The Multi-Modal Evaluation of Sensory Sensitivity (MESSY): Assessing a commonly missed symptom of acquired brain injury

Figures & data

Figure 1. An open-ended (Panel A) and a multiple-choice (Panel B) item of the MESSY.

Figure 2. Respondent flow diagram. ADHD = Attention Deficit Hyperactivity Disorder. ASD = Autism Spectrum Disorder.

Table 1. Characteristics of all included respondents.

	Neurotypical adults	Acquired brain injury patients
N	818	341
Age range (in years)	18–96	18–93
Mean age (sd) (in years)	49 (24)	56 (13)
Number of male respondents (%)1	244 (30%)	126 (37%)
Number of respondents who completed higher education (%)2	411 (50%)	105 (31%)
Mean time since brain injury (sd) [Range] (in years)3		6 (8) [0–69]
Number of participants with a single brain injury (%)4		284 (83%)

Sd: standard deviation. Higher education: minimally a bachelor degree awarded by a college or university.

¹ One neurotypical adult and one stroke patient did not specify their gender.

² 40 neurotypical adults and 104 acquired brain injury patients did not specify their education level.

³ 33 acquired brain injury patients did not specify the time since injury

⁴ 29 acquired brain injury patients did not specify the number of brain injuries.

Table 2. Characteristics of included acquired brain injury patients per type of injury.

	Stroke	Traumatic brain injury	Brain tumour
N	204	80	57
Age range (in years)	23–93	18–74	28–78
Mean age (sd) (in years)	59 (12)	49 (13)	52 (11)
Number of male respondents (%)	81 (40%)	20 (25%)	25 (44%)
Number of respondents who completed higher education (%)1	52 (25%)	39 (49%)	14 (25%)
Mean time since brain injury (sd) [Range] (in years)	5 (7) [0–69]	8 (10) [0–48]	8 (8) [1–32]
Number of respondents with a single brain injury (%)2	169 (83%)	74 (93%)	41 (72%)
Number of patients with a ischemic / hemorrhagic / unclear stroke type (%)	102 / 88 / 14 (50% / 43% / 7%)
Mild / moderate to severe traumatic brain injury		28 / 52 (35% / 65%)

Sd: standard deviation. Higher education: minimally a bachelor degree awarded by a college or university.

¹ 64 stroke patients, 30 traumatic brain injury patients, and 20 brain tumour patients did not specify their education level.

² 11 stroke patients, 2 traumatic brain injury patients, and 16 brain tumour patients did not specify the number of brain injuries.

Table 3. Internal consistency of the MESSY in neurotypical adults and acquired brain injury patients.

	Neurotypical adults (n = 818)	Acquired brain injury patients (n = 341)
Cronbach alpha	.94	.96
Omega	.96	.98
Hierarchical omega	.79	.82

Table 4. Goodness-of-fit indicators for the different factor models.

Model	χ^2	df	P	CFI	TLI	RMSEA	95% confidence interval	SRMR
Seven factors model	2444.49	384	<.01	.95	.95	.07	[.07 − .07]	.05
Five factors model	3482.58	395	<.01	.93	.92	.08	[.08 − .09]	.06
One factor model	10178.53	405	<.01	.78	.76	.14	[.14 − .15]	.11

Df = Degrees of freedom, CFI: Comparative fit index, TLI: Tucker-Lewis index (TLI), RMSEA: Root mean square errors of approximation; SRMR: Standardized root mean square residuals. Results are based on the data of 818 neurotypical adults and 341 acquired brain injury patients.

Table 5. Standardized factor loadings of the seven-factor model in neurotypical adults and acquired brain injury patients.

