Development and pilot testing of an early childhood somatosensory assessment: Somatosensory test of reaching.

Thirty-two children (50% female, 59.3% White, 7-60 months), from middle to high socioeconomic status families, participated in pilot feasibility and validity testing of the somatosensory test of reaching (STOR). STOR tested the child's accuracy of reach to visual and somatosensory targets. All children were able to complete the assessment. Statistically significant differences were found between age groups (p = .0001), showing developmental trends, and between test conditions (p < .001), showing that the ability to reach to visible targets develops before somatosensory targets. STOR also showed a moderate correlation with the Developmental Assessment of Young Children 2nd edition. STOR appears to be a promising tool for assessing somatosensory processing in very young children, and it warrants additional testing in larger participant samples.

Concurrent validity of a low-cost and time-efficient clinical sensory test battery to evaluate somatosensory dysfunction.

BACKGROUND: This study describes a low-cost and time-efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST). METHOD: Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non-specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated. RESULTS: Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind-up ratio) did not significantly correlate with QST. CONCLUSION: Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low-cost screening tool in a clinical setting. SIGNIFICANCE: Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low-cost and time-efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.

Robotic Assessment of Motor, Sensory, and Cognitive Function in Acute Sport-Related Concussion and Recovery.

There is a need for better tools to objectively, reliably, and precisely assess neurological function after sport-related concussion (SRC). The aim of this study was to use a robotic device (Kinesiological Instrument for Normal and Altered Reaching Movements; KINARM) to quantify neurological impairments in athletes acutely and when clinically asymptomatic post-SRC. Robotic assessments included five KINARM standard tasks that evaluate aspects of motor, sensory, and cognitive function. We hypothesized that acutely concussed athletes would demonstrate significant rates of impairment on the robotic assessment, and that impairments would be associated with acute symptom severity. Pre-season assessments were conducted from 2011 to 2016 on 1051 athletes. Eighty-four athletes were reassessed acutely (≤10 days post-injury) and while symptomatic post-SRC and 89 when clinically asymptomatic. Forty-four parameters were measured from the KINARM assessment to characterize neurological function. Reliable change indices (80% confidence interval) identified impairments in healthy and concussed individuals for each parameter. In concussed individuals, impairment rate varied across parameters from 4% to 27% at the acute time point and from 2% to 18% when clinically asymptomatic. Healthy athlete impairment rates were between 2% and 16% across all testing time points. We identified relationships between acute symptom severity and task performance for only two parameters, both of which evaluated attributes of motor function. Overall, the KINARM identified impairments in motor, sensory, and cognitive function in athletes with SRC; however, impairment rates were low and largely did not relate to symptom severity. More complex tasks may be necessary to identify potentially subtle neurological impairments post-SRC.

Assessment of Somatosensory Function in Patients With Idiopathic Dry Eye Symptoms.

