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Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Open accessAbstract
Background: Researchers recently investigated the effectiveness of virtual reality (VR) in helping children with cerebral palsy (CP) to improve motor function. A systematic review of randomized controlled trials (RCTs) using a meta-analytic method to examine the effectiveness of VR in children with CP was thus needed. Purpose: The purpose of this study was to update the current evidence about VR by systematically examining the research literature. Data Sources: A systematic literature search of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science up to December 2016 was conducted. Study Selection: Studies with an RCT design, children with CP, comparisons of VR with other interventions, and movement-related outcomes were included. Data Extraction: A template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Effect size was computed and combined using meta-analysis software. Moderator analyses were also used to explain the heterogeneity of the effect sizes in all RCTs. Data Synthesis: . The literature search yielded 19 RCT studies with fair to good methodological quality. Overall, VR provided a large effect size (d = 0.861) when compared with other interventions. A large effect of VR on arm function (d = 0.835) and postural control (d = 1.003) and a medium effect on ambulation (d = 0.755) were also found. Only the VR type affected the overall VR effect: an engineer-built system was more effective than a commercial system. Limitations: The RCTs included in this study were of fair to good quality, had a high level of heterogeneity and small sample sizes, and used various intervention protocols. Conclusions: Then compared with other interventions, VR seems to be an effective intervention for improving motor function in children with CP.
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TL;DR
This systematic review and meta-analysis of 19 studies (20 RCTs; 504 children with CP) found that VR intervention produced a strong overall effect on motor function compared with conventional therapy or controls (d = 0.861; 95% CI = 0.51–1.22). Effects were large for activity and postural control, medium for body structure/function, and small for participation, with engineer-built VR systems outperforming commercial systems.
Key findings
- Across all studies, VR showed a strong effect (d = 0.861; 95% CI = 0.51–1.22), with large heterogeneity (I² = 70%; Q = 60.36; P < .000001). Trim-and-fill correction shifted the overall effect size from 0.861 to 0.724; excluding 4 studies with effect sizes larger than 2.000 shifted it from 0.861 to 0.510.
- By ICF component: body structure and function d = 0.672 (8 studies; 95% CI = 0.364–0.980), activity d = 0.899 (19 studies; 95% CI = 0.530–1.267), and participation d = 0.408 (3 studies; 95% CI = 0.078–0.738).
- By motor function: arm function d = 0.835 (13 RCTs; 95% CI = 0.388–1.282), ambulation d = 0.755 (8 studies; 95% CI = 0.348–1.161), and postural control d = 1.003 (10 studies; 95% CI = 0.503–1.502).
- VR system was a significant moderator overall (P = .05): engineer-built systems d = 1.572 versus commercially available systems d = 0.628. For arm function, VR system, children’s age, and daily dosage were significant (P = .03, P = .01, P = .04); for ambulation, CP type, age, and PEDro score were significant (P = .02, P = .037, P = .0002); for postural control, no moderators reached significance.
Methods
- PRISMA-guided systematic review and meta-analysis; databases searched in December 2016 were PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science, plus manual reference-list searching. Inclusion criteria were children with CP aged birth to 21 years, RCT or randomized cross-over design, comparison of VR with conventional therapy or control, motor-function outcomes, and English or Chinese language.
- From 418 nonoverlapping articles, 31 RCTs were retrieved for full evaluation; 19 studies (20 RCTs) with 504 participants, published 2002–2016, were included. Quality was assessed with the PEDro scale; scores ranged from 4 to 8, indicating fair to good quality.
- Effect sizes were calculated as Cohen d, combined with a random-effects model, classified by the ICF model and by motor function (arm function, ambulation, postural control), and examined with subgroup/meta-regression analyses for 10 potential moderators. Publication bias was assessed with funnel plots and Duval-Tweedie trim-and-fill correction.
Limitations
- Stated: the included RCTs were fair to good in quality, with high heterogeneity and various intervention protocols; sample sizes in each RCT were relatively small; a large-scale, multi-site RCT with a more homogenous participant group of similar age and diagnosis is needed.
- Stated/evident: publication bias was assessed and minor asymmetry was noted in the overall and arm-function analyses, with trim-and-fill corrections reducing effect sizes; some subgroup analyses had few studies (participation, 3 studies; ambulation, 8 studies; postural control, 10 studies), and the paper notes that nonsignificant dosage findings in ambulation and postural control may be due to too few studies.
- Evident from the text: the search was limited to December 2016 and to English or Chinese publications; several RCTs were combined or excluded because of insufficient data, and PEDro scores ranged from 4 to 8, indicating fair-to-good but not excellent methodological quality.
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49 Own result · 46 Not checked yet · 12 Own interpretation · 8 Own method · 8 No basis given
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In the paper
“Thus, a total of 31 RCTs were retrieved for full evaluation (Fig. 1).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Results
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Therefore, a total of 19 studies (in 20 RCTs) that were published between 2002 and 2016 were included in this review.41-44,46-61”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Downloaded
What the sources say
- Not checked yetcites [41] Chen, 2013, Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy, Osteoporos Int source
- Not checked yetcites [42] Chen, 2012, Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy, Res Dev Disabil source
- Not checked yetcites [43] James, 2015, Randomized controlled trial of web-based multimodal therapy for unilateral cerebral palsy to improve occupational performance, Dev Med Child Neurol source
- Not checked yetcites [44] Mitchell, 2016, A randomized controlled trial of web-based training to increase activity in children with cerebral palsy, Dev Med Child Neurol source
- Not checked yetcites [46] Sharan, 2012, Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy, Work source
- Not checked yetcites [47] Rostami, 2012, Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: a randomised controlled trial, NeuroRehabilitation source
- Not checked yetcites [48] Acar, 2016, Efficacy of neurodevelopmental treatment combined with the Nintendo® Wii in patients with cerebral palsy, J Phys Ther Sci source
- Not checked yetcites [49] AlSaif, 2015, Effects of interactive games on motor performance in children with spastic cerebral palsy, J Phys Ther Sci source
- Not checked yetcites [50] Atasavun Uysal, 2016, Effects of Nintendo WiiTM training on occupational performance, balance, and daily living activities in children with spastic hemiplegic cerebral palsy: a single-blind and randomized trial, Games Health J source
- Not checked yetcites [51] Chiu, 2014, Upper limb training using Wii Sports Resort for children with hemiplegic cerebral palsy: a randomized, single-blind trial, Clin Rehabil source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“All of the studies but 4 51,55,57,58 showed at least 1 positive change in 1 outcome variable (Tab.2) with VR intervention.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
What the sources say
- Not checked yetcites [51] Chiu, 2014, Upper limb training using Wii Sports Resort for children with hemiplegic cerebral palsy: a randomized, single-blind trial, Clin Rehabil source
- Not checked yetcites [55] Reid, 2006, The use of virtual reality with children with cerebral palsy: a pilot randomized trial, Ther Recreation J
- Not checked yetcites [57] Sajan, 2017, Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: a pilot, randomized controlled trial, Dev Neurorehabil source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies using an engineer-built VR system had a larger effect size than studies using a commercially available VR system (d = 2.162 for engineer-built systems; d = 0.491 for commercially available VR systems).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“a large effect by the activity component (19 studies; d = 0.899; 95% CI = 0.530-1.267)”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“and a small effect by the participation component (3 studies; d = 0.408; 95% CI = 0.078-0.738).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a medium effect was found when measured by the body structure and function component (8 studies; d = 0.672; 95% CI = 0.364-0.980)”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“There were 13 RCT studies that included outcome variables measuring arm function.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“For the subgroups and meta-regression analyses, none of the moderators reached statistical significance.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Postural Control.
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across all studies, there was a strong effect (d = 0.835; 95% CI = 0.388-1.282)(Fig. 3a shows a forest plot).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 28
- It may state two separate claims as one. 41
- The quote only partly states this claim. 2
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In the paper
“A total of 418 nonoverlapping published articles were found from the database searches.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Results
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“There were 504 participants in the 19 studies.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plainn = 504- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“When classifying outcome measures based on the ICF model (Tab.2), the majority (9 studies) included outcome in the activity component only, 7 studies contained body structure and activity components, 2 studies contained activity and participation components, and 1 contained all components.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“VR intervention over the entire study ranged from 8 to 80 hours, and the daily dosage ranged from 20 minutes to 90 minutes.Intervention length ranged from 4 weeks to 20 weeks, and treatment frequency ranged from once per week to 7 d/wk.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“The average age of participants ranged from 4.6 to 12.1 years.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plainn = 504- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“VR intervention was offered mostly in clinics (9 studies), followed by in the laboratory (6 studies) and home (4 studies).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The PEDro quality scores for the studies ranged from 4 to 8 (4 studies with a score of 4, 4 studies with a score of 5, 3 studies with a score of 6, 3 studies with a score of 7, and 5 studies with a score of 8), indicating that the quality of the RCTs included in this meta-analysis was fair to good.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across all studies, there was a strong effect (d = 0.861; 95% CI = 0.51-1.22) of VR intervention in children with CP.”
- Also stated in: § Discussion · boosted
“In general, when combining all outcome measures of all studies, virtual reality intervention showed a strong effect in improving motor function in children with CP when comparing with conventional therapy or controls (d = 0.861).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
boosteddirect- Asserted: passes — The authors put it forward as true.
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The quote only partly states this claim.
- Also stated in: § Discussion · boosted
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In the paper
“Nine studies had a matched-dose comparison group, whereas 10 studies did not.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The mostly commonly used VR system was Nintendo Wii (9/19 studies).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The focus of the outcome measures included arm function only (8 studies); postural control only (2 studies); combination of postural control and ambulation (4 studies); combination of postural control and arm function (1 study); combination of arm function and ambulation (1 study); and combination of arm function, postural control, and ambulation (4 studies).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Not surprisingly, we also found large heterogeneity among the studies as the value of I 2 was 70% (Q = 60.36;P <.000001).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found large heterogeneity among the studies as the value of I 2 was 67% (Q = 27.50;P = .001).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Postural Control.
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The overall effect size was 0.755 (95% CI = 0.348-1.161),indicating a medium to large effect size (Fig. 3b).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The overall effect size was 1.003 (95% CI = 0.503-1.502),indicating a large effect size (Fig. 3c).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Postural Control.
hedgeddirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies that included children with diplegia or mixed type seemed to have a better effect than studies that included only children with hemiplegia (d = 1.064 for diplegia, d = 0.883 for mixed type, and d = 0.249 for hemiplegia).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Minor asymmetry was noted in the plot, and the Duval-Tweedie trim and fill correction was used to correct the overall effect size.This correction shifted the overall effect size from 0.861 to 0.724.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Overall Effect of VR Intervention
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Publication bias was found, and the Duval-Tweedie trim and fill correction was used.The effect size on ambulation shifted from 0.755 to 0.378.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the subgroups and meta-regression analyses, VR system, children's age, and VR daily dosage were shown to be significant factors (P = .03for VR system, P = .01for children's age, and P = .04for daily dosage).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Publication bias was also assessed, and minor asymmetry was noted.After using the Duval-Tweedie trim and fill correction, we found that the overall effect size shifted from 0.835 to 0.691.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found large heterogeneity among the studies, as the value of I 2 was 75% (Q = 47.82;P < .000001).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-regression analyses also showed a statistically significant negative linear relationship between age and study effect size: the younger the children were, the larger the effect”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Upper Extremity Function.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-regression analyses showed a statistically significant negative linear relationship between age and study effect size, and between PEDro score and study effect size: the younger the children's age was, the larger the effect size; and the lower the PEDro score was, the larger the effect size.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For the subgroups and meta-regression analyses, CP type, children's age, and PEDro score were shown to be significant factors (P = .02for CP type, P = .037for children's age, and P = .0002for PEDro score).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found medium heterogeneity among the studies, as the value of I 2 was 59% (Q = 17.01;P = .017).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Only”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Most of the VR system can provide more than 1 game with similar training goals and children with CP in these studies were encouraged to choose which games they wanted to play (or at least had the chance to discuss with their therapists which games to choose).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, the association between VR effect and treatment dosage was only significant in arm function: the larger the daily dosage, the larger the VR effect.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-analyses were run with a random-effects model that accounted for true interstudy variation in effects as well as for random error within studies.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Synthesis and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“This study showed a conflicting result regarding whether VR could enhance postural control in children with CP: 2 studies showed improvement in standing balance and 1 showed no improvement in functional standing balance.18”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
What the sources say
- Not checked yetcites [18] Dewar, 2015, Exercise interventions improve postural control in children with cerebral palsy: a systematic review, Dev Med Child Neurol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The authors concluded it was difficult to compare the different studies because of the lack of standardized rehabilitation strategies and different clinical assessment tools.19”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
What the sources say
- Not checked yetcites [19] Bonnechère, 2014, Can serious games be incorporated with conventional treatment of children with cerebral palsy? A review, Res Dev Disabil source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The quality of RCTs was evaluated using the Physiotherapy Evidence Data-base (PEDro scale).25”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Extraction and Quality Assessment
What the sources say
- Not checked yetcites [25] Macedo, 2010, There was evidence of convergent and construct validity of Physiotherapy Evidence Database quality scale for physiotherapy trials, J Clin Epidemiol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct this review.23,24”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Sources and Searches
What the sources say
- Not checked yetcites [23] Moher, 2009, Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement, PLoS Med source
- Not checked yetcites [24] Liberati, 2009, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration, PLoS Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In addition, the subgroup analyses showed younger children receiving home or laboratory-based VR and using an engineer-built VR system had a better effect.16”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
What the sources say
- Not checked yetcites [16] Chen, 2014, Effect of virtual reality on imporving upper-extremity function in children with cerebral palsy: a meta-analysis., Pediatr Phys Ther source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Relevant information from the included studies was extracted and coded by the same author (Y.C.).A second reviewer (H.D.F.) checked all the extracted data.Any discrepancies were resolved by discussion in order to reach a consensus.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Extraction and Quality Assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“When the outcome variables were further broken down according to the ICF model, a large effect was reported in participation (d = 1.92), a small effect on activity (d = 0.46), and a medium effect on body structure and function (d = 0.70).16”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
What the sources say
- Not checked yetcites [16] Chen, 2014, Effect of virtual reality on imporving upper-extremity function in children with cerebral palsy: a meta-analysis., Pediatr Phys Ther source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Clinically, a medium effect size (d = 0.5) corresponds to an amount of change that is noticeable to a careful observer.[28][29][30]”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Synthesis and Analysis
What the sources say
- Not checked yetcites [28] Mann, 2012, Quantifying clinically significant change: a brief review of methods and presentation of a hybrid approach, Am J Sports Med source
- Not checked yetcites [29] Eisen, 2007, Measuring clinically meaningful change following mental health treatment, J Behav Health Serv Res source
- Not checked yetcites [30] Norman, 2003, Interpretation of change in health-related quality of life: the remarkable universality of half a standard deviation, Med Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The effect of publication bias on the primary meta-analyses was addressed by combining a funnel plot assessment with the Duval-Tweedie trim and fill correction.22”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Synthesis and Analysis
What the sources say
- Not checked yetcites [22] Borenstein, 2009 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two authors (Y.C., H.D.F.) independently conducted systematic literature searches in December 2016, using the electronic databases: PubMed, CINAHL, Cochrane Central Register of Controlled Trials, ERIC, PsycINFO, and Web of Science, as well as a manual search of the reference lists of each article.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Data Sources and Searches
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Recently, Levac et al 11 in a scoping review suggested some possible reasons from VR therapy that help children with CP improve their motor skills including from the user's side (VR enhanced problem-solving and cognitive engagement during play and increased motivation and neuroplasticity changes);”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [11] Levac, 2012, Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: a scoping review, Res Dev Disabil source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“All these active elements from VR help to change personal and environmental barriers that a child with CP may face.By decreasing these barriers or enhancing the enablers, a child with CP may gradually decrease impairments of his/her body structure and function and activity limitations, and gradually improve participation in school, communities, and society.11”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [11] Levac, 2012, Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: a scoping review, Res Dev Disabil source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Learning would be optimized if learners not only repeat the tasks alone but also cognitively engage in problem solving the motor task.12”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [12] Levac, 2014, Motor learning and virtual reality source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“For example, children will work hard to achieve a higher game score when receiving training in VR, which facilitate children's cognitive engagement in solving the motor task by 'thinking through' how to make their movements more efficiently and faster, which enhance their motor learning.12”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [12] Levac, 2014, Motor learning and virtual reality source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“VR games usually have goals to attain that can be progressed and enhance children's attention in therapy.[11][12][13]”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [11] Levac, 2012, Defining the active ingredients of interactive computer play interventions for children with neuromotor impairments: a scoping review, Res Dev Disabil source
- Not checked yetcites [12] Levac, 2014, Motor learning and virtual reality source
- Not checked yetcites [13] Weiss, 2006, Virtual reality applications in neurorehabilitation source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The possible mechanism for why VR worked remained uncertain.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The flexibility of many VR applications offers the opportunities to ensure that training is ecologically meaningful in an enriched environment, which provide the opportunity for children to cognitively engage in problem solving their motor task.12,13”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Consequently, children with CP performed better with VR than with the conventional intervention in which therapists might focus more on internal attention cues by requesting the children to move their arms faster or to open their hands wider.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“G = 0.58 for activity level”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites Lohse et al 67
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This kind of game selection supports children's need for autonomy, enhances their motivation, increases task interest, and leads to a better learning as this grants learners control over their practice conditions.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Wulf and Lewthwaite 64 recently suggested supporting a learner's autonomy by providing choices and enhanced expectancies (eg, positive feedback, reduced perceived task difficulty) could optimize learning through increased motivation as autonomy and enhanced expectancies allow learners to feel”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [64] Wulf, 2016, Optimizing performance through intrinsic motivation and attention for learning: the OPTIMAL theory of motor learning, Psychon Bull Rev source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“G = 0.56 for participation level”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites Lohse et al 67
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, in order for a child with CP to pick up a virtual object in the virtual environment, the child does not need to have a full range of finger flexion.Instead, a small range (eg, 5°) can easily allow the child to pick up an object in the virtual world, which reduces perceived task difficulty.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“G = 0.48 for body structure and function”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites Lohse et al 67
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“This was consistent with the proposal of Wulf and Lewthwaite 64 : when the instructions to learners prompted them to direct their attention to an external focus (eg, minimize movements of a balance platform) rather than to direct their attention to an internal focus (eg, try not to move your feet), learners in the external attention cue”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [64] Wulf, 2016, Optimizing performance through intrinsic motivation and attention for learning: the OPTIMAL theory of motor learning, Psychon Bull Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“have stronger motivation and are more engaged in playing video games”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [69] The NPD Group, Inc, 2017
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“and various intervention protocols.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Commercial systems, on the other hand, are not designed to train children (eg, gradually increase task difficulty, changing task demands and contexts) with CP because these systems have more restrictions on their preset game difficulties and require some adaptations and careful game selections prior to use.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“This was consistent with the idea of early intervention as younger children may have more brain plasticity and adaptability to improve their motor function than children at older ages.71,72”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites [71] Morgan, 2013, Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis., Pediatrics source
- Not checked yetcites [72] Spittle, 2012, Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants, Cochrane Database Syst Rev
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“In this model, there were 3 nested circles, the inner”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
What the sources say
- Not checked yetcites Weiss et al 13
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In conclusion, VR is a viable intervention to improve arm function, ambulation, and postural control in children with CP.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
An engineer-built VR system costs much more than a commercial system ($15,000 versus $150).
