In this mini-review, the authors discuss virtual reality (VR), a simulation of the real world based on computer graphics, and its utility in pediatric rehabilitation. I congratulate the authors for their excellent concise review of this upcoming ‘therapeutic’ tool and its impact on motor development and physical activity.

General comments:

The authors have attempted to highlight the different areas where VR could be of use in pediatric practice, specifically pediatric rehabilitation. Virtual Reality is mainly utilized in pediatric neurorehabilitation: attention deficit hyperactivity disorder (ADHD), autism and cerebral palsy (CP), and possibly in pediatric pain management. At present, VR is only used as an adjunct to a well-established, dominant mode of therapy. However, as the authors rightly conclude, virtual reality has the potential to revolutionize the world of medicine in the future.

Specific comments:

The following points would strengthen the review:

1. It would be worth mention, in the Introduction, making the readers mindful of the differences and advantages of VR over the traditional electronic games. May be the viscous cycle of dependency/addiction with traditional games? And that traditional electronic game interfaces are known to provide fine motor experience, rather than gross.[1]
2. Considering the scope of the article, it is desirable to state the specific learning objectives (SLO) of the article
3. Other potential areas for utility, like laparoscopic surgery training to increase both speed and accuracy of performance, from physician point of view, [2] stroke rehabilitation, [3] both within the purview of pediatrics, and use of VR as an educational tool as part of  rehabilitation
4. A note on some of the negative aspects of this modality; namely, it is unclear at present which characteristics of VR are most important, whether these effects are sustained in the longer term is still questioned. Chances of VR setting up a vicious cycle among children??
5. Availability of cost-effectiveness data
6. Feasibility in limited–resource settings? Any study addressing this aspect?
7. Authors' experience at their centre, if any, and (documented) Indian experience in general. any suggestions for future research in these settings?
8. Utility in the treatment of psychiatric disorders (e.g., phobias, post-traumatic stress disorder and anxiety disorder) mentioned in the Introduction is not deliberated in Discussion.
9. Karin et al. quoted in paragraph-2 in Discussion should be Brutsch et al (Ref.1)
10. Abstract is uninformative; keywords not provided, and References style is not uniform
11. It is not clear what the authors meant by ‘relatively inexpensive’ in conclusion
12. Conclusion should include a clear statement that the current level of evidence concerning the role of VR in pediatric neurorehabilitation is poor and future methodologically rigorous studies are required.

This review may be considered ‘publication standard’ if the authors are willing to address the above comments and revise accordingly. A second review by an expert in a related field is needed.

References

1. Yuji H. Computer games and information-processing skills. Percept Mot Skills 1996, 83: 643-7.
2. Rosser JC, Lynch PJ, Cuddihy L, Gentile DA, Klonsky J, Merrell R. The impact of video games on training surgeons in the 21st century. Arch Surg 2007, 142: 181-6.
3. Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2011; 9: CD008349.

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Its a well researched article into how virtual reality can change the future of pediatric rehabilitation.The author could have written a little bit more about virtual reality helping children with phobias and anxiety defaulters

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