Revised Nottingham Sensory Assessment Research Articles

The Turkish Version of the Revised Nottingham Sensory Assessment: Validity and Reliability in Chronic Stroke Survivors.

Evaluation of sensory functions in chronic stroke survivors is essential to plan and implement effective treatment and rehabilitation. To investigate the validity and reliability of the Turkish version of the Revised Nottingham Sensory Assessment (rNSA-T) in chronic stroke survivors. We applied the World Health Organization's translation protocols to develop the rNAS-T. We then tested its validity and reliability in 85 chronic stroke survivors using criterion validity and consistency for demographic variables, as well as test-retest and inter-rater reliability analyses. The criterion validity of the rNSA-T was supported by significant correlation between participants' scores on the rNSA-T, the Katz Index of Independence in Activities of Daily Living (Katz-AD) (r = 0.430-0.674, P < 0.05), and the Rivermead Motor Assessment (RMA) (r = 0.528-0.773, P < 0.05). rNSA-T results remained consistent across variables of sex and side affected by stroke (P > 0.05). The test-retest reliability of the rNSA-T was excellent in all subdimensions (ICC = 0.865-1.000), as was the inter-rater reliability (κ = 0.875-1.000). The rNSA-T is a valid and reliable tool for evaluation of sensory functions in chronic stroke survivors.

Comparisons of three different modes of digital mirror therapy for post-stroke rehabilitation: Preliminary results of randomized controlled trial

Objective Technologically adapted mirror therapy shows promising results in improving motor function for stroke survivors. The treatment effects of a newly developed multi-mode stroke rehabilitation system offering multiple training modes in digital mirror therapy remain unknown. This study aimed to examine the effects of unilateral mirror visual feedback (MVF) with unimanual training (UM-UT), unilateral MVF with bimanual training (UM-BT), and bilateral MVF with bimanual training (BM-BT) on clinical outcomes in stroke survivors, compared to classical mirror therapy (CMT). Methods Thirty-five participants were randomly assigned to one of four groups receiving fifteen 60-minute training sessions for 3–4 weeks. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), Revised Nottingham Sensory Assessment (rNSA), Motor Activity Log (MAL), and EQ-5D-5L were administered at pre- and post-intervention and at 1-month follow-up. Results After intervention and follow-up, significant within-group treatment efficacies were found on most primary outcomes of the FMA-UE and CAHAI scores in all four groups. Significant within-group improvements in the secondary outcomes were found on the MAL and EQ-5D-5L index in the UM-BT group, and the rNSA tactile sensation and MAL quality of movement subscales in the BM-BT group. No significant between-group treatment efficacies were found. Conclusions UM-UT, UM-BT, BM-BT, and CMT led to similar clinical effects on the FMA-UE and can be considered effective alternative interventions for post-stroke upper-limb motor rehabilitation. UM-BT and BM-BT showed within-group improvements in functional performance in the patients’ affected upper limbs in real-life activities.

Effects of acupuncture synchronized rehabilitation therapy on upper limb motor and sensory function after stroke: a study protocol for a single-center, 2 × 2 factorial design, randomized controlled trial.

Upper limb function reconstruction has been an important issue in the field of stroke rehabilitation. Due to the complexity of upper extremity dysfunction in stroke patients, the clinical efficacy produced by central or peripheral stimulation alone is limited. For this reason, our group has proposed acupuncture synchronized rehabilitation therapy (ASRT), i.e., simultaneous scalp acupuncture and intradermal acupuncture during rehabilitation. Pre-experiments results showed that this therapy can effectively improve the motor and sensory functions of upper limbs in post-stroke patients, but the clinical efficacy and safety of ASRT need to be further verified, and whether there is a synergistic effect between scalp acupuncture and intradermal acupuncture also needs to be studied in depth. Therefore, we designed a randomized controlled trial to compare the efficacy and safety of different therapies to explore a more scientific "synchronous treatment model." This is a single-center, randomized controlled trial using a 2 × 2 factorial design. We will recruit 136 stroke survivors with upper extremity dysfunction and randomize them into four groups (n = 34). All subjects will undergo routine treatment, based on which the Experimental Group 1: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb; Experimental Group 2: rehabilitation training of the affected upper limb synchronized with focal-side scalp acupuncture treatment, and Experimental Group 3: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb synchronized with focal-side scalp acupuncture treatment; Control Group: rehabilitation training of the affected upper limb only. The intervention will last for 4 weeks, 5 times a week. Both acupuncture treatments will be performed according to the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcome indicators for this trial are Fugl-Meyer Assessment-Upper Extremity and Somatosensory Evoked Potential. Secondary outcome indicators include Wolf Motor Function Test, Upper Extremity Function Test, revised Nottingham Sensory Assessment Scale, Diffusion Tensor Imaging, and Modified Barthel Index. The incidence of adverse events will be used as the indicator of safety. The study will provide high-quality clinical evidence on whether ASRT improves upper limb motor and sensory function and activities of daily living (ADL) in stroke patients, and determine whether scalp acupuncture and intradermal acupuncture have synergistic effects. https://www.chictr.org.cn/, Chinese Clinical Trial Registry [ChiCTR2200066646].

