The Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment for patients following acquired brain injury: Translation and reliability study.

OBJECTIVE: To develop the Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment and to investigate its internal consistency, intra- and inter-rater reliability. DESIGN: Prospective cohort study. SETTING: Rehabilitation department. SUBJECTS: A total of 34 patients with acquired brain injury. MAIN MEASURE: The translation and cultural adaptation process was completed, and the testing procedures of the Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment were standardized. Internal consistency was evaluated using Cronbach's alpha index; assessment of intra- and inter-rater reliability was carried out using weighted kappa coefficient. RESULTS: The internal consistency of the tactile sensations and the proprioception items of the Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment were generally acceptable to excellent with a range of Cronbach's alpha between 0.73 and 0.97. The intra-rater reliability of the tactile sensations and the proprioception items of the Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment were generally good to excellent with a range of weighted kappa coefficients between 0.47 and 1.00. Likewise, the inter-rater reliabilities of these items were predominantly good to excellent with a range of weighted kappa coefficients between 0.42 and 0.92. CONCLUSION: The Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment is a reliable screening tool to evaluate primary somatosensory impairments in patients with acquired brain injury. Further research is necessary to consolidate these results and establish the validity and responsiveness of the Italian version of the Erasmus MC modifications to the Nottingham Sensory Assessment.

Sensory impairments of the lower limb after stroke: a pooled analysis of individual patient data.

OBJECTIVE: To obtain more generalizable information on the frequency and factors influencing sensory impairment after stroke and their relationship to mobility and function. METHOD: A pooled analysis of individual data of stroke survivors (N = 459); mean (SD) age = 67.2 (14.8) years, 54% male, mean (SD) time since stroke = 22.33 (63.1) days, 50% left-sided weakness. Where different measurement tools were used, data were recorded. Descriptive statistics described frequency of sensory impairments, kappa coefficients investigated relationships between sensory modalities, binary logistic regression explored the factors influencing sensory impairments, and linear regression assessed the impact of sensory impairments on activity limitations. RESULTS: Most patients' sensation was intact (55%), and individual sensory modalities were highly associated (κ = 0.60, P < .001). Weakness and neglect influenced sensory impairment (P < .001), but demographics, stroke pathology, and spasticity did not. Sensation influenced independence in activities of daily living, mobility, and balance but less strongly than weakness. CONCLUSIONS: Pooled individual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated; interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.

Are the hierarchical properties of the Fugl-Meyer assessment scale the same in acute stroke and chronic stroke?

BACKGROUND: The motor function section of the Fugl-Meyer assessment scale (FM motor scale) is a robust scale of motor ability in people after stroke, with high predictive validity for outcome. However, the FM motor scale is time-consuming. The hierarchical properties of the upper extremity (UE) and lower extremity (LE) sections of the FM motor scale have been established in people with chronic stroke. These data support the use of a more concise method of administration and confirm scores can be legitimately summed. OBJECTIVE: The aim of this study was to establish that a similar hierarchy exists in people within 72 hours after stroke onset. DESIGN: A prospective, cross-sectional design was used. METHODS: Data were obtained from 75 eligible people in a nationwide prospective study (the Early Prediction of Functional Outcome After Stroke). The full version of both sections of the FM motor scale was administered within 72 hours after stroke onset. The hierarchy of item difficulty was investigated by applying Guttman scaling procedures within each stage and each subsection of the UE and LE sections of the scale. The scaling procedures then were applied to item difficulty between stages and subsections and finally across all scale items (stage divisions ignored) of the FM motor scale. RESULTS: For all analyses, the results exceeded acceptable levels for the coefficient of reproducibility and the coefficient of scalability. LIMITATIONS: The sample was a population of people with stroke of moderate severity. CONCLUSIONS: The unidimensional hierarchy of the UE and LE sections of the FM motor scale (already established for chronic stroke) within 72 hours after stroke onset was confirmed. A legitimate total summed score can indicate a person's level of motor ability.

Hierarchical properties of the motor function sections of the Fugl-Meyer assessment scale for people after stroke: a retrospective study.

BACKGROUND AND PURPOSE: The upper-extremity (UE) and lower-extremity (LE) sections (excluding balance) of the motor function domain of the Fugl-Meyer (FM) assessment scale (a construct referred to here as the FM motor scale) are recognized as a robust part of the scale for use with people after stroke. However, it is frequently criticized as a lengthy and time-consuming measurement tool. The aims of this study were to support a shortened method of administration for the FM motor scale and to provide arguments for the use of a summed score. In pursuit of these aims, the hierarchical properties of both the UE and LE sections of the FM motor scale were investigated. PARTICIPANTS AND METHODS: A retrospective analysis of data from 62 people with a previous stroke was performed. Guttman scale analysis considered the hierarchy of items within each subsection and each stage, between subsections and stages, and across all of the scale items (ignoring the stage divisions) of the FM motor scale. RESULTS: For the within-stage and subsection analyses and between-stage and subsection analyses, all of the results met or exceeded the acceptable levels for the coefficient of reproducibility and the coefficient of scalability. When stage divisions were ignored, the coefficient of reproducibility for both extremities was just below acceptable levels. DISCUSSION AND CONCLUSION: The results support the use of the UE and LE sections of the FM motor scale as a stagewise and subsectionwise hierarchical assessment and outcome measure. This allows the use of a shortened method of administration, which can potentially reduce the time required for scale administration, and appropriate scores can be allocated for untested items, such that a legitimate total summed score can be used. A limitation of this study was that the study population consisted predominantly of older people with such severe disability that they were unable to function independently.