Sustained Attention in Exposure to Tactile Stimuli Among Children 4 to 10 Years Old With and Without Sensory Modulation Disorders

Abstract

Date Presented 03/28/20

The study’s aim is to assess sustained attention in the presence of different tactile stimuli among children with and without sensory modulation disorder. The Short Sensory Profile 2 was used for group allocation. Sustained attention was measured by an electrophysiological tool. Significant differences in sustained attention were found between different tactile stimuli and between groups. The results enable development of tailored interventions that rely on the child’s brain engagement.

Primary Author and Speaker: Orit Bart

Contributing Authors: Lihi Liberman

PURPOSE: Sensory Modulation Disorder (SMD) is a difficulty in regulating and organizing the degree, intensity and nature of one’s responses to sensory input in all sensory systems (Miller, Anzalone, Lane, Cermak, & Osten, 2007). This study will focus on the tactile system.

Some studies found significant correlation between SMD and anxiety which may impact attention. SMD is a significant domain of Occupational Therapy (OT), however the underlying mechanism of the phenomena is still unknown.

Therefore, the aim of the study is to assess sustained attention in relation to stressful tactile stimuli exposure. We used the Brain Engagement Index (BEI) as an electrophysiological marker for sustained attention (SA) (Bartur, Joubran, Peleg-Shani, Vatine, & Shahaf, 2017). We hypothesized that there would be differences in BEI between children with and without SMD during exposure to different types of tactile stimuli (pleasant, unpleasant, and neutral).

DESIGN: This is a cross-sectional research study. The study was approved by the University Institutional Review Board. A written informed consent was obtained from all parents of children participating in the study.

The study sample was comprised of 15 children aged 4-10 years old, with and without SMD. Children were recruited from OT clinics, and from the community using a convenient sample method. Children with a severe additional diagnosis were excluded. All children attend mainstream educational settings.

METHOD: Parents completed the Short Sensory Profile Questionnaire 2 (SSP-2). Children who scored >31 on the Sensory Scale were allocated to the SMD group. Those who scored <32 were allocated to the control group. An EEG “MindWave mobile 2” headset was placed on the child’s head and was connected via Bluetooth to a computer. BEI was recorded while the child replicated designs using building blocks under three different conditions: (1) wearing pleasant-textured gloves; (2) wearing unpleasant-textured gloves; and (3) wearing no gloves (neutral).

Measurement Tools

NeuroSky EEG MindWave is an electro-physiological marker for SA measuring BEI. It is a single-channel system with one frontal electrode (∼Fpz), and one reference electrode attached to the earlobe. It uses dry EEG electrodes at a sampling rate of 512Hz. The BEI is valid to identify SA in different populations and health conditions.

The Short Sensory Profile 2; SSP-2 is a short standard caregiver questionnaire designed to measure children’s sensory processing patterns in response to daily sensory stimuli; it is presented to children 3-14 years old.

RESULTS: Using Repeated Measures ANOVA, significant differences (F _(1,12)= 4.538, p=.037) were found in the BEI between the three types of tactile exposures (pleasant, unpleasant, and neutral) and between children with and without SMD (F _(1,12)=11.708, p=.002).

Using logistic regression we found that the unpleasant tactile stimuli tend to recruit sustained attention whereas the pleasant tactile stimuli did not.

Significant correlation was found between the BEI during exposure to unpleasant tactile stimuli, and the behavior and sensory scales of the SSP-2) r=-.494, p=.06; r=-.628, p=.022, respectively).

CONCLUSION: Our preliminary electrophysiological findings support the link between SMD and SA, which is a marker for stress. These findings enable us to better understand the underlying mechanism of SMD in relation to SA in stressful situations. Based on the results, we can develop tailored OT interventions that rely on the specific child’s brain engagement. Moreover, we can now plan interventions using ongoing BEI monitoring during the treatment session in order to increase the child’s compliance and treatment efficacy.

References

Bartur, G., Joubran, K., Peleg-Shani, S., Vatine, J.-J., & Shahaf, G. (2017). Clinical study an EEG tool for monitoring patient engagement during stroke rehabilitation: A feasibility study. BioMed Research International. https://doi.org/10.1155/2017/9071568

Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61(2), 135–142. https://doi.org/10.5014/ajot.61.2.135