Section 241 of 440
Complete canonical tutorial. This reader section contains the same teaching body as PWR-058 · Sensory recovery and retraining. Open the Power dossier.
PWR-058 · SUPERVISED full tutorial
Tell smooth foam from ribbed foam and keep heat compensation
Sensation can sometimes be retrained or supplied through technology, but recovery and substitution must not be confused. Sensory recovery and sensory substitution are different. This lesson teaches a provider-selected discrimination trial with safe objects, controlled vision, immediate feedback and a functional protection check. Numb skin is never tested with heat, sharpness or injury.
1 · Permission and limits
Know exactly what you may do
2 · Get ready
Gather what you need and check the starting conditions
What you need
- A smooth foam block S and ribbed foam block R, equal in size and weight and approved for the tested skin/hand.
- A screen or eye closure method selected for safe testing.
- A folded ten-trial texture key S,R,R,S,R,S,S,R,S,R; the clinician presents one block for the same interval and hand position on each trial and rests after trial 5.
- Prescribed protective, visual or technology-based compensation aids.
Before you start
- The clinician identifies the affected modality and skin/nerve condition and chooses a non-injurious stimulus.
- Inspect the test area for redness, wound, swelling or pressure injury.
- Never use hot/cold extremes, needles, blades or painful pressure to “wake up” sensation.
- Keep fall protection and usual visual or mobility aids for the functional part.
3 · The method
Follow these steps in order
- Declare S versus R
Write S = smooth foam and R = ribbed foam. Keep shape, size, weight, tested hand and contact interval matched.
Why: A single texture contrast makes each error interpretable.
Check: Trial card names texture, S/R labels, tested hand and contact rule.
- Learn both foam anchors
With vision available, Amir looks at and feels S once, then R once, and points to each printed label.
Why: Visible anchors link each safe texture to one response.
Check: Amir labels both unscored anchors correctly before screening begins.
- Support hand behind screen
Rest Amir's forearm on its support, inspect contact skin and place clinician-selected screen so eyes cannot reveal S or R.
Why: Stable hand/contact plus hidden vision prevent position and visual clues replacing texture.
Check: Forearm, contact area and screen remain fixed for every coded presentation.
- Follow concealed ten-item key
Clinician presents S,R,R,S,R, rests, then S,S,R,S,R using identical contact time and hand placement; Amir cannot see order.
Why: Five of each texture in a concealed order prevents an alternating or majority guess.
Check: Ten rows reproduce folded order and any changed contact is marked void.
- Commit label before reveal
After each contact, Amir says S, R or no response and rates confidence before screen moves.
Why: Committed texture label separates discrimination from recognition after looking.
Check: Each row contains label plus confidence before keyed feedback.
- Give one paired texture correction
Reveal block, state keyed S/R, let Amir look and feel it once, then cover again without overwriting original response.
Why: Immediate pairing teaches texture–label link while keeping raw miss.
Check: Baseline answer remains visible beside keyed label and correction.
- Total S/R responses and recheck skin
After trial 10, total correct, incorrect and no-response without converting void contacts to misses; clinician reinspects contact skin.
Why: Separate response categories plus skin status preserve both interpretation and protection.
Check: Ten valid/void rows reconcile with totals and post-block skin check is documented.
- Keep hot-cup protection
For a cup, Amir looks and uses prescribed temperature indicator; he does not judge heat with affected hand even after correct S/R trials.
Why: Foam texture learning does not restore protective temperature sensation.
Check: Vision/indicator is used and heat remains outside texture score.
4 · Worked example
See the whole method used once
Scenario
A therapist works with Amir after a stroke on distinguishing a smooth foam block from a ribbed foam block in his affected hand.
Walkthrough
- Amir sees and names both blocks first.
- The therapist supports his hand behind a screen and presents one block for the same interval each trial.
- Amir answers before looking, then sees and feels the correct block for feedback.
- They complete ten random trials with a rest after five.
- For a daily-task check, Amir uses vision and a temperature indicator rather than trusting the hand to judge a hot cup.
Result
Amir identifies seven of ten textures and consistently uses protection for heat. The discrimination result does not prove full sensation recovery.
