The convergence of game technology (software and hardware), the Internet, and rehabilitation science forms the second-generation virtual rehabilitation framework. This reduced-cost and patient/therapist familiarity facilitate adoption in clinical practice. This paper presents a PlayStation 3-based hand physical rehabilitation system for children with hemiplegia due to perinatal brain injury (hemiplegic cerebral palsy) or later childhood stroke. Unlike precursor systems aimed at providing hand training for post-stroke adults in a clinical setting, the experimental system described here was developed for in-home tele-rehabilitation on a game console for children and adults with chronic hemiplegia after stroke or other focal brain injury. Significant improvements in Activities of Daily Living function followed three months of training at home on the system. Clinical trials are ongoing at this time.