The Work of HPS for a Child Who Undergoes Wada Test
Hiroe Kojima ・ Ikuko Hatai*
I. Introduction“The Epilepsy Service Center” in General Hospital A, opened in April 2008, was designed toprovide comprehensive services for people afflicted with eplepsy. The center is one of few facilities
where the departments of epilepsy surgery, neurology and pediatric neurology work together and thetreatments that they offer attain some progress even in cases of intractable (refractory) epilepsy.
Because of such characteristics, many patients from other prefectures visit the center. Among thosevisitors, children in particular tend to experience great anxiety about the unfamiliar setting andpeople around them.
It was the first time that HPS was requested to practice some play intervention to a child who wasgoing to undergo WADA test prior to epilepsy surgery. In this article, the work of HPS that offered toreduce the level of anxiety and pain through play intervention was reported. The child’s previous
medical history and experiences were also reviewed.
Wada Test

There are two hemispheres in the brain; the left and the right. The functions are very differentfrom each other. In general, the left side is responsible for linguistic functions, including
speech and understanding of written/spoken language. Such variety of linguistic functions areextensively spread throughout the left hemisphere. A drug to shut down functions is introduced into
one of two hemispheres alternately. After a subject is given a series of language and memory related
tests, including asking one’s name, address and birth date, the result is evaluated to measure which
hemisphere retains language and memory functions.
Itissignificantly

importanttodetermine language

lateralization priortoepilepsy

surgery. During Wada test, a patient is introduced an intra-arterial catheter from the femoral
artery while he/she is awake that can result in psychological distresses and pain to the patient.
II. Objectives and method
1. Intervention at the outpatient department
To understand the child’s physical and mental status, including his interest and surroundings,
HPS develops a trusting relationship in cooperation with his family through play intervention. Also
HPS provides procedure infromation on the medical examination by using a preparation booklet andmakes sure to show the understanding of the child’s anxiety and whether he/she wishes to see theactual surgical room beforehand.
2. Conditions of pre-/post- examination
1) Prior to the examination：

We visited the child in his/her room after we received a confirmation of his/her admission from theward. The child selected a type of play for the examination while reviewing the examination
procedure in a preparation book and talking about his/her feelings to HPS. When we provided thechild’s status and music that he/she liked to staffs in the examination room, we were told when theroom was vacant in order to take a tour with the child. Later we brought the child andlooked around the actual examination room together. The child was observing the devices and lay on
the bed. We decorated the examination room before we left.
2) During the examination
Prior to intravenous access and the introduction of an intra-arterial catheter, we explained theprocedure once again and made sure to synchronize timing when the child felt ready and when thecatheter was introduced into his/her body. In the past, there was a case that a child did not really
understand the surgical procedure even though the child was provided with a preparation bookbeforehand. Accordingly, we prepared an operation chart (Appendix 1) that clearly explained about
the thorough process of the examination. By checking the chart, the child was able to understandsteps that he/she was taking and how he/she could cooperate. Finally the examination was begun
with our play intervention.
3) Post-Examination
We praised the child for having taken the examination calmly. We listened to the child carefully
regarding the examination while playing with him/her with a plastic board creation, slime andgames that the child had chosen.
３．Working together with healthcare staff of other departments
Since various medical professionals, including physicians, nurses, a speech therapist and aclinical laboratory technician, are involved in Wada tests, we created a list of HPS roles on theexamination day (Appendix 2) and tried to gain the understanding of our work from other medical
professionals. The timing of intervention was discussed with other medical professionals and we
received the child’s medical status and other information beforehand. In order to build atrusting relationship earlier, we arranged to involve ourselves in the child’s case from the very startof his/her admission. Information that we acquired through our work, including the child’s status,
requests and so on, were shared with other medical professionals.
III. Result
1. By using a preparation booklet, we received information on the child’s level of understanding
toward the examination and what he/she wished or did not wish to know. Eventually a proper
setting and a condition for the child were provided. Since we were able to contact the child prior to
his/her admission and introduced play intervention then, the child was mentally prepared and wasable to imagine what to expect during his/her hospitalization. Having taken an observation tour tothe actual examination room and having had a talk with nurses in the room, thechild felt comfortable.

