Development of the Hand Active Sensation Test: reliability and validity

[Psychometric properties of performance outcome tools to assess sensitivity in subjects with stroke sequela: A systematic review]

The objective was to perform a systematic review of those performance outcomes (HRD) tools that assess sensitivity in post-stroke subjects, as well as to know which of all is the most reliable and viable. The design was a systematic review. The following were included: HRD, developed in post-stroke subjects, of any etiology and period of evolution; 18 years of age or older and testing for sensitivity; results on psychometric properties. Excluded: self-reported results, the report of cross-cultural adaptation, designed through computerized means. 19 HRD were acquired. The psychometric properties analyzed were reliability, internal consistency, measurement error, construct validity, content validity, and sensitivity to change, the first being the most studied. Psychometric properties were identified, assessed, compared, and summarized. Of all of them, we recommend the use of the modified Erasmus Nottingham Sensory Assessment, as it presents the best degree of confidence in the evidence.

The effect of sensory-motor training on hand and upper extremity sensory and motor function in patients with idiopathic Parkinson disease

STUDY DESIGN

Blinded randomized controlled trial.

INTRODUCTION

Patients with Parkinson disease (PD) have sensory problems, but there is still no accurate understanding of the effects of sensory-motor interventions on PD.

PURPOSE OF THE STUDY

To investigate the effects of sensory-motor training (SMT) on hand and upper extremity sensory and motor function in patients with PD.

METHODS

Forty patients with PD were allocated to the SMT group or the control group (CG) (mean ages ± standard deviation: SMT, 61.05 ± 13.9 years; CG, 59.15 ± 11.26 years). The CG received the common rehabilitation therapies, whereas the SMT group received SMT. The SMT included discrimination of temperatures, weights, textures, shapes, and objects and was performed 5 times each week for 2 weeks.

RESULTS

Significantly reducing the error rates in the haptic object recognition test (dominant hand [DH]: F = 15.36, P = .001, and effect size [ES] = 0.29; nondominant hand [NDH]: F = 9.33, P = .004, and ES = 0.21) and the error means in the wrist proprioception sensation test (DH: F = 9.11, P = .005, and ES = 0.19; NDH: F = 13.04, P = .001, and ES = 0.26) and increasing matched objects in the hand active sensation test (DH: F = 12.15, P = .001, and ES = 0.24; NDH: F = 5.03, P = .03, and ES = 0.12) founded in the SMT. Also, the DH (F = 6.65, P = .01, and ES = 0.15), both hands (F = 7.61, P = .009, and ES = 0.17), and assembly (F = 7.02, P = .01, and ES = 0.15) subtests of fine motor performance, as well as DH (F = 10.1, P = .003, and ES = 0.21) and NDH (F = 8.37, P = .006, and ES = 0.18) in upper extremity functional performance, were improved in the SMT.

DISCUSSION

SMT improved hand and upper extremity sensory-motor function in patients with PD.

CONCLUSION

The SMT group showed improved sensory and motor function. But these results were limited to levels 1 to 3 of the Hoehn and Yahr Scale.

A new clinical test for sensorimotor function of the hand - development and preliminary validation

BACKGROUND

Sensorimotor disturbances of the hand such as altered neuromuscular control and reduced proprioception have been reported for various musculoskeletal disorders. This can have major impact on daily activities such as dressing, cooking and manual work, especially when involving high demands on precision and therefore needs to be considered in the assessment and rehabilitation of hand disorders. There is however a lack of feasible and accurate objective methods for the assessment of movement behavior, including proprioception tests, of the hand in the clinic today. The objective of this observational cross- sectional study was to develop and conduct preliminary validation testing of a new method for clinical assessment of movement sense of the wrist using a laser pointer and an automatic scoring system of test results.

METHODS

Fifty physiotherapists performed a tracking task with a hand-held laser pointer by following a zig-zag pattern as accurately as possible. The task was performed with left and right hand in both left and right directions, with three trials for each hand movement. Each trial was video recorded and analysed with a specifically tailored image processing pipeline for automatic quantification of the test. The main outcome variable was Acuity, calculated as the percent of the time the laser dot was on the target line during the trial.

