Kirshner Sharon, Weiss Patrice L, Tirosh Emanuel
Rehabilitation Unit, Haemek Medical Center, Afula, Israel.
Department of Occupational Therapy, University of Haifa, Israel.
Res Dev Disabil. 2016 Feb-Mar;49-50:247-57. doi: 10.1016/j.ridd.2015.11.025. Epub 2015 Dec 29.
Efforts to improve the participation and performance of children with cerebral palsy (CP) are often related to the adaptation of environmental conditions to meet their cognitive and motor abilities. However, the influence of affective stimuli within the environment on emotion and performance, and their ability to improve or impede the children's participation has not been investigated in any systematic way although the emerging evidence suggests that it affects the individuals in many levels.
(1) To measure autonomic responses to affective stimuli during a simulated Meal-Maker task in children with CP in comparison to children who are typically developing, and (2) to examine the interactions between autonomic functions, subjective reports of stress, and task performance among children with and without CP.
Fifteen children with CP and 19 typically developing peers (6 to 12 years) participated. After completing behavioral questionnaires (e.g., State and Trait Anxiety Inventories), children prepared meals within a camera tracking virtual Meal-Maker environment. Either a negative, positive, or neutral visual stimulus was displayed, selected from the International Affective Picture System. Children also passively viewed the same pictures while rating their valence and arousal levels. Heart rate (HR) and skin conductance were recorded synchronously with stimulus onset.
Significant differences in autonomic functions were found between groups, i.e., a higher "low frequency" to "high frequency" (LF:HF) ratio in the children with CP during the meals associated with a negative stimulus (p=0.011). Only children with CP had significant positive correlations between trait anxiety and LF:HF ratio during virtual meal-making associated with positive (p=0.049) and negative stimuli (p=0.003) but not during neutral stimuli. For children with CP the amplitude of skin conductance response during passive picture viewing was significantly higher for negative than for positive stimuli (p=0.017) but there were no significant changes in autonomic responses during virtual Meal-Maker task. Significant correlations between trait anxiety, autonomic activity during the calm state and Meal-Maker performance outcomes were found only for children with CP.
In general, the Meal-Maker virtual environment was shown to be a feasible platform for the investigation of the effect of emotionally loaded stimuli on the balance of autonomic functions in children with and without CP. Anxiety level appears to play a significant role in children with CP and should be considered as a potentially important factor during clinical evaluation and intervention. Further studies are needed to develop additional measurements of emotional responses and to refine the types of affective interference.
改善脑瘫（CP）儿童参与度和表现的努力通常与调整环境条件以适应他们的认知和运动能力有关。然而，尽管新出现的证据表明环境中的情感刺激会在多个层面影响个体，但尚未对其对情绪和表现的影响以及改善或阻碍儿童参与的能力进行任何系统研究。
（1）与发育正常的儿童相比，测量CP儿童在模拟“制作餐食”任务期间对情感刺激的自主反应；（2）研究有和没有CP的儿童自主功能、压力主观报告和任务表现之间的相互作用。
15名CP儿童和19名发育正常的同龄人（6至12岁）参与研究。完成行为问卷（如状态焦虑量表和特质焦虑量表）后，儿童在一个有摄像头跟踪的虚拟“制作餐食”环境中准备餐食。从国际情感图片系统中选择显示负面、正面或中性的视觉刺激。儿童在被动观看相同图片时，还要对其效价和唤醒水平进行评分。心率（HR）和皮肤电导率在刺激开始时同步记录。
两组之间在自主功能方面存在显著差异，即CP儿童在与负面刺激相关的用餐期间“低频”与“高频”（LF:HF）比值较高（p = 0.011）。只有CP儿童在与正面刺激（p = 0.049）和负面刺激（p = 0.003）相关的虚拟用餐制作过程中，特质焦虑与LF:HF比值之间存在显著正相关，而在中性刺激期间则没有。对于CP儿童，被动观看图片期间皮肤电导率反应的幅度在负面刺激时显著高于正面刺激（p = 0.017），但在虚拟“制作餐食”任务期间自主反应没有显著变化。仅在CP儿童中发现特质焦虑、平静状态下的自主活动与“制作餐食”任务表现结果之间存在显著相关性。
总体而言，“制作餐食 ”虚拟环境被证明是一个可行的平台，可用于研究情绪负荷刺激对有和没有CP的儿童自主功能平衡的影响。焦虑水平在CP儿童中似乎起着重要作用，在临床评估和干预期间应将其视为一个潜在的重要因素。需要进一步研究以开发额外的情绪反应测量方法并完善情感干扰的类型。
