Name: design, fabrication, and administration of the hand active sensation test (haste)
Uploaded: 2015-09-08T15:00:00
Description: Watch this Scientific Journal Video about Design, Fabrication, and Administration of the Hand Active Sensation Test HASTe at JoVE.com

This work was supported in part by OSU&#8217;s CCTS Program through TL1TR001069 award to Dr. Borstad.&#160; We would like to acknowledge Amelia Siles, DPT, NCS for her valuable measurement insights and Sarah Alexander for her assistance with editing the final draft of this manuscript.

1. Design and Fabrication of Visual Screen and HASTe (See &#34;Table of Materials&#34;&#160;for All Required Equipment and Materials):
<ol>
	<li>Assemble Visual Screen (Figure 1):
	<ol>
		<li>Cut four pieces of 0.5-inch PVC pipe (material a) to 10 inches (these form the base of the screen). Cut three pieces of 0.5-inch PVC pipe to 20 inches (these form the upright portion of the screen).</li>
		<li>Insert two pieces of 10-inch pipe into both PVC Tee&#8217;s (parallel openings) (material b). Insert two ...

<ol>
	<li>Nakayama, H., Jgtgensen, H., Stig, K., Raaschou, H. O., Olsen, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recovery+of+upper+extremity+function+in+stroke+patients:+the+Copenhagen+Stroke+Study.">Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.</a> Age (SD). 74, 12 (1994).</li><li>Carey, L. M., Matyas, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+of+discriminative+sensory+loss+in+the+hand+after+stroke+in+a+rehabilitation+setting.">Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting.</a> Journal of Rehabilitation Medicine. 43, 257-263 (2011).</li><li>Winward, C. E., Halligan, P. W., Wade, D. 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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Somatosensory+impairment+after+stroke:+frequency+of+different+deficits+and+their+recovery.">Somatosensory impairment after stroke: frequency of different deficits and their recovery.</a> Clinical Rehabilitation. 22, 758 (2008).</li><li>Winward, C. E., Halligan, P. W., Wade, D. 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C., Zeringue, A., Greenspan, A., Blanton, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Factors+influencing+stroke+survivors'+quality+of+life+during+subacute+recovery.">Factors influencing stroke survivors' quality of life during subacute recovery.</a> Stroke. 36, 1480-1484 (2005).</li><li>Borstad, A. L., Nichols-Larsen, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+and+treating+Higher-level+Somatosensory+Impairments+Post+Stroke.">Assessing and treating Higher-level Somatosensory Impairments Post Stroke.</a> Topics in Stroke Rehabilitation. 21, 290-295 (2014).</li><li>Byl, N., Leano, J., Cheney, L. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Byl-Cheney-Boczai+Sensory+Discriminator:+reliability,+validity,+and+responsiveness+for+testing+stereognosis.">The Byl-Cheney-Boczai Sensory Discriminator: reliability, validity, and responsiveness for testing stereognosis.</a> Journal of Hand Therapy. 15, 315-330 (2002).</li><li>Lincoln, N. B., Jackson, J. M., Adams, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+revision+of+the+Nottingham+Sensory+Assessment+for+stroke+patients.">Reliability and revision of the Nottingham Sensory Assessment for stroke patients.</a> Physiotherapy. 84, 358-365 (1998).</li><li>Carey, L. M., Nankervis, , et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> , (2006).</li><li>Ayres, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Sensory integration and praxis test (SIPT). , (1989).</li><li>Kalisch, T., Tegenthoff, M., Dinse, H. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improvement+of+sensorimotor+functions+in+old+age+by+passive+sensory+stimulation.">Improvement of sensorimotor functions in old age by passive sensory stimulation.</a> Clinical Interventions in Aging. 3, 673 (2008).</li><li>Meyer, S., Kattunen, A. H., Thijs, V., Feys, H., Verheyden, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+do+somatosensory+deficits+in+the+arm+and+hand+relate+to+upper+limb+impairment,+activity,+and+participation+problems+after+stroke?+A+systematic+Review.">How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic Review.</a> Physical Therapy. 94, (2014).</li><li>Williams, P. S., Basso, D. M., Case-Smith, J., Nichols-Larsen, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+Hand+Active+Sensation+Test:+reliability+and+validity.">Development of the Hand Active Sensation Test: reliability and validity.</a> Arch. Phys. Med. Rehabil. 87, 1471-1477 (2006).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> International Classification of Functioning, Disability and Health (ICF). , (2001).</li><li>McDonnell, M. N., Hillier, S. L., Miles, T. S., Thompson, P. D., Ridding, M. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+combined+afferent+stimulation+and+task-specific+training+following+stroke:+a+pilot+randomized+controlled+trial.">Influence of combined afferent stimulation and task-specific training following stroke: a pilot randomized controlled trial.</a> Neurorehabilitation and neural repair. 21, 435-443 (2007).</li><li>Byl, N. N., Pitsch, E. A., Abrams, G. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+outcomes+can+vary+by+dose:+learning-based+sensorimotor+training+for+patients+stable+poststroke.">Functional outcomes can vary by dose: learning-based sensorimotor training for patients stable poststroke.</a> Neurorehabilitation and neural repair. 22, 494 (2008).</li><li>Carey, L., Macdonell, R., Matyas, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SENSe:+Study+of+the+Effectiveness+of+Neurorehabilitation+on+Sensation+A+Randomized+Controlled+Trial.">SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation A Randomized Controlled Trial.</a> Neurorehabilitation and neural repair. 25, 304-313 (2011).</li></ol>

