## 3 Results and Questions Analysis
### Value Question: Are We Getting the Benefits? The positive outcomes of VR rehabilitation therapies were rated by [PERSON] et al. [16] according to the use of specific virtual environments and standard computer games, showing better results in specific virtual environments. This study also showed that the best positive outcomes were on body structure and function, activity level, and, secondarily, on cognitive functions, although issues about sample size and on the variability of the measurement methods were identified. This also supports the idea that we should include the type of environment (specific or general purpose) as a relevant variable in future virtual rehabilitation studies to avoid potential bias. According to [PERSON]'s 2012 and 2017 Cochrane reviews [30; 65], using VR for stroke patients' rehabilitation was found to be significantly more effective for upper limb function and activities of daily living function recovery, but the authors mentioned that \"further studies are required to confirm these findings\". A review by [PERSON] et al. [66] also supports the contribution of VR to stroke patients improving their upper- and lower-limb motor function, although no improvement was observed in cognitive functions. Nonetheless, there are other studies such as the one by [PERSON] et al. [67] that found improvements in this area. [PERSON] et al. [68] also highlight improvements in upper-limb and balance, but not in gait or hand dexterity. Some other studies have started using the so called Adaptive Conjunctive Cognitive Training (ACCT) where a combination of different cognitive domain training is used with positive results. For instance, [PERSON] et al. [67] and [PERSON] et al. [69] reported an improvement in attention and spatial awareness as well as in depressive symptoms [70]. However, other authors such as [PERSON] et al. [66], in a meta-analysis covering 23 randomized control trials with 894 patients, showed that improvements were significant only in executive function, memory, and visuo-spatial function, whilst in the case of global cognitive function, attention, verbal fluency, depression, and quality of life, they were not significant (compared to traditional methods). Other studies showed that a combination of a conventional physiotherapy program with interactive semi-immersive tools present better results than without it--[71; 72]. [PERSON] et al. [73] showed that there could be more positive outcomes than traditional therapies for motor control and motor learning, thanks to feedback and other features, using the application of VR to make the accomplishment of motor control and learning principles easier. Comparing and assessing outcomes from different studies is difficult given the different ways that authors measure them, while aforementioned authors such as [PERSON] et al. prefer to focus on the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale [10], others such as [PERSON] et al. [74] use the SF-36 and Fugl-Meyer tests, whilst [PERSON] et al. [75] complement Fugl-Meyer with the Functional Independence Measure. This is particularly evident in research carried out by [PERSON] et al. [31] where they mention that 42 different outcome measures were used across 100 studies. 17 different outcomes were aimed at measuring impairments, 16 were used to measure activity limitations, etc. Other studies such as [PERSON] and [PERSON] [76] present the same conclusion, even in the case of traditional intervention (not only virtual reality interventions). So, we should add difficulties of measurement diversity to the difficulties of tools used, small samples, etc. This happens even in most recent studies like [PERSON] et al. [77], where they found that while Computer Assisted Cognitive Rehabilitation showed significant difference in Stroke patients, the use of VR did not show equivalent benefits. Furthermore, recent studies like [PERSON] et al. [78] showed that other alternative techniques like acupuncture or transcranial magnetic stimulation showed more consistent results than VR use.