FACIAL EXPRESSION DISCRIMINATES BETWEEN PAIN AND ABSENCE OF PAIN IN THE NON-COMMUNICATIVE, CRITICALLY ILL ADULT PATIENT

BACKGROUND: Pain assessment is a significant challenge in critically ill adults, especially those unable to communicate their pain level. At present there is no universally accepted pain scale for use in the non-communicative (cognitively impaired, sedated, paralyzed or mechanically ventilated) patient. Facial expressions are considered among the most reflexive and automatic nonverbal indices of pain. The facial expression component of pain assessment tools include a variety of facial descriptors (wincing, frowning, grimacing, smile/relaxed) with inconsistent pain intensity ratings or checklists of behaviors. The lack of consistent facial expression description and quantification of pain intensity makes standardization of pain evaluation difficult. Although use of facial expression is an important behavioral measure of pain intensity, precise and accurate methods for interpreting the specific facial actions of pain in critically ill adults has not been identified. OBJECTIVE: The three specific aims of this prospective study were: 1) to describe facial actions during pain in non-communicative critically ill patients; 2) to determine facial actions that characterize the pain response; 3) to describe the effect of patient factors on facial actions during the pain response. DESIGN: Descriptive, correlational, comparative. SETTING: Two adult critical care units (Surgical Trauma ICU-STICU and Medical Respiratory ICU-MRICU) at an urban university medical center. SUBJECTS: A convenience sample of 50 non-communicative critically ill intubated, mechanically ventilated adult patients. Fifty-two percent were male, 48% Euro-American, with mean age 52.5 years (±17. 2). METHODS: Subjects were video-recorded while in an intensive care unit at rest (baseline phase) and during endotracheal suctioning (procedure phase). Observer-based pain ratings were gathered using the Behavioral Pain Scale. Facial actions were coded from video using the Facial Action Coding System (FACS) over a 30 second time period for each phase. Pain scores were calculated from FACS action units (AU) following Prkachin and Solomon metric. RESULTS: Fourteen facial action units were associated with pain response and found to occur more frequently during the noxious procedure than during baseline. These included areas of brow raiser, brow lower, orbit tightening, eye closure, head movements, mouth opening, nose wrinkling, and nasal dilatation, and chin raise. The sum of intensity of the 14 AUs was correlated with BPS (r=0.70, P\u3c0.0001) and with the facial expression component of BPS (r=0.58, P\u3c0.0001) during procedure. A stepwise multivariate analysis predicted 5 pain-relevant facial AUs [brow raiser (AU 1), brow lower (AU 4), nose wrinkling (AU 9), head turned right (AU 52), and head turned up (AU53)] that accounted for 71% of the variance (Adjusted R2=0.682) in pain response (F= 21.99, df=49, P\u3c0.0001). The FACS pain intensity score based on 5 pain-relevant facial AUs was associated with BPS (r=0.77, P\u3c0.0001) and with the facial expression component of BPS (r=0.63, P\u3c0.0001) during procedure. Patient factors (e. g., age, gender, race, and diagnosis, duration of endotracheal intubation, ICU length of stay, and analgesic and sedative drug usages, and severity of illness) were not associated with the FACS pain intensity score. CONCLUSIONS: Overall, the FACS pain intensity score composed of inner brow raiser, brow lower, nose wrinkle, and head movements reflected a general pain action in our study. Upper facial expression provides an important behavioral measure of pain which may be used in the clinical evaluation of pain in the non-communicative critically ill patients. These results provide preliminary results that the Facial Action Coding System can discriminate a patient’s acute pain experience

Computer Vision Based Early Intraocular Pressure Assessment From Frontal Eye Images