		Standardized factor loadings
Item	Subscale	Entire Sample (n = 1159)	Neurotypical adults (n = 818)	Acquired brain injury patients (n = 341)
I suffer or feel overwhelmed when there are a lot of people around me	Multisensory	.82	.73	.89
I get a headache when there are many environmental stimuli, such as lights, sounds, or smells, around me	Multisensory	.80	.75	.83
I get tired when there are many environmental stimuli, such as lights, sounds, or smells, around me	Multisensory	.84	.77	.88
When I try to concentrate, I am easily distracted by disturbing environmental stimuli	Multisensory	.76	.68	.86
I have the feeling that my brain has to work too hard or my head feels heavy when I process environmental stimuli, such as lights, sounds, or smells	Multisensory	.87	.84	.89
I have the feeling that my brain does not get calm or quiet	Multisensory	.73	.70	.78
I feel light-headed when there are a lot of environmental stimuli, such as lights, sounds, or smells, around me	Multisensory	.76	.75	.71
I am sensitive to bright light	Visual	.72	.67	.77
I suffer or feel overwhelmed when there is a lot to see around me	Visual	.89	.84	.93
I get distracted when there is a lot to see around me	Visual	.82	.75	.91
I find it annoying when there is a lot of movement around me	Visual	.87	.81	.92
I suffer from bright colors	Visual	.78	.72	.83
I get annoyed by sounds that are not bothersome for other people	Auditory	.87	.84	.90
I try to block out sound	Auditory	.82	.76	.91
I stay away from noisy environments	Auditory	.72	.58	.88
I am sensitive to sound	Auditory	.90	.86	.95
I find it hard to concentrate on a conversation when there is environmental sound around me	Auditory	.83	.75	.91
Certain fabrics or certain clothing feel uncomfortable	Tactile	.72	.70	.87
It feels unpleasant when my skin gets touched	Tactile	.92	.88	.98
I am sensitive to touch	Tactile	.88	.86	.95
I find strong smells annoying	Chemosensory	.83	.80	.92
I find smells very strong while others do not suffer from them	Chemosensory	.91	.85	.97
When I smell a strong smell I find it hard to concentrate on something else	Chemosensory	.90	.85	.96
Food tastes very strong to me	Chemosensory	.65	.69	.66
Normal environmental temperatures that do not bother other people are too warm or too cold for me	Environmental Temperature	.75	.76	.76
I feel overwhelmed when I feel too hot or too cold	Environmental Temperature	.88	.83	.93
When I feel, too hot or too cold, I find it hard to concentrate on something else	Environmental Temperature	.87	.86	.92
When I turn my body or when I stretch or bend, I feel dizzy	Motion	.76	.73	.79
I dislike the feeling of certain movements, like being pushed in a wheelchair, standing or sitting in a moving elevator, or driving in a car	Motion	.92	.84	.99
When I look up, I get dizzy or nauseous	Motion	.79	.79	.77

Table 6. Summary of the measurement invariance analysis.

Model	χ2	df	P	CFI	ΔCFI	TLI	RMSEA	95% confidence interval	SRMR
Configural invariance	2779.46	768	<.01	.960		.954	.067	[.065 − .070]	.055
Metric invariance	2710.04	791	<.01	.962	.002	.958	.065	[.062 − .067]	.061
Scalar invariance	3060.71	874	<.01	.956	−0.006	.957	.066	[.063 − .068]	.055

Df = Degrees of freedom, CFI: Comparative fit index, ΔCFI: Difference in Comparative fit index, TLI: Tucker-Lewis index (TLI), RMSEA: Root mean square errors of approximation, SRMR: Standardized root mean square residuals. Results are based on the data of 818 neurotypical adults and 341 acquired brain injury patients.

Table 7. The reliability and validity of the MESSY.

		n	Sample characteristics	Spearman rho correlation coefficient	p
MESSY (session 1)	Adult/Adolescent Sensory Profile	326	Mean age (sd): 29 (17) Age range: 18–86 16% male	.71	< .01
	Social Anxiety and Interaction Scale	326	Mean age (sd): 29 (17) Age range: 18–86 16% male	.39	< .01
	Inventory of Interpersonal Situations	255	Mean age (sd): 25 (15) Age range: 18–86 16% male	−0.03	.66
	MESSY (session 2)	213	Mean age (sd): 26 (16) Age range: 18–86 15% male	.84	<.01

Sd = standard deviation, age is displayed in years.

Figure 3. Observed and predicted total MESSY score based on age (in years) stratified according to gender in 818 neurotypical adults. A higher MESSY score represents a higher severity of sensory hypersensitivity.

Table 8. Multiple regression for the total score on the MESSY in neurotypical adults (n = 818).

	β	95% CI	Standard Error	t	p
Intercept	62.71	[58.95; 66.47]	1.91	32.75	< .01
Gender	6.34	[3.82; 8.87]	1.29	4.93	< .01
Age	−0.13	[-0.19; −0.07]	0.03	−4.19	< .01
Education level	−2.76	[-5.61; 0.08]	1.45	−1.91	.06

CI: Confidence interval.

Table 9. Normative data for the MESSY based on data in neurotypical adults (aged 18-96, n = 818).

		Total score		Multisensory		Visual		Auditory		Tactile		Chemosensory		Environmental temperature		Motion
	Percentile	M	F	M	F	M	F	M	F	M	F	M	F	M	F	M	F
18–44 years (n = 54 males, 291 females)	5	35	40	1.3	1.3	1	1	1	1.2	1	1	1	1	1	1	1	1
	10	37	43	1.3	1.4	1.2	1.2	1	1.4	1	1	1	1	1	1.3	1	1
	25	47	51	1.6	1.9	1.4	1.6	1.6	1.6	1	1	1.3	1.3	1.3	1.7	1	1.3
	50	56	64	2	2.4	1.8	2.2	2	2.2	1.3	1.7	1.8	1.8	1.8	2.3	1.3	1.7
	75	68	79	2.4	3.1	2.2	2.8	2.6	3.1	2	2.3	2	2.5	2.7	3.3	1.7	2.3
	90	76	95	3	3.6	2.6	3.2	3	3.8	2.7	3	2.8	3.3	3.2	4	2.2	3
	95	80	106	3.1	4	3.1	3.7	3.8	4.2	3	3.3	3.1	3.8	4.1	4.3	2.3	3.3
	99	90	121	3.6	4.5	3.5	4.4	4.3	4.4	3.3	4	3.6	4.8	4.8	5	2.5	3.7
		Total score		Multisensory		Visual		Auditory		Tactile		Chemosensory		Environmental temperature		Motion
	Percentile	M	F	M	F	M	F	M	F	M	F	M	F	M	F	M	F
45–69 years (n = 63 males, 166 females)	5	34	34	1.1	1.1	1	1	1	1	1	1	1	1	1	1	1	1
	10	36	39	1.1	1.3	1	1	1.2	1.2	1	1	1	1	1	1	1	1
	25	41	47	1.4	1.6	1.2	1.4	1.5	1.6	1	1	1.1	1.3	1	1.3	1	1
	50	47	57	1.9	2	1.6	1.8	1.8	2.2	1.3	1.3	1.3	1.8	1.3	2	1.3	1.3
	75	58	71	2.3	2.7	2.1	2.4	2.4	3.2	1.5	2	1.8	2.5	2	2.3	1.7	2
	90	73	86	2.6	3	2.4	3.1	3	3.8	2	2.8	2.3	3.3	2.3	3	2	2.3
	95	74	94	3	3.5	2.8	3.4	3.4	4.2	2.3	3.3	2.5	3.3	2.7	3.3	2	2.7
	99	85	104	3.3	3.9	3.1	3.9	4	4.6	4	3.7	3.1	3.5	3	3.8	2.3	3.8
		Total score		Multisensory		Visual		Auditory		Tactile		Chemosensory		Environmental temperature		Motion
	Percentile	M	F	M	F	M	F	M	F	M	F	M	F	M	F	M	F
70 years and older (n = 127 males, 116 females)	5	35	34	1	1	1	1	1	1	1	1	1	1	1	1	1	1
	10	37	37	1.1	1.1	1	1	1.2	1.2	1	1	1	1	1	1	1	1
	25	43	43	1.3	1.4	1.2	1.4	1.4	1.6	1	1	1.3	1.3	1.3	1.3	1	1
	50	50	57	1.7	1.9	1.6	1.8	2	2	1.3	1.3	1.5	1.8	1.7	2	1.3	1.3
	75	59	67	2	2.3	2	2.2	2.7	2.6	1.7	2	2	2.3	2	2.3	2	2
	90	72	78	2.6	2.7	2.6	2.8	3.2	3.4	2.1	2.7	2.5	3	2.7	3.3	2.3	2.3
	95	79	88	2.8	2.9	2.7	3.1	3.4	3.6	2.6	3	2.9	3.1	2.9	3.7	3	2.7
	99	92	92	3.2	3.1	3.5	3.7	4.2	4	3.3	4.2	3.2	3.5	3.6	4	3.6	3.3

M = Male, F = Female.

Table 10. The percentage of acquired brain injury patients with post-injury sensory hypersensitivity per sensory modality and per type of brain injury.

