VR in Occupational Therapy: Usage & Effectiveness

The application of virtual reality in occupational therapy is generally subdivided into the immersive and non-immersive formats, and while both of these formats support rehabilitation, they provide different levels of engagement and sensory experience.

The non-immersive experience, as of November 2025, is the common format, characterized by the interaction of the individual with a virtual environment through a screen, i.e. computer or TV, while using a mouse, joystick, or motion tracking devices to perform the activities. In a non-immersive experience, the patient is still fully conscious of his or her own environment, but their focus is centered on engaging with a digital task that helps them practice coordination, problem-solving, or motor control. This immersion format is especially useful for patients who require a more subtle introduction to virtual environments or may feel uncomfortable wearing headsets.

Immersive VR, on the other hand, takes the introduction of the virtual experience a bit further by using equipment such as a Virtual Reality headset, hand controllers, and sometimes even motion-capture systems, to immerse individuals in the virtual environment. Instead of looking at a screen to practice tasks. Immersive VR allows patients to experience a 360-degree view where their movements are responded to in real time. This level of presence naturally helps to increase the patient’s focus, motivation, and repetition – all of which are essential for functional therapy.

In most cases, occupational therapists choose between these 2 formats based on the patient’s condition, confidence level, and the specific skill that is being practiced. Therapists, in some cases, start their patients off with non-immersive VR to help develop their familiarity before moving into immersive scenarios. In some other instances, the therapists get their patients to jump straight into immersive VR because it better mirrors their specific real-life daily tasks and encourages more natural movement.

The integration of VR into occupational therapy involves a process that effectively combines technology with clinical expertise for the purpose of targeting specific skills and therapeutic goals.

To integrate VR into occupational therapy, therapists typically start by identifying the patients’ needs and therapeutic objectives. When the therapists have a clear understanding of the daily activities that their patients find challenging, the motor and cognitive skills need to be improved, and how their patients’ therapy treatment can be structured safely, they then proceed to select and customize the VR programs that exactly fit those objectives.

For example, a therapist whose patient is recovering from a wrist injury might select a VR program that simulates cooking tasks that require precise hand movements and grip control. Another patient with balance issues might be engaged with VR simulations where they have to navigate a room filled with obstacles while improving their train coordination and spatial awareness – all without the risk of getting hurt or falling.

Virtual reality also integrates efficiently when combined with traditional occupational therapy techniques. A therapist, for example, might start off their patients' treatment with simple real-world tasks that serve as warm-ups, transition to VR where the patients start to safely practice more targeted skills, and then have them return to physical tasks so that the patients may reinforce what they have learned in the virtual environments. VR technology, during this time of practice, helps to provide instant feedback, measurable performance data, and adjustable difficulty levels – all of which allow the therapist to make a quick decision and customize the virtual environments in real time.

The use of VR in occupational therapy is not confined only to the hospital or clinic space. With the advent of telehealth-friendly VR systems, patients can continue to practice clinically-advised tasks while their therapist monitors their progress remotely. VR’s flexibility helps patients to stay consistent, practice more often, and reinforce their skills in a structured and engaging way.

Essentially, the integration of VR into occupational therapy is not about using virtual reality to replace the traditional techniques, but by strengthening them through the creation of safe and structured simulations where patients can practice the essential skills that are needed for them to regain their independence.

As we have mentioned earlier in this article, progress does not come from doing a task once, but rather doing the same task over and over again, with the right level of focus and effort. However, the challenge faced with this in real-life therapy is that getting patients to stay motivated, consistent, and emotionally invested can be difficult, especially when the exercises begin to feel repetitive, difficult, or uncomfortable.

VR helps to overcome this challenge through its ability to turn what seems like boring, uncomfortable therapeutic tasks into activities that are engaging and meaningful. For instance, instead of just lifting cones, sorting blocks, or repeating basic hand movements, patients using VR are constantly engaged by completing purposeful and engaging tasks inside a virtual, but life-like environment such as reaching for floating objects, navigating a calming room, building shapes, cooking with a virtual kitchen or interacting with sensory elements that are designed to hold their attention.

