Liisa Holsti

Objectives: To explore and describe learning challenges experienced by children with brachial plexus birth injury compared to the Canadian population. Methods: A retrospective chart review of 127 patients (mean age = 10 years 1 month, SD 5 years 1 month, n = 74 females) in a Canadian provincial brachial plexus clinic database was performed. Collected data included: patient demographics, birth history and complications, treatment interventions, and learning challenges. Data were summarized descriptively. The prevalence of learning challenges was compared with Canadian population data. Associations between reported learning challenges and patient and treatment characteristics were analyzed. Results: The per cent of learning challenges was 22.6% for males and 8.1% for females, compared to 4.0% and 2.5%, respectively, for the general population. Of those with a reported learning challenge, 56% had a formal diagnosis. Attention deficit hyperactivity disorder and speech delay were the most reported. Conclusion: This exploratory study found a higher prevalence of learning challenges in children with brachial plexus birth injury compared to Canadian children and youth. Further research is needed to corroborate and build on these initial results. Implementation of regular screening practices to support early detection of learning challenges may be considered to facilitate referral to specialty services with the goal of optimizing a child's health and well-being.

Background: Early onset of mental health disorders is common, but many cases remain undetected and untreated, highlighting the need for early intervention. In Canada, youth mental health services face challenges, including fragmentation and resource limitations. Integrated youth services (IYS) aim to address these gaps for individuals aged 12–24 years. Mobile health (mHealth) programs, like Foundry Virtual BC, offer potential solutions, yet their integration and sustainability within IYS require further exploration. Objective: This study examined interest-holder perspectives on creating a sustainable, youth-centred mHealth system to improve mental health outcomes. The research focused on three questions: (a) How do users, service providers, and nonclinical staff perceive mHealth's effectiveness and impact? (b) What are the barriers and facilitators to mHealth integration within the Foundry IYS network? and (c) What strategies support the sustainability of mHealth services? Methods: A qualitative study using semi-structured interviews was conducted with 23 interest-holders, including youth users, service providers, and nonclinical staff from the Foundry network. Participants were recruited via social media and snowball sampling. Thematic analysis identified key themes and subthemes. Results: Three themes emerged regarding mHealth perceptions: (a) its own value, (b) its potential to address barriers to in-person care, and (c) its inherent limitations. Barriers and facilitators of mHealth integration were categorized into three domains: (a) design characteristics (e.g., app usability and content quality), (b) individual youth factors (e.g., privacy concern and inner struggle), and (c) external factors (e.g., safe space and support from peers). Sustainability was linked to service quality and external support. Conclusion: This study highlights the complexity of mHealth integration within an IYS network. Interest-holders emphasized addressing user motivations, privacy, and accessibility while advocating for co-design approaches to ensure mHealth meets diverse youth needs. Future research should focus on underrepresented groups to promote equity and improve mental health outcomes through sustainable mHealth solutions.

Background: People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. Objective: This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). Methods: The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. Results: By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. Conclusions: Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies.

Objective: Non-contact respiratory rate estimation (RR) is highly desirable for infants because of their sensitive skin. We propose a novel RGB video-based RR estimation method for infants in the neonatal intensive care unit (NICU) that can accurately measure the RR contact-less. Methods and Procedures: We utilize Eulerian video magnification (EVM) method and develop an adaptive peak prominence threshold value estimation method to address challenges of RR estimation (e.g., dark environments, shallow breathing, babies swaddled or under blankets). We recruited 13 infants recorded for 4 consecutive hours per case. We then evaluate the performance of the algorithm for several ( i.e ., 19 to 25) randomly selected videos, each lasting 1 minute, for each case. Results: Intraclass correlation coefficients of the proposed method over manually and automatically selected ROIs are 0.91 (95%CI: 0.89 − 0.93) and 0.88 (95%CI: 0.85 − 0.9), indicating excellent and good reliability, respectively. The Bland-Altman analysis of the proposed algorithm shows higher agreement between the estimated values via the proposed method and visually counted RR than the agreement between the RR obtained from the impedance sensors and reference RR, and agreement between a former EVM-based method and reference RR values. Conclusion: Our algorithm shows promising results for RR estimation in a real-life NICU environment under various conditions that can confound the estimation. Clinical impact: We present a robust algorithm for non-contact neonatal respiratory rate monitoring, capable of performing well under various environmental lighting conditions in NICU, even when the infant is clothed or covered.

Objective: Dynamic, real-time, in-home methods of data collection are increasingly common in child health research. However, these methods are rarely cocreated or used with families of youth with developmental disabilities. We aimed to determine the feasibility of codesigned methods for in-home data collection for youth across the developmental spectrum. Methods: Sixteen youth (14–18 years) with autism spectrum disorder, cerebral palsy, and/or chronic pain completed 14 days of data collection, wearing an accelerometer, answering Ecological Momentary Assessment (EMA) questionnaires, and collecting salivary cortisol samples. Participants completed a poststudy interview regarding their experiences. Data were analyzed for feasibility, quantity, and quality. Results: At least 1 EMA response was provided on 73% of days, with 54% of the total number of administered prompts answered before the next prompt arrived. In total, 77% of participants wore the accelerometer ≥10 hours for at least 7 days. Adherence to 8-day saliva sampling after accounting for protocol violations and dry samples was 28%. No significant adverse events were reported aside from mild emotional distress (25%). Families reported generally high satisfaction, willingness to participate again, and acceptability, with moderate burden and interference. Qualitative interviews described: (1) the research question's value to the family as a motivator of engagement; (2) in-home data collection is not a passive or neutral experience; (3) personalized approaches and context are important to families; and (4) a clear need for continued iteration and engagement. Conclusion: In-home multimodal data collection is potentially feasible for families across the developmental spectrum but requires iteration based on family feedback to increase adherence.

