Immersive Technologies in Psychological Support for Patients with Motor Disorders

This study aimed to evaluate the efficacy of integrating high-tech hardware-software systems of virtual and augmented reality into the psychological support for patients with motor disorders during medical rehabilitation. The study involved 336 patients with post-stroke hemiparesis or chronic pain due to musculoskeletal disorders, who were randomized into experimental, control, and comparison groups. Efficacy was assessed using validated psychodiagnostic tools, including the McGill Pain Questionnaire, the Tampa Scale for Kinesiophobia, the SCL-90-R, a Visual Analogue Scale for general well-being, and neuropsychological screening. The interventions comprised three hardware-software systems: “Visual Medicine” for neurorehabilitation, a virtual reality headset for pain correction, and the “PRAK” program of resonant acoustic oscillations for light-sound brain stimulation. The results indicated that patients in the experimental group with post-stroke disorders demonstrated statistically significant positive dynamics in the recovery of various types of praxis and spatial gnosis. In the correction of chronic pain, the experimental group showed a significant reduction in pain intensity and the psychological component of kinesiophobia among patients with mixed-type pain. The application of the “PRAK” complex led to a significant improvement in well-being and a reduction in somatization and kinesiophobia levels. Thus, the efficacy of immersive technologies for improving psychological status and cognitive functions is confirmed, validating their inclusion in multidisciplinary comprehensive rehabilitation programs.

Иммерсивные технологии в психологической поддержке
пациентов с двигательными нарушениями

А.В. Котельникова ^a, Т.С. Бузина ^b

 ^a Федеральное государственное автономное образовательное учреждение высшего образования Первый Московский государственный медицинский университет имени И.М. Сеченова Минздрава России (Сеченовский Университет), Москва, Россия

^b Федеральное государственное бюджетное образовательное учреждение высшего образования «Российский университет медицины» Министерства здравоохранения Российской Федерации, Москва, Россия

Резюме. Данное исследование направлено на оценку эффективности включения высокотехнологичных аппаратно-программных комплексов виртуальной и дополненной реальности в психологическое сопровождение пациентов с двигательными нарушениями в процессе медицинской реабилитации. В исследовании приняли участие 336 пациентов с гемипарезом после инсульта или хронической болью на фоне заболеваний опорно-двигательного аппарата, которые были рандомизированы в основные, контрольные группы и группы сравнения. Оценка эффективности проводилась с помощью валидизированного психодиагностического инструментария, включавшего опросник Мак-Гилла, шкалу кинезиофобии Тампа, SCL-90-R, визуальную аналоговую шкалу оценки самочувствия и нейропсихологический скрининг. В качестве вмешательства использовались три аппаратно-программных комплекса: «Визуальная медицина» для нейрореабилитации, шлем виртуальной реальности для коррекции боли и программа резонансно-акустических колебаний «ПРАК» для светозвуковой стимуляции. Результаты показали, что у пациентов основной группы с постинсультными нарушениями наблюдалась статистически значимая положительная динамика в восстановлении различных видов праксиса и пространственного гнозиса. При коррекции хронической боли в основной группе было зафиксировано достоверное снижение интенсивности боли и психологической составляющей кинезиофобии у пациентов со смешанным типом боли. Применение комплекса «ПРАК» привело к значительному улучшению самочувствия, снижению уровня соматизации и кинезиофобии. Таким образом, подтверждена эффективность иммерсивных технологий для улучшения психологического статуса и когнитивных функций, что обосновывает их включение в программы мультидисциплинарной комплексной реабилитации.

Ключевые слова: иммерсивные технологии, виртуальная реальность, дополненная реальность, психологическое сопровождение, инсульт, хроническая боль

Introduction

1.1. Background

The relevance of scientific and practical developments regarding the use of virtual and augmented reality technologies in clinical practice is undeniable: strategic documents adopted at the state level define the transition to high-tech healthcare and health-saving technologies as a priority direction for the development of medicine.

