The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP).
The GRASSP is a clinical impairment measure specific to the upper limb for use after tetraplegia. The GRASSP measure sensorimotor and prehension function through three domains; important in describing arm and hand function:
PURPOSE OF THE MEASURE
The GRASSP was developed with the intent to be a clinical and a
research tool that would:
- capture information on upper limb impairment from the traumatic tetraplegic population
- obtain integrated sensory and motor impairment data, and discriminate the population according to impairment and function
- be responsive (sensitive) to change over time
- assess the extent of spontaneous (natural) recovery
- be applied in clinical settings and in clinical trials/studies to evaluate the effect of novel interventions
The GRASSP is recommended for use in the early acute phase to any point in the post-injury time-course, particularly when a change in neurological status is the construct of interest. The GRASSP is intended for use with traumatic cervical SCI patients that are being followed for recovery of the upper limb. The GRASSP V1 is not designed for the non-traumatic SCI populations, pediatric population or SCI candidates undergoing tendon transfer/peripheral nerve transfer surgery as yet. Further development is required for the GRASSP to meet the needs of these specific groups.
The GRASSP measure is for use by clinicians in the clinical setting as a clinical outcome measure, researchers in the clinical/research setting as a primary or secondary outcome measure, and academics who are involved in investigator driven research. The developers and funding agencies that have supported GRASSP development would like to promote widespread use in both clinical and research settings. If you are interested in purchasing a GRASSP Kit please go to Products and Purchasing tab now.
VERSIONS of GRASSP
The original version is GRASSP Version 1, which is the version currently in use worldwide. Recently the GRASSP Research and Development Group (GRDG) has been working to launch version 2 which is also specific to traumatic SCI. In addition the GRDG is working on a version for cervical myelopathy related to non-traumatic causes; and field testing of versions for pediatric patients and patients undergoing tendon transfer surgery are in progress. See development tab for more information on Versions.
GRASSP Version 1 (GV1)
Launched in 2011 by the GRDG immediately after the reliability and validity had been established, the GRASSP V1 has been available for clinical and research use. The GRASSP V1 has been made available to the SCI community at large. GV1 has been developed for use with the traumatic tetraplegia population. The general description of GRASSP V1 is above:
GRASSP Version 2 (GV2)
Updating the GRASSP Version 1 to GRASSP Version 2 was planned from the release of GV1. The rationale for the modification/s was to reduce items that were redundant, in turn reducing the administration time of the test without compromising sensitivity. However, the evidence to make changes was not yet available. Recently, with the acquisition of robust datasets from Europe and Canada this analysis was feasible. Every effort has been made to minimize the effect on existing set ups and use of GV1. The research team has confidence that the transition for clinicians and researchers is manageable and the mergence of GV1 and GV2 data will be straight-forward. Information on the website and evidentiary manuscripts will provide insight to users on how to implement GV2. In addition, new web-tools will be made available on the GRASSP website www.grassptest.com to facilitate this process.The second version of GRASSP has gone through a process of item reduction based on the following data:
1. Input from clinicians and their experiences with patients
2. Rasch analysis of the European dataset
3. Validation of the European Rasch analysis with the Canadian dataset
4. Comparison analysis of manual muscle testing (isometric vs. isotonic)”
GRASSP Version Myelopathy (GVM)
The GRASSP-M is a clinical assessment tool used to measure the degree of upper limb impairment and dysfunction in patients suffering from cervical non-traumatic spinal cord injuries. It is a modified version of the GRASSP V1. While the GRASSP is robust in detecting the subtle impairment in the traumatic spinal cord injury population, it is not sensitive enough to the adaptive changes in upper limb function characteristic in non-traumatic populations. The GRASSP-M was modified to detect the specific upper limb dysfunction in cervical myelopathy; this population encompasses all patients suffering from myelopathy as a result of non-traumatic degeneration in the cervical spine as well as cord compression related to tumors, aneurysms and abscesses. The GRASSP-M integrates sensory, motor and dexterity measures to accurately represent the level of dysfunction a patient experiences, and can be used to track functional deterioration over time.