Intraocular Pressure (IOP) in general, refers to the pressure in the eyes. Gradual increase of IOP and high IOP are conditions or symptoms that may lead to certain diseases such as glaucoma, and therefore, must be closely monitored. While the pressure in the eye increases, different parts of the eye may become affected until the eye parts are damaged. An effective way to prevent rise in eye pressure is by early detection. Exiting IOP monitoring tools include eye tests at clinical facilities and computer-aided techniques from fundus and optic nerves images. In this work, a new computer vision-based smart healthcare framework is presented to evaluate the intraocular pressure risk from frontal eye images early-on. The framework determines the status of IOP by analyzing frontal eye images using image processing and machine learning techniques. A database of images from the Princess Basma Hospital was used in this work. The database contains 400 eye images; 200 images with normal IOP and 200 high eye pressure case images. This study proposes novel features for IOP determination from two experiments. The first experiment extracts the sclera using circular hough transform, after which four features are extracted from the whole sclera. These features are mean redness level, red area percentage, contour area and contour height. The pupil/iris diameter ratio feature is also extracted from the frontal eye image after a series of pre-processing techniques. The second experiment extracts the sclera and iris segment using a fully conventional neural network technique, after which six features are extracted from only part of the segmented sclera and iris. The features include mean redness level, red area percentage, contour area, contour distance and contour angle along with the pupil/iris diameter ratio. Once the features are extracted, classification techniques are applied in order to train and test the images and features to obtain the status of the patients in terms of eye pressure. For the first experiment, neural network and support vector machine algorithms were adopted in order to detect the status of intraocular pressure. The second experiment adopted support vector machine and decision tree algorithms to detect the status of intraocular pressure. For both experiments, the framework detects the status of IOP (normal or high IOP) with high accuracies. This computer vison-based approach produces evidence of the relationship between the extracted frontal eye image features and IOP, which has not been previously investigated through automated image processing and machine learning techniques from frontal eye images

Research in action (1983-09)

A publication devoted to describing the scholarly and creative activities of Virginia Commonwealth University.https://scholarscompass.vcu.edu/ria/1017/thumbnail.jp

PABI: Developing a New Robotic Platform for Autism Therapy

Autism Spectrum Disorder affects many children across the world. Through the use of Applied Behavioral Analysis (ABA) therapy, improvements in behavior and social outcomes have been observed. We have developed a new, robust, and durable research platform designed to interact with children through basic ABA therapy in order to test the effectiveness of robots in autism therapy. This platform is able to log therapy sessions while interacting with the child in an innovative way through multiple degrees of freedom. The platform is also designed to be expandable by future researchers with the ability to integrate both additional actuators and sensors. Lastly, the entire structure is modular in its construction, meaning entire modules can be removed and added in the future with minimal effort

The management of Bell’s palsy at selected community health centres in the Cape Metropolitan District of the Western Cape, South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio)Bell’s palsy (BP), a fairly common disorder predominantly prevalent in the adult age group, affects nerves and muscles in the face causing paralysis or dropping of one side of the face. Clients with Bell’s palsy face many challenges, including psychological, physical and emotional. A long recovery period and/or delayed complete healing could lead to a negative effect on many aspects of an individual's life. How society perceives the person could negatively influence the client’s self-confidence. The management of Bell’s palsy depends on the individual case and may include medication, physiotherapy and as a last option, surgery. The aim of the study was to investigate the management of Bell’s palsy at primary health care level in the Cape Metropolitan District of the Western Cape. The study specific objectives was to investigate the management or treatment protocol of clients with Bell’s palsy, to determine the tendency for referral for physiotherapy, to determine whether an association exists between the type of management or treatment received and the recovery of clients with Bell’s palsy and to explore the impact Bell's Palsy has on the clients. The over-arching design of the study was the sequential explanatory mixed methods design where qualitative data was used to assist in explaining and interpreting the findings of a primarily quantitative study. Stratified random sampling was done proportionately to ensure equal representation. A self-administered questionnaire, comprising of four sections, was used to collect quantitative data that was analysed using SPSS version 21. Descriptive statistics was employed to summarise the data on the socio-demographic information of the clients. Inferential statistics was used to determine the distributions of cases in the various groups. Significant differences tested for using the Chisquare test and effect size through Cramer’s V tests. A semi-structured interview guide was developed based on the results of the analysis of the quantitative data. Focus group discussions were employed to a sub-sample of the clients with Bell’s palsy. Permission an ethical clearance will be obtained from Senate Higher Degrees Committee at the University of the Western Cape (UWC), the Western Cape Department of Health and the facility managers of the participating CHCs

Defining Diagnosis: A Reflexive Account of a Chronic Dis-ease Process

This is an autoethnographic account of the experience of living with chronic illness and a liminal status. This reflexive study is divided into three parts: 1) Lupus, the defining diagnosis, 2) Dis-ease, identity and reevaluation 3) Dis-identification, chronic dis-ease, and liminality. Throughout, music lyrics and my own poetry are used to represent my fluctuating identity. Systemic lupus erythematous (SLE) is a rare yet complex disease. The etiology is constantly questioned by doctors and not readily seen; it is both contested and invisible. Patients with this illness are highly stigmatized, and their psychological welfare can become neglected in a biomedical system that does not account for the overall well-being of patients. This case study addresses some potential consequences for an identity tarnished in this way. Misdiagnosis is sorely understudied throughout the literature and fails to account for the lived experience of the patient. This study seeks to fill these gaps