Tips for Custom-Making Gamification and Computer Training for Higher Brain Dysfunction Using AI
I will explain in detail the changes in rehabilitation for higher brain dysfunction, particularly training using computers and video games, and its evidence, from the 2004 edition to the 2023 edition of the Stroke Treatment Guidelines, based on the latest information and research.
In the 2004 edition of the guidelines, computer-based training was mentioned specifically in the rehabilitation of attention disorders.
Specifically, reports were cited stating that computer-based attention training for attention disorders, as well as the Attention Process Training (APT) which evaluates elements such as sustained, selective, alternating, and divided attention and includes tasks like target digit cancellation, were effective compared to standard care.
However, it was stated that there was insufficient scientific evidence regarding the lasting effects of these trainings or their generalization to activities of daily living (ADL), with a recommendation grade of B or C1 and an evidence level of medium to low.
Regarding training using video games, there was no clear mention in the 2004 edition, and computer-based training was mainly limited to attention disorders, with almost no mention of specific programs for executive dysfunction or memory impairment.
At this point, the evidence for computer-based training was limited, mainly relying on research based on traumatic brain injury, and its application to stroke patients was insufficient.
In the 2009 edition, computer-based training was described in more detail, with mentions expanding particularly to attention disorders and executive dysfunction.
For attention disorders, reports stating that computer-based attention training and APT are effective continued to be cited, with a recommendation grade of B and a medium evidence level.
Regarding executive dysfunction, metacognitive strategy training and problem-solving training targeting patients with traumatic brain injury were recommended, and limited evidence showing the effectiveness of computer-based working memory training was reported for chronic stroke patients.
However, there was almost no research on its effectiveness for acute to subacute stroke patients, and the evidence level was considered low (Level 1).
Training using video games was still not clearly addressed, and computer-based training was mainly limited to the areas of attention and working memory.
Even at this point, scientific evidence regarding generalization to ADL and long-term effects was lacking, and recommendations were cautious.
In the 2021 edition (revised 2023 edition), training using computers and video games is more clearly positioned as part of rehabilitation for higher brain dysfunction and is recommended for attention disorders and executive dysfunction.
For attention disorders, computer-based training and APT are considered effective, with a recommendation grade of B and a medium evidence level.
Furthermore, it is reported that training using computers and video games may bring about improvements for executive dysfunction, but there is no specific training for which effectiveness has been clearly demonstrated, and evidence remains limited.
In this edition, training using video games is explicitly mentioned for the first time, and it is suggested that it may contribute particularly to the improvement of executive dysfunction.
Also, for general cognitive dysfunction, the effectiveness of new technologies including virtual reality (VR) and neurofeedback therapy has been reported, but it is stated that sufficient evidence is not yet available.
Regarding the impact of these trainings on ADL, there are few high-quality reports, and it is pointed out that direct ADL training is more effective for unilateral spatial neglect.
Recent research indicates that training using computers and video games may be effective in improving cognitive function.
For example, a 2023 study reported that training using video games contributes to the improvement of attention and executive function disorders, and that 3D platform games, in particular, enhance sustained attention and functional connectivity of the prefrontal-hippocampal network in both healthy individuals and patients with schizophrenia.
Furthermore, it has been pointed out that video games may improve visuospatial ability, attention, and working memory, and promote structural and functional plasticity of the brain.
These studies suggest that video games with high action elements or high cognitive load, in particular, bring about changes in brain regions such as the prefrontal cortex, parietal lobe, and hippocampus.
However, research is insufficient regarding whether these effects can be specifically applied to stroke patients or whether generalization to ADLs is possible, and further verification is required.
On social media, while there are voices from patients and their families saying that rehabilitation using video games is "fun and easy to continue," there are also opinions that it is difficult to use in regions where access to specialized programs is limited.
Discussion
From the 2004 version to the 2023 version, the evidence regarding training using computers and video games has evolved both quantitatively and qualitatively.
In the 2004 version, computer-based training was limited to attention disorders and there was almost no mention of video games, whereas in the 2021 version (revised in 2023), the possibility that video games contribute to the improvement of executive function disorders and general cognitive function is clearly stated, and it is evaluated as Recommendation B with a moderate level of evidence.
