# Effects of Virtual Reality on Motor Function and Balance in Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis of Controlled Trials

## TL;DR

This study reviews how virtual reality can help improve balance in people with incomplete spinal cord injuries, but more research is needed for clear results.

## Contribution

The paper provides a systematic review and meta-analysis on VR/AR effectiveness for balance and locomotor function in iSCI patients.

## Key findings

- VR/AR interventions showed a significant improvement in balance with a large effect size.
- Evidence for locomotor function improvements remains inconclusive due to limited homogeneous studies.
- Substantial variability between studies suggests effectiveness depends on intervention specifics.

## Abstract

Background/Objectives: Incomplete spinal cord injury (iSCI) represents a significant challenge in neurorehabilitation, with conventional limitations including recovery plateaus and declining patient motivation. Virtual reality (VR) and augmented reality (AR) have emerged as promising technologies to supplement traditional therapy through gamification and multisensory feedback. This systematic review and meta-analysis evaluates the effectiveness of VR and AR interventions for improving balance and locomotor function in patients with incomplete spinal cord injury. Methods: A systematic review was conducted following PRISMA guidelines, with searches in PubMed, Scopus, Web of Science, Science Direct, and Google Scholar. Randomized controlled trials and high-quality controlled studies evaluating VR/AR interventions in patients with iSCI (American Spinal Injury Association Impairment Scale [AIS] classifications B, C, or D) for a minimum of 3 weeks were included. A random-effects meta-analysis (Standardized Mean Difference, SMD; 95% Confidence Interval, CI) was conducted for the balance outcome. Results: Eight studies were included (n = 142 participants). The meta-analysis for balance (k = 5 studies) revealed a statistically significant improvement with a large effect size (SMD = 1.21, 95% CI: 0.04–2.38, p = 0.046). For locomotor function, a quantitative meta-analysis was not feasible due to a limited number of methodologically homogeneous studies; a qualitative synthesis of this evidence remained inconclusive. Substantial heterogeneity was observed in the balance analysis (I2 = 81.5%). No serious adverse events related to VR/AR interventions were reported. Conclusions: VR/AR interventions show potential as an effective adjunctive therapy for improving balance in patients with iSCI, though the benefit should be interpreted with caution due to considerable variability between studies. The current evidence for locomotor function improvements is insufficient to draw conclusions, highlighting a critical need for more focused research. Substantial heterogeneity indicates that effectiveness may vary according to specific intervention characteristics, populations, and methodologies. Larger multicenter studies with standardized protocols are required to establish evidence-based clinical guidelines.