“However, the cost of purchasing an engineer-built VR system might be much higher than a commercially available system ($15,000 versus $150).”
The paper relies on this without support.
VR can motivate children to participate in the intervention.
“With regard to clinical implications, VR can motivate children to participate in the intervention.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This adaptability, along with the interactive nature of AVGs, can support rehabilitation for adolescents and young adults with conditions such as cerebral palsy, stroke, burns, spinal cord injury, and spina bifida [69, 81].”
From Health Benefits of Video Games in Adolescents and Young Adults (2026) · cites this paper as [81]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Description of Studies
“Intervention length ranged from 4 weeks to 20 weeks”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
“45 min × 6 d × 3 wk”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
“8-10”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
“(11.9)”
Citations
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Novak, I., Morgan, C., Fahey, M. C., Finch‐Edmondson, M., Galea, C., Hines, A., Langdon, K., McNamara, M., Paton, M. C. B., Popat, H. P., et al. (2020) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-020-1022-z · Cited by 1,208
Virtual reality applications toward medical field
Javaid, M., & Haleem, A. (2019) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2019.12.010 · Cited by 272
A Review on Recent Advances of Cerebral Palsy
Paul, S., Nahar, A., Bhagawati, M., & Kunwar, A. J. (2022) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2022/2622310 · Cited by 256
“Though VR is used as a pain management strategy in CP patients, functional outcome studies are scarce in this population [68].”
A Call to Unify Definitions of Virtual Reality
Kardong‐Edgren, S., Farra, S. L., Alinier, G., & Young, H. M. (2019) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2019.02.006 · Cited by 247
The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review
Massetti, T., da Silva, T. D., Crocetta, T. B., Guarnieri, R., de Freitas, B. L., Lopes, P. B., Watson, S., Tonks, J., & Monteiro, C. B. D. M. (2018) · Journal of Central Nervous System Disease · doi:10.1177/1179573518813541 · Cited by 257
What is Virtual Reality? A healthcare-focused systematic review of definitions
Abbas, J. R., O’Connor, A. D., Ganapathy, E., Isba, R., Payton, A., McGrath, B. A., Tolley, N., & Bruce, I. A. (2023) · Health Policy and Technology · doi:10.1016/j.hlpt.2023.100741 · Cited by 157
Technology Use for Adolescent Health and Wellness
Radović, A., & Badawy, S. M. (2020) · PEDIATRICS · doi:10.1542/peds.2019-2056g · Cited by 114
“67,68,79 The use of VR and/or AR does not come without risks or potential harm, such as eyestrain, nausea, sickness,”
BackgroundMethodEffectiveness of virtual reality-based exercise therapy in rehabilitation: A scoping review
Asadzadeh, A., Samad‐Soltani, T., Salahzadeh, Z., & Rezaei‐Hachesu, P. (2021) · Informatics in Medicine Unlocked · doi:10.1016/j.imu.2021.100562 · Cited by 125
Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses
Voinescu, A., Sui, J., & Fraser, D. S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10071478 · Cited by 121
“with CP [34,36,48] and reported significant and large effects for VR, but low quality of”
BackgroundMethodInfluentialCorrigan, N., Poetar, C.-R., & Voinescu, A. (2023) · Virtual Reality · doi:10.1007/s10055-023-00768-1 · Cited by 113
“…age has been highlighted as a significant moderator in a meta-analysis investigating the effectiveness of VR-based interventions for children with cerebral palsy, with effect sizes on arm function and ambulation for younger children significantly larger than older children (Chen et al. 2018).”
BackgroundFandim, J. V., Saragiotto, B. T., Porfírio, G. J. M., & Santana, R. F. (2020) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2020.11.003 · Cited by 86
Peng, L., Zeng, Y., Wu, Y., Si, H., & Shen, B. (2021) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001847 · Cited by 67
The Potential of Virtual Reality for Inducing Neuroplasticity in Children with Amblyopia
Coco-Martín, M. B., Pinero, D. P., Vega, L. L., Hernández-Rodríguez, C. J., Adiego, J., Molina‐Martín, A., Sáiz, D. D. F., & Arenillas, J. F. (2020) · Journal of Ophthalmology · doi:10.1155/2020/7067846 · Cited by 69
Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis
Ghai, S., & Ghai, I. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00236 · Cited by 72
Warnier, N., Lambregts, S. A. M., & van de Port, I. G. L. (2019) · Developmental Neurorehabilitation · doi:10.1080/17518423.2019.1683907 · Cited by 68
Virtual Reality for Neurorehabilitation: Insights From 3 European Clinics
O’Neil, O., Fernández, M. M., Herzog, J., Beorchia, M., Gower, V., Gramatica, F., Starrost, K., & Kiwull, L. (2018) · PM&R · doi:10.1016/j.pmrj.2018.08.375 · Cited by 61
“This space was set up in response to current evidence reporting the potential of VR for improving motor function and activity level in stroke and cerebral palsy [1,15].”
BackgroundJuras, G., Brachman, A., Michalska, J., Kamieniarz, A., Pawlowski, M. E., Hadamus, A., Białoszewski, D., Błaszczyk, J. W., & Słomka, K. J. (2018) · Games for Health Journal · doi:10.1089/g4h.2018.0034 · Cited by 63
“24,48,49 The results of this review, which is only based on control trials of at least moderate quality (Table 2), also exhibit ambiguous findings.”
