A Report regarding Play Preparation Development for EEG Recording
Yoshimi Tanase*
１．Introduction
Our hospital is a pediatric specialized hospital consisting of six wards in total: two wards ofinternal medicine, two wards of surgery, a psychiatric ward and ICU. Approximately 400 children
visit our hospital as outpatients on a daily basis and they visit one or few department(s) out of 27.
There are five children’s nurses who implement play preparations by using everyday play. Three outof five of those children nurses had taken an HPS training program at University Shizuoka JuniorCollege and obtained the certificate from the university (hereinafter referred to as HPS).
In August 2013, a pediatric psychiatrist was requesting HPS for a play preparation during theelectroencephalogram (EEG) recording for a young male who had an emotional problem. Accordingly,
HPS developed a specific play preparation especially for children who suffer from emotional
disorders and developmental impairments.
２．Objectives
Children who suffer from psychiatric disorders including emotional disorders and developmental
impairments are prone to panic and/or get extremely nervous when they encounter an event thatthey have never experienced before. Consequently it can be difficult to apply medical examinations
and treatments to children with such conditions. To reduce children’s fear and misunderstanding of
medical examinations, HPS used a model EEG and a doll. This article also reports the measurement
and comparison of brain waves at the onset of sleep and when awaking during EEG recording.
３．Method
１）Subjects：Children who suffer from psychiatric disorders including emotional disorders anddevelopmental impairments
２）Creation of a play preparation booklet

Image．Play Preparation Booklet
３） Practice model of play preparation: The explanation is given by using personal computer(hereinafter referred to as PC)(1) Explanation of the procedure of pre-examination (administration of a sedative agent or asuppository)(2) Introduction of attending laboratory technicians and of the examination room(3) Explanation of the procedure of the examination by using a doll (60cm) which has electrodes
on its scalp [See images below]（4）Explanation that the subject can watch DVDs and games while waiting until all electrodes areattached to his/her scalp (for approximately 10 -15 minutes)（5）Explanation of situations when the subject falls asleep and when he/she wakes by showing
images of a light stimulus test（6）Explanation of how to remove electrodes after the completion of the examination

４） Introduction of a play preparation
Preparation for EEG recording
For toddlers ~ grade 2
By Children Nurses and HPSChild life section, General Pediatrics
Aichi Children’s Health and Medical Center

What is EEG?
This is a test
to check the inside of your head
and to see how it is working

Before the examination
Take a pill to make you feel sleepy-a medicine to take by mouth-a pill to insert into your bottom

Here is the examination room

1) The explanation of sedative medicine and suppository
The child is transferred to the examination room after having taken sedative
medicine or suppository

Here is the inside of the room2) Introduction of the examination room
To let a child see the image of the room and how dark it can be3) Introduction of laboratory
technicians4) Explanation of electrodes
Seals will be attached to your head5) Explanation of electrode attachment
procedure and time requiredThe child is allowed to watch DVDs and playgames by iPad while waiting
It takes about 20 minutes

The examination begins

6)Explanation of during the examination andtime required

The examination will take about
45 minutes to 60 minutes

We are watching
you from here

What’s next
After the examination?
We are going home!