This change reflects the accumulation of research suggesting that video games are effective for improving cognitive function, and it has been shown that training using action-oriented games and VR, in particular, may have a positive impact on attention, working memory, and visuospatial ability.
These training methods are considered superior to conventional simple cognitive tasks in that they stimulate complex cognitive processes simultaneously and increase patient engagement.
In the evolution of guidelines, it is important that the harmony between evidence and individual differences is emphasized.
In the 2023 version, along with evidence-based recommendations (e.g., the effectiveness of APT and video game training), a flexible approach that considers patient preferences, the clinical situation, and medical economic perspectives is required.
Training using video games has the advantage of being fun and easy for patients to continue, which contributes to maintaining motivation.
However, costs and access issues can sometimes be barriers.
As pointed out on social media, facilities where specialized programs are available are limited, and regional disparities restrict patient access.
This point indicates a challenge where the reflection of the "balance between benefits and harms" and "patient preferences" aimed for by the guidelines is not being sufficiently realized in actual clinical practice.
Recent studies have shown that video game training may enhance the functional connectivity of brain regions such as the prefrontal cortex and hippocampus, contributing to improvements in attention and executive function.
However, evidence regarding its application to stroke patients is still limited.
In particular, there is a lack of high-quality randomized controlled trials (RCTs) regarding the effects on acute and subacute stroke patients and generalization to ADLs.
Although the guidelines support these training methods with a Recommendation B, further research is needed regarding long-term effects and adaptation to the specific needs of stroke patients.
Furthermore, while the effectiveness of VR and neurofeedback therapy has been suggested, the lack of sufficient evidence highlights the gap between technological advancement and clinical application.
The guideline's stance of avoiding evidence-supremacy aligns with modern medical trends that prioritize patient-centered care.
However, the introduction of training using computers and video games is significantly influenced by medical economic perspectives and constraints on regional medical resources.
Video game training has the potential to increase patient motivation and contribute to the improvement of cognitive functions.
On the other hand, it is not necessarily applicable to all patients, and alternative rehabilitation methods may be required, especially for patients with severe cognitive impairment or economic constraints.
Furthermore, there is a need to develop highly individualized programs that consider the diverse backgrounds of stroke patients (age, degree of disability, living environment).
Future challenges include strengthening evidence for video game-based training specifically for stroke patients, and in particular, conducting RCTs to verify long-term effects from the acute phase to the chronic phase and generalization to ADLs.
In addition, resolving regional disparities and developing low-cost programs that are easily accessible to patients and their families are essential to realizing the philosophy of the guidelines.
The evolution of evidence from the 2004 version to the 2023 version has expanded the possibilities of training using computers and video games, but to provide this fairly to all stroke patients, structural reform of the medical system and strengthening of multidisciplinary collaboration are required.
Such evolution will become the foundation that truly supports the improvement of patients' QOL and their return to society.
As of 2025, we will examine the possibility of using generative AI such as "ChatGPT, Claude, Copilot, Gemini, Grok, and DeepSeek" in cognitive rehabilitation for higher brain dysfunction using video games and computers to resolve regional disparities and create low-cost, custom-made gamification that is easily accessible to patients and families in a short period of time, based on the latest information and research.
Below, we introduce the top 10 innovations to achieve this in a ranking format.
1st Place: Patient-specific cognitive task generation using generative AI. Generative AI such as ChatGPT and Claude can rapidly generate customized cognitive tasks according to the type (e.g., attention deficit, memory impairment, executive dysfunction) and degree of a patient's cognitive impairment.
For example, if a patient has memory impairment, it is possible to instruct the AI to create a "game to memorize a shopping list for daily life" and generate a scenario that incorporates the patient's life background (e.g., favorite ingredients or stores).
DeepSeek has low-cost, high-precision reasoning capabilities and can design game stories based on the patient's hobbies and interests in a short time.
This method makes it easy to reflect individual patient factors, and since games can be created by inputting prompts without programming skills, it lowers the hurdle for self-creation.
2nd Place: Collaboration with open-source game development platforms. This is a method of creating gamification by utilizing open-source platforms such as Dify and ComfyUI and combining them with generative AI.
By using Dify's workflow function, it is possible to combine ChatGPT and Claude to build game logic tailored to a patient's cognitive tasks without coding.
