The Graded Redefined Assessment of Strength, Sensibility and Prehension
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Current Research Incorporating The GRASSP

The GRASSP is currently being used in a number of studies in both Europe and North America. The studies are listed and in brackets are the countries involved:

1. GRASSP Longitudinal Study (Canada, Switzerland, Germany)

The Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) has been developed to capture information after cervical SCI for any level at any point during recovery (acute, sub acute, chronic). The GRASSP allows for the evaluation of subtle changes in impairment which are important because small improvements can have a significant impact on functional independence, and subtle changes may be the only changes occurring at this time in the development of emerging therapies. Current measures are not sensitive enough to pick up subtle changes in the hand and upper limb. A more sensitive measure will enable researchers to establish how beneficial new treatments can be. A longitudinal study following individuals with acute SCI is is currently in progress to establish the responsiveness of the GRASSP. The findings of following cervical SCI individuals over time will enable the developers to use the GRASSP as an outcome measure in future intervention studies. The scientific aims of this study are: 1) To develop the psychometric properties of responsiveness for the GRASSP 2) To establish what meaningful change and minimally clinical important differences (MCID) are to the tetraplegic population compared to clinicians and 3) To establish a neurological impairment profile of recovery for the upper limb post cervical SCI.

2. Upper limb rehabilitation in acute SCI: Piloting a novel computer and robotic assisted rehab device (Canada, Switzerland)

Rehabilitation during the 3 to 5 months following SCI is important to functional motor recovery. Recovery of upper limb function can vastly improve activities of daily living, but rehabilitation exercises often require manual support of the arm by a therapist. This is labour-intensive for the therapist, leading to fewer sessions per week and sub-optimal recovery outcomes. Weight bearing assistive devices can help to overcome this problem by reducing the amount of manual assistance required. The Armeo® system is a sophisticated device that combines adjustable weight bearing support of the arm with a grip sensor and an advanced virtual reality environment that stimulates increased interest in rehabilitation training. A multi-center study is currently under way to investigate the feasibility of a rehabilitation program that uses the Armeo® to improve arm and hand function after SCI. The GRASSP assessment tool is being used to measure changes in hand function as a result of the Armeo® training. This study is being conducted at the International Collaboration for Repair Discoveries (ICORD) in Vancouver and at the Toronto Rehabilitation Institute (TRI) in Toronto, under the direction of Professors John Steeves of ICORD and Milos Popovic of TRI.

3. Upper Limb MRCT (Canada)

One of the most promising approaches to improving hand function is functional electrical stimulation (FES), which uses bursts of short electrical pulses to generate muscle contractions. FES is used to produce particular muscle contractions in the forearm to enable a person who otherwise has paralyzed hands to grasp and release objects. The objective of this research program is to conduct a multi-site clinical study that will evaluate the effectiveness of and clinical utility of FES based upper limb interventions for people with tetraplegia. In addition, this study will also evaluate three new upper limb assessments, which have specifically been developed to measure impairment and function of the hand in persons with tetraplegia (Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Toronto Rehab Hand Function Test (TR-HFT), and ReJoyce kinematic and kinetic assessment test. The Study will be conducted at four sites in Canada (Alberta, Montreal, Toronto and New Brunswick).

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