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Background  Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the  Elements  system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of  Elements  as a virtual rehabilitation approach for stroke survivors.    Methods  Twenty-one adults (42–94 years old) with sub-acute stroke were randomized to four weeks of  Elements  virtual rehabilitation (three weekly 30–40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.    Results  Effect sizes for the experimental group ( d  = 1.05–2.51) were larger compared with controls ( d  = 0.11–0.86), with  Elements  training showing statistically greater improvements in motor function of the most affected hand ( p  = 0.008), and general intellectual status and executive function ( p  ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.    Conclusion  A course of  Elements  virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.    Trial registration  this pilot study was not registered.

Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study