Assessment for Tactile Perception in Children With Cerebral Palsy.

Impaired tactile perception frequently accompanies motor deficits in children with cerebral palsy (CP). Assessing tactile perception precisely for children with CP remains challenging because of a lack of assessments with robust psychometric evidence or standard procedures. To develop a standardized assessment tool, the Tactile Perceptual Test (TPT), for measuring tactile perception in children with CP and to examine its psychometric properties. Observational study design. University research laboratory and medical center. Children with CP (n = 100) and typical development (TD; n = 50). The TPT includes four subtests measuring stereognosis, roughness, hardness, and heaviness. Three comparator instruments, Semmes-Weinstein monofilaments, Two-Point Discrimination, and the stereognosis subtest of the Revised Nottingham Sensory Assessment, were used for convergent validity. Good test-retest reliability was confirmed for all of the TPT subtests. The values of minimal detectable change were acceptable. Moderate correlations between the TPT and comparator instruments were found, as expected. For known-groups validity, the significant difference was confirmed between children with CP and those with TD. The TPT is a reliable and valid measure for multiple subdomains of tactile perception in children with CP. This tactile assessment may help clarify tactile performance to provide appropriate, precise interventions. What This Article Adds: The TPT measures tactile perception in children with CP. It has four subdomains of tactile perception that could facilitate prioritization of tactile treatment of specific subdomains and thereby aid in the provision of appropriate interventions.

Effect Of Thermal Stimulation And Mirror Therapy On Hand Functions In Patients With Stroke: An Interventional Study

&#x0D; Background: Thermal stimulation can be used as an intervention to enhance sensory function. Activated areas by thermal stimulation are greater than those by tactile or mechanical stimulation. Mirror therapy creates the illusion of normal movement with the mirror image of the unaffected upper extremity. Thermal stimulation provides somatosensory stimulation that causes the forced use of the involved extremity as a protective response to heat which provokes volitional/reflexive motor activity. Somatosensory stimulation may induce brain plasticity.&#x0D; Purpose: This study was carried out to determine the effect of thermal stimulation and mirror therapy in the sensorimotor and functional recovery of hand in stroke patients with hand impairment.&#x0D; Methods: 18 stroke survivors were randomly assigned to Thermal Stimulation rehabilitation treatment and Mirror Therapy rehabilitation group (30 minutes daily for 3 weeks). Three measures, including Brunnstorm stage, Wolf motor Function Test, and Revised Nottingham Sensory Assessment scale was used as an outcome measure to assess the motor and sensory recovery.&#x0D; &#x0D; &#x0D; &#x0D; Results: The Thermal Stimulation group showed a potential trend for improved recovery stage as measured by Brunnstorm staging for motor recovery of hand as compared to the Mirror therapy group. The Thermal Stimulation group also showed a statistically significant and large improvement in tactile, proprioception and stereognosis score as measured by Revised Nottingham sensory assessment scale whereas Mirror Therapy group showed significant improvement in stereognosis score alone.&#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Thermal stimulation has more positive effect in the sensorimotor and functional recovery of hand in acute stroke patients with hand impairment within 3 weeks in comparison to Mirror Therapy. Thermal stimulation protocol should be added in the clinical setting of rehabilitation in stroke patients with hand impairment on the basis of the result of this study.&#x0D;

Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial

BackgroundCombining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT).MethodsThis single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT.DiscussionThe findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke.Trial registrationThis trial was registered December 12, 2018, at www.clinicaltrials.gov (NCT03773653).