	Number of acquired brain injury patients with post-injury sensory hypersensitivity
Modality	Stroke	TBI	Brain tumour	Total (%)
Multisensory	122	68	45	235 (69%)
Auditory	97	63	31	191 (56%)
Visual	97	54	30	181 (53%)
Motion	35	29	14	78 (23%)
Environmental temperature	32	23	15	70 (21%)
Chemosensory	30	18	11	59 (17%)
Tactile	19	12	6	37 (11%)

Sensory modalities were ordered from most to least prevalent. TBI: Traumatic brain injury.

Table 11. Results of the Quade’s ANCOVA (n = 1159).

		Total Score			Multisensory			Visual			Auditory
	Df	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$
Group	4	50.49	<.01	.15	83.00	<.01	.22	59.88	<.01	.17	67.34	<.01	.19
Gender	1	20.05	<.01	.02	20.89	<.01	.02	13.49	<.01	.01	4.32	.49	.004
Group*Gender	4	1.06	1	.004	1.10	1	.004	1.20	1	.004	.32	1	.001
		Tactile			Chemosensory			Environmental Temperature			Motion
	Df	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$	F	p	${\eta }_{\mathrm{\text{par}}}^2$
Group	4	23.59	<.01	.08	32.24	<.01	.10	32.24	<.01	.10	17.89	<.01	.06
Gender	1	.88	1	.001	3.34	.81	.003	2.92	.96	.003	1.27	1	.001
Group*Gender	4	1.45	1	.004	.38	1	.001	.03	1	0	.89	1	.003

Df = degrees of freedom. F = Quade’s F. p = adjusted pvalue. ${\eta }_{\text{par}}^2$ = partial eta squared. The sample sizes of the different groups and the number of male respondents per group (in %) are as follows (see also Supplementary Table 2): across all tests: Neurotypical adults n = 818 (30%).

Total score: ABI (without SH): n = 70 (59%), Stroke (with SH): n = 153 (35%), TBI (with SH): n = 71 (20%), Brain tumour (with SH): n = 47 (38%).

Multisensory: ABI (without SH): n = 106 (47%), Stroke (with SH): n = 122 (37%), TBI (with SH): n = 68 (21%), Brain tumour (with SH): n = 45 (40%).

Visual: ABI (without SH): n = 160 (51%), Stroke (with SH): n = 97 (28%), TBI (with SH): n = 54 (13%), Brain tumour (with SH): n = 30 (40%).

Auditory: ABI (without SH): n = 150 (53%), Stroke (with SH): n = 97 (26%), TBI (with SH): n = 63 (19%), Brain tumour (with SH): n = 31 (35%).

Tactile: ABI (without SH): n = 304 (40%), Stroke (with SH): n = 19 (21%), TBI (with SH): n = 12 (0%), Brain tumour (with SH): n = 6 (17%).

Chemosensory: ABI (without SH): n = 282 (41%), Stroke (with SH): n = 30 (17%), TBI (with SH): n = 18 (17%), Brain tumour (with SH): n = 11 (36%).

Environmental Temperature: ABI (without SH): n = 271 (41%), Stroke (with SH): n = 32 (25%), TBI (with SH): n = 23 (13%), Brain tumour (with SH): n = 15 (40%).

Motion: ABI (without SH): n = 263 (41%), Stroke (with SH): n = 35 (34%), TBI (with SH): n = 29 (10%), Brain tumour (with SH): n = 14 (21%).

ABI: acquired brain injury. SH: post-injury sensory hypersensitivity.

Figure 4. The distribution of the total score on the MESSY for neurotypical adults, for acquired brain injury patients without post-injury sensory hypersensitivity (ABI without SH), and stroke, traumatic brain injury (TBI), and brain tumour patients with post-injury sensory hypersensitivity (with SH).

Figure 5. The distribution of the mean item scores per modality on the MESSY for neurotypical adults, for acquired brain injury patients without post-injury sensory hypersensitivity (ABI SH-) and stroke, traumatic brain injury (TBI), and brain tumour patients with post-injury sensory hypersensitivity (SH+).

Table 12. The adjusted pvalue of the pairwise Dunn tests per sensory modality.

