Consideration for Positive and Negative Effect of Multi-Sensory Environment Interventions on Disabled Patients through Electrocardiography

Round 1

Reviewer 1 Report

The paper is long. You need to summarize some Sections and shorten the paper accordingly.

The contribution and novelty are not clear at all, the author should rewrite some section highlighting the originality and novelty proposed

Please, clearly explain how your solution advances existing approaches,

Abstract requires numerical findings of your work.

If possible, organize a summary of the Related Work section in a table to improve the quality of your research work.

The paper lacks of a summary of the method before presenting the details. This makes it complex to read and understand

The descriptions given in this proposed scheme are not sufficient that this manuscript only adopted a variety of existing methods to complete the experiment where there are no strong hypothesis and methodical theoretical arguments. Therefore, the reviewer considers that this paper needs more works

The author should compare the proposed algorithm with other recent works or provide a discussion. Otherwise, it's hard for the reader to identify the novelty and contribution of this work

Describe more about your datasets and your evaluation metrics

More experiments, especially comparative experiments, should be involved to verify the performances of the proposed algorithm.

Does the proposed method have some shortcomings? In fact, shortcomings don’t reduce the availability of the proposed method. By contrast, it is a very suitable way to help readers to understand the proposed method comprehensively in my opinion.

In the Conclusion section, please explain more about future works

Some references used are too old the author should add some more recent one

Author Response

Dear Reviewer #1

 

Thank you for your valuable comments. I revised the manuscript according to your advices. Please check this one more time. In Japanese hospital, care-providers try to give some interesting their disabled patients. Most of disabled patients enjoy the acitivy like multi-sensory environmental interventions (MSE), however a few patients have a difficulty in breathing during their activity. The authors assume that some patients may get some negative effect during the MSE because of their weak and abnormal heartbeat. Through the analysis, we found that our hypothesis may be right because the disabled patient has a short QT syndrome which is related to heart failure from the sudden shock.

 

• Comment: The paper is long. You need to summarize some Sections and shorten the paper accordingly.
• Response: The template is the one column and the page is 16 pages. I understand this page length looks long. However, I think that the length is reasonable because the length for the IEEE template with two columns is 8 pages in general (when the one column will be 16 pages).
• Comment: The contribution and novelty are not clear at all, the author should rewrite some section highlighting the originality and novelty proposed.
• Response: I inserted the contribution point in this study at the end of Introduction Section. “The contribution was that the continuous measurement of nasal temperature enabled us to evaluate the emotional arousal of disabled patients in MSE while cross-checking the results of ECG.” Please check this. Then, the above general description of this study helps you understand the value of this study.
• Comment: Please, clearly explain how your solution advances existing approaches,
• Response: The measurement of nasal temperature during the multi-sensory environmental interventions (MSE) was the first trial in the world to recognize the emotional arousal. Most conventional works were just related to the interview.
• Comment: Abstract requires numerical findings of your work.
• Response: I inserted the QT time which is the risky sign in general.
• Comment: If possible, organize a summary of the Related Work section in a table to improve the quality of your research work.
• Response: Thank you for your suggestion. But there was little way to evaluate the effect of MSE on patients through the measurement. Furthermore, the authors focused on the negative effect. Most of studies have interest for the good effect.
• Comment: The paper lacks of a summary of the method before presenting the details. This makes it complex to read and understand.
• Response: The flowchart in Figure 3 represents the summary of the method. It is necessary to measure the proposed method while measuring the gold standard method. Thus, you felt the method looked complex. Please check the flowchart. I am sure that you can understand the method in this study.
• Comment: The descriptions given in this proposed scheme are not sufficient that this manuscript only adopted a variety of existing methods to complete the experiment where there are no strong hypothesis and methodical theoretical arguments. Therefore, the reviewer considers that this paper needs more works
• Response: As I explain the concept and motivation of this study at the above paragraph, care-providers try to give patients the interesting activity with the good intention. But most of disabled patients may have the weak heartbeat because of the long bed stay. Thus, the authors have the assumption that the sudden shock (stimulation) during the MSE may provide the negative effect to the disabled. When the patient is in the MSE, there was little way to measure the emotional arouse without the interview.
• Comment: The author should compare the proposed algorithm with other recent works or provide a discussion. Otherwise, it's hard for the reader to identify the novelty and contribution of this work 
• Response: That is the reason why the authors measured the golden standard data. The study compared the proposed simple non-invasive method with the golden standard method.
• Comment: Describe more about your datasets and your evaluation metrics
• Response: The flowchart in Figure 3 could help you understand this. At first, it is necessary to decide the emotional arousal during the event while comparing the autonomous neuron system (LF/HF). Then, the effect of occurred emotional arousal is evaluated whether this is positive or negative through ECG data as the gold standard method.
• Comment: More experiments, especially comparative experiments, should be involved to verify the performances of the proposed algorithm.
• Response: The authors performed all of experiments while measuring gold standard vital data.
• Comment: Does the proposed method have some shortcomings? In fact, shortcomings don’t reduce the availability of the proposed method. By contrast, it is a very suitable way to help readers to understand the proposed method comprehensively in my opinion.
• Response: The shortcoming of the proposed method is the face direction. During the MSE event, the patient can move the face to the left or right direction. But because the proposed method should measure the nasal temperature, the face should be the frontal direction.
• Comment: In the Conclusion section, please explain more about future works
• Response: I inserted the future work. “The authors would like to continue to perform the experiment to increase the human subject while considering the possibility of drug-induced short QT syndrom in the future.”
• Comment: Some references used are too old the author should add some more recent one
• Response: If possible, could you suggest some recent references in this research field?