RESULTS

The results showed a significantly better Acuity for the dominant compared to non-dominant hand. Participants with right hand pain within the last 12 months had a significantly reduced acuity (p < 0.05), and although not significant there was also a similar trend for reduced Acuity also for participants with left hand pain. Furthermore, there was a clear negative correlation between Acuity and Speed indicating a speed-accuracy trade off commonly found in manual tasks. The repeatability of the test showed acceptable intra class correlation (ICC_2.1) values (0.68-0.81) and standard error of measurement values ranging between 5.0-6.3 for Acuity.

CONCLUSIONS

The initial results suggest that the test may be a valid and feasible test for assessment of the movement sense of the hand. Future research should include assessments on different patient groups and reliability evaluations over time and between testers.

Relationship between somatosensory deficit and brain somatosensory system after early brain lesion: A morphometric study

Cerebral Palsy (CP) is a group of permanent motor disorders due to non-progressive damage to the developing brain. Poor tactile discrimination is common in children with unilateral CP. Previous findings suggest the crucial role of structural integrity of the primary (S1) and secondary (S2) somatosensory areas located in the ipsilesional hemisphere for somatosensory function processing. However, no focus on the relationship between structural characteristics of ipsilesional S1 and S2 and tactile discrimination function in paretic hands has been proposed. Using structural MRI and a two-point discrimination assessment (2 PD), we explore this potential link in a group of 21 children (mean age 13 years and 7 months) with unilateral CP secondary to a periventricular white matter injury (PWMI) or middle cerebral artery infarct (MCA). For our whole sample there was a significant negative correlation between the 2 PD and the gray matter volume in the ipsilesional S2 (rho = -0.50 95% confidence interval [-0.76, -0.08], one-tailed p-value = 0.0109) and in the ipsilesional S1 (rho = -0.57, 95% confidence interval [-0.81, -0.19], one-tailed p-value = 0.0032). When studying these relationships with regard to the lesion types, we found these correlations were non-significant in the patients with PWMI but stronger in patients with MCA. According to our results, the degree of sensory impairment is related to the spared gray matter volume in ipsilesional S1 and S2 and is marked after an MCA stroke. Our work contributes to a better understanding of why some patients with CP have variable somatosensory deficit following an early brain lesion.

The Brief Kinesthesia test is feasible and sensitive: a study in stroke

BACKGROUND:

Clinicians lack a quantitative measure of kinesthetic sense, an important contributor to sensorimotor control of the hand and arm.

OBJECTIVES:

The objective here was to determine the feasibility of administering the Brief Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from persons with chronic stroke and a healthy comparison group and 2) examining the relationship between the BKT scores and other valid sensory and motor measures.

METHOD:

Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-, and handedness-matched healthy comparison group (N=12) completed the BKT by reproducing three targeted reaching movements per hand with vision occluded.

OTHER MEASURES:

the Hand Active Sensation Test (HASTe), Touch-Test^(tm) monofilament aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log (MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores between groups. Pearson product-moment correlation coefficients assessed the relationship between BKT scores and other measures.

RESULTS:

Post-stroke participants performed more poorly on the BKT than comparison participants with their contralesional and ipsilesional upper extremity. The mean difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34; p<0.008). The BKT score for the contralesional limb was strongly correlated with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the BBT (r=0.77, p=0.006).

CONCLUSIONS:

The BKT was feasible to administer and sensitive to differences in reaching accuracy between persons with stroke and a comparison group. With further refinement, The BKT may become a valuable clinical measure of post-stroke kinesthetic impairment.

