Abstract Number: Esoc2026a822 Virtual Reality Neurorrehabilitation in Acute Stroke Patients and the Add-on Effect of Cerebrolysin

Abstract Background and aims Virtual reality (VR) is increasingly used in stroke neurorehabilitation; however, its safety and effectiveness during the hyperacute phase of acute ischemic stroke (AIS) remain insufficiently evaluated. Cerebrolysin, recommended as an add-on therapy enhances functional recovery. This study aimed to assess the tolerance and effectiveness of VR-based neurorehabilitation in the hyperacute phase of AIS and to evaluate the impact of Cerebrolysin on functional outcomes. Methods We included 185 AIS patients. VR-based neurorehabilitation was conducted between day 2 and day 9 after stroke onset. A dedicated questionnaire assessed vertigo, nausea, diplopia, headache, chest pain, arrhythmia, anxiety, and sweating at baseline and on day 7 of training, before and after VR sessions. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), and ECG were monitored before and after training. Results VR-based neurorehabilitation was well tolerated in the hyperacute phase of AIS, with no significant changes in questionnaire scores, SBP, DBP, HR, or ECG parameters. A substantial improvement in NIHSS score, was observed (P0.001). VR scenarios enabled patients to practice real-world self-care activities within a hospital environment. VR-induced sensorimotor illusions may facilitate neuronal reprogramming of motor control, contributing to a reduction in intention tremor. In a Bayesian analysis, patients treated with Cerebrolysin demonstrated greater functional improvement (BF₁₀=1.071×10¹8) compared with patients not receiving Cerebrolysin (BF₁₀=308.2). Conclusions VR-based neurorehabilitation is safe and well tolerated during the hyperacute phase of AIS and supports early post-stroke recovery. Parallel administration of Cerebrolysin further enhances the therapeutic effects of VR-based rehabilitation. Conflict of interest S.Michalak.nothing to disclose, E.Kozielewska-Zwierska.nothing to disclose, P.Sniatała. nothing to disclose, J.Biskup-Danielak. nothing to disclose, K.Sniatała.nothing to disclose, S.Balinskinothing to disclose