The objective of the telerehabilitation is a continuation of the rehabilitation process on patients' home. Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. The current challenges facing game based telerehabilitation including the packaging, internet capabilities and access, data management, technical support, privacy protection, distance trials, scientific scrutiny and support from insurance companies. The telerehabilitation approach in VR game based rehabilitation improves muscle strength in stroke patients and has similar effect on patients' motor function improvement as conventional therapy in clinical settings. However, when this VR therapy is continued on patient's home instead of the hospital or clinic, it would eventually decrease the number of outpatients' visits, reduce related costs and enable treatment of larger number of patients. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach.