Insights and Perspectives of Neuro Physiotherapists Towards the use of Virtual Reality in Neurorehabilitation

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1. Introduction

Neurorehabilitation is a specialized area of physiotherapy focused on improving movement, function, participation, and independence in individuals with neurological conditions. Conditions such as stroke, Parkinson’s disease, cerebral palsy, and spinal cord injury may result in impairments in movement, balance, coordination, and functional independence. Neurorehabilitation therefore plays an important role in promoting recovery and functional improvement through principles of neuroplasticity.

Neurological recovery may be complex and can require prolonged, repetitive, and meaningful practice. Maintaining patient motivation, active participation, and consistent practice is important during rehabilitation. Conventional rehabilitation remains the foundation of treatment, while technological developments have introduced additional approaches that may complement therapeutic practice. One such approach is Virtual Reality (VR).

VR is a computer-generated interactive environment that allows users to experience and interact with surroundings in real time. In neurorehabilitation, VR can provide an engaging and task-oriented environment in which patients may practise repetitive and meaningful movements, with potential applications in motor recovery, balance, coordination, and functional performance.

VR can be broadly classified as non-immersive, semi-immersive, or fully immersive. Non-immersive VR commonly uses screens such as computers or televisions with input devices, whereas semi-immersive systems may use large displays or projection systems. Fully immersive VR commonly uses head-mounted displays to create an interactive three-dimensional environment. VR may provide repeated practice with visual or auditory feedback, which can support motor learning.

The use of VR may also increase engagement by making therapeutic activities interactive and goal-oriented. Virtual tasks can be adapted to functional ability and graded as the patient progresses. However, implementation in clinical practice may depend on factors such as physiotherapists’ knowledge and awareness, equipment availability, cost, training requirements, clinical setting, and acceptance by therapists and patients. Understanding neuro physiotherapists’ insights is therefore relevant to the potential integration of VR into neurorehabilitation practice.

2. Aim and Objectives

Aim: To explore the insights of neuro physiotherapists regarding the use of Virtual Reality (VR) in

Objectives

• To assess the awareness of neuro physiotherapists towards Virtual Reality. • To assess their knowledge regarding the use of Virtual • To assess their usage and exposure to Virtual Reality. • To explore their perspectives towards the use of Virtual • To identify perceived barriers to the implementation of Virtual Reality. • To assess their readiness to learn and integrate Virtual Reality into neurorehabilitation practice.

3. Materials and Methods

3.2. Study Setting and Duration: The Study Was

Conducted in Maharashtra Over A Period Of 6 Months

3.3. Study population and sample size: The study

population consisted of neuro physiotherapists. The project results included 112 participants.

3.5. Materials: Digital gadget (smartphone/tablet/laptop)

and an online questionnaire.

3.6. Inclusion criteria: Postgraduate students of Neuro

Physiotherapy; clinical or academic neuro physiotherapists; Ph.D. scholars in Neuro Physiotherapy; and participants willing to participate.

3.7. Exclusion criteria: BPT interns; undergraduate BPT

students; and participants unwilling to participate.

3.8. Outcome measure: A self-structured questionnaire was

developed to assess awareness, knowledge, usage/exposure, perspectives, perceived barriers, and readiness regarding VR in neurorehabilitation.

3.9. Validity and Reliability: Content validity was reviewed

by senior faculty members from Dr. Ulhas Patil College of Physiotherapy and Dr. Ulhas Patil Medical College and Hospital. Reliability was assessed using the split-half method. Pearson’s correlation coefficient between the two halves was 0.68, and the Spearman–Brown reliability coefficient for the complete questionnaire was 0.81.

3.10. Procedure: Ethical clearance was obtained from the

Institutional Ethics Committee of Dr. Ulhas Patil College of Physiotherapy, Jalgaon, prior to commencement. Eligible participants were recruited according to the selection criteria. The validated questionnaire was converted into a Google Form and shared online through email or WhatsApp. Responses were collected online and analysed statistically.

3.11. Statistical analysis: Data were entered into Microsoft

Excel and analysed using descriptive statistics. Categorical variables, including demographic characteristics and questionnaire responses, were expressed as frequency and percentage. Responses were categorized as Yes, No, and Maybe/Unsure. No inferential statistical tests were performed because the study was descriptive in nature.

4. Results

A total of 112 participants were included in the analysis.

4.1. Age-Wise Distribution

Table 1 Age group (years) Frequency Percentage Fig 1 Graph 1: Age-Wise Distribution Interpretation: The majority of participants were aged 23– 28 years (59; 52.68%), followed by 29–34 years (35; 31.25%). The remaining participants were distributed across the other age groups. The mean age reported in the project was 29.95 ± 6.23 years.

4.2. Gender-Wise Distribution

Table 2 Gender Frequency Percentage Male 45 40.18% Female 67 59.82% Fig 2 Graph 2. Gender-Wise Distribution Interpretation: Of the 112 participants, 45 (40.18%) were male and 67 (59.82%) were female.

4.3. Years of Professional Experience

Table 3 Experience Frequency Percentage <1 year 32 28.57% >15 years 6 5.36% Fig 3 Graph 3. Years of Professional Experience Interpretation: Half of the participants (56; 50.00%) had 1– 5 years of experience. The mean years of experience reported in the project was 3.92 ± 4.02 years.

4.4. Qualification-Wise Distribution

Table 4 Qualification Frequency Percentage MPT Neurology student 42 37.50% MPT Neuro Physiotherapist 63 56.25% Other 7 6.25% Fig 4 Graph 4. Qualification-Wise Distribution Interpretation: Among the participants, 63 (56.25%) were MPT Neuro Physiotherapists, 42 (37.50%) were MPT Neurology students, and 7 (6.25%) were categorized as other.