Frontoparietal white matter integrity predicts haptic performance in chronic stroke

Frontoparietal white matter supports information transfer between brain areas involved in complex haptic tasks such as somatosensory discrimination. The purpose of this study was to gain an understanding of the relationship between microstructural integrity of frontoparietal network white matter and haptic performance in persons with chronic stroke and to compare frontoparietal network integrity in participants with stroke and age matched control participants. Nineteen individuals with stroke and 16 controls participated. Haptic performance was quantified using the Hand Active Sensation Test (HASTe), an 18-item match-to-sample test of weight and texture discrimination. Three tesla MRI was used to obtain diffusion-weighted and high-resolution anatomical images of the whole brain. Probabilistic tractography was used to define 10 frontoparietal tracts total; Four intrahemispheric tracts measured bilaterally 1) thalamus to primary somatosensory cortex (T–S1), 2) thalamus to primary motor cortex (T–M1), 3) primary to secondary somatosensory cortex (S1 to SII) and 4) primary somatosensory cortex to middle frontal gyrus (S1 to MFG) and, 2 interhemispheric tracts; S1–S1 and precuneus interhemispheric. A control tract outside the network, the cuneus interhemispheric tract, was also examined. The diffusion metrics fractional anisotropy (FA), mean diffusivity (MD), axial (AD) and radial diffusivity (RD) were quantified for each tract. Diminished FA and elevated MD values are associated with poorer white matter integrity in chronic stroke. Nine of 10 tracts quantified in the frontoparietal network had diminished structural integrity poststroke compared to the controls. The precuneus interhemispheric tract was not significantly different between groups. Principle component analysis across all frontoparietal white matter tract MD values indicated a single factor explained 47% and 57% of the variance in tract mean diffusivity in stroke and control groups respectively. Age strongly correlated with the shared variance across tracts in the control, but not in the poststroke participants. A moderate to good relationship was found between ipsilesional T–M1 MD and affected hand HASTe score (r = − 0.62, p = 0.006) and less affected hand HASTe score (r = − 0.53, p = 0.022). Regression analysis revealed approximately 90% of the variance in affected hand HASTe score was predicted by the white matter integrity in the frontoparietal network (as indexed by MD) in poststroke participants while 87% of the variance in HASTe score was predicted in control participants. This study demonstrates the importance of frontoparietal white matter in mediating haptic performance and specifically identifies that T–M1 and precuneus interhemispheric tracts may be appropriate targets for piloting rehabilitation interventions, such as noninvasive brain stimulation, when the goal is to improve poststroke haptic performance.

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Poststroke participants had a wide range of haptic performance, the majority were impaired.

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A good relationship was found between ipsilesional Thal–M1 integrity and poststroke haptics.

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Around 90% of haptic performance was predicted by frontoparietal white matter integrity.

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Precuneus interhemispheric tract integrity was a strong predictor of haptic performance.

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Diminished integrity across the frontoparietal network suggests a general stroke-related factor.

Design, Fabrication, and Administration of the Hand Active Sensation Test (HASTe)

The concept of personalizing neurologic rehabilitation, based on individual impairments, has experienced a recent surge. In parallel, the number of outcome measures of upper extremity motor performance has grown. However, clinicians and researchers lack practical, quantitative measures of the hand's natural role as a receptor of the environment. The Hand Active Sensation Test (HASTe), developed by Williams and colleagues in 2006, is a valid and reliable measure of haptic performance. Though not available commercially, the HASTe can be fabricated from inexpensive materials, and it has been used successfully to identify impairments in haptic touch in individuals with stroke. (Williams, 2006). This paper presents the methods of design and fabrication of the HASTe testing kit, as well as a visual screen to be used during administration, and instructions for the tests administration and scoring.

Sensorimotor interventions and assessments for the hand and wrist: a scoping review

STUDY DESIGN

Scoping review.

INTRODUCTION

Sensorimotor deficits can impair function and may be present in individuals with common upper extremity conditions.

PURPOSE OF THE STUDY

To provide clinicians with an understanding of the usefulness of the assessments to evaluate sensorimotor function and the interventions reported in the literature to effect positive change in our patients with sensorimotor deficits affecting the hand and wrist.

METHODS

A systematic search produced seventeen studies involving sensorimotor retraining and assessment of sensorimotor performance for the upper extremity.

RESULTS

Sensorimotor interventions and assessments found in the literature vary in regards to their effectiveness in restoring sensorimotor function in subjects with a number of conditions that affect hand and wrist function.

CONCLUSIONS

There is a potential value of sensorimotor interventions for individuals with specific upper extremity conditions. There is a need for further studies to improve treatment of sensorimotor deficits and understanding of sensorimotor interventions.

