Validation of French upper limb Erasmus modified Nottingham Sensory Assessment in stroke.

BACKGROUND: Somatosensory impairment of the upper limb (UL) occurs in approximately 50% of adults post-stroke, associated with loss of hand motor function, activity and participation. Measurement of UL sensory impairment is a component of rehabilitation contributing to the selection of sensorimotor techniques optimizing recovery and providing a prognostic estimate of UL function. To date, no standardized official French version of a measure of somatosensory impairment has been established. OBJECTIVE: To develop and validate a French version of the Erasmus modified Nottingham Sensory Assessment somatosensory (EmNSA-SS) and stereognosis (EmNSA-ST) component for evaluating the UL among adults with stroke. METHODS: This study is a single-center observational cross-sectional study. A French version of the EmNSA for UL was developed by forward-backward translation and cross-cultural adaptation. Fifty stroke patients were recruited to establish concurrent-criterion-related validity, internal consistency, intra- and inter-rater reproducibility with intracorrelation coefficients (ICCs) for reliability and the minimal detectable change with 95% confidence interval (MDC95) for agreement, as well as ceiling and floor effects. Criterion validity was assessed against the Fugl-Meyer Assessment-Sensory (FMA-S) for the UL. RESULTS: The median (range) EmNSA-SS score was 41.5 (1-44). The Spearman rank correlation coefficient between EmNSA-SS and FMA-S total scores was moderate (rho=0.74, P<0.001). The EmNSA-SS/ST internal consistency was adequate across subscales; with Cronbach α ranging from 0.82-0.96. For the EmNSA-SS total score, intra- and inter-rater reliability was excellent (ICC=0.92 in both cases), with MDC95 of 12.3 and 14.6, respectively. EmNSA-SS/ST total scores demonstrated no ceiling or floor effects. CONCLUSIONS: The French EmNSA is a valid and reproducible scale that can be used for comprehensive and accurate assessment of somatosensory modalities in adults post-stroke. Taking less than 30min to administer, the instrument has clinical utility for use in patients with cognitive comorbidities and at various stages of recovery in multidisciplinary clinical practice and research settings.

Relationship between oral stereognostic ability and dietary intake in older Japanese adults with complete dentures.

PURPOSE: Oral stereognostic ability (OSA) is a useful indicator of oral perception to recognize food characteristics during mastication. Previous studies have shown associations between dietary intake and oral health status, such as taste perception. However, the effect of oral sensory ability on dietary intake is unclear. The purpose of this study was to investigate the association between oral sensory ability and dietary intake in older Japanese complete denture wearers. METHODS: This cross-sectional study included 164 participants aged 69-71 or 79-81years old, wearing both maxillary and mandibular complete dentures. OSA test was used to evaluate oral tactile perception. Diet during the preceding month was assessed using a self-administered diet history questionnaire. Multivariable linear regression analysis was conducted to assess the association between OSA score and food and nutrient intake after adjusting for age, sex, socioeconomic factors, and occlusal force. RESULTS: The bivariate analysis showed that OSA score was significantly and positively correlated with intake of green and yellow vegetables and negatively correlated with intake of cereals among examined foods. OSA score was also positively correlated with intake of vitamins A, B2, and C and α-tocopherol (as a substitute for vitamin E) among examined nutrients. After adjusting for age, sex, socioeconomic factors, and occlusal force, OSA score remained significantly associated with intake of green and yellow vegetables and α-tocopherol. CONCLUSIONS: OSA was significantly associated with intake of green and yellow vegetables in older complete denture wearers.

Tactile spatial acuity in elderly persons: assessment with grating domes and relationship with manual dexterity.

