{"schema_version":1,"research_id":"eoa_inverse_innovation_exp04_external_evaluation_20260802","source_assessment_id":"negative_space_design__neuroscience:RETRIEVAL_FIRST:v0","cell_id":"negative_space_design__neuroscience","search_queries":["post-stroke somatosensory impairment prevalence rehabilitation official guideline sensory retraining","site:strokeguideline.org sensory impairment rehabilitation pacing fatigue individualized delivery stroke","SENSUPP post stroke sensory relearning 20 minute blocks 15 minute break","SENSe Study effectiveness neurorehabilitation sensation randomized controlled trial stroke somatosensory discrimination","Current clinical practice managing somatosensory impairments stroke rehabilitation PLOS ONE 132 therapists","Consolidation of human skill linked to waking hippocampo-neocortical replay Cell Reports 10 second rest","Tactile angle discriminability improvement roles training time intervals different training tasks 2019","NIH Research Plan on Rehabilitation 2021 dosing timing personalization outcome measurement","site:trialsjournal.biomedcentral.com \"SENSory re-learning of the UPPer limb\" intervention TIDieR 15-minute break","\"SENSory re-learning of the UPPer limb\" \"15-min break\"","site:nichd.nih.gov/sites/default/files 2021 NIH Research Plan Rehabilitation PDF dosing timing","site:strokeguideline.org/chapter/sensory-effects-of-stroke somatosensory prevalence 80%","\"SENSory re-learning of the UPPer limb after stroke (SENSUPP): study protocol\" DOI","site:europepmc.org/articles/PMC8259719 consolidation human skill linked waking hippocampo-neocortical replay","site:europepmc.org/articles/PMC6879964 tactile angle discriminability improvement training intervals","site:nih.gov/news-events \"taking short breaks\" brains learn new skills 2021","PMC6879964 printable tactile angle discriminability","\"Micro-offline gains do not reflect offline learning during early motor skill acquisition in humans\" journal 2025","site:pnas.org \"Micro-offline gains do not reflect offline learning\""],"sources":[{"source_id":"S1","title":"Rehabilitation and recovery – sensory effects of stroke","publisher":"National Clinical Guideline for Stroke for the UK and Ireland","url":"https://www.strokeguideline.org/chapter/sensory-effects-of-stroke/","source_class":"OFFICIAL_GUIDANCE","publication_date":"2023","accessed_at":"2026-08-02","claims_supported":["Sensory loss after stroke is recognized, reported prevalence estimates vary and reach up to 80%, and altered touch or other sensation can affect safety and social engagement.","The guideline recommends standardized assessment but states that no particular passive or active sensory intervention has good supporting evidence and that further goal-directed research is needed.","This supports the broad clinical problem, not the proposed interblock-interference mechanism."]},{"source_id":"S2","title":"Rehabilitation and recovery – principles of rehabilitation","publisher":"National Clinical Guideline for Stroke for the UK and Ireland","url":"https://www.strokeguideline.org/chapter/rehabilitation-and-recovery-principles-of-rehabilitation/?id=228","source_class":"OFFICIAL_GUIDANCE","publication_date":"2023","accessed_at":"2026-08-02","claims_supported":["Stroke rehabilitation should be individualized for fatigue, tolerance, goals, preferences, and comorbidities and may be paced across the day.","Qualified therapists guide rehabilitation practice, and people with stroke should participate collaboratively in rehabilitation choices.","The guidance authorizes individualized pacing but does not endorse consolidation-oriented stimulus-free interblock gaps."]},{"source_id":"S3","title":"Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation","publisher":"PLOS ONE","url":"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270693","source_class":"PRIMARY_RESEARCH","publication_date":"2022-08-11","accessed_at":"2026-08-02","claims_supported":["A survey included 132 physiotherapists and occupational therapists working with stroke patients in Singaporean hospitals and rehabilitation centers.","Therapists reported tactile, object-discrimination, proprioceptive, movement, and task-specific interventions, although somatosensory-specific interventions and standardized assessments were uncommon.","Therapists expressed interest in objective, reliable assessment and identified price, usability, space, setup time, funding, and patient needs as implementation constraints; the survey did not ask for protected rest gaps."]},{"source_id":"S4","title":"SENSory re-learning of the UPPer limb (SENSUPP) after stroke: development and description of a novel intervention using the TIDieR checklist","publisher":"Trials / Springer Nature","url":"https://link.springer.com/article/10.1186/s13063-021-05375-6","source_class":"PRIMARY_RESEARCH","publication_date":"2021-07-05","accessed_at":"2026-08-02","claims_supported":["SENSUPP operationalizes therapist-supervised, graded sensory relearning and task-specific training for people after stroke.","Each 2.5-hour session includes 60 minutes of sensory relearning, a fixed 15-minute break, and 60 minutes of task-specific training, with each training hour divided into three 20-minute blocks.","The protocol was delivered in a quiet outpatient room and tailored to participant capacity, but it did not randomize stimulus-free versus active-filler transitions or adapt break duration to preceding-block difficulty."]},{"source_id":"S5","title":"SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation: a randomized controlled trial","publisher":"Neurorehabilitation and Neural Repair / SAGE Publications","url":"https://journals.sagepub.com/doi/full/10.1177/1545968310397705","source_class":"PRIMARY_RESEARCH","publication_date":"2011-02-24","accessed_at":"2026-08-02","claims_supported":["Fifty stroke survivors were randomized to somatosensory discrimination training or nonspecific sensory exposure in a blinded controlled trial.","The intervention used texture discrimination, limb-position sense, and tactile-object recognition in ten approximately 60-minute sessions; standardized measures had reported reliability of 0.85 to 0.92.","The study demonstrates feasibility of graded sensory-discrimination rehabilitation and blinded outcomes, but does not test interblock rest content or 24-hour item-specific retention."]},{"source_id":"S6","title":"Consolidation of human skill linked to waking hippocampo-neocortical replay","publisher":"Cell Reports","url":"https://static1.squarespace.com/static/6080a0b345a5c1682515a3c6/t/6158d28f9b5b826baffa6ea6/1633211026363/CellRest2021.pdf","source_class":"PRIMARY_RESEARCH","publication_date":"2021-06-08","accessed_at":"2026-08-02","claims_supported":["Healthy participants performed 36 ten-second motor-sequence practice periods interleaved with ten-second waking-rest periods while magnetoencephalography was recorded.","Sequence-specific replay during rest correlated with micro-offline performance gains, but the authors acknowledged that causality was not established.","The study is mechanistically adjacent but does not involve stroke, somatosensory discrimination, active filler, difficulty-based duration, or 24-hour retention."]},{"source_id":"S7","title":"Micro-offline gains do not reflect offline learning during early motor skill acquisition in humans","publisher":"Proceedings of the National Academy of Sciences","url":"https://www.diedrichsenlab.org/pubs/Das_PNAS_2025.pdf","source_class":"PRIMARY_RESEARCH","publication_date":"2025-10-28","accessed_at":"2026-08-02","claims_supported":["Across five experiments with 631 participants, short-rest performance gains did not persist when groups were tested under comparable conditions.","The authors attributed the apparent micro-offline gains partly to recovery from fatigue or reactive inhibition and to preplanning rather than durable offline consolidation.","This directly weakens reliance on brief-rest motor findings as evidence for consolidation, while not testing delayed somatosensory retention after stroke."]},{"source_id":"S8","title":"NIH Research Plan on Rehabilitation 2021","publisher":"National Institutes of Health / National Center for Medical Rehabilitation Research","url":"https://www.nichd.nih.gov/sites/default/files/2021-11/NIH_Research_Plan_on_Rehabilitation.pdf","source_class":"OFFICIAL_ORGANIZATION_DATA","publication_date":"2021-11-01","accessed_at":"2026-08-02","claims_supported":["NIH identifies rehabilitation mechanisms, intervention timing, evidence quality, outcome measurement, accessibility, and translation as research priorities.","The plan documents substantial NIH rehabilitation investment and an institutional mandate to support and coordinate rehabilitation research.","It identifies a credible funder class and broad research pull, not a commitment to fund this candidate."]}],"problem_evidence":{"support":"WEAK","rationale":"Post-stroke sensory impairment visibly exists, is common, affects safety and function, and lacks a clearly established best rehabilitation intervention. The narrower stated problem—that sensory or cognitive filler immediately after a sensory-training block interferes with that block's 24-hour retention—was not demonstrated by any opened source. The positive waking-rest motor evidence is indirect and correlational, while newer motor evidence disputes whether brief-rest gains represent durable consolidation. Thus the consequential clinical context is supported but the nominated causal failure remains unverified.","source_ids":["S1","S3","S4","S5","S6","S7"]},"stakeholder_evidence":{"support":"MODERATE","rationale":"Stroke physiotherapists and occupational therapists are identifiable operators; treating therapists and institutional ethics bodies are identifiable authorizers; and NIH/NCMRR is an identifiable potential funder with expressed interest in rehabilitation timing, mechanisms, measurement, accessibility, and translation. Patients are reported to experience sensory training as neglected, and therapists want objective assessment. No source expresses demand for stimulus-free gaps specifically, and no clinic or funder has committed to this study.","source_ids":["S2","S3","S4","S8"]},"prior_art":{"proximity":"SUBSTANTIAL_COLLISION","closest_analogues":[{"name":"SENSUPP block-structured post-stroke sensory relearning","similarity":"Already combines therapist supervision, graded touch and proprioceptive discrimination, repeated 20-minute blocks, quiet-room delivery, individual tailoring, and a scheduled 15-minute break.","remaining_difference":"Its break is fixed between two major training hours; it is not a difficulty-selected stimulus-free gap at each eligible transition and is not compared with duration-matched active filler using immediate and 24-hour retention.","source_ids":["S4"]},{"name":"SENSe somatosensory-discrimination rehabilitation","similarity":"Already provides a randomized, assessor-blinded, perceptual-learning-based post-stroke sensory-discrimination intervention with reliable standardized outcomes.","remaining_difference":"It evaluates multi-session treatment effects rather than transition content, difficulty-adaptive gaps, or the proposed immediate-null/delayed-benefit pattern.","source_ids":["S5"]},{"name":"Brief waking-rest replay during motor practice","similarity":"Already interleaves ten-second rest with practice and associates rest-period neural replay with apparent offline performance gains.","remaining_difference":"It is a healthy motor-sequence paradigm without active filler, stroke sensory rehabilitation, difficulty-linked duration, or 24-hour retention; causality was not established.","source_ids":["S6"]},{"name":"Short-rest recovery and preplanning account","similarity":"Directly tests whether apparent gains across brief motor-practice rests represent learning and supplies fatigue, reactive-inhibition, and preplanning alternatives to consolidation.","remaining_difference":"It challenges the mechanism in healthy motor-sequence tasks but does not determine whether stimulus-free gaps protect delayed tactile learning after stroke.","source_ids":["S7"]}],"distinctive_claim_remaining":"In therapist-guided post-stroke somatosensory discrimination training, explicitly cued stimulus-free gaps whose duration is selected from therapist-approved bounds by the preceding block's predefined difficulty category produce better 24-hour retention than equal-duration active filler, while immediate performance, trial dose, total elapsed time, cueing, and therapist contact remain equivalent.","confidence":"HIGH"},"implementation_evidence":{"support":"MODERATE","rationale":"Existing trials show that trained therapists can deliver graded block-based sensory discrimination, tailor difficulty, record treatment, and use blinded standardized outcomes. Randomized interval cues and timers require no novel device. The exact workflow remains untested: item-level 24-hour measures need alternate forms and reliability work; within-person transition randomization creates