Jha, K. K., Karunanithi, B. G., Sahana, A., & Karthikbabu, S. (2021) · Somatosensory & Motor Research · doi:10.1080/08990220.2021.1876016 · Cited by 67
“The children get constant feedback about the movement and posture of their body in virtually immersive and non-immersive conditions that are contusive to motor learning (Chen et al. 2018).”
BackgroundInfluentialMontoro‐Cárdenas, D., Cortés‐Pérez, I., Zagalaz‐Anula, N., Osuna‐Pérez, M. C., Obrero‐Gaitán, E., & Lomas‐Vega, R. (2021) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14947 · Cited by 62
Liu, C., Wang, X., Chen, R., & Zhang, J. (2022) · JMIR Serious Games · doi:10.2196/38972 · Cited by 56
“Previous meta-analyses have shown that VR can significantly improve children’s hand function, balance function, gross motor function, and walking function [8-11].”
BackgroundChen, L., Guoen, C., Huidan, W., Yingqing, W., Chen, Y., Xiao-chun, C., & Ye, Q. (2020) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001447 · Cited by 48
Self-citationChan, Z. Y. S., MacPhail, A. J. C., Au, I. P. H., Zhang, J. H., Lam, B. M. F., Ferber, R., & Cheung, R. T. H. (2019) · PLoS ONE · doi:10.1371/journal.pone.0225972 · Cited by 49
Johansen, T. E. B., Strøm, V., Simic, J., & Rike, P.-O. (2020) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2633 · Cited by 52
“Chen and colleagues (14) found that engineer-built systems had a larger effect than MCVGs.”
BackgroundCugusi, L., Prosperini, L., & Mura, G. (2020) · PM&R · doi:10.1002/pmrj.12444 · Cited by 47
Effectiveness of treadmill training on gait function in children with cerebral palsy: meta-analysis
Han, Y.-G., & Yun, C.-K. (2020) · Journal of Exercise Rehabilitation · doi:10.12965/jer.1938748.374 · Cited by 45
“5 was considered clinically significant (Chen et al., 2018).”
Conner, B. C., Remec, N. M., & Lerner, Z. F. (2022) · Clinical Rehabilitation · doi:10.1177/02692155221087084 · Cited by 43
Tobaiqi, M. A., Albadawi, E. A., Fadlalmola, H. A., & Albadrani, M. S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12227091 · Cited by 46
“Effective neurorehabilitation requires repeated and varied tasks with increasing difficulty, which can help the brain form new muscle synergies for specific goals [7,14–16].”
BackgroundKomariah, M., Amirah, S., Abdurrahman, M. F., Handimulya, M. F. S., Platini, H., Maulana, S., Nugrahani, A. D., Mulyana, A. M., Qadous, S. G., Mediani, . S., et al. (2024) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s432249 · Cited by 43
“10 This study demonstrated a large effect size (d = 0.861) for VR compared with other interventions, underscoring the substantial impact of VR in rehabilitation settings.”
ResultInfluentialVirtual reality: A review and a new framework for integrated adoption
Fares, O. H., Aversa, J. M., Lee, S. H., & Jacobson, J. (2024) · International Journal of Consumer Studies · doi:10.1111/ijcs.13040 · Cited by 53
Alrashidi, M., Wadey, C. A., Tomlinson, R., Buckingham, G., & Williams, C. A. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2071484 · Cited by 47
Biddiss, E. A., Chan-Víquez, D., Cheung, S. T., & King, G. A. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1613681 · Cited by 37
Lino, F., Arcangeli, V., & Chieffo, D. P. R. (2021) · Children · doi:10.3390/children8040270 · Cited by 35
Saussez, G., Bailly, R., Araneda, R., Paradis, J., Ebner‐Karestinos, D., Klöcker, A., Sogbossi, E. S., Riquelme, I., Brochard, S., & Bleyenheuft, Y. (2023) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-023-01218-4 · Cited by 34
“…greater efficacy in hand/arm function than conventional care in children with CP, with generally poorer results seen for commercially “off the shelf” devices compared to engineer-built environments, and no evidence for transfer of the improved motor functions to daily life activities [13, 17–20].”
BackgroundResultKilcioğlu, S., Schiltz, B., Araneda, R., & Bleyenheuft, Y. (2023) · JMIR Serious Games · doi:10.2196/42067 · Cited by 38
“Rathinam et al [16] and Chen et al [39] also noticed in their reviews that more intensive VR training has more potential to result in improvements of functions in children with CP immediately after the intervention.”
BackgroundResultEffects of virtual reality-based intervention on depression in stroke patients: a meta-analysis
Liu, H., Cheng, Z., Wang, S., Jia, Y., & Li, C. (2023) · Scientific Reports · doi:10.1038/s41598-023-31477-z · Cited by 37
Martins, F., Massetti, T., Crocetta, T. B., Lopes, P. B., da Silva, A., Figueiredo, E. F., de Abreu, L. C., da Silva, T. D., & Monteiro, C. B. D. M. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s184510 · Cited by 32
“Furthermore, Collange Grecco et al38 compared the effects of anodal vs sham transcranial direct current stimulation (tDCS) combined with VR training for improving gait in children with CP.”
BackgroundInfluentialNaqishbandi, T. A., Mohamed, E. S., & Veronese, G. (2023) · International Journal of E-Adoption · doi:10.4018/ijea.316537 · Cited by 36
Self-Management Mobile Virtual Reality Program for Women with Gestational Diabetes
Kim, S.-H., Kim, H. J., & Shin, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041539 · Cited by 31
Hao, J., Huang, B., Remis, A., & He, Z. (2023) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2184220 · Cited by 28
Technological Advancements in Cerebral Palsy Rehabilitation
Reyes, F. I., Niedzwecki, C. M., & Gaebler-Spira, D. J. (2019) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2019.09.002 · Cited by 33
de Araújo, P. A., Starling, J. M. P., Oliveira, V. C., Gontijo, A. P. B., & Mancini, M. C. (2019) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2019.04.005 · Cited by 33
A Game-Based Rehabilitation System for Upper-Limb Cerebral Palsy: A Feasibility Study
Daoud, M. I., Alhusseini, A., Ali, M. Z., & Alazrai, R. (2020) · Sensors · doi:10.3390/s20082416 · Cited by 31
“Literature reveals that many previous studies that used game-based rehabilitation for cerebral palsy patients evaluated the effectiveness of the game-based exercises using outcome measures that compare the body structure and function, such as range of motion and weakness of muscles, and the level of activity, such as…”
Li, S., Song, Y., Cai, Z., & Zhang, Q. (2022) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-022-00532-z · Cited by 25
“deviation and variance were averaged to represent the outcome of the task [49].”