Thank you.

 

Sincerely,

Hieyong Jeong

Chonnam National University

Author Response File: Author Response.pdf

Reviewer 2 Report

The paper explores multi-sensory environment interventions' positive and negative effects on disabled patients. The study group consisted of twenty disabled patients who participated in experiments for 12 minutes and were divided into two categories: ten with muscular dystrophy and ten with severe motor and intellectual disabilities. For results measurement, the authors used the nasal temperature and emotional arousal after facial detection.

From a statistics perspective, the study group is quite limited, and the results may not be easily generalised, but the findings may be relevant from a medical point of view. Some statistical measures could also be employed to validate the most common effects and how they differ among the group.

From a technical perspective, I would add that Haar cascades from OpenCV are not the only approach for face detection, and other methods could bring different results; in some cases, it is worth exploring at least two methods (models) before having a conclusion.

Author Response

Dear Reviewer #2

 

Thank you for your valuable comments. I revised the manuscript according to your advices. Please check this one more time. In Japanese hospital, care-providers try to give some interesting their disabled patients. Most of disabled patients enjoy the activity like multi-sensory environmental interventions (MSE), however a few patients have a difficulty in breathing during their activity. The authors assume that some patients may get some negative effect during the MSE because of their weak and abnormal heartbeat. Through the analysis, we found that our hypothesis may be right because the disabled patient has a short QT syndrome which is related to heart failure from the sudden shock.

 

• Comment: The paper explores multi-sensory environment interventions' positive and negative effects on disabled patients. The study group consisted of twenty disabled patients who participated in experiments for 12 minutes and were divided into two categories: ten with muscular dystrophy and ten with severe motor and intellectual disabilities. For results measurement, the authors used the nasal temperature and emotional arousal after facial detection. 
• Response: Thank you for your summary.
• Comment: From a statistics perspective, the study group is quite limited, and the results may not be easily generalised, but the findings may be relevant from a medical point of view. Some statistical measures could also be employed to validate the most common effects and how they differ among the group.
• Response: Thank you for your understanding. Care-providers wonder whether the patients enjoy the MSE event or not. Then, care-providers also know that the MSE event give the disabled the good stimulus. The proposed method is non-contact, thus so useful in the medical environment.
• Comment: From a technical perspective, I would add that Haar cascades from OpenCV are not the only approach for face detection, and other methods could bring different results; in some cases, it is worth exploring at least two methods (models) before having a conclusion.
• Response: Thank you for your valuable comment. Actually, the dlib API was applied for this study. Because Haar cascades detects the face with four features, sometimes this method failed to detect the face and nose. So the authors used the dlib which detects the 68 key pint in the face with the machine-learning-based train.

Thank you.

 

Sincerely,

Hieyong Jeong

Chonnam National University

Reviewer 3 Report

The authors presented a method in this paper for assessing how multisensory environment interventions affect people who have disabilities. The scope of the work is clear from the abstract. Although this study is intriguing, it is challenging to understand its significance.

 The structure of the manuscript must be improved significantly. Reviewing the manuscript after the following changes would be preferable:

1. The title is not compelling 

2. The authors should explain why the QT intervals are short.

3. A flowchart is useful to understand how the experiment was conducted. But rather than presenting it as a separate subsection, it should be incorporated into the methodology.

