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Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)
Availability
GRASSP V2.0 is now available for use.
Classification
Supplemental: Spinal Cord Injury (SCI)
Exploratory: SCI-Pediatric (for children aged 8 years and older)
Short Description of Instrument
Construct measured: Upper extremity function
 
Generic vs. disease specific: Disease specific
 
Intended respondent: Participant
 
# domains: strength; sensation; prehension
 
# of subscales and names of sub-scales: 5 subtests; dorsal sensation, palmar sensation, strength, prehension ability, and prehension performance
Comments/Special Instructions
Scoring: Scoring for GRASSP V1  is as follows for the 5 subtests (no. of items, item score range, subtest score range) (Kalsi-Ryan, et al., 2012).
1. Dorsal sensation (3, 0-4, 0-12)
2. Palmar sensation (3, 0-4, 0-12)
3. Strength (10, 0-5, 0-50)
4. Prehension ability (3, 0-4, 0-12)
5. Prehension performance (6, 0-5, 0-30)
 
Scoring for GRASSP V2 was revised following additional data (Kalsi-Ryan et al., 2019; Velstra, et al., 2018) and redundant items were removed, resulting in 4 subtests. Dorsal sensation was removed and the scoring for prehension performance is now scored out of 20. (https://www.grassptest.com/)
 
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. In GRASSP V2, there are 4 subtests (dorsal sensation subset has been removed).
 
Available for Purchase (approximately, $1000 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: "GRASSP (V1 and V2) is a valid, reliable, and responsive outcome measure to evaluate upper limb function in individuals with tetraplegia" (Velstra et al., 2018). 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.
 
Responsiveness: "Longitudinal construct validity demonstrated GRASSP and all external measures to be responsive to neurological change 1-year post-injury. SRM values for the GRASSP subtests ranged from 0.25 to 0.85 units greater than that for ISNCSCI strength and sensation, SCIM-SS, and CUE-Q. MDD values for GRASSP subtests ranged from 2-5 points. GRASSP demonstrates good responsiveness and excellent sensitivity that is superior to ISNCSCI and SCIM III. MDD values are useful in the evaluation of interventions in both clinical and research settings. The responsiveness and sensitivity of GRASSP make it a valuable condition-specific measure in tetraplegia, where changes in upper limb neurological and functional outcomes are essential for evaluating the efficacy of interventions." (Kalsi-Ryan et al., 2016)
"…GRASSP (V1 and V2) are responsive to change in persons with acute cervical spinal cord injury…" (Marino et al., 2018), MCID and GRASSP v. 2.0. (Kalsi-Ryan, 2016 Marino, 2018; Velstra, 2018).
References
GRASSP V1
 
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.
 
Marino RJ, Sinko R, Bryden A, Backus D, Chen D, Nemunaitis GA, et al. Comparison of Responsiveness and Minimal Clinically Important Difference of the Capabilities of Upper Extremity Test (CUE-T) and the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP). Topics Spinal Cord Injury Rehabil. 2018;24(3):227-238.
 
Mulcahey MJ, Calhoun Thielen C, Dent K, Sinko R, Sadowsky C, Martin R, Vogel LC, Davidson L, Taylor H, Bultman J, Gaughan J. Evaluation of the graded redefined assessment of strength, sensibility and prehension (GRASSP) in children with tetraplegia. Spinal Cord. 2018;56(8):741-749.
 
Velstra IM, Bolliger M, Tanadini LG, Baumberger M, Abel R, Rietman JS, Curt A. Prediction and stratification of upper limb function and self-care in acute cervical spinal cord injury with the graded redefined assessment of strength, sensibility, and prehension (GRASSP). Neurorehabil Neural Repair. 2014;28(7):632-642.
 
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.
 
GRASSP V2
 
Kalsi-Ryan S, Chan C, Verrier M, Curt A, Fehlings M, Bolliger M, Velstra IM; GRASSP Cross Sectional Study Team; GRASSP Longitudinal Study Team. The graded redefined assessment of strength sensibility and prehension version 2 (GV2): Psychometric properties. J Spinal Cord Med. 2019;42(sup1):149-157.
 
Velstra IM, Fellinghauer C, Abel R, Kalsi-Ryan S, Rupp R, Curt A. The Graded and Redefined Assessment of Strength, Sensibility, and Prehension Version 2 Provides Interval Measure Properties. J Neurotrauma. 2018;35(6):854-863.