Purpose/Hypothesis: To assess the clinical feasibility and effectiveness of providing home-based virtual environment (VE) training using a remotely controlled telerehabilitation system. Number of Subjects: 12 patients with chronic stroke were admitted; 1 patient dropped out prior to start of training. Mean age for subjects who completed training was 56.7 ± 15.6yr.; duration post-injury was 5.8 ± 4.4yr.; gender, 6 male, 5 female; involved side, 5 Right, 6 Left. Mean upper extremity (UE) Fugl-Meyer (FM) motor score (max=66) at entry was 38.3 ± 13.8. Materials/Methods: Treatment intervention consisted of 30 one-hr sessions of real-time interactive VE motor training for the involved UE, delivered remotely by a therapist via the internet, 5x/wk for 6 wk. During training, patients practiced movements within virtual ‘scenes’ designed to elicit goal oriented movements. Outcome measures FM, Wolf Motor test (WMT) and Strength (grip, shoulder flexion) were given Pre-training, Post 15 and 30 sessions, and at 4 mo. follow-up. Stability of motor recovery prior to training was assessed with FM (2 tests, 1–12wk apart). Paired t-tests were used to assess significance. Results: Mean values for the 2 baseline FM-UE tests showed no significant difference (−0.3 +/− 1.6, p=0.56), indicating stable motor recovery prior to VE training via telerehabilitation. Following training, mean FM-UE Motor scores improved significantly after 15rx (+2.5, p=0.003), after 30rx (+6.7, p= < 0.0001), and at 4 mo. follow-up (+7.6, p=0.001). Mean WMT scores improved significantly after 15rx (−6 sec, p=0.0235), after 30rx (−15.5sec., p=0.0097), and at 4 mo. follow-up (−18.4 sec., p=0.0032). Shoulder Strength improved after 15rx (40%, p=0.0027), 30rx (69%, p=0.0010) and at follow-up (66%, p= < 0.0001). Grip Strength improved significantly after 30rx (44%, p=0.0253) but was only partially maintained at followup (26%, p=0.0897). Conclusions: Subjects'improvements indicate that VE training conducted remotely over the internet is feasible and may be a viable new method for neurorehabilitation. Subjects gains on all 3 clinical measures (FM, WMT, Strength) show that they were able to generalize motor training received in VE to real world performance, even to tasks not specifically trained in VE, and to retain gains for 4 mos. Our results concur with those of others, that subjects with chronic stroke are capable of significant motor improvements even many years s/p stroke. Clinical Relevance: The novel home-based treatment method used in this study may provide advantages and a viable treatment alternative for patients with stroke. For example, the difficulty of obtaining transportation to/from therapy clinic is avoided; no commute also allows patients to have more energy to devote to motor practice during sessions, and facilitates more intense frequency of treatment. VE motor retraining via telerehabilitation appears effective in improving UE motor control and functional performance in subjects with chronic stroke; in addition it provides a fun and motivating treatment alternative to standard therapy exercises. Supported by NIH Grants No. HD40959, HD40959-02S1 and 3MO1RR 01066-25S.