For example, you can design a visual search game for patients with attention deficits and incorporate visuals that the patient prefers (e.g., natural landscapes or anime-style). It is low-cost and can be used by local medical institutions and families, and on social media, there are comments such as, 'I was able to create a game easily with intuitive operations.'
3rd Place: Customizing VR Templates. Cognitive rehabilitation using VR provides training close to ADLs, such as shopping tasks in a virtual shopping street.
You can use Gemini or Copilot to customize existing VR templates (e.g., a cooking game in a virtual kitchen) to meet the patient's needs.
For example, for patients with unilateral spatial neglect, you can instruct the AI to automatically generate visual cues within the VR to direct attention to the neglected space.
While the cost of VR equipment is a challenge, utilizing low-cost smartphone-compatible VR headsets can help reduce regional disparities.
4th Place: Streamlining Game Design through Prompt Engineering. By refining generative AI prompts, you can quickly design games tailored to the patient's individual differences (e.g., age, culture, degree of impairment).
For example, if you instruct ChatGPT to 'propose a story and rules for a simple puzzle game to improve attention deficits for a 60-year-old stroke patient,' a game tailored to the patient's interests (e.g., gardening or history) will be generated.
On social media, prompt engineering is praised as allowing 'even non-technical people to create games,' enabling self-production in a short period.
5th Place: Adapting Low-Cost Existing Video Games. This is a method of adapting commercially available video games (e.g., puzzle games or simulation games) to a patient's cognitive needs using generative AI.
Using Copilot or DeepSeek, you can generate guidelines to simplify tasks in existing games or adjust the difficulty level according to the patient's cognitive level.
For example, for patients with memory impairment, the AI can create instructions to modify in-game tasks into a format suitable for note-taking.
This avoids the development of expensive specialized software and allows for the low-cost use of widely available games.
6th Place: Automatic Feedback via AI Agents. You can utilize generative AI as an AI agent to build a system that evaluates and provides feedback on a patient's performance during a game in real-time.
Using Claude or Grok, you can design prompts that analyze which cognitive functions are challenging when a patient makes a mistake in a game and automatically adjust the content of the next game.
This method provides tailor-made rehabilitation according to the patient's progress and reduces the burden on medical professionals.
On social media, AI agent feedback is well-received as 'increasing patient motivation.'
7th Place: Supporting Collaboration with Local Communities via AI. To eliminate regional disparities, you can use generative AI to create a mechanism for local medical institutions and families to jointly develop and share games.
Using Gemini or ChatGPT, you can generate a 'Game Development Guide for Patients with Higher Brain Dysfunction' for local support centers and design workshops where patients and families can participate.
This allows for the low-cost self-production of rehabilitation games even outside urban areas and strengthens local support systems. On social media, local workshops are praised for 'deepening family understanding.'
8th Place: Development of Voice-Interactive Games. By utilizing voice-interactive AI such as ChatGPT-OpenAI-Smart-Speaker, you can create your own cognitive rehabilitation games that patients can operate by voice.
For example, for patients with aphasia, a simple question-and-answer game can be designed, with the AI adjusting the difficulty level according to the patient's language ability.
Voice-based games allow for intuitive operation, making them easy to use for elderly patients and family members unfamiliar with technology, and they can be developed at a low cost.
9th Place: Cloud-based Game Distribution. This is a method of integrating generative AI into cloud platforms (e.g., AWS Bedrock, Google Cloud) to distribute rehabilitation games that patients and their families can access online.
By utilizing DeepSeek or Claude, games based on the patient's cognitive data can be generated in the cloud and made available on smartphones or tablets.
This eliminates the need for expensive equipment and can reduce regional disparities.
On social media, cloud-based tools are well-received for being 'accessible from anywhere'.
10th Place: Patient/Family Participatory Game Design Workshop. This is a method of holding workshops using generative AI where patients and their families can directly participate in game design.
Using ChatGPT or Grok, prototypes of games that reflect the patient's wishes (e.g., preferred themes or difficulty levels) can be generated instantly and adjusted during the workshop.
This approach has the effect of increasing the patient's autonomy and deepening the family's understanding, allowing for the low-cost, self-made creation of games that meet local needs.
Discussion
As of 2025, the self-creation of gamification for cognitive rehabilitation of higher brain dysfunction using generative AI such as ChatGPT, Claude, Copilot, Gemini, Grok, and DeepSeek holds great potential for resolving regional disparities and realizing low-cost, made-to-order solutions.