clustering and carryover; difficulty-linked duration may confound difficulty with elapsed time; and active filler may introduce fatigue rather than neutral interference. Ethics approval, informed consent, privacy-compliant data handling, preserved therapist supervision, accessible communication, an immediate stop signal, and rollback to ordinary interaction are required. Aphasia, neglect, cognitive impairment, fatigue, pain, anxiety, and sensory hypersensitivity must be accommodated. No legal or regulatory stop is apparent for a noninvasive behavioral study, but clinical adoption cannot precede evidence and local governance.","source_ids":["S1","S2","S3","S4","S5","S7","S8"]},"scores":{"meaningful_impact":{"score":3,"rationale":"If retained benefit improved without more trials, the change could make scarce therapy time more productive. The affected population matters, but transition-specific loss prevalence, effect size, functional transfer, and realized impact are unknown.","source_ids":["S1","S3","S4"]},"stakeholder_pull":{"score":3,"rationale":"Therapists, patients, clinical guidance, and NIH priorities support better sensory rehabilitation, pacing, measurement, and research. Pull for this exact scheduling intervention is absent.","source_ids":["S2","S3","S4","S8"]},"incremental_advantage":{"score":3,"rationale":"The intervention is low-equipment and reversible and could improve retention at matched dose and time. Its advantage over ordinary fixed rest, reduced fatigue, neutral inactivity, or simpler scheduling has not been shown.","source_ids":["S4","S6","S7"]},"distinctiveness_plausibility":{"score":2,"rationale":"The exact combination was not found, but post-stroke sensory discrimination, graded difficulty, block schedules, quiet-room delivery, scheduled breaks, and brief-rest learning theories are already established separately or in close combinations.","source_ids":["S4","S5","S6","S7"]},"technical_implementability":{"score":4,"rationale":"Timers, cues, block randomization, tactile materials, and delayed assessment are technically straightforward. Valid measurement, condition separation, carryover control, and accessible delivery need protocol development rather than new technology.","source_ids":["S4","S5"]},"adoption_authority_feasibility":{"score":3,"rationale":"A therapist-led rehabilitation research site can conduct the study after ethics approval and consent, with the treating therapist retaining interruption authority. Routine adoption would require efficacy and local governance evidence.","source_ids":["S2","S3","S8"]},"evidence_readiness":{"score":2,"rationale":"Operational sensory-training protocols and adjacent rest paradigms exist, but the central problem and comparative effect lack target-population evidence, and recent motor evidence disputes the motivating consolidation interpretation.","source_ids":["S4","S5","S6","S7"]},"safety_net_benefit":{"score":2,"rationale":"The intervention is reversible and can preserve all ordinary care, but it has little direct safety-net benefit. Misinterpreted silence or inaccessible cueing could disadvantage participants with communication or cognitive impairments.","source_ids":["S1","S2","S4"]},"scalability":{"score":4,"rationale":"If validated, timers and protected quiet require little capital and can be protocolized. Added session time, therapist throughput, fidelity, accessibility, and delayed outcome collection constrain scale.","source_ids":["S2","S3","S4"]}},"score_confidence":"MODERATE","costs":{"first_evidence":{"band_2026_usd":"10K_TO_50K","scope":"One-site protocol co-design, patient-adviser and therapist review, measurement-reliability rehearsal, statistical simulation, accessible cue materials, preregistration, and ethics preparation before efficacy enrollment.","confidence":"LOW","assumptions":["Existing rehabilitation space and tactile materials","Mostly in-kind investigator, therapist, statistician, and patient-adviser effort","No imaging, investigational device, medication change, or overnight admission","Institution-specific indirect costs may move the estimate upward"],"source_ids":["S4","S5","S8"]},"initial_deployment_startup":{"band_2026_usd":"50K_TO_250K","scope":"Single-site randomized feasibility study infrastructure and enrollment, including staff training, coordinator time, therapist delivery, blinded 