Effects of a Virtual Reality–Based Balance Training Program on Clinical Outcomes and Cortical Oscillatory Activity: A Combined Behavioral and EEG Study

Background: Stroke-related balance and mobility deficits often persist despite conventional rehabilitation. Virtual reality (VR)-based training may improve functional recovery. This study examined whether short-term VR training enhances clinical mobility outcomes and whether accompanying electroencephalography (EEG) changes reflect global cortical adaptations. Methods: In a prospective single-group repeated-measures study, 28 subacute stroke survivors completed 12 VR sessions over 4 weeks. Outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, affected and unaffected limb scores on the Lower-Extremity Motor Coordination Test (LEMOCOT), and resting EEG recorded with the Emotiv EPOC + headset. Assessments were performed at baseline, week 2, and week 4. Global EEG band power was averaged across Fz, Cz, C3, and C4 electrodes. Repeated-measures analyses with adjusted pairwise comparisons and standardized effect sizes evaluated longitudinal changes. Partial correlations controlling for baseline EEG and clinical scores assessed associations between EEG and functional improvement. Results: Clinical outcomes improved significantly over 4 weeks. Mean BBS scores increased from 38.3 to 49.7, TUG time decreased from 68.4 to 47.7 seconds, and affected-side LEMOCOT scores increased from 5.0 to 8.7, with large overall effects. Global EEG power increased progressively in beta, alpha, and theta bands. Balance gains correlated with alpha increases ( r  = 0.38 overall; r  = 0.63 during weeks 2-4), while mobility improvements and early affected-limb coordination were associated with beta modulation. Conclusions: Four weeks of VR training produced meaningful functional gains alongside widespread increases in cortical oscillatory activity, supporting a mechanistic relationship between VR-induced neuroplasticity and recovery in subacute stroke survivors undergoing rehabilitation.