Balance and cognition are vital components to a variety of daily activities that are major concern to physical therapists in the rehabilitation process. Purpose: This study aimed to evaluate the effect of virtual reality games on balance and cognitive skills in children with hemiparesis. Subjects: It was a randomized controlled trial. 40 spastic children with hemiparesis of both sexes were randomized into 2 groups. The inclusion criteria included children between the ages of 7 and 10 years with mild spasticity ranging from 1 to 1+ according to the Modified Ashwarth scale. They could stand independently according to the Gross Motor Function Classification System (GMFCS). Also, they were able to easily understand and comprehend instructions. Children were excluded if they had deformities, auditory or visual defects. They were divided into two equal groups; control group (A) and study group (B). Methods: The control group (A) received a selected physical therapy program based on Neurodevelopment approach. The study group (B) applied virtual reality in addition to receiving the same program as the control group. The applied virtual reality was in form of Wii games for balance training. For evaluating postural stability, the Biodex balance system was utilized and for evaluating cognitive skills, Rehacom system was utilized in both groups. Results: Regarding the results of biodex, findings revealed that there was a significant difference between both groups in overall stability index (OSI), antero/posterior stability index (APSI) and medio/lateral stability index (MLSI) (p > 0.001). Regarding the results of Rehacom system there was also a significant difference between both groups (p > 0.001). Conclusions: It can be concluded that the use of virtual reality combined with standard intervention may have a significant effect on balance and cognitive functions in the rehabilitation of hemiparetic children