Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group ( ). Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject’s attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice. 1. Introduction Stroke is a global, debilitating problem which is increasing both in prevalence and incidence [1, 2]. Stroke ranks as the second highest cause of death and as one of the main causes of acquired adult disability [3, 4]. It is reported that between 55 and 75% of stroke survivors suffer from motor impairments which substantially reduce the quality of their life [5, 6]. Therefore, during rehabilitation, stroke survivors must learn or relearn voluntary control over the affected muscles. The current standard of care for stroke rehabilitation is comprised of physical therapy and occupational therapy that help motor skills learning or relearning after stroke. However the standard rehabilitation for stroke is labour- and resource-intensive, tedious and often results in modest and delayed effects in clients [7, 8]. As a result, the demand for alternative rehabilitation resources has recently become more highlighted [9]. One proposed novel solution is virtual reality (VR) technologies [8, 10, 11]. VR is a computer-human interface that
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