Another advantage of using VR in occupational therapy, which drives engagement, is the technology’s ability to simulate tasks and environments that meet each patient at their current level of need. For example, some patients who are battling with anxiety can be introduced to a calm, quiet environment, while the individual who needs excitement can be immersed in more dynamic virtual environments. This way, the therapist does not have to push for motivation as the virtual environment already supports it.

VR also maintains patient engagement and motivation by providing visual feedback of:

• Movements that are reflected in real-time
• Progress that is displayed clearly
• Small noticeable improvements
• Tasks that can be repeated without the patient feeling fatigue or frustrated

Additionally, because virtual environments can be personalized to match each patient’s ability and tolerance, the patients are always faced with tasks that they find challenging enough to improve themselves without causing setbacks. For occupational therapy, where consistency and repetition drive functional recovery, this level of balance is especially useful for helping patients stay engaged longer, practice more repetitions, and actually look forward to more sessions.

One of the reasons why VR integrates well into occupational therapy is that it supports a wide range of skills that patients need for their everyday independence. Instead of practicing each skill in isolation, VR makes it possible for therapists to effectively combine activities in a way that feels both purposeful and realistic.

A major example of skills that VR helps to develop is motor skills. This refers to both fine motor skills, such as grasping, sorting, or rotating objects, and gross motor movements like reaching, bending, stepping, or maintaining balance. VR develops these skills by allowing patient interaction with virtual objects in a controlled environment where they are directed to carry out grasping, rotating, or hand-to-hand coordination activities. For the development of gross motor function using VR, the therapist might have their patient reach, bend, step over obstacles, or practice balance inside a safe virtual environment.

VR also helps to improve patients’ cognitive abilities by allowing patients to virtually participate in tasks that are configured to improve attention, memory, problem-solving, planning, and decision-making. For example, a patient using VR might be tasked to follow a recipe in a virtual kitchen, sort items based on rules, or navigate a virtual room while remembering where items were placed. These activities, despite how simple they seem, can help to develop essential cognitive pathways for real-life tasks.

For patients who are struggling with sensory processing, VR helps to provide a controlled sensory experience where the therapist can always adjust the sound levels, visual complexity, movement speed, or environmental cues to meet the patient's needs. This makes it possible for the patients to gradually build up their tolerance or refine their sensory responses without feeling overwhelmed.

There is also the development of functional daily living skills such as meal preparation, dressing routines, or personal hygiene activities like brushing of teeth. VR helps to develop these everyday skills by creating realistic virtual environments that replicate real-life scenarios, such as shopping, meal preparation, and allowing patients to practice these skills safely, repeatedly, and at the exact difficulty level that they require.

Essentially, VR helps therapists to focus on the skills that matter the most while providing patients with structured environments where they can practice as many times as necessary without feeling discouraged or unsafe.

One thing therapists quietly value about VR, more than most patients notice, is the built-in safety net it creates. In a normal therapy session, there’s always this ongoing concern about the potential safety issues. A near-fall during gait work, a sudden wobble when someone reaches overhead, a kid who bolts toward the hallway because the lights or noises pushed them over the edge. Even with the most comprehensive plan, what happens in real-world exposure sessions cannot be totally predicted or controlled.

VR helps to change that dynamic by creating environments where patients can practice difficult or sensitive tasks without facing any physical consequences. For instance, a patient trying to relearn how to navigate a living room can be immersed in a virtual living room where they are tasked to step over virtual obstacles, reach for items on shelves, or practice moving between spaces – all without the danger of tripping or getting injured. Also, an individual looking to rebuild his/her fine motor skills can be immersed in a virtual environment and engaged in handling virtual objects without worrying about dropping anything or causing pain. With VR, the patient is more concerned about overcoming the challenge, as the danger now seems of no consequence.

Another way VR facilitates a safe environment for rehabilitation is through the level of control it has over the virtual scenarios it creates. The therapist in charge of a patient’s VR treatment can easily remove distractions, reduce sensory overload, or adjust the complexity of the task with a single setting. If, for instance, a patient is struggling with anxiety and requires a calm virtual environment for rehabilitation, the therapist can select a peaceful forest setting and can gradually progress the intensity of the environments into more stimulating environments as the patient’s tolerance level increases over time. For patients who are recovering from an illness or injury, especially those who tend to feel anxious, vulnerable, or unsure of their abilities, this sense of safety is very important. VR helps to provide patients with the space they need to try, fail, and adjust, without a sense of fear, embarrassment, or physical harm.

