Nothing here is going to help get survivors recovered. Testing does nothing since the results of the tests never lead directly to protocols that will 100% recover that function. The only goal in stroke is 100% recovery. ALL stroke research should lead directly to that goal. This does nothing of the sort.
Semmes-Weinstein Monofilament Test here.
Thumb Localizing Test here:
The latest here:
Validity and Reliability of the Semmes-Weinstein Monofilament Test and the Thumb Localizing Test in Patients With Stroke
Mabu Suda1,2, 
Michiyuki Kawakami1*, 
Kohei Okuyama1, 
Ryota Ishii3, Osamu Oshima1, 
Nanako Hijikata1, Takuya Nakamura1, Asako Oka1, Kunitsugu Kondo2 and Meigen Liu1- 1Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- 2Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
- 3Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
Background: Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself.
Objective: We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis.
Methods: Fifty patients with chronic stroke (median time after onset of stroke, 848 [474–1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated.
Results: Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83–0.95)/ 0.75 (0.60–0.91) and 0.80 (index finger, 0.67–0.93)/0.79 (0.66–0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71–0.95)/ 0.83 (0.73–0.92), 0.90 (navel level distal space, 0.85–0.96)/ 0.80 (0.69–0.90), 0.80 (shoulder level proximal space, 0.68–0.92)/ 0.77 (0.65–0.89), and 0.87 (shoulder level distal space, 0.80–0.93)/ 0.80 (0.68–0.92) (P < 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94–2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item (r = 0.65, p < 0.001), as did the TLT with the SIAS position sense item (r = −0.70–0.62, p < 0.001 each space).
Conclusions: The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.
Introduction
Somatosensory impairments, such as of touch, temperature, pain, and proprioception, are common in patients who have had a stroke (1, 2). It has been reported that 85% of patients with chronic stroke have impairment of some sensory modality (3), but the observed prevalence varies between studies (4). Somatosensory impairment correlates with motor function and disturbs the control of fine and coordinated upper extremity (UE) movements (5–7) and goal-directed use of the arm (8). This impairment has an effect on the ability to function in activities of daily living (ADL) (9–11) and participation in life activities (12). Furthermore, the longitudinal process of somatosensory recovery has recently been reported (13, 14), and detecting somatosensory impairment is important clinically.
Various examinations have been developed to detect somatosensory impairment. Traditional clinical examinations such as the light touch test (15), up-down test (16), positional mimicry (15), finger finding (15), and so on can be conveniently performed. However, it has been reported that up to 52% of patients had false-negative results with such traditional clinical examinations compared to the non-affected hand (17). Clinical examinations are routinely performed, but they are sometimes inaccurate and insufficient (18). This unreliability might be caused by differences in the procedure among examiners and by poor quantification of the examination itself (15). Therefore, a series of examinations has been invented. The reliability of examinations with special instruments like the Tactile object identification test (19), the Shape/Texture Identification test (20), the Tactile Discrimination Test (17), and the Wrist Position Sense Test (17) has been reported, but they are not usually available in the hospital. The Fugl-Meyer Assessment set (FMA) (21), the Revised Nottingham Sensory Assessment (NSA) (22), the Erasmus-modified NSA (Em-NSA) (23), the Rivermead assessment of somatosensory performance (RASP) (24), and Quantitative sensory testing (QST) (25) were established assessment sets that contained somatosensory evaluations, and their reliability has also been reported (26). However, Lin reported poor to moderate inter-rater reliability of FMA sensory items of the UE (27). The revised-NSA has many items and requires time to evaluate, and the FMA, Em-NSA, and RASP have only three scoring levels, so they cannot describe the deficits in detail. The light touch item of the QST is measured with a Modified von Frey filament, and it can classify the degree of the deficit more, but its reliability in patients with stroke has not yet been verified.
According to a cross-sectional study (28), 93% of 172 occupational therapists and physiotherapists routinely assess sensory impairment in patients with stroke, and another reported that 87–100% of doctors and therapists perform some clinical examinations to evaluate light touch sensation and proprioception (29). However, there have been few studies in which the researchers rigorously followed original methods and evaluated the psychometric properties of clinical examinations of somatosensory function in patients with stroke. We thought that it would be useful to examine these sensations with convenient clinical examinations with fixed procedures, to share them among examiners, and to evaluate their reliability and validity.
In this study, the Semmes-Weinstein Monofilament Test (SWMT) (30) was used to examine light touch sensation of the UE, and the Thumb Localizing Test (TLT) (31) was used for proprioception. The SWMT is considered a simple and inexpensive touch threshold test and is widely used by clinicians to evaluate sensory disturbances of neuropathic diseases, such as diabetes mellitus and carpal tunnel syndrome. Its reliability and validity in patients with those diseases have been confirmed in previous research (32, 33), but in patients with stroke, those of the SWMT as an index of light touch sensation are poorly documented. However, it is easy to quantify sensory disturbances in detail with the SWMT, so it has often been used as a follow-up index for patients with stroke in the latest studies (34, 35).
To evaluate proprioception, we chose the TLT because Hirayama et al. reported that the TLT showed a greater frequency of abnormalities than other physical examinations for proprioception (36), and the TLT deficits were strongly correlated with the deficits found in joint position and movement (JPM) and the tactile cutaneous localization test (31). However, very few studies have investigated the reliability and validity of the TLT in patients with chronic stroke.
We hypothesized that, with fixed procedures, two convenient clinical examinations, the SWMT and the TLT, could be used to examine light touch sensation and proprioception reliably. The purpose of this study was to verify the reliability and validity of the SWMT and the TLT as indices of somatosensory impairment of the UE in patients with chronic post-stroke hemiparesis.
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