5 · Right and wrong
Compare correct or safer execution with the common wrong version
| Moment | Right / safer | Wrong / riskier | Why it matters |
|---|---|---|---|
| Stimulus | Use safe, broad differences chosen by the clinician. | Use sharp, very hot or very cold items. | Absent sensation removes a protective warning. |
| Modality | Test one contrast at a time. | Mix texture, weight and location into one score. | A mixed score cannot show what changed. |
| Answer timing | Commit the answer before visual feedback. | Look first and report the known answer. | That tests recognition with vision, not sensory discrimination. |
| Miss | Preserve the miss and give one paired correction. | Erase misses after feedback. | Raw misses are needed to measure learning. |
| Function | Use compensation for untrusted sensation. | Stop using protection after one good score. | Clinic discrimination does not guarantee hazard detection. |
6 · Common mistakes
Spot the error and apply the correction
| Mistake | Fix |
|---|---|
| Use sharp, very hot or very cold items. | Use safe, broad differences chosen by the clinician. |
| Mix texture, weight and location into one score. | Test one contrast at a time. |
| Look first and report the known answer. | Commit the answer before visual feedback. |
| Erase misses after feedback. | Preserve the miss and give one paired correction. |
| Stop using protection after one good score. | Use compensation for untrusted sensation. |
7 · Practice
Turn the steps into a usable skill
First session
- The clinician inspects Amir's hand, approves the equal-size smooth S and ribbed R foam blocks, supports the forearm and records the ten-item folded order.
- With vision available, Amir looks at and feels S then R and points to the correct printed label for both anchors.
- Behind the screen, the clinician presents S,R,R,S,R, rests, then S,S,R,S,R with fixed contact; Amir answers and rates confidence before each reveal.
- Every response remains on the sheet; the clinician totals correct, incorrect and no-response and checks for examiner cueing or position changes.
- For the related cup task, Amir keeps vision and the prescribed temperature indicator rather than trusting the affected hand, then both inspect skin.
Repeat plan
The clinician sets frequency and advances from obvious to closer contrasts or to a related daily object only after matched random-order blocks show reproducible discrimination beyond the learner’s first block without skin harm. Compensation remains until functional safety is directly established.
Progress when
- Accuracy improves on a new random order.
- Confidence becomes better calibrated to correct and incorrect responses.
- The learner applies protection reliably in the related daily task.
Do not progress when
- Skin redness, wound, swelling or pain appears.
- Performance depends on visual, sound or examiner clues not in the declared task.
- The learner wants to test temperature or sharpness without clinical controls.
8 · Check the result
Measure what changed
Correct, incorrect and no-response trials for one named safe sensory contrast, plus use of the paired protection routine
How: Record correct, incorrect and no-response trials for the named modality, confidence, presentation rule, skin condition and use of compensation in a declared functional task.
Good result: The provider sees repeatable improvement above the baseline on novel random orders plus reliable safety compensation.
This does not prove: Psychophysical thresholds, discrimination, proprioception, task function and embodiment are separate; device-on effects are not biological recovery.
Self-check
- Can you demonstrate ‘Learn both foam anchors’? Amir labels visible S and R before concealed trials.
- Can you demonstrate ‘Commit label before reveal’? S/R/no-response and confidence precede screen movement.
- Can you demonstrate ‘Total S/R responses and recheck skin’? Ten rows reconcile with response totals and skin check.
- Can you demonstrate ‘Keep hot-cup protection’? Vision and prescribed indicator remain in use regardless of foam score.
9 · Stop, adapt or get help
Keep the safety boundary practical
Stop and get help
- Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
- Seek urgent assessment for sudden numbness with weakness, speech/vision change, severe headache or loss of balance.
- Contact the rehabilitation or prosthetic team when a device causes pressure, shock sensation or altered skin condition.
Accessibility and adaptations
- Use spoken, symbol or eye-gaze responses; motor speech is not required to show discrimination.
- Choose larger objects or alternate safe body sites while recording the change.
- Use high-contrast visual feedback or tactile reference boards for learners with combined sensory needs.