The tips listed in the ranking are innovative in that they leverage the high flexibility and accessibility of generative AI to rapidly develop programs that respond to individual patient factors and unique differences.
In particular, the 1st place 'Individualized Cognitive Task Generation' and 4th place 'Prompt Engineering' are highly practical for non-technical medical professionals and family members, as they allow for the creation of customizable games through prompt input alone, without the need for programming skills.
These methods embody the 'harmony between evidence and individual differences' emphasized by guidelines and are ideal for providing rehabilitation that reflects the patient's wishes and life background.
The use of generative AI also contributes significantly to cost and time reduction.
The 2nd place 'Collaboration with Open Source Platforms' and 9th place 'Cloud-based Game Distribution' avoid the development of expensive specialized equipment or software and provide widely accessible, low-cost solutions.
In particular, low-cost, high-performance AI like DeepSeek is effective for resolving regional disparities from a medical-economic perspective.
Voices of patients and families on social media also praise the fact that 'rehabilitation can be done at home at a low cost,' indicating the potential for generative AI to improve the accessibility of regional medical care.
Furthermore, the 3rd place 'VR Template Customization' and 8th place 'Voice-Interactive Games' contribute to maintaining motivation by increasing patient engagement and allowing them to enjoy rehabilitation while continuing it.
However, there are also challenges.
First, game development using generative AI requires a certain level of skill in prompt design and data input, necessitating training for medical professionals and family members to acquire these skills quickly.
On social media, there are comments that "writing prompts is difficult," indicating a need for guidelines and tutorials tailored for non-technical users.
Second, there is a risk of hallucinations (generation of incorrect information) in generative AI outputs, and accuracy is particularly critical in the medical field. For example, if the game content generated by ChatGPT or Claude is inappropriate for a patient's cognitive needs, the effectiveness of rehabilitation may be reduced.
Third, addressing regional disparities assumes the widespread availability of the internet and devices; in areas lacking digital infrastructure, cloud-based solutions are also limited.
Recent research suggests that generative AI has the potential to be used in game design for cognitive rehabilitation, but evidence specific to stroke patients is still insufficient.
In the 2023 guidelines, the effectiveness of video games and VR is listed with a recommendation level of B, but verification of generalization to ADLs and long-term effects remains inadequate.
Further clinical trials are needed to determine to what extent self-made games using generative AI contribute to improving patients' cognitive functions and quality of life.
Additionally, while corporate competition in generative AI (e.g., ChatGPT vs. DeepSeek) accelerates technological evolution, data biases and ethical considerations specific to each company (e.g., Copilot's emphasis on neutrality) may affect reliability in medical applications.
Looking ahead, to promote the self-creation of gamification using generative AI, it is essential to provide simple prompt templates and workshops for medical professionals and family members.
The 10th-ranked "patient and family participatory workshops" are effective in enhancing patient autonomy and strengthening local support systems.
Furthermore, as a countermeasure against generative AI hallucinations, it is necessary to strengthen verification processes by medical experts and the protection of patient data privacy.
To resolve regional disparities, the development of digital infrastructure and the spread of low-cost devices are also required, making collaboration between government and private companies important.
Custom-made gamification utilizing generative AI has the potential to revolutionize rehabilitation for patients with higher brain dysfunction, but its realization requires a tripartite effort involving technology, medicine, and the local community.
This approach will serve as a foundation that truly supports the improvement of quality of life for patients and their families.
I will explain research on cognitive rehabilitation for higher brain dysfunction using the latest video games and virtual reality (VR), based on detailed information and the latest findings.
In recent years, cognitive rehabilitation using video games and VR has attracted attention as a promising approach for patients with higher brain dysfunction, particularly for attention deficits, memory impairment, executive dysfunction, and visuospatial impairment following a stroke.
Research up to 2023 has reported that training using action-oriented video games and VR may contribute to improvements in sustained and selective attention, working memory, and visuospatial abilities.
For example, studies using 3D platform games have shown that in healthy individuals and patients with schizophrenia, gameplay enhances functional connectivity in the prefrontal cortex and hippocampus, leading to improvements in sustained attention and cognitive processing speed.
These games provide an environment for processing complex cognitive tasks simultaneously, achieving higher engagement than traditional, simple cognitive training.