Assessment from Functional Perspectives: Using Sensorimotor Control in the Hand as an Outcome Indicator in the Surgical Treatment of Carpal Tunnel Syndrome

To investigate whether sensorimotor control of the hand could be an outcome indicator after carpal tunnel release (CTR), this work examined changes in the results of patients’ manual tactile test (MTT), pinch-holding-up activity (PHUA), two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) tests. Participants included 30 predominantly sensory neuropathy CTS patients, as confirmed by a nerve conduction study. The MTT, precision pinch performance in PHUA and traditional sensibility (2PD and SWM) tests were used to examine different aspects of sensory status at the time-points of two weeks before operation and one month post-operation, with a single-blind design. The results showed significant improvements in the sensory function as detected by the 2PD and SWM tests (p<0.001) and sensorimotor function as detected by the MTT (p<0.001) and PHUA test (p<0.05) for patients receiving CTR. The responsiveness of the SWM, MTT and PHUA tests (effect size>0.5, p<0.01) are better than that of two-point discrimination test (effect size<0.5, p<0.001). However, pinch strength saw a decline compared to baseline with a moderate effect sizes (effect size = 0.7, p<0.001). This cohort study found that the MTT and PHUA test can both meet all the statistical criteria with regard to assessing treatment outcomes for patients with CTS. In addition, the results of this work provide clinicians with the information that the sensorimotor functions of the hands, as assessed by MTT and PHUA, are responsive to clinical changes due to CTR.

Precisão, sensibilidade e confiança na percepção háptica de peso na presença ou ausência de movimento e visão

Esta pesquisa investigou a influência do movimento muscular e da visão na precisão, sensibilidade e nível de confiança na percepção háptica de peso. Os participantes compararam pesos colocados sobre as palmas das mãos e, conforme a condição experimental, podiam movimentar ou não os braços, bem como visualizar ou não suas mãos e os estímulos. Os resultados mostraram que a precisão e a sensibilidade foram influenciadas pelo movimento e, em menor grau, pela visão. Em geral, o movimento leva à maior precisão e mais sensibilidade, e a contribuição da visão ocorreu nas condições sem movimento. O nível de confiança não foi influenciado pelo movimento, mas foi influenciado pela visão, sobretudo nas condições sem movimento. O nível de confiança foi congruente à precisão dos julgamentos somente na ausência de visão, sugerindo um conhecimento implícito da precisão.

Assessing and treating higher level somatosensory impairments post stroke

Poststroke somatosensory impairment is prevalent, yet commonly used clinical measures lack the sensitivity needed to quantify impairment and detect change due to intervention. This selective review, prepared and presented as a part of the I-Treat Conference (June 22, 2013, Columbus, Ohio), discusses the prevalence of somatosensory impairment after stroke, highlights measures of higher level somatosensory processing, and briefly reviews sensorimotor rehabilitation. The goal of this article is to encourage dialogue regarding the development and use of measures of higher level somatosensory function that will enable personalization of sensorimotor rehabilitation.

Validity and test-retest reliability of a measure of hand sensibility and manual dexterity in people with multiple sclerosis: the ReSense test

PURPOSE

To evaluate the concurrent validity and reliability of the ReSense tool, a new clinical test aimed at determining sensory and functional deficits of the hand in people with multiple sclerosis (PwMS).

METHODS

Study participants included 90 PwMS, 58 women, characterized by significant sensory symptoms in one or both hands. Thirty healthy subjects, 19 women, served as controls. The ReSense evaluation tool measures the ability to perceive and recognize texture and spatial properties of specific elements. ReSense scores were compared with the two-point discrimination (2PD), Semmes-Weinstein monofilament (SWM), Nine-Hole Peg Test (9-HPT), Box and Block Test (BBT) and the Functional dexterity (FDT) tests.

RESULTS

The Cronbach alpha value for the ReSense test for PwMS was 0.84. The ReSense was significantly correlated with the 9-HPT; Pearson's R = -0.44 and FDT; Pearson's R = -0.35. Significant correlations were demonstrated between the ReSense score to SWM and 2PD. The strongest correlation was found with the 2PD performed on the dominant hand; Pearson's R = -0.55.

