GRASSP
The Graded Redefined Assessment of Strength, Sensibility and Prehension
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Development Of The GRASSP Measure

Introduction

Initiated by the North American Clinical Trials Network (NACTN) and the European Clinical Trials Network (EUCTN), a meeting was held on May 12 and 13, 2006 in Chicago (local organizer Drs. Zev Rymer and Lisa-Ann Wuermser, financially supported by the Christopher and Dana Reeve Foundation and Novartis) to discuss the measurement of hand impariment and function in patients suffering from tetraplegia.

Members of the networks and independent clinical specialists in hand measurement and therapy, as well as researchers wth expertise in engineering and computer technology; discussed the development of a comprehensive protocol to assess upper limb impairment and recovery post tetraplegia.

The result of the meeting was a task force to further develop a clinical assessment protocol of upper limb function by modifying existing tools and introducing new measures that would allow for the quanitification of change in upper limb function for individuals with tetraplegia.

The GRASSP is a combined effort by six clinicians/researchers who have contributed their work (results of tool developpment through previous research, in some instances graduate studies), skills and time. The GRASSP is a mosaic of the Link Hand Function Test (Link, 2004) and The Tertraplegia Hand Measure (Kalsi-Ryan et al. 2004).


Design And Development Of The GRASSP

The GRASSP is a frmework that assembles different clinical tools to measure the various aspects of complex sensori-motor upper limb function.

For the development of the GRASSP, each of the three modules was assigned to one of the measurement developers (Strength - Susan Duff, Sensibility - Sukhvinder Kalsi-Ryan, and Prehension - Claudia Rudhe) under the direction of Armin Curt, Michael Fehlings and Molly Verrier. Although individuals were responsible for the separate modules, all members of the task force made significant contributions to all components of the GRASSP.

Development

The GRASSP has been developed over four stages with the fourth stage being the current and ongoing longitudinal study by the developers. Table 1 defines the Development, researchers and funding agencies involved to date. The GRASSP development has been supported by the Christopher and Dana Reeve Foundation, The Rick Hansen Institute, Novartis AG and the Physiotherapy Foundation of Canada. Phase I and II have been completed with all results disseminated. Phase III data collection has been completed with pending dissemination via four manuscripts. The first manuscript has been published and is available in the March 2009 issue of Topics in Spinal Cord Injury Rehabilitation. This publication is available by going to the publications tab.

Phase I and II have been completed with all results disseminated. Phase III data collection has been completed with pending dissemination via four manuscripts. The first manuscript has been published and is available in the March 2009 issue of Topics in Spinal Cord Injury Rehabilitation.

Table 1: Development of GRASSP

 
Development Phase Team Involved Outcome of Work Funding
Phase I - Workshop to bring Task Force together
2006
Kalsi-Ryan, Rudhe, Duff, Curt, Fehlings, Verrier International GRASSP Research & Design Team Christopher and Dana Reeve Foundation, Novartis AG
Phase II - Theoretical Development
2006
Kalsi-Ryan, Rudhe, Duff, Curt, Fehlings, Verrier Alpha Version of GRASSP Christopher and Dana Reeve Foundation
Phase III - Cross Sectional Study, Europe & North America
2007-2010
Kalsi-Ryan, Rudhe, Duff, Curt, Fehlings, Verrier GRASSP Cross Sectional Study Group including NA and European Members

GRASSP Version 1.0

-GRASSP Inclusion, development of scoring, reliability, validity, impairment function relationships

Christopher and Dana Reeve Foundation,

Rick Hansen Foundation and Ontario Neurotrauma Foundation

Phase IV - Longitudinal Study - Ongoing
2009-present
Kalsi-Ryan, Beaton, Curt, Fehlings, Popovic, Verrier, Velstra, Bolliger, and GRASSP Longitudinal Study Groups in Canada and Europe -Responsiveness
-Recovery Profile - Minimal Clinically Important Difference

Ontario Neurotrauma Foundation,

Rick Hansen Institute Physiotherapy Foundation of Canada


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