Abstract
Pain is difficult to assess in non-verbal populations such as individuals with intellectual and developmental disability (IDD). Due to scarce research in this area, pain assessment for individuals with IDD is still lacking, leading to maltreatment. To improve medical care for individuals with IDD, immediate, reliable, easy to use pain detection methods should be developed. The goal of this preliminary study was to examine the sensitivity of acoustic features of vocal expressions in identifying pain for adults with IDD, assessing their feasibility as a pain detection indicator for those individuals. Such unique pain related vocal characteristics may be used to develop objective pain detection means. Adults with severe-profound IDD level (N = 9) were recorded in daily activities associated with pain (during diaper changes), or without pain (at rest). Spontaneous vocal expressions were acoustically analyzed to assess several voice characteristics. Analyzing the data revealed that pain related vocal expressions were characterized by significantly higher number of pulses and higher shimmer values relative to no-pain vocal expressions. Pain related productions were also characterized by longer duration, higher jitter and Cepstral Peak Prominence values, lower Harmonic-Noise Ratio, lower difference between the amplitude of the 1st and 2nd harmonic (corrected for vocal tract influence; H1H2c), and higher mean and standard deviation of voice fundamental frequency relative to no-pain related vocal productions, yet these findings were not statistically significant, possibly due to the small and heterogeneous sample. These initial results may prompt further research to explore the possibility to use pain related vocal output as an objective and easily identifiable indicator of pain in this population.
Highlights
Intellectual and developmental disability (IDD) results from a variety of disorders, including congenital brain malformations, brain injuries, and other genetic or acquired syndromes
Analyzing the data using the exact Wilcoxon signed-rank test, a significant difference was found in the number of pulses between pain related vocal productions relative to no-pain related productions, p = 0.026
Similar analysis revealed a significant difference in the shimmer values between pain related productions relative to no-pain related productions, p = 0.048
Summary
Intellectual and developmental disability (IDD) results from a variety of disorders, including congenital brain malformations, brain injuries, and other genetic or acquired syndromes. The prevalence of IDD is close to 3%, while the estimated prevalence of severe and profound IDD is about 0.1% of the population (Maulik et al, 2011). Studies in this field indicate that people with. Individuals with severe or profound levels of IDD are more likely to have additional disabling conditions or multiple complex medical problems coupled with communication difficulties. Such medical problems, whether directly or indirectly linked to the disability, often necessitate painful procedures, including physical therapy treatments and various medical interventions. Individuals with severe cognitive impairments and low communication abilities are likely to experience the most pain over time (Breau et al, 2003)
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