Technologies to Support Assessment of Movement During Video Consultations: Exploratory Study.

BACKGROUND: Understanding and assessing patients' body movements is essential for physical rehabilitation but is challenging in video consultations, as clinicians are frequently unable to see the whole patient or observe the patient as they perform specific movements. OBJECTIVE: The objective of this exploratory study was to assess the use of readily available technologies that would enable remote assessment of patient movement as part of a video consultation. METHODS: We reviewed the literature and available technologies and chose four technologies (Kubi and Pivo desktop robots, Facebook Portal TV, wide-angle webcam), in addition to help from a friend or a simple mobile phone holder, to assist video consultations. We used 5 standard assessments (sit-to-stand, timed "Up & Go," Berg Balance Test, ankle range of motion, shoulder range of motion) as the "challenge" for the technology. We developed an evaluation framework of 6 items: efficacy, cost, delivery, patient setup, clinician training and guidance, and safety. The coauthors, including 10 physiotherapists, then took the roles of clinician and patient to explore 7 combinations of 5 technologies. Subsequently, we applied our findings to hypothetical patients based on the researchers' family members and clinical experience. RESULTS: Kubi, which allowed the clinician to remotely control the patient's device, was useful for repositioning the tablet camera to gain a better view of the patient's body parts but not for tracking movement. Facebook Portal TV was useful, but only for upper body movement, as it functions based on face tracking. Both Pivo, with automated full body tracking using a mobile phone, and the wide-angle webcam for a laptop or desktop computer show promise. Simple solutions such as having a friend operate a mobile phone and use of a mobile phone holder also have potential. The setup of these technologies will require better instructions than are currently available from suppliers, and successful use will depend on the technology readiness of patients and, to some degree, of clinicians. CONCLUSIONS: Technologies that may enable clinicians to assess movement remotely as part of video consultations depend on the interplay of technology readiness, the patient's clinical conditions, and social support. The most promising off-the-shelf approaches seem to be use of wide-angle webcams, Pivo, help from a friend, or a simple mobile phone holder. Collaborative work between patients and clinicians is needed to develop and trial technological solutions to support video consultations assessing movement.

The effect of digital media on children in their formative years.

Over the past 2 decades, personal digital devices have evolved to become portable, attractive, readily accessible, interactive, and ubiquitous. Although digital and social media have evidence-based benefits, including early learning, exposure to new ideas and knowledge, and increased opportunities for social contact and support, unsupervised and unchecked use of personal digital devices can have negative consequences for the physical and mental health of children in their formative years.The widespread use of portable digital devices has been accompanied by a concomitant rise in the prevalence of physical and mental health issues in children. Research suggests an association between these trends, which also may be considered from a public health perspective. Proposed interventions include the development and implementation of individual family media use plans for children of all ages.

Experiences of a Motivational Interview Delivered by a Robot: Qualitative Study.

BACKGROUND: Motivational interviewing is an effective intervention for supporting behavior change but traditionally depends on face-to-face dialogue with a human counselor. This study addressed a key challenge for the goal of developing social robotic motivational interviewers: creating an interview protocol, within the constraints of current artificial intelligence, which participants will find engaging and helpful. OBJECTIVE: The aim of this study was to explore participants' qualitative experiences of a motivational interview delivered by a social robot, including their evaluation of usability of the robot during the interaction and its impact on their motivation. METHODS: NAO robots are humanoid, child-sized social robots. We programmed a NAO robot with Choregraphe software to deliver a scripted motivational interview focused on increasing physical activity. The interview was designed to be comprehensible even without an empathetic response from the robot. Robot breathing and face-tracking functions were used to give an impression of attentiveness. A total of 20 participants took part in the robot-delivered motivational interview and evaluated it after 1 week by responding to a series of written open-ended questions. Each participant was left alone to speak aloud with the robot, advancing through a series of questions by tapping the robot's head sensor. Evaluations were content-analyzed utilizing Boyatzis' steps: (1) sampling and design, (2) developing themes and codes, and (3) validating and applying the codes. RESULTS: Themes focused on interaction with the robot, motivation, change in physical activity, and overall evaluation of the intervention. Participants found the instructions clear and the navigation easy to use. Most enjoyed the interaction but also found it was restricted by the lack of individualized response from the robot. Many positively appraised the nonjudgmental aspect of the interview and how it gave space to articulate their motivation for change. Some participants felt that the intervention increased their physical activity levels. CONCLUSIONS: Social robots can achieve a fundamental objective of motivational interviewing, encouraging participants to articulate their goals and dilemmas aloud. Because they are perceived as nonjudgmental, robots may have advantages over more humanoid avatars for delivering virtual support for behavioral change.

Recognizing and treating ADHD in adults.

Patients with attention deficit hyperactivity disorder (ADHD) commonly present in primary care settings. Because untreated adult ADHD can impair patients' quality of life, clinicians need to know how to recognize and treat this potentially lifelong disorder.

Comparing children and adolescents engaged in cyberbullying to matched peers.

