The article, written by authors based at Texas Christian University, the University of Kentucky, the University of Washington, the Shirley Ryan AbilityLab, and BrainRobotics, synthesizes current evidence on virtual reality in rehabilitation for people with limb loss, such as acquired amputation, and limb difference, meaning congenital limb absence. The team spans expertise in virtual reality, psychological wellbeing, motor function, physical activity, and body composition, alongside clinical researchers who are also prosthetists, occupational therapists, and physical therapists. One author, a nurse with lower-limb loss, has used VR recreationally, grounding the perspective in lived experience as well as technical knowledge.

The scale of the population involved is substantial. In the United States, the three most prevalent causes of limb loss are dysvascular disease, accounting for roughly 54 percent of cases, trauma at about 45 percent, and cancer-related causes at around 2 percent. Most people with limb loss are estimated to be older adults, between 44 and 65 percent, and that proportion is projected to increase as the population ages and dysvascular diseases become more prevalent. Limb difference, by contrast, refers to someone born without a limb or a portion of a limb. The perspective covers people with lower-limb loss, upper-limb loss, and limb difference alike.

Virtual reality refers to a computer-generated environment that can produce a sense of physical presence in a virtual world. Systems vary by level of immersion. The most immersive devices are head-mounted displays, which block the physical reality of the user, accommodate a range of senses, and provide a panoramic environment through a high-resolution display, allowing users to navigate and interact within a scene from a full 360-degree perspective. Less immersive formats, such as flat-screen displays viewed through a phone application or television monitor, provide audiovisual stimulation but with lower interactivity, embodiment, and presence. This distinction matters clinically, because the degree of immersion shapes how well virtual training transfers to real-world function.

On the motor function side, the evidence points to several areas where VR could help. Physical activity, defined as any movement produced by skeletal muscle contraction that increases caloric expenditure above resting values, is a cornerstone of rehabilitation after limb loss. Yet many studies report that people with lower-limb loss do not receive adequate physical activity. Peripheral artery disease, one of the leading causes of lower-limb loss and often associated with type 2 diabetes, is itself linked to low activity levels. People with limb loss have reported barriers including transportation, reluctance to exercise in public, lack of motivation, and the absence of a formalized exercise program after concluding physical therapy sessions. Home-based VR systems could potentially mitigate these barriers, although the authors note that, to their knowledge, no studies have compared physical activity parameters in people using VR against traditional rehabilitation following lower-limb amputation.

Body composition adds another layer of technical complexity. Physical inactivity combined with limb loss promotes biomechanical deficits and systemic adaptations, including an increased metabolic cost of movement and tissue degradation. Skeletal muscle loss alters the power-to-weight ratio, and muscle quality is compromised by intramuscular fat infiltration, known as myosteatosis. These changes contribute to a maladaptive cycle of inactivity, muscle loss, and fat accumulation, resulting in sarcopenic obesity across the lifespans of people with limb loss while raising the risk of cardiovascular disease, metabolic syndrome, and mortality. Limb loss also leads to a decline in bone mineral density, particularly in the residual limb, increasing fracture risk despite prosthesis use. As an exergaming modality, VR has the potential to increase energy expenditure and reduce fat mass while preserving lean tissue, particularly when resistance or power-oriented tasks are included in gameplay, and may attenuate bone density loss when it incorporates weight-bearing components. However, studies integrating comprehensive and objective body composition data remain scarce.

Balance and gait represent a third motor domain. Impaired physical activity and altered body composition contribute to balance and gait deficits associated with high fall risk in this population. A limited number of studies have examined how VR interventions can improve the kinematic and kinetic properties of balance and gait, but which aspects of motor function improve, and how such changes might reduce fall risk, remain unknown. Large and expensive systems such as the Computer Assisted Rehabilitation Environment have shown clinical mobility improvements and altered gait mechanics, and lower-cost VR systems could offer similar benefits for spatiotemporal gait metrics while targeting individual biomechanical deficits. Few studies have addressed the retention of motor skills or their transfer to real-world tasks, and current VR interventions primarily use exergames without harnessing technologies that afford the study of motor skill acquisition beyond clinical environments. A further limitation is that current head-mounted displays do not provide sophisticated tactile or haptic feedback, which may reduce their ability to support prosthetic motor learning.