Effects of proximal priority and distal priority robotic priming techniques with impairment-oriented training of upper limb functions in patients with chronic stroke: study protocol for a single-blind, randomized controlled trial

BackgroundThe sequence of establishing a proximal stability or function before facilitation of the distal body part has long been recognized in stroke rehabilitation practice but lacks scientific evidence. This study plans to examine the effects of proximal priority robotic priming and impairment-oriented training (PRI) and distal priority robotic priming and impairment-oriented training (DRI).MethodsThis single-blind, randomized, comparative efficacy study will involve 40 participants with chronic stroke. Participants will be randomized into the PRI or DRI groups and receive 18 intervention sessions (90 min/day, 3 days/weeks for 6 weeks). The Fugl-Meyer Assessment Upper Extremity subscale, Medical Research Council Scale, Revised Nottingham Sensory Assessment, and Wolf Motor Function Test will be administered at baseline, after treatment, and at the 3-month follow-up. Two-way repeated-measures analysis of variance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after PRI and DRI.DiscussionThrough manipulating the sequence of applying wrist and forearm robots in therapy, this study will attempt to examine empirically the priming effect of proximal or distal priority robotic therapy in upper extremity impairment-oriented training for people with stroke. The findings will provide directions for further studies and empirical implications for clinical practice in upper extremity rehabilitation after stroke.Trial RegistrationClinicalTrials.gov NCT04446273. Registered on June 23, 2020.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation.

Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear.Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors.Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl–Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data.Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data.Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies.Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.

Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study.

The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. Randomized, crossover-controlled, assessor-blinded study. Rehabilitation clinic. Patients (N = 24) with moderate motor and sensory deficits. Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Translation and Validation of the Korean Version Revised Nottingham Sensory Assessment

Translation and Validation of the Korean Version Revised Nottingham Sensory Assessment

The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study.

The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.

The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits

Background/AimsThe Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits.MethodsA pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test.ResultsAlmost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved.ConclusionsThe 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke? Investigating Behavioral Outcome and Neural Correlates

Background. Proportional motor recovery in the upper limb has been investigated, indicating about 70% of the potential for recovery of motor impairment within the first months poststroke. Objective. To investigate whether the proportional recovery rule is applicable for upper-limb somatosensory impairment and to study underlying neural correlates of impairment and outcome at 6 months. Methods. A total of 32 patients were evaluated at 4 to 7 days and 6 months using the Erasmus MC modification of the revised Nottingham Sensory Assessment (NSA) for impairment of (1) somatosensory perception (exteroception) and (2) passive somatosensory processing (sharp/blunt discrimination and proprioception); (3) active somatosensory processing was evaluated using the stereognosis component of the NSA. Magnetic resonance imaging scans were obtained within 1 week poststroke, from which lesion load (LL) was calculated for key somatosensory tracts. Results. Somatosensory perception fully recovered within 6 months. Passive and active somatosensory processing showed proportional recovery of 86% (95% CI = 79%-93%) and 69% (95% CI = 49%-89%), respectively. Patients with somatosensory impairment at 4 to 7 days showed significantly greater thalamocortical and insulo-opercular tracts (TCT and IOT) LL (P < .05) in comparison to patients without impairment. Sensorimotor tract disruption at 4 to 7 days did not provide significant contribution above somatosensory processing score at 4 to 7 days when predicting somatosensory processing outcome at 6 months. Conclusions. Our sample of stroke patients assessed early showed full somatosensory perception but proportional passive and active somatosensory processing recovery. Disruption of both the TCT and IOT early after stroke appears to be a factor associated with somatosensory impairment but not outcome.

Treatment efficacy of a hybrid home-based rehabilitation intervention for patients with stroke: A randomized crossover trial

This study aimed to investigate the treatment effects of a hybrid home-based rehabilitation program combining mirror therapy and task-specific training compared with clinic-based rehabilitation in stroke patients. This was a single-blinded, 2-sequence, 2-period, crossover-designed study. The participants were randomly allocated to 1 of 2 order conditions: home-based rehabilitation first or clinic-based rehabilitation first. During each period, each participant received 12 treatment sessions, with a 4-week washout phase between the 2 periods. Both the home-based and clinic-based rehabilitation groups received 30 to 45 minutes of mirror therapy, followed by 45 to 60 minutes of functional task training, at each 90-min session. Before the interventions began, the client-centered Canadian Occupational Performance Measure was administered to help identify individual tasks and goals of patients. Outcome measures were selected based on the ICF. Outcomes of impairment level were the Fugl–Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire. A total of 24 and 18 patients with stroke completed the study during the intervention period 1 and 2, respectively. Pretest analyses showed that there was no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the amount of use subscale of Motor Activity Log ( P = 0.01) than clinic-based rehabilitation. Clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire ( P = 0.02) than home-based rehabilitation. There were no statistically significant differences between the 2 groups on the other outcomes. This study is unique in developing a hybrid home-based stroke rehabilitation intervention with patient-oriented goals. The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

Effects of Anodal Transcranial Direct Current Stimulation on Somatosensory Recovery After Stroke

The aim of this study was to evaluate the effect of anodal transcranial direct current stimulation over the primary somatosensory cortex on the recovery of somatosensation, motor function, and the activities of daily living in patients with subacute stroke. This study was a prospective, randomized sham controlled, double-blinded study. Patients with subacute stroke having somatosensory deficits (N = 24) were enrolled and assigned randomly to the anodal and sham stimulation groups. Patients received 10 consecutive anodal or sham transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion. Before and after each stimulation session, Nottingham sensory assessments, Semmes Weinstein monofilaments examination, and manual function tests were performed, and modified Brunnstrom classification, modified Barthel index, and functional ambulation categories were assessed. Although there was no clear significant difference between the two groups, when the changes from baseline to posttreatment evaluation were compared between the groups, a partially significant improvement was observed in the anodal stimulation group compared with the sham stimulation group. Interestingly, the tactile sensation of the unaffected side also improved. Moreover, the greater improvement in activities of daily living function was observed in the anodal stimulation group too. Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.

Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

ObjectiveWe investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke. DesignA single-blinded, 2-sequence, 2-period, crossover-designed study. SettingRehabilitation clinics and participant’s home environment. ParticipantsIndividuals with disabilities poststroke. InterventionsDuring each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training. Main Outcome MeasuresOutcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire. ResultsPretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant. ConclusionsThe home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study.

[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol’s feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

Interrater Reliability of Four Sensory Measures in People with Multiple Sclerosis.

Sensory disturbances are a major problem for people with multiple sclerosis (MS), and up to 80% of people with MS present with various sensory deficits. To date, only one study has investigated the reliability of sensory measures in people with MS. We sought to determine the interrater reliability of the verbal analogue scale (VAS), the Erasmus MC modifications to the revised Nottingham Sensory Assessment (EmNSA), Semmes-Weinstein monofilaments (SWMs), and the neurothesiometer (NT) in people with MS. A random sample of 34 people with MS who could walk independently with or without a device was tested by two raters on the same day. For categorical data, percentage agreement, Cohen's kappa, and prevalence-adjusted bias-adjusted kappa were used. For continuous data, interclass correlation coefficient (ICC[2,1]) with 95% confidence intervals (95% CIs), Bland and Altman analysis, and standard error of measurement (SEM) were calculated. For NT, ICC(2,1) values were good, with the highest for first metatarsophalangeal joint (ICC[2,1] = 0.84, 95% CI = 0.69-0.92, SEM = 4.98). The highest ICC(2,1) for VAS was for the question relating to feeling numbness in the hand (ICC[2,1] = 0.93, 95% CI = 0.86-0.96, SEM = 0.64). Findings for EmNSA and SWMs need further verification owing to possible ceiling effects. The NT and VAS had good interrater reliability and should be considered for measuring sensation in ambulatory people with MS. Findings for EmNSA and SWMs revealed either questionable or poor reliability, suggesting the need for further investigation.

Effects of Mirror Therapy on Motor and Sensory Recovery in Chronic Stroke: A Randomized Controlled Trial

ObjectiveTo compare the effects of mirror therapy (MT) versus control treatment (CT) on movement performance, motor control, sensory recovery, and performance of activities of daily living in people with chronic stroke. DesignSingle-blinded, randomized controlled trial. SettingFour hospitals. ParticipantsOutpatients with chronic stroke (N=33) with mild to moderate motor impairment. InterventionsThe MT group (n=16) received upper extremity training involving repetitive bimanual, symmetrical movement practice, in which the individual moves the affected limb while watching the reflective illusion of the unaffected limb's movements from a mirror. The CT group received task-oriented upper extremity training. The intensity for both groups was 1.5 hours/day, 5 days/week, for 4 weeks. Main Outcome MeasurementsThe Fugl-Meyer Assessment; kinematic variables, including reaction time, normalized movement time, normalized total displacement, joint recruitment, and maximum shoulder-elbow cross-correlation; the Revised Nottingham Sensory Assessment; the Motor Activity Log; and the ABILHAND questionnaire. ResultsThe MT group performed better in the overall (P=.01) and distal part (P=.04) Fugl-Meyer Assessment scores and demonstrated shorter reaction time (P=.04), shorter normalized total displacement (P=.04), and greater maximum shoulder-elbow cross-correlation (P=.03). The Revised Nottingham Sensory Assessment temperature scores improved significantly more in the MT group than in the CT group. No significant differences on the Motor Activity Log and the ABILHAND questionnaire were found immediately after MT or at follow-up. ConclusionsThe application of MT after stroke might result in beneficial effects on movement performance, motor control, and temperature sense, but may not translate into daily functions in the population with chronic stroke.

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.