Evidence suggests that similar to motor recovery following stroke, somatosensory recovery requires task specific training. 18,19,20 Therefore, if we aim to improve the hands performance as a haptic receptor, haptic impairments must be identified. 15 The opportunity to quantify haptic ability in the clinic and laboratory has been limited, to some extent, based on the availability of valid and reliable outcome measures. &#160;The large number of stroke survivors with somatosensory impairmen...

Imagine the feel of a loved one&#8217;s hand. It is calloused or smooth? Strong or delicate? Warm or cool? Do you hold it in a handshake or with fingers intertwined? If you have evoked a memory, it is likely grounded in your ability to use movement of your hands to solicit somatosensory information, which is called haptic touch, or active sensation. Characteristics that can be determined with haptic touch include size, shape, weight, texture, surface compliance, and temperature. &#160;Haptic receptors include proprioceptors, which are found in the skin, muscles, tendons, and joints, as well as cutaneous receptors, both of which are activated during manual exploration of objects. Different hand actions aid in the determination of object characteristics. For example, repeatedly performing a lateral rubbing motion across an object may expose texture properties, or lifting the object in the hand may reveal object weight. Therefore, both manual dexterity and somatosensation are vital to haptic performance and the human experience.
Following stroke, both somatosensory and motor impairments contribute to diminished haptic performance. 1 Poststroke motor impairments are common and well defined, with approximately 70% of stroke survivors experiencing some level of paresis. 1 Somatosensory impairments after stroke are also common, occurring in 47-89% 2-4 of individuals. Researchers agree that both cutaneous and proprioceptive impairments are common after stroke. For a thorough characterization of the consequences of stroke on somatosensory domains the reader is referred to the works by of Carey et al., 2 Connell et al., 5 and Sullivan. 4
Somatosensory impairments contribute to diminished rehabilitation outcomes, 6 upper limb coordination, 7 function and quality of life.8 However, quantification of somatosensory impairments, especially active sensation, is lacking in clinical practice in part due to the fact that somatosensory loss is less apparent and more difficult to quantify than motor impairments.9 Measures which have been developed to quantify active sensation include the Byl-Chyney-Boczai Sensory Discriminator (BCB), 10 the stereognosis component of the Revised Nottingham Sensory Assessment, 11 the Functional Tactile Object Recognition Tests (fTORT), 12 &#160;the Manual Form Perception Test (a subset of the Sensory Information and Praxis Test), 13 and the Haptic Object Recognition Test (HORT). 14 Although these measures are available, a recent systematic review, which sought to describe how somatosensory impairments in the arm and hand relate to upper limb problems following stroke, concluded that clinicians and researchers currently lack valid and reliable tests of somatosensation. 15 Therefore, addressing the availability of clinically useful and parametrically sound measures of haptic performance is essential.
The Hand Active Sensation Test (HASTe) is an 18-item match-to-sample test of weight and texture discrimination, originally published by Williams and colleagues in 2006. 16 The HASTe is a measure of haptic touch and is sensitive to haptic impairments in individuals with stroke (indicated by fewer than 13 correct matches). As the HASTe seeks to measure haptic perception, as minimum criteria, individuals need the abilities to grasp and lift with the hand and arm and follow the test instructions. In the International Classification of Functioning, Disability and Health (ICF) model, 17 the HASTe is considered an activity level measurement. The HASTe takes between 15-30 min to administer per hand tested. Advantages of the HASTe include that it is inexpensive, total of material prices for 2015 estimated at $100, and easy to construct and that it&#8217;s 18-point scale provides greater resolution regarding performance than more common dichotomous characterization of &#8220;intact&#8221; or &#8220;impaired&#8221;.
The purpose of this paper is to describe the design, fabrication and administration of the HASTe. While it is possible to infer the test set-up from the original HASTe publication, this paper provides detailed methods for fabricating a visual screen and a HASTe test kit, both to be used during testing. The equipment required for assembly, as well as a detailed list of all required materials is listed in the Table of&#160;Materials. A single sheet with instructions for administering and scoring the HASTe is also provided as the following:
APPENDIX 1: HASTe&#160; Administration Instructions and Score Sheet &#160;&#160;&#160; &#160;&#160;&#160; Participant ID#_______&#160; Date_______
Set Up:&#160; Seat the test participant at a table (table ~29 inches high and chair seat ~18 inches high) with, initially, the dominant or less impaired upper extremity resting on the table and placed under the assembled visual screen. During the test, keep all objects in numerical order to maintain organization.
Demonstration Trials:&#160; Administer two demonstration trials prior to scoring. Provide the participant with objects A and B, and instruct him/her to compare the objects&#8217; weights. Then, provide the participant with objects A and C, and instruct him/her to compare the objects&#8217; textures. Offer feedback only for the demonstration trials.
Scored Trials:&#160; There will be 18 trials scored per extremity, with a maximum of 5 min allowed for each. Instruct the participant to manually explore the specified test object (identified &#8220;test&#8221; in the tables below) with the dominant or less impaired hand, then explore each of the three possible object matches (numbered otherwise within each trial box below) with this same hand. The possible matches will vary by either weight or texture, but never by both within one trial.&#160; Instruct the participant to find the match of the original object and tell him/her they can touch each object as many times as needed to determine an answer.&#160; Do not inform the participant as to which object property (texture or weight) he or she is matching within a trial, and do not assist the participant with manual exploration of the objects. Indicate the participant&#8217;s final answer for each trial in the tables below by circling the number of that object. Test the more impaired upper extremity after the participant completes the test with the less impaired upper extremity. Using the tables below, score the test by determining the number of correct matches from a total of 18 trials per hand (one box per trial below).
Verbal Instructions to Participant: &#8220;Use one hand to manually explore the test object first. Then, explore each of the three possible matches, which vary by either weight or texture but never by both within one trial.&#160; Find the match. You can touch each object as many times as you need to determine your answer. There will be 18 trials. You have a maximum of 5 min for each trial.&#8221;
<img alt="Score card" src="/files/ftp_upload/53178/53178scorecard.jpg" />

