899715f4eb1e5066b6095ac1b4f40781 254894.pdf fefec113affd6c13b28f3e3777d05543a184ba95 254894.pdf 522c39b77bfd8935bc156e4924e49dc0d3a32ea46b501dc192ceadbda3711fb9 254894.pdf Title: Observing Pain in Individuals with Cognitive Impairment:A Pilot Comparison Attempt across Countries and across Different Types of Cognitive Impairment Subject: Facial expression is a key aspect in observational scales developed to improve pain assessment in individuals with cognitive impairments. Although these scales are used internationally in individuals with different types of cognitive impairments, it is not known whether observing facial expressions of pain might differ between regions or between different types of cognitive impairments. In a pilot study, facial responses to standardized experimental pressure pain were assessed among individuals with different types of cognitive impairments (dementia, mild cognitive impairment, Huntington’s disease, and intellectual disability) from different countries (Denmark, Germany, Italy, Israel, and Spain) and were analyzed using facial descriptors from the PAIC scale (Pain Assessment in Impaired Cognition). We found high inter-rater reliability between observers from different countries. Moreover, facial responses to pain did not differ between individuals with dementia from different countries (Denmark, Germany, and Spain). However, the type of cognitive impairment had a significant impact; with individuals with intellectual disability (all being from Israel) showing the strongest facial responses. Our pilot data suggest that the country of origin does not strongly affect how pain is facially expressed or how facial responses are being scored. However, the type of cognitive impairment showed a clear effect in our pilot study, with elevated facial responses in individuals with intellectual disability.40pt Keywords: pain; cognitive impairment; facial expression; cultural differences; dementia; mild cognitive impairment; intellectual disability; pain observation; PAIC Author: Miriam Kunz, Petra Crutzen-Braaksma, Lydia Giménez-Llort, Sara Invitto, Gaya Villani, Marina deTommaso, Laura Petrini, Lene Vase, Susan Tomczak Matthiesen, Hanne Gottrup, Jone Ansuategui Echeita, Stefan Lautenbacher and Ruth Defrin Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Nov 2 07:37:45 2021 CET ModDate: Tue Nov 2 08:04:11 2021 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 989348 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- 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Rel. 1.12.1 (2019-04-17) LastModified: 2022-03-10 17:50:40 CET Size: 989348 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 348 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Participants Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Observers Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Statistics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Step 1: Pre-Analyses Item Selection Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Step 2: Differences between Observers (Decoding of Pain) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Step 3: Differences between Participants (Encoding of Pain) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Children: Item: Title: Facial Encoding and Decoding of Pain: Differences between Countries Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Facial Encoding of Pain: Differences between Different Types of Cognitive Impairments Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Limitations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Info: Title: Observing Pain in Individuals with Cognitive Impairment:A Pilot Comparison Attempt across Countries and across Different Types of Cognitive Impairment Author: Miriam Kunz, Petra Crutzen-Braaksma, Lydia Giménez-Llort, Sara Invitto, Gaya Villani, Marina deTommaso, Laura Petrini, Lene Vase, Susan Tomczak Matthiesen, Hanne Gottrup, Jone Ansuategui Echeita, Stefan Lautenbacher and Ruth Defrin Subject: Facial expression is a key aspect in observational scales developed to improve pain assessment in individuals with cognitive impairments. Although these scales are used internationally in individuals with different types of cognitive impairments, it is not known whether observing facial expressions of pain might differ between regions or between different types of cognitive impairments. In a pilot study, facial responses to standardized experimental pressure pain were assessed among individuals with different types of cognitive impairments (dementia, mild cognitive impairment, Huntington’s disease, and intellectual disability) from different countries (Denmark, Germany, Italy, Israel, and Spain) and were analyzed using facial descriptors from the PAIC scale (Pain Assessment in Impaired Cognition). We found high inter-rater reliability between observers from different countries. Moreover, facial responses to pain did not differ between individuals with dementia from different countries (Denmark, Germany, and Spain). However, the type of cognitive impairment had a significant impact; with individuals with intellectual disability (all being from Israel) showing the strongest facial responses. Our pilot data suggest that the country of origin does not strongly affect how pain is facially expressed or how facial responses are being scored. However, the type of cognitive impairment showed a clear effect in our pilot study, with elevated facial responses in individuals with intellectual disability.40pt Keywords: pain; cognitive impairment; facial expression; cultural differences; dementia; mild cognitive impairment; intellectual disability; pain observation; PAIC Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Tue Nov 02 07:37:45 CET 2021 ModDate: Tue Nov 02 08:04:11 CET 2021 ID: 0x33bdae1722e4ecc886e0778104a6ac68, 0x33bdae1722e4ecc886e0778104a6ac68 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: DXJVEE+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: DXJVEE+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: SOSCBV+CMSY10 FontSubset: true FirstChar: 0 LastChar: 2 FontDescriptor: FontName: SOSCBV+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true 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