BackgroundMenekşeoğlu, A. K., Çapan, N., Arman, S., & Aydın, A. R. (2022) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002060 · Cited by 28
“Compared with commercial off-the-shelf systems, disease-specific VR-mediated systems are reported to be more effective in CP rehabilitation.(11) In VR applications developed specifically for the disease, it is possible to control the virtual environment and tasks to transfer functional gains to the real world.”
BackgroundMethodInfluentialBurin-Chu, S., Baillet, H., Leconte, P., Lejeune, L., Thouvarecq, R., & Benguigui, N. (2023) · Clinical Rehabilitation · doi:10.1177/02692155231187858 · Cited by 27
“For instance, Chen et al. 27 in 2018 and Fandim et al. 28 in 2020 performed reviews interested in the effectiveness of these technologies on the upper limb, but also on the lower limb, ambulation, and postural control.”
BackgroundResultInfluentialChen, J., Xie, Z., & Or, C. K. (2021) · Health and Technology · doi:10.1007/s12553-021-00561-7 · Cited by 26
Commercial Exergaming in Home-Based Pediatric Constraint-Induced Therapy: A Randomized Trial
Wang, T., Chen, Y., Shieh, J., & Chen, H. (2021) · OTJR Occupational Therapy Journal of Research · doi:10.1177/1539449220984110 · Cited by 24
“Enhanced motivation can help to increase the intensity and duration of practice, which facilitates brain reorganization (Y. P. Chen et al., 2018).”
BackgroundSelf-citationLeal, A. F., da Silva, T. D., Lopes, P. B., Bahadori, S., de Araújo, L. V., da Costa, M. V. B., de Moraes, Í. A. P., Marques, R. H., Crocetta, T. B., de Abreu, L. C., et al. (2020) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-020-00689-z · Cited by 24
Ammann‐Reiffer, C., Kläy, A., & Keller, U. (2022) · JMIR Serious Games · doi:10.2196/38509 · Cited by 23
“So far, VE interventions targeting gait function in children with neuromotor impairment were considerably less frequent, and consequently, evidence on their effectiveness remains limited [6-8,10].”
BackgroundResultInfluentialda Silva, T. D., Fontes, A. M. G. G., de Oliveira-Furlan, B. S., Roque, T. T., Lima, A. I. I., de Souza, B. M. M., Alberissi, C. A. D. O., Silveira, A. C., de Moraes, Í. A. P., Collett, J., et al. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00953 · Cited by 25
Goyal, C., Vardhan, V. D., & Naqvi, W. M. (2022) · Cureus · doi:10.7759/cureus.21693 · Cited by 25
“VR seems to be an effective intervention for improving motor function in children with CP based on the results of preliminary studies [8,9].”
BackgroundGuinet, A.-L., Bouyer, G., Otmane, S., & Desailly, É. (2021) · Sensors · doi:10.3390/s21082697 · Cited by 24
“based on the ICF (International classification of functioning, disability and health [15]) concluded that VR/AR had a large effect size for the activity component (including ambulation function) for children with CP [16].”
MethodArnoni, J. L. B., Kleiner, A. F. R., Lima, C. R. G., de Campos, A. C., & Rocha, N. A. C. F. (2021) · Games for Health Journal · doi:10.1089/g4h.2021.0009 · Cited by 21
“13 Intervention techniques based on nonimmersive virtual reality (VR) are proposed as a promising technique 14,15 to minimize neuromotor and musculoskeletal deficiency disorders, as well as to improve the ability to perform activities in children with CP. 19–21 Furthermore, in a rehabilitation point…”
Virtual Reality–Based Rehabilitation to Restore Motor Function in People With Amputation
Hao, J., Chen, Z., Remis, A., & He, Z. (2022) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002150 · Cited by 21
Antonovics, E., Boitsios, G., & Saliba, T. (2024) · Korean Journal of Pediatrics · doi:10.3345/cep.2023.00388 · Cited by 22
VIDA-Nursing v1.0: immersive virtual reality in vacuum blood collection among adults
de Souza-Junior, V. D., Mendes, I. A. C., Tori, R., Marques, L. P., Mashuda, F. K. K., Hirano, L. A. F., & de Godoy, S. (2020) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.3685.3263 · Cited by 21
“Fifteen meta-analyses report VR simulators intended to support the treatment of patients(24-38), while”
BackgroundMolina-Cantero, A. J., Merino-Monge, M., Castro-García, J. A., Pousada, T., Valenzuela-Muñoz, D., Gutiérrez-Párraga, J., López-Álvarez, S., & Gómez, I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18179179 · Cited by 21
“RPA produces benefits in motor functions in children [23–25] and adolescents with CP [26,27] and improves gait speed [28,29], spasticity [30], balance [31] and muscle strength [27,29].”
BackgroundRadwan, A., Eltalawy, H. A., Abdelziem, F. H., Macaluso, R., O’Brien, M. K., & Jayaraman, A. (2023) · Children · doi:10.3390/children10020222 · Cited by 20
“Neuroimaging studies suggest that VR can facilitate learning and recovery by stimulating cortical reorganization and neural plasticity [16,17].”
BackgroundMelo, R. D. S., Lemos, A., Delgado, A., Raposo, M. C. F., Ferraz, K. M., & Belian, R. B. (2023) · Sensors · doi:10.3390/s23146601 · Cited by 23
Pin, T. W. (2019) · Gait & Posture · doi:10.1016/j.gaitpost.2019.07.122 · Cited by 20
Zhang, Y., Li, R., Miao, X., Cheng, L. J., & Lau, Y. (2021) · Gait & Posture · doi:10.1016/j.gaitpost.2021.10.046 · Cited by 18
Current state of play: Children’s learning in the context of digital games
Blumberg, F. C., Flynn, R. M., Homer, B. D., Bailey, J. O., Eng, C. M., Green, C. S., Giannakos, M. N., Papadakis, S., & Gentile, D. A. (2024) · Journal of Children and Media · doi:10.1080/17482798.2024.2335725 · Cited by 22
“Findings already show that VR can be used as an intervention for children with developmental disabilities (Mesa-Gresa et al., 2018) as demonstrated in motor improvements for children with Cerebral Palsy that exceeded traditional interventions (Chen et al., 2018).”