IMPORTANCE: Somatosensory dysfunction likely underlies dry eye (DE) symptoms in many individuals yet remains an understudied component of the disease. Its presence has important diagnostic and therapeutic implications. OBJECTIVE: To assess the integrity of nociceptive system processes in persons with DE and ocular pain using quantitative sensory testing (QST) techniques applied at a site remote from the eye. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study conducted at Miami Veterans Affairs Hospital included 118 individuals with a wide variety of DE symptoms and signs. The study was conducted from October 31, 2013, to January 28, 2016. INTERVENTIONS: Individuals completed questionnaires regarding ocular symptoms (5-Item Dry Eye Questionnaire [DEQ5], Ocular Surface Disease Index [OSDI], and Neuropathic Pain Symptom Inventory modified for the eye [NPSI-E]), psychological status, and medication use and underwent an ocular surface examination. The QST metrics included measures of vibratory and thermal thresholds and cold and hot pain temporal summation (surrogate measures of central sensitization) on the forearm. MAIN OUTCOMES AND MEASURES: Correlations among DE and ocular pain symptom severity with QST metrics measured on the forearm. The OSDI score ranges from 0 to 100, with 100 indicating the most severe DE symptoms. The DEQ5 score ranges from 0 to 22, with the highest score indicating the most severe symptoms, and the NPSI-E score ranges from 0 to 100, with the highest score indicating the most severe symptoms. Psychological state was measured with the 9-item Patient Health Questionnaire, the PTSD Checklist-Military Version for PTSD, and the Symptom Checklist-90 for anxiety. RESULTS: Of the 118 patients who participated in the study, 105 (88.9%) were men (mean [SD] age, 60 [10] years), and a mean of 41% had PTSD, 10% depression, and 0.93% anxiety. Using stepwise linear regression analyses, significant associations were identified between overall DE symptom severity and posttraumatic stress disorder scores and tear breakup time (DEQ5 model: R = 0.54; OSDI model: R = 0.61, P < .001). All other variables (ie, demographics, comorbidities, medications, tear film factors, and QST metrics) dropped out of these models. When specifically considering neuropathic-like qualities of DE pain, however, anxiety and hot pain temporal summation at the forearm explained 17% of the variability in ocular burning (R = 0.41; P < .001), and PTSD score, tear breakup time, and hot pain temporal summation at the forearm explained 25% of the variability in sensitivity to wind (R = 0.50; P < .001) and 30% of the variability in total NPSI-E scores (R = 0.55; P < .001). CONCLUSIONS AND RELEVANCE: Our findings demonstrate that neuropathic-like DE pain symptom severity correlates with quantitative measures of pain sensitivity at a site remote from the eye. This result provides additional evidence that DE symptoms are not only manifestations of a local disorder but also involve somatosensory dysfunction beyond the trigeminal system.

Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation.

OBJECTIVE: This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke. METHOD: The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA-S) and motor subscale (FMA-M) and the Nottingham Extended Activities of Daily Living (NEADL) scale. RESULTS: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA-M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51-.83). CONCLUSION: This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

Somatosensory assessment and treatment after stroke: An evidence-practice gap.

BACKGROUND/AIM: Loss of body sensations is common after stroke, impacting negatively on recovery and performance of activities of daily living. Despite advances in the evidence for the assessment and treatment of somatosensory impairment post-stroke, the translation from research into clinical practice has been slow. The aim of this study was to determine current clinical practice of occupational therapists and physiotherapists in the assessment and treatment of somatosensory impairment post-stroke. METHODS: A cross-sectional, self-administered online survey of occupational therapists and physiotherapists currently working with stroke clients in Australian health organisations, identified through an audit of stroke rehabilitation services and a professional member association. RESULTS: 172 clinicians, 62.8% occupational therapists and 37.2% physiotherapists currently working with stroke clients completed the survey. Most respondents (93.0%) indicated routinely assessing for sensory loss in stroke clients. The most commonly used measures were light touch and proprioception, with the majority (70.4%) not using standardised measures. Most respondents (97.7%) reported providing treatment to address sensory impairment, with compensatory strategies and sensory re-education the two most frequently reported. Evidence-based treatment choices were not common and therapists frequently relied on colleagues' opinions and previous experience to inform practice. Therapists commonly experienced barriers to implementing evidence-based sensory rehabilitation, including time constraints, large caseloads and lack of access to evidence-based somatosensory assessment and treatment resources. CONCLUSIONS: Most therapists perceived somatosensory assessment and treatment as important. However, frequently utilised methods lack a sound theoretical or empirical basis. Despite published evidence regarding somatosensory assessment and treatment, an evidence-practice gap exists.

Assessment of coarse and fine hand motor performance in asymptomatic subjects exposed to hand-arm vibration.

A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures.

Functional assessment of sensory functions after photothrombotic stroke in the barrel field of mice.

