Review of the Accuracy of Two Pain Assessment Tools in Nonverbal Adult Patients

Intensive care units frequently have patients that are unable to verbally communicate their pain, thus negating conventional pain assessment techniques and making pain assessment difficult. Pain management is often a priority in all patients’ circumstances and therefore, assessment and reassessment are included in the plan of care. Different observational pain scales have been used in intensive care units, but often times these scales must be adapted to fit the patient’s circumstances. Pain scales that are used for nonverbal patients typically include behavioral indicators and some are adapted to incorporate physiologic indicators such as vital signs. The aim of this review is to determine if the use of the Critical-Care Pain Observation Tool (CPOT), an assessment tool that is strictly observational, leads to more accurate pain assessment scores for nonverbal adult patients in comparison to the Adult Nonverbal Pain Scale (NVPS), a tool that incorporates vital signs. A search was conducted using five databases and the key words included, but are not limited to, Critical-Care Pain Observation Tool, Adult Nonverbal Pain Scale, nonverbal patients, and pain assessment. It was found that the CPOT was more accurate in determining pain assessment scores due to a discrepancy regarding the inconsistency of vital signs

In vitro-virtual-reality: an anatomically explicit musculoskeletal simulation powered by in vitro muscle using closed loop tissue-software interaction

Muscle force-length dynamics are governed by intrinsic contractile properties, motor stimulation and mechanical load. Although intrinsic properties are well-characterised, physiologists lack in vitro instrumentation accounting for combined effects of limb inertia, musculoskeletal architecture and contractile dynamics. We introduce in vitro virtual-reality (in vitro-VR) which enables in vitro muscle tissue to drive a musculoskeletal jumping simulation. In hardware, muscle force from a frog plantaris was transmitted to a software model where joint torques, inertia and ground reaction forces were computed to advance the simulation at 1 kHz. To close the loop, simulated muscle strain was returned to update in vitro length. We manipulated 1) stimulation timing and, 2) the virtual muscle's anatomical origin. This influenced interactions among muscular, inertial, gravitational and contact forces dictating limb kinematics and jump performance. We propose that in vitro-VR can be used to illustrate how neuromuscular control and musculoskeletal anatomy influence muscle dynamics and biomechanical performance