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ObjectiveTo design a multi-domain return-to-play assessment system (R2Play) for youth athletes with concussion.MethodsThe R2Play system was developed using an overarching user-centered approach, the Design Thinking Framework, and research activities included: 1) structured brainstorming within our research team, 2) interviews with clinician and youth sports coaches, 3) building a testable prototype, and 4) interface testing through cognitive walkthroughs with clinician partners.ResultsClinician and coach participants provided feedback on the R2Play concept, which was integrated into the design process and provided future directions for research. Examples of feedback-driven design choices included reducing assessment time, increasing ecological validity by adding in background noise, and developing youth-friendly graphical results screens. Following refinement based on stakeholder feedback, the R2Play system was outlined in detail and a testable prototype was developed. It is made up of two parts: a clinician tablet, and a series of tablet “buttons” that display numbers and letters. Youth athletes run between the buttons to connect a “trail” in ascending alphanumeric order, 1-A-2-B, etc. Their performance across a series of levels of increasing difficulty is logged on the clinician tablet. Initial testing with five clinicians showed the system's interface to have excellent usability with a score of 81% (SD = 8.02) on the System Usability Scale.ConclusionThrough this research, a prototype of the R2Play system was innovated and evaluated by clinician and coach stakeholders. Initial usability was excellent and directions for future iterations were highlighted. Outcomes suggest the potential benefits of using technologies to assist in complex clinical assessment, as well as utilizing a user-centered approach to design.

BackgroundActive rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. ObjectiveThis paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. MethodsThe intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. ResultsTele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. ConclusionsThe Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.

The Polar H10 is a low-cost wearable with a heart rate monitor and tri-axial accelerometer with potential for many applications. While the device’s heart rate monitor has been widely studied, there is no research validating the accelerometer specifically. The purpose of this study was to conduct a validation of the Polar H10 accelerometer to establish static and dynamic validity during a sports-based task. Static validity was determined by computing the relative error when using a level guide to hold each axis of the Polar H10 against gravity. Fifteen healthy adults (8F/7M) participated in sports-based tasks while wearing the Polar H10 (Polar Electro, Kempele, Finland) and a comparison device, the MetaMotionR inertial measurement unit (MbientLab Inc., San Francisco, CA, USA). Dynamic validity was characterized using Pearson’s correlation coefficient and root mean square error (RMSE). Additionally, common features in human activity recognition (mean magnitude, root mean square, power, and signal magnitude area) were computed in 2 s windows and compared via RMSE and Wilcoxon rank sum tests. When held against gravity, the Polar H10 had relative errors ranging from 2.620% to 4.288%, suggesting high static validity. During sports-based tasks, the accelerometers had correlations between 0.888 and 0.954, indicating sufficient concurrent validity for all axes, as well as acceleration magnitude. The differences in acceleration features were minimal (RMSE for mean, root mean square, power, and signal magnitude were 0.003 G, 0.004 G, 0.112 G, and 0.017 G, respectively), but all reached significance (p < 0.001). These results provide evidence for the use of the Polar H10 accelerometer to measure movement during sport-like activities.