Although characteristics of traditional bullying participants have been identified and studied for years, research on cyberbullying is limited. The purpose of this study is to expand the literature on cyberbullying with a particular focus on the relationships among cyberbullying characteristics, typical social activities, and more traditional forms of bullying. The typical activities and experiences with traditional bullying and cyberbullying of 52 children ages 11 to 17 were compared to those of 52 matched controls. Children exposed to cyberbullying, whether as a cyberbully, cybervictim, or both (bully/victim), spent more time on computer-based social activities. Nearly two thirds of cyberbully/victims were also traditional bully/victims. While preliminary, results suggest that efforts to prevent cyberbullying may need to focus on patterns of Internet use, amount and type of social activities, and exposure to traditional bullying as risk factors for engaging in cyberbullying.

Bullying and ostracism experiences in children with special health care needs.

OBJECTIVE: Bullying experiences are becoming increasingly common in children and can have devastating consequences. Ostracism threatens a child's need for self-esteem, sense of belonging, sense of control, and meaningful existence. Recent literature suggests that children with special health care needs may be at risk for these negative events and consequences. This study compares bullying and ostracism experiences in children with and without various special health care needs. METHODS: Participants aged 8 to 17 years completed questionnaires during a routine primary care or subspecialty clinic visit. Children with learning disabilities (N = 34), attention deficit or hyperactivity disorder (N = 100), autism spectrum disorders (N = 32), behavioral or mental health disorders (N = 33), and cystic fibrosis (CF, N = 22) were compared with 73 control children with no diagnosis on Reynolds' Bully-Victimization Scale scores and a 15-item pilot ostracism scale. RESULTS: Compared with the control group, children in the learning disabilities, autism spectrum disorders, and attention deficit or hyperactivity disorder groups exhibited significant victimization scores on the Bully-Victimization Scale, whereas the behavioral or mental health disorders group had increased mean victimization scores. The learning disabilities group also reported clinically significant bullying. The CF group did not report involvement as bullies or victims. All children with special health care needs groups had increased mean frequency of threats to basic needs related to ostracism, and children with attention deficit or hyperactivity disorder and autism spectrum disorders were at higher risk for ostracism experiences. CONCLUSION: Children with special health care needs may be at higher risk for bullying, victimization, and ostracism. Further research is needed to explore this relationship, especially as it relates to child adjustment. Children with special health care needs should be asked about bullying and ostracism experiences and potential effects as part of mental health screening.

Brief report: sluggish cognitive tempo among pediatric survivors of acute lymphoblastic leukemia.

OBJECTIVE: The purpose of the present study was to assess sluggish cognitive tempo (SCT) behavioral symptoms among pediatric survivors of acute lymphoblastic leukemia (ALL) and to determine the relationship of these behaviors with cognitive late effects. METHODS: ALL survivors (n = 80) and a sibling control group (n = 19) were administered intelligence (IQ) testing, achievement testing and SCT behavioral items. Group differences (patients vs. siblings) were examined on the SCT behaviors and partial correlations were conducted to explore the relationship of the SCT behaviors with IQ and achievement, while controlling for age at treatment and time since treatment. RESULTS: ALL survivors exhibited significantly more SCT symptoms than the sibling control group and increased SCT symptoms were associated with lower IQ and achievement scores. CONCLUSIONS: ALL survivors are vulnerable to SCT symptoms and these behaviors are associated with cognitive late effects. SCT symptoms may represent a behavioral component of cognitive late effects.

Duplex scan characteristics of bypass grafts to mesenteric arteries.

BACKGROUND: Mesenteric bypass grafts may be followed postoperatively with duplex scanning. It is unknown, however, if duplex-derived velocity measurements vary over time or if the type of procedure (antegrade vs retrograde) and the caliber of graft affect velocity measurements. The purpose of this study was to characterize duplex findings in mesenteric bypass grafts with respect to the type of revascularization, graft caliber, and changes over time. This study also sought to identify duplex characteristics that could predict subsequent graft failure. METHODS: Duplex examinations of mesenteric bypass grafts were reviewed. Peak systolic velocities (PSV) from the inflow artery, proximal anastomosis, mid graft, distal anastomosis, and outflow arteries were analyzed with respect to timing of the examination (index study vs follow-up exam), inflow source, distal target, and graft diameter. The results were compared with analysis of variance (P < .05). Univariate and multivariate analyses were used to determine any association with mid-graft PSV. RESULTS: Fasting postoperative duplex scans were reviewed from 43 mesenteric bypass grafts in 38 patients (28 superior mesenteric artery [SMA] alone, 3 celiac alone, 5 celiac and SMA, 2 SMA and renal). A total of 167 duplex exams were analyzed (mean of 4.5 studies per patient; range, 1 to 14). Inflow artery velocities were significantly lower in antegrade vs retrograde configurations (93 +/- 73 cm/s vs 154 +/- 73 cm/s, P < .05); however, proximal and mid-graft PSVs were not significantly different between the two groups. In addition, no effect was noted on mid-graft PSV when distal targets were compared (SMA vs celiac, 149 +/- 42 cm/s vs 160 +/- 78 cm/s, P = NS). An association between smaller graft diameter and higher mid-graft PSV was seen with univariate analysis (P = .03), with a trend toward significance with multivariate analysis (P = .06). In 18 bypass grafts where a follow-up examination was available >1 year (mean 38 +/- 25 months) after the index postoperative exam, velocity did not significantly change over time. No duplex scan characteristics were predictive of graft thrombosis. CONCLUSION: This is the first study, to our knowledge, to fully characterize duplex-derived flow velocities in mesenteric artery bypass grafts. Although surveillance duplex scans after mesenteric bypass procedures may be affected by graft diameter, they are not significantly affected by the choice of inflow artery. These data can serve as standards for postoperative surveillance of mesenteric bypass grafts.

