Article | Published:

Evaluation of the graded redefined assessment of strength, sensibility and prehension (GRASSP) in children with tetraplegia

Spinal Cordvolume 56pages741749 (2018) | Download Citation

Abstract

Study design

Psychometric study.

Objective

To validate the GRASSP in pediatric SCI populations and establish the lower age of test administration.

Setting

United States: Pennsylvania, Maryland, Illinois, Michigan, California, Texas.

Methods

Mean, SD and range of scores were calculated and examined for known-group differences. Test-retest reliability was measured by the intra-class correlation, concurrent validity of the GRASSP against the SCIM, SCIM-SS, and the CUE-Q was measured by the Spearman correlation.

Results

GRASSP scores differed between participants with motor complete and incomplete injuries (p = <0.0001−0.036). Test-retest reliability was strong (ICC = 0.99). Weak correlation with the total SCIM (r = 0.33−0.66), and moderate to strong correlation with the SCIM-SC (r = 37−0.70) and CUE-Q (r = 0.40−0.84).

Conclusion

Results support the validity of the GRASSP and provide evidence that the scores are reliable when administered to children. The GRASSP sensory and strength subtests are recommended for children beginning at 6 years of age, and the GRASSP prehension performance/ability subtest for children beginning at 8 years of age. Normative data are needed for the performance components of the GRASSP.

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References

  1. 1.

    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;14:34–46.

  2. 2.

    Weinstein S. Fifty years of somatosensory research: from the Semmes-Weinstein monofilaments to the Weinstein Enhanced Sensory Test. J Hand Ther. 1993;6:11–22.

  3. 3.

    Kirshblum S, Waring W. Updates for the International Standards for Neurological Classification of Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2014;25:505–17.

  4. 4.

    Sollerman C, Ejeskär A. Sollerman hand function test. A standardised method and its use in tetraplegic patients. Scand J Plast Reconstr Surg Hand Surg. 1995;29:167–76.

  5. 5.

    Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, et al. The graded redefined assessment of strength, sensibility and prehension: reliability and validity. J Neurotrauma. 2012;29:905–14. 1089/neu.2010.1504

  6. 6.

    Kalsi-Ryan S, Curt A, Verrier MC, Fehlings MG. Development of the graded redefined assessment of strength, sensibility and prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia. J Neurosurg: Spine. 2012;12(Suppl):65–76.

  7. 7.

    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;30:295–306. 10.1177/1545968315593806.

  8. 8.

    Zariffa J, Curt A, Verrier MC, Fehlings MG, Kalsi-Ryan S. GRASSP Cross-Sectional Study Team and Ontario GRASSP Longitudinal Study Team. Predicting task performance from upper extremity impairment measures after cervical spinal cord injury. Spinal Cord. 2016;54:1145–51. 10.1038/sc.2016.77.

  9. 9.

    Kalsi-Ryan S, Beaton D, Ahn H, Askes H, Drew B, Curt A, 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;33:307–14. https://doi.org/10.1089/neu.2015.4217

  10. 10.

    Velstra IM, Curt A, Frotzler A, Abel R, Kalsi-Ryan S, Rietman JS, et al. Changes in strength, sensation, and prehension in acute cervical spinal cord injury: European Multicenter Responsiveness Study of the GRASSP. Neurorehabil Neural Repair. 2015;29:755–66. https://doi.org/10.1177/1545968314565466

  11. 11.

    Zariffa J, Kapadia N, Kramer JLK, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, et al. Relationship between clinical assessments of function and measurements from an upper limb robotic rehabilitation device in cervical spinal cord injury. IEEE Trans Neural Syst Rehabil Eng. 2012;20:341–50.

  12. 12.

    Zariffa J, Kapadia N, Kramer JLK, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, et al. Feasibility and efficacy of upper limb robotic rehabilitation in subacute cervical spinal cord injury population. Spinal Cord. 2012;50:220–6.

  13. 13.

    Zbogar D, Eng JJ, Miller WC, Krassioukov A, Verrier MC. Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation. Spinal Cord. 2017;55:172–9.

  14. 14.

    Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of outcomes of upper limb reconstructive surgery for tetraplegia. Arch Phys Med Rehab. 2016;96(suppl 2):S169–82.

  15. 15.

    Mulcahey MJ, Weiss A. Contemporary issues related to management of the upper limb in tetraplegia. Hand Clin. 2008;24:xi.

  16. 16.

    Kozin S. Tetraplegia. J Hand Surg. 2002;2:141–52.

  17. 17.

    Betz RR, Mulcahey MJ, Smith BT. Unique aspects of the pediatric patient with spinal cord injury and the effects on upper-limb management. J Rehabil Res Dev. 2004;41:15.

  18. 18.

    Mulcahey MJ, Betz RR, Smith BT, Weiss AA. A prospective study of the outcomes of tendon transfers with children with tetraplegia. J Pediatr Orthop. 1999;19:319–28.

