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Modifications and Troubleshooting:
Commercial or custom-made eyeblink conditioning systems should present the stimuli to the subject in an experimentally controlled manner and be able to detect the behavioral responses. Although this is a non-invasive procedure, the technical requirements for conducting these experiments in less compliant populations (e.g., infants) is challenging. Physically attaching the head-mount to the eye is possible for animal experiments, such as conditioning experiments in sheep12,13. Older children may tolerate wearing a headband with an attached air-puff delivery unit6,7,8 and can be encouraged to maintain a constant eye position using television as a distraction. Although compliance in very young infants can be achieved by conditioning during sleep14, older infants approaching one year of age are generally easily distracted, making them a uniquely challenging population. Despite the challenges, eyeblink conditioning experiments are possible for some awake, one-year-old infants. Our success rates are similar to those reported previously in the literature (~40% - 50% compliance)9, with the likelihood of success probably reflected by the infant's temperament on the day of the experiment.
Critical Steps Within the Protocol:
We recommend adapting a commercially-available EBC set-up, or using a custom-built air pressure generator as previously described, for younger infants9,10,11. The initial challenge is maintaining the air-puff delivery unit in the correct position throughout the experiment, which requires a smaller, modified headpiece. Eye safety is a particular concern for non-compliant infants who attempt to remove the headpiece themselves. Therefore, infants must be closely monitored at all times. A proportion of children will not tolerate wearing the headband or receiving the air puff to the eye (here, ~35%), although this may be improved by gently distracting the infant if the experimental protocol allows this and if this does not overtly interfere with infant behavior. For the children who do complete the experiment, air-puff-only trials are essential to confirm that the headpiece was positioned correctly, as lack or reversal of conditioning responses may be caused by poor delivery of the air puff throughout the experiment.
While manual video analysis is time-consuming, automated measures of infant eyeblink responses are currently difficult to achieve. Infrared sensors supplied with commercial EBC set-ups (positioned on the headband adjacent to the air puff unit) record the moment-to-moment reflectance from the cornea at a 1-kHz sampling rate, and blinks can be detected by measuring the change in reflectance following the stimulus onset. Significant changes from baseline reflectance indicate that an eyeblink has occurred, and automated analysis can be used to detect and classify blink responses. However, we and others9,10,11 suggest that researchers should not rely on infrared corneal reflectance measurements provided with commercial EBC set-ups to detect blinks in one-year-old children. While this method may be suitable for adult participants or older children6,7, we were unable to reliably detect blinks in one-year-olds using this method. Here, negligible change in the baseline reflectance is observed over the length of the trial epoch, indicating that the eyeblink is not detected by the infrared sensor. In addition, false positive peaks are commonly observed, which are caused by the infant's head movements that change the positioning of the sensor. Pilot testing in adults suggests that the participant must focus on or slightly above their horizontal line of sight, with the air puff unit positioned within 1 - 2 cm of the cornea, to successfully detect the eyeblinks-conditions that cannot be maintained consistently with an infant. In addition, the small interpalpebral fissure size in infants may reduce corneal reflectance, making blink detection more difficult than in adults or older children.
Significance with Respect to Existing Methods:
Despite the need for manual video camera analysis and the lower temporal resolution of a 60-Hz video in comparison to 1-kHz reflectance measurements, the improved success rates of video recordings make this a superior method to the infrared sensor. Although the corneal air puff is also delivered by the same headpiece attachment as a commercial infrared sensor, stimulus delivery appears to be more resilient to positioning than the infrared sensor, as the air puff strength can be adjusted as required. This avoids excessive adjustment of the headband, which tends to reduce infant compliance. Researchers who can achieve higher success rates using the infrared sensor may still require supporting video camera analysis. For the trials where there is no detectable eyeblink response recorded by the infrared sensor, video recordings can distinguish between true responses or invalid trials (i.e., whether the child was wearing the air puff unit in the correct position, whether they did not blink, or whether the infrared sensor failed to detect the blink). Equally, video recordings are necessary to confirm false positive results, as movements during the trial can also produce artefacts masquerading as blinks. Eye-tracking apparatus15,16 and electromyography9,10,14 of the orbicularis oculi muscle are other automated methods of blink detection that are beyond the scope of this paper, although without visual confirmation of the air puff unit positioning for each trial, these methods are likely to suffer the same drawbacks as the infrared eyeblink detection software described here.
Previously published work on eye-blink conditioning has focused on younger infants, typically 4 - 5 months of age; this work adds to this body of literature by describing techniques for use with older infants (12 ± 1 month of age) and the unique challenges this age group presents. Other authors have also used video analysis (either alone or in combination with electromyography) with infants9,10,11,14. The results presented here are consistent with these previous findings which suggest frame-by-frame video analysis is the best method of detecting eyeblinks in infants, as both electromyography and infrared monitoring can be problematic due to facial and head movements in very young children. This work also supports the finding that infants can develop conditioned responses even at very young ages, at least for a 650-ms delay interval9.
Future Applications:
As a limited number of studies have attempted eyeblink conditioning experiments in human infants, the stimulus parameters should be carefully considered in future experiments. Conditioning has been observed as early as 10 days of age17 and at least within the first month of life14, although a long inter-stimulus interval (e.g., 1,500 ms) appears to be more successful in these very early stages of infancy18. In comparison, children approaching six months of age can be more reliably conditioned with a shorter interval10, although less successfully than in adults19. The 650-ms interval between the tone and the air puff suggested for one-year-old children in this protocol can successfully induce conditioning in 4- or 5-month-old infants9,10,11, as well as in older children6,7. This suggests that eyeblink conditioning is developmentally regulated, with the optimal delay between the tone and the air puff decreasing with infant age10, although additional experiments adapting this protocol are required to investigate these parameters further.
Limitations of This Technique:
EBC can be challenging to set up and may require troubleshooting in each individual situation. Determining when conditioning has occurred is difficult to define and is best observed over multiple trials or sessions. For example, other studies have used an arbitrary conditioning rate of 40% within each block of 10 trials to define conditioning and compared any changes between successive experimental sessions6,9,10,11. Successfully completing the required number of trials to observe conditioning can, therefore, be difficult to achieve in young children.
In regards to the data analysis, one of the particular challenges is separating stimulus-evoked blinks from spontaneous (endogenous) blinks9. The rate of spontaneous eyeblinks is different between individuals but can be influenced by environmental factors such as room humidity, as well as behavioral states. Double blinks occur when there are two complete eyelid closures in a very short space of time (e.g., 400 ms)20, and it is possible that these reflect spontaneous blinks occurring at the same time as a reflexive (conditioned or unconditioned) eyeblink. We occasionally observed double blinks in our data set and, using this protocol, we recorded the latency to the first blink only. However, discarding these trials may increase certainty that the analysis is capturing stimulus-evoked blinks only.
Researchers will also need to make decisions on the latency window in which to define a conditioned or unconditioned response, as well as whether to define latency to the blink onset or the blink peak (eyelid closure). Here we have conservatively defined a conditioned response as a blink that peaks prior to 650 ms in either paired or unpaired trials, to provide certainty that the blink is initiated before the air puff onset rather than in response to the air puff. However, this latency window could be extended for unpaired trials where no air puff is presented, particularly if using blink peak to define the latency of the response. The important principle here is that all instances are dealt with in the same manner, by all examiners, and that this criterion is determined prior to any data analysis commencing.
In summary, frame-by-frame video analysis can provide a reliable and reproducible method of assessing classical EBC responses in young infants. These measures provide one measure of learning behavior, although a comprehensive developmental assessment is required to fully characterize neurodevelopment in infancy.