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Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)
Availability
Classification
Exploratory: Spinal Cord Injury (SCI) and SCI-Pediatric (age 5 and over)
Short Description of Instrument
Construct measured: Upper extremity function
 
Generic vs. disease specific: Disease specific
 
Intended respondent: Participant
 
# of subscales and names of sub-scales: 5 subtests; dorsal sensation, palmar sensation, strength, prehension ability, and prehension performance
Comments/Special Instructions
Scoring: Scoring is as follows for the 5 subtests.
1.  Dorsal sensation (3 locations), each scored 0–4 (sum = subtest score, 0–12)
2.  Palmar sensation (3 locations), each scored 0 01504 (sum = subtest score, 0– 12)
3.  Strength (10 muscles of arm & hand), 0-5 for each (sum = subtest total, 0–50)
4.  Prehension ability – 3 grasps – each scored 0–4 (sum = subtest score, 0–12)
5.  Prehension performance - 6 prehension tasks – each scored 0–5 (sum = subtest score, 0–30)
 
Background: This is a performance measure. This test is used to assess sensorimotor hand function in people with spinal cord injuries. It measures three domains of hand function - strength, sensibility, and prehension, and consists of 5 subtests – dorsal sensation, palmar sensation, strength, prehension ability, and prehension performance.
Available for Purchase (approximately, $800 US).
 
SCI-Pediatric-specific: Validation in children currently under way.
Rationale/Justification
Strengths/Weaknesses: The GRASSP is more of a "kit" than it is an outcome measure as the kit includes many subtests. The kit is a good choice for studies that are exclusively focused on hand function and therefore require exhaustive testing of hand function. There are alternative tests available that have applicability across clinical populations, and these are likely preferable for most applications as the investigator can select the specific validated tests that are best suited to the purpose of their study. The sensory and grasp components are appropriate for any stage after injury. Items that require sitting recommended for subacute and chronic studies.
 
Psychometric Properties: Good to strong inter-rater and test-retest reliability with ICC values ranging from 0.84–0.98. Concurrent validity was moderate to good (0.57– 0.83). Studies show that sensation, strength and hand function of upper limb can be predictive of outcomes in SCI.
References
Harvey LA, Dunlop SA, Churilov L, Hsueh YS, Galea MP. Early intensive hand rehabilitation after spinal cord injury ("Hands On"): a protocol for a randomized controlled trial. Trials. 2011;12:14.
 
Kalsi-Ryan S, Beaton D, Ahn H, Askes H, Drew B, Curt A, Popovic MR, Wang J, Verrier MC, Fehlings MG. Responsiveness, Sensitivity, and Minimally Detectable Difference of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, Version 1.0. J Neurotrauma. 2016;33(3):307–314.
 
Kalsi-Ryan S, Curt A, Verrier MC, Fehlings MG. Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia. J Neurosurg Spine. 2012;17(1 Suppl):65–76.
 
Kalsi-Ryan S, Curt A, Fehlings M, Verrier M. (2009) Assessment of the Hand in Tetraplegia Using the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP). Topics in Spinal Cord Inj Rehabil. 2009;14(4):34–46.
 
Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity. J Neurotrauma. 2012;29(5):905–914.
 
Velstra IM, Bolliger M, Krebs J, Rietman JS, Curt A. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury. Neurorehabil Neural Repair. 2016;30(4):295–306.
 
Zariffa J, Kapadia N, Kramer JL, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, Albisser U, Willms R, Townson A, Curt A, Popovic MR, Steeves JD. Relationship between clinical assessments of function and measurements from an upper-limb robotic rehabilitation device in cervical spinal cord injury. IEEE Trans Neural Syst Rehabil Eng. 2012;20(3):341–350.
 
Zariffa J, Kapadia N, Kramer JL, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, Willms R, Townson A, Curt A, Popovic MR, Steeves JD. Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population. Spinal Cord. 2012;50(3):220–226.
 
Zariffa J, Steeves JD. Computer vision-based classification of hand grip variations in neurorehabilitation. IEEE Int Conf Rehabil Robot.2011;2011:5975421.
 
Zariffa J, Kapadia N, Kramer JL, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, Willms R, Townson A, Curt A, Popovic MR, Steeves JD. Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population. IEEE Int Conf Rehabil Robot. 2011;2011:5975400.
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