24-hour assessment, accessible consent, data capture, fidelity checks, and safety monitoring.","confidence":"LOW","assumptions":["Approximately 24-36 participants with repeated randomized transitions","Existing outpatient clinic and standard sensory-testing equipment","Part-time coordinator, therapist, blinded assessor, and statistician","Participant travel and 24-hour follow-up are reimbursed without overnight care"],"source_ids":["S4","S5"]},"operational_launch":{"band_2026_usd":"250K_TO_1M","scope":"Adequately powered multisite comparative study with central randomization, fixed-rest and active-filler comparators, blinded delayed outcomes, fidelity auditing, accessible recruitment, data management, analysis, and dissemination.","confidence":"LOW","assumptions":["Approximately 80-200 participants across two to five sites, subject to formal power and clustering calculations","No high-cost imaging endpoint","Research visits are layered onto existing outpatient rehabilitation","Institutional indirect costs and central coordination are included"],"source_ids":["S5","S8"]},"annual_recurring":{"band_2026_usd":"50K_TO_250K","scope":"Post-validation maintenance across a modest rehabilitation network: therapist onboarding, protocol auditing, accessibility updates, outcome surveillance, data governance, and periodic analysis, excluding ordinary therapy already delivered.","confidence":"LOW","assumptions":["Five to fifteen sites","Protocol embedded into existing sessions","No proprietary hardware or licensing","Research-grade outcome surveillance continues"],"source_ids":["S2","S3","S4"]}},"verified_pipeline_gates":{"externally_supported_problem":{"status":"NO","reason":"The broad burden of post-stroke sensory impairment is supported, but no opened source shows that filled sensory-training transitions cause worse 24-hour retention. Positive brief-rest motor evidence is indirect and newer motor evidence offers a contradictory recovery-and-preplanning explanation.","source_ids":["S1","S4","S5","S6","S7"]},"externally_credible_adopter_or_authorizer":{"status":"YES","reason":"Stroke physiotherapists and occupational therapists are credible operators, treating therapists and institutional ethics bodies provide an authority path, and NIH/NCMRR is a credible aligned funder. This is credibility and expressed broad need, not an adoption or funding commitment.","source_ids":["S2","S3","S4","S8"]},"distinct_testable_incremental_claim":{"status":"YES","reason":"The residual claim specifies population, training task, gap content, difficulty-linked duration rule, duration-matched filler, immediate null prediction, and 24-hour retention benefit and can be directly falsified.","source_ids":["S4","S5","S6","S7"]},"bounded_next_evidence_step":{"status":"YES","reason":"A preregistered single-site, within-participant feasibility experiment can randomize a finite set of matched transitions, include fixed-rest and filler comparators, use blinded 24-hour testing, and apply explicit feasibility and safety thresholds.","source_ids":["S4","S5"]},"no_unresolved_safety_or_authority_stop":{"status":"YES","reason":"No intrinsic high-risk component or legal stop was found. This gate is conditional on ethics approval, consent, treating-therapist authority, maintained communication and supervision, accessible cueing, immediate interruption, and restoration of ordinary interaction for distress or clinical need.","source_ids":["S1","S2","S3","S4","S8"]},"credible_cost_scope_and_range":{"status":"UNCERTAIN","reason":"The four scopes and bands are bounded resource-equivalent estimates informed by the staffing and workflow of existing behavioral rehabilitation studies, but the sources provide no protocol-specific 2026 budgets, local labor rates, power calculation, recruitment rate, or site quotation.","source_ids":["S4","S5","S8"]}},"next_evidence_step":"After ethics approval and participant co-design, run a preregistered single-site randomized within-participant feasibility study in approximately 24-36 eligible stroke survivors. At matched sensory-discrimination block transitions, use a 2-by-2 design crossing interval content (explicitly cued stimulus-free quiet versus low-load active filler) with duration policy (predefined difficulty-linked duration versus a fixed-duration schedule matched on aggregate interval time). Keep trial