CONCLUSIONS

The ReSense is a valid tool developed for testing sensing properties of the hand in PwMS. We believe that the sensitivity and specificity values of this tool will assist the clinician to formulate decisions related to rehabilitation management of his/her patient.

Control of reach extent with the paretic and nonparetic arms after unilateral sensorimotor stroke II: planning and adjustments to control movement distance

Nondisabled adults utilize both planning and feedback-based compensatory adjustments to control actual distance moved for skilled reach actions. The purpose of this study was to determine whether individuals post-stroke utilize planning and compensatory adjustments to control movement distance for reaches to targets that vary in distance. Individuals with mild to moderate motor impairment after stroke and nondisabled adults reached with both arms to targets presented at three distances (8, 16, 24 cm). The control of movement distance was compared between arms (control, nonparetic, and paretic) as to the use of planning (correlation of peak acceleration with movement distance), compensatory adjustments prior to peak velocity (correlation of time to peak velocity with movement distance), and compensatory adjustments after peak velocity (variance in movement distance accounted for by deterministic statistical model). The correlation of peak acceleration with movement distance for reaches with the paretic arm was significantly less than controls suggesting a decreased reliance on planning. Feedback-based compensatory adjustments, however, were present prior to and after peak velocity that assisted in achievement of movement distance in a similar manner as controls. Overall reach performance with the paretic arm was impaired, however, as evidenced by greater endpoint error and longer movement times than controls. The decreased use of planning to control movement distance after stroke suggests that the selected motor command was suboptimal in producing the desired movement outcome and may be related to an inability to generate muscle force quickly, lack of knowledge of arm dynamics due to decreased arm use, or lesion characteristics.

Haptic Tests for Use with Children and Adults with Visual Impairments: A Literature Review

We sought to provide a quantitative overview of haptic tests, so as to identify what has been done in this area so far and discuss possible avenues for the future design of haptic tests for use with persons with visual impairments. We reviewed 24 haptic psychometric tests, that is, tests performed in the haptic modality, with no reliance on vision. We found that haptics (that is, tactilokinesthetic perception or the sense of active touch) has been used in two different ways: first, to assess nonverbal or practical intelligence, replacing vision in haptic analogs of mainstream tests (for example, tactile adaptations of Wechsler performance scales); second, to assess, per se, the quality of haptic functioning in specialized tests (for example, Tactual Profile, Haptic Test Battery). In both cases, we found that only a limited number of tests had been standardized for children or were developmental tests or both. We also noticed an overwhelming use of 3-D material in the tests, and a general lack of a comparison group (blindfolded sighted participants) during the standardization process. We discuss the usefulness of designing developmental haptic test batteries to assess 2-D haptic functioning in visually impaired and sighted children.

Occupational Therapy for Upper Limb Post-Stroke Sensory Impairments: A Survey

Purpose:

Upper limb post-stroke sensory impairments have an impact on a significant number of stroke survivors. There is limited research in this area and it is unclear how occupational therapists are addressing sensory impairments in clinical practice. This study aimed to investigate the clinical practice patterns of occupational therapists, perceived barriers to providing interventions and information sources used when addressing upper limb post-stroke sensory impairments.

Methods:

A survey was sent to 500 randomly selected occupational therapists in the United States.

Findings:

The majority of the 145 respondents reported frequently assessing sensation, and half reported providing interventions for sensory impairments. Interventions primarily focused on providing passive sensory stimulation followed by compensatory strategies. Most therapists provided patient/caregiver education about safety. Therapists cited lack of knowledge and skills, patients' short length of stay and lack of time as barriers to utilizing interventions. Most therapists reported not being up to date with current research and requested continuing education to support practice.

Conclusion:

This survey established a profile of American occupational therapists' practice with people with upper limb post-stroke sensory impairments. Therapists have a need for information and training in all aspects of the management of upper limb post-stroke sensory impairment. Further research, evaluating the effectiveness of interventions and exploring therapists' clinical decision making when choosing interventions, is also needed.

