In the era of digital transformation, the utilisation of Virtual Reality (VR) applications in brain injury rehabilitation presents a novel
frontier with vast potential. However, concerns persist about how traditional communication pathways between therapists and patients can be transformed into digital equivalents. Immersive virtual reality submerses patients in a virtual world, with therapists taking the role of external spectators. This has implications for the therapeutic alliance (TA), which is based on interpersonal bonds and effective communication between therapist and patient. This study investigated the use of immersive VR in clinical settings for the rehabilitation of acquired brain injury (ABI). The aim was to understand how to design a smart virtual therapeutic system that can be adapted to various needs of patients and therapists during the intervention. Through observation and semi-structured interviews, patient-therapist interactions were analysed during VR-assisted and traditional rehabilitation sessions, revealing challenges related to effective collaboration. Findings indicated changes in interaction and communication with the introduction of VR: informal dialogue decreased, while shared laughter and therapist feedback increased. Despite the visual disconnect imposed by VR headsets,therapists continued to use guiding gestures and engaged with patients. Interviews highlighted the importance therapists place on rapport-building, and both relied on each other for expertise and reassurance. This research offers valuable insights into the potential to transit, transform and enhance traditional rehabilitation practices with the use of virtual reality and suggests avenues for human-centred design of VR applications tailored to ABI rehabilitation and TA, ultimately enhancing therapeutic outcomes in this
domain.