BackgroundMeyns, P., Blanckaert, I., Bras, C. E. C., Jacobs, N., Harlaar, J., van de Pol, L. A., Plasschaert, F. S., Waelvelde, H. V., & Buizer, A. I. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1954704 · Cited by 15
Campo-Prieto, P., Carral, J. M. C., de Oliveira, I. M., & Fuentes, G. R. (2020) · Retos · doi:10.47197/retos.v0i39.78195 · Cited by 18
“Además, el uso de entornos inmersivos se extiende a todas las franjas de edad (Chen, Fanchiang & Howard, 2018; Howes, Charles, Holmes, Pedlo., Wilson & McDonough, 2017; Kim, Darakjian & Finley, 2017).”
BackgroundLim, J., Kang, E. Y., Park, S.-J., et al. (2024) · Journal of Exercise Rehabilitation · doi:10.12965/jer.2448186.093 · Cited by 17
Personalized rehabilitation for children with cerebral palsy
Tresser, S., Kuflik, T., Levin, I., & Weiss, P. L. (2021) · User Modeling and User-Adapted Interaction · doi:10.1007/s11257-021-09296-6 · Cited by 18
Meng, J., Yan, Z., Gu, F., Tao, X., Xue, T., Liu, D., & Wang, Z. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e12695 · Cited by 13
“VR as an adjunct could be used not only for stroke [8, 12] but also for cerebral palsy [7], Parkinson’s disease [10], schizophrenia [11], anxiety [9], and post-traumatic stress disorder [35], etc.”
BackgroundÖzlü, A., Üstündağ, S., Özkaya, D. B., & Menekşeoğlu, A. K. (2024) · Games for Health Journal · doi:10.1089/g4h.2023.0108 · Cited by 19
“34 In the current study, software developed specifically for patients with shoulder impingement syndrome was used for a total of 15 sessions.”
Stander, J., du Preez, J. C., Kritzinger, C., et al. (2021) · South African Journal of Physiotherapy · doi:10.4102/sajp.v77i1.1516 · Cited by 17
Malick, W. H., Butt, R., Awan, W. A., Ashfaq, M., & Mahmood, Q. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.895055 · Cited by 16
Children’s experiences of play in digital spaces: A scoping review
Loudoun, F. M., Boyle, B., & Larsson-Lund, M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0272630 · Cited by 22
“Similarly, other studies focussed on a genre linking play, videogames and health, namely, exergames and increasingly Virtual Reality games, can be seen to demonstrate how the active, play potential of gaming technology can reap health dividends for children, mirroring research in outdoor play [62,63].”
BackgroundBono, G. L. P., Achermann, P., Rückriem, B., et al. (2022) · American Journal of Occupational Therapy · doi:10.5014/ajot.2022.049008 · Cited by 15
“Robots, in combination with exergames, can provide high-dose and high-intensity training with precise feedback on movement accuracy and induce motor learning in children diagnosed with cerebral palsy (CP; Bertani et al., 2017; Chen et al., 2018; Gilliaux et al., 2015).”
Effects of Nonimmersive Virtual Reality Intervention on Children With Spastic Cerebral Palsy
Wang, N., Liu, N., Liu, S., & Gao, Y. (2023) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002321 · Cited by 16
Neural correlates of virtual reality-based attention training: An fMRI study
Lorentz, L., Schüppen, A., Boris Suchan, A., & Binkofski, F. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.120454 · Cited by 16
“Especially in neurorehabilitation, VR has entered several fields of application, including motor rehabilitation (Chen et al., 2018; De Rooij et al., 2016), pain management (He et al., 2022; Eijlers et al., 2019; Mallari et al., 2019), and exposure therapy (Kim and Kim, 2020; Van Loenen et al.,…”
Lin, Y., Lin, P., Lin, P., Lin, C.-Y., Kabasawa, Y., Choi, Y.-K., & Huang, H. (2023) · Digital Health · doi:10.1177/20552076231203891 · Cited by 14
Han, Y.-G., & Kim, M.-K. (2023) · Medicine · doi:10.1097/md.0000000000036441 · Cited by 16
“[61] Unlike play-oriented exercise, the WBV exercise provides intervention in a static posture.”
BackgroundWelsby, E., Hordacre, B. G., Hobbs, D., Bouckley, J., Ward, E., & Hillier, S. (2024) · Frontiers in Pediatrics · doi:10.3389/fped.2024.1327445 · Cited by 14
How Video Passthrough Headsets Influence Perception of Self and Others
Santoso, M., & Bailenson, J. (2024) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2024.0398 · Cited by 14
Gerçek, N., Tatar, Y., & Uzun, S. (2021) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2021.1926853 · Cited by 12
“These findings were consistent with the previous studies examining the effects of traditional sports programs and virtual reality games on motor functions in children with CP (Dimitrijevi c et al., 2012, Tseng et al, 2013, Christensen et al, 2017, Chen et al., 2018).”
BackgroundMethodResultInfluentialHan, Y.-G., & Park, S.-W. (2023) · PeerJ · doi:10.7717/peerj.15964 · Cited by 16
The application of metaverse in mental health
Wang, Y., Duan, B., Chen, X., Song, Y., & Liu, X. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1463494 · Cited by 16
Levac, D. E., Glegg, S., Pradhan, S. D., Fox, E. J., Espy, D., Chicklis, E., & Deutsch, J. E. (2019) · International Conference on Virtual Rehabilitation · doi:10.1109/icvr46560.2019.8994624 · Cited by 14
“Systematic reviews have suggested more robust evidence for rehabilitation-specific customized systems [18-20].”
BackgroundDigital Health Technologies in Pediatric Trials
Sacks, L. V., Kunkoski, E., & Noone, M. (2022) · Therapeutic Innovation & Regulatory Science · doi:10.1007/s43441-021-00374-w · Cited by 12
Kashif, M., Albalwi, A. A., Kazmi, S. A. M., Alharbi, A. A., Bashir, K., Aslam, M., & Ghaffar, T. (2024) · Medicine · doi:10.1097/md.0000000000037214 · Cited by 11
“Furthermore, VR has presently been investigated as a potential approach to enhance functional ability and movement in pediatrics diagnosed with CP. [55,56] In light of the available research, VR is beneficial as it can easily be exercised in a domestic environment that is through internet.”
