## 4 Discussion  
This review concisely summarizes the effects of integrating FES with VR treatments for stroke patients compared to conventional or no interventions. It is important to note that VR training for stroke patients has been integrated with traditional methods, including conventional exercises and more advanced approaches like robotic-assisted gait training and functional electrical stimulation, all aimed at enhancing motor function. Further examination of the integration of these various approaches is needed, underscoring the importance of additional research in this field. This study reviewed four studies investigating rehabilitation systems using exercises tailored to each patient through the combination of virtual reality technology with functional electrical stimulation devices in motor rehabilitation enhancement. The studies conducted on stroke patients included a varied number of subjects, ranging from 13 to 51. The duration of these studies ranged from 12 to 25 therapy sessions, depending on the objectives pursued. The selected studies utilized various assessment scales to evaluate motor deficits meticulously. The FMA-UE scale serves as a critical index for assessing sensorimotor deficiency in individuals with a stroke history [43]. Furthermore, the WMFT, BBT, JTT, 9-HPT, Barthel Index, Abilhand Questionnaire, and MAL were employed as additional evaluation methods to craft a comprehensive rehabilitation program. In the studies conducted by [PERSON] et al. [33], 2018, and [PERSON] et al. [35], 2020, passive movement resistance was also evaluated using the modified Ashworth scale, which is an essential factor in assessing the degree of disability, with a significant impact on the rehabilitation process [44]. These rigorous assessments aim to meticulously monitor the progression of motor and functional status during activities of daily living. Despite using different functional tests and scales, [PERSON] et al. [45], 2019, and [PERSON] et al. [46], 2022, focus on upper limb rehabilitation for stroke patients. Their shared objective is to evaluate the effectiveness of functional electrical stimulation (FES) in restoring upper limb ability. This can involve achieving a more comprehensive range of movements, enhancing existing movements, or the ability to grasp various objects, all of which can significantly improve a patient's quality of life, enabling them to perform daily self-care activities and more, a crucial aspect of their rehabilitation journey. The results of both studies were promising. In [PERSON] et al. 's study [45], 2019, video analyses showed a significant improvement in upper limb movement range, while [PERSON] et al. [46], 2022, used specific tests such as the Fugl-Meyer Assessment Arm Section Score (FMA-AS), BBT, and SIS German version to assess patient progress. These positive outcomes should inspire optimism about the potential of FES and VR therapy for stroke rehabilitation. Furthermore, FES, which employs electrical stimulation to activate pathology-related muscles, has demonstrated potential in enhancing muscle control, strength, and coordination, thereby assisting in rehabilitating motor function [47]. Conversely, VR therapy entails using computerized simulated environments to deliver interactive and captivating experiences for patients during rehabilitation exercises [48]. In 2011, [PERSON] and [PERSON] conducted a study to assess the effectiveness of VR in post-stroke rehabilitation. They performed a meta-analysis of randomized clinical trials that investigated the use of VR in post-stroke rehabilitation, comparing VR therapy with other interventions or no intervention in control groups. The study measured improvements in motor function, cognitive abilities, and quality of life as primary outcomes. The meta-analysis found that VR therapy had a significantly positive effect on motor function in post-stroke patients, and there was also a trend toward improvement in cognitive abilities and quality of life. However, these results were not always statistically significant.