Stroke patients in the UK currently spend up to 80% of their hospital day in non-therapeutic activities, and many receive inadequate rehabilitation after discharge. A virtual reality system called Virtue aims to close this gap by delivering immersive, task-based cognitive therapy—simulating real-world activities like cooking or shopping—both in hospital and at home. This matters because two-thirds of stroke survivors develop post-stroke cognitive impairment, which reduces independence and increases care costs. Current NHS guidelines recommend at least three hours of therapy daily, but stretched resources mean many patients get far less. Virtue offers a scalable, cost-effective way to deliver more therapy without requiring more staff. In an earlier trial, Virtue reduced hospital stays by five days and saved £400 per bed per day. Patients with severe cognitive impairments showed an eight-point improvement on the MoCA cognitive scale compared to controls. The system is already UKCA-marked and meets NHS digital standards. This next trial will test Virtue in community settings, where rehabilitation services are even more limited. If successful, the system could extend continuous cognitive rehabilitation beyond hospital walls, reducing long-term care burdens and improving independence for stroke survivors across the UK.
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Each year, 15 million people worldwide suffer strokes, including 100,000 in the UK?(1). More than 1 million people live with long-term effects in the UK, costing £26 billion annually in healthcare, social care, and lost productivity?(2). Two-thirds of stroke survivors experience post-stroke cognitive impairment (PSCI), which is associated with poorer outcomes, reduced independence, higher care costs, and increased caregiver burden?(3,4,5). Rehabilitation relies on neuroplastic cortical reorganisation, which is achieved through intensive, repetitive therapy. NICE guideline NG236 recommends at least 3 hours of therapy per day?(6). However, many patients receive far less due to overstretched resources, and rehabilitation teams have long struggled to meet the previous recommendation of 45 minutes per day?. Patients often spend up to 80% of their day in non-therapeutic activities?(7,8), and after discharge, many receive inadequate support. There is an urgent need for solutions that can bridge this gap and provide continuous, accessible cognitive rehabilitation both in hospitals and at home. Virtue is an immersive Virtual Reality (VR) system that simulates real-world Activities of Daily Living (ADLs) to support stroke patients in regaining cognitive function. It offers interactive, task-based rehabilitation that promotes neuroplasticity through repetitive practice. Virtue provides continuous therapy beyond the hospital setting, extending rehabilitation into the home, which helps address the drop in care intensity following discharge?(9). By offering a scalable and cost-effective solution, Virtue enables rehabilitation teams to deliver more therapy than is otherwise possible under current resource constraints. Its unique focus on cognitive rehabilitation through ADLs sets it apart from other VR solutions, which mainly focus on physical rehabilitation. Additionally, therapists can remotely monitor progress and adjust treatment plans, ensuring patients receive personalised care. Virtue is currently at Technology Readiness Level (TRL) 7/8. In a Phase 2b trial, Virtue demonstrated a reduction in hospital stays by five days, saving £400 per bed per day, while patients with severe cognitive impairments showed an 8-point improvement on the MoCA scale compared to controls?. The system is now UKCA-marked and meets NHS digital standards?(e.g DTAC and DCB0129), making it ready for broader clinical deployment in the UK. This next trial will expand on earlier findings by evaluating Virtue in community settings, where rehabilitation services are even more limited. . Patient and public involvement (PPI) has been integral to Virtue s development. Feedback from stroke survivors and their families at the Countess of Chester Hospital has directly influenced Virtue s design, making it more user-friendly and adaptable for home use. Focus groups have provided insights on how to improve real-world task relevance, ensuring the system meets patient needs?. Virtue aligns with the FAST call by addressing an unmet need for cognitive rehabilitation. It offers a scalable, cost-effective solution that extends rehabilitation into community settings, improving patient outcomes and reducing the burden on NHS resources. Virtue s demonstrated ability to reduce hospital stays and enhance long-term cognitive recovery makes it well-suited for broader adoption and investment?.
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