The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

1. Assessment of Response to Light Touch
<ol>
	<li>Place the electrode net (e.g.&#160;128-channels geodesic sensor net) on child or infant&#39;s head. Adjust sensors for full contact using warm saline solution. If on a child, ensure child is sitting comfortably in parent or caregiver lap. If on an infant, ensure that infant is lightly swaddled and either held in caregiver&#39;s arms or in a supine position in an open crib.</li>
	<li>Position a 1 mm nozzle 0.5 cm below the tip of the index finger of the tested ...

<ol>
	<li>Nelson, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neural+plasticity+and+human+development:+the+role+of+early+experience+in+sculpting+memory+systems.">Neural plasticity and human development: the role of early experience in sculpting memory systems.</a> Dev. Sci. 3 (2), 115-136 (2000).</li><li>Wallace, M. T., Stein, B. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+experience+determines+how+the+senses+will+interact.">Early experience determines how the senses will interact.</a> J. Neurophysiol. 97 (1), 921-926 (2007).</li><li>Greenough, W. T., Black, J. E., Wallace, C. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experience+and+brain+development..">Experience and brain development..</a> Child Dev. 58 (3), 539-559 (1987).</li><li>Lickliter, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Role+of+Sensory+Stimulation+in+Perinatal+Development:+insights+from+comparative+research+for+care+of+the+high-risk+infant.">The Role of Sensory Stimulation in Perinatal Development: insights from comparative research for care of the high-risk infant.</a> J. Dev. Behav. Pediatr. 21 (6), 437-447 (2000).</li><li>Lickliter, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+integrated+development+of+sensory+organization.">The integrated development of sensory organization.</a> Clin. Perinatol. 38 (4), 591-603 (2011).</li><li>Pleger, B., Villringer, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+human+somatosensory+system:+From+perception+to+decision+making.">The human somatosensory system: From perception to decision making.</a> Prog. Neurobiol. 103, 76-97 (2013).</li><li>Allison, T., McCarthy, G., Wood, C. C., Jones, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Potentials+evoked+in+human+and+monkey+cerebral+cortex+by+stimulation+of+the+median+nerve:+a+review+of+scalp+and+intracranial+recordings.">Potentials evoked in human and monkey cerebral cortex by stimulation of the median nerve: a review of scalp and intracranial recordings.</a> Brain. 114 (6), 2465-2503 (1991).</li><li>Majnemer, A., Rosenblatt, B., Riley, P., Laureau, E., O'Gorman, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Somatosensory+evoked+response+abnormalities+in+high-risk+newborns.">Somatosensory evoked response abnormalities in high-risk newborns.</a> Pediatr. Neurol. 3 (6), 350-355 (1987).</li><li>Auld, M. L., Ware, R. S., Boyd, R. N., Moseley, G. L., Johnston, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reproducibility+of+tactile+assessments+for+children+with+unilateral+cerebral+palsy.">Reproducibility of tactile assessments for children with unilateral cerebral palsy.</a> Phys. Occup. Ther. Pediatr. 32 (2), 151-166 (2012).</li><li>Nakanishi, T., Shimada, Y., Toyokura, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Somatosensory+evoked+responses+to+mechanical+stimulation+in+normal+subjects+and+in+patients+with+neurological+disorders.">Somatosensory evoked responses to mechanical stimulation in normal subjects and in patients with neurological disorders.</a> J. Neuro. Sci. 21 (3), 289-298 (1974).</li><li>Schubert, R., Blankenburg, F., Lemm, S., Villringer, A., Curio, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Now+you+feel+it-now+you+don't:+ERP+correlates+of+somatosensory+awareness.">Now you feel it-now you don't: ERP correlates of somatosensory awareness.</a> Psychophysiology. 43 (1), 31-40 (2006).</li><li>Hamalainen, H., Kekoni, J., Sams, M., Reinikainen, K., Naatanen, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Human+somatosensory+evoked+potentials+to+mechanical+pulses+and+vibration:+contributions+of+SI+and+SII+somatosensory+cortices+to+P50+and+P100+components.">Human somatosensory evoked potentials to mechanical pulses and vibration: contributions of SI and SII somatosensory cortices to P50 and P100 components.