Social Facilitation within Immersive Virtual Reality Enhances Perseverance in Stroke Rehabilitation Training

Christos Hadjipanayi¹Dimitris Sokratous^1,2Christos Kyrlitsias¹Domna Banakou¹Despina Michael-Grigoriou^1*

• ¹GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
• ²Physiotherapy Unit, Neurology Clinics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus

Integrating social interaction into stroke rehabilitation is recommended but often underutilized due to limited resources. Virtual Reality (VR) offers a way to incorporate social facilitation through virtual agents in rehabilitation training. Understanding how chronic stroke survivors respond to virtual agents can help physiotherapists enhance their practices using innovative digital tools. This paper presents five case studies of chronic stroke survivors with motor impairments—two female and three male—all with paresis in the dominant right upper limb. Participants engaged in a VR-based upper limb exergame, played either alone or with a virtual agent acting as a second player, whose behavior was governed by a rule-based algorithm. The study examined rehabilitation progress, task performance, and engagement. Participants who completed all sessions showed consistently higher engagement when playing with a virtual agent compared to playing alone, although game performance remained unaffected. These findings suggest that virtual agents can enhance task engagement and promote perseverance in stroke rehabilitation. The paper discusses these results in the current context of VR rehabilitation and outlines implications and directions for future research.