Rewiring Attention: Virtual Reality and Brain-Computer Interfaces in the Rehabilitation of Unilateral Spatial Neglect

Unilateral spatial neglect (USN) is a complex cognitive syndrome frequently observed after stroke. Characterized by a failure to attend, respond and orient to stimuli on the side opposite the brain lesion, USN significantly impairs patients' functional independence and presents significant challenges for rehabilitation. Current rehabilitation strategies often fall short in addressing the heterogenous manifestations of USN across perceptual modalities due to limited ecological validity, patient engagement and adaptability to individual needs. Recent advances in neurotechnologies such as virtual reality (VR) and brain-computer interfaces (BCIs) offer promising avenues for overcoming these limitations. These tools enable top-down rehabilitation strategies that directly engage cognitive recovery mechanisms to promote neuroplasticity, and support adaptive interventions tailored to individual profiles. This narrative review explores recent developments and future prospects of VR and BCI technologies in the rehabilitation of USN, both individually and in combination. After outlining key features of USN to frame rehabilitation challenges, it examines VR, BCI, and their integrated applications in this context. While there is growing evidence supporting VR interventions efficacy in enhancing conventional strategies and alleviating USN symptoms, research on BCI applications in this context is still emerging. Nevertheless, insights from broader neurorehabilitation research suggest that combining VR and BCI holds significant promise for advancing cognitive rehabilitation and addressing USN-specific challenges. To illustrate the transformative value of advanced USN interventions, we present a concrete example of a VR-BCI integrated rehabilitation framework in the making, designed to provide a comprehensive and personalized therapeutic approach, bridging technological potential with clinical rehabilitation needs.