Facial expression in adults with Down's syndrome

Measuring movement-exacerbated pain in cognitively impaired frail elders

OBJECTIVE

Prior research examining the utility of nonverbal measures of pain in persons with cognitive impairments has focused on acute procedurally-induced phasic pain (i.e., venipuncture and needle injections). The goal of the current project was to examine the utility of both self-report and nonverbal measures of pain in frail elders experiencing exacerbations of chronic musculoskeletal pain. These were assumed to be more representative of the day-to-day pain experience of elderly patients.

DESIGN

Participants were 58 frail elders, 29 of whom had been found to have significant cognitive impairments. All were filmed as they undertook a series of structured activities (e.g., walking and reclining), and pain was assessed using self-report. Trained coders identified the incidence of pain-related behaviors using the videotapes. The various pain measures (i.e., self-report and nonverbal indices) were compared across both patient groups and the several activities.

RESULTS

Consistent with our hypotheses, more pain was identified (using both self-report and nonverbal measures) when patients engaged in more physically demanding activities. Facial reactions varied as a function of patient cognitive status, with those participants who were cognitively impaired more responsive. Of the various nonverbal indices that we examined, guarded behavior appeared to be especially sensitive. The various pain indices were only modestly correlated with one another.

CONCLUSIONS

This study supports the validity of self-report and behavioral measures of pain in frail elders with and without cognitive impairments. Each of the measures used contributed different information to pain assessment, suggesting that investigations of pain in elders with cognitive impairments should employ varying types of pain assessment tools.

An evaluation of facial expression displayed by patients with chest pain

OBJECTIVE

To determine whether patterns of facial expressions of patients complaining of chest pain can aid in the diagnosis of myocardial infarctions.

DESIGN

Exploratory.

SETTING

Southeastern university medical center emergency department (ED).

PATIENTS

Twenty-eight patients in the ED who presented with chest pain. Age range was 40 to 84 years, with a mean of 65.4 years.

OUTCOME MEASURES

Common patterns of facial expressions among patients diagnosed with myocardial infarction.

INTERVENTION

On admission to the ED, patients were videotaped during physical examination. Videotapes were reviewed to code the facial action units exhibited by the patients. The presence or absence of creatine kinase (CK) enzymes was determined; these results were blinded to the coders until after all facial actions were coded.

RESULTS

With use of the Facial Action Coding System, 4 facial expressions were found to be associated with true myocardial infarction: lowering the brow, pressing the lips, parting the lips, and turning the head left.

CONCLUSION

Additional research with a larger sample of patients presenting with chest pain is needed to validate the findings of this study. However, if these findings are supported, instruction regarding assessment of specific facial expressions in clinical settings may be warranted.