title: Physiological and Behavioral Responses to Calibrated Noxious Stimuli Among Individuals with Cerebral Palsy and Intellectual Disability.
abstract: As individuals with intellectual disability (ID) due to cerebral palsy (CP) are at high risk of experiencing pain, measuring their pain is crucial for adequate treatment. While verbal reports are the gold standard in pain measurements, they may not be sufficient in ID. The aim was to detect behavioral/autonomic responses that may indicate the presence and intensity of pain in individuals with CP and ID, using calibrated stimuli, here for the first time.
  
  
  
  Thirteen adults with CP and ID (CPID), 15 healthy controls (HC), and 5 adults with CP with no ID (CPNID).
  
  
  
  Subjects received pressure stimuli of various intensities. Self-reports (using a pyramid scale), facial expressions (retrospectively analyzed with Facial Action Coding System = FACS), and autonomic function (heart rate, heart rate variability, pulse, galvanic skin response) were analyzed.
  
  
  
  Self-reports and facial expressions but not the autonomic function exhibited stimulus-response relationship to pressure stimulation among all groups. The CPID group had increased pain ratings and facial expressions compared with controls. In addition, the increase in facial expressions along the increase in noxious stimulation was larger than in controls. Freezing in response to pain was frequent in CPID.
  
  
  
  1) Individuals with CP and ID have increased responses to pain; 2) facial expressions and self-reports, but not autonomic variables can reliably indicate their pain intensity; 3) the pyramid scale is suitable for self-report in this population. Although facial expressions may replace verbal reports, increased facial expressions at rest among these individuals may mask pain, especially at lower intensities.
authors.affiliation: Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Benromano
authors.affiliation: Department of Anatomy and Anthropology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.|Sagol School of Neuroscience, Tel-Aviv University, Israel.
authors.forename: Chaim G
authors.initials: CG
authors.lastname: Pick
authors.affiliation: National Institute of Child Health and Human Development, Office of the Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem and Division of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Joav
authors.initials: J
authors.lastname: Merick
authors.affiliation: Sagol School of Neuroscience, Tel-Aviv University, Israel.|Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ruth
authors.initials: R
authors.lastname: Defrin
mesh_terms: D000328:Adult; D002547:Cerebral Palsy; D005149:Facial Expression; D005260:Female; D005712:Galvanic Skin Response; D006339:Heart Rate; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010812:Physical Stimulation
keywords: Autonomic Function; Cognitive Impairment; Experimental Pain; Pain Behavior; Perception