Over the years, many clinical studies have been conducted to examine how VR helps patients to rebuild their motor function, improve balance, develop cognitive skills, and gain confidence in performing their daily tasks.

For example, a study was conducted at Wong Tai Sin Hospital in 2024 to determine the effects of virtual reality-based training on PR (pulmonary rehabilitation) patients’ psychological well-being, training engagement, adherence to breathing control exercises, and sense of security. The assessment of the outcomes of this study was intended to confirm the potential benefits of VR in augmenting PR efficacy. For the study, a single-group design of 10 participants was selected (aged 67 to 91), and they were all diagnosed with COPD (chronic obstructive pulmonary disease), COVID-19, and lung cancer. The participants received 30 minutes of immersive VR exposure sessions every day in addition to their occupational therapy routines. Before and after the intervention, the clinicians recorded their functional and psychological assessment scores, which were measured by qualitative methods such as the Hospital Anxiety and Depression Scale (HADS), and semi-structured interviews that allowed the patient to describe their experience, feelings, and perceptions of VR in their own words.

At the end of the study, it was later concluded that merging VR technology into Occupational therapy (OT) services helps to yield positive results. VR was confirmed as a healthy addition that helped improve psychological well-being, training engagement, and exercise compliance.

Another review was conducted in 2024 to confirm the effectiveness of virtual reality (VR) interventions when combined with occupational therapy for adults recovering from stroke. The researchers began the study by searching major databases such as PubMed/Medline, Scopus, Web of Science, and ScienceDirect for randomized controlled trials that were published within the last 10 years, which involved stroke survivors who undertook VR interventions that were targeted at upper limb and functional recovery. At the end of their search, 16 studies met their inclusion criteria. The quality assessment process followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with the risk of bias assessed using the Cochrane tool and methodological quality evaluated using GRADEpro (Grading of Recommendations, Assessment, Development and Evaluations).

At the end of the study, it was concluded that VR emerged as a beneficial tool when included in conventional treatments to improve people’s motor and cognitive functions after a cerebrovascular accident. It was also realized that VR encourages adherence to the interventional process of rehabilitation through occupational therapy.

When evaluating the effectiveness of VR in occupational therapy, therapists rely on a combination of objective and subjective metrics. The objective metrics mainly included performance-based measures such as the patients’ speed, accuracy, or range of motion in completing specific tasks. For instance, if a patient is using VR to improve fine motor skills after a stroke, the clinicians might assess their progress and the effectiveness of their VR treatment by tracking how quickly and precisely they can pick up virtual objects or complete hand coordination exercises.

The subjective metrics, on the other hand, serve to complement the objective metrics by capturing the patients’ own experiences and engagement. It includes metrics like motivation, enjoyment, perceived improvement, or confidence in performing daily activities, and is measured with tools like questionnaires and self-reported scales. Some studies also allow the measurement of psychological factors, such as stress levels or heart rate, to confirm whether or not the VR sessions are reducing anxiety or promoting relaxation during therapy.

All of these metrics are combined to help provide a holistic view of success that effectively balances functional gains, patient satisfaction, and overall engagement. They also help to ensure that VR interventions are improving rehabilitation outcomes and not just technologically impressive.

When you place the traditional occupational therapy approach side by side with the VR-enhanced therapy method, the major difference that often shows up is in both the pace and the quality of patient improvement. While the traditional therapy method works effectively, the VR-enhanced method tends to present the activities to be practiced in a more engaging manner that pushes the patients to try a bit harder and be more consistent. For example, a patient practicing balance in a regular clinic might lose interest after a few repetitions. With VR, however, that same exercise can feel real in a virtual world where they are performing the activity as they would in the real world. The increased repetition of this practice usually results in faster improvements.

Another difference between these 2 approaches in terms of patient outcomes is that patients using virtual reality tend to experience a smoother transition from their virtual treatment into real life. This is mainly because VR realistically simulates everyday tasks such as reaching for shelves, using both hands together, or navigating crowded spaces – making the improvements easier to translate into functional independence. A lot of patients report feeling less anxious during VR sessions because they tend to feel more relaxed, willing to try difficult tasks, and more confident in their abilities.