Motor, sensory and cognitive deficits are common impairments observed in human stroke as well as in animal stroke models. Using a battery of behavioural tests we assessed sensorimotor deficits after photothrombotic stroke localized within or beyond cortical representation of mouse sensory vibrissae. We found restricted, modality specific behavioural consequences in the acute post-stroke period. Among incorporated tests, adhesive removal test, novelty exploration test and sensory labyrinth task were sensitive to the somatosensory cortical deficits. Injured animals explored new objects significantly longer, they also needed distinctly more time to contact and to remove the adhesive tape placed on whiskers contralateral to the infarct. Moreover, we observed that after stroke animals were unable to solve the sensory labyrinth depending only upon tactile sensation from whiskers with injured cortical representation. Spontaneous recovery could be observed within the first post-stroke week for adhesive tape removal and within 14 days for labyrinth performance. However, for the novel object exploration we did not observed the recovery for the period of 18 days after stroke. Moreover, new object exploration test performance differed between the somatosensory and visual cortical impairments. We suggest that those three tests might be valuable in assessing the usefulness of therapies designed to support brain repair after experimental stroke.

Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions.

Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.

Comparison of LEP and QST and their contribution to standard sensory diagnostic assessment of spinal lesions: a pilot study.

This study evaluates the additional use of laser-evoked potentials (LEP) and quantitative sensory testing (QST) in the sensory assessment of spinal lesions. Four consecutive patients with spinal lesions verified by MRI and clinical evidence for mild spinothalamic tract involvement were included. The electrophysiological workup [somatosensory evoked potentials (SEP) and LEP] was compared to QST. Electrophysiology and QST were reassessed after about 6 months. LEP detected impaired spinothalamic tract function in 7/8 examinations. QST pointed to spinothalamic tract lesions by loss of thermal function (3/8); most frequent positive sensory signs (3/8) were paradoxical heat sensations. LEP and QST results were concordant in 6/8 examinations. SEPs were abnormal in 2/8 examinations. Congruent results between SEP and both LEP and QST were obtained in 3/8 examinations. LEP detected more deficits than any single QST parameter or their combination but additional QST allows the detection of positive sensory signs. The diagnostic gain of SEP was limited.

Guidelines and recommendations for assessment of somatosensory function in oro-facial pain conditions--a taskforce report.

The goals of an international taskforce on somatosensory testing established by the Special Interest Group of Oro-facial Pain (SIG-OFP) under the International Association for the Study of Pain (IASP) were to (i) review the literature concerning assessment of somatosensory function in the oro-facial region in terms of techniques and test performance, (ii) provide guidelines for comprehensive and screening examination procedures, and (iii) give recommendations for future development of somatosensory testing specifically in the oro-facial region. Numerous qualitative and quantitative psychophysical techniques have been proposed and used in the description of oro-facial somatosensory function. The selection of technique includes time considerations because the most reliable and accurate methods require multiple repetitions of stimuli. Multiple-stimulus modalities (mechanical, thermal, electrical, chemical) have been applied to study oro-facial somatosensory function. A battery of different test stimuli is needed to obtain comprehensive information about the functional integrity of the various types of afferent nerve fibres. Based on the available literature, the German Neuropathic Pain Network test battery appears suitable for the study of somatosensory function within the oro-facial area as it is based on a wide variety of both qualitative and quantitative assessments of all cutaneous somatosensory modalities. Furthermore, these protocols have been thoroughly described and tested on multiple sites including the facial skin and intra-oral mucosa. Standardisation of both comprehensive and screening examination techniques is likely to improve the diagnostic accuracy and facilitate the understanding of neural mechanisms and somatosensory changes in different oro-facial pain conditions and may help to guide management.

Issues in combining the categorical and visual analog scale for the assessment of perceived thermal sensation: methodological and conceptual considerations.