  19. 19.

    Mulcahey MJ, Zlotlow D, Kozin S. Upper extremity management. In: Vogel, Zebracki, Betz RR and Mulcahey MJ eds. The Child With SCI, 2nd edition. McKeith Press London; 2014. ISBN:978-1-909962-34-7.

  20. 20.

    Biering-Sorensen F, Alai S, Anderson K, Charlifue S, Chen Y, DeVivo M, et al. Common data elements for spinal cord injury clinical research: a National Institute for Neurological Disorders and Stroke project. Spinal Cord. 2015;53:265–77.

  21. 21.

    Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM–spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35:850–6.

  22. 22.

    Mulcahey MJ, Thielen CC, Sadowsky C, Silvestri JL, Martin R, White L, et al. Despite limitations, the SCIM-III is reproducible and a valid indicator of physical function in youth with SCI. Spinal Cord. 2017. https://doi.org/10.1038/s41393-017-0036-0

  23. 23.

    Oleson CV, Marino RJ. Responsiveness and concurrent validity of the revised capabilities of the upper extremity questionnaire (CUE-Q) in patients with acute tetraplegia. Spinal Cord. 2014;52:625–8.

  24. 24.

    Mulcahey MJ, Vogel L, Betz R, Samdani A, Chafetz R, Gaughan J. The international standards for neurological classification of spinal cord injury: psychometric evaluation and guidelines for use with children and youth. Phys Med Rehabil. 2011;92:1264–9. https://doi.org/10.1016/j.apmr.2011.03.003

  25. 25.

    Dua K, Lancaster TP, Abzug JM. Age-dependent reliability of Semmes-Weinstein and 2-point discrimination tests in children. J Pediatr Orthop. 2016. https://doi.org/10.1097/BPO.0000000000000892

  26. 26.

    Reedman SE, Beagley S, Sakzewski L, Boyd RN. The Jebsen Taylor Test of Hand Function: a pilot test retest reliability study in typically developing children. Phys Occup Ther Pediatr. 2016;36:292–304.

  27. 27.

    Mulcahey MJ, Smith BT, Betz RR. Psychometric rigor of the grasp and release test for measuring functional limitation of persons with tetraplegia: a preliminary analysis. Spinal Cord. 2004;27:41–46.

  28. 28.

    Auld ML, Ware RS, Boyd RN, Moseley GL., Johnston LM. Reproducibility of tactile assessment for children with unilateral cerebral palsy. Phys Occup Ther Pediatr. 2012 32:151–66.

  29. 29.

    Gogola G, Velleman PF. Hand dexterity in children: administration and normative values of the functional dexterity test. J Hand Ther. 2013;38:2426–31.

  30. 30.

    Smith Y, Hong E, Presson C. Normative validation studies of the nine hole peg test with children. Percept Mot Skills. 2000;90:823–4.

  31. 31.

    Beagley SB, Reedman SE, Sakzewski L. Establishing Australia norms for the Jebsen Taylor test of hand function in typically developing children aged 5–10 years: a pilot study. Phys Occup Ther Pediatr. 2016;36:88–109.

  32. 32.

    Humphrey R, Jeweel K, Rosenberger RC. Development of in-hand manipulation and relationship with activities. Am J Occup Ther. 1995;49:763–71.

  33. 33.

    Exner C. Development of hand skills. In: Case-Smith J, editor. Occupational therapy for children. 5th ed. St Louis: Elsevier, Inc; 2005.

  34. 34.

    Mathiowetz V, Wiemer DM, Federman SM. Grip and pinch strength: norms for 6-to 19-year olds. Am J Occuptional Ther. 1986;l40:705–11.

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Acknowledgements

This study was funded by the Craig H Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award #282592 (Mulcahey, PI). Becky Sinko OTD, OTR/L, Jennifer L Silvestri, MS, OTR/L, Lauren White, PT, DPT, PCS, Julie A Cagney PT, DPT, PCS, Ingrid Parry, PT, Jennifer Schottler MSPT, Kristine Higgins, PT, MS, NCS, Michelle L. Feltz, BA, and Jenny Mazurkiewicz MS, OTR/L are acknowledged for their role in data collection. Sue Duff is acknowledge for review of the manuscript.

Funding

The study was funded by the Craig H. Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award Grant #282592 (Mulcahey, PI).

Author information

Affiliations

  1. Thomas Jefferson University, Philadelphia, PA, USA

    • MJ Mulcahey
    • , Christina Calhoun Thielen
    • , Kathryn Dent
    • , Rebecca Sinko
    •  & John Gaughan
  2. Shriners Hospitals for Children, Philadelphia, PA, USA

    • MJ Mulcahey
  3. Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA

    • Cristina Sadowsky
    •  & Rebecca Martin
  4. Shriners Hospitals for Children, Chicago, IL, USA

    • Lawrence C. Vogel