Background: Acquired brain injuries are injuries that occur after birth and are a leading cause of long-term disability and death in children and young adults. They may result from trauma, hypoxia, stroke, infection, or a variety of other causes. Fatigue is one of the most common and underrecognized consequences of pediatric acquired brain injury, often expressed behaviorally rather than verbally. Traditional rehabilitation programs are frequently static and cognitively demanding, limiting engagement and therapeutic outcomes. Extended reality (XR) technologies offer new opportunities to address these challenges by enabling interactive, adaptive, and motivating home therapy environments. However, few XR systems are co-developed with children and therapists, and there is limited knowledge about how to co-design engaging, gamified, XR-based motor rehabilitation solutions that take into account children’s fatigue. Objective: This study explores why specific gamification and XR design elements facilitate or hinder engagement and effective fatigue response during rehabilitation for children with acquired brain injuries. Methods: A qualitative case study approach was employed with a total of 25 participants (22 provided consent), combining co-design workshops, interviews with health care professionals, observational data, and iterative user testing with children ages 8-16, their parents, and the clinical team. Participants who provided consent included 4 children with acquired brain injury (ages 8-16), 4 parents, 4 clinicians, and 10 healthy children involved in early ideation only. The XR prototype was developed using Unity, Cognitive3D, and the Meta Quest 3 headset. Engagement and fatigue related to prototype use were evaluated using subjective measures adapted from the User Engagement Scale and the Virtual and Mixed Reality Fatigue Scale, supplemented by thematic analysis of interview and workshop data. Results: Children demonstrated higher engagement with short, modular XR sessions (3-10 minutes) that included interactive game elements and preserved visibility of their surroundings. Fatigue was identified through behavioral cues such as gaze, posture, and responsiveness. Therapists emphasized the importance of adaptive difficulty, personalization, and simplified environments. A therapist-facing dashboard was developed to visualize behavioral fatigue-related cues, consistent with clinician observation. Conclusions: This qualitative case study provides preliminary insights into how XR-based rehabilitation, when co-designed with children and clinicians, may support engagement and facilitate observation of fatigue-related behaviors in pediatric brain injury contexts. The findings provide design-oriented insights for creating engaging XR home-rehabilitation experiences while accounting for fatigue-related limitations (eg, short, modular sessions; visual grounding; adaptable challenge). The results of our study indicate a need for objective fatigue measurement within XR solutions to adjust content in ways that support both engagement and fatigue considerations. However, fatigue detection was not validated in this study and should be addressed in future research.
Mapping Practice-Based Signals of Generative AI in Psychiatric Care: Qualitative Study of Korean Psychiatrists’ Experiences, Interpretations, and Implementation Priorities
Background: Generative artificial intelligence (GenAI) has increasingly entered psychiatric practice through patient-facing chatbots, self-help tools, and clinician-facing workflow support. Although prior research has examined clinicians’