ABSTRACT
BACKGROUND AND OBJECTIVE: Computers offer the potential for the assessment of children who have difficulties in communication and cannot describe pain using conventional approaches. Such approaches must be reliable and valid. As a preliminary step towards this goal, the validity and reliability of a computer-assisted pain assessment for children (MacInterview) was assessed using children with no known disabilities who had undergone surgery. METHODS: MacInterview uses body outlines and a range of different pain representations with scaling for size and intensity, and associated emotion. Following piloting with non-clinic children, the experience of acute postoperative pain was assessed for 30 children undergoing adenotonsillectomy or tonsillectomy the day following surgery using the MacInterview and three existing standardized assessment measures. Each child self-reported their current experience of postoperative pain on two occasions 30 min apart, and retrospectively on pain the previous evening in the immediate postoperative period. RESULTS: Analyses indicated good performance of MacInterview, showing positive correlations between 0.65 and 0.88 with standardized pain-intensity measures, and test-retest reliability was 0.9. Face validity was high, and children enjoyed the procedure. CONCLUSIONS: The procedure shows promise and is likely to merit further development for children showing difficulties in communication.
Subject(s)
Computers , Interviews as Topic , Pain Measurement/methods , Pain, Postoperative/physiopathology , Child , Child, Preschool , Humans , Reproducibility of ResultsABSTRACT
In order to study brain activation during the formation of equivalence relations, 12 subjects underwent fMRI during matching-to-sample (MTS) tests of (1) previously trained arbitrary relationships between iconic stimuli and the untrained, emergent relations of (2) symmetry, (3) transitivity, and (4) symmetry with transitivity, plus a test of verbal fluency (VF). Brain activation was similar in all MTS tasks and in the VF task. In particular, both types of task activated dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex bilaterally. However VF, but not the MTS tasks, activated Broca's area. In three of the four MTS tasks, behavioural accuracy was significantly correlated with left lateralisation of DLPFC activity. Brain activation patterns during equivalence thus resembled those involved in semantic processing underlying language, without involving regions concerned with the simple sub-vocal articulation of stimulus names.
Subject(s)
Discrimination Learning/physiology , Frontal Lobe/physiology , Magnetic Resonance Imaging , Prefrontal Cortex/physiology , Adult , Female , Functional Laterality/physiology , Humans , Male , Photic StimulationABSTRACT
Good measures for self-report of pain in children are important, particularly as other informants tend to underestimate children's pain. This paper describes the development of a new computer-assisted approach to assessment of pain in children. The child can represent a range of different types of pains on body maps, and use two scales to indicate the size of the pain and the 'throb' or intensity. Facial expressions of associated emotions can also be incorporated into the figure. A series of 'pain pages' is included in the program. The pages allow changes in pain to be tracked over time, building up a cumulative record. The child can also report on different experiences and give retrospective accounts. Potential applications are suggested, for example in facilitating communication with children who find it difficult to give a clear verbal account of their pain, due to emotional difficulties, language or disability. Research directions are outlined.