4.5. Awareness

Table 5 Question no. Yes No Maybe/Unsure Fig 5 Graph 5. Awareness Responses Interpretation: Positive responses ranged from 66.1% to 84.8% across the four awareness questions. The highest affirmative response was for Question 1 (84.8%), while the lowest was for Question 2 (66.1%).

4.6. Knowledge

Table 6 Question no. Yes No Maybe/Unsure Fig 6 Graph 6. Knowledge Responses Interpretation: Positive responses ranged from 67.6% to 83.8%. The highest affirmative response was for Question 2 (83.8%), while the lowest was for Question 4 (67.6%).

4.7. Usage/Exposure

Fig 7 Graph 7. Usage/Exposure Responses Interpretation: Practical exposure was comparatively limited. “No” responses were predominant across the four questions, ranging from 41.4% to 66.7%, while “Yes” responses ranged from 26.1% to 46.8%.

4.8. Perspectives

Fig 8 Graph 8. Perspectives Responses Interpretation: Participants generally expressed positive perspectives. “Yes” responses ranged from 66.1% to 72.3%, with relatively low “No” responses of 2.7% to 8.9%.

4.9. Barriers

Fig 9 Graph 9. Barriers Responses Interpretation: Participants commonly identified barriers to VR implementation. “Yes” responses ranged from 51.4% to 78.6%, while “Maybe/Unsure” responses ranged from 16.1% to 39.6%.

4.10 Readiness Question no. Yes No Maybe/Unsure

Fig 9 Graph 10. Readiness Responses Interpretation: Readiness was high, with affirmative responses ranging from 75.9% to 83.9%. Negative responses remained low, ranging from 5.4% to 8.0%.

5. Discussion

The present cross-sectional study explored awareness, knowledge, usage/exposure, perspectives, perceived barriers, and readiness regarding the use of Virtual Reality in neurorehabilitation among neuro physiotherapy participants. The overall pattern showed good awareness and knowledge, comparatively limited practical exposure, generally positive perspectives, recognition of implementation barriers, and high readiness.

Awareness: The present study demonstrated a high level of awareness regarding VR, with affirmative responses ranging from 66.1% to 84.8%. The variation between individual items indicates that familiarity with VR may not be uniform across all aspects of its clinical application. These findings are comparable with Joshi and Musale (2024) [1], who reported awareness of VR and AR applications among physiotherapists and highlighted the need for further education to support clinical implementation. Knowledge: The knowledge domain showed predominantly positive responses, ranging from 67.6% to 83.8%. However, the proportion of uncertain responses reached 26.1% for one item, suggesting that some participants may require additional exposure to specific clinical applications of VR. Vasanthi et al. (2023) similarly examined physiotherapists’ perceptions of the usefulness and ease of VR and emphasized the importance of clinicians’ familiarity with the technology. Usage and exposure: In contrast to awareness and knowledge, actual usage and exposure were comparatively limited. “No” responses predominated in all four questions. This distinction between knowing about VR and having hands-on clinical exposure is consistent with findings reported by Elser et al. (2025) [3] regarding VR use in physiotherapy in Germany and by Slatman et al. (2024) [6], who reported limited VR use in primary-care physiotherapy for chronic pain. Perspectives: Participants generally expressed positive perspectives, with affirmative responses ranging from 66.1% to 72.3% and relatively low negative responses. These findings are in line with literature examining physiotherapists’ beliefs and clinicians’ perspectives regarding VR-supported rehabilitation, including Brady et al. (2022) [2] and Felsberg et al. (2025).

Perceived barriers: Participants identified several factors that may limit VR implementation, with affirmative responses ranging from 51.4% to 78.6%. The project identified cost, technological knowledge, patient discomfort, and setup time as relevant barriers. Elser et al. (2025) [3] likewise reported implementation-related barriers, including cost and awareness, highlighting that successful integration may require more than simply making technology available. Readiness: Readiness showed strongly positive responses, ranging from 75.9% to 83.9%. This finding is notable alongside the limited practical exposure. It indicates that limited current use does not necessarily correspond to unwillingness to consider VR. Participants may have limited hands-on experience while remaining willing to learn about and potentially integrate VR into future practice.

6. Conclusion

The study found that neuro physiotherapy participants demonstrated good awareness and knowledge regarding Virtual Reality in neurorehabilitation, while actual usage and practical exposure were comparatively limited. Participants generally expressed positive perspectives and high readiness toward learning and using VR. At the same time, several barriers to implementation were recognized. Overall, the findings indicate a gap between familiarity with VR and practical exposure, together with considerable readiness to consider VR as an adjunct to neurorehabilitation practice.

7. Limitations

1. The study mainly assessed awareness, knowledge, perspectives, barriers, and readiness and did not explore participants detailed personal experiences with VR. 2. The study used descriptive statistics and did not examine associations between participant characteristics and questionnaire responses.

3. The findings may not be generalizable to all neuro physiotherapists because participants were recruited using purposive sampling with a snowball technique.

1. Future research may include neuro physiotherapists from

different geographical regions and healthcare settings.

2. Comparative studies may examine perspectives across

different professional and clinical settings. 3. Future studies may investigate training requirements and structured educational programs for VR use in 4. Interventional studies may evaluate the effectiveness and feasibility of VR integration alongside conventional

Acknowledgements

The authors acknowledge Dr. Chitra Mridha and Dr. Jaywant Nagulkar for their guidance and support, and all participants for their valuable time and cooperation.

Disclosure Statement The authors declare that there are no conflicts of interest related to this study.

Funding

No external funding was received for this study.

Ethics Statement Ethical clearance was obtained from the Institutional Ethics Committee of Dr. Ulhas Patil College of Physiotherapy, Jalgaon, prior to commencement of the study. Participants provided consent before participation.