While research targeting stroke patients is still limited, it has been pointed out that video games may promote brain plasticity and support the recovery of cognitive function.
In cognitive rehabilitation using VR, realistic task simulations in virtual spaces are being utilized.
A 2012 study developed a VR system using a shopping task in a virtual shopping district, demonstrating its applicability as a tool for evaluating executive function and memory in patients with higher brain dysfunction.
This system measured the number of correct shopping items, the frequency of list and bag usage, the number of movements, and the time required, and verified the correlation with traditional neuropsychological tests.
As a result, it was concluded that VR testing is effective in that it allows for evaluation in an environment close to activities of daily living (ADL) and reflects the difficulties patients face in actual life situations.
Such evaluations using VR are considered useful not only for diagnosis but also for planning rehabilitation.
Recent studies have reported that training using VR may be effective in improving hemispatial neglect and attention deficits.
For example, visual search training and task execution training in a VR environment can encourage patients to practice directing attention to the space they ignore, potentially contributing to improvements in ADL.
The 2023 guidelines also state that training using VR or computers is effective for improving attention deficits and executive dysfunction, listing it with a recommendation grade of B and a moderate level of evidence.
However, there is a lack of high-quality evidence regarding whether these trainings lead to generalization to ADL or long-term effects, and further research is required.
Training using VR is considered effective for maintaining motivation because patients can engage in rehabilitation while having fun in an immersive environment.
VR research targeting patients with dementia also provides insights for the rehabilitation of higher brain dysfunction.
Since 2020, programs that simulate visuospatial agnosia and disorientation in dementia using VR have been developed and are being used as tools to deepen the understanding of healthcare workers and family members.
These programs have the potential to improve the quality of rehabilitation and support by allowing others to understand symptoms from the patient's own perspective.
Although applications for stroke patients are still limited, it is suggested that environmental adjustments and task training using VR may contribute to the improvement of cognitive impairment and life adaptation.
On social media, patients and their families have commented that rehabilitation using video games and VR is "fun and easy to continue."
In particular, there are opinions that compared to traditional rehabilitation, game elements increase motivation, and by simulating tasks close to daily life in VR, patients can actively engage in rehabilitation.
However, challenges have also been pointed out, such as the difficulty of access in regions where professional VR programs and high-performance equipment are limited.
Discussion
Research on cognitive rehabilitation for higher brain dysfunction using video games and VR has shown significant progress between 2004 and 2023.
In the 2004 guidelines, computer-based training was primarily limited to attention disorders, with almost no mention of video games or VR.
However, in the 2023 version, these technologies are clearly positioned as effective for improving attention and executive function disorders, with a recommendation grade of B and a moderate level of evidence.
This change reflects the accumulation of scientific evidence that video games and VR contribute to the improvement of cognitive functions.
In particular, the possibility that action-oriented video games enhance functional connectivity in the prefrontal cortex and hippocampus, and promote brain plasticity, opens up new possibilities in the rehabilitation of stroke patients.
VR-based training is excellent in that it reproduces tasks close to daily life in a virtual space, allowing for the evaluation of difficulties in the patient's actual life and applying them to rehabilitation.
Such technological evolution aligns with the philosophy of "harmonizing evidence with individual differences" emphasized by the guidelines.
Video games and VR are effective in increasing patient motivation and allowing them to engage in rehabilitation while having fun, thereby reducing psychological burden and respecting patient preferences.
Especially since stroke patients may find it difficult to continue rehabilitation, game elements and immersive VR environments can be important tools to support long-term engagement.
Furthermore, research on tasks such as shopping using VR enables evaluations and training directly linked to ADLs, showing the potential to contribute to improving the patient's quality of life (QOL).
This point is consistent with the approach of considering the "balance of benefits and harms" and "patient preferences" that the guidelines aim for.
However, there are several issues with current research.
First, there is a lack of high-quality evidence regarding the effects of video games and VR specifically tailored for stroke patients.
Many studies target healthy individuals or other diseases (e.g., schizophrenia, dementia), and further randomized controlled trials (RCTs) are needed regarding applicability to stroke patients, long-term effects, and generalization to ADLs. Second, issues from a medical economic perspective and regional disparities are hindering the spread of this technology.
