Patient groups

SilverFit systems are in use in hospitals, rehabilitation clinics, skilled nursing facilities, care homes, day care centres, extra care schemes, assisted living apartments and retirement villages for a diverse group of people with many different objectives.

The systems are adopted by physio therapists, ocupational therapists, speech and language therapists, activity coordinators, gym instructors, care staf, volunteers and family members. They systems are mostly part of rehabilitation, fall prevention and active ageing programmes.  

We have listed below a number of patient categories that have benefitted from using our systems so far. We are very interested in your experience with these patient categories, or with patients not yet listed here.

Stroke or CVA is defined, by the World Health Organization,as “suddenly occurring clinical manifestations of a focal disorder in the brain that last longer than 24 hours or lead to death, for which no other cause but a vascular disorder is present”. In the Stroke 2014 Guideline by the KNGF (Royal Dutch Society of Physiotherapists), it is described that the number of people with CVA continues to increase because of an ageing population in the Netherlands. Incidence in the Netherlands is an estimated 45,000 people with CVA, the prevalence is also increasing and was estimated at 226,600 people with a CVA or stroke in 2007.


There has been much scientific research because the disease is becoming more common. The directive of the CBO, the quality centre for Dutch healthcare, requires rehabilitants to exercise about 6 hours per week after a stroke. This is by far not achieved in most cases. There is strong scientific evidence that more exercise leads to better skills in the performance of daily actions such as dressing and washing oneself, etc. In the physiotherapy section of the KNGF guidelines, a number of exercises are defined and recommended, such as practicing stability of the upper body while seated, practicing standing up and sitting down again, training endurance, walking exercises, or if this no longer applies, training of independent wheelchair driving, fall prevention, and exercising the paretic arm.

CVA and SilverFit systems

Most of the exercises that are essential after a CVA are repetitive in nature and require constant motivational attention from a therapist. The SilverFit 3D and SilverFit Compact  offers a solution for these exercises. In many cases, the rehabilitant can exercise without constant guidance, so that it is possible to offer more training in the same time.

The SilverFit 3D camera contains an advisory menu with a detailed treatment guideline for CVA clients. This treatment guideline was developed by a clinical physiotherapist and assessed and evaluated by peer review. You may use this treatment guideline as inspiration for your own approach. However, it is important to remember that each client may be different.

The SilverFit Compact can be used, in addition to individual or group therapy, in the room of the client in order to increase the number of training moments and achieve quicker results. In addition, the client can use the SilverFit Compact at home. 

Clients with swallowing problems after a CVA can train their swallowing function with a speech and language pathologist using the Rephagia.

With the SilverFit Newton post-stroke survivors can train their muscle strength in a challenging way. The Newton is widely applied to a leg press or pulley.

Endurance training with treadmill, stationary bike, active/passive cycling or bed bike can also be done with SilverFit systems. Depending on the level of the client, endurance can be built up. This can be in the exercise room, but also on the ward or at the home of the client.

Rehabilitation and training of motor functions after a total knee arthroplasty and total hip arthroplasty is of great importance. In the rehabilitation process, it is often difficult for the client to keep motivated to do all exercises (daily) and repeat them. Due to this, therapy adherence is often lower than desired. Virtual exercises can make therapy more enjoyable. SilverFit offers a set of exercises on different systems for rehabilitation after a total hip or total knee surgery. Systems for training of gross motor skills, muscle strength and endurance.

Total knee and hip arthroplasty and SilverFit systems

With the SilverFit 3D gross motor skills can be trained, such as:

  • Touching certain spots on the floor with legs while seated
  • walking backward/forward
  • walking sideways
  • lifting knees in place
  • bending knees

Many therapists also use fall prevention exercises for this category of patients. The SilverFit 3D contains an advisory menu which has a treatment guideline made by a clinical therapist. This has been assessed and evaluated by peer review. You may use this treatment guideline as inspiration for your own approach. 

Muscle strength training is of great importance after orthopedic surgery. With the SilverFit Newton muscle strength can be trained in a challenging way.

Endurance training is also important after orthopedic surgery. Cycling with video and walking with video will motivate the clients to sustain the exercises longer.

People with Parkinson's disease have a wide variety of symptoms. The Guideline by the KNGF (the Dutch Royal Society of Physiotherapists) indicates several exercises that are important for people with Parkinson’s disease, including walk and balance exercises. Preventive action, such as learning cues and retaining a good level of fitness, is also recommended by the guideline. 