So while traditional occupational therapy helps to build the foundation, VR-enhanced therapy tends to accelerate progress, boost confidence, and make rehabilitation feel less like work and more like a meaningful, interactive experience.

Even though VR is changing occupational therapy in several important ways, it is not without its own challenges and limitations, which therapists have to navigate. Some of these issues stem from the technology itself, while others are tied to cost, training, and patient readiness. VR can only be best optimized when the therapist understands its limitations and plans around them.

One of the technical challenges that is commonly faced by therapists when using virtual reality in clinics is the difficulty of ensuring that the equipment works smoothly during the exposure sessions. There are times when the VR equipment has lag, loses tracking, or develops issues during exposures, thereby interrupting the flow of treatment.

Another common challenge of using VR in clinical settings is the setup and space requirements. While there are some VR machines that are portable in size, therapists in actual clinics need to have a VR-dedicated work space that allows their patients enough room to safely turn, reach, or walk without bumping into walls or any other VR equipment. Not every clinic facility has this kind of open space available, and because of that, they are unable to efficiently deliver VR treatment to their patients.

There is also the challenge of device compatibility and software updates. Most VR platforms frequently release new software versions, and their therapists need to install these updates so that their apps can function properly. These updates can sometimes change the interface, and the therapist has to relearn small parts of the system, while clinics without access to these updates risk experiencing glitches.

Cost is regarded as a major barrier that is preventing many clinics from adopting VR. For smaller therapy practices, the initial investment of VR can be unaffordable as the space setup and VR equipment, like a compatible computer and motion sensors, can add up to a high cost.

However, the value of the cost to be incurred when adopting VR is not just limited to the cost of buying the equipment alone. There are also the constant expenses of maintaining the VR equipment, and this includes the repairs, updates, and replacements - especially in busy clinics where multiple patients use the same headset every day. There are also certain platforms that charge annual or monthly licensing fees, which can make budgeting even more difficult for practices that are already trying to manage their financial constraints.

There is also the challenge of convincing the decision-makers of the clinic that the return on investment (ROI) on VR equipment is worth it. While VR, over the years, has been proven to improve both patient engagement and outcomes, there are several clinics that still operate on limited insurance reimbursement, which does not always cover VR-based interventions. So, even when therapists want to integrate VR, the financial structure of healthcare systems can make the integration of VR difficult.

The cost factor does not mean VR is out of reach. It just implies that clinics need to plan carefully, compare their options, and adopt virtual reality in a way that exactly fits their budget without compromising the quality of care they deliver.

Although virtual reality brings a lot of value to occupational therapy, there are still a few limitations that therapists have to always consider.

For some patients, especially those with balance problems, visual sensitivity, or certain neurological conditions, VR exposures can feel a bit overwhelming for the patients. This can be easily identified in patients when they begin to experience symptoms such as mild dizziness, eye strain, or discomfort when the visuals move too quickly, or the environment is too stimulating. This kind of situation will require that the therapists introduce VR gradually and choose the experiences that match the patient’s tolerance level.

Another limitation of VR in occupational therapy is that the technology cannot fully replace the tactile feedback that traditional therapy provides. There are moments in rehabilitation when the therapists have to physically guide a patient’s limb, adjust posture, or help a patient feel a correct movement pattern – all of which cannot be replicated by VR environments.

Also, the different adaptive capabilities of each patient to VR can be a limitation in occupational therapy. Some older adults, especially those who have cognitive difficulties or are not familiar with digital devices, may feel unsure or hesitant the first time they put on a headset. This category of individuals might require extra support to properly understand how to navigate the virtual environments, follow on-screen cues, or stay oriented during the session.

Now, this does not necessarily mean that VR will not work for these individuals. It just implies that the therapist in this kind of situation will have to slow things down, give simple instructions, and sometimes repeat the steps until the patient feels comfortable. This is why VR works best when it is combined with a therapist’s expertise and real-world practice.

VR can be integrated into occupational therapy when therapists come into a full understanding of what it can potentially contribute to their existing routines and how it can support certain rehabilitation goals. This is why the process of VR integration into occupational therapy is more about the planning than the technology itself. With the right setup, VR can be integrated to become a natural extension of occupational therapy that therapists use to help patients practice real-life tasks in a controlled, motivating environment.