As pointed out on social media, high-performance VR equipment and specialized programs are costly, making access difficult in areas outside of urban centers.
This creates a situation where guideline recommendations can only be applied to a limited number of patients.
Third, it has been reported that excessive use of VR and video games may cause mild symptoms of depersonalization or loss of reality, so careful management is required in the design and implementation of training.
Future prospects include the development of video games and VR programs specifically for stroke patients and large-scale clinical trials to verify their effects.
In particular, research evaluating long-term effects from the acute phase to the living phase, as well as generalization to ADLs, is essential.
Additionally, the development of low-cost, accessible programs and policy support to promote introduction in regional medical care are necessary to realize the philosophy of the guidelines.
While VR and video games have the potential to increase patient engagement and revolutionize cognitive rehabilitation, structural reform of the medical system and strengthening of interprofessional collaboration are essential to provide this fairly to all patients.
Such technological advancements will serve as a foundation that truly supports the improvement of quality of life for patients with higher brain dysfunction and their families.
I will explain in detail the cognitive rehabilitation for higher brain dysfunction using virtual reality (VR), based on the latest information and research regarding improving patient engagement, challenges in medical systems, eye strain issues, and the effectiveness of neurofeedback therapy and reduction therapy.
Cognitive rehabilitation using VR is attracting attention as a promising approach for improving higher brain dysfunction after a stroke, particularly for attention deficits, memory impairment, executive dysfunction, and hemispatial neglect.
VR is excellent in that it allows patients to train cognitive functions in a realistic environment by simulating tasks close to daily life (e.g., shopping, cooking, moving) in a virtual space.
A 2023 study showed that visual search training using VR has the potential to improve attention functions in patients with hemispatial neglect and enhance their ability to perform tasks related to ADLs (activities of daily living).
Furthermore, because the VR environment provides a highly gamified, immersive experience, it increases patient motivation and engagement, thereby improving the continuity of rehabilitation.
For example, a 2012 study using a shopping task in a virtual shopping district confirmed that VR is an effective tool for assessing a patient's executive function and memory, and that it allows for assessments closer to real-life situations than conventional neuropsychological tests.
As of 2025, due to the evolution of VR technology, low-cost smartphone-compatible VR headsets have become widespread, and the number of programs available for patients and their families to use at home is increasing.
However, there are also challenges in the medical application of VR.
Eye strain is reported as a common problem when using VR, and especially in elderly stroke patients, eye fatigue and discomfort caused by long-term use of VR headsets may hinder the continuation of rehabilitation.
A 2023 study observed eye strain and dizziness after VR use in some patients and suggested that this could be mitigated by limiting session times to 20 to 30 minutes.
In addition, appropriate display settings (e.g., high refresh rates and low latency) and regular breaks are recommended.
On social media, voices from patients and their families such as "VR is fun, but my eyes get tired" and "I can't use it for a long time" can be heard, indicating that measures against eye strain are essential for the widespread adoption of VR rehabilitation.
As interventions other than VR for general cognitive impairment, the effectiveness of neurofeedback therapy and reduction therapy (e.g., drug therapy or reduction of stimulation) has been reported in some cases.
Neurofeedback therapy involves monitoring brain waves in real-time and training patients to regulate their own brain activity, and it is considered effective in improving attention deficits and executive dysfunction.
A 2024 study suggested that neurofeedback may contribute to improving attention and working memory in stroke patients by regulating prefrontal cortex activity.
However, there is a lack of high-quality evidence regarding the sustainability of the effects and generalization to ADLs, and it is classified as recommendation grade C with a low level of evidence in the 2023 edition of the Stroke Treatment Guidelines.
Regarding reduction therapy, approaches such as avoiding over-stimulating environments to prevent the worsening of cognitive impairment or optimizing drug use are being attempted, but the standardization of specific protocols and verification of effectiveness have not progressed.
While the effectiveness of VR, neurofeedback therapy, and reduction therapy has been reported in cognitive rehabilitation for stroke patients, the lack of sufficient evidence remains a challenge.
As of 2025, research indicates that while VR and neurofeedback are effective for specific cognitive functions (e.g., attention, visuospatial ability), there is a limited number of randomized controlled trials (RCTs) regarding their direct impact on ADLs and long-term prognostic improvement.
