The Rivermead Assessment of Somatosensory Performance (RASP) is a standardized test used to assess somatosensory functioning through 7 subtests involving discrimination of sensations like touch, pressure, temperature, and proprioception. It is comprised of standardized instruments that comprehensively measure somatosensory functions across 10 body areas. The RASP provides reliable and quantifiable data to inform rehabilitation for patients with somatosensory impairments from conditions like stroke, MS, or head injuries.

1. Rivermead Assessment of
Somatosensory Performance
Raiza Belarmino, Andy Phung,
Jessica Hoang, & Jasmine Vassel

2. Raiza Belarmino,
OTS California State University San
Marcos
BA Communication
Stanbridge University
MS Occupational Therapy

3. Andy Phung, OTS
California State University
Fullerton
BA Health Science
Stanbridge University
MS Occupational Therapy

4. Jessica Hoang, OTS
California State University Long
Beach
BA Psychology
Stanbridge University
MS Occupational Therapy

5. Jasmine Vassel, OTS
Azusa Pacific University
BA in Psychology w/ concentration
in Health Psychology
Stanbridge University
MS in Occupational Therapy

6. Introduction
What is the somatosensory system?
Concerned with conscious perception of touch, pressure, pain, temperature,
position, movement, and vibration which arises from the muscles, joints, and
skin.
Who would have somatosensory impairments?
Stroke
Multiple Sclerosis
Head Injury

7. What is the RASP?
Standardized battery test designed to provide an quantifiable and reliable
assessment of somatosensory functioning
Includes standardized instruments that provide comprehensive measures
of various somatosensory functions to inform and monitor rehabilitation
and recovery

8. What is the RASP?
Comprised of Seven Subtests
5 Primary Subtests
Sharp/dull discrimination
Surface pressure touch
Surface localization
Temperature discrimination
Movement and direction proprioceptive discrimination
2 Secondary Subtests

9. RASP Instrument: Neurometer
Used to test
Sharp/dull discrimination
Surface pressure touch
Surface localization
Sensory extinction
2 parts
Top = sharp/ dull discrimination
Lower = surface pressure touch, surface localization and sensory extinction

10. RASP Instrument: Neurotemp
Red and blue colored instruments with liquid crystal displays
Blue instrument displays temperatures from 6-10°C
Red instrument displays temperatures from 44-49°C

11. RASP Instrument: Neurodisc
Four-pointed, fixed-distance, two-point discriminator
Used to establish extent of two-point discrimination on finger pads
Applied perpendicular to skin surface and parallel to the finder axis and
depressed approximately 1 mm briefly
Three fixed distances: 3, 4, and 5 mm

12. Patient and Control Sample
Reliability and validity for RASP established
Inclusion Criteria:
Patients with diagnosis of first ever unilateral stroke
Exclusion Criteria:
Evidence of bilateral signs, noncompliance, severe visual/hearing impairment, cognitive
impairments
The presence of another neurological condition
100 patients used in standardization

13. Test Reliability
Reliability established by comparing 15 different patients scored
independently by 2 different raters and the original research therapist

14. Patient Reliability
Assumes that sometimes information provided can be inaccurate
Controls possible sources of unreliability
Series of sham trials on 2 of the 5 primary subjects
Sharp/dull discrimination
Surface pressure touch
Sham trials, also known as “non-touch” trials, are performed to control
patient reliability

15. Sham Trial
The examiner pretends to give a stimulus when in fact none is applied
Six sham trials are conducted for each side
Helps identify patients whose performance demonstrates unreliability
Improves patient reliability by enabling the examiner to exclude those that
are consistently reporting sensations on sham trials

16. Who uses the RASP?
Medical doctors
Neurologists
General Practitioners
Physiotherapists
Occupational therapists
Speech and language pathologists
Nurses
Used when health care practitioners
wish to document sensory loss
in a patient for clinical or
research purposes
Provides a comprehensive picture of
the patient’s performance
Findings can be used to inform and
monitor rehabilitation and
recovery.

