## 1 Introduction  
The Global Burden of Diseases (GBD) in the adult ranking of the Institute for Health Metrics and Evaluation (IHME) [1] finds that cerebrovascular diseases (CVD) are the second most common diseases in the world, following Ischemic Heart Disease. Specifically, strokes are the most common manifestation of this disease and are the major cause of severe disability [2]. According to [PERSON] et al. [3], \"a stroke can cause sensory, motor, and cognitive deficits as well as a further dependence on the activities of daily living and a decreased interaction in social and community events\".  
According to the same IHME dataset, strokes represent 5.65% of total disability-adjusted life years (DALYs) with a 0.46% increase from 2015 to 2019, the last year with processed data. From these numbers, the contribution to global DALYs of people 50 or older who suffered a stroke represents a total of 21.63%, while the age group below 50 accounts for 3.6% of global DALYs.  
By looking at deaths, CVD (and specifically strokes) are in second place with 11.59% of total deaths based on the previous IHME dataset, so everything indicates that investing in rehabilitation and the prevention of strokes should be an important action to improve population health and make healthcare systems more sustainable [4]. Moreover, this type of disease is a great social, medical, and economic burden, so any intervention method, including the use of new technologies, can be very important. On the other hand, disease prevention, health promotion, and sustainability seem to be the main objectives that strategies of healthcare services in the world are pursuing according to [PERSON] et al. [5].  
Given the high prevalence and impact of CVD on the population, and especially strokes, we decided to analyze how the use of Virtual Rehabilitation (VR) can improve the health outcomes of these patients. In addition, rehabilitation processes for these patients are usually long, and rehabilitation at medical centers should be complemented with rehabilitation at home, so the use of technology can be especially helpful in these cases.  
On the other hand, the information technology (IT) governance approach will help us to analyze outcomes from a results-based perspective, examining the impact and effectiveness of technology on an organization. It should be noted that that the focus here is not on the technology itself but rather on how it sustains and extends the organization's strategy.  
In this paper, we assess whether there is enough scientific evidence to integrate, in a general way, the virtual reality rehabilitation for physical and cognitive intervention after suffering a CVD. We first present the challenge that CVD constitutes for society with the most recent data about DALYs and quality-adjusted life years (QALYs). We then review the strategies that different healthcare services are adopting to reduce the disease burden, and we carry out an information technology governance-based analysis to review how IT is supporting and extending these strategies, improving rehabilitation, prevention, and interventions to reduce the impact of this disease on patients' lives.  
This study, initially focused on publications from 2015 to 2019, and it was extended to include the years 2020 and 2022 in order to incorporate the use of virtual reality in the pandemic situation generated by COVID-19 and after, where these approaches have been very useful [6] to maintain the intensity of treatment and permit patients to remain at home as much as possible [7].  
We therefore assess the IT contribution to these objectives using the IT governance paradigm, using the \"Four Ares\" defined by [PERSON] in his book _The Information Paradox_[8], one of the seminal works on IT governance, after reviewing the existing bibliography about virtual rehabilitation for patients who have suffered a stroke. Few studies, to date, have considered this type of approach in the study of the efficacy of virtual reality-based brain injury treatment.