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The validity of the US-Nottingham Sensory

Assessment in persons with chronic stroke.

Sue Doyle PhD OTR/L CFE, Domonique Herrin OTS, Alina Muller OTS
Occupational Therapy Program, University of Puget Sound, Tacoma WA



Rationale/Background. Currently the most frequently

used assessment of sensation after stroke is
unstandardized and has poor reliability (Doyle, Bennett,
& Gustaffson, 2013). The Nottingham Sensory
Assessment (NSA) has been developed in Europe and is
a multi-modal sensory assessment that has strong
parametric properties and good clinical utility and is
recommended for use after stroke (Connell & Tyson,
2012). The NSA has been modified for use in America
(Miller, Acorta, & Doyle, 2016) but further testing to
demonstrate the validity of this revised measure is

Results showed very high concurrent validity between

the US-NSA and the FMA-S (r = .911). Moderate
relationships between UE sensory (US-NSA UE (r =
.676) & FMA-S (r= .577) and functional hand and arm
use (CAHI) were found.

Aim. The purpose of this study was to explore the

concurrent validity of the United States version of the
Nottingham Sensory Assessment (US-NSA) in persons
with chronic stroke.

Design. A quantitative, descriptive study.
Participants. We recruited a convenience sample of 12
adults (5 males, 7 females) with chronic stroke from a probono outpatient clinic. The participants ranged in age from
53 to 85 years old with an average time post-stroke of 5.6
Methods to Obtain Data. The US-NSA consists of 5
sensory modalities that are tested in 4 locations in both
upper and lower limbs and scored on a 3 point ordinal
scale. There is also a 6 item stereognosis subscale. Total
score possible for each side of the body is 92 with higher
scores indicating less impairment.
Fugl-Meyer Assessment-Sensory subscale (FMA-S)
consists of 6 items for each of the upper and lower limbs
that are scored on a similar 3 point ordinal scale for a total
possible score of 24 points.


The Chedoke Arm Hand Inventory (9) is a 9 item measure

that assesses functional recovery of the arm and hand using
a 7 point quantitative scale for a possible total score of 63
Participants were evaluated on all measures within a 3 week
time period over 2 sessions. The US-NSA was administered
by trained, experienced therapists participating in the study of
inter-rater reliability of the US-NSA. The scores from the first
administration of the and the FMA-s & CAHI were
administered at a second session by the two of the
researchers who had completed training and achieved
consistency in administration.
Analytical Methods. The concurrent validity of the US-NSA
was evaluated using Pearsons product moment correlation
with the FMA-S. The relationship between functional use of
the upper limb (CAHI) and sensory abilities (US-NSA & FMAs) after stroke was also evaluated using Pearsons product
moment correlation.
Significance level was chosen to be .05, and the correlations
strengths were interpreted as follows: .901.00 very high,
.70.90 high, .50.70 moderate, .30.50 low, and .00.30
little if any correlation (Hinkle, Wiersma, & Jurs, 1998).

Discussion. This study provides preliminary support

for the validity of the US-NSA. While further studies
with larger sample sizes and higher power are
warranted to evaluate the psychometric properties of
the US-NSA, based on the current results, and
previous studies on prior versions of the NSA,
therapists could use the US-NSA in clinical practice.
Impact Statement: Using a reliable and valid
measure of sensory impairments will provide
practitioners with accurate data on which to plan
intervention strategies. The US-NSA demonstrates
potential to be a measure with good parametric
characteristics and clinical utility for use with clients
after stroke.
ACKNOWLEDGEMENTS: The participants (both
therapists and persons with stroke) who volunteered
for the project.

Doyle, S.D., Bennett, S., & Gustafsson, L. (2013).
Occupational therapy for upper limb post-stroke sensory
impairments: a survey. British Journal of Occupational
Therapy, 76(10), 434-442.
Miller, B., Acorta, A., & Doyle, S. D. The development and
reliability of the US-Nottingham Sensory Assessment in
persons with chronic stroke. Research paper. American
Occupational Therapy Association Annual Conference,
Chicago, IL. April, 2016.