From a medical and social perspective, diseases accompanied by limited motor functions are characterized by high prevalence, a significant degree of disability, and substantial costs for patient treatment and rehabilitation (Churyukanov et al., 2025; Kirilenko, Antonenkov, 2024; Skvortsova et al., 2018; Skvortsova et al., 2018). In the clinical picture of motor disorders, physical suffering is closely intertwined with mental suffering, making the participation of psychologists in the multidisciplinary rehabilitation team indisputable. Currently, the clinical psychologist has been integrated as a core member of the primary structural and functional unit responsible for medical rehabilitation – the multidisciplinary rehabilitation team – and is officially recognized as a healthcare professional with a higher non-medical education.

Clinical psychologists have a wide array of psychocorrection techniques at their disposal, with the ability to visualize being the primary resource for interventions targeting the patient’s emotional and imaginative sphere and for teaching self-regulation skills. However, as noted in several studies, this resource is not available to all patients (Makarova, Degtyareva, 2023). For instance, the phenomenon of aphantasia – the inability to form mental images of objects – renders classical visualization methods scarcely applicable for some patients. Furthermore, systematic training is required to master this technique successfully, indicating that visualization skills need targeted development. The effectiveness of traditional methods can also be significantly reduced by various destabilizing factors, such as underdeveloped imagination, the presence of pain of varying intensity, secondary gain from illness, and pathologically reinforced neuro-response patterns based on the cyclical interplay of pain, fear of pain, and fear of fear itself.

The rapidly changing modern world necessitates a focused research effort on finding new forms and methods of psychological support. In recent years, so-called high technologies have been increasingly used in various fields of psychology and medicine. However, their clinical application in psychological rehabilitation is still in its early stages: existing research is predominantly phenomenological, and there is a lack of methodological frameworks and clinical guidelines (Keshner et al., 2019). The need for evidence-based implementation of immersive technologies in the psychological support of patients with motor function impairments defined the goal of this study.

1.2. Aim

The aim of this study was to evaluate the effectiveness of integrating high-tech virtual and augmented reality tools into the psychological support for patients with motor function impairments during medical rehabilitation. Corresponding to this aim, the study was designed as a comparative experimental trial using randomized groups.

Method

2.1. Participants

The study included 336 patients with motor impairments of two nosologies (post-stroke hemiparesis, chronic pain due to musculoskeletal disorders) undergoing rehabilitation in an inpatient restorative care facility. The sample consisted of 59.4% women and 40.6% men; the mean age was 57.5 ± 12.9 years; time since stroke onset was up to 1 year, pain duration was 38.3 ± 2.6 months, and pain intensity was no higher than moderate.

2.2. Procedure

The effectiveness of integrating high-tech hardware and software systems into psychocorrection was assessed through a comparative analysis of outcomes across randomized groups: experimental, control, and comparison groups. All patients received a standard medical rehabilitation program according to their motor impairment nosology (physiotherapy, massage). Patients in the control groups received no psychocorrection, those in the comparison groups received a standard psychocorrection format, and those in the experimental groups received the standard format plus one of the hardware-software complexes.

2.3. Psychodiagnostic Methods

The following targets for psychocorrection were identified: subjective pain perception, characteristics of current emotional state (anxiety, depression, kinesiophobia), general well-being, and the state of higher mental functions. A set of validated psychodiagnostic instruments was used for their objective assessment. Subjective pain perception was evaluated using the Russian version of the McGill Pain Questionnaire, which analyzes sensory, affective, and evaluative pain components through the Pain Rating Index and the Number of Words Chosen (Kastyro et al., 2012). For daily monitoring of pain intensity, patients completed a “Pain Diary” based on the Faces Pain Scale (Shimansky, Tanyashin, Poshataev, 2014). Current emotional state was investigated using the SCL-90-R questionnaire (Tarabrina, 2007). Specific fear of movement (kinesiophobia) was diagnosed using the Tampa Scale for Kinesiophobia (Kotelnikova, Kukshina, 2018) interpreted via two factors: “Psychological Subscale” and “Physical Activity Subscale”. General well-being was measured using a Visual Analogue Scale (VAS), where patients marked their state on a 100-mm line [1] (Antunes et al., 2014). The state of higher mental functions was assessed using neuropsychological screening, comprising a set of tests aimed at evaluating visuospatial gnosis, various types of praxis, and executive functions, with performance success quantitatively scored on a 4-point system (Vasserman, Dorofeeva, Meerson, 1997).

