GRASSP Version 1 (GV1) was developed in 2006 by the GRASSP Development and Research Group. It was designed using elements of the Link Hand Function Test, Quadriplegia Hand Assessment Tool and Sollerman Hand Function Test. GV1 has been tested for the psychometric properties during early development. The psychometric properties are excellent; evidence for the reliability, validity and responsiveness are published.

Development of the GRASSP has been a staged process with a number or different research groups and funding agencies involved. Once the GRASSP V1 had been assembled and GRDG conducted a cross sectional study to field test and establish the psychometric properties of reliability and validity.


This study was conducted in Europe, Canada and the USA. Seventy-two patients were enrolled into a study designed to evaluate the reliability and validity of the GRASSP. This study was conducted on a sample of chronic patients.

Cross Sectional Study Team Investigators:Sukhvinder Kalsi-Ryan
Professor Molly Verrier
Dr. Michael Fehlings
Dr. Armin Curt
Dr. Dorcas Beaton
Dr. Milos Popovic
Claudia Rudhe
Susan Duff.

Balgrist University Hospital Zurich Switzerland

Claudia Rudhe GRDG, Examiner
Christina Robert Examiner

Krakenhaus Hohe Worte Bayreuth Germany

Kristin Lorenz Examiner
Petra Schatz Examiner

Traumacenter Murnau, Murnau Germany

Martha Horn Examiner
Simone Hirsch Examiner

Rehabilitation Institute of Chicago USA

Kimberley Eberhardt Examiner
Rebecca Ozelie Examiner

Thomas Jefferson University Philadelphia USA

Gina Cooke Examiner
Susan Duff Examiner

Vancouver Coastal Health Vancouver, Canada

Dr. Armin Curt GRDG
Megan Watts Examiner
Robert Corcoran Examiner

Toronto Rehab Institute, Toronto Canada

Sukhvinder Kalsi-Ryan GRDG, Examiner
Marlene Adams Examiner
Sylvia Coates Examiner
Abigail Dry Examiner
Professor Molly Verrier GRDG

UHN, Toronto Canada

Dr. Michael Fehlings GRDG

GRASSP development has been a staged process with a number of different research groups and funding agencies involved.

Longitudinal Study Group

This study was a longitudinal study enrolling 130 patients in Canada and Europe to establish responsiveness, recovery profiles and minimally clinical important difference (MCID). The responsiveness of the GRASSP is excellent and it is more sensitive than some of the existing measures in SCI. Data collection for the longitudinal study concluded in November of 2014. MCID has been established, but not yet published. This longitudinal dataset has also enable the team to perform Rasch Analysis, which has rendered a revision to GRASSP Version 1. The GRDG is currently in the process of launching GRASSP Version 2.


Sukhvinder Kalsi-Ryan Dr. Dorcas Beaton
Professor Molly Verrier Dr. Milos Popovic
Dr. Michael Fehlings Dr. Inge Marie Velstra
Dr. Armin Curt

Canadian GRASSP Longitudinal Study Group

Toronto Rehab, Toronto

Professor Molly Verrier Site Investigator
Vera Zivanovic Research Coordinator, Examiner
Naz Kapadia Examiner

Toronto Western Hospital

Sukhvinder Kalsi-Ryan Site Investigator
Jean Brown Examiner
Kathy Murphy Examiner

St. Michael’s Hospital

Dr. Henry Ahn Site Investigator
Kayee Tung Research Coordinator
Faye Uy Examiner
Zia Poonjiaji Examiner
Kerry Doherty Examiner

Sunnybrook Health Sciences Centre

Dr. Michael Ford Site Investigator
Aimee Gallant Research Coordinator
Jocelyn Denomme Examiner

Hamilton Health Sciences Centre

Dr. Brian Drew Site Investigator
Deborah Tsui Research Coordinator
Sera Nicosia Examiner
Barbara Murray Examiner
Dorinda Taylor Examiner
Mirela Anton Examiner
Dee Whitman Examiner

London Acute (St.Joseph's)

Dr. Chris Bailey Jennifer Fleming
Jennifer Fleming Research Coordinator, Examiner

London Parkwood Rehab

Dalton Wolfe Site Investigator
Heather Askes Research Coordinator
Sarah Miles Examiner/Investigator
Karen Gilbert Examiner
Andy Morton Examiner
Ange Woolner Examiner

European GRASSP Longitudinal Study Group

Balgrist, University Hospital, Zurich

Marc Bolliger/Armin Curt Site Investigator
Urs Albisser Examiner (Site Coordinator)
Hartmut Pöhlmann Examiner
Anja Bodenmann Examiner
Josch Wagner Examiner
Karin Akermann Examiner
Claudia Rudhe Examiner

Swiss Paraplegic Center Nottwil, Nottwil

Inge-Marie Velstra Research Coordinator, Examiner
Diana Sigrist Nix Examiner
Emanuela Albisetti Examiner
Friederike Ebert Examiner
Bart de Kimpe Examiner

BG-Kliniken Bergmannstrost, Halle

Daniel Kuhn Examiner (Site Coordinator)
Kerstin Rolle Examiner
Diana Pannier Examiner
Reinhard Keck Examiner
Carola Losel Examiner

Berufsgenossenschaftliche Unfallklinik Murnau, Murnau

Denise Haupt Examiner (Site Coordinator)
Maren Bauch Examiner

Krankenhaus Hohe Warte Bayreuth, Bayreuth

Kristin Lorenz Examer/Site Coordinator
Petra Schatz Examiner
Elke Engelbrecht Examiner

Stiftung Orthopädische Universitätsklinik Heidelberg

Ruth Krahl Examiner (Site Coordinator)
Marlis Euler Examiner

Zentrum für Rückenmarkverletzte Werner-Wicker Klinik Bad Wildungen, Bad Wildungen-Reinhardshausen

Uta Mesecke Examiner (Site Coordinator)
Fr.M.Wagener Examiner
Fr.S.Eichenberg Examiner


Multiple agencies funded this project and some of the individuals involved in the development of GRASSP

Christopher and Dana Reeve Foundation
Rick Hansen Institute
Canadian Institutes for Health Research
Ontario Neurotrauma Foundation
Physiotherapy Foundation of Canada
Craig Neilsen Foundation


North American Clinical Trials Network
European Multi-Centre SCI Study
Krembil Neurosciences-Centre
Toronto Rehabilitation Institute
University Hospital Balgrist
Swiss Paraplegic Centre Nottwil, Switzerland


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 below:

GRASSP Version 2 (GV2)

The rationale behind updating the GRASSP Version 1 to GRASSP Version 2 is and was planned from the release of GV1. However, the evidence to make changes was not yet available. 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 to facilitate this process. The second version of GRASSP has gone through a process of item reduction based on the following data:

5. Input from clinicians and their experiences with patients
6. Rasch analysis of the European dataset
7. Validation of the European rasch analysis with the Canadian dataset
8. 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.

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