Parkinson's disease and SilverFit systems

Some of the exercises on the SilverFit 3D provide clear (audio-) cues that may be extremely useful for many Parkinson's patients. Especially walking and balance exercises (forward, sideways, in place) are made possible. 

The SilverFit Compact can be used to train their daily fitness and gross motor skills. 

To following systems are very suitable for training general fitness and strength: SilverFit Newton, cycling with video and walking with video. 

If people with Parkinson's disease experience swallowing problems, the speech and language pathologist can train the swallowing function with the Rephagia

Moderate to intensive exercise is prescribed for people with COPD and people who are rehabilitating after heart failure. Therapy adherence is often a problem, sometimes caused by anxiety. The SilverFit games motivate the user and encourage them to move. Because their attention is directed at the game, rather than at the movement itself, people want to play longer and are more inclined to repeat. The intensity of the games can be set by the therapist or adapted by the system to meet the level of the user. In this way, trainings can still take place at a relatively high fitness level.

COPD & cardio and SilverFit systems

The SilverFit 3D and SilverFit Compact offer the option of training gross motor skills, such as upper extremity exercises, walking and balance exercises.

The systems walking with video and cycling with video train overall fitness. The games or videos motivate the client to sustain the exercises for a longer period of time and overcome their anxiety. 

Muscle strength of the extremities can be trained with the SilverFit Newton on a pulley or leg press, for instance. 

Loss of independence amongst elderly people is often caused by falls and falls-related injuries. There is strong evidence that fall risk and fall rates can be reduced by exercise programmes that combine balance training with additional forms  of exercise such as coordination and muscle strengthening1. 

SilverFit 3D

A recent study by the University of Trondheim (Norway) concludes that the SilverFit is the most applicable exergame for fall prevention2.

The SilverFit provides a fall prevention protocol. The aim of this exercise programme is to decrease the number of falls and the anxiety to fall; especially for elderly who have experienced a fall. The protocol is developed by a clinical physiotherapist and validated in a pilot study.  Research in collaboration with the Avans University (Netherlands) shows that the SilverFit exercises have a number of characteristics that make them especially useful: 

  • They stimulate the player to continuously shift balance
  • They train lateral and backward step better than traditional exercises
  • They offer dynamic, unpredictable exteroceptive cues
  • They offer a cognitive/physical dual task 
  • They make the patient focus on the game. In traditional exercises, patients look at their legs or feet, which makes the movement less natural.

SilverFit Mile 

Virtual therapy for walking and cycling leads to better results on balance parameters. Gait and cycling training improves strength of the lower extremity. Unfortunately, exercising on a home trainer or treadmill is far less motivating than actually going outside. The SilverFit Mile projects a film, so that the indoor experience resembles reality.

SilverFit Newton

The SilverFit Newton is a virtual therapy system for strength training. It can be fitted to any type of equipment provided this works using weights. Training on a leg press is an intensive exercise to improve the strength of the lower extremity. The games used by SilverFit Newton make strength training fun and dynamic. 

"The leg press used to be the 'torture rack'. With the SilverFit Newton, people are standing in line for it”.
Rolf van der Burgt, Physiotherapist


1 Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M., Lamb, S.E. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev., CD007146.

 2 Skjaeret et al. (2014). Designing for Movement Quality in Exergames: Lessons Learned from Observing Senior Citizens Playing Stepping Games. Gerontology November  10.1159/000365755


Exercise is extremely important for people living with dementia. Inactivity is disastrous for our brains. Exercise stimulates blood circulation to our brains. Besides positve effect for our brain, exercise has a strong positive impact on our heart, lungs and muscles as well.

Please find more information here what we can do to motivate people living with dementia to participate in small physical and cogntive activities.

Due to Multiple Sclerosis (MS), multiple body functions may work less well or no longer work at all. This can have effects on activities in daily life. Symptoms of fatigue and loss of balance are common. There is increasing scientific evidence that training and physical exercise have a beneficial effect on the treatment of fatigue, loss of balance, stiffness and spasticity. Depending on the problems in people with MS, SilverFit systems can be used.

MS and SilverFit systems

The SilverFit 3D trains gross motor functions. 

Some useful exercises are:

  • Balancing of the upper body, possibly on a ball or balance cushion
  • Standing up/sitting down
  • Stretching the arms
  • Touching certain spots with foot while seated (eq. exercise set by Frenkel)
  • Touching certain spots with foot while standing
  • Walking sideways and forward
  • Balance exercises

To prevent fatigue, SilverFit can be adjusted to incorporate regular breaks in the exercise program.