In guidelines, VR-based training is evaluated with a recommendation grade of B and a moderate level of evidence, whereas neurofeedback and reduction therapy remain at a recommendation grade of C, indicating that further research is required.
On social media, while patients and their families appreciate the fun and intuitive operability of VR, there are also voices noting that "it is difficult to feel the effects" and "specialized facilities are far away," highlighting inequality in access.
Structural reform of the medical system and the strengthening of multidisciplinary collaboration are key to providing VR fairly to all patients.
As of 2025, VR rehabilitation is concentrated in specialized facilities in urban areas, and regional disparities are a major barrier.
To promote the use of VR in local medical institutions and at home, it is necessary to popularize low-cost equipment, provide training for medical professionals on VR utilization, and offer simple operation guides for patients and their families.
Furthermore, a system is required to design and implement VR programs tailored to individual patient needs through multidisciplinary collaboration (e.g., rehabilitation physicians, occupational therapists, psychologists, and engineers).
Discussion
Cognitive rehabilitation using VR has the potential to increase patient engagement and revolutionize the treatment of higher brain dysfunction, but its widespread adoption requires structural reform of the medical system and the strengthening of multidisciplinary collaboration.
The strength of VR lies in its ability to provide training close to the patient's daily life through realistic task simulation in a virtual space.
As shown by 2023 research, VR is effective in improving hemispatial neglect and attention deficits, and a highly gamified environment increases patient motivation, thereby improving the continuity of rehabilitation.
Voices of patients and families on social media also appreciate that the "fun" and "immersion" of VR reduce the burden of rehabilitation, making it a suitable approach that reflects the "patient's wishes" emphasized by guidelines.
However, the issue of eye strain is a major challenge in the widespread adoption of VR.
Elderly stroke patients have high vulnerability in their visual and nervous systems, and discomfort caused by VR use may hinder the continuation of rehabilitation.
While short sessions and the optimization of display settings recommended by 2023 research are effective, a protocol that can be uniformly applied to all patients has not yet been established.
In addition, the cost and complexity of operating VR equipment are fueling regional disparities and inequality in access.
In regions outside of urban areas, there is a shortage of specialized facilities and high-performance equipment, and comments on social media such as "there are no VR rehabilitation facilities nearby" clearly illustrate this problem.
The popularization of low-cost smartphone-compatible VR headsets is promising, but fair provision will be difficult without their introduction in local medical institutions and the enhancement of patient education.
The lack of evidence regarding the effectiveness of neurofeedback therapy and reduction therapy also remains a challenge.
Neurofeedback is gaining attention as a highly individualized training method utilizing brain waves, but as of 2024, its long-term effectiveness and impact on activities of daily living (ADL) remain unclear.
Low-stimulation therapy is an approach that reduces cognitive load by avoiding overstimulating environments, but it lacks standardized protocols, limiting its practical application in clinical settings.
While these interventions may have synergistic effects when combined with VR, as guidelines point out, verification through high-quality randomized controlled trials (RCTs) is urgently needed.
Structural reform of the medical system and the strengthening of interdisciplinary collaboration are keys to accelerating the adoption of VR and neurofeedback.
As of 2025, VR rehabilitation remains dependent on specialized facilities; to promote its use in local medical institutions and at home, it is necessary to develop training programs that enable occupational therapists and psychologists to utilize VR technology.
Furthermore, in collaboration with engineers, there is a need for mechanisms to develop and provide low-cost VR programs tailored to individual patient needs (e.g., type of disability, age, culture).
As indicated by patient voices on social media, inequality in access stems from medical economic perspectives and regional disparities; to realize the guideline principle of balancing benefits and harms, infrastructure development through the cooperation of government and private enterprises is essential.
Future prospects include the need for large-scale clinical trials to strengthen the evidence base for VR and neurofeedback.
In particular, research is needed to verify long-term effects from the acute phase to the chronic phase for stroke patients, as well as the generalization of these effects to ADL.
Additionally, as a measure against eye strain, it is important to standardize VR settings according to a patient's visual characteristics and to provide simple operation guides.
To resolve regional disparities, the use of cloud-based VR programs and telerehabilitation is effective, and approaches that combine generative AI to achieve low-cost customization for each patient are also promising.
These technological innovations and system reforms will serve as the foundation that truly supports the improvement of quality of life for patients with higher brain dysfunction.