2. The HPS’s intervention was clearly shown and explained to other healthcare professionals by thelist of HPS roles that we made on the day of the examination. The operation chart created for thechild to follow the whole procedure easily made the child undergo the examination without confusionand panic because it provided the child images of whole procedure and he/she was able to see what toexpect during and the next of actual procedure.
3. During the earlier intervention prior to the admission, there was enough time for building atrusting relationship with the child and for collecting information by which the child was alsomentally prepared for the examination in a positive manner. Additionally, having shared collected
information with other healthcare professionals, everyone was able to work efficiently for the child.
IV. Discussion
Wada test is an important examination before epilepsy surgery. During the procedure, a patient
remains awake and is monitored by numerous healthcare staff. Not to mention the pain the patient
experiences while the catheter is being introduced into his/her body, tremendous anxiety andtension can be resulted from the procedure. In our case, however, the child overcame his/her anxiety
and underwent the examination smoothly. It was considered because the child was well heard andrespected and he/she was able to follow the entire procedure by a chart.
V. Conclusion
It was the first time HPS were involved in the procedure of Wada test. It was evident that toestablish a trusting relationship as early as possible through continuous involvement with the childand his/her family was vital. At the same time, issues including support for children who have strong
anxiety and the way to work with other departments efficiently still remain challenges of our field.
We shall work towards our goal – to be the best supporters of children – with our understanding of
their psychological distresses and simultaneously with our encouragement so that they face
their medical procedures at peace and with confidence.

Appendix 1: Intervention of HPS, on the day of Wada test
 Before the test
Confirmation before the test (to the child and the family)Why are you here today?

Is there anything you feel anxious about?

To confirm whether the parents accompany. If so explain the procedure*1）

Regarding Play Preparation

Why play before the test

In order to relax. To confirm a type of play between the interval during the test When entering the examination room
To promote a smooth procedureTo encourage the child to respond when doctors and nurses address him.

To decorate the examination room with the child. HPS may ask the attending nurse forthe decoration.

To provide necessary support for the family in a case where they accompany their child.

 During the test
Play during the test

To provide 2）“distractions” in order to divert the child’s attention from pain-associatedtreatments such as intravenous access the introduction of an intra-arterial catheter.

While radiation is applied to the child, HPS leave the room.

During the interval of the test, to provide some games (play) that the child previouslychose in order to avoid him getting boredTo support the child so that he/she can undergo the second half of the proceduresmoothlyTo parentsTo tell the family terms and behaviors necessary for the given situation

To praise the child for completing the procedure

To praise for good work and cooperation. To ask doctors to provide some symbol ofrecognition to the child such as a medal or a card.

HPS will take the child to his/her room.

In a case where parents do not accompany during the test, HPS will provide them theirchild’s status1) The objectives of Play Preparation are to alleviate children’s anxieties
and to provide solutions their questions regarding medical procedures
through playing so that they can be mentally ready for the forthcoming
treatment/test.

HPS/Children’s nurse

2) Distraction is a method to divert children’s attention through playing
from treatments and tests that may cause distresses.

Kojima, Hatai, Oya* The contents of play preparation vary depending on a subject’s age,level of development, the previous medical histories and so on.

Appendix 2: What is Wada test? What do you do?
Sequence
1

What to do

Please cooperate with us on…

To enter the examination room
Time for introduction

We will ask you some questions, including
your name, birthdate and what kind of2

medical test you will take.
Please answer those questions.

3
4

5

6
7

To lay on the bed
To put monitors on your body
To take off your underwear

Please lift your buttocks.

To measure blood pressure/

It stings a bit, but the pain doesn’t(insertion of an intravenous line)

continue. So please hold out!

To apply antiseptic solution at theYou may find it as a little cool touch.

base of thighTo put a green sheet on your body
After an injection of local anesthetic (aInitially it stings a little, but you won’t feeldrug to numb the area), insert anpain after that. So please hold out and try

catheter (a thin tube)

not move.

9

The first test

Please play quiz with a speech therapist.

10Play time811

The second test

therapist
To remove the catheter

12

Please play quiz again with a speechYour doctor will press your thigh a little inorder to stop blood coming out. Hold out!

13To put a board to your thigh14

To go back to your room

You did it well!
Thankyoucooperation!

somuchforyour