2.4. Psychocorrection Methods

Standard format psychocorrection involved psychoeducational work with patients, organized according to the “Patient School” principle tailored to the motor impairment nosology, as well as individual sessions utilizing cognitive-behavioral, body-oriented, art therapy, and other techniques. When incorporating high-tech means, the following hardware-software systems were used: “Visual Medicine” for restorative hand movement training in post-stroke patients with motor impairments, using neuro-tests aided by computer vision algorithms (14 daily sessions of 20-25 minutes each); “PRAK” – a program of resonant-acoustic oscillations for correcting emotional state via brainwave entrainment using light and sound (8 daily relaxation procedures in “relaxation” mode, lasting 30 minutes each); “HTC Vive Focus Plus Virtual Reality System” – a head-mounted display (VR headset) for correcting pain syndrome developed against chronic musculoskeletal disorders (10 daily procedures lasting 15-20 minutes each, administered twice daily).

2.5. Data Collection

Psychodiagnostic assessment was conducted twice – before the start of rehabilitation measures, on the second day of inpatient stay, and after rehabilitation completion, prior to discharge for the outpatient rehabilitation phase. A preliminary explanatory conversation was held with each patient by a clinical psychologist, and voluntary informed consent for participation in the study was obtained. All necessary data were recorded individually, maintaining the confidentiality of the information obtained.

2.6. Statistical Analysis

Data processing and analysis were performed using the “Statistics, 10.0” software package. In accordance with the study objectives and stages, descriptive statistics analysis, normality testing, and analysis of significance for dependent and independent groups within a non-parametric model (Wilcoxon, Kruskal-Wallis, Mann-Whitney tests) were used. The level of statistical significance sufficient for hypothesis acceptance was set at p ≤ 0.05.

Results

3.1. Stage I – “Visual Medicine” Hardware-Software System

Before rehabilitation, neuropsychological screening identified impairments in the spatial-dynamic organization of motor acts (difficulty reproducing hand positions, reciprocal coordination) in all patients (n=81 – patients with motor impairments resulting from stroke). Following psychocorrection, statistically significant (p≤0.05) positive dynamics were recorded in the recovery of serial movement organization, dynamic, kinesthetic, visuospatial, and constructive praxis. Patients in the experimental group demonstrated more accurate reproduction of hand postures based on tactile and visual models, and more effective execution of motor programs compared to patients in the control and comparison groups. Test performance in the experimental group was characterized by a faster pace and greater accuracy. These results are presented in Table 1.

This stage included patients with motor function impairments resulting from chronic musculoskeletal disorders (n=130). Subsequently, based on data from the McGill Pain Questionnaire, subjective pain perception was analyzed in 60 patients, identifying clusters of patients with mixed (neuropathic, dysfunctional) and nociceptive pain characteristics. Psychocorrection interventions (n=70), conducted during comprehensive medical rehabilitation, were combined with comparable prescriptions of analgesic pharmacotherapy using non-steroidal anti-inflammatory drugs across the groups. During the hospital stay, pain decreased in all patients; however, the dynamic curve of the “Pain Diary” differed between the groups starting from the seventh day, when the reduction ended in the control and comparison groups but continued in the experimental group (Figure 1).

