Graded and Redefined Assessment of Strength, Sensibility and Prehension
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Graded and Redefined Assessment of Strength, Sensibility, and Prehension

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Purpose

The GRASSP is a clinical impairment measure to assess sensorimotor hand function in persons with cervical spinal cord injuries (C1-T1).

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Instrument Details

Acronym GRASSP

Area of Assessment

Functional Mobility
Upper Extremity Function

Assessment Type

Performance Measure

Cost

Not Free

Actual Cost

$850.00

Diagnosis/Conditions

  • Pediatric + Adolescent Rehabilitation
  • Spinal Cord Injury
  • Sports & Musculoskeletal Injuries

Populations

Spinal Injuries

Key Descriptions

  • 3 domains of hand function:
    1) Strength
    2) Sensibility
    3) Prehension
  • 5 Subtests:
    1) Dorsal sensation (3 locations), each scored 0-4 (sum = subtest score, 0-12)
    2) Palmar sensation (3 locations), each scored 0-4 (sum = subtest score, 0-12)
    3) Strength (10 muscles of arm & hand), motor grade 0-5 for each (sum = subtest total, 0-50)
    4) Prehension ability – 3 grasps (cylindrical, lateral key, tip to tip) – each scored 0-4 (sum = subtest score, 0-12)
    5) Prehension performance - 6 prehension tasks (pour water from bottle, open jars, pick up and turn key, transfer 9 pegs from board to board, pick up four coins and place in slots, screw four nuts onto bolts – each scored 0-5 (sum = subtest score, 0-30)
  • Subtest scores given for the left and the right.
  • Designed to capture changes in neurological recovery and hand function.

Number of Items

25 per hand

Equipment Required

  • GRASSP Kit:
  • Minikit of Semmes Weinstein Monofilaments
  • A standardized set of all materials for Prehension Testing
  • The GRASSP Manual
  • CD with score sheet and graphing program

Time to Administer

45 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Cara Leone Weisbach, PT, DPT, Wendy Romney, PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 5/2012.

Body Part

Upper Extremity

ICF Domain

Body Structure
Body Function
Activity

Measurement Domain

Motor
Sensory

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 for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

LS

LS

R

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

R

R

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)

SCI EDGE

No

No

Yes

Not reported

Considerations

  • Individuals with sensory level of C5 or above are expected to score 0 on the sensory testing of the GRASSP.
  • Clinical utility is decreased secondary to cost of GRASSP kit and increased time to complete measure.
  • Domains can be used individually or together.
  • This battery of tests has been developed through a comprehensive four phase process examining existing measures and identifying best methods for assessing subtle and clinically meaningful changes and how sensory and motor impairments contribute to integrate function.

 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Spinal Injuries

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Test/Retest Reliability

Chronic Tetraplegia:

(Kalsi-Ryan et al., 2012; n = 72; mean age = 39.2(10.7) years; mean time since injury = 7.6(6.1) years) 

  • Excellent test-retest reliability for each subtest total (ICC = 0.86 – 0.98, p < 0.0001) 

Test-Retest Reliability for GRASSP Subtests

 

 

Subtest

Test-Retest Reliability (ICC)

Sensation right

0.95

Sensation left

0.86

Strength right

0.98

Strength left

0.98

Prehension ability right

0.98

Prehension ability left

0.98

Prehension performance right

0.93

Prehension performance left

0.96

 

Interrater/Intrarater Reliability

Chronic Tetraplegia: 

(Kalsi-Ryan et al., 2012) 

  • Excellent inter-rater reliability for each subtest total (ICC = 0.84-0.96, p < 0.0001) 

Inter-rater Reliability for GRASSP Subtests

 

 

Subtest

Inter-rater Reliability (ICC)

Sensation right

0.84

Sensation left

0.91

Strength right

0.95

Strength left

0.95

Prehension ability right

0.95

Prehension ability left

0.95

Prehension performance right

0.95

Prehension performance left

0.96

 

Criterion Validity (Predictive/Concurrent)

Chronic Tetraplegia:

(Kalsi-Ryan et al., 2012) 

Concurrent Validity 

(Correspondence between GRASSP subtests and the Capabilities of Upper Extremities Questionairre (CUE), Spinal Cord Independence Measure II (SCIM) and the SCIM self-care subscale (SCIM-SS); p < 0.0001) 

  • Excellent correlation of sensation subtest of GRASSP with SCIM-SS and CUE (r = 0.74 and 0.77, respectively) 
  • Excellent correlation of strength subtest of GRASSP with SCIM-SS and CUE (r = 0.74 and 0.76, respectively) 
  • Excellent correlation of prehension performance subtests of GRASSP with SCIM, SCIM-SS and CUE (r = 0.68, 0.79, 0.83, respectively) 
  • Adequate correlation of sensation and strength subtests of GRASSP with SCIM (r = 0.57 and 0.59, respectively) 
  • Subtest that measures impairment within a functional context (prehension performance) shows stronger associations with the existing measures, than the subtests reflecting impairment alone.

Construct Validity

Chronic Tetraplegia:

(Kalsi-Ryan et al., 2012) 

Sensation & strength subtests of GRASSP compared to sensory (light touch) & motor upper limb items in the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) 

  • 54% discordance in sensory innervations when assessed with GRASSP due to additional test points included and the increased response levels used in the GRASSP 
  • GRASSP was more sensitive to identifying sensation than INSCSCI 
  • Adequate agreement (kappa coefficient between 0.412-0.511) between the GRASSP(Semmes Weinstein Monofilament) C6, C7, C8 dorsal test locations and ISNCSCI (light touch) - comparison of same test points 
  • 53% discordance in motor innervations when assessed with GRASSP due to added motor points in GRASSP and determination of level by most caudal segment in ISNCSCI 
  • Overall the GRASSP is ~50% more sensitive than the ISNCSCI in determining sensory and motor integrity in the upper limb

Bibliography

Alexander, M. S., Anderson, K., et al. (2009). "Outcome measures in spinal cord injury: recent assessments and recommendations for future directions." Spinal Cord 47(8): 582-591. Find it on PubMed

Harvey, L. A., Dunlop, S. A., et al. (2011). "Early intensive hand rehabilitation after spinal cord injury (" Hands On"): a protocol for a randomised controlled trial." Trials 2011(12): 14. Find it on PubMed

Kalsi-Ryan, S., Beaton, D., et al. (2012). "The Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP)–Reliability and Validity." Journal of Neurotrauma(ja). Find it on PubMed

Kalsi-Ryan, S., Curt, A., et al. (2009). "Assessment of the Hand in Tetraplegia Using the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)." Topics in Spinal Cord Injury Rehabilitation 14(4): 34-46.

Zariffa, J., Kapadia, N., et al. (2011). "Relationship between clinical assessments of function and measurements from an upper-limb robotic rehabilitation device in cervical spinal cord injury." Neural Systems and Rehabilitation Engineering, IEEE Transactions on(99): 1-1. Find it on PubMed

Zariffa, J., Kapadia, N., et al. (2011). "Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population." IEEE. Find it on PubMed

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