Background: Chronic neuropathic pain (CNP) is a common consequence of neurological conditions such as spinal cord injury (SCI), complex regional pain syndrome (CRPS), and phantom limb pain (PLP). These conditions are often associated with distorted body representation (BR) and altered sensory processing. Virtual reality (VR) offers immersive, multisensory experiences that can modulate attention, recalibrate BR, and potentially alleviate pain. Objective: This systematic review aims to synthesize evidence on the use of VR-based interventions for managing CNP in patients with neurological conditions. It explores how VR can influence pain perception through body remapping. Furthermore, this review seeks to identify gaps in current research, offering recommendations for future research directions and clinical applications. Methods: We performed a comprehensive literature search in PubMed, Web of Science, and Scopus for studies published between January 2014 and December 2024. We included original studies that examined VR interventions in patients with neurological conditions and CNP, assessing pain reduction, improvements in BR, or functional recovery. We excluded reviews, animal model studies, migraine-related studies, and those lacking a clear VR intervention or relevant clinical outcome data. The quality of the included studies was evaluated using the revised Cochrane Risk of Bias Tool for Randomized Trials and the Cochrane Risk of Bias in Nonrandomized Studies of Interventions tool. Given the heterogeneity in study design, VR protocols, and outcome measures, a qualitative synthesis approach was adopted based on the synthesis without meta-analysis framework. Results: Ten studies—both randomized controlled trials and uncontrolled experimental designs—met the inclusion criteria. These studies focused on the application of VR in SCI (n=4, 40%), CRPS (n=4, 40%), and PLP (n=2, 20%), using interventions such as immersive VR, mirror visual feedback, visuotactile stimulation, and virtual body illusions. Sample sizes ranged from 9 to 70 participants, with varying degrees of neurological impairment. Most of the studies (n=7, 70%) reported substantial reductions in pain intensity and improvements in embodiment and perceived body ownership. In SCI, combining VR with neuromodulation techniques enhanced analgesic effects. In CRPS, modifying the visual appearance of the affected limb improved body image and decreased pain perception. In PLP, kinesthetic and visual feedback delivered through VR environments significantly reduced PLP and improved movement representation. Conclusions: Overall, the quality of evidence ranged from moderate to low, mainly due to small sample sizes, protocol heterogeneity, and risk of bias. Evidence regarding adherence to VR therapy was particularly limited. Nonetheless, VR shows strong potential as a noninvasive, patient-tailored therapeutic tool for CNP. VR could provide innovative and engaging strategies to reduce pain and enhance functional outcomes in populations with neurological conditions. Future research should focus on developing standardized protocols and conducting large-scale, high-quality trials to validate VR’s long-term efficacy and integration into routine clinical practice. Trial Registration: PROSPERO CRD42024606150; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024606150

Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee–ankle–foot orthosis. A powered knee–ankle–foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine differences of the powered knee–ankle–foot orthosis compared to a locked knee–ankle–foot orthosis in kinematic data and temporospatial parameters during ambulation. Quasi—experimental design. Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee–ankle–foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. Walking with the powered knee–ankle–foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee–ankle–foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. The new powered orthosis permitted improved knee joint kinematic for knee–ankle–foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee–ankle–foot orthosis. This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities.

The aim of this study was to evaluate the effect of dynamic elastomeric fabric orthoses (DEFOs) on postural control in children with cerebral palsy (CP). Ten children with spastic diplegic CP and 10 children with typical development participated. Knee extension was measured using electrogoniometry. The standard deviation of excursion and phase plane portraits of velocity in the anteroposterior and mediolateral directions were calculated from force platform signals as center of pressure parameters with or without a DEFO. Maximum standing knee extension for children with CP improved after 6 weeks of wearing DEFOs (P < .05). Center of pressure parameters did not improve when comparing pre- to 6 weeks post-DEFO use (P < .05). The DEFO can reduce the crouch position without any negative effect on postural stability in children with CP. However, postural control does not improve in a 6-week timeframe.

A powered knee–ankle–foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee–ankle–foot orthosis with drop lock knee joints. Quasi experimental study. Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee–ankle–foot orthosis. Walking with the powered knee–ankle–foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee–ankle–foot orthosis. Using a powered knee–ankle–foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. This powered knee–ankle–foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee–ankle–foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted.

Background: Aging often results in thoracic kyphosis and adverse postural changes. This may interfere with physiologic activity of paraspinal muscles. Few styles of spinal orthosis have been already used to reduce thoracic kyphosis. This paper describes the development of a novel orthosis, which is designed based on the anatomy of the back muscles. This novel orthosis may potentiate muscle activity and balance control among older hyper kyphotic subjects. Objectives: The object of this study was to design and preliminary testing of a new orthosis to potentiate muscle activity and balance control among older hyper kyphotic subjects. Material and Methods: In this quasi-experimental study, a new postural control orthosis with a textile band structure was designed to provide an additional support for spine and muscles of the back. The functional impact of this orthosis was evaluated in six older hyper-kyphotic subjects. According to the results, the paraspinal muscles activity and balance control were significantly improved. Results: The RMS sEMG of the lumbar and thoracic erector spinae muscles reduced significantly (p<0.05), and a significant improvement (p<0.05) was observed in the balance test when patients put on the novel orthosis (p<0.05). Conclusion: The new orthosis can considerably improve the paraspinal muscles activity at both the upper and lower lumbar levels. It can also recover balance control among elderly subjects.