***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to compare the effect of virtual reality to passive distraction and st and ard care on  burn treatment pain in adolescents . This single-blinded , r and omized controlled study enrolled 30 adolescents who were 10 to 17 years of age from the burn clinic of a large children ’s hospital . After providing informed consent/assent , these participants were r and omly assigned to one of three groups during wound care : st and ard care , passive distraction watching a movie , or virtual reality ( VR ) using a tripod-arm device rather than an immersive helmet . Before wound care , participants completed the Spielberger ’s State-Trait Anxiety Inventory for Children and Pre-Procedure Question naire while blinded to group assignment . A total of 28 participants completed the study and rated treatment pain after wound care by using the Adolescent Pediatric Pain Tool and completed a Post-Procedure Question naire . The VR group reported less pain during wound care than either the passive distraction or st and ard care group as determined by multivariable linear regression adjusted for age , sex , preprocedure pain , state anxiety , opiate use , and treatment length . The VR group was the only group to have an estimated decrease in pain perception from baseline preprocedure pain to procedural pain reported . Adolescents pretreated with opiate analgesics and female adolescents reported more pain during wound care . This between-subjects clinical study provides further support for VR , even without requiring wearing of an immersive helmet , in lessening burn wound care pain in adolescents . Passive distraction by watching a movie may be less effective in reducing treatment pain . Additional between-subjects r and omized controlled trials with larger sample s of children and during other healthcare treatments may further support VR ’s effectiveness in pediatric procedural pain management Traumatic brain injury ( TBI ) is the leading cause of death and permanent disability in children and adolescents . Although cognitive and behavioural effects have now been reported for all degrees of TBI severity in children , other aspects of functioning which might be related ( such as psychosocial adjustment ) , have been neglected . In the present study the social and behavioural effects of TBI were assessed by comparing 27 TBI children with 27 controls . TBI children demonstrated significantly lower levels of self-esteem and adaptive behaviour , and higher levels of loneliness , maladaptive behaviour and aggressive/antisocial behaviour . These findings confirm the previously demonstrated detrimental effects of TBI on children 's behavioural functioning and offer new evidence for the detrimental effects of TBI on children 's social functioning Objectives : The question of whether any adverse cognitive or psychosocial outcomes occur after mild head injury in early childhood has evoked considerable controversy . This study examined mild head injury before age 10 and potential differences in late childhood/early adolescence as a function of severity of mild injury and age at injury . Methods : A fully prospect i ve longitudinal design tracked a large birth cohort of children . Confirmed cases of mild head injury before age 10 were divided on the basis of outpatient medical attention ( n=64–84 )  or inpatient observation  ( hospital overnight ; n=26–28 ) and compared with the non-injured remainder of the cohort ( reference group ; n=613–807 ) . A range of pre-injury and post-injury child and family characteristics were used to control for any potential confounds . Outcome after injury before and after age 5 was also assessed . Results : After accounting for several demographic , family , and pre-injury characteristics , the inpatient but not the outpatient group displayed increased hyperactivity/inattention and conduct disorder between ages 10 to 13 , as rated by both mothers and teachers . Psychosocial deficits were more prevalent in the inpatient subgroup injured before age 5 . No clear effects were evident for various cognitive/academic measures , irrespective of severity of mild injury or age at injury . Conclusions : Most cases of mild head injury in young children do not produce any adverse effects , but long term problems in psychosocial function are possible in more severe cases , perhaps especially when this event occurs during the preschool years . The view that all mild head injuries in children are benign events requires revision and more objective measures are required to identify cases at risk Background Pedestrian injuries are a leading cause of paediatric injury . Effective , practical and cost-efficient behavioural interventions to teach young children street crossing skills are needed . They must be empirically supported and theoretically based . Virtual reality ( VR ) offers promise to fill this need and teach child pedestrian safety skills for several reasons , including : ( A ) repeated unsupervised practice without risk of injury , ( B ) automated feedback on crossing success or failure , ( C ) tailoring to child skill levels : ( D ) appealing and fun training environment , and ( E ) most recently given technological advances , potential for broad dissemination using mobile smartphone technology . Objectives and methods Extending previous work , we will evaluate delivery of an immersive pedestrian VR using mobile smartphones and the Google Cardboard platform , technology enabling st and ard smartphones to function as immersive VR delivery systems . We will overcome limitations of previous research suggesting children learnt some pedestrian skills after six VR training sessions but did not master adult-level pedestrian skills by implementing a r and omised non-inferiority trial with two equal-sized groups of children ages 7–8 years ( total N=498 ) . All children will complete baseline , postintervention and 6-month follow-up assessment s of pedestrian safety and up to 25 30-min pedestrian safety training trials until they reach adult levels of functioning . Half the children will be r and omly assigned to train in Google Cardboard and the other half in a semi-immersive kiosk VR . Analysis of Covariance ( ANCOVA ) models will assess primary outcomes . Discussion If results are as hypothesised , mobile smartphones offer substantial potential to overcome barriers of dissemination and implementation and deliver pedestrian safety training to children worldwide OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Purpose : To evaluate the effectiveness of the Nintendo Wii compared to traditional balance therapy in improving balance , motivation , and functional ability in children undergoing acute rehabilitation after brain injury . Methods : A non-concurrent , r and omized multiple baseline