dose, therapist presence, cue length, safety access, and assessment timing constant. Use alternate item sets, model transitions as clustered within participants, and obtain blinded immediate and 24-hour retention assessments. Measure recruitment, adherence, protocol separation, masking, test-retest reliability, missing follow-up, fatigue, expectancy, confusion, distress, and therapist interruptions. Advance only if at least 80% of assigned transitions remain distinct, at least 85% of participants complete 24-hour assessment, reliability is adequate for a powered trial, masking is credible, and there is no condition-related serious event or clinically material excess distress. The primary mechanistic contrast is the interval-content-by-delay interaction; difficulty adaptation must also outperform fixed-duration quiet or show a prespecified interaction with block difficulty. Falsify the candidate if quiet does not improve 24-hour retention over matched filler, if any advantage is already present immediately, if it disappears after fatigue or expectancy adjustment, or if fixed quiet performs equivalently and difficulty adaptation adds no value.","blocking_evidence":["No direct estimate of how often post-stroke sensory learning is lost because of transition filler.","No target-population comparison of stimulus-free quiet with duration-matched active filler using both immediate and 24-hour sensory outcomes.","No evidence that preceding-block difficulty is a valid or superior rule for selecting gap duration.","No validated active-filler task that matches expectancy and therapist contact without adding fatigue, sensory interference, or independent learning.","No validated item-level alternate-form outcome with sufficient reliability and low practice effects for immediate and 24-hour testing.","No site-specific recruitment rate, accessibility assessment, power calculation, labor rates, or 2026 budget.","No named rehabilitation-site investigator, therapist lead, ethics sponsor, or funder commitment."],"research_disposition":"PARTNERED_RESEARCH_PROGRAM","world_novelty_boundary":"This bounded evaluation used eight independently opened direct sources and found substantial component-level collision plus conflicting mechanistic evidence. It did not perform exhaustive patent-family or classification searching, trial-registry expansion, subscription-database review, dissertation and conference searching, non-English review, citation-network saturation, freedom-to-operate analysis, market sizing, or field verification. Failure to locate the exact combination is not evidence of worldwide novelty. World novelty, patentability, freedom to operate, market size, and realized impact remain unmeasured.","arm":"RETRIEVAL_FIRST","candidate_version":0,"controller_recommendation":{"action":"STOP_EMPIRICAL_RESEARCH_NEEDED","repairable":true,"material_progress_observed":true,"progress_targets":["Measure whether interval content predicts item-level 24-hour retention after controlling for immediate learning, difficulty, dose, fatigue, expectancy, and within-participant clustering.","Demonstrate that quiet and active-filler intervals are operationally distinct, acceptable, accessible, and safe for stroke survivors with varied communication and cognitive profiles.","Validate alternate-form sensory outcomes with adequate reliability, limited practice effects, and blinded 24-hour administration.","Compare difficulty-linked duration with fixed-duration quiet to determine whether adaptation adds value beyond generic rest.","Obtain a named rehabilitation-site investigator, therapist lead, ethics pathway, recruitment estimate, formal power simulation, and site-specific 2026 budget.","Proceed to a powered multisite trial only if preregistered feasibility, safety, measurement, and delayed-retention thresholds are met."],"reason":"Web evidence establishes the broad clinical burden, credible operators and funders, implementable sensory-training workflows, and close prior art. It does not establish the candidate's central transition-interference problem or comparative retention effect, and 2025 primary evidence challenges the brief-rest consolidation interpretation. The remaining uncertainties require target-population fieldwork, proprietary site data, and live randomized testing rather than additional bounded web search."}}