Western Neuro Sensory Stimulation Profile

Last Updated

November 28, 2012

Purpose

The WNSSP examines the degree of responsiveness of a patient with disorders of consciousness and charts basic cognitive sensory recovery over time.

Acronym WNSSP

Cost

Not Free

Cost Description

Unknown

Diagnosis/Conditions

Brain Injury Recovery

Brain Injury

32 items in scale
6 subscales (points)
1) Auditory comprehension (30)
2) Visual comprehension (25)
3) Visual tracking (18)
4) Object manipulation (15)
5) Arousal/Attention (8)
6) Tactile/Olfactory (6)
All items are scored using multipoint systems which range from 0-1 to 0-5 and vary from item to item.
Higher scores are associated with better cognitive function.
The minimum score is 0; the maximum score is 110.
Subscale scores provide a means for evaluating a patient’s pattern of response.

Number of Items

Wet cloth
Non-verbal sound (music/bell/clicker, etc.)
Hand-held mirror
Picture
Brush
Rough towel
Comb
Cue tip
Spoon
Comb
Pencil
Cologne
Vinegar
Cinnamon
Garlic
Coffee

45 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Erin Donnelly, PT, MSPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 8/2012.

ICF Domain

Body Structure
Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
*LS / UR*	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations based on level of care in which the assessment is taken:

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

TBI EDGE

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
TBI EDGE	No	No	No	Not reported

Considerations

The American Congress of Rehabilitation Medicine expert consensus panel recommends the use of the WNSSP for Disorders of Consciousness with moderate reservations, citing methods that did not adequately control for examiner bias.

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Normative Data

Closed Head Injury (functioning at Ranchos Levels II, III, IV, or V): (Ansell, et al., 1989; n= 57; mean age= 29 years old (14-72 years old); mean time from injury= 8 months (range 1-43 months))

Ranchos Level	N	WNSSP Total Score (out of 110)	Auditory Comp (30)	Visual Comp (25)	Visual Traking (18)	Object Manip (15)	Arousal/Attn (8)	Tactile/Olfactory (6)
II	279	14.10(8.58)[1-40]	2.21(3.10)[0-16]	1.01(2.12)[0-12]	.2.01(3.10)[0-16]	.21(.95)[0-9]	4.29(1.94)[0-8]	2.32(1.29)[0-6]
III	161	44.81(15.78)[5-80]	9.17(5.36)[0-27]	5.11(5.30)[0-23]	10.88(5.54)[0-18]	4.72(4.35)[0-15]	6.59(1.80)[1-8]	4.21(1.54)[1-6]
IV	22	77.32(13.93)[54-103]	21.46(6.94)[6-30]	13.05(8.24)[0-25]	15.00(4.53)[4-18]	7.14(4.65)[0-15]	7.77(.43)[7-8]	5.55(1.10)[1-6]
V	76	82.46(16.10)[46-110]	21.71(6.72)[7-30]	14.07(7.86)[0-25]	15.32(3.63)[3-18]	11.29(3.91)[0-15]	7.70(.61)[5-8}	5.68(.082)[1-6]
*Mean (Standard Deviation) [Range]

Interrater/Intrarater Reliability

Closed Head Injury (functioning at Ranchos Levels II, III, IV, or V): (Ansell, et al., 1989)

Total Score, Auditory Comprehension subscale, Visual comprehension subscale, visual tracking subscale, and object manipulation: Excellent interrater reliability (Pearson correlations ranges=.94-.99)
Arousal/Attention Subscale: Adequate to Excellent IRR (Pearson correlation ranges = .78-.90)
Tactile/Olfactory Subscale: Poor to Adequate IRR (Pearson correlation ranges = .64-.86)
Small sample study with no evaluation of systematic error, introducing a high risk for bias; considered unproven by the ACRM (Seel et al, 2010)

Internal Consistency

Closed Head Injury (functioning at Ranchos Levels II, III, IV, or V): (Ansell, et al., 1989)

Total score: Excellent internal consistency (Cronbach alpha = .95)
Subscales:
- Auditory Comprehension: Excellent IC (coefficient alpha= .87)
- Visual Comprehension: Excellent IC (Coefficient = .87)
- Visual Tracking: Excellent IC (Coefficient = . 95)
- Object Manipulation: Excellent IC (Coefficient = .94)
- Arousal/Attention: Adequate IC (Coefficient = .73)
- Tactile/Olfactory : Poor IC(Coefficient= .59)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Closed Head Injury (functioning at Ranchos Levels II, III, IV, or V): (Ansell, et al, 1989)

Adequate criterion validity (absolute coefficient value = .73 between the WNSSP total and the Rancho Scale)
Research design lacked independent or masked raters

Predictive Validity:

Closed Head Injury: (Ansell, 1993; n=116; mean age = 30.3 years (range from 12-78 years old; mean time post injury= 93.6 days (range 25-364 days))

Compared Rehab Ready (RR) individuals to Non-rehab Ready (NRR) individuals Initial Assessment:
- WNSSP total score for RR individuals was significantly higher than for NRR individuals (P = .0001)
- Auditory Comp, visual comp and visual tracking scores for RR individuals were significantly higher than for those NRR (P = .011 or less) **When assessed by the ACRM, this study was considered to have a very high risk of bias secondary to using concurrent scores from investigational scale as the predictor and the outcome scale. Therefore, it is considered that the Predictive Validity is Unproven.

Construct Validity

Pediatrics with Severe TBI: (Patrick, et al. 2009; n = 10; mean age= 16.7 years old (range 8-21 years); mean time post injury= 66 days)

Excellent convergent validity (k=.99) between the WNSSP and a communication score (p<.0001), but more limited correlations between WNSSP and arousal (k=.93) and awareness (k=.77) scores.

Content Validity

Good Content Validity. According to expert consensus-based evaluations, the content of the WNSSP assesses all 4 VS versus MCS criteria (Seel et al, 2010).

Floor/Ceiling Effects

Traumatic Brain Injury: (Lammi, et al, 2005; n = 18; mean age at time of injury= 37.89 years old; mean time post injury = 43.36 months)

Poor ceiling effect: 50% of participants at follow-up were at the ceiling and 33% had total scores between 110 and 112

Bibliography

Ansell, B. J. (1993). "Slow-to-recover patients: Improvement to rehabilitation readiness." The Journal of Head Trauma Rehabilitation.

Ansell, B. J. and Keenan, J. E. (1989). "The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients." Arch Phys Med Rehabil 70(2): 104-108. Find it on PubMed

Lammi, M. H., Smith, V. H., et al. (2005). "The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury." Arch Phys Med Rehabil 86(4): 746-754. Find it on PubMed

Patrick, P. D., Wamstad, J. B., et al. (2009). "Assessing the relationship between the WNSSP and therapeutic participation in adolescents in low response states following severe traumatic brain injury." Brain Inj 23(6): 528-534. Find it on PubMed

Seel, R. T., Sherer, M., et al. (2010). "Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research." Arch Phys Med Rehabil 91(12): 1795-1813. Find it on PubMed