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Equipment Needed for Assembly</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Tape measure</td>
			<td></td>
			<td></td>
			<td>To measure lengths of materials</td>
		</tr>
		<tr>
			<td>PVC saw</td>
			<td></td>
			<td></td>
			<td>To cut PVC pieces to appropriate lengths given below</td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td></td>
			<td></td>
			<td>To cut paper, cork and laminating material</td>
		</tr>
		<tr>
			<td>Scale accurate to 0.1 ounce</td>
			<td></td>
			<td></td>
			<td>To determine exact weight of test objects</td>
		</tr>
		<tr>
			<td>Sharpie Permanent Marker</td>
			<td></td>
			<td></td>
			<td>To label test item number and weight</td>
		</tr>
		<tr>
			<td>Visual Screen Materials</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td></td>
		</tr>
		<tr>
			<td>0.5-inch PVC Pipe (Sch. 40 Plain-End Pipe)</td>
			<td>Home Depot</td>
			<td>530048</td>
			<td>104 inches total, will be cut into four 10-inch and three 20-inch pieces</td>
		</tr>
		<tr>
			<td>0.5-inch PVC Tee (Sch. 40 SxSxS Tee)</td>
			<td>Home Depot</td>
			<td>406005RMC</td>
			<td>Two pieces</td>
		</tr>
		<tr>
			<td>PVC Elbow (Lasco 0.5-inch Dia 90 degree PVC Sch 40 Side Outlet Elbow)</td>
			<td>Home Depot</td>
			<td>413005RMC</td>
			<td>Two pieces</td>
		</tr>
		<tr>
			<td>Pillowcase</td>
			<td></td>
			<td></td>
			<td>One to be hung from the PVC frame as a visual shield</td>
		</tr>
		<tr>
			<td>ACCO Binder Clips, Medium</td>
			<td>amazon.com</td>
			<td>72050</td>
			<td>Two to hold the pillowcase to the PVC frame</td>
		</tr>
		<tr>
			<td>Testing Kit Materials</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>1.5-inch PVC Sch. 40 DWV Plain End Pipe</td>
			<td>Home Depot</td>
			<td>531111</td>
			<td>85 inches total, will be cut into 21 4-inch pieces</td>
		</tr>
		<tr>
			<td>Quartet Cork Roll, 1/16-inch thick</td>
			<td>amazon.com</td>
			<td>NA</td>
			<td>1 roll, 24x48 inches, will be cut into 42 4x7-inch pieces to cover all test and example items</td>
		</tr>
		<tr>
			<td>Oatey all purpose cement for CPVC and PVC</td>
			<td>Home Depot</td>
			<td>308213</td>
			<td>8 ounce can, to use to adhere cork, paper and end caps to PVC test items</td>
		</tr>
		<tr>
			<td>Avery Self-Adhesive Laminating Roll</td>
			<td>amazon.com</td>
			<td>73610</td>
			<td>One 24x600-inch roll, will be cut into six 4x7-inches pieces to cover cork on six test objects</td>
		</tr>
		<tr>
			<td>Brown Builder&#39;s Paper</td>
			<td>Home Depot</td>
			<td>35140</td>
			<td>One roll, will be cut into six 4x7-inch pieces to cover cork on six test objects</td>
		</tr>
		<tr>
			<td>3M Pro Grade 9 Sandpaper</td>
			<td>Home Depot</td>
			<td>25060P-G</td>
			<td>One piece 4x7 inches, to use to cover one example item</td>
		</tr>
		<tr>
			<td>Ranger Glossy Cardstock</td>
			<td>amazon.com</td>
			<td>NA</td>
			<td>One 8.5x11-inch, 10-Pack, white, will be cut into two 4x7-inch pieces to cover example items</td>
		</tr>
		<tr>
			<td>Marblex-durable self modeling clay in moist form</td>
			<td>amaco.com/shop/</td>
			<td>X-242</td>
			<td>One 5-pound package, used to achieve correct weights of test objects</td>
		</tr>
		<tr>
			<td>Medium density polyethylene packing foam</td>
			<td>amazon.com</td>
			<td>NA</td>
			<td>One foam sheet, 220 poly, charcoal, 2x24x18 inches, to fill the remaining space in test objects after clay has been inserted</td>
		</tr>
		<tr>
			<td>Knock Out Plug for 1.5-inch PVC</td>
			<td>Home Depot</td>
			<td>85000</td>
			<td>42 caps to seal the ends of the 21 test items</td>
		</tr>
		<tr>
			<td>Sterilite 6-quart plastic storage box</td>
			<td>Home Depot</td>
			<td>16428960</td>
			<td>One to store/transport test objects</td>
		</tr>
	</tbody>
</table>

