# PWR-058 — Sensory recovery and retraining: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 10 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Basic stationery or digital tools — 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. Space: Desk / seated Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Detailed research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context 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. Target outcome: With a rehabilitation professional, Amir completes coded S/R foam trials and uses vision plus a temperature indicator for a cup instead of trusting impaired heat sensation. ### Authority and setup conditions - 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. ### Required or supplied materials - 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. ## 1. 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. Success check: Trial card names texture, S/R labels, tested hand and contact rule. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Trial card names texture, S/R labels, tested hand and contact rule.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. 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. Success check: Amir labels both unscored anchors correctly before screening begins. Accessible alternative: A spoken or tactile version of “With vision available, Amir looks at and feels S once, then R once, and points to each printed label.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Amir labels both unscored anchors correctly before screening begins.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. 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. Success check: Forearm, contact area and screen remain fixed for every coded presentation. Accessible alternative: A spoken or tactile version of “Rest Amir's forearm on its support, inspect contact skin and place clinician-selected screen so eyes cannot reveal S or R.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Forearm, contact area and screen remain fixed for every coded presentation.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. 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. Success check: Ten rows reproduce folded order and any changed contact is marked void. Accessible alternative: A spoken or tactile version of “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.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Ten rows reproduce folded order and any changed contact is marked void.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. 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. Success check: Each row contains label plus confidence before keyed feedback. Accessible alternative: A spoken or tactile version of “After each contact, Amir says S, R or no response and rates confidence before screen moves.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Each row contains label plus confidence before keyed feedback.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. 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. Success check: Baseline answer remains visible beside keyed label and correction. Accessible alternative: A spoken or tactile version of “Reveal block, state keyed S/R, let Amir look and feel it once, then cover again without overwriting original response.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Baseline answer remains visible beside keyed label and correction.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. 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. Success check: Ten valid/void rows reconcile with totals and post-block skin check is documented. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Ten valid/void rows reconcile with totals and post-block skin check is documented.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. 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. Success check: Vision/indicator is used and heat remains outside texture score. Accessible alternative: A spoken or tactile version of “For a cup, Amir looks and uses prescribed temperature indicator; he does not judge heat with affected hand even after correct S/R trials.” can rehearse the response sequence, but it removes the declared visual stimulus and is therefore a related activity, not an equivalent attempt at Sensory recovery and retraining. To preserve the target, keep the authored visual stimulus and adapt only non-target access such as response input, instructions, breaks or support; retain this success check: “Vision/indicator is used and heat remains outside texture score.” Alternative relationship: Related alternative changes trained or measured target Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.