4.The results related to risk analysis and relation between nose temperature and ECG should be under the result section.  Otherwise, the author should explain why they are not included under the result section. 

Author Response

Dear Reviewer #3

 

Thank you for your valuable comments. I revised the manuscript according to your advices. Please check this one more time. In Japanese hospital, care-providers try to give some interesting their disabled patients. Most of disabled patients enjoy the activity like multi-sensory environmental interventions (MSE), however a few patients have a difficulty in breathing during their activity. The authors assume that some patients may get some negative effect during the MSE because of their weak and abnormal heartbeat. Through the analysis, we found that our hypothesis may be right because the disabled patient has a short QT syndrome which is related to heart failure from the sudden shock.

 

The authors presented a method in this paper for assessing how multisensory environment interventions affect people who have disabilities. The scope of the work is clear from the abstract. Although this study is intriguing, it is challenging to understand its significance.

 The structure of the manuscript must be improved significantly. Reviewing the manuscript after the following changes would be preferable:

1. The title is not compelling 

Response: Thank you for your comment. If possible, can you suggest your idea? When we perform much larger dataset, we can set the title in terms of medical side. But the current condition could not put the title in terms of medicine. Although we should increase the number of human subjects, it is difficult to continue to perform the experiment under the COVID 19.

2. The authors should explain why the QT intervals are short.

Response: The disabled patients stay in the bed side for a long time. Thus, ECG data is not normal as you can see Figure 7. Although it is difficult to explain the reason and cause of Short QT Syndrome, the sudden stimulus has a high possibility to lead to the heart failure. This study classified whether there is the good or negative effect during the MSE event with ECG data. Care-providers can think the MSE event is always good stimulus for the patients, however, the results of this study shows that sometimes is good, but not always.

3. A flowchart is useful to understand how the experiment was conducted. But rather than presenting it as a separate subsection, it should be incorporated into the methodology.

Response: Thank you for your comment. In my opinion, I think that it is necessary to explain the flowchart after the description of experimental environment and system. Without the subsection, Section of methodology will be too long to understand.

4. The results related to risk analysis and relation between nose temperature and ECG should be under the result section.  Otherwise, the author should explain why they are not included under the result section. 

Response: The proposed method is to measure the nasal temperature for recognizing the emotional arousal. ECG data are the gold standard role. Through ECG data, it is possible to analyze the autonomous nerve system. All these data are included in the Results section. Please check it.

 

Thank you.

 

Sincerely,

Hieyong Jeong

Chonnam National University

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

I appreciate the authors' efforts in responding to the comments. However, such information, such as the reason why QT intervals are short, must be included in the manuscript. I still think the paper has to be carefully organized and presented.

 

Author Response

Dear Reviewer #3

 

Thank you for your valuable comments. I revised the manuscript according to your advices. Please check this one more time.

 

• Comment

I appreciate the authors' efforts in responding to the comments. However, such information, such as the reason why QT intervals are short, must be included in the manuscript. I still think the paper has to be carefully organized and presented.

• Response

Thank you for your valuable comment. The authors divided into two section in Discussion Section: (1) Positive and negative impacts of multi-sensory environment interventions on psychological state, and (2) Possibility of drug-induced short QT syndrome. Then, the authors tried to describe the reason why QT intervals are short in the sub-section (2).

 

Table 1 shows the list of prescribed medications that all patients should take regularly. Patients with MD tend to take the drugs to relieve constipation commonly. Still, those with SMID tend to take anti-epileptic and anti-psychotic drugs, mainly for constipation. The arrhythmogenic potential of short QT intervals has recently been highlighted in patients with a short QT syndrome (SQTS) [8], [36], [37].

 

Drug-induced QT-interval prolongation is a well-known risk factor for ventricular tachyarrhythmias. However, reports on drug-induced QT-interval shortening are rare, and pro-arrhythmic effects remain unclear because SQTS is an inheritable primary electrical disease of the heart that was discovered in 1999. This disorder is characterized by an abnormally short QT interval (< 300 ms) and a propensity to atrial fibrillation, SCD, or both.

 

Thank you.

 

Sincerely,

Hieyong Jeong

Chonnam National University

Author Response File: Author Response.pdf

Round 3

Reviewer 3 Report

Thanks for your efforts for revising the paper.