- 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
- A remote version (rGRASSP) and a version for people with degenerative cervical myelopathy have been developed.
- GRASSP v.2 was modified from its original version to improve objectivity, reduce assessment time, and improve usability:
- GR-Str: Isotonic Manual Muscle Testing (MMT) changed to isometric MMT
- GR-Sens: Reduction of 6 test locations to 3 per hand (elimination of dorsal sensation)
- GR-PP: Reduction of 6 items to 4 items. • Instruction manual revised for clarity and standardization
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.
ICF Domain
Body Function and Structures ▶ Neuromusculoskeletal & Movement-Related Functions & Structures
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
- 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.
- Performance test: assesses movement within a functional paradigm, and evaluates how the movement is performed. Tasks are scored 0-5.
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
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.
- Dorsal sensation subscale score ranges from 0-12 (3 locations for dorsal side of each hand, scored from 0-4)
- Palmar sensation subscale score ranges from 0-12 (3 locations for palmar side of each hand, scored from 0-4)
- Strength subscale score ranges from 0-50 (10 muscles graded 0-5)
- Prehension ability subscale score ranges from 0-12 (3 grasps graded 0-4)
- Prehension performance subscale score ranges from 0-30 (6 grasps graded 0-5)
- A total score is not calculated.
Languages
English
Training Required
No formal training required. However, reading the GRASSP manual is recommended.
Availability
The GRASSP worksheet can be purchased here.
The GRASSP Version 1.0 Kit retails for $1250.00 CND (plus tax in Canada) plus shipping and handling.
Measurement Property Summary
Number of studies reporting psychometric properties: 14
Interpretability
- No cut-points or normative data have been established for the SCI population; however, published data is available (see the Research Summary sheet of this tool).
- MCID: not established in SCI
- 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 |
Reliability – High
Number of studies reporting reliability data: 4
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. 201)
Validity – Moderate to High
- Moderate to High correlation between the GRASSP subtests, SCIM-self care, & ASIA UEMS:
- At 1-month post-injury:
- Strength & SCIM-self-care: r = 0.78
- Strength & ASIA UEMS: r = 0.95
- Sensation & SCIM-self-care: r = 0.63
- Prehension performance & SCIM-self-care: r = 0.85
- At 12-month post-injury:
- Strength & SCIM-self-care: r = 0.82
- Strength & ASIA UEMS: r = 0.88
- Sensation & SCIM-self-care: r = 0.56
- Prehension performance & SCIM-self-care: r = 0.82
- At 1-month post-injury:
- Moderate to High predictive validity: ROC analysis AUC: r = 0.71-0.86
(Velstra et al. 2015; n=74, 51 males, 23 females; mean (SD) age: 49 (18) years; traumatic and non-traumatic; 18 ASIA A, 12 ASIA B, 10 ASIA C, and 34 ASIA D; tetraplegia; and 16-40 days post-injury)
- Moderate to High correlation between GRASSP and CUE-Q: r= 0.40-0.84
- Moderate to High correlation between GRASSP and SCIM/SCIM-SC:
- SCIM: r=0.37-0.70
- SCIM-SC: r=0.40-0.84
(Mulcahey et al. 2017; n=47; 28 males, 19 females; children (3-17 years); tetraplegia; 14 ASIA A, 4 ASIA B, 10 ASIA C, 8 ASIA D, and 11 unknown)
- Moderate to High correlation to SCIM: 0.530–0.830, P < 0.0001
(Kalsi-Ryan et al. 2019; Crosssectional: n=72, AIS 28A, 18B, 14C, 12D; Longitudinal: n=127, AIS: 29A, 17B, 26C, 55D)
Responsiveness
Effect Size:
Between 1-12 months post-injury
- Strength: 1.48
- Sensation: 0.64
- Prehension ability: 0.99
- Prehension performance: 1.03
(Velstra et al. 2015; n=74, 51 males, 23 females; mean (SD) age: 49 (18) years; traumatic and non-traumatic; 18 ASIA A, 12 ASIA B, 10 ASIA C, and 34 ASIA D; tetraplegia; and 16-40 days post-injury)
Floor/Ceiling effect
No values were reported for the presence of floor/ceiling effects in the GRASSP for the SCI population.
Reviewers
Dr. Janice Eng, Dr. Carlos L. Cano-Herrera
Date Last Updated
December 31, 2024
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
