Immersive Virtual Reality for Stroke Rehabilitation: Linking Clinical and Digital Measures of Motor Recovery—A Pilot Study

Background: Immersive virtual reality (VR) has emerged as a promising tool to enhance neuroplasticity, motivation, and engagement during post-stroke motor rehabilitation. However, evidence on its feasibility and data-driven integration into clinical practice remains limited. Objective: This pilot study aimed to evaluate the feasibility, usability, and short-term motor outcomes of an immersive VR-assisted rehabilitation program using the Travee-VR system. Methods: Fourteen adults with post-stroke upper-limb paresis completed a 10-day hybrid rehabilitation program combining conventional therapy with immersive VR sessions. Feasibility and tolerability were assessed through adherence, adverse events, the System Usability Scale (SUS), and the Simulator Sickness Questionnaire (SSQ). Motor outcomes included active and passive range of motion (AROM, PROM) and a derived GAP index (PROM–AROM). Correlations between clinical changes and in-game performance metrics were explored to identify potential digital biomarkers of recovery. Results: All participants completed the program without adverse events. Usability was rated as high (mean SUS = 79 ± 11.3), and cybersickness remained mild (SSQ < 40). Significant improvements were observed in shoulder abduction (+7.3°, p < 0.01) and elbow flexion (+5.8°, p < 0.05), with moderate-to-large effect sizes. Performance gains in the Fire and Fruits games correlated with clinical improvement in shoulder AROM (ρ = 0.45, p = 0.041). Cluster analysis identified distinct responder profiles, reflecting individual variability in neuroplastic adaptation. Conclusions: The Travee-VR system proved feasible, well tolerated, and associated with measurable short-term improvements in upper-limb function. By linking clinical outcomes with real-time kinematic data, this study supports the role of immersive, feedback-driven VR as a catalyst for data-informed neuroplastic recovery. These results lay the groundwork for adaptive, clinic-to-home rehabilitation models integrating clinical and digital biomarkers.