###### Abstract  
Background: This systematic literature review aims to explore the impact of rehabilitation in post-stroke patients, particularly highlighting the roles of virtual reality (VR) technology and functional electrical stimulation (FES). Methods: To ensure all relevant studies were included, a thorough search was conducted in PubMed and Web of Science databases using keywords such as 'post-stroke', 'FES', 'functional electrical stimulation', 'virtual reality', and 'VR'. Studies on rehabilitating upper limb function through VR and FES in post-stroke patients were included, regardless of publication year. Studies had to compare this combination therapy with conventional methods and report outcomes related to upper limb coordination, functional mobility, and daily activities. Studies not meeting these criteria were excluded. The selection process involved screening titles, abstracts, and full texts by four independent reviewers. The quality and risk of bias of the included studies were assessed using the PEDro scale and Robvis tool. Results: The review included four studies involving 135 post-stroke patients. Two articles examined the effectiveness of an approach involving virtual reality, robotic therapy, and functional electrical stimulation in rehabilitating upper limbs in post-stroke patients, showing significant improvements in motor function and quality of life. The other two studies explored the effects of rehabilitation therapy using virtual reality combined with functional electrical stimulation on upper limb function in stroke patients, finding that combined therapy (FES with VR) was superior to functional electrical stimulation or robotic therapy. Discussion: The review was limited by the small number of studies and participants, which may affect the generalizability of the results. Variations in intervention protocols and outcome measures across studies posed challenges in synthesis. Integrating these technologies brings benefits and increases the potential for personalizing and optimizing the rehabilitation process, enhancing patient engagement and satisfaction, and promoting a holistic approach to post-stroke management. Future research should focus on larger, more standardized trials to confirm these findings and optimize intervention protocols. stroke rehabilitation; virtual reality; functional electrical stimulation; upper extremity; motor function; physical therapy modalities; systematic review +
Footnote †: journal: Medicalrequires an extended period, depending on the severity of the stroke, associated pathologies, the patient's age, and the time elapsed since the stroke when rehabilitation began [2]. Rehabilitation is recommended for most patients to assist individuals with disabilities in regaining independence and improving their quality of life by restoring lost functions or increasing their functional level [3]. Medical rehabilitation plays a critical role in the recovery process following a stroke. It emphasizes physical therapy and personalized physiotherapy programs tailored to the individual rather than directly targeting the affected brain regions [4]. The rehabilitation of patients who have suffered a stroke is based on several principles; the most important is represented by the early intervention of the rehabilitation program [5]. Conventional rehabilitation emphasizes therapeutic exercises, and occupational therapy exercises aim to reintegrate the patient into daily activities (ADLs) and enhance communication skills through speech therapy [6; 7; 8]. Neurological rehabilitation should begin as soon as possible when the medical condition is considered stable [9]. The rehabilitation program should be customized for each patient, starting during early hospitalization, continuing long-term, and concluding after discharge. Stroke symptoms depend on the affected area of the central nervous system. Primary motor deficits such as spasticity and paralysis pose challenges for treatment.