What is GRASSP?

GRASSP Version 1

The Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP).

The GRASSP Version 1 (V1) is a clinical impairment measure specific to the upper limb for use after tetraplegia. The GRASSP measures sensorimotor and prehension function through three domains; important in describing arm and hand function:

Domains:

Strength
Sensation
Prehension

PURPOSE OF THE MEASURE

The GRASSP V1 was developed with the intent to be a clinical and a
research tool that would:

capture information on upper limb impairment from the traumatic tetraplegic population
obtain integrated sensory and motor impairment data, and discriminate the population according to impairment and function
be responsive (sensitive) to change over time
assess the extent of spontaneous (natural) recovery
be applied in clinical settings and in clinical trials/studies to evaluate the effect of novel interventions

RECOMMENDED USE

The GRASSP is recommended for use in the early acute phase to any point in the post-injury time-course, particularly when a change in neurological status is the construct of interest. The GRASSP is intended for use with traumatic cervical SCI patients that are being followed for recovery of the upper limb. The GRASSP V1 is not designed for the non-traumatic SCI populations. Some work has been done that makes recommendations for GRASSP V1 use in the pediatric population. Currently there is some field testing being conducted to determine how GRASSP can be used with the tendon transfer/peripheral nerve transfer surgery groups.

The GRASSP measure is for use by clinicians in the clinical setting as a clinical outcome measure, researchers in the clinical/research setting as a primary or secondary outcome measure, and academics who are involved in investigator driven research. The developers and funding agencies that have supported GRASSP development would like to promote widespread use in both clinical and research settings. If you are interested in purchasing a GRASSP Kit please go to Products and Purchasing tab now.

VERSIONS of GRASSP

In 2009 GRASSP Version 1 was launched; currently there are three versions available:
GRASSP Version 1 – An impairment measure specific to the upper limb post traumatic tetraplegia.
GRASSP Version 2 – An impairment/activity measure specific to the upper limb post traumatic tetraplegia.
GRASSP Version Myelopathy – An impairment measure specific to the upper limb post non-traumatic tetraplegia secondary to cervical myelopathy related to tumor compression, epidural abscess or degenerative cervical myelopathy.

The original version is GRASSP Version 1, which is the version currently in use worldwide. Recently the GRASSP Research and Development Group (GRDG) has launched Version 2 and Version Myelopathy.

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 above:

GRASSP Version 2 (GV2)

Updating the GRASSP Version 1 to GRASSP Version 2 was planned from the release of GV1. The rationale for the modification/s was to reduce items that were redundant, in turn reducing the administration time of the test without compromising sensitivity. However, the evidence to make changes was not yet available. Recently, with the acquisition of robust datasets from Europe and Canada this analysis was feasible. 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 www.grassptest.com to facilitate this process. The second version of GRASSP has gone through a process of item reduction based on the following data:

1. Input from clinicians and their experiences with patients
2. Rasch analysis of the European dataset
3. Validation of the European Rasch analysis with the Canadian dataset
4. 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.

WHICH VERSION TO USE

GRASSP V1 is the original version developed and validated in 2009. This is the most robust of the three assessments. The most meaningful application of this measure is when the assessor is looking for more detailed information regarding the hand. GRASSP V1 is specifically developed to assess the traumatic tetraplegic upper extremity. GV1 is currently being used an important endpoint in many neuro-restorative trials where the hand is the primary target for treatment.

GRASSP V2 is a reduced version of GV1. This measure has stronger reliability for the subtests, and the sensitivity of the prehension performance is not as strong as GV1. Again, GV2 is specific to the traumatic tetraplegic upper limb and is currently being used as an important endpoint in many clinical drug trials where the therapy has a more centrally based target.

GRASSP VM is a reduced and modified version of GV1. It has measurement properties established, both reliability and validity. The application of this measure is specific to the non-traumatic tetraplegic upper limb. The emphasis is on manual dexterity, which distinguishes it from GV1 and GV2. GVM is useful where individuals have relatively intact function that is impaired due to slow and progressive compression of the cervical cord.

Translations available for GRASSP Versions:

GRASSP Manuals are available in select languages, translated GRASSP manuals are provided upon request only, please contact timryan@neuraloutcomes.com for more information. Translated manuals are only provided with purchase of a kit.

GV1 is available in English and Canadian French.

GV2 is available in English, German, Italian, Czech and Spanish.

GVM is available in English Only.

DISCLOSURE

GRASSP ver. 1, 2, and Myelopathy are non-medical, outcome measuring, and manually operative devices. These devices do not require any electric, electronic, chemical, magnetic power nor do they need any intravenous administration to operate. Since its design, manufacturing, packaging, and usage are known to be non-hazardous and safe for its users and administrators, the device is exempted from a CE or FDA certification.

For further information please refer the websites below:

https://www.nibusinessinfo.co.uk/content/products-need-ce-marking

http://tradecommissioner.gc.ca/world-monde/133383.aspx?lang=eng#Find

Although measuring equipment is mentioned as a category of products requiring CE certification, this refers to products that require calibration and/or are electronically powered. Again, the GRASSP or parts do not fall into these categories.

https://www.fda.gov/medicaldevices/deviceregulationandguidance/overview/classifyyourdevice/ucm2005371.htm