Researchers and clinicians intending to perform pediatric neuroimaging face a broad range of challenges to name just a few. The child participants are challenged by a need for motivation, alertness, and cooperation. Anxiety may be an additional factor to be addressed.
Researchers or clinicians need to consider time constraints, movement restriction, scanner, background noise, and unfamiliarity with the MR Scanner environment. The suggested protocol incorporates general testing guidelines, as well as RI specific approaches and intends to guide researchers as well as clinicians during imaging sessions, including the following steps, preparation, training, and FMRI Experiment. Hi, I am NARA Rush LE from the GOB Lab at the laboratories of cognitive neuroscience at the Children's Hospital in Boston.
Hi, I am Michelle Lee, also from the GO Lab. And I'm Nadine Gab. Today we'll show you how a pediatric neuro imaging session involving young children can look like.
Over the last decade, functional magnetic resonant imaging or short FMRI has grown into a prominent research tool to non-invasively explore typical and atypical development of the human brain. However, FMRI in children, especially as young as kindergarten or preschool age, presents many practical and technical challenges. This protocol can be useful for both structural and functional MRI for research as well as clinical purposes.
So let's get started. As in every testing session with pediatric populations, general guidelines and recommendations for how to best work with young children should be considered especially important are comfort, appropriateness, and motivation for neuro imaging sessions involving young children. For example, the terminology and practices used during pediatric neuroimaging sessions should be carefully chosen for a successful session.
A child appropriate choice of technical terms and avoiding certain phrases is recommended. One can use brain camera instead of MR Scanner mirror holder instead of head coil camera click instead of scanner, background noise and so on. In preparation for the narrow imaging session, the participating families are provided with information through print or online media, which contain age appropriate descriptions, offering the participants a preview of the study content and details the neuro imaging session begins with in the mock scanner area.
Encouraging the participants to invite their family, siblings, or friends is one way to facilitate active participation during neuroimaging sessions. Cole, you wanna come here too. A mock scanner area replicates actual MRI room and MR scanner.
The mock scanner mirrors the appearance and the background noise produced by the actual MR Scanner and is thus an ideal place to start a narrow imaging session. Ideally, this room provides the same equipment including experiment specific response tools as the actual MRI room, but without a static magnetic field. Therefore, the room can be made more child-friendly by adding stuffed animals, placing a few toys in the room, but not too many so as not to distract the child.
And by having parents and siblings sit on child-sized chairs and tables First go over the paperwork, Which also serves to ensure that the scope of the NI imaging session is clear. Be sure to go over the institutional review board or IRB forms, such as consent and ascent forms, MR.Scanner screening forms, and address the reimbursement procedures. Use a digital camera to explain how an MR Scanner works.
The use of clear and blurry photographs to demonstrates the negative impact of movement on image acquisition. Play the freezing game to demonstrate unwanted movement or how to minimize head movement. This game requires the child to stay very still for a short period of Time.
Whoa, you could do 10 seconds without moving.Awesome. Before introducing the experimental tasks, one can start with a short, enjoyable activity. For this experiment, a child friendly theme is added to the neuro imaging session.
The children can take part in a spaceship adventure, which is introduced by a short movie. The characters in the movie guide the child through the neuro imaging tasks, which are referred to as games. The storyline incorporates features of the MR scanner.
For example, the MR Scanner can be seen as a spaceship and the scanner background noise can be the engine sound of the spaceship. Let's do two example with the headphones and then we'll go inside. The use of the mock scanner is incorporated step by step.
First, the child sits on the mock scanner bed while video instructions to the experimental tasks are shown on the screen. Because not all children are familiar with computers, you can show the child printouts of the screenshots during the experimental task. In order to ensure that the child understands the instructions while sitting on the mock scanner bed, the child starts solving the first few examples of the experimental task.
With the help of the research team after receiving aid and solving the first few examples of the experimental task, the next training items are presented in real time. Corresponding to the presentation rate of the actual FMRI experiment. The demand is then increased by turning on a CD with recorded scanner background noise, and placing headphones on the child's head.
Finally, the child performs the experimental task while inside the mock scanner, including a playback of the scanner, background noises, and with headphones on as required. During the actual FMRI experiment. If using more than one response tool such as one button in each hand, make sure it is clear which response tool corresponds to a answer Because a child may not know the difference between left and right.
Instead of the instructions, press the right button. The instructions are changed to press the monkey button. Are you ready?
Before moving on to the FMRI experiment.Wow. The Research team assures understanding of the experimental tasks by observing the child's performance. If the training items could be completed without any problem, the research team continues with the next step.
If not, repeat the instructions and training items to encourage completion of the experimental task. A traditional sticker chart may be used during the training while the child is performing the experiment inside the MR Scanner later on. That's a great job.
