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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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“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
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“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
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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
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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
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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
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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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“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.
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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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“There were 10 studies that included outcome variables that mea sured postural control.”
§ 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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“There were 8 studies that included outcome variables that measured ambulation function.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Effectiveness of VR for Ambulation.
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In the paper
“A statistically significant positive linear relationship was found between daily dosage and study effect size: the larger the daily dosage was, the larger the effect size was (slope = 0.01027).”
§ 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.
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“There was no publication bias.”
§ 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.
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In the paper
“When excluding the 4 studies (Rostami 2012_1 and Rostami 2012_2, 47 Reid, 54 and Tarakci et al 59 ) with ES larger than 2.000, the overall effect size shifted from 0.861 to 0.510.”
§ 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 [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 [54] Reid, 2002, Changes in seated postural control in children with cerebral palsy following a virtual play environment intervention: a pilot study, Israel J Occup Ther
- Not checked yetcites [59] Tarakci, 2016, Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy, Pediatr Int source
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In the paper
“d = 1.003 for postural control”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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In the paper
“When outcome measures in our review were classified based on the ICF model, a medium effect size was found for the body structure and function component (d = 0.672)”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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In the paper
“a large effect size was found for the activity component (d = 0.899)”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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In the paper
“d = 0.835 for arm function”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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“but a small effect size was found for the participation component (d = 0.408).”
§ 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.
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“a medium to large effect on ambulation (d = 0.755).”
§ 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.
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“However, we did not find this similar trend in ambulation and postural control function.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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“When carefully examining the effect size in the commercial systems, they reached a medium effect size (d = 0.619)”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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In the paper
“the daily dosages of Ren et al 56 and Rostami et al 47 were 80 to 90 minutes, with a large effect (d ranged from 1.270 to 5.576).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
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“In addition, the majority of the studies used VR in training arm function and postural control.”
§ 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.
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In the paper
“the daily dosage of James et al 43 and Zoccolillo et al 61 was 30 minutes, with small or almost no effect (d = 0.342 and d = 0.272, respectively)”
§ 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.
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In the paper
“In our review, VR effect had a negative linear association with children's age in arm function and ambulation: the younger the children, the better the 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.
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In the paper
“In our review, VR effect had a negative linear association with children's age in arm function and ambulation: the younger the children, the better the 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.
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“Our findings showed a trend that use of an engineer-built system was more effective than using a commercial system.”
- Also stated in: § Discussion · hedged
“Although using an engineer-built VR system may have a better effect”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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“All these published systematic reviews included very few RCTs (3-7 RCTs only).”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
plain- Asserted: passes — The authors put it forward as true.
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“To the best of our knowledge, no systematic reviews using a meta-analytic method (ie, using statistical method to compute and combine data from multiple studies) 21,22 to examine the effectiveness of VR in children with CP have ever been published, except for our own work in arm function.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“In our previous meta-analysis, 16 which included 3 randomized controlled trials (RCTs) and 11 case series that examined the effect of VR on arm function in children with CP, we found VR overall provided a strong effect size (d = 1.00) when comparing between post-VR and pre-VR interventions.”
§ 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
boosteddirectn = 11- Asserted: passes — The authors put it forward as true.
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In the paper
“At least 20 studies using RCT design have been published since the databases were accessed by the authors of the most recently published systematic reviews.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > C
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In the paper
“The augmented feedback provided by the VR system such as seeing own movements during play can enhance motor learning, especially in children with CP whose intrinsic feedback from their sensory system might be impaired.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
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.
In the paper
“Also, the animated environment provided by VR can vividly provide a simulated environment for children to practice some skills that may not be feasible to do in the real world.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 [13] Weiss, 2006, Virtual reality applications in neurorehabilitation source
plainconditional- 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.
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
“All these perspectives can be achieved via training in VR: the gaming features of the VR provide children the ability to repeatedly practice the same task with a greater number of repetitions without noticing.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
plaindirectSingle case- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“From the motor learning perspectives, when children with CP learn a motor skill, it required hundreds of repetitions per day of a challenging functional task to lead to structural neurological change.62,63”
§ 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.
In the paper
“For example, when a child with CP played a PlayStation 2 Eye Toy game called Slap Stream, the child could repeat reaching movements at least 150 times in a 3-minute interval without notice.15”
§ 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 [15] Chen, 2007, Use of virtual reality to improve upper-extremity control in children with cerebral palsy: a single-subject design, Phys Ther source
hedgedSingle case- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“The more similar the VR is toward the real-world environment, the better transfer in motor skill.13,14”
§ 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: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Moreover, if motor learning occurred when the practice conditions are as similar as the contexts where the task would be performed, the learning will be promoted with better retention effect.[12][13][14]”
§ 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
- Not checked yetcites [13] Weiss, 2006, Virtual reality applications in neurorehabilitation source
- Not checked yetcites [14] Bossard, 2008, Transfer of learning in virtual environments: a new challenge?, Virtual Real 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.
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
“Interestingly, VR effect seemed to be more effective in children with CP than in patients with stroke.”
§ Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials > Discussion
hedgedcorrelational- 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.