Insurance barriers for childhood survivors of pediatric brain tumors: the case for neurocognitive evaluations.

OBJECTIVE: The purpose of the present study was to provide empirical evidence of system-based barriers to psychological services for pediatric brain tumor patients when they are medically indicated. METHOD: Insurance claims data covering 263,866 insured lives during the 1996 fiscal year were pooled from a cross-sectional national sample of adults and their families insured by private insurance companies or self-insured firms. Based on inclusion criteria, records for 209 pediatric brain tumor patients aged 18 and under were extracted and analyzed. Claims data including total amount of payments made on behalf of a member, total length of hospital stays, and total number of unique admissions were recorded for all patients, and current procedural terminology (CPT) codes were analyzed to determine frequency of payment for routinely billed psychological procedures. Results were then compared to the frequency of payment for routinely billed psychological procedures for children with other medical conditions. RESULTS: Results indicate that two of the CPT codes commonly associated with neurocognitive evaluations were reimbursed by these third-party payers for pediatric brain tumor patients during the 1996 fiscal year. Additionally, seven of the CPT codes commonly associated with psychological therapy were also reimbursed. CONCLUSIONS: The present findings provide empirical evidence of system-based obstacles (i.e., lack of third-party reimbursement) for medically indicated psychological services in pediatric brain tumor patients.

Prospective evaluation of the relationship between C-reactive protein, D-dimer and progression of peripheral arterial disease.

OBJECTIVE: Elevated levels of C-reactive protein (CRP) and D-dimer (DD) have been associated with the presence and progression of various forms of atherosclerotic disease, particularly coronary heart disease. We hypothesize that there is a relationship between elevated levels of baseline CRP and DD and progression of peripheral arterial disease (PAD) in patients with symptomatic PAD. The current study is a prospective evaluation of this hypothesis. METHODS: Between 1996 and 2003, 384 subjects were enrolled in a National Institutes of Health-sponsored blinded, prospective trial evaluating the effects of multiple atherosclerotic risk factors on progression of symptomatic PAD. Baseline levels of CRP and D-dimer were obtained in 332 subjects. Subjects were followed every 6 months with clinical history and exam, ankle-brachial pressure index (ABI), and carotid artery duplex scanning (CDS). The primary study end point was a composite of ABI progression, CDS progression, stroke, myocardial infarction, amputation, and death from cardiovascular disease. Secondary end points included each of the components of the primary end point. The relationship between time to the various endpoints and baseline CRP and DD levels was examined by life-table analysis and Cox proportional hazards analysis. RESULTS: Adequate baseline samples for CRP and DD were available in 332 subjects (mean age, 67 years; 57.8% men) with mean follow-up of 38.4 months (range, 1 to 99 months). Mean baseline levels (+/- SD) for CRP were 0.8 +/- 1.14 (range, 0.03 to 13.0), and mean DD levels were 227.4 +/- 303.3 (range, 1.9 to 2744.8). Progression, as defined by the primary end point, occurred in 48.5% of subjects. Subjects with elevated CRP (highest tertile) were no more likely to have any of the progression end points than those with the lowest values (lowest tertile) (P = NS, log-rank test, for all comparisons). By univariate analysis, subjects with elevated DD (highest tertile) were significantly more likely to die from any cause compared with subjects with the lowest DD values (lowest tertile) (P = .03, log-rank test). They were, however, no more likely to reach any of the other progression end points, including the primary end point (P = NS, log-rank test for all other comparisons). Multivariate analysis showed that DD level was a significant independent variable associated with occurrence of myocardial infarction (hazard ratio, 2.3; P = .02). CONCLUSIONS: In subjects with symptomatic PAD, elevated baseline DD, a marker of thrombotic activity, was significantly associated with the occurrence of myocardial infarction. This study did not confirm a relationship between progression of PAD and baseline DD or CRP during the first 3 years. Baseline DD and CRP do not provide useful risk stratification in patients at high risk for progression of symptomatic PAD. Future studies should evaluate serial levels of these markers to assess their utility in predicting progression of symptomatic PAD.