measures were the Fugl-Meyer Upper Extremity (F-M UE) and Functional Independence Measure (FIM) scales. Results: Both treatments significantly improved F-M UE and FIM scores, but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone. The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 (P < 0.001) pts and 3.2 ± 1.2 (P = 0.007) pts, respectively. Conclusions: VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities. Trial registration: Italian Ministry of Health IRCCS Research Programme 2590412 Keywords: Stroke, Upper limb, Exercise therapy, Virtual reality, Motor recovery, Treatment outcome Background Stroke is a disorder associated with long term disability and is more common in older people [1]. The symptoms of stroke such as cognitive, motor and emotional sequalae often impact on a person’ s level of independence and quality of life [2]. The purpose of neurological rehabilita- tion is to promote a rapid recovery from the manifold post-stroke deficits and the attainment of a lifestyle, as close as possible to the pre-morbid state [3]. A large body of evidence has demonstrated that the lo- cation of the stroke lesion is strictly related to the sever- ity of motor function impairment affecting the upper limb, thus the involvement of deep anatomical structures (i.e. corona radiata, internal capsule) is related to poorer outcomes of motor function recovery [4,5]. A recent study reported that impairment of the upper limb motor function is present in more than 80% of all stroke pa- tients, with 30% to 40% regaining some dexterity after six months [6]. Nevertheless, the upper limb remain not functional in performing activities of daily living (ADL) in up to 66% of all stroke patients [7], representing the most disabling of all the residual impairments. * Correspondence: andrea.turolla@ospedalesancamillo.net 1 I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy Full list of author information is available at the end of the article JNER JOURNAL OF NEUROENGINEERING AND REHABILITATION © 2013 Turolla et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Turolla et al. Journal of NeuroEngineering and Rehabilitation 2013, 10:85 http://www.jneuroengrehab.com/content/10/1/85