Stroke rehabilitation continues to face challenges in accessibility and patient engagement, where traditional approaches often fall short. Virtual reality (VR)-based telerehabilitation offers a promising avenue, by enabling home-based recovery through immersive environments and gamification. This systematic review evaluates current VR solutions for upper-limb post-stroke recovery, focusing on design principles, safety measures, patient-therapist communication, and strategies to promote motivation and adherence. Following PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed, IEEE Xplore, and ScienceDirect. The review reveals a scarcity of studies meeting the inclusion criteria, possibly reflecting the challenges inherent in the current paradigm of VR telerehabilitation systems. Although these systems have potential to enhance accessibility and patient autonomy, they often lack standardized safety protocols and reliable real-time monitoring. Human-centered design principles are evident in some solutions, but inconsistent patient involvement during the development process limits their usability and clinical relevance. Furthermore, communication between patients and therapists remains constrained by technological barriers, although advancements in real-time feedback and adaptive systems offer promising solutions. This review underscores the potential of VR telerehabilitation to address critical needs in upper-limb stroke recovery while highlighting the importance of addressing existing limitations to ensure broader clinical implementation and improved patient outcomes.

翻译：脑卒中康复在可及性与患者参与度方面持续面临挑战，传统方法往往难以满足需求。基于虚拟现实（VR）的远程康复通过沉浸式环境和游戏化设计，为实现居家康复提供了前景广阔的途径。本文通过系统综述评估当前用于上肢脑卒中后功能恢复的VR解决方案，重点关注设计原则、安全措施、医患沟通以及提升患者动机与依从性的策略。遵循PRISMA 2020指南，我们在PubMed、IEEE Xplore和ScienceDirect数据库进行了全面检索。综述发现符合纳入标准的研究数量有限，这可能反映了当前VR远程康复系统范式固有的挑战。尽管这些系统具备提升可及性与患者自主性的潜力，但普遍缺乏标准化的安全协议和可靠的实时监测机制。部分解决方案体现了以人为中心的设计原则，但开发过程中患者参与的不连贯性限制了其可用性与临床相关性。此外，尽管实时反馈与自适应系统的技术进步提供了有前景的解决方案，医患沟通仍受技术壁垒制约。本综述强调了VR远程康复在应对上肢脑卒中恢复关键需求方面的潜力，同时指出必须解决现有局限性，以确保更广泛的临床实施和改善患者预后。