Measures of sensation in neurological conditions: A systematic review

Division of Physiotherapy Education, University of Nottingham, Nottingham, UK.
Clinical Rehabilitation (Impact Factor: 2.24). 01/2012; 26(1):68-80. DOI: 10.1177/0269215511412982
Source: PubMed


To systematically review the psychometric properties and clinical utility of measures of sensation in neurological conditions to inform future research studies and clinical practice.
Electronic databases (MEDLINE, CINAHL, EMBASE and AMED) were searched from their inception to December 2010.
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)
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.
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.

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    • "Clinical assessments of proprioception are commonly based on discriminating the upward or downward position of a passively moved finger (Lincoln et al. 1991; Winward et al. 1999). While traditional evaluations of sensory function often include proprioceptive tasks (Winward et al. 1999) and have proven useful in evaluating the condition of patients with stroke (Carey and Matyas 2011) and other impairments , these assessments are frequently insensitive, unreliable , and subjective and found to lack standardization (Lincoln et al. 1991; Connell and Tyson 2012). In contrast, robotic assessments are quantitative and sensitive and can detect motor and sensory deficits in patients who receive normal scores on traditional clinical assessment measures (Reinkensmeyer and Boninger 2012; Debert et al. 2012; Simo et al. 2014). "
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    ABSTRACT: Age-related changes in proprioception are known to affect postural stability, yet the extent to which such changes affect the finger joints is poorly understood despite the importance of finger proprioception in the control of skilled hand movement. We quantified age-related changes in finger proprioception in 37 healthy young, middle-aged, and older adults using two robot-based tasks wherein participants' index and middle fingers were moved by an exoskeletal robot. The first task assessed finger position sense by asking participants to indicate when their index and middle fingers were directly overlapped during a passive crisscross movement; the second task assessed finger movement detection by asking participants to indicate the onset of passive finger movement. When these tasks were completed without vision, finger position sense errors were 48 % larger in older adults compared to young participants (p < 0.05); proprioceptive reaction time was 78 % longer in older adults compared to young adults (p < 0.01). When visual feedback was provided in addition to proprioception, these age-related differences were no longer apparent. No difference between dominant and non-dominant hand performance was found for either proprioception task. These findings demonstrate that finger proprioception is impaired in older adults, and visual feedback can be used to compensate for this deficit. The findings also support the feasibility and utility of the FINGER robot as a sensitive tool for detecting age-related decline in proprioception.
    Full-text · Article · Sep 2015 · Experimental Brain Research
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    • "We calculated the scores of these three subscales in this study. The FMA–S, part of a widely used measurement in people with stroke, has good balanced usability and robustness (Connell & Tyson, 2012). It includes testing of 7002290040p2 March/April 2016, Volume 70, Number 2 light touch (four items: upper arms, palmar surface of the hands, thighs, and soles of feet) and proprioception (eight items: shoulder, elbow, wrist, thumb, hip, knee, ankle, toe). "
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    ABSTRACT: Objectives: To establish the concurrent validity, predictive validity, and responsiveness of the revised Nottingham Sensation Assessment (rNSA) during rehabilitation in individuals with stroke. Method: The study recruited 147 patients with stroke. The main measure was the rNSA, and outcome 10 measures were the Fugl-Meier Assessment (FMA) sensory subscale (FMA-S) and motor subscale (FMA-M), and the Nottingham Extended Activities of Daily Living (NEADL). Results: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a strong predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for FMA-M and NEADL, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = 0.51–0.83). Conclusion: The results of our study might support the concurrent validity, predictive validity, and responsiveness of the rNSA for individuals with stroke. We recommended the use of all of the rNSA sensory modalities to represent concurrent somatosensory function, motor performance, and participation in activities of daily living. In contrast, the specific sensory 3 modality of the rNSA could predict functional and participation conditions. That is, after an intervention, proprioception could possibly predict somatosensory functions, and stereognosis and tactile-pinprick for proximal upper limb could possibly predict motor performance and daily activities, respectively. The tactile sensation subscale of the rNSA was more responsive in detecting a change after an intervention for stroke rehabilitation than the proprioception and stereognosis subscales.
    Full-text · Article · Feb 2016 · The American journal of occupational therapy.: official publication of the American Occupational Therapy Association
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    • "There is no widely-accepted or standardized test of sensory impairments after stroke [34]. Impairments in cutaneous sensation are usually assessed at the index fingertip [9], [35], or clinically by descriptors such as ‘present’, ‘absent’ or ‘impaired’ [8], [18], [36], [37]. "
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    ABSTRACT: Sensation is commonly impaired immediately post-stroke but little is known about the long-term changes in cutaneous sensation that have the capacity to adversely impact independence and motor-function. We investigated cutaneous sensory thresholds across the hand in the chronic post-stroke period. Cutaneous sensation was assessed in 42 community-dwelling stroke patients and compared to 36 healthy subjects. Sensation was tested with calibrated monofilaments at 6 sites on the hand that covered the median, ulnar and radial innervation territories and included both glabrous (hairless) and hairy skin. The motor-function of stroke patients was assessed with the Wolf Motor Function Test and the upper-limb motor Fugl-Meyer Assessment. Impaired cutaneous sensation was defined as monofilament thresholds >3 SD above the mean of healthy subjects and good sensation was ≤3 SD. Cutaneous sensation was impaired for 33% of patients and was 40-84% worse on the more-affected side compared to healthy subjects depending on the site (p<0.05). When the stroke patient data were pooled cutaneous sensation fell within the healthy range, although ∼1/3 of patients were classified with impaired sensation. Classification by motor-function revealed low levels of impaired sensation. The magnitude of sensory loss was only apparent when the sensory-function of stroke patients was classified as good or impaired. Sensation was most impaired on the dorsum of the hand where age-related changes in monofilament thresholds are minimal in healthy subjects. Although patients with both high and low motor-function had poor cutaneous sensation, overall patients with low motor-function had poorer cutaneous sensation than those with higher motor-function, and relationships were found between motor impairments and sensation at the fingertip and palm. These results emphasize the importance of identifying the presence and magnitude of cutaneous sensory impairments in the chronic period after stroke.
    Full-text · Article · Aug 2014 · PLoS ONE
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