Systematic reviews of clinical trials evaluating upper limb rehabilitation after stroke have consistently concluded that restoration of motor function requires high intensity, repetitive and challenging practice [8-12]. Unsupervised exercise programs are fraught with low compliance [13-15] and there are insufficient therapists to provide supervision of such high intensity programmes. Video games facilitate meeting these evidence based requirements, since playing requires many repetitions of movement patterns and task difficulty can be interactively adjusted to make game play challenging and engaging irrespective of the patients’ changing abilities [16-19]. Video games increase compliance since the focus is on game play and fun and not on impairment [20, 21].
There is increasingly strong evidence of the therapeutic value of action video games for upper limb rehabilitation (e.g. [18, 19, 22-27]) with two recent randomised controlled trials showing significant benefits for action video games on upper limb function compared with non action video games [28, 29]. Action video games have the important advantage that perceptual-motor learning from playing action video games transfers to real-world tasks [30-41] unlike non action games  and more traditional forms of exercise based therapy and training where learning is specific to the task, stimuli and environment used during training [43-45]. Non-game players who play action video games have demonstrated persistent enhancement of generic skills in perception, attention, motor control and cognition compared to controls playing non-action video games; these include heightened ability to view small details in cluttered scenes and to perceive dim signals, enhanced top-down control of attention and the ability to choose among different options; improved reaction times, visual short-term memory, decision making and strategy; increased flexibility to switch from one task to another and more precise multisensory temporal processing abilities [46-57]. Although studies have largely been carried out in young adults, similar effects from action video games have been reported in the elderly with improvements in visuomotor coordination, dexterity, and reaction time [58-60], cognitive functioning [61, 62], attention and concentration , self esteem and quality of life [59, 64].