10 · Evidence and limits
Why these instructions are here
- primary research
A randomised pilot trial supports studying structured sensory retraining after stroke while leaving dose and generalisation bounded.
Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial - official guidance
WHO guidance supports assistive products as a valid route to function, distinct from biological sensory recovery.
Assistive technology
Limits
- Psychophysical thresholds, discrimination, proprioception, task function and embodiment are separate; device-on effects are not biological recovery.
- Unsupported claim: regrow lost nerves through practice.
- Unsupported claim: restore every sense.
- Unsupported claim: prosthesis becomes biologically identical.
- Object discrimination does not establish pain, temperature or protective sensation, and device-assisted sensation is not biological restoration.
Open the complete canonical research register
- Primary empirical supportLimiting / contrarySensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial
Elizabeth A Lynch; Susan L Hillier; Kathy Stiller; Rachel R Campanella; Penny H Fisher · 2007 · Primary research
- Primary empirical supportLimiting / contraryHome Use of a Neural-connected Sensory Prosthesis Provides the Functional and Psychosocial Experience of Having a Hand Again
Emily L Graczyk; Linda Resnik; Matthew A Schiefer; Melissa S Schmitt; Dustin J Tyler · 2018 · Primary research
- Primary empirical supportLimiting / contraryRestoration of motor control and proprioceptive and cutaneous sensation in humans with prior upper-limb amputation via multiple Utah Slanted Electrode Arrays implanted in residual peripheral arm nerves
Suzanne Wendelken; David M Page; Tyler Davis; Heather A C Wark; David T Kluger; Christopher Duncan; David J Warren; Douglas T Hutchinson; Gregory A Clark · 2017 · Primary research
- Limiting / contraryOfficial boundary contextAssistive technology
World Health Organization · 2024 · Official guidance
Read the complete evidence interpretation on the Power dossier.
Tutorial delivery controls
Learn, adapt, troubleshoot and resume
Progress is saved only in this browser on this device.
Step-by-step learner mode
Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.
Declare S versus R
Write S = smooth foam and R = ribbed foam. Keep shape, size, weight, tested hand and contact interval matched.
A single texture contrast makes each error interpretable.
Trial card names texture, S/R labels, tested hand and contact rule.
I’m stuck on this step
Reset: Re-read this authored instruction — “Write S = smooth foam and R = ribbed foam. Keep shape, size, weight, tested hand and contact interval matched.” — and its success check, then attempt only this step.
Possible snag: Mix texture, weight and location into one score.
Correction: Test one contrast at a time.
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Learn both foam anchors
With vision available, Amir looks at and feels S once, then R once, and points to each printed label.
Visible anchors link each safe texture to one response.
Amir labels both unscored anchors correctly before screening begins.
I’m stuck on this step
Reset: Re-read this authored instruction — “With vision available, Amir looks at and feels S once, then R once, and points to each printed label.” — and its success check, then attempt only this step.
Possible snag: The result from “With vision available, Amir looks at and feels S once, then R once, and points to each printed label.” does not yet meet this declared check: Amir labels both unscored anchors correctly before screening begins.
Correction: Return to the start of “Learn both foam anchors”, reduce complexity or pace, and repeat only the part needed to satisfy: “Amir labels both unscored anchors correctly before screening begins.”
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Support hand behind screen
Rest Amir's forearm on its support, inspect contact skin and place clinician-selected screen so eyes cannot reveal S or R.
Stable hand/contact plus hidden vision prevent position and visual clues replacing texture.
Forearm, contact area and screen remain fixed for every coded presentation.
I’m stuck on this step
Reset: Re-read this authored instruction — “Rest Amir's forearm on its support, inspect contact skin and place clinician-selected screen so eyes cannot reveal S or R.” — and its success check, then attempt only this step.
Possible snag: Use sharp, very hot or very cold items.
Correction: Use safe, broad differences chosen by the clinician.
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Follow concealed ten-item key
Clinician presents S,R,R,S,R, rests, then S,S,R,S,R using identical contact time and hand placement; Amir cannot see order.
Five of each texture in a concealed order prevents an alternating or majority guess.
Ten rows reproduce folded order and any changed contact is marked void.