BackgroundAbbas, J. R., Gantwerker, E. A., Volk, M. S., Payton, A., McGrath, B. A., Tolley, N., Isba, R., & Bruce, I. A. (2024) · Journal of Medical Extended Reality · doi:10.1089/jmxr.2024.0022 · Cited by 10
“4 This confusion can have several negative impacts across academia, health care, and the technological ecosystem including slowing technology adoption due to lack of understanding, failure to communicate the value proposition of VR training sti fl ing implementation, and the slowing of academic…”
Xue, Z., Zhang, W., Zhou, N., Ma, P., Yuan, K., Zheng, P., Li, J., & Chang, J. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1483370 · Cited by 13
Cheng, M., Anderson, M., & Levac, D. E. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.623200 · Cited by 11
Goyal, C., Vardhan, V. D., Naqvi, W. M., & Arora, S. P. (2022) · Pan African Medical Journal · doi:10.11604/pamj.2022.41.155.32475 · Cited by 11
“Virtual reality (VR) has emerged as a promising intervention for improving motor function in children with CP in a few previous studies, though groups were heterogeneous with a small sample size [6,16,17].”
Backgroundvan de Wouw, C. L., Visser, M., Gorter, J. W., Huygelier, H., & Nijboer, T. C. W. (2023) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2023.2174561 · Cited by 9
Shahane, V., Kumavor, P. D., Morgan, K. D., Friel, K. M., & Srinivasan, S. M. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-071742 · Cited by 12
Meriggi, P., Mandalà, M., Randazzo, M., Brazzoli, E., Castagna, A., Giusto, V. D., Cavallini, A. R., Marzegan, A., Lencioni, T., & Olivieri, I. (2024) · Journal of Pediatric Rehabilitation Medicine · doi:10.3233/prm-230028 · Cited by 10
“Motivation in particular is crucial as a functional neuroplasticity modulator [10–12].”
BackgroundResultDigital Narratives in Extended Realities
Bruni, L. E., Kadastik, N., Pedersen, T. A., & Dini, H. (2022) · doi:10.1002/9781119865810.ch2 · Cited by 9
Physical Activity in Cerebral Palsy: A Current State Study
Molina-Cantero, A. J., Pousada, T., Pacheco‐da‐Costa, S., Lebrato-Vázquez, C., Mendoza-Sagrera, A., Meriggi, P., & Gómez, I. (2024) · Healthcare · doi:10.3390/healthcare12050535 · Cited by 10
“Regardless of its intensity, (RPA) exerts a favorable impact on elements such as balance, muscle strength, and gait speed [9,10,13], with benefits correlating to both time commitment and frequency [41].”
BackgroundWilliamson, S. D., Aaby, A., & Ravn, S. L. (2025) · Spinal Cord · doi:10.1038/s41393-024-01057-7 · Cited by 9
Eckert, M., Soria, B. D., & Gil, N. T. (2023) · JMIR Serious Games · doi:10.2196/36110 · Cited by 9
“…mainstream video games cannot be personalized and that there are still very few offers for therapeutic video games, which are quite expensive [11-13 Some commercial solutions we found are the MIRA software platform (MIRA Rehab Limited), [21], VirtualRehab (Evolv) [22], and REHABILITY…”
Wang, T., Liang, K., Liu, Y.-C., et al. (2023) · Neurorehabilitation and neural repair · doi:10.1177/15459683231162330 · Cited by 9
Ziab, H. M., Mazbouh, R., Saleh, S., Talebian, S., Sarraj, A. R., & Hadian, M. R. (2022) · Archives of Neuroscience · doi:10.5812/ans-122865 · Cited by 10
Baillet, H., Burin-Chu, S., Lejeune, L., Thouvarecq, R., Clément-Guillotin, C., Leconte, P., & Benguigui, N. (2024) · Developmental Neurorehabilitation · doi:10.1080/17518423.2024.2438949 · Cited by 8
“…have suggested that VR technologies could be a relevant rehabilitation tools, facilitating the integration of motor learning principles, 6,13,21–23 insofar as these tools lead patients to perform various active movements and encourage repetitive, intensive, and varied practice with increased…”
Ochandorena‐Acha, M., Terradas‐Monllor, M., Cabrera, T. F. N., Rodas, M. T., & Grau-Carrión, S. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061988 · Cited by 9
Pérez-Cárcamo, J., Hernandez-Martinez, J., Vásquez-Carrasco, E., Fernandez-Cardenas, D., Branco, B. H. M., Sandoval, C., Carmine-Peña, E., Peña, F., Aristegui-Mondaca, J., & Valdés-Badilla, P. A. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14217582 · Cited by 7
Metadata
- Authors
- Chen, Y., Fanchiang, H. D., & Howard, A.
- Affiliations
- Georgia State University (US)
- National Taiwan Sport University (TW)
- Georgia Institute of Technology (US)
- Corresponding author
- Chen, Yuping
- Venue
- Physical Therapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-10-23
- Volume
- 98
- Issue
- 1
- Pages
- 63-77
- ISSN
- 0031-9023 (ISSN-L)
- 1538-6724
- PMC
- PMC6692882
- OpenAlex
- W2771836772
- Semantic Scholar
- 340d03973db763fe983022953aa4047024218dce
- Cited by
- 257
- References
- 87
- Citations by year
- 2026: 22 · 2025: 32 · 2024: 43 · 2023: 32 · 2022: 42 · 2021: 41 · 2020: 22 · 2019: 16 · 2018: 7
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Physical Therapy (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Advancing Translational Sciences
- National Institutes of Health (UL1TR000454)
- Topics
- Health Sciences › Medicine › Rehabilitation › Cerebral Palsy and Movement Disorders
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- virtual reality, cerebral palsy, children, motor function, upper limb function, postural control, ambulation, rehabilitation therapy
- MeSH terms
- Virtual Reality, Adolescent, Cerebral Palsy, Child, Child, Preschool, Postural Balance, Humans, Movement, Randomized Controlled Trials as Topic, Treatment Outcome, Virtual Reality Exposure Therapy
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