Advancing rehabilitation in Parkinson’s disease through virtual reality: a narrative review

Background: Virtual reality (VR) is increasingly explored in Parkinson's disease (PD) rehabilitation, yet the clinical evidence remains heterogeneous. Objective: To provide an integrative narrative synthesis of the neurophysiological rationale, VR modalities (immersive, semi-immersive, and non-immersive), and motor/non-motor outcomes associated with VR-based rehabilitation in PD. Methods: Narrative review of peer-reviewed studies published between 2010 and 2025. Fifteen PD + VR rehabilitation studies meeting eligibility criteria were included in the qualitative synthesis. Mechanistic, non-PD, pre-2010, or otherwise non-eligible studies were discussed only as contextual/supporting evidence. Findings were synthesized narratively, and methodological limitations were examined through a structured critical appraisal. Objective: Across small and methodologically heterogeneous samples, VR-based rehabilitation was associated mainly with improvements in balance and gait-related outcomes, including Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) performance, Functional Gait Assessment (FGA), stride length, gait velocity, and walking distance. Selected studies also reported gains in upper-limb function and balance confidence. Effects on freezing of gait and tremor were variable. Cognitive and executive effects were less established than motor findings and should be considered preliminary. Conclusion: VR appears promising as an adjunct to conventional rehabilitation in PD, particularly for gait, balance, and motor-cognitive training, but the certainty of evidence remains moderate to low. Broader mechanistic interpretations should be considered plausible explanatory frameworks rather than demonstrated therapeutic effects. Priorities for future research include protocol standardization, blinded assessment, improved safety reporting, sham/yoked comparator designs, responder profiling, and evaluation of scalable home-based and AI-adaptive platforms.