I’m stuck on this step
Reset: Re-read this authored instruction — “Clinician presents S,R,R,S,R, rests, then S,S,R,S,R using identical contact time and hand placement; Amir cannot see order.” — and its success check, then attempt only this step.
Possible snag: The result from “Clinician presents S,R,R,S,R, rests, then S,S,R,S,R using identical contact time and hand placement; Amir cannot see order.” does not yet meet this declared check: Ten rows reproduce folded order and any changed contact is marked void.
Correction: Return to the start of “Follow concealed ten-item key”, reduce complexity or pace, and repeat only the part needed to satisfy: “Ten rows reproduce folded order and any changed contact is marked void.”
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Commit label before reveal
After each contact, Amir says S, R or no response and rates confidence before screen moves.
Committed texture label separates discrimination from recognition after looking.
Each row contains label plus confidence before keyed feedback.
I’m stuck on this step
Reset: Re-read this authored instruction — “After each contact, Amir says S, R or no response and rates confidence before screen moves.” — and its success check, then attempt only this step.
Possible snag: Look first and report the known answer.
Correction: Commit the answer before visual feedback.
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Give one paired texture correction
Reveal block, state keyed S/R, let Amir look and feel it once, then cover again without overwriting original response.
Immediate pairing teaches texture–label link while keeping raw miss.
Baseline answer remains visible beside keyed label and correction.
I’m stuck on this step
Reset: Re-read this authored instruction — “Reveal block, state keyed S/R, let Amir look and feel it once, then cover again without overwriting original response.” — and its success check, then attempt only this step.
Possible snag: Erase misses after feedback.
Correction: Preserve the miss and give one paired correction.
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Total S/R responses and recheck skin
After trial 10, total correct, incorrect and no-response without converting void contacts to misses; clinician reinspects contact skin.
Separate response categories plus skin status preserve both interpretation and protection.
Ten valid/void rows reconcile with totals and post-block skin check is documented.
I’m stuck on this step
Reset: Re-read this authored instruction — “After trial 10, total correct, incorrect and no-response without converting void contacts to misses; clinician reinspects contact skin.” — and its success check, then attempt only this step.
Possible snag: The result from “After trial 10, total correct, incorrect and no-response without converting void contacts to misses; clinician reinspects contact skin.” does not yet meet this declared check: Ten valid/void rows reconcile with totals and post-block skin check is documented.
Correction: Return to the start of “Total S/R responses and recheck skin”, reduce complexity or pace, and repeat only the part needed to satisfy: “Ten valid/void rows reconcile with totals and post-block skin check is documented.”
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Keep hot-cup protection
For a cup, Amir looks and uses prescribed temperature indicator; he does not judge heat with affected hand even after correct S/R trials.
Foam texture learning does not restore protective temperature sensation.
Vision/indicator is used and heat remains outside texture score.
I’m stuck on this step
Reset: Re-read this authored instruction — “For a cup, Amir looks and uses prescribed temperature indicator; he does not judge heat with affected hand even after correct S/R trials.” — and its success check, then attempt only this step.
Possible snag: Stop using protection after one good score.
Correction: Use compensation for untrusted sensation.
Stop / get help: Stop for new skin injury, burning, swelling, severe pain or rapid sensory loss.
Correct versus incorrect execution
These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.
Use safe, broad differences chosen by the clinician.
Use sharp, very hot or very cold items.
Test one contrast at a time.
Mix texture, weight and location into one score.
Commit the answer before visual feedback.
Look first and report the known answer.
Preserve the miss and give one paired correction.
Erase misses after feedback.
Use compensation for untrusted sensation.
Stop using protection after one good score.
Method-structure checklist
10 of 10 structural checks present
- Ordered, Power-specific instructions — present
- Every activity has a success check — present
- Materials or supplied records are declared — present
- Measurement or assessment rule is present — present
- Tutorial-specific troubleshooting is present — present
- Stopping or escalation boundary is present — present
- Every activity has an adjacent alternative — present
- Correct-versus-incorrect comparison is present — present
- Evidence context is bound to the Power record — present
- Planning metadata is present — present
The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.
Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.