Table 1. Differences in the Severity Level of HMF (Higher Mental Functions) Characteristics Before and After Psychocorrection

3.2. Stage II – “Virtual Reality Headset” Hardware-Software System

Figure 1. Pain Dynamics in the Groups, According to Self-Observation Diaries

Positive dynamics in well-being in the control group were achieved due to improvement in patients with nociceptive pain. In the experimental and comparison groups, where sessions with a clinical psychologist were included in the psychocorrection program, improvement was observed in all patients, regardless of pain characteristics. However, in the experimental group, a statistically significant (p≤0.05) reduction in both pain intensity and the psychological component of kinesiophobia was recorded, but this pertained only to patients with mixed pain. The results upon which these generalizations are based are presented in Table 2.

Table 2. Analysis of Significance of Differences in the Severity Level of Psychological Indicators Before and After Rehabilitation Measures in Comparison with Pain Characteristics

Note: Indicators showing statistically significant changes (p≤0.05, Wilcoxon T-test) resulting from rehabilitation measures are highlighted with shading.

3.3. Stage III – “PRAK” Resonant-Acoustic Oscillation Hardware-Software System

The efficacy of the resonant-acoustic oscillation hardware-software system was confirmed regarding the dynamics of well-being, emotional state, and pain syndrome intensity in patients with motor impairments resulting from stroke (n=65) or chronic musculoskeletal disorders (n=60). Analysis of the patients’ psychological status before rehabilitation (n=125) revealed high levels of somatization of anxiety and depressive experiences, as well as pronounced fear of movement (kinesiophobia), in terms of general well-being and emotional state characteristics, regardless of the motor impairment nosology (p>0.05, Mann-Whitney U test). Moderate pain intensity was recorded only in the group of patients with degenerative diseases of large joints and the spine. After enrollment, patients were randomized into experimental (n=56), comparison (n=37), and control (n=32) groups, maintaining proportional representation of motor impairment nosologies. Upon completion of rehabilitation, statistically significant (p≤0.05) improvement was observed in all groups; however, in the experimental group, the p-value for most indicators substantially exceeded corresponding values in the control and comparison groups, suggesting a potentially more sustainable outcome when incorporating “PRAK” into psychocorrection programs. Significant changes in pain were recorded only in the experimental group, where the pain level decreased from a median of 3 to 2 points on a 5-point scale (p=0.04). These results are presented in Table 3.

Table 3. Dynamics of Emotional State Indicators During Psychocorrection in the Groups

Note: the “*” sign indicates the confidence level of the Wilcoxon criterion at p<0.05, “**” – p<0.01, “***” – p<0.001.

Discussion

The conducted study demonstrates a comprehensive approach to evaluating the efficacy of immersive technologies in the psychological support of patients with motor impairments of various origins. The obtained results confirm that the integration of high-tech hardware-software systems into the medical rehabilitation program exerts a significant positive influence on the key psychocorrectional targets for this patient cohort.

During the first stage, the application of the “Visual Medicine” hardware-software system in patients with post-stroke hemiparesis demonstrated efficacy through the implementation of the following key principles: gamification, a personalized approach to rehabilitation training, and gradual task complexity increase following a “simple to complex” progression. The statistically significant positive dynamics in the recovery of serial movement organization, dynamic, kinesthetic, visuospatial, and constructive praxis in the experimental group, surpassing the results in the control and comparison groups, indicates that augmented reality technologies provide an external, controlled visual feedback loop. This loop is critically important for maintaining motivation to perform rehabilitation exercises (Yastrebtseva, Krivonogov, 2018).

During the second stage, the use of the virtual reality headset for correcting chronic pain syndrome showed selective efficacy depending on the pain characteristics. The most significant reduction in pain intensity and the psychological component of kinesiophobia was recorded in experimental group patients with mixed-type pain. This result holds important clinical significance, as it confirms the hypothesis that VR technologies, exerting their effect through distraction and attentional switching (Kanschik et al., 2023; Matheve, Bogaerts, Timmermans, 2023), are most effective for modulating complex, multi-level pain sensations in whose genesis the psychological component plays a substantial role. The continued reduction of pain in the experimental group after the seventh day of rehabilitation, unlike in the other groups, indicates a cumulative treatment effect.

