Patricia Solomon

The painful face - Pain expression recognition using active appearance models

Pain is typically assessed by patient self-report. Self-reported pain, however, is difficult to interpret and may be impaired or in some circumstances (i.e., young children and the severely ill) not even possible. To circumvent these problems behavioral scientists have identified reliable and valid facial indicators of pain. Hitherto, these methods have required manual measurement by highly skilled human observers. In this paper we explore an approach for automatically recognizing acute pain without the need for human observers. Specifically, our study was restricted to automatically detecting pain in adult patients with rotator cuff injuries. The system employed video input of the patients as they moved their affected and unaffected shoulder. Two types of ground truth were considered. Sequence-level ground truth consisted of Likert-type ratings by skilled observers. Frame-level ground truth was calculated from presence/absence and intensity of facial actions previously associated with pain. Active appearance models (AAM) were used to decouple shape and appearance in the digitized face images. Support vector machines (SVM) were compared for several representations from the AAM and of ground truth of varying granularity. We explored two questions pertinent to the construction, design and development of automatic pain detection systems. First, at what level (i.e., sequence- or frame-level) should datasets be labeled in order to obtain satisfactory automatic pain detection performance? Second, how important is it, at both levels of labeling, that we non-rigidly register the face?

The structure, reliability and validity of pain expression: evidence from patients with shoulder pain.

Abstract The present study examined psychometric properties of facial expressions of pain. A diverse sample of 129 people suffering from shoulder pain underwent a battery of active and passive range‐of‐motion tests to their affected and unaffected limbs. The same tests were repeated on a second occasion. Participants rated the maximum pain induced by each test on three self‐report scales. Facial actions were measured with the Facial Action Coding System. Several facial actions discriminated painful from non‐painful movements; however, brow‐lowering, orbit tightening, levator contraction and eye closing appeared to constitute a distinct, unitary action. An index of pain expression based on these actions demonstrated test–retest reliability and concurrent validity with self‐reports of pain. The findings support the concept of a core pain expression with desirable psychometric properties. They are also consistent with the suggestion of individual differences in pain expressiveness. Reasons for varying reports of relations between pain expression and self‐reports in previous studies are discussed.

Painful data: The UNBC-McMaster shoulder pain expression archive database

A major factor hindering the deployment of a fully functional automatic facial expression detection system is the lack of representative data. A solution to this is to narrow the context of the target application, so enough data is available to build robust models so high performance can be gained. Automatic pain detection from a patients face represents one such application. To facilitate this work, researchers at McMaster University and University of Northern British Columbia captured video of participants faces (who were suffering from shoulder pain) while they were performing a series of active and passive range-of-motion tests to their affected and unaffected limbs on two separate occasions. Each frame of this data was AU coded by certified FACS coders, and self-report and observer measures at the sequence level were taken as well. This database is called the UNBC-McMaster Shoulder Pain Expression Archive Database. To promote and facilitate research into pain and augment current datasets, we have publicly made available a portion of this database which includes: 1) 200 video sequences containing spontaneous facial expressions, 2) 48,398 FACS coded frames, 3) associated pain frame-by-frame scores and sequence-level self-report and observer measures, and 4) 66-point AAM landmarks. This paper documents this data distribution in addition to describing baseline results of our AAM/SVM system. This data will be available for distribution in March 2011.

Active patient involvement in the education of health professionals

Context  Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient‐centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self‐care.

Perceptions of student peer tutors in a problem-based learning programme

The use of student peer tutors is an attractive and affordable alternative in a problem-based programme. Previous literature has focused on comparing the academic performance of faculty-tutored and student-tutored groups. This study used qualitative methods to examine a peer-tutoring model from the perspective of the student tutor. Students in the final semester of a two-year accelerated physiotherapy programme kept a reflective journal outlining their experiences in facilitating a group of peers from the same class. Content analysis of 56 journals indicated that the students struggled with basic facilitation skills and had difficulty separating the role of student from that of tutor. Students also developed strategies to allow them to succeed, were able to evaluate their performance in a positive light and appeared to value their tutoring experience.