7) Explanation of how to remove the electrodes

5) Examination Record
Outpatient / Inpatient （Ward/Department:）EEG Preparation Record
Recorded by: Children’s nurse（）Laboratory technician（）
Subject
Registration No.：
Department：
Name of disease：
Name：
Sex:
M/FAge：Developmental Impairment： Yes / No
IQ：
EEG：Never before / Previous record:time(s)Name of facility：
Accompanied by(during explanatory session)
Date of preparation
Date:
Time： ： ～ ： （minutes） Place：
Date of examination
EEG recording
Sedative drugs：Yes / No
Date:Time ： ： ～ ： ：Rental request (ex. DVD)
Yes（）・No
Accompanied byYes（）・No(during examination)
Behaviors of the child1) When introduced to the examination room and machines
before/after the preparation
2) When introduced to laboratory technicians－practiced and recorded by 3) During explanation about what to do before the examination (procedure ofchildren’s nurses－electrode attachment)
4) When selecting DVD or a game during having electrodes attached（）5) During explanation about during the examination (a) when asleep (b) whenawake6) During explanation about how to remove the electrodes7) When reflecting the examination using a doll
8) When observing the examination room
What did the child think( about the whole procedure)
What did his/her parentthink
Evaluation by children’snurses＜EEG＞
3. Whole procedure went smoothlyBehaviors of the child during 4. The examination was completed with minor difficulties
the examination
5. The examination was completed with struggles－practiced and recorded by 6. The examination had to be quit in the middle of procedurelaboratory technicians－(reason:)
7. The examination could not be practiced(reason:)
8. Other（）
Remarks from the child
After the examination－ recorded by children’s
Remarks from his/her parent
nurses－４．Result
There were two case examples in total: one was a patient who was hospitalized in the psychiatricdepartment and another was an outpatient in the department of neurology. When we announced thecontents of play preparations to collaborators in the hospital, a nurse manager of the outpatient
department showed her concern that the light stimuli produced by PC could trigger an epileptic
seizure in a subject. We then received a piece of advice from a laboratory technician that it would not
be a problem when the speed of light was slowed down or the frequency of blinking was reduced.
Accordingly we decided to reduce the frequency of blinking to two at a time. For such a case, anexplanation was provided to the subject. In the case of individuals with previous history of seizure
and/or with severe autism, we decided not to use blinking images but to use photos instead.
For the following two case examples, photo images were used instead of images produced withlight stimuli.
1) Case example 1
In August 2013, upon request of a doctor of the psychiatric department (pediatric psychiatrist),
HPS practiced a play preparation to a child (8 year-old) who had an emotional problem in the samemonth. The child’s mother accompanied them during the preparation. Though the child was restless,he understood the essential point of our explanation. The child reflected what he heard about themedical examination by using a doll.
On the day of the examination, the child felt secure since his mother accompanied him when heunderwent the EEG. He was watching a cartoon DVD while electrodes were applied to his scalp andthe procedure went well. A test that was supposed to be practiced when the child fell asleep could not
be done since the child did not take a suppository beforehand. The attending doctor told us that it
was good enough since the child was able to attach the electrodes and went through some tests
without having any panic.
2) Case example 2
In January 2014, upon request of a neurologist, HPS practiced a play preparation to a child (5year-old) with a complex febrile convulsion. An explanatory session was given through PC to thechild and his/her mother. Electrodes were applied to the child while he was playing games on an iPad.
Though tests that were operated while awaking went smoothly, other tests were not be able tocomplete as the child was not able to fall asleep.
５．Discussion
Since there are limited numbers of cases of play preparations for EEG this time, this report isfocusing on designing and recording and not on evaluations and improvement. To design thepreparation, HPS worked together with laboratory technicians specialized for brain waves in orderto learn the procedure and the key points of the examination. There was new information andknowledge for HPS who had no experience of EEG before. Though the name EEG sounded rather
familiar, it brought the realization that HPS had very little idea of the actual procedure and detailsof the examination. Through observing the actual examination closely, I felt children’s fear andanxiety. This whole process helped me see the situation from their perspectives.
The necessity a play preparation for the examination seems very limited to certain children. In
most cases, play preparations are not necessary. Children undergo the examination without
particular problems when they receive proper pre-explanation and when their parent accompanies
them during the examination. In cases where a child has psychological problem(s) such as a severe
emotional disorder and/or developmental impairment, play preparation should be practiced in orderto predict the child’s behaviors during the examination and to reduce possible distresses that thechild may suffer. Though the probability is rather small, cases described in this report indicate thatto design a proper play preparation for a child with a severe disorder can be useful. This is definitely
a field that we shall cultivate.
６．Conclusion
To practice a play preparation for examinations and treatments difficult to operate for children isimperative. It is e especially hard to operate MRI with children and there are many requests for play
preparations on the examination. Regarding EEG, it is still difficult to proceed but there are very few
request for play preparations. For a hospital that shall respect all children, however, a play
preparation shall be provided for any kind of examination or treatment.
To design a play preparation for a new field is time consuming and requires careful schedulingespecially when you are engaged in other existing duties. It does however provide important newexperiences for HPS to build up skills and eventually helps to realize one of our objectives “For allchildren. Everything is for all children” one day. To achieve our goal, more practices shall be needed
through working together with other HPS and children’s nurses.

【References and Cited references】
Katsuhiko Araki (2000). The New Handbook of Child Care Policy in Nursery Center, GAKKENHOLDINGS Co., LTD.
Akito Kita, Akemi Morita, Akira Hirosawa, Shigeto Aramaki (2009). Convention on the Rights of theChild, Nippon Hyoron Sha Co., Ltd.
Chika Mastudaira (2010). Introductory of Hospital-Play, Kenpakusha Press
Chika Mastudaira (2012). Practical Use of Hospital-Play, SOUHEKI-SHA
The Japanese Society of Care and Education in Pediatrics (2009). HPS Training Text certified by TheJapanese Society of Care and Education in Pediatrics.