During the third stage, the efficacy of the “PRAK” resonant-acoustic oscillation hardware-software system for correcting emotional state was confirmed. The significant improvement in scores on the somatization, well-being, and kinesiophobia scales, particularly in the experimental group where the level of statistical significance (p-value) was highest, suggests that the resonant-acoustic oscillation method promotes non-specific relaxation and reduces general psychophysiological tension. This is especially valuable in the context of motor impairments, where anxiety and fear of movement often act as secondary destabilizing factors (Pogonchenkova et al., 2025).

Conclusions

The study confirmed the efficacy of integrating high-tech hardware-software complexes into the psychological support for patients with motor function impairments during medical rehabilitation. The psychocorrectional capabilities of virtual and augmented reality devices have been established concerning the improvement of general well-being, stabilization of current emotional state, subjective perception of pain syndrome, and restoration of cognitive status in post-stroke patients. Further research is warranted in the context of developing algorithms for integrating immersive technologies into rehabilitation plans, taking into account individual patient characteristics.

Competing interests: The authors state that the study was conducted in the absence of any commercial or financial relationships that could be interpreted as a potential conflict of interest.

Acknowledgments

The author expresses gratitude to the team of the S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Healthcare Department for their assistance in organizing and conducting the study. The authors thank all the participants of the study

Ethics Statement:

The collection of empirical data was organized in accordance with generally accepted ethical standards. The study was approved at the meeting of the Local Ethical Committee of the S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of the Moscow Healthcare Department on February 6, 2020 (Protocol No. 1).

CRediT author statement: Kotelnikova A.V.: conceptualization, methodology, formal analysis, investigation, visualization, writing – original draft, software; Buzina T.S.: investigation, resources, formal analysis.

The authors have read and approved the final version and are responsible for all aspects of the manuscript.