Emotional contagion for pain is intact in autism spectrum disorders

Perceiving others in pain generally leads to empathic concern, consisting of both emotional and cognitive processes. Empathy deficits have been considered as an element contributing to social difficulties in individuals with autism spectrum disorders (ASD). Here, we used functional magnetic resonance imaging and short video clips of facial expressions of people experiencing pain to examine the neural substrates underlying the spontaneous empathic response to pain in autism. Thirty-eight adolescents and adults of normal intelligence diagnosed with ASD and 35 matched controls participated in the study. In contrast to general assumptions, we found no significant differences in brain activation between ASD individuals and controls during the perception of pain experienced by others. Both groups showed similar levels of activation in areas associated with pain sharing, evidencing the presence of emotional empathy and emotional contagion in participants with autism as well as in controls. Differences between groups could be observed at a more liberal statistical threshold, and revealed increased activations in areas involved in cognitive reappraisal in ASD participants compared with controls. Scores of emotional empathy were positively correlated with brain activation in areas involved in embodiment of pain in ASD group only. Our findings show that simulation mechanisms involved in emotional empathy are preserved in high-functioning individuals with autism, and suggest that increased reappraisal may have a role in their apparent lack of caring behavior.

Qualitative research in evidence-based rehabilitation

1. The contribution of qualitative research to evidence-based practice. 2. Using qualitative evidence to inform theories of occupation. 3. Exploring leisure meanings that inform client-centred practice. 4. Building knowledge through participatory research. 5. Using qualitative focus groups to evaluate health programmes and service delivery. 6. Ensuring a client perspective in evidence based rehabilitation. 7. Integrating grounded theory and action research to develop guidelines for sensitive practice with childhood sexual abuse survivors. 8. How qualitative research evidence can inform and challenge occupational therapy practice. 9. Using a multiple case study research design to develop an understanding of clinical expertise in physical therapy. 10. Exploring views and perceptions of evidence-based practice influencing practice. 11. Using qualitative evidence as a basis for evidence-based practice

Scoping the Field: Identifying Key Research Priorities in HIV and Rehabilitation

The purpose of this project was to identify key research priorities related to HIV and rehabilitation. We conducted a scoping study which included a literature review of published and grey literature, followed by focus group and interview consultations with 28 participants including people living with HIV, researchers, educators, clinicians, and policy makers with expertise in HIV and rehabilitation. Qualitative content analysis was used to identify emergent themes related to research priorities in HIV and rehabilitation. The resulting Framework of HIV and Rehabilitation Research provided an outline for approaching research in the field. The framework included three overlapping research priorities: (a) living with HIV across the lifespan, (b) disability, and (c) rehabilitation that should be viewed through environmental and/or personal contextual lenses, using different methodological approaches. Six key research priorities from this framework were identified through additional consultation with new and returning participants including: (1) disability and episodic disability, (2) concurrent health conditions aging with HIV, (3) HIV and the brain, (4) labour force and income support, (5) access to and effectiveness of rehabilitation, and (6) development and evaluation of outcome measurement tools. These priorities inform a future plan for HIV and rehabilitation research that will increase our knowledge to enhance practice, programming and policy for people living with HIV.

Career Choice and Professional Preferences in a Group of Canadian Physiotherapy Students

This article focuses on reasons for the career choice and the longitudinal development of attitudes to healthcare work and the physiotherapy profession. The study is part of a larger project on professional development in physiotherapy. A cohort of 60 Canadian physiotherapy students was surveyed on two occasions during their educational programme. The questionnaire was constructed using a theoretical framework about professional socialization. Forty students completed both versions of the questionnaire yielding a response rate of 67%. Seventy-two per cent were women and 28% were men. Job accessibility or economic (25.5%) were the most frequently indicated reasons for the career choice. The most frequently chosen role models were the preceptors in clinical placements (52%). None of the students indicated having a faculty member as a role model. The desire to work in private practice and with adults was ranked highly in both administrations of the questionnaire. Few students regarded home care and community health as preferable healthcare facilities after graduation. Research, managerial work or occupational health were not given as preferable areas of practice. There advantages were statistically significant differences between women and men in their preferences for private practice work and the public sector of healthcare. The results are discussed in relation to gendered division of labour in healthcare and to the development of the profession.

Problem-based learning: A review of current issues relevant to physiotherapy education

This article reviews the development of problem-based learning (PBL) over the past decade within the context of physiotherapy practice. Although there is an emerging literature in physiotherapy, the research is primarily from medical education. Some of the original claims of superiority of PBL in developing problem-solving and self-directed learning skills have not been supported. Results from studies comparing traditional and PBL curricula are inconsistent and have numerous methodological shortcomings. There is no evidence to suggest there is one best way of implementing PBL, however it appears faculty training is required to be most successful. There is a need for physiotherapy specific research; although based on the experiences of our medical colleagues long term studies comparing the outcomes of programs of different curricular designs may not be warranted. PBL may help promote skills important for current practice and remains a viable alternative for those interested in curricular innovation.