A virtual sticker chart designed after the children's game shoots and ladders is used where the participants have to complete different games in order to find their way home. The virtual sticker chart both rewards the child and gives the research team time after each experimental run. To prepare for the next one, use the training session to teach the child that a gentle hand press on their leg during the neuroimaging session signals that they are moving their head too much.
This signal can be used later during the actual FMRI experiment as a way for the attendant to communicate with the child after the training. A short break is recommended. You're This break can be used to play a dice game with the child.
The outcome of the dice game can be used to randomize the order of the experimental tasks. So can you show me the five As a next step? The most important rules are repeated to the child in just two or three main points.
In order to minimize memory demand on young children, remember to repeat these points throughout the session. Note that during the training to end MR session, the child may become hesitant about taking part in the experiment. In such a case, act immediately offer to take a break and address the child's concerns.
Strategies to help an anxious child get familiar with the MRI environment may include a set of different games. For example, the child can be allowed to crawl through the mock scanner tunnel. A stuffed animal can be set up in the mock scanner and the scanner.
Background noise and procedure can be experienced together while the stuffed animal is in the mock scanner. Similarly, the child can help a research team member into the mock scanner before going in on Their own. Finally, allow the child and their family to take a short break while the research team sets up the MR scanner room and prepares all equipment.
After the training session and a short break for the family, the FMRI experiment can Begin to Facilitate the child's transition to the actual MRI room. The child is accompanied by a research staff member and may choose to bring along a parent and the child's favorite stuffed animal as long as it does not contain any Ferris parts. There's in there.
Before starting the FMRI experiment, screen the child for iron containing objects. Use a handheld metal detector rub magnet to introduce the screening playfully. Go over There, You see the buttons.
That's where we go. Next, Check the response tools used for the given experiment and make sure the child knows how to use it and which response corresponds to which response tool. For experiments containing visualizations, check the screen and mirror positioning and make sure the child can see the screen clearly while lying down.
Show the child a picture and ask what they see for auditory experiments. Check the sound volume by playing a short sentence for the child and ask the child to repeat the sentence orally. Are you ready to take part in our spaceship adventure?
Make sure to provide ear protection for everyone in the MRI Scanner room. Now Start the actual FMRI experiment, which ideally lasts no longer than 45 minutes to an hour for young children and includes breaks in between. Before the start of each experimental task, the video instructions are presented again after each experimental task.
The virtual sticker chart rewards the child's cooperation during the child's in scanner performance. The research team member in the MRI room monitors the comfort and movement of the child. This allows essential communication and motivating feedback to be given directly to the child.
Okay, Head movement of the child may be observed by the research team member present in the MRI room, or by the researcher monitoring the image acquisition outside of the MRI room. A gentle hand press practice during the training session signals to the child that they are moving too much. A short break during the FMRI experiment can maintain the child's comfort.
Motivation can be maintained by showing the child his or her own brain image. Finally, structural MRI image acquisition requires the participant to lie still without performing any experimental task. The child can be entertained by watching a short movie during this time.
Recommended examples of appropriate movies are animal movies or documentaries so you know how he works, as they are unlikely to reduce laughing, which may lead to head movements during image acquisition. Keep each experimental task as short as possible so that the child remains alert. Since the biggest challenge for many children is to stay very still over a long period of time, a maximum of a five to seven minute experimental task is proven accomplishable by children's school age or younger.
But the duration of an experimental run may vary based on experimental constraints or population. The child handles movement restriction during the time of image acquisition more easily. If the information is given that pictures acquired during this time will be presented to them as a gift to take home, such as a CD with the child's brain pictures, The Use of a standardized and child appropriate protocol for testing young children can decrease the child's anxiety as well as positively influence a child's cooperation motivation and performance inside the MR Scanner.
As a result, data quality as well as the overall experience of our child participants and their families is positively affected using the current protocol. We have obtained functional and structural brain imaging data in a group of children with an age range between four and six years. Over 95%of all children have been able to complete our narrow imaging session, including mock scanner training and FMRI experiment.
The guidelines and procedures presented in this protocol were designed for pediatric neuroimaging sessions. However, the general principle and many of the named tools can be applied to pediatric imaging sessions in general, such as image Acquisition of body parts. In the current video report, we have presented a complete pediatric neuroimaging protocol to be used with awake children.
This allows clinicians to reduce the use of sedation or general anesthesia in children undergoing neuroimaging procedures, and it hopefully it will increase the use of EMRI. In research studies with younger age group, We incorporated general testing guidelines as well as MRI specific approaches and offer clinicians as well as researchers. An example how pediatric neuro imaging sessions can be designed and conducted.
When working with young children, it's very important to make the whole procedure a flexible process. Allow enough time for each child to proceed at the pace that is comfortable for them, Try to design your research sessions in a child friendly and age appropriate manner, and try to maximize the comfort, appropriateness, and motivation of your research participants and patients. So that's it.
Thanks for watching and good luck with your experiment.