</a> Electroencephal. Clin. Neurophysiol. 75 (2), 13-21 (1990).</li><li>Eimer, M., Forster, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulations+of+early+somatosensory+ERP+components+by+transient+and+sustained+spatial+attention.">Modulations of early somatosensory ERP components by transient and sustained spatial attention.</a> Exp. Brain Res. 151 (1), 24-31 (2003).</li><li>Forster, B., Eimer, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Covert+attention+in+touch:+Behavioral+and+ERP+evidence+for+costs+and+benefits.">Covert attention in touch: Behavioral and ERP evidence for costs and benefits.</a> Psychophysiology. 42 (2), 171-179 (2005).</li><li>Tamura, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+processes+in+two-point+discrimination:+an+ERP+study.">Cognitive processes in two-point discrimination: an ERP study.</a> Clin. Neurophysiol. 115 (8), 1875-1884 (2004).</li><li>Fabrizi, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+shift+in+sensory+processing+that+enables+the+developing+human+brain+to+discriminate+touch+from.">A shift in sensory processing that enables the developing human brain to discriminate touch from.</a> 21 (18), 1552-1558 (2011).</li><li>Putnam, L. E., Vanman, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Startle+Modification:+Implications+for+Neuroscience,+Cognitive+Science.+Google+Books.">Startle Modification: Implications for Neuroscience, Cognitive Science. Google Books.</a> Startle Modification: Implications for. , (1999).</li><li>Maitre, N. L., Barnett, Z. P., Key, A. P. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+assessment+of+cortical+response+to+somatosensory+stimuli+in+children+with+hemiparetic+cerebral+palsy.">Novel assessment of cortical response to somatosensory stimuli in children with hemiparetic cerebral palsy.</a> J. Child Neurol. 27 (10), 1276-1283 (2012).</li><li>Molholm, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Audio-Visual+Multisensory+Integration+in+Superior+Parietal+Lobule+Revealed+by+Human+Intracranial+Recordings.">Audio-Visual Multisensory Integration in Superior Parietal Lobule Revealed by Human Intracranial Recordings.</a> J. Neurophysiol. 96 (2), 721-729 (2006).</li><li>Molholm, S., Ritter, W., Murray, M. M., Javitt, D. C., Schroeder, C. E., Foxe, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multisensory+auditory-visual+interactions+during+early+sensory+processing+in+humans:+a+high-density+electrical+mapping+study.">Multisensory auditory-visual interactions during early sensory processing in humans: a high-density electrical mapping study.</a> Brain Res. 14 (1), 115-128 (2002).</li><li>Foxe, J. J., Morocz, I. A., Murray, M. M., Higgins, B. A., Javitt, D. C., Schroeder, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multisensory+auditory-somatosensory+interactions+in+early+cortical+processing+revealed+by+high-density+electrical+mapping.">Multisensory auditory-somatosensory interactions in early cortical processing revealed by high-density electrical mapping.</a> Brain Res.. 10 (1-2), 77-83 (2000).</li><li>Gick, B., Derrick, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aero-tactile+integration+in+speech+perception.">Aero-tactile integration in speech perception.</a> Nature. 462 (7272), 502-504 (2009).</li><li>Stevens, K. N., Blumstein, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Invariant+cues+for+place+of+articulation+in+stop+consonants.">Invariant cues for place of articulation in stop consonants.</a> J. Acoust. Soc. Am. 64 (5), 1358-1368 (1978).</li><li>Hari, R., Parkkonen, L., Nangini, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+brain+in+time:+insights+from+neuromagnetic+recordings.">The brain in time: insights from neuromagnetic recordings.</a> Ann. NY Acad. Sci. 1191, 89-109 (2010).</li><li>Key, A. P. F., Dove, G. O., Maguire, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Linking+Brainwaves+to+the+Brain:+An+ERP.">Linking Brainwaves to the Brain: An ERP.</a> Dev. Neuropsychol. 27 (2), 183-215 (2005).</li></ol>