Millions of individuals with diabetes use glucose monitors to track blood sugar levels. Research shows that such individuals seek to customize different aspects of their interactions with these devices, including how they engage with, decorate, and wear them. However, it remains challenging to tailor both device form and function to accommodate individual needs. To address this challenge, we introduce GlucoMaker, a system for collaboratively customizing physical design aspects of glucose monitors. Prior to designing GlucoMaker, we conducted a prototyping and focus group study to understand customization preferences and collaboration benefits. GlucoMaker provides individuals with the ability to a) select monitor form and function preferences, b) alter predefined and downloadable digital model files, c) receive feedback on monitor designs from stakeholders, and d) learn technical design aspects. We further demonstrate the versatility and design space of GlucoMaker with three examples of different form and function use cases.

Background: Children with severe neurologic impairment (SNI) regularly require major surgery to manage their underlying conditions. Anecdotal evidence suggests that children with SNI experience unexpected and persistent postoperative functional changes long after the postoperative recovery period; however, evidence from the perspective of caregivers is limited. The purpose of the study was to explore the functional postoperative recovery process for children with SNI. Methods: Eligible participants were English-speaking caregivers of children with SNI between 6 months and 17 years who were nonverbal, Gross Motor Function Classification Scale level IV/V, and who had surgery/procedure requiring general anesthetic at a tertiary children’s hospital between 2012 and 2022. Demographic and basic health information were collected via surveys and corroborated by a review of the child’s electronic health record. Semi-structured interviews were conducted and a thematic content analysis was used to formulate results. Results: Data from 12 primary caregiver interviews revealed four main themes: (1) functional changes and complications in the child; (2) feeling unprepared; (3) perioperative support; and (4) changes to caregiver roles. Conclusions: Postoperative functional decline in children with SNI was prevalent in our sample. Providing pre-operative information to families to describe this phenomenon should be a regular part of family-informed care.

BACKGROUND People with Achilles tendinopathy (AT) experience persistent pain that can limit engagement with daily occupations and negatively impact mental health. Current therapeutic exercise approaches vary in success, with many people experiencing reinjury, leading to a cycle of chronic tendinopathy often lasting years. High-magnitude precision loading may help people exit this feedback cycle, but applying these principles clinically is challenging. OBJECTIVE This user-centered design case study aims to provide an overview on how the PhysViz (a prototype for a novel remote rehabilitation intervention for AT management) was developed and evaluated following the development phase of the Framework for Accelerated and Systematic Technology-Based Intervention Development and Evaluation Research (FASTER). METHODS The development process engaged a multidisciplinary team comprising people with AT experiences, clinicians, and engineers. It followed the 5 stages within the FASTER development phase: empathize, define, ideate, prototype, and test. The PhysViz development and evaluation were informed by needs assessments, surveys, literature reviews, validation studies, case studies, roundtable discussions, and usability testing (some of which have been published previously). The FASTER systematically guided the integration of evidence-based features and behavior change theory. RESULTS By using the FASTER and ensuring that the PhysViz system was underpinned by diverse stakeholder needs, this work resulted in the development of a working prototype for both the PhysViz physical exercise tool and the accompanying PhysViz software package (mobile app and web application). A variety of study designs informed user-desired features that were integrated into the PhysViz prototype, including real-time biofeedback in the form of precision load monitoring, customizable exercise programs, and pain tracking. In addition, clinicians can visualize client data longitudinally and make changes to client exercise prescriptions remotely based on objective data. The identified areas for improvement, such as upgrading the user interface and user experience and expanding clinical applications, provide valuable insights for future PhysViz iterations. Further research is warranted to assess the long-term efficacy and feasibility of the PhysViz in diverse clinical settings and its potential to improve AT symptoms. CONCLUSIONS Being one of the first technology development initiatives guided by the FASTER, this study exemplifies a systematic and multidisciplinary approach to creating a remote rehabilitation intervention. By incorporating stakeholder feedback and evidence-based features, the PhysViz addresses key challenges in AT rehabilitation, offering a novel solution for precision loading and therapeutic exercise engagement. Positive feedback from users and clinicians underscores the potential impact of the PhysViz in improving AT management outcomes. The PhysViz serves as a model for technology-based intervention development, with potential implications for other tendinopathies and remote rehabilitation strategies.

Today’s knowledge workers face cognitively demanding tasks and blurred work-life boundaries amidst rising stress and burnout in the workplace. Holistic approaches to supporting workers, which consider both productivity and well-being, are increasingly important. Taking this holistic approach, we designed an intervention inspired by cognitive behavioral therapy that consists of: (1) using the term “Time Well Spent” (TWS) in place of “productivity”, (2) a mobile self-logging tool for logging activities, feelings, and thoughts at work, and (3) a visualization that guides users to reflect on their data. We ran a 4-week exploratory qualitative comparison in the field with 24 graduate students to examine ourTherapy-inspiredintervention alongside a classicBaselineintervention. Participants who used our intervention often shifted toward a holistic perspective of their primary working hours, which included an increased consideration of breaks and emotions. No such change was seen by those who used theBaselineintervention.