17. The Patient Should Be
Appropriately dressed so the examiner is able to assess all 10 areas of the
body
Have the purpose of each assessment explained to them
Always shown what the test involves prior to administration
Made aware they will first be assessed on the unaffected side
Informed they will need to keep their eyes closed for all tests
Discouraged from guessing
Reassured not to be surprised if sometimes they cannot feel anything

18. The Tester Should
Be aware that altered body functions may affect test procedures and limit
access to certain test regions
Always allow for a few practice trials
Carry out testing in a quiet setting and ensure the participant is comfortable
Record relevant participant details on the score sheet
Use clinical judgment in deciding the number and types of subtests to
employ

19. Scoring
10 anatomically referenced test regions
Alternating pattern from unaffected side → affected side; head → feet
Each test region is approximately 25mm squared● Scoring is recorded on specific table/body chart
● Total score represents patient’s ability to detect and discriminate
sensory stimulation
● Sham trials scored separately
False positives = 1
Maximum sham score = 2

20. Anatomical Reference

21. Limitations
All tests require verbal responses
Subjects with speech or language difficulties will need accommodations
Examiner has 2 options for verbally impaired patients:
1. Point to pictures, objects, or words on designated cards
2. Use hand signals

22. Test Sequence
1. Sharp/dull discrimination
2. Surface pressure touch
3. Surface localization
4. Sensory extinction
5. Two point discrimination
6. Temperature discrimination
7. Proprioception

23. Sharp/Dull Discrimination
Equipment needed:
2 neurometers, 2 neurotips, scoring sheet
Regions on the body to be tested:
Face (1 and 2), hand (3-6), foot (7-10)
Procedure:
Subtest administered with patient’s eyes closed
Work from unaffected to affected side, neurometer is applied to test area pseudo-
randomized order (designated trial sequence)

24. Sharp/Dull Discrimination
● Explanation to patient:
○ Patient is shown two neurometers with sharp and dull ends pointed out
○ Examiner tells patient that he/she is going to test whether patient can feel
sharp or dull
● Scoring:
○ Only correct detections are noted
○ Record each response for stimulus on scoring sheet
○ Test provides single score representing patient’s ability to detect sharp/dull
discrimination

25. Sharp/Dull Scoring

26. Surface Pressure Touch
Test equipment needed:
1 neurometer, scoring sheet
Regions on the body to be tested:
Face (1 and 2), hand (3-6), foot (7-10)
Procedure:
Subtest is administered with patient’s eyes closed
Neurometer is set to level one throughout testing
Neurometer applied to designated testing area briefly (until thick white filament

27. Surface Pressure Touch
Explanation to Patient:
Patients are informed that Neurpen will be used to touch areas of face, arms and
legs
Examiner will say, “I want to see if you can feel this light touch. Before each trial
I’m going to say “Do you feel this?”
Scoring:
Only correct discriminations are noted
Record each response on scoring sheet

28. Surface Pressure Touch Scoring

29. Surface Localization
Test equipment needed:
1 neurometer, scoring sheet
Regions on the body to be tested:
Face (1 and 2), hand (3-6), foot (7-10)
Explanation to Patient:
Patient is requested to identify where on their body they have been touched
Responses can be verbal or on the body chart
If the patient indicates they have not felt the stimulus, it can be repeated once

30. Surface Localization
Procedure:
Test is administered with the patient’s eyes closed
Neurometer is set to level one
Total of 60 trials (30 left and 30 right) are administered
Sequence of touches: 1 (unaffected side), 2 (affected side), 3 (unaffected
side), 9 (affected side), 2 (unaffected side), 3 (affected side)
No sham trials

31. Surface Localization Scoring
Only correct localizations are recorded

32. Sensory Extinction
Test equipment needed:
2 neurometers, scoring sheet
Regions on the body to be tested:
Face and hand
Explantation:
Explain to the patients that they may feel one or two touches on similar area either by itself
or at the same time (e.g. hands and face)
Procedure:
Examiner sets the neurometer to level two and see if the patient can feel the stimulus on

33. Sensory Extinction Scoring
Scores are obtained for left and right brain damaged patients and are divided
into face and hand

34. Two-point Discrimination
Test equipment needed:
Discriminator, scoring sheet
Regions on the body to be tested:
Fingertip of index finger on both hands
Explantation:
Show the patient the discriminator and explain how it will be used to find out whether they
can feel one or two points on the tip of their index finger
Procedure:
Test is administered with patient closing their eyes and other parts of the hand does not

35. Two-point Discrimination Scoring
Patients that failed to detect within 3-5 mm range are considered to show
impairment.