In this study, we sought to better define the limit of spatial resolution at the fingertips of elderly participants (n = 30, age 60-95 years) using an extended set of JVP grating domes, incorporating four new grating dimensions (2.5-, 3.5-, 4.0- and 4.5-mm width). A secondary aim was to examine whether deficits in tactile acuity could be related to hand dysfunction in older adults. Spatial resolution thresholds were determined by the finest grating whose orientation (dominant index finger) could be reported reliably. Manual dexterity was assessed with the Grooved Pegboard Test (GPT). The extended set of domes improved threshold measurements in a majority of participants (21/30). Still, accurate threshold estimates could not be obtained in one third of the participants, mostly in the older age group (8/9, 74-95 years). Grating resolution thresholds at the index finger were strongly correlated (r = 0.66, p<0.01) with dexterity scores derived from the GPT. From these results, we conclude that the 2.5- and 3.5-mm grating domes are suitable additions when assessing spatial acuity at the fingertips of older subjects between 60 and 70 years of age (mean threshold, 2.7+/-0.6 mm). For the older ones, the 4.0- and 4.5-mm domes can improve threshold measurements but interpretation of values can be complicated by the presence of undiagnosed pathologies (e.g., diffuse polyneuropathy) as people advance in age. The strong relationship between grating resolution thresholds and dexterity scores indicates that an impaired spatial acuity at the fingertips may translate into great difficulties in tasks requiring fine manipulations. These findings have important implications for the assessment of hand function in older adults.

Assessment of spatial acuity at the fingertip with grating (JVP) domes: validity for use in an elderly population.

JVP domes are of a set of small grating surfaces recently introduced for cutaneous spatial resolution measurement. The gratings are placed on the skin and subjects are required to identify the orientation of grooves and bars. The finest grating whose orientations are discriminated reliably (75% correct) provides an estimate of the spatial resolution limit in the tested area. In the present study, we sought to determine the capacity of elderly subjects to resolve such grating stimuli in order to obtain normative data for this population. Thirty-two elderly individuals in good health (range: 60-88 years) were assessed for their ability to perceive grating orientation at the tip of the dominant index finger. Testing proceeded from the widest grating dome (3 mm) to the next (e.g., 2 mm), until the performance level dropped below 75% correct discrimination. The grating orientation task proved to be very difficult for most subjects and only a minority (14/32) was able to provide reliable reports of grating orientation even with presentation of the widest dome available (3 mm). Accordingly, individual grating resolution thresholds were often considerably higher (> 2.5 mm, n = 26) than values previously reported in young adults for the fingertip region (approximately 1 mm). These results suggest that the current set of grating domes may not be adequate for spatial acuity measurement at the fingertip of older adults. New larger grating dimensions should be added to the set presently available to improve their sensitivity for an older population.

Effect of focus lateralization on memory assessment during the intracarotid amobarbital procedure.

Despite the use of stimuli that can be processed by both hemispheres, a number of studies have reported lower memory scores after the left intracarotid amobarbital procedure (IAP) than after the right IAP. Because of that, failure after ipsilateral IAP is observed more often in patients with a left temporal seizure focus (LT) than in right temporal patients (RT), possibly needlessly excluding some LT patients from surgery. In order to overcome the deleterious effects of anesthetizing the dominant hemisphere, we designed an IAP protocol that did not promote verbal encoding of the stimuli. For this purpose, a large number of visual and tactile stimuli (colored pictures and real objects) were presented to be recognized later. The effect of seizure focus lateralization was examined in 82 temporal lobe epileptic patients who underwent IAP as part of their presurgical evaluation. As expected, for both RT and LT patients, long-term recognition of pictures presented under the effect of amobarbital was highly sensitive to the presence of a contralateral epileptic focus. However, contrary to what is generally reported, LT patients performed better than RT patients when their left (ipsilateral) hemisphere was anesthetized. In RT patients, although memory scores were lower after the left contralateral injection, the disparity in memory scores between the right and left injection was not as marked as in LT patients. These results are discussed in terms of the influence of type of processing required during the initial encoding on later recognition during IAP.

Sensory deficit in the hands of children with cerebral palsy: a new look at assessment and prevalence.

The sensory function of the hand was assessed in 55 children with cerebral palsy (CP) and 15 control children with lower-limb involvement after poliomyelitis by testing stereognosis and two-point discrimination. A 0 to 10 per cent error in the post-polio group defined normal limits, according to which 51 per cent of the CP group showed impairment on one or both of the tests. These results confirm those of studies carried out 30 to 40 years ago, and draw attention to a neglected aspect of CP in which the possibility of therapeutic intervention has yet to be adequately explored.