design, fabrication, and administration of the hand active sensation test (haste)

The concept of personalizing neurologic rehabilitation, based on individual impairments, has experienced a recent surge. In parallel, the number of outcome measures of upper extremity motor performance has grown. However, clinicians and researchers lack practical, quantitative measures of the hand&#8217;s natural role as a receptor of the environment. The Hand Active Sensation Test (HASTe), developed by Williams and colleagues in 2006, is a valid and reliable measure of haptic performance. Though not available commercially, the HASTe can be fabricated from inexpensive materials, and it has been used successfully to identify impairments in haptic touch in individuals with stroke. (Williams, 2006). This paper presents the methods of design and fabrication of the HASTe testing kit, as well as a visual screen to be used during administration, and instructions for the tests administration and scoring.

Williams and colleagues published the original study, which established the reliability and validity of the HASTe, in 2006. Based on that study, individuals scoring fewer than 13 correct matches on the HASTe are considered to have impaired haptic performance, while those scoring between 13 and 18 are considered to have unimpaired haptic performance. 16 When an individual scores 6 or fewer correct matches, it is considered a chance score, based on the odds in an 18 trial/3 item match to sample design.
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Watch this Scientific Journal Video about Design, Fabrication, and Administration of the Hand Active Sensation Test HASTe at JoVE.com

Design, Fabrication, and Administration of the Hand Active Sensation Test HASTe

The Hand Active Sensation Test (HASTe) is a valid and reliable measure of haptic performance, which has been used successfully to identify impaired haptic touch in individuals with stroke. The purpose of this paper is to describe the design, fabrication and administration of the HASTe.

Design, Fabrication, and Administration of the Hand Active Sensation Test (HASTe)

The concept of personalizing neurologic rehabilitation, based on individual impairments, has experienced a recent surge. In parallel, the number of ...

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