BACKGROUND: Head-mounted displays can be used to offer personalized immersive virtual reality (IVR) training for patients who have suffered an Acquired Brain Injury (ABI) by tailoring the complexity of visual and auditory stimuli to the patient's cognitive capabilities. However, it is still an open question how these virtual environments should be designed. METHODS: We used a human-centered design approach to help define the characteristics of suitable virtual training environments for ABI patients. We conducted (i) observations, (ii) interviews with eleven neurorehabilitation experts, and (iii) an online questionnaire with 24 neurorehabilitation experts to examine how therapists modify current training environments to promote patients' recovery in conventional sensorimotor neurorehabilitation settings. Finally, (iv) we involved eight neurorehabilitation experts in a participatory design workshop to co-create examples of IVR training environments. RESULTS: Five phases of the recovery process (Screening, Planning, Training, Reflecting, and Discharging) and six key themes describing the characteristics of suitable (physical) training environments (Specific, Meaningful, Versatile, Educational, Safe, and Supportive) were identified. The experts agreed that modulating the number of elements (e.g., objects, people) or distractions (e.g., background noise) in the physical training environment enables therapists to provide their patients with suitable conditions to execute functional tasks. Additionally, the experts highlighted the importance of developing IVR training environments that are meaningful and realistic. CONCLUSIONS: Through consultations with neurorehabilitation experts, we gained insights into how therapists adjust physical training environments to promote the execution of functional sensorimotor tasks in patients with diverse cognitive capabilities. Their recommendations on how to modulate and make IVR environments meaningful may contribute to increased motivation and skill transfer. Future studies on IVR-based neurorehabilitation should involve patients themselves.

Head-mounted displays can offer personalized immersive virtual reality (VR) training for patients who have suffered an Acquired Brain Injury by tailoring the complexity of visual and auditory stimuli to their cognitive capabilities. However, how these virtual environments should be designed remains undetermined. We conducted a participatory design workshop with eight neurorehabilitation experts to collect their opinions on using immersive VR-based neurorehabilitation and co-create examples of low and high-cognitively demanding immersive virtual training environments. Participants highlighted the importance of developing meaningful and realistic environments. This study provides an example of a high-tech co-creation workshop whose results provide insights into designing training environments in immersive VR to meet patients’ needs.