| dc.contributor.author | Breau, Lynn Marie. | en_US |
| dc.date.accessioned | 2014-10-21T12:37:08Z | |
| dc.date.available | 2002 | |
| dc.date.issued | 2002 | en_US |
| dc.identifier.other | AAINQ75693 | en_US |
| dc.identifier.uri | http://hdl.handle.net/10222/55844 | |
| dc.description | This research investigated the pain of a cohort of 101 children aged 3 to 18.7 years (M = 10.3, SD = 4.4) who had severe cognitive impairments. Five studies are described, each included a subgroup of this cohort. | en_US |
| dc.description | Study 1 examined four Pain Surveys administered to caregivers by telephone at 3-month intervals. During each, caregivers reported the features of their children's pain over the past week. They had, on average, over 9 hours of pain each week and 35% to 52% had pain each week. Most pain was due to chronic conditions or illnesses (82%). Study 2 examined the effect of pain on 89 children's development of adaptive skills. Skills in four areas (communication, daily living skills, socialization, motor skills) were documented at entry to the study and one year later. Time with pain (hours, minutes), over four one-week periods at three-month intervals was summed and its effect on change in the four adaptive areas examined. Children with more pain gained significantly fewer adaptive skills overall. Univariate effects of pain were significant for communication, daily living skills and motor skills. | en_US |
| dc.description | Study 3 investigated the psychometric properties of the Non-communicating Children's Pain Checklist-Revised (NCCPC-R) for everyday pain. As part of one-week Pain Diaries, 71 caregivers completed the NCCPC-R and rated the intensity of pain occurring during daily two-hour observations. Comparisons were made between scores during observations with and without pain. The NCCPC-R demonstrated excellent internal reliability (alpha =.93), total scores were significantly correlated with pain intensity ratings (r =.46), and total scores during pain (M = 21.1, SD = 15.9) differed significantly from scores when pain was absent (M = 4.8, SD = 5.2). Receiver operating characteristic (ROC) curves indicated a total score of 7/90 had 84% sensitivity and 68% specificity. | en_US |
| dc.description | For Study 4, researchers and caregivers completed the Non-communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV) before and after 24 children had surgery. Total postoperative scores were significantly greater (M = 12.2, SD = 10.9) than preoperative scores (M = 4.8, SD = 3.6) and ROC curves indicated a total score of 11/81 provided good sensitivity (75%--88%) and specificity (63%--81%). Inter-rater reliability of total postoperative NCCPC-PV scores was good (r = .72). | en_US |
| dc.description | Study 5 examined the validity of the Child Facial Coding System (CFCS) for postoperative pain in 26 children. The 13 facial actions of the CFCS were coded for five 10-second time segments selected from film collected in the recovery room. Visual analogue scale (VAS) ratings of pain intensity and sedation were also made for each segment. Children with VAS pain ratings of 30 or more out of 100 displayed significantly more frequent and intense facial actions. Facial action was not related to sedation ratings. Categorical principle components analyses revealed a "pain face" (brow lower, nose wrinkle, nasolabial furrow, cheek raiser, horizontal mouth stretch and flared nostril) that was related to higher VAS pain ratings and analgesic administration. | en_US |
| dc.description | The results of these studies suggest children with severe cognitive impairments have frequent pain that is most often due to chronic conditions and illnesses and that pain reduces development of adaptive skills. The results also suggest observational pain measures are viable with this group. The importance of these results to furthering research and improving clinical care for children with severe cognitive impairments is discussed. | en_US |
| dc.description | Thesis (Ph.D.)--Dalhousie University (Canada), 2002. | en_US |
| dc.language | eng | en_US |
| dc.publisher | Dalhousie University | en_US |
| dc.publisher | | en_US |
| dc.subject | Psychology, Psychometrics. | en_US |
| dc.subject | Psychology, Physiological. | en_US |
| dc.title | The nature, expression and impact of pain in children with severe cognitive impairments. | en_US |
| dc.type | text | en_US |
| dc.contributor.degree | Ph.D. | en_US |