Feasibility of a novel functional sensibility test as an assisted examination for determining precision pinch performance in patients with carpal tunnel syndrome

To understand the feasibility of a novel functional sensibility test for determining precision pinch performance in patients with carpal tunnel syndrome, this study investigates the validity, sensitivity and specificity of functional sensibility derived from a pinch-holding-up activity (PHUA) test. Participants include 70 clinically defined carpal tunnel syndrome (CTS) patients with 119 involved hands and 70 age- and gender-matched controls. To examine the discriminating ability of the functional sensibility test, the differences in the ability of pinch force adjustments to the inertial load of handling object between CTS and control subjects are analyzed. The results of functional sensibility are correlated with the severity of CTS to establish concurrent validity. The receiver operating characteristic (ROC) curve is constructed to demonstrate the accuracy of the proposed test. The functional sensibility score significantly discriminates the patients and control groups (respectively, 12.94±1.72 vs. 11.51±1.15N in peak pinch force (FP_Peak), p<0.001; 2.92±0.41 vs. 2.52±0.24 in force ratio, p<0.001) and is moderately correlated (r = 0.42–0.54, p<0.001) with the results of traditional sensibility tests (touch-pressure threshold and two-point discrimination test). In addition, there is a statistical difference in the results of functional sensibility (p<0.001) among the subgroups of CTS severity based on electrophysiological study. The sensitivity and specificity are 0.79 and 0.76, respectively, for the functional sensibility test. The areas under the ROC curve are 0.85 and 0.80 for the force ratio and FP_Peak, respectively. In conclusion, the functional sensibility test could be feasibly used as a clinical tool for determining both the sensibility and precision pinch performance of hands for the patients with CTS.

Sensorimotor training and neural reorganization after stroke: a case series

BACKGROUND AND PURPOSE

Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel 2-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization.

CASE DESCRIPTION

Behavioral/performance changes were identified via sensorimotor evaluation. Activity-induced neural reorganization was examined using sensory functional magnetic resonance imaging, diffusion tensor tractography, and brain volume measurement. Participant 1 was a 75-year-old right-handed man 1 year post-right hemisphere stroke, with severe sensory impairment across domains in his left hand; he reported limited left-hand/arm use. Participant 2 was a 63-year-old right-handed woman who had experienced a left hemisphere stroke 9 months earlier, resulting in mild sensory impairment across domains in her right hand, as well as mild motor deficit.

INTERVENTION

Participants were trained 4 hours per day, 5 days per week for 2 weeks. Training tasks required sensory discrimination of temperature, weights, textures, shapes, and objects in the context of active exploration with the involved hand. Random multimodal feedback was used.

OUTCOMES

Both participants had improved scores on the Wolf Motor Function Test after training. Participant 1 had no measurable change in sensory function, while participant 2 improved in touch perception, proprioception, and haptic performance. Sensory functional magnetic resonance imaging suggested neural reorganization in both participants; participant 1 had a small increase in brain volume, while superior thalamic radiation white matter connectivity was unchanged in either participant.

DISCUSSION

Participating in sensorimotor training focused on sensory discrimination during manual manipulation was feasible for both participants. Future research to determine efficacy and identify optimal measures of sensory function and neural reorganization is recommended.

VIDEO ABSTRACT AVAILABLE

(see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A38) for more insights from the authors.

Neural correlates supporting sensory discrimination after left hemisphere stroke

BACKGROUND

Nearly half of stroke patients have impaired sensory discrimination, however, the neural structures that support post-stroke sensory function have not been described.

OBJECTIVES

1) To evaluate the role of the primary somatosensory (S1) cortex in post-stroke sensory discrimination and 2) To determine the relationship between post-stroke sensory discrimination and structural integrity of the sensory component of the superior thalamic radiation (sSTR).

METHODS

10 healthy adults and 10 individuals with left hemisphere stroke participated. Stroke participants completed sensory discrimination testing. An fMRI was conducted during right, impaired hand sensory discrimination. Fractional anisotropy and volume of the sSTR were quantified using diffusion tensor tractography.

