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

Abstract

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.

Get full access to this article

View all access options for this article.

References

Carey LM Somato-sensory loss after stroke. Crit Rev Phys Rehabil Med 1995; 7: 51-91.

Bobath B. Adult hemiplegia: evaluation and treatment, third edition. Butterworth-Heinnemann, 1990.

Partridge C. , Cornall C. , Lynch M. et al. Physical therapies in neurological rehabilitation. In Greenwood R , Barnes M , McMillan T , Ward C. eds. Neurological Rehabilitation. Mosby Hall, 1997.

Winward CE , Halligan PW , Wade DT The Rivermead Assessment of Somatosensory Performance (RASP): standardization and reliability data. Clin Rehabil 2002; 16: 523-33.

Tyson S. , Hanley M. , Chillala J. , Selley AB , Tallis RC Sensory loss in hospital-admitted people with stroke: characteristics, associated factors and relationship with function. Neurorehabil Neural Repair 2008; 22: 166-72.

Tyson SF , Hanley M. , Chillala J. et al. Balance disability after stroke. Phys Ther 2006; 86: 30-38.

Tyson SF , DeSouza LH Development of the Brunel Balance Assessment: a new measure of balance disability post stroke. Clin Rehabil 2004; 18: 801-10.

Landis JR , Koch GG The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-74.

Demeurrise G. , Demol O. , Robaye E. Motor evaluation of vascular hemiplegia. Eur Neurol 1980; 19: 382-89.

10.

Collen F. , Wade D. , Robb G. , Bradshaw C. The Rivermead Mobility Index; a further development of the Rivermead Motor Assessment. Int Disabil Stud 1991; 13: 50-54.

11.

Collin C. , Wade DT , Davis S. , Horne V. The Barthel ADL Index: A reliability study. Int Disabil Stud 1988; 10: 61-63.

12.

Lincoln NB , Jackson JM , Adams SA Reliability and revision of the Nottingham Sensory Assessment for stroke patients . Physiotherapy 1998; 84: 358-65.