36. Temperature Discrimination
Test equipment needed: 2 Neurotemps, scoring sheet
Regions on the body to be tested: face (1 and 2), hand (3-6), foot (7-10)

37. Temperature Discrimination Procedure
● Explanation to patient: “I am going to use these Nuerotemps to test whether you can
feel warm or cold. Just before the trial I am going to say “What’s this?” Don’t worry if you don’t
feel all the trials and remember to indicate only warm or cold”
● Procedure:
○ Ensure Nuerotemps are at the end of the temp window (Warm = 44-49°C, Cold = 6-10°C)
prior to administering the test
○ Place Neurometer for up to 1 second on patient
○ For each of the 10 test regions 6 stimuli are presented (for a total of 60 trials)
■ 3 warm and 3 cold in the following order - WCCWWC
○ Each of the patient’s response are recorded in the corresponding box

38. Temperature Discrimination Scoring

39. Proprioception Movement/Direction Discrimination
Test equipment needed:
Scoring sheet
Joints to be tested:
Elbow (L/R), wrist (L/R), thumb or finger (L/R), ankle, toe (L/R)
Explanation to patient:
Say: “I am going to move your [elbow, etc] up and down and I want you
to tell me whether you can feel me moving this joint and in which
direction. Up is towards your head and down is towards your feet.
Before each trial I am going to say ‘What’s this?’ Don’t worry if you

40. Proprioception Movement/Direction Discrimination
Procedure:
Patient is given several practice trials and instructed to close their eyes
Each joint should be held by lateral surfaces
Starting position may be up to 20° either side of the mid-joint
Only move each joint approximately 20°
Each joint is moved 6 times in the following order: up, down, down, up,
up down
Wait 1-2 seconds between movements

41. Proprioceptive Movement Discrimination Scoring
Scoring depends on the detection of movement
Movement or no movement

42. Proprioceptive Direction Discrimination Scoring
Scoring depends on the detection of direction of movement
Up or down

43. References
Busse, M. & Tyson, S.F. (2009). How many body locations need to be tested when assessing sensation after
stroke? An investigation of redundancy in the Rivermead Assessment of Somatosensory Performance.
Clinical rehabilitation, 23, 91-95. doi: 10.1177/0269215508097296
Connell, L.A., Lincoln, N.B., & Radford, K.A. (2008). Somatosensory impairment after stroke: frequency of
different deficits and their recovery. Clinical Rehabilitation, 22, 758-767. doi:
http://dx.doi.org/10.1177/0269215508090674
Helliwall, S. (2009). Does the use of a sensory re-education programme improve the somatosensory and
motor function of the upper limb in subacute stroke? A single case experimental design. The British Journal
of Occupational Therapy, 72(12), p. 551-558. doi: https://doi.org/10.4276/030802209X12601857794853
Winward, C.E., Halligan, P.W., & Wade D.T. (2002). The Rivermead Assessment of Somatosensory
Performance (RASP): standardization and reliability data. Clinical Rehabilitation, 16, 523-533. doi:
http://dx.doi.org/10.1191/0269215502cr522oa
Winward, C.E., Halligan, P.W., & Wade D.T. (2007). Somatosensory recovery: A longitudinal study of the first
6 months after unilateral stroke. Disability and Rehabilitation, 29(4), 293-299. doi:
10.1080/09638280600756489
Wu, C., Chuang, I., Ma, H., Lin, K., & Chen, C. (2016). Validity and responsiveness of the revised nottingham
sensation assessment for outcome evaluation in stroke rehabilitation. The American Journal of
Occupational Therapy, 70(2). doi:10.5014/ajot.2016.018390

44. QUESTIONS?

45. THANK YOU