In addition to the training of gross motor skills with the Silverfit 3D camera, this can this also be trained with the SilverFit Compact. This is a small portable system that can be used in the room, in the institution or at home. 

Endurance training can be done with the following systems: cycling with video and walking with video.  Strength training with the help of the SilverFit Newton on a pulley or leg press, for instance. 

The speech and language pathologist can use the Rephagia to train swallowing function if the patient has trouble swallowing.

Physical activity is very important for people with multiple disabilities. Exercise goals can be any of the following: preventing a sedentary lifestyle, rehabilitation, health improvement or improved functioning in daily life. Research shows that even in the functionally least restricted group, barely 17% reaches the exercise norm. Clearly it is important to stimulate physical activity among people with multiple disabilities.

Accessible and stimulating

The SilverFit systems motivate and stimulate so that physical activity becomes more enjoyable. The game provides a clear objective to the exercise and offers a challenge. The SilverFit 3D and the SilverFit Mile can be used to train people with severely restricted physical and cognitive abilities. The SilverFit is used frequently as all exercises can be adjusted to the cognitive and physical needs of the participant. The SilverFit trains gross motor skills in an open space. A number of protocols are available to provide the right exercises for people with multiple disabilities.

The SilverFit Mile is often used on a bike or a passive-active seated bike and where possible on a treadmill. This creates the sense of being outside. The SilverFit Mile is very easy to use and adoption by residents and staff is almost immediate.

Some practical examples

SilverFit systems are used at various locations for people with intellectual disabilities. Complete fitness rooms have been installed at a number of locations of the Koraalgroep. St. Anna was the first location in 2012. The first virtual gym for elderly people with intellectual disabilities was established. A few of the comments:

“Clients are very enthusiastic and fully immerge themselves in the imagery, and forget that they’ve been cycling for 20 minutes.”

“One response came from a lady, who when she came home, told them that she cycled along the Maas to her brother in Venlo and that it was wonderful there.”

“Another lady who comes to see me to practice on the SilverFit, loves to virtually throw balls, and she told the group leaders that she had been to the fair and had thrown balls at animals that appeared.”

“A man who exhibits severe screaming behaviour, has recently started exercising with SilverFit, you can tell that he is focused on the SilverFit exercises and that he exhibits no screaming behaviour at that time.”

Osteoarthritis is a condition to one or more joints, where the cartilage between bone ends has become thinner and the quality is reduced. Cartilage is important, because it absorbs impact and because it ensures the joint can move smoothly. People often experience pain and stiffness, causing them to be less active. As a result, fitness and muscle strength decrease, which exacerbates the symptoms. Movement and exercise is very important for people with knee and hip osteoarthritis. The SilverFit systems can help motivate clients to exercises and keep them motivated by the use of games. 

Osteoarthritis of the hip and knee with SilverFit systems

The SilverFit 3D trains gross motor functions. The SilverFit 3D contains an advisory menu with a detailed treatment guideline for clients with hip or knee osteoarthritis. This treatment guideline was developed by a clinical physical therapist and assessed and evaluated by peer review. You may use this treatment guideline as inspiration for your own approach. However, it is important to remember that each client may be different.

The SilverFit Compact offers the possibility of executing additional training moments. This system can be placed in the room of the client or at home. 

Loss of muscle strength and a reduction in overall endurance will occur due to inactivity. The SilverFit Newton can be connected to a pulley and/or leg press to train muscle strength in a challenging way. Endurance training can be done with the following systems: cycling with video and walking with video.

Dysphagia, swallowing disorders, is one of the most common disorders treated by a Speech and Language Pathologist (SLP).

Relearn to swallow

The Rephagia system is a supportive device to help the SLP better treat their patients with dysphagia. It supports the SLP to help their patients perform specific exercises that are well known to improve swallowing in patients with dysphagia. During these exercises both the patient as well as the SLP receive objective valuable insights and data regarding the patients progress. The patients swallowing reflex, delay in swallowing onset and the duration of a swallow are characterised through sEMG, a method that measures the electrical currence through a muscle when activated.


Dysphagia can be caused by a number of different underlying pathologies, like Stroke (Wallenberg Syndrom for example), Oncology, Parkinsons Disease (or one of its derivatives), Multiple Sclerosis, Traumatic Brain Injury or genetical factors. The underlying pathology determines the efficiency of treatment. During treatment the therapist focusses on functional disorders that manifest as difficulty protecting the airway or transporting the bolus or a coordination malfunction of the two.

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