single-subject research design was used with three participants . Data were analyzed by visual inspection of trend lines . Results : Daily Wii balance training was equally motivating to traditional balance therapy for two participants and more motivating for one participant . While improvements in dynamic balance were observed , the results for static balance remain inconclusive . All participants demonstrated improvements in functional ability . Conclusion : Wii balance therapy is a safe , feasible , and motivating intervention for children undergoing acute rehabilitation after an acquired brain injury . Further research to examine the effectiveness of Wii balance therapy in this population is warranted Stroke and traumatic brain injury affect an increasing number of people , many of whom retain permanent damage in cognitive functions . Conventionally , cognitive function has been assessed by a paper-based neuropsychological evaluation . However these test environments differ substantially from everyday life . This problem can be overcome by using virtual reality ( VR ) to objective ly evaluate behaviors and cognitive function in simulated daily activities . With our virtual shopping simulation , we compared people who had undergone a stroke with control participants  in an immersive VR program that used a head-mounted display ( HMD ) . We evaluated user satisfaction with the tests , complications , and the user interface . Significant differences were consistently found between the stroke group and the control group for the following tasks : stage 1 performance index , interaction error ; stage 2 delayed recognition memory score , attention index ; and stage 3 executive index ( p < 0.001 ) . Perceptive dysfunction , visuospatial dysfunction , level of computer experience , and level of education affected the performance of the stroke group . The frequency of complications in the stroke group , calculated using the cut-off score for the Simulator Sickness Question naire , was 9.6 % for nausea , 41.9 % for oculomotor complications , and 25.8 % for disorientation . The frequency of complications between the stroke and control groups was not significantly different . Thirty-five percent of participants in the stroke group and 13 % in the control group reported difficulties with using the joystick . This computer-generated VR-based cognitive test shows promise in assessing cognitive function in patients with stroke . More refinements are needed in the user interface and the projection methods The social outcomes of pediatric traumatic brain injury ( TBI ) were examined in a prospect i ve , longitudinal study that included 53 children with severe TBI , 56 with moderate TBI , and 80 with orthopedic injuries , recruited between 6 and 12 years of age .  Child and family functioning were assessed at baseline , at 6- and 12-month follow-ups , and at an extended follow-up a mean of 4 years post injury . Growth curve analyses revealed that pediatric TBI yields negative social outcomes that are exacerbated by family environments characterized by lower socioeconomic status , fewer family re sources , and poorer family functioning . After controlling for group membership , age , race , socioeconomic status , and IQ , path analyses indicated that long-term social outcomes were accounted for in part by specific neurocognitive skills , including executive functions and pragmatic language , and by social problem-solving . Deficits in these domains among children with TBI are likely to reflect damage to a network of brain regions that have been implicated in social cognition Executive functions have been argued to be the most vulnerable to brain injury . In providing an analogue of everyday situations amenable to control and management virtual reality ( VR ) may offer better insights into planning deficits consequent upon brain injury . Here 17 participants with a non-progressive brain injury and reported executive difficulties in everyday life were asked to perform a VR task ( working in a furniture storage unit ) that emphasised  planning , rule following and prospect i ve memory tasks .  When compared with an age and IQ-matched control group , the patients were significantly poorer in terms of their strategy , their time-based prospect i ve memory , the overall time required and their propensity to break rules . An examination of sensitivity and specificity of the VR task to group membership ( brain-injured or control ) showed that , with specificity set at maximum , sensitivity was only modest ( at just over 50 % ) . A second component to the study investigated whether the patients ' performance could be improved by periodic auditory alerts . Previous studies have demonstrated that such cues can improve performance on laboratory tests , executive tests and everyday prospect i ve memory tasks . Here , no significant changes in performance were detected . Potential reasons for this finding are discussed , including symptom severity and differences in the tasks employed in previous studies OBJECTIVE There are potential benefits of playing videogames for health improvement such as increasing knowledge about health-related issues by playing educational games and fighting a sedentary lifestyle by playing exergames . The number of systematic review articles about " videogames " and " health improvement " is limited . Therefore , the purpose of this study is to review those r and omized controlled trials ( RCTs ) with the topic of " videogames " and " health improvement . " MATERIAL S AND METHODS Several electronic data bases were search ed for RCTs testing  videogames on health outcomes that were published in English between January 2000 and April 2012 . RESULTS Forty-five articles met the eligibility criteria and were categorized into five groups : ( 1 ) videogames and patient pain and stress reduction ( nine articles ) , ( 2 ) videogames and  patient behavioral change  ( 19 articles ) , ( 3 ) videogames and patient rehabilitation  ( eight articles ) , ( 4 ) videogames as diagnostic tools ( three articles ) , and ( 5 ) videogames and cognitive ability ( six articles ) . CONCLUSIONS Most of the articles have shown promising results in using videogames within various fields of healthcare . Although exergames are the most prominent choice regarding health improvement , videogames have the potential to be used as a pain management tool , diagnostic tool , or educational tool . They also can be used as a facilitator in physical rehabilitation or cognitive loss prevention . More RCTs are needed to fully uncover the 
    Output:
    
A positive impact was found for VR-based interventions on children ’s physical rehabilitation post-TBI .
The present review identified positive effects of VR interventions for pediatric TBI rehabilitation especially in physical outcomes .