On the psychological side, VR literature has concentrated heavily on phantom limb pain, which affects over 60 percent of people with limb loss. VR provides a dynamic interface for manipulating a virtual limb and has been shown to reduce pain, with effects comparable to mirror therapy. Studies also indicate that VR-based limb representations can improve perceived limb ownership and the sense of agency, supporting psychological adjustment. But the authors argue that current research treats the symptom while neglecting the opportunity to use VR as a comprehensive tool for psychological wellbeing, addressing the person as a whole. VR can create immersive and controllable environments for relaxation, mindfulness-based activities, or graded exposure therapy, which may help address disrupted mood, decreased self-efficacy, heightened anxiety, and difficulty adjusting to altered body image. Evidence from other populations shows VR can improve depression, anxiety, pain, and quality of life, yet these approaches have not been widely applied to people with limb loss and limb difference.

Implementation barriers may prove the toughest challenge. People with limb loss are cared for across hospital systems, inpatient rehabilitation, and outpatient care involving prosthetists, physical therapists, and occupational therapists, settings that operate under different clinical responsibilities and reimbursement mechanisms. Outpatient VR use has been integrated into supervised therapy sessions using time-based billing, but VR has not been incorporated into prosthetic practice, which is reimbursed primarily through device-based billing using Healthcare Common Procedure Coding System L-codes that offer limited mechanisms to support VR-based rehabilitation. The authors suggest that hospital-based VR rental programs and existing time-based reimbursement pathways within physical and occupational therapy may offer feasible next steps. Workflows must also be efficient: if clinicians spend more than a few minutes setting up a system, the technology is unlikely to be used consistently. Protocols for safety, patient education, clinician scope of practice, and HIPAA-compliant data handling must be established before wide-scale adoption, and factors such as technology costs, IT support, lack of high-speed internet, and space availability may pose barriers that implementation science research can assess.

Equity and inclusion round out the research agenda. VR research is heavily weighted toward people who use lower-limb prostheses and remains underexplored in people with upper-limb loss or difference, including applications such as myoelectric pattern-recognition training, bimanual coordination tasks, and virtual object manipulation for activities of daily living. Even in lower-limb populations, research is needed for those with limb difference, those who do not use a prosthesis, and older adults, who make up a large share of the population yet are underrepresented in most VR literature, which is based on adults under 65 years. The authors push back on the misconception that older adults will not adopt new technologies, noting that the digital divide is decreasing and many older adults demonstrate high engagement with health technology, including VR. People residing in rural locations face greater risk for lower-limb amputation and poorer outcomes afterward, and expanding home-based telehealth and VR could benefit them as well as those lacking reliable transportation. Safety remains a primary concern for independent home use, since people with limb loss have increased fall risk and prior studies used safety harnesses or clinician supervision; technologies allowing visual access to the real-world environment, such as mixed reality and augmented reality, will likely be safer alternatives during unassisted at-home rehabilitation. The authors conclude that larger sample sizes and randomized controlled trials, particularly for upper-limb populations, are needed to determine efficacy, and that people with limb loss and limb difference, along with clinicians and clinic owners, should be included as participants in developing research studies to ensure adoption and genuine translation to clinical practice.

Subject of Research: Health

Article Title: Virtual reality for people who have limb loss or limb difference: a multidisciplinary perspective on needs for clinical translation and future research

Article References: Braun-Trocchio, R., King, A., Porter, R., Graybeal, A. J., Clemens, S., McDonald, C. L., Turner, K. L., Hoffmann, D., & Finco, M. G. (2026). Virtual reality for people who have limb loss or limb difference: a multidisciplinary perspective on needs for clinical translation and future research. Frontiers in Virtual Reality, 7, Article 1895833. https://doi.org/10.3389/frvir.2026.1895833

Image Credits: AI Generated

DOI: 10.3389/frvir.2026.1895833

Keywords: virtual reality, rehabilitation, limb loss, limb difference, prosthetics, phantom limb pain, health equity, implementation science, Virtual, reality, people, limb