RESULTS

Sensory discrimination was impaired in 60% of participants with left stroke. Peak activation in the left (S1) did not correlate with sensory discrimination ability, rather a more distributed pattern of activation was evident in post-stroke subjects with a positive correlation between peak activation in the parietal cortex and discrimination ability (r=.70, p=.023). The only brain region in which stroke participants had significantly different cortical activation than control participants was the precuneus. Region of interest analysis of the precuneus across stroke participants revealed a positive correlation between peak activation and sensory discrimination ability (r=.77, p=.008). The L/R ratio of sSTR fractional anisotropy also correlated with right hand sensory discrimination (r=.69, p=.027).

CONCLUSIONS

Precuneus cortex, distributed parietal lobe activity, and microstructure of the sSTR support sensory discrimination after left hemisphere stroke.

Measures of sensation in neurological conditions: a systematic review

Objective: To systematically review the psychometric properties and clinical utility of measures of sensation in neurological conditions to inform future research studies and clinical practice.

Data sources: Electronic databases (MEDLINE, CINAHL, EMBASE and AMED) were searched from their inception to December 2010.

Review methods: Search terms were used to identify articles that investigated any sensory measures in neurological conditions. Data about their psychometric properties and clinical utility were extracted and analyzed independently. The strength of the psychometric properties and clinical utility were assessed following recommendations. 1

Results: Sixteen sensory measures were identified. Inter-rater reliability and redundancy of testing protocols are particular issues for this area of assessment. Eleven were rejected because they were not available for a researcher or clinician to use. Of the remaining five measures, the Erasmus MC modifications of the Nottingham Sensory Assessment and the Sensory section of the Fugl–Meyer Assessment showed the best balance of clinical utility and psychometric properties.

Conclusion: Many measures of sensory impairment have been used in research but few have been fully developed to produce robust data and be easy to use. At present, the sensory section of the Fugl–Meyer Assessment and the Erasmus MC modifications of the Nottingham Sensory Assessment show the most effective balance of usability and robustness, when delivered according to the operating instructions.

Relationship between functional connectivity and sensory impairment: red flag or red herring?

Resting-state functional magnetic resonance imaging (fMRI) can be used to study the functional connectivity in the somatosensory system. However, the relationship between sensory network connectivity, sensory deficits, and structural abnormality remains poorly understood. Previously, we investigated the motor network in children with congenital hemiparesis due to middle cerebral artery strokes (MCA, n = 6) or periventricular lesions (PL, n = 8). In the present study, we validate the use of interleaved resting-state data from blocked fMRI designs to investigate the somatosensory network in these patients. The approach was validated by assessing the predicted "crossed-over" connectivity between the cerebral cortex and the cerebellum. Furthermore, the impact on the volume of gray-matter (GM) in primary (S1) and secondary (S2) somatosensory cortex on functional connectivity measures was investigated. We were able to replicate the well-known "crossed-over" pattern of functional connectivity between cerebral and cerebellar cortex. The MCA group displayed more sensory deficit and significantly reduced functional connectivity in the lesioned S2 (but not in lesioned S1) when compared with the PL group. However, when accounting for GM volume loss, this difference disappeared. This study demonstrates the applicability of analyzing resting-state connectivity in patients with brain lesions. Reductions of functional connectivity within the somatosensory network were associated with sensory deficits, but were fully explained by the underlying GM damage.

Development of a participatory process to address fragmented application of outcome measurement for rehabilitation in community settings

PURPOSE

Outcome measurement is an integral part of delivering rehabilitation services in community settings. However, measurement is of little value if instruments are chosen ad hoc and are not administered consistently. The purpose of this study was to develop and test a participatory process of outcome measure selection which would engender consistent use of robust and appropriate instruments.

METHOD

The ICF provided the conceptual framework for a systematic review of the literature for relevant outcome measures. A summary of the critical appraisal of the clinimetric properties of the identified instruments was created. The summaries were reviewed and vetted by stakeholders including clinicians, researchers, and managers/policy makers.

RESULTS

From the 300 identified and appraised measures, 28 were chosen and made available in a Compendium of Clinical Measures for Community Rehabilitation. The Compendium contains three core measures to be used routinely with all rehabilitation clients and a further 25 that cover particular discipline and client needs. This resource is now available to all clinicians working in the participating rehabilitation services.

CONCLUSION

A participatory process combining rigorous review of the literature, expert opinion, and clinician feedback is recommended in the selection and implementation of outcome measures in rehabilitation settings in the community.