The process of integrating VR into a clinic involves a structured, thoughtful approach and does not necessarily require that the clinic make major changes to its existing setup. The first step to take is to identify the therapeutic goals that you are integrating virtual reality to support. For example, the focus could be on upper limb rehabilitation, balance training, cognitive skills, or sensory integration. Knowing the exact purpose for which VR is being installed in a clinic helps the therapist in the selection of the right VR platform, instead of being overwhelmed by options.

After the selection of the VR platform with respect to the clinic’s needs, the next step is to select the VR equipment and software that match their clinical needs. Some systems are configured for high-intensity motor rehab, while others are better optimized for cognitive or functional training. During VR equipment selection, it is important for the therapist to look for solutions that provide medical-grade exercises, clear progress tracking, and easy-to-use interfaces that allow both the medical professional in charge and their patient to navigate the system with ease.

The next step is to create an appropriate space to install the VR tools. The space does not necessarily have to be huge. It just has to be functional enough to create enough room for the patients to be able to reach, step, or turn safely without bumping into anything. It is also important that the space has proper lighting, stable internet, and a clutter-free area to ensure that the exposure session runs smoothly.

Lastly, it's important that the clinic and occupational therapist start out with VR small and progress slowly, especially during the early stage of integration. A pilot phase with a few patients after setup is a great way for clinics to test their setup, understand how each exercise works, and adjust the workflow before expanding VR to more cases.

The right kind of training that is required for occupational therapists to use virtual reality well is the one that helps them connect the technology to real therapeutic goals. The first step to acquiring this knowledge is to properly understand how VR systems work, and this includes knowing how to set the VR equipment, adjust difficulty levels, choose the right activities, and troubleshoot basic issues. The importance of having this understanding is to help ensure that the VR sessions run smoothly without taking any time away from patient care.

Aside from the comprehension of the technical basics, the therapist also needs to have a solid understanding of how VR activities result in functional outcomes. For example, an occupational therapist must understand that a virtual reaching task is not only fun but also an activity that helps to improve a patient’s shoulder mobility, hand coordination, balance, or whichever skill the therapist is targeting. The common training programs from virtual reality providers include clinical guides, case examples, and protocols that help therapists match structured, virtual exercises with their actual therapeutic goals.

It is also beneficial for therapists to receive patient safety and adaptation training. This type of training helps to equip therapists with the knowledge of how to introduce VR gradually, monitor for dizziness or discomfort, and how to modify tasks for patients who are struggling with cognitive challenges, low endurance, or sensory sensitivities.

The purpose of these types of training is not to turn therapists into tech experts but to equip them with the right knowledge that gives them enough confidence and clinical insight to use VR intentionally, safely, and effectively during rehabilitation.

One of the biggest strengths of VR in occupational therapy is how easy it is for the technology to customize virtual scenarios. The therapists in charge of VR settings can always use the control panel to adjust the virtual environment, task difficulty, pacing, and even the type of feedback that a patient receives – all depending on what the patient needs at that moment during their recovery. For example, if a patient who recently sustained a hand injury is working to improve his/her fine motor control, the therapist can start engaging the patient by selecting smaller objects, slower movements, or tasks that encourage precise finger coordination. However, if another patient needs to build confidence with standing balance, the therapist would need to switch to a completely different VR scenario, which challenges posture, stepping, or weight shifting.

Virtual reality also makes it possible for therapists to make changes to the sensory load. Patients who get easily overwhelmed can start their VR exposure treatment with calmer environments that are characterized by low movement, soft colors, and minimal distractions. As the patient’s tolerance level improves over time, the therapist can gradually increase challenges, visual input, or more complex tasks.

Furthermore, VR’s ability to record performance data in real-time helps therapists to instantly know whether the approach is yielding results, the ones that are not, and what needs to be adjusted. In a situation where the VR scenario or intensity is causing the patient to struggle, the tasks in the scenario can be immediately changed or reduced in level of intensity. Also, if the patients are observed to be progressing quickly, the difficulty levels can be increased without needing to wait for the next session. This level of flexibility helps to make the therapy experience more responsive, personal, and ultimately more effective.