In the paper
“Movement accuracy was also better with the external attention cues rather than with the internal attention cues.66”
§ 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 [66] Wulf, 2007, An external focus of attention enhances golf shot accuracy in beginners and experts, Res Q Exerc Sport source
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.
None of the sources cited for this claim have been checked yet.
In the paper
“almost no effect on global motor function (d = 0.14)”
§ 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 Laver et al
- Not checked yetcites [68] Laver, 2015, Virtual reality for stroke rehabilitation, Cochrane Database Syst Rev
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.
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
“When children with CP played VR games in general, they did not pay attention to their own body movements, but instead, they paid”
§ 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: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“a small effect on activity of daily living (d = 0.43)”
§ 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 Laver et al
- Not checked yetcites [68] Laver, 2015, Virtual reality for stroke rehabilitation, Cochrane Database Syst Rev
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.
None of the sources cited for this claim have been checked yet.
In the paper
“almost no effect on gait speed (d = 0.07)”
§ 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 Laver et al
- Not checked yetcites [68] Laver, 2015, Virtual reality for stroke rehabilitation, Cochrane Database Syst Rev
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.
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
“An advantage of using VR is how easy it is to adjust game 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: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“a Cochrane systematic review by Laver et al indicated a small effect of using VR on arm function in adults with stroke (d = 0.28)”
§ 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 Laver et al
- Not checked yetcites [68] Laver, 2015, Virtual reality for stroke rehabilitation, Cochrane Database Syst Rev
hedgeddirect- 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.
In the paper
“The effect of using VR on arm function is quite consistent with our previous meta-analysis (d = 1.00 in Chen et al 16 ), which included 3 RCTs and 11 case series.”
§ 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 Chen et al 16
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.
In the paper
“In the United States, around 84% of children between the ages of 2 and 17 are gamers”
§ 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
hedged- 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.
In the paper
“In addition, motivation has been recognized as an important reason in explaining why VR works.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
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.
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
“The sample size in each RCT was relatively small.”
§ 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.
In the paper
“When comparing more intensive interventions with nonintensive rehabilitation treatment for children with CP, a large effect size with intensive intervention (d = 1.32) compared with the nonintensive therapy.”
§ 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 Arpino et al. 73
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.
In the paper
“Weiss et al 13 have proposed a model to explain VR-based rehabilitation within the context of terminology from the ICF model, which can help to explain why we found only small effect in 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 Weiss et al 13
plainconditional- 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.
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
“with high heterogeneity among studies”
§ 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.
In the paper
“Engineer-built system might also have the flexibility to provide a more task-specific training than the commercial systems.70”
§ 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 [70] Guadagnoli, 2004, Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning, J Mot Behav 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.
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
“the quality of the research studies included in this review was fair to good”
§ 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: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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
“As expected, an engineer-built system can meet the children's special needs through better adjustment of game difficulty and training goals.”
§ 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.
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
“Our current meta-analysis has improved the quality of evidence by only including research with RCT design.”
§ 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.
In the paper
“The use of engineer-built system can provide optimal challenge of the skill difficulty to children with CP to obtain the optimal learning of the skill (challenge point theory).70”
§ 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 [70] Guadagnoli, 2004, Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning, J Mot Behav source
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.
In the paper
“Our finding that intensive practice dosage in training upper extremity function in children with CP showed a better effect than low practice dosage was consistent with findings in the meta-analysis of Arpino et al. 73”
§ 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 Arpino et al. 73
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.
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 required number of repetitions is very challenging to achieve in a single therapeutic session.”
§ 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.
In the paper
“Human studies have shown that improving arm function requires hundreds of repetitions per day of a challenging functional task to lead to structural neurological change.70”
§ 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 [70] Guadagnoli, 2004, Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning, J Mot Behav source
boosteddirect- 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. 28
- It may state two separate claims as one. 41
- The quote only partly states this claim. 2
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 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.
- 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 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
“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.
- 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 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
“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.
- 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.
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 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.
- 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.
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 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.
- 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 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.
- 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.
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.
- 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
“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.
- 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.
The quote only partly states this claim.
- Also stated in: § Discussion · boosted
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
“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.
- 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.
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.
- 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 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.
- 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.
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.
- 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
“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.
- 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
“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.
- 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
“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.
- 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
“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.
- 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
“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.
- 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
“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.
- 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, 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.
- 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
“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.
- 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
“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
Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,603
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,417
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,762
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225
A report: the definition and classification of cerebral palsy April 2006
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., BAX, M. C. O., Damiano, D. L., Dan, B., & Jacobsson, B. (2007) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2007.tb12610.x · Cited by 5,028
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000062554.74615.4c · Cited by 4,700
Research works printed but not linked: 5
- Centers for Disease Control and Prevention, 2017, Cerebral Palsy
- Howick, 2017, The 2011 Oxford CEBM levels of evidence: introductory document
- Cooper, 1994, eds
- Sharan, 2012, Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy, Work, 41, 3612, 10.3233/wor-2012-0667-3612 · DOI · Paper page
- The NPD Group, Inc, 2017, Kids ages 2-to-14 consume digital content on a device between three and seven times per month
Cited by
Sorted by citations
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
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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