This novel combination of air puff and ERP (referred to as the &#34;Puffer system&#34;) to measure cortical processing of light touch and tactile-auditory responses is well tolerated by young children with disabilities and by infants. This holds true for unisensory and multisensory versions, and whether the attentional component is added or not in the case of young children. The reasons for the success of this methodology in assessing a young and vulnerable population are due to both the use of an innocuous tactile stimu...

The study of developing cortical sensory processes is essential to understanding the basis for most higher order functions. Sensory experiences are responsible for much of the brain&#39;s organization through infancy and childhood, laying the foundation for complex processes such as cognition, communication, and motor development1-3. Most pediatric studies of sensory processes focus on auditory and visual domains, mainly because these stimuli are easiest to develop, standardize, and test. However, tactile processing is of particular interest in infants and children as it is the first sense to develop in the fetus4,5, and somatosensory information is integral to the function of other cortical systems (e.g. motor, memory, associative learning, limbic)6. Current methods assessing somatosensory processing are limited by the choice of tactile stimulus. A common choice is direct electrical median nerve stimulation7,8, with the potential for discomfort. Other effective methods use active tasks such as discrimination, recognition, and localization of stimuli, requiring both attention and high levels of comprehension9. All of these methods are therefore limited in their use in young children and infants.
Therefore, our goal was to develop a tactile paradigm that addresses these limitations by being noninvasive and reducing the need for a subject&#39;s active participation. Additionally, it needed to have a standardized level of stimulation and a sham-control. For this we developed the &#34;puffer&#34; system, a dual-channel, timed, and calibrated air-puff delivery system, allowing us to measure the effects of light touch in infants and other vulnerable populations.
Functional MRI studies showed that stimulation by puffs of air activates sensory cortices, although the length and challenges of such studies, such as immobilization, lengthy sessions, and anxiety-provoking settings make them difficult to perform in young children. Therefore, we combined our novel delivery system with Event-Related Potential (ERP) methodology in order to provide temporal resolution of sensory processing of light touch in a brief, child-friendly testing session.
This new paradigm offers the needed flexibility to study sensory processing in diverse populations, ages and clinical settings. It also has the advantage of being compatible with auditory stimuli, allowing for multisensory assessments. Until now, accurate and reliable tactile assessment has not been possible in infants or in children who are unable to reliably respond due to intellectual/language disorders. This methodology aims to fill this gap&#160;in order to aid in early identification of sensory processing deficits and intervention during a period of maximal brain plasticity. Improvements in sensory processing in infancy may influence the cascade of neurodevelopmental
The following procedures are all included in Vanderbilt Institutional Review Board approved protocols.

<table border="0" cellpadding="0" cellspacing="0" width="703">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="22">
			<td height="22" style="height:22px;width:249px;">Geodesic sensor net</td>
			<td style="width:168px;">EGI, Inc., Eugene, OR</td>
			<td style="width:119px;">depends on size</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:249px;">Net Station EEG software v. 4.2</td>
			<td style="width:168px;">EGI, Inc., Eugene, OR</td>
			<td style="width:119px;">NA</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:249px;">E-Prime stimulus control application</td>
			<td style="width:168px;">PST, Inc. Pittsburgh, PA</td>
			<td style="width:119px;">NA</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:249px;">Manometer (model 6&#8221; 0-60PSI)</td>
			<td style="width:168px;">H. O. Trerice Co, Oak Park, MI</td>
			<td style="width:119px;"></td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:249px;">Custom Puffer setup</td>
			<td style="width:168px;">Nathalie Maitre</td>
			<td style="width:119px;"></td>
			<td style="width:167px;"></td>
		</tr>
	</tbody>
</table>

quantitative assessment of cortical auditory-tactile processing in children with disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess children&#39;s cortical processing of light touch, speech sounds and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing children discomfort. To accomplish this we developed a dual channel, time and strength calibrated air puff stimulator that allows both tactile stimulation and sham control. We combined this with the use of event-related potential methodology to allow for high temporal resolution of signals from the primary and secondary somatosensory cortices as well as higher order processing. This methodology also allowed us to measure a multisensory response to auditory-tactile stimulation.

Assessment of light touch (Figure 3): 
Characteristics of the cortical response to tactile stimulation using the Puffer system: The patterns of peaks in response to the puff are very similar to the cortical responses obtained using median nerve stimulation in normal adults10,11. The early response (P50, N70, P100 peaks) primarily reflects activity in the primary sensory cortex12 and does not require awareness of stimulation....

Watch this Scientific Journal Video about Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities at JoVE.com

Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess infants and children&#39;s cortical processing of light touch, speech sounds, and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing discomfort in vulnerable patients.

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology ...

quantitative-assessment-cortical-auditory-tactile-processing-children

Research

JoVE Journal

Behavior

10.7K 조회수.  Vanderbilt University.  감각 처리의 목적과 쉽게 측정 비언어적 또는 취약한 소아 환자에서 매우 어렵습니다. 우리는 활동 주체의 참여를 요구하거나 취약한 환자의 불편을 초래하지 않고, 정량적으로 유아와 가벼운 터치의 아이들의 대뇌 피질의 처리, 음성 소리를 평가하는 새로운 방법, 및 2 자극의 감각적 처리를 개발했다. 