Evidence-based assessment

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Several screening tools, clinical and quantitative measures have been developed to assess somatosensory function. Identification and review of these measures has been undertaken by several authors (Carey, 1995, 2017; Dellon, 2000; Sullivan & Hedman, 2008; Winward, Halligan, & Wade, 1999). It is important that therapists select appropriate measures according to their purpose for testing; considering the type and nature of sensory loss is important to assess the functional implications.

Clinical measures commonly used, such as light touch using the fingertip and limb position sense using up–down movements of the thumb, are largely subjective; lack a standardized protocol; use gross scales such as normal, impaired, or absent; and have variable reliability and no defined criterion of abnormality (Carey, 1995; Carey, Matyas, & Oke, 2002 ; Winward et al., 1999). Moreover, these measures are often insensitive or inaccurate (Kim & Choi-Kwon, 1996; Carey, Matyas, & Oke, 2002).

A few sensory screening tools have been developed for use in the clinical setting after stroke. These include the Nottingham Sensory Assessment (Lincoln, Jackson, & Adams, 1998) and the Rivermead Assessment of Somatosensory Performance (Winward et al., 2002). Detection of light touch and deep pressure may be measured using calibrated monofilaments such as the Semmes-Weinstein monofilaments or Weinstein Enhanced Sensory Test hand monofilaments (Weinstein, 1993).

Discrimination of tactile stimuli, such as precisely defined texture gratings, may be quantitatively assessed using the Tactile Discrimination Test (Carey, Oke, & Matyas, 1997). The Wrist Position Sense Test (Carey, Oke, & Matyas, 1996) is a quantitative measure of limb position sense at the wrist that has high test–retest reliability (r = .88 to .92, standard error of measurement = 2.8°), good discriminative validity, and normative standards (Carey et al., 1996).

Quantitative measures of object recognition that have been developed and may be considered for use with people with stroke are the Hand Active Sensation Test (Williams, Basso, Case-Smith, & Nichols-Larsen, 2006), and modified Moberg pick-up test (Dellon, 2000) and the functional Tactile Object Recognition Test (Carey, Mak-Yuen & Matyas, 2020). Although quantitative, evidence-based measures are available to assess body sensations, these are often not being used in clinical settings (Pumpa et al., 2015).

Please see the SENSe Assess for details of quantitative, evidence-based assessments that may be used. These include:

Tactile Discrimination Test (TDT)

Wrist Position Sense Test (WPST)

Functional Tactile Object Recognition Test (fTORT)


Carey, L. M. (1995). Somatosensory loss after stroke. Critical Reviews™ in Physical and Rehabilitation Medicine7(1), 51-91. doi: 10.1615/CritRevPhysRehabilMed.v7.i1.40.

Carey, L.M. (2017). Review on somatosensory loss after stroke. Critical reviews in Physical and Rehabilitation Medicine, 29(1-4), 1-46. doi: 10.1615/CritRevPhysRehabilMed.v29.i1-4.10

Carey, L.M., Mak-Yuen, Y., & Matyas, T. (2020). The functional Tactile Object Recognition Test: A unidimensional measure with excellent internal consistency for haptic sensing of real objects after stroke. Frontiers in Neuroscience. doi: 10.3389/fnins.2020.542590 

Carey, L. M., Matyas, T. A., & Oke, L. E. (2002). Evaluation of impaired fingertip texture discrimination and wrist position sense in patients affected by stroke: comparison of clinical and new quantitative measures. Journal of Hand Therapy15(1), 71-82.

Carey, L. M., Oke, L. E., & Matyas, T. A. (1996). Impaired limb position sense after stroke: a quantitative test for clinical use. Archives of physical medicine and rehabilitation77(12), 1271-1278.

Carey, L. M., Oke, L. E., & Matyas, T. A. (1997). Impaired touch discrimination after stroke: a quantitative test. Journal of Neurologic Rehabilitation11(4), 219-232.

Dellon, A. L. (2000). Somatosensory Testing and Rehabilitation. Baltimore, MD: The Institute for Peripheral Nerve Surgery.

Kim, J. S., & Choi-Kwon, S. (1996). Discriminative sensory dysfunction after unilateral stroke. Stroke27(4), 677-682.

Lincoln, N. B., Jackson, J. M., & Adams, S. A. (1998). Reliability and revision of the Nottingham Sensory Assessment for stroke patients. Physiotherapy84(8), 358-365.

Pumpa, L. U., Cahill, L. S., & Carey, L. M. (2015). Somatosensory assessment and treatment after stroke: An evidence‐practice gap. Australian occupational therapy journal62(2), 93-104.

Sullivan, J.E., & Hedman, L.D. (2008) Sensory dysfunction following stroke: incidence, significance, examination, and intervention. Topics in Stroke Rehabilitation, 15(3), 200-217. doi: 10.1310/tsr1503-200

Weinstein, S. (1993). Fifty years of somatosensory research: from the Semmes-Weinstein monofilaments to the Weinstein Enhanced Sensory Test. Journal of Hand therapy6(1), 11-22.

Williams, P. S., Basso, D. M., Case-Smith, J., & Nichols-Larsen, D. S. (2006). Development of the Hand Active Sensation Test: reliability and validity. Archives of physical medicine and rehabilitation87(11), 1471-1477.

Winward, C. E., Halligan, P. W., & Wade, D. T. (1999). Current practice and clinical relevance of somatosensory assessment after stroke. Clinical rehabilitation13(1), 48-55. doi: 10.1191/026921599701532126

Winward, C. E., Halligan, P. W., & Wade, D. T. (2002). The Rivermead Assessment of Somatosensory Performance (RASP): standardization and reliability data. Clinical rehabilitation16(5), 523-533.