Sensory Stimulation Assessment Measure

Last Updated

January 17, 2013

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Purpose

The SSAM was developed as a tool for measuring the senses of an unconscious patient over a long period of time. It is intended to assist in treatment planning and to address the demands of scientific research.

Link to Instrument

Instrument details

Acronym SSAM

Cost

Free

Diagnosis/Conditions

Brain Injury Recovery

Brain Injury

5 scales consistent with the 5 senses:
1) visual
2) auditory
3) tactile
4) gustatory
5) olfactory
Each item scored based on intensity of response to stimuli in 3 categories:
1) eye opening
2) motor
3) vocalization
No invasive, noxious, or painful stimulation used.
Scoring guidelines:
1) 15 items
2) Minimum score= 15
3) Maximum score = 90
Each response scale is hierarchically arranged:
1) Lowest score assigned to responses that reflect no change from baseline behavior.
2) Highest score represents the patient’s ability to use behaviors as communication with acceptable reliability and consistency.
Description of response categories (eye opening, motor, and vocalization) is found on p. 313 in Rader & Ellis, 1994, and a summary table is on p. 316.

Number of Items

Pen light
Common objects
Extracts: strawberry, almond, orange, lemon, baking soda, and chocolate
Hot and cold items

30 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

According to the American Congress of Rehabilitation review of outcome measures, the expert panel concluded that the SSAM has well-defined administration and scoring procedures that facilitate consistent use (Seel et al, 2010). Overall, they recommend that the SSAM may be used to assess DOC with moderate reservations, because of concerns about possible bias in determining reliability (unblended assessors). This recommendation is supported by expert consensus that the SSAM has acceptable content validity and acceptable standardized administration and scoring procedures.

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Test/Retest Reliability

Traumatic Brain Injury, Anoxia, and Aneurym: (Rader and Ellis, 1994; n= 20; mean age= 31 (range 16-59); average time post injury= 12.4 months (range2-33 months))

Excellent Test-retest Reliability (correlation coefficient = .89)

Interrater/Intrarater Reliability

Traumatic Brain Injury, Anoxia, and Aneurym: (Rader and Ellis, 1994)

Excellent Interrater Reliability (correlation coefficient= .89)

Criterion Validity (Predictive/Concurrent)

Traumatic Brain Injury: (Rader and Ellis, 1994)

Adequate correlations with Glasgow Coma Scale score (r=.70), Rancho Los Amigos Scale of Cognitive Functioning (r=.68) and Disability Rating Scale (r=-.61), all p<.01

Construct Validity

Traumatic Brain Injury: (Davis and Gimenez, 2003; n=12 individuals with severe TBI who were 3 or more days post injury with stable ICP and Rancho Level I-III, mean age 30, GCS 5.5 for intervention group (n=9), GCS 6 for control group (n=3))

9 patients in the intervention group (repetitive sensory stimulation program) improved significantly more than those in the control group (t= -3.03, p=.015)

Traumatic Brain Injury: (Rader and Ellis, 1994)

Known group validity, SSAM scores were significantly different between patients classified as Rancho level II, III-IV, and V (p<.001)

Content Validity

Good Content Validity
According to the review by the American Congress of Rehabilitation (Seel et al, 2010), the SSAM demonstrates good content validity, containing items that could differentiate persons who are VS, MCS, or emerged from MCS.

Bibliography

American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force, Seel, R.T., Sherer, M., Whyte, J., Katz, D.I., Giacino, J.T., Rosenbaum, A.M., Hammond, F.M., Kalmar, K., Pape, T.L., Zafonte, R., Biester, R.C., Kaelin, D., Kean, J., & Zasler, N. (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

Davis, A. E., & Gimenez, A. (2003). "Cognitive-behavioral recovery in comatose patients following auditory sensory stimulation." J Neurosci Nurs 35(4): 202-209, 214. Find it on PubMed

Rader, M. A., & Ellis, D. W. (1994). "The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severely brain-injured patients." Brain Inj 8(4): 309-321. Find it on PubMed