References

1. Antunes, R. S., de Macedo, B. G., Amaral, T. D. S., Gomes, H. D. A., Pereira, L. S. M., & Rocha, F. L. (2013). Pain, kinesiophobia and quality of life in chronic low back pain and depression. Acta Ortopedica Brasileira, 21(1), 27–29. https://doi.org/10.1590/S1413-78522013000100005
2. Churyukanov, M. V., Davydov, O. S., Kukushkin, M. L., & Yakhno, N. N. (2025). Prevalence of chronic pain in adult population of the Russian Federation: an all-Russian epidemiological study. Russian Journal of Pain, 23 (2), 54–62. https://doi.org/10.17116/pain20252302154
3. Kanschik, D., Bruno, R. R., Wolff, G., Eden, M., Brado, E., & Wengenmayer, T. (2023). Virtual and augmented reality in intensive care medicine: a systematic review. Annals of Intensive Care, 13(1), 81. https://doi.org/10.1186/s13613-023-01176-z
4. Keshner, E. A., Weiss, P. T., Geifman, D., & Raban, D. (2019). Tracking the evolution of virtual reality applications to rehabilitation as a field of study. Journal of Neuroengineering and Rehabilitation, 16(1), 76. https://doi.org/10.1186/s12984-019-0552-6
5. Kirilenko, K. Yu., & Antonenkov, Yu. E. (2024). Dostiženiâ i problemy v sfere profilaktiki ortopedičeskih zabolevanij u vzroslogo naseleniâ v Rossii i Central’nom federal’nom okruge (obzor literatury) [Achievements and problems in the prevention of orthopedic diseases in the adult population in Russia and the Central Federal District (literature review)]. Obŝestvennoe zdorov’e i zdravooranenie, (4), 27–33. https://doi.org/10.56685/18120555_2024_83_4_27
6. Kotelnikova, A. V., & Kukshina, A. A. (2018). Aprobaciâ metodiki izmereniâ kineziofobii u bol’nyh s narušeniem dvitel’nyh funkcij [Testing a method for measuring kinesiophobia in patients with impaired motor functions]. Èksperimental’naâ psihologiâ, 11(2), 50–62. https://doi.org/10.17759/exppsy.2018110204
7. Kastyro, I. V., Popadyuk, V. I., Blagonravov, M. L., Klyuchnikova, O. S., & Kravtsova, Zh. V. (2012). Oprosnik boli Mak-Gilla kak metod opredeleniya urovnya bolevogo sindroma u patsientov posle rinosiptoplastiki i polipotomii nosa [McGill Pain Questionnaire as a method for determining the level of pain syndrome in patients after rhinospectoplasty and nasal polypectomy]. Byulleten’ VSNTs SO RAMN, 4(86), 68–71.
8. Makarova, E. A., & Degtyareva, E. N. (2023). Vizualizaciâ kak metod umen’šeniâ simptomov trevogi i stressa [Visualization as a method of reducing symptoms of anxiety and stress]. Innovacionnaâ nauka: psihologiâ, pedagogika, defektologiâ, 6(4), 33–41. https://doi.org/10.23947/2658-7165-2023-6-4-33-41
9. Matheve, T., Bogaerts, K., & Timmermans, A. (2020). Virtual reality distraction induces hypoalgesia in patients with chronic low back pain: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 17(1), 55. https://doi.org/10.1186/s12984-020-00688-0
10. Pogonchenkova, I. V., Makarova, M. R., Somov, D. A., Skorobogatykh, N. V., Golovkina, M. A., & Popikhina, E. E. (2025). Virtual Reality Technologies in the Correction of Motor Disorders and Kinesiophobia in Patients with Musculoskeletal Pathology. Bulletin of the Medical Institute “REAVIZ” (REHABILITATION, DOCTOR AND HEALTH), 15(1), 52–60. https://doi.org/10.20340/vmi-rvz.2025.1.CLIN.4
11. Shimansky, V. N., Tanyashin, S. V., & Poshataev, V. K. (2014). Hirurgičeskaâ korrekciâ sindromov sosudistoj kompressii čerepnyh nervov: kliničeskie rekomendacii [Surgical correction of cranial nerve vascular compression syndromes: clinical guidelines]. M.
12. Skvortsova, V. I., Shetova, I. M., Kakorina, E. P., Ionova, V. G., & Stakhovskaya, L. V. (2018). Results of the implementation of the “Set of measures to improve medical care for patients with acute cerebrovascular accidents in the Russian Federation”. Žurnal nevrologii i psihiatrii imeni S.S. Korsakova, 118(4), 5–12. https://doi.org/10.17116/jnevro2018118415-12
13. Solokha, O. A., Akhmedzhanova, L. T., Kuz’minova, T. I., & Lavrenenko, D. S. (2020). Back pain: from diagnosis to treatment. Meditsinskiy sovet = Medical Council, (2), 34–42. https://doi.org/10.21518/2079-701X-2020-2-34-42
14. Tarabrina, N. V. (2007). Praktičeskoe rukovodstvo po psihologii posttravmatičeskogo stressa. Čast’ 1. Teoriâ i metody [Practical guide to the psychology of post-traumatic stress. Part 1. Theory and methods]. Kogito-Centr.
15. Vasserman, L. I., Dorofeeva, S. A., & Meerson, Y. A. (1997). Metody nejropsihologičeskoj diagnostiki [Methods of neuropsychological diagnosis]. Strojlespechat’.
16. Yastrebtseva, I. P., & Krivonogov, V. A. (2018). Stabilometricheskiy trening s ispol’zovaniem biologicheskoy obratnoy svyazi s razlichnoy modal’nost’yu: analiz rezul’tatov [Stabilometric training using biological feedback with different modalities: analysis of results]. Doctor.Ru, (1), 16–20.