	ABI patients with post-injury sensory hypersensitivity (per type of injury)			ABI patients with post-injury sensory hypersensitivity (per type of injury) compared to ABI patients without post-injury sensory hypersensitivity			ABI patients with post-injury sensory hypersensitivity (per type of injury) compared to neurotypical adults			ABI patients without post-injury sensory hypersensitivity compared to neurotypical adults
	Stroke – TBI	Stroke – Brain tumour	TBI – Brain tumour	Stroke – ABI (without SH)	TBI – ABI (without SH)	Brain tumour – ABI (without SH)	Stroke – NT	TBI – NT	Brain tumour – NT	ABI (without SH) – NT
Total score	< .01	.59	.01	< .01	< .01	< .01	< .01	< .01	< .01	< .01
Multisensory	.13	.39	.08	< .01	< .01	< .01	< .01	< .01	< .01	.05
Visual	.25	.33	.13	< .01	< .01	< .01	< .01	< .01	< .01	.14
Auditory	.34	.69	.85	< .01	< .01	< .01	< .01	< .01	< .01	< .01
Tactile	1	1	.96	< .01	< .01	< .01	< .01	< .01	< .01	< .01
Chemosensory	.43	.63	.48	< .01	< .01	< .01	< .01	< .01	.03	< .01
Environmental Temperature	1	1	.80	< .01	< .01	< .01	< .01	< .01	< .01	< .01
Motion	.98	.97	.94	< .01	< .01	< .01	< .01	< .01	< .01	.52

Non-significant pvalue (α ≥ .05) are displayed in bold. ABI (without SH): acquired brain injury patients without post-injury sensory hypersensitivity.

(in the month previous to participation). TBI: traumatic brain injury. NT: neurotypical adults. The sample sizes of the different groups and the number of.

male respondents per group (in %) are as follows (see also Supplementary Table 2): across all tests: Neurotypical adults n = 818 (30%).

Total score: ABI (without SH): n = 70 (59%), Stroke (with SH): n = 153 (35%), TBI (with SH): n = 71 (20%), Brain tumour (with SH): n = 47 (38%).

Multisensory: ABI (without SH): n = 106 (47%), Stroke (with SH): n = 122 (37%), TBI (with SH): n = 68 (21%), Brain tumour (with SH): n = 45 (40%).

Visual: ABI (without SH): n = 160 (51%), Stroke (with SH): n = 97 (28%), TBI (with SH): n = 54 (13%), Brain tumour (with SH): n = 30 (40%).

Auditory: ABI (without SH): n = 150 (53%), Stroke (with SH): n = 97 (26%), TBI (with SH): n = 63 (19%), Brain tumour (with SH): n = 31 (35%).

Tactile: ABI (without SH): n = 304 (40%), Stroke (with SH): n = 19 (21%), TBI (with SH): n = 12 (0%), Brain tumour (with SH): n = 6 (17%).

Chemosensory: ABI (without SH): n = 282 (41%), Stroke (with SH): n = 30 (17%), TBI (with SH): n = 18 (17%), Brain tumour (with SH): n = 11 (36%).

Environmental Temperature: ABI (without SH): n = 271 (41%), Stroke (with SH): n = 32 (25%), TBI (with SH): n = 23 (13%), Brain tumour (with SH): n = 15 (40%).

Motion: ABI (without SH): n = 263 (41%), Stroke (with SH): n = 35 (34%), TBI (with SH): n = 29 (10%), Brain tumour (with SH): n = 14 (21%).

ABI: acquired brain injury. SH: post-injury sensory hypersensitivity.

Table 13. Results of the Wilcoxon rank-sum test comparing the sensory sensitivity between patients with sensory hypersensitivity after a mild traumatic brain injury and patients with sensory hypersensitivity after a moderate to severe traumatic brain injury.

	Number of patients with sensory hypersensitivity after mild traumatic brain injury	Number of patients with sensory hypersensitivity after moderate to severe traumatic brain injury	W	p
Total Score	25	46	635.5	.47
Multisensory	25	43	591	.50
Visual	22	32	316	.53
Auditory	24	39	471	.97
Tactile	8	4	13.5	.73
Chemosensory	6	12	27.5	.44
Environmental temperature	10	13	65.5	1
Motion	11	18	92	.77

Data availability statement

The datasets analyzed during the current study are available upon request from the corresponding author (CRG) or are openly available at https://doi.org/10.6084/m9.figshare.21840504.