The AsTex: clinimetric properties of a new tool for evaluating hand sensation following stroke

OBJECTIVES

To investigate the clinimetric properties and clinical utility of the AsTex((R)), a new clinical tool for evaluation of hand sensation following stroke.

DESIGN

The AsTex((R)) was administered on two occasions separated by a week to appraise test-retest reliability, and by three assessors on single occasion to establish inter-rater reliability. Pilot normative values were collected in an age-stratified sample. Clinical utility was evaluated based on ease of administration, ceiling and floor effects, and responsiveness to sensory recovery.

PARTICIPANTS

Test-retest (n = 31) and inter-rater (n = 31) reliability and normative values (n = 95) for the AsTex((R)) were established in neurologically normal participants aged 18-85 years. Test-retest reliability was investigated in 22 individuals a mean of 46 months (range 12-125) post stroke and clinical utility was evaluated in an additional 24 subacute stroke participants a mean of 29.4 days (range 12-41) post stroke.

MAIN MEASURE

The AsTex((R)).

RESULTS

The AsTex((R)) demonstrated excellent test-retest (intraclass correlation coefficient (ICC) = 0.98, 95% confidence interval (95% CI) = 0.97-0.99) and inter-rater reliability (ICC = 0.81, 95% CI = 0.73-0.87) in neurologically normal participants. Test-retest reliability of the AsTex((R)) in individuals following stroke was excellent (ICC = 0.86, 95% CI = 0.68-0.94). The AsTex((R)) was simple to administer, demonstrated small standard error of measurement (0.14 mm), minimal floor and ceiling effects (12.5% and 8.3%) and excellent responsiveness (standardized response mean = 0.57) in subacute stroke participants.

CONCLUSION

The AsTex((R)) is a reliable, clinically useful and responsive tool for evaluating hand sensation following stroke.

Somatosensory system in two types of motor reorganization in congenital hemiparesis: topography and function

This study investigates the (re-)organization of somatosensory functions following early brain lesions. Using functional magnetic resonance imaging (fMRI), passive hand movement was studied. Transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) were used as complementary methods. fMRI data was analyzed on the first level with regard to topographical variability; second-level group effects as well as the overall integrity of the somatosensory circuitry were also assessed. Subjects with unilateral brain lesions occurring in the third trimester of pregnancy or perinatally with different types of motor reorganization were included: patients with regular, contralateral motor organization following middle cerebral artery strokes (CONTRA(MCA), n = 6) and patients with reorganized, ipsilateral motor functions due to periventricular lesions (IPSI(PL), n = 8). Motor impairment was similar, but sensory impairment was more pronounced in the CONTRA(MCA) group. Using fMRI and MEG, both groups showed a normal pattern with a contralateral somatosensory representation, despite the transhemispherically reorganized primary motor cortex in the IPSI(PL) group, as verified by TMS. Activation topography for the paretic hands was more variable than for the nonparetic hand in both groups. The cortico-cerebellar circuitry was well-preserved in almost all subjects. We conclude that in both models of motor reorganization, no interhemispheric reorganization of somatosensory functions occurred. Also, no relevant intrahemispheric reorganization was observed apart from a higher topographical variability of fMRI activations. This preserved pattern of somatosensory organization argues in favor of a differential lesion effect on motor and somatosensory functions and demonstrates a limited compensatory potential for the latter.

Sensory dysfunction following stroke: incidence, significance, examination, and intervention

Recent studies have provided evidence of the widespread incidence of sensory dysfunction following stroke. The importance of these findings lies in the association between sensory loss poststroke and poorer outcomes in motor capacity, functional abilities, length of inpatient stay, and quality of life. Since literature suggests that clinicians can use information about clients' sensory status to predict rehabilitation outcomes and select appropriate interventions, the accuracy of somatosensory assessment is extremely clinically relevant. However, many of the clinical tests that are commonly used to examine sensation have not been found to be valid or reliable. Emerging evidence supports the efficacy of several interventions that target the sensory systems. This article reviews the incidence, significance, examination, and interventions for sensory dysfunction following stroke and summarizes the important characteristics of interventions directed at somatosensation.