Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP)

Download Clinical Summary PDF

Tool Description

  • Clinical impairment measure that incorporates three domains vital to upper limb function: sensation, strength, and prehension.
  • Multimodal test comprising 5 subtests for each upper limb: dorsal sensation, palmar sensation, strength, prehension ability and prehension performance.
  • Results in 5 numerical scores that provide a comprehensive profile of upper-limb function.

ICF Domain:

Body Function and Structures – Neuromusculoskeletal and Movement-Related Functions & Structures

Number of Items:

Sensation: 3 dorsal locations and 3 palmar locations for each hand

Strength: 10 arm and hand muscles for each arm

Prehension: 3 grasping tasks; 6 prehension tasks for each arm

Brief Instructions for Administration & Scoring

Administration:

  • Sensation: Key test locations (palmar and dorsal) that represent significant anatomical levels of sensory innervation and functionally important areas of the hand are tested using the Semmes Weinstein monofilament (SMW) mini-kit.
  • Strength: traditional motor grading (Daniels and Worthington 1995) is performed for 10 muscles with strong representation at each anatomical neurological level; each muscle is tested with resistance through its full range and graded from 0-5.
  • Prehension – divided into ability vs. performance; included to represent the influence of sensation and strength on goal-oriented upper limb tasks

o   Ability test: involves 3 types of grasp tasks to ensure that the presence or absence of movement of the hand during the early stages post-injury is not missed. Graded by an assessor (0-4) using specific components of grasp acquisition outlined in the GRASSP manual.

o   Performance test: assesses movement within a functional paradigm, and evaluates how the movement is performed. Tasks are scored 0-5.

Equipment:

  • GRASSP kit (contains SMW minikit and standardized equipment ex. wooden blocks)
  • Manual muscle test equipment

Scoring:

  • Scores for tasks in each section (sensation-dorsal, sensation-palmar, strength, prehension-ability, prehension-performance) are summed for each subscale score.

o   Dorsal sensation subscale score ranges from 0-12 (3 locations for dorsal side of each hand, scored from 0-4)

o   Palmar sensation subscale score ranges from 0-12 (3 locations for palmar side of each hand, scored from 0-4)

o   Strength subscale score ranges from 0-50 (10 muscles graded 0-5)

o   Prehension ability subscale score ranges from 0-12 (3 grasps graded 0-4)

o   Prehension performance subscale score ranges from 0-30 (6 grasps graded 0-5)

  • A total score is not calculated.

Interpretability

MCID: not established

SEM and MDC:
SEM and MDC for GRASSP items for right and left hand (calculated from data in Kalsi-Ryan et al. 2012):

GRASSP items:

SEM

MDC

R

L

R

L

Strength (0-50)

1.8

1.9

5.1

5.3

Dorsal sensation (0-12)

--

--

--

--

Palmar sensation (0-12)

--

--

--

--

Prehension ability (0-12)

0.6

0.6

1.8

1.7

Prehension performance (0-30)

2.5

1.8

7.0

4.9

  • No cut-points or normative data have been established for the SCI population; however, published data is available (see the Study Details sheet of this tool).

Languages:

n/a

Training Required:

Reading the GRASSP manual is recommended.

Availability:

Purchase link is found here: http://grassptest.com/Purchase.aspx

The GRASSP Version 1.0 Kit retails for $1250.00 CND (plus tax in Canada) plus shipping and handling.

Clinical Considerations

  • Authors recommend that a partial GRASSP (sensibility, strength, tone and qualitative prehension) be administered prior to 3-4 weeks post-injury as it is unlikely that the patient will tolerate enough sitting (45 min) for the quantitative grasp portion of the test.

Measurement Property Summary

# of studies reporting psychometric properties: 3

Reliability:

  • Both inter-rater reliability and test-retest reliability are High and significant for all GRASSP subtests:

GRASSP Subtest:

Inter-rater reliability

Test-retest reliability

ICC

CI

ICC

CI

Sensation right

0.84

0.75-0.89

0.95

0.91-0.97

Sensation left

0.91

0.86-0.94

0.86

0.76-0.92

Strength right

0.95

0.93-0.97

0.98

0.98-0.99

Strength left

0.95

0.92-0.97

0.98

0.96-0.98

Prehension ability right

0.95

0.92-0.97

0.98

0.96-0.99

Prehension ability left

0.95

0.92-0.97

0.98

0.97-0.99

Prehension performance right

0.95

0.92-0.97

0.93

0.88-0.96

Prehension performance left

0.96

0.93-0.97

0.96

0.93-0.98

[Kalsi-Ryan et al. 2009, Kalsi-Ryan et al. 2012]

Validity:

  • Correlation of the GRASSP subtest Sensation Total (R & L) is Moderate with the Spinal Cord Independence Measure (SCIM) (0.57), and High with both the SCIM-self care subscale (0.74) and the Capabilities of Upper Extremity (CUE) (0.77).
  • Correlation of the GRASSP subtest Strength Total (R & L) is Moderate with the SCIM (0.59), and High with both the SCIM-self care subscale (0.74) and the CUE (0.76).
  • Correlation of the GRASSP subtest Strength Total (R & L) is High with the SCIM (0.68), the SCIM-self care subscale (0.79) and the CUE (0.83).

[Kalsi-Ryan et al. 2009, Kalsi-Ryan et al. 2012, Kalsi-Ryan et al. 2013]

Responsiveness:

No values were reported for the responsiveness of the GRASSP for the SCI population.

Floor/Ceiling effect:

No values were reported for the presence of floor/ceiling effects in the GRASSP for the SCI population.

Reviewer

Dr. Janice Eng, John Zhu, Jeremy Mak

Date Last Updated:

November 7, 2016

Download the measure

Download Worksheet:
Purchase link is found here: http://grassptest.com/Purchase.aspx

Video

n/a

Scoring

n/a

Equipment Needed

Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP):

Kalsi-Ryan S, Beaton D, Ahn H, et al. 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):307-14.
http://www.ncbi.nlm.nih.gov/pubmed/26560017

Kalsi-Ryan S, Curt A, Fehlings MG, Verrier MC. Assessment of the Hand in Tetraplegia Using the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): Impairment Versus Function. Top Spinal Cord Inj Rehabil 2009; 14(4): 34-46.
http://thomasland.metapress.com/content/h265344543w0k0t4/

Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. Graded Redefined Assessment of Strength Sensibility and Prehension: Reliability and Validity. J Neurotrauma, 2012; 29: 905-914.
http://www.ncbi.nlm.nih.gov/pubmed/21568688

Kalsi-Ryan S, Beaton, D, Curt A, Duff S, Jiang D, Popovic MR, Rudhe C, Fehlings MG, Verrier MC. Defining the Role of Sensation, Strength and Prehension for Upper Limb Function in Cervical Spinal Cord Injury. Neurorehabil Neural Repair, 2013; XX(X): 1-9 [Epub].
http://www.ncbi.nlm.nih.gov/pubmed/23778700

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.
http://www.ncbi.nlm.nih.gov/pubmed/26156192

Velstra IM, Bolliger M, Tanadini LG, et al. 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):632-42.
http://www.ncbi.nlm.nih.gov/pubmed/24566986

Velstra IM, Curt A, Frotzler A, Abel R, Kalsi-Ryan S, Rietman JS, Bolliger M. Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury: European Multicenter Responsiveness Study of the GRASSP. Neurorehabil Neural Repair. 2015;29(8):755-66.
http://www.ncbi.nlm.nih.gov/pubmed/25567122