Typically, the scales for the measurement of thermal sensation have been formatted as categorical scales (CS). Emerging is the use of CS combined with visual analog scale (VAS) for the measurement of thermal sensation to improve the sensitivity of scales. However, reports are rare comparing the typical CS, standard VAS, and combined CS with VAS. Methodological and conceptual issues are arising with the combining of scales, but there are insufficient reports about the advantages and limitations of different scales. The present study compared 9-points categorical scale (9pts CS), VAS, and CS combined with VAS (graphic CS) through a questionnaire survey (n=988) and a controlled experiment during exercise (17 male subjects). Our results showed that graphic CS was more closely related to indoor air temperature for resting residents rather than VAS or 9pts CS. Around thermal neutral zone indoor environments, sensitivity to discriminate thermal sensation was the greatest for graphic CS. In particular, questionnaire responses to VAS showed a remarkable clustering around the thermal neutral zone. For dynamic exercising subjects, mean skin temperature was more closely related to graphic CS than 9pts CS. Our results indicated that graphic CS seemed to be more valid and sensitive than 9pts CS or VAS for the measurement of thermal sensation, but there are many issues to be considered when combining CS and VAS from the methodological and conceptual view points: definitions of terms, verbalizing with descriptors, number of category, scoring length, unipolar/bipolar construction, language translation, central terms, both anchor terms, orientation, color, etc. The above methodological and conceptual issues were discussed.

New and low-cost auto-algometry for screening hypertension-associated hypoalgesia.

OBJECTIVE: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. DESIGN AND SETTING: Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale. PATIENTS AND INTERVENTIONS: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto-algometry examination. RESULTS: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4-6 range. CONCLUSION: The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.

The value of skin biopsy with recording of intraepidermal nerve fiber density and quantitative sensory testing in the assessment of small fiber involvement in patients with different causes of polyneuropathy.

The primary aim of our study was to demonstrate how the diagnostic characteristics of skin biopsy used to evaluate small fiber involvement in patients with different causes of polyneuropathy are intrinsically related to the method used to establish the reference values (cut-off values). We also investigated intraepidermal nerve fiber (IENF) density and abnormalities in quantitative sensory testing (QST) in patients with different causes of polyneuropathy and signs of small fiber involvement. A total of 210 patients with symptoms and signs of polyneuropathy were entered into the study. All patients underwent neurological examination, nerve conduction studies, QST on the thigh and distal part of the calf with detection of warm and cold perception thresholds, and skin biopsy with assessment of IENF density. Cut-off values for IENF density were established from our reference material using Z-scores (calculated from multiple regression analysis), fifth percentile, and receiver operating characteristic (ROC) analysis. Of the patients participating in the study, 65 had an established diagnosis of diabetes mellitus, 70 were classified with idiopathic polyneuropathy, and 75 had other possible causes of polyneuropathy. Forty-five patients met the criteria for small fiber polyneuropathy (SFN), and the remaining 165 had also involvement of large nerve fibers. Of the total patient cohort, 84 (40%) had reduced IENF density based on the Z-score, and 106 patients (50%) had at least one abnormality based on QST. In the SFN group, skin biopsy showed a sensitivity of 31% and a specificity of 98% when reference values were presented with Z-scores. When the fifth percentile was used as the cut-off value (6.7 fibers/mm), sensitivity was 35% and specificity 95%. Applying the ROC analysis with a chosen sensitivity of 78% and specificity of 64%, we had a cut-off point of 10.3 fibers/mm. We conclude that skin biopsy with assessment of IENF is a useful method for investigating patients with SFN. The diagnostic value of the test, however, depends upon on the approach used to estimate the reference values.

Reliability of posturographic measurements in the assessment of impaired sensorimotor function in chronic low back pain.

UNLABELLED: The evaluation of postural stability using posturography could be both a valuable functional diagnostic and treatment outcome monitoring tool in rehabilitation practice of patients with chronic low back pain (cLBP). No evidence, however, seems to exist, whether or not such posturographic measures are reliable in these patients and therefore clinically and scientifically useful. The aims of this study were manifold and aimed at investigating (1) differences of posturographic measures between cLBP patients and healthy controls (HCs), (2) short- (intrasession-) and long-term (intersession-) reliability of these measurements, and (3) the relationship between both pain intensity and test-related feelings and significant learning effects of the posturographic measures in cLBP. A total of 32 cLBP patients and 19 non-sportive HCs completed (1) comprehensive clinical examination, (2) quantitative posturographic testing (SMART EquiTest, Neurocom International, Clackamas, Oregon) that included all the sensory organisation test (SOT), the motor control test (MCT) and the adaptation test (ADT) and (3) psychological ratings of pain as well as posturographic test related personal feelings and fear associated beliefs. Of these, 22 cLBP patients who received no therapy repeated all measurements and examinations on a second day, 2-3 weeks later. Results revealed significant differences between cLBP patients and HCs in the more demanding postural test conditions of the SOT and the SOT composite score only. Intra-session reliability testing demonstrated significant improvements of the SOT and ADT measures for both HCs and cLBP patients. Results of long-term reliability testing showed significant improvements of the more challenging SOT conditions and SOT composite score. VAS ratings of pain, feelings and fear associated beliefs were not associated with such longitudinal changes. CONCLUSION: Our findings suggest that the significant learning effects observed for the SOT conditions may limit the clinical application of SMART EquiTest postural stability measures for cLBP patients in rehabilitation everyday practice. Further development in software processing will be necessary to identify new postural parameters that are less prone to learning effects.

How many body locations need to be tested when assessing sensation after stroke? An investigation of redundancy in the Rivermead Assessment of Somatosensory Performance.

OBJECTIVE: Assessing sensation after stroke is time consuming. This study aimed to identify how many body locations need to be tested to establish whether sensation is ;intact', ;impaired' or ;absent' and to assess validity of that classification. DESIGN: Participants' sensation was tested in a single assessment session. Agreement between the scores for individual anatomical sites and those for the whole limb was calculated using a weighted kappa and percentage agreement for each modality. High agreement between tests indicated redundancy, suggesting that the number of anatomical sites tested could be reduced. The Kruskal-Wallis test assessed the validity of classification by comparing a range of measures of functional ability in people with intact, impaired and absent sensation. SETTING: Hospital-based stroke care. SUBJECTS: One hundred and two patients tested 2-4 weeks after stroke. MAIN MEASURES: Four proprioceptive and tactile modalities were measured using the Rivermead Assessment of Somatosensory Performance. RESULTS: Agreement between the total limb score and individual anatomical sites was substantial to excellent for all modalities and anatomical sites. Agreement was greater than 90% when sensation was intact or absent. The comparison between patients with intact, impaired and absent sensation showed significant differences in functional mobility, independence in the activities of daily living, balance and weakness in people with stroke. CONCLUSIONS: Sensory impairment can be classified as ;intact', ;impaired' or ;absent'. There is a high redundancy between anatomical sites when the patient's sensation is ;intact' or ;absent' and not all sites need to be tested. Reducing the number of sites tested will improve usability of the Rivermead Assessment of Somatosensory Performance in day-to-day clinical practice.

The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders.

OBJECTIVE: To investigate the intra-rater and inter-rater reliability of the Erasmus MC modifications to the Nottingham Sensory Assessment (EmNSA). SUBJECTS: A consecutive sample of 18 inpatients, with a mean age of 57.7 years, diagnosed with an intracranial disorder and referred for physiotherapy. SETTING: The inpatient neurology and neurosurgery wards of a university hospital. DESIGN: Through discussions between four experienced neurophysiotherapists, the testing procedures of the revised Nottingham Sensory Assessment were further standardized. Subsequently, the intra-rater and inter-rater reliabilities of the EmNSA were investigated. RESULTS: The intra-rater reliability of the tactile sensations, sharp blunt discrimination and the proprioception items of the EmNSA were generally good to excellent for both raters with a range of weighted kappa coefficients between 0.58 and 1.00. Likewise the inter-rater reliabilities of these items were predominantly good to excellent with a range of weighted kappa coefficients between 0.46 and 1.00. An exception was the two-point discrimination that had a poor to good reliability, with the range for intra-rater reliability of 0.11-0.63 and for inter-rater reliability -0.10-0.66. CONCLUSION: The EmNSA is a reliable screening tool to evaluate primary somatosensory impairments in neurological and neurosurgical inpatients with intracranial disorders. Further research is necessary to consolidate these results and establish the validity and responsiveness of the Erasmus MC modifications to the NSA.