Erasmus MC Modification of the (revised) Nottingham Sensory Assessment

Abstract

The Erasmus MC Modification of the (revised) Nottingham Sensory Assessment (EmNSA) is a standardized observational tool designed to measure and quantify sensory limitations, specifically in the upper and lower extremity. Developed as a refinement of the original Nottingham Sensory Assessment (NSA), the EmNSA evaluates three primary sensory functions: tactile sensation (touch), sharp-dull discrimination, and proprioception (joint position sense). The assessment systematically divides both the upper and lower limbs into four distinct anatomical regions or joints. Scoring utilizes a three-point ordinal scale (0=absent, 1=impaired, 2=normal), allowing for objective evaluation and calculation of a total impairment score. Administration of the assessment for the upper extremity typically requires 10 to 15 minutes.

Keywords

EmNSA, Nottingham Sensory Assessment, Proprioception, Tactile sensation, Sharp-dull discrimination, Sensory impairment, Somatosensation, Upper extremity, Lower extremity, Neurological assessment.

Authors

Stolk-Hornsveld F, Crow JL, Hendriks EP, van der Baan R, Harmeling-van der Wel BC (2006)

Purpose

The primary purpose of the EmNSA is to provide a structured and reliable method for quantifying the severity and distribution of sensory deficits following neurological events, such as stroke or central nervous system injury. By focusing on specific modalities of sensation—touch, pain/temperature proxies (via sharp-dull discrimination), and joint position sense—the instrument assists clinicians and researchers in precisely locating the extent of sensory loss and tracking recovery over time.

The instrument is particularly valuable in rehabilitation settings, offering detailed, objective data necessary for developing targeted therapy plans. It facilitates the measurement of sensory functions that are crucial for motor control and functional independence, ensuring that interventions address both motor and underlying somatosensation deficits.

Construct

The EmNSA measures components of the somatosensory system. Specifically, it assesses the integrity of the pathways responsible for transmitting discriminative touch and conscious proprioception. These functions are typically mediated by the dorsal column-medial lemniscus pathway.

The scale operationalizes the construct by examining the patient’s ability to perceive standard stimuli at defined points across the limbs. The assessment structure ensures that both fine touch (light touch) and crude sensation (sharp/dull) are evaluated, alongside the crucial ability to perceive joint movement and position without visual input. The systematic regional testing—starting distally and moving proximally—provides a detailed topographic map of sensory function.

Validity

Specific validity data (content, criterion, construct) for the 2006 Erasmus MC Modification were not provided in the source material. However, as a modification of the widely recognized Nottingham Sensory Assessment (NSA), the EmNSA inherits foundational content validity derived from the NSA’s established use in stroke and neurological populations.

For a modified instrument, high concurrent validity with the original NSA and other established sensory scales (e.g., Rivermead Assessment of Somatosensory Performance) would be expected. Researchers utilizing the EmNSA should refer to the original publication by Stolk-Hornsveld et al. (2006) for detailed psychometric validation studies demonstrating its ability to accurately measure sensory deficits.

Reliability

Specific reliability data (inter-rater, intra-rater, test-retest) for the EmNSA were not detailed in the source content. Given that the EmNSA is an observational measure relying on standardized administration and scoring of patient responses, high inter-rater reliability is crucial for its clinical utility.

The detailed instructions, defined points of application, and the use of a simple 3-point scoring scale are intended to maximize objectivity and minimize measurement error, thereby bolstering the instrument’s reliability when administered by trained personnel.

Factor Analysis

Information regarding specific factor analysis performed on the EmNSA was not provided in the source material. Typically, factor analysis would be employed to confirm that the scale items indeed group into the intended sensory domains (tactile sensation, sharp/dull discrimination, and proprioception) and to verify if the upper and lower extremity subscales represent distinct or unified factors of sensory function.

Instrument

Test Type: Observational Measurement Tool

Format: Structured clinical assessment utilizing standardized stimuli and a defined scoring form.

Language Available: Original documentation provided in Dutch (as per source).

Population Group: Adults, Elderly

Age Group: Typically used with adult populations experiencing acquired sensory deficits.

Population Details: Primarily used for individuals with conditions affecting the nervous system and senses, common in rehabilitation settings (e.g., post-stroke, traumatic brain injury).

Test Methodology: The examination begins distally for each sensory modality. A 3-point scoring scale is employed (0=absent, 1=impaired, 2=normal). The assessment includes a detailed instruction manual describing defined contact points and the precise execution of the proprioception testing, often supplemented with illustrative images. The administration time for the upper extremity assessment is approximately 10 to 15 minutes.

Keywords

Clinical assessment, Rehabilitation, Neurological deficit, NSA modification, Extremity function, Somatosensory deficits, Observational scale, Stolk-Hornsveld.

Authors

Author ORCID Identifier: Information not available in source content.

Affiliation Email addresses: Information not available in source content.

Correspondence Address: Information not available in source content.

Permissions & Fee and Test Year

Information regarding specific permissions, licensing fees, and current usage rights for the EmNSA is not available in the source material and must be sought directly from the authors or the Erasmus MC institution.

Test Year: 2006 (Year of publication for the modification).

The original Explanation Form (Toelichtingsformulier) can be downloaded here: EmNSA-form-.pdf

The original Measurement Instrument (Meetinstrument) can be downloaded here: EmNSA-meetinstr.pdf

Reference’s

Stolk-Hornsveld F, Crow JL, Hendriks EP, van der Baan R, Harmeling-van der Wel BC (2006). Title of original publication detailing the EmNSA modification (Specific title not provided in source).

Items of the Erasmus MC Modificatie van de (revised) Nottigham Sensory Assessment

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

De EmNSA heeft als doel om sensorische beperkingen van de bovenste en onderste extremiteit te meten. De geteste sensorische functies zijn tastzin, de scherp-dof discriminatie en de propriocepsis.

De bovenste extremiteit wordt onderverdeeld in vier delen c.q. gewrichten:

• Voor de tastzin en scherp-dof discriminatie:
1. vingers;
2. hand;
3. onderarm;
4. bovenarm.
• Voor de propriocepsis:
1. vingers;
2. pols;
3. elleboog;
4. schouder.

De onderste extremiteiten zijn ook onderverdeeld in vier delen c.q. gewrichten:

• Voor de tastzin en scherp-dof-discriminatie:
1. tenen;
2. voet;
3. onderbeen;
4. bovenbeen.
• Voor de propriocepsis:
1. tenen;
2. enkel;
3. knie;
4. heup.

Bij elke type sensibiliteit wordt distaal gestart met meten en wordt een 3 puntsschaal gebruikt met de scores 0 (afwezig), 1 (gestoord) en 2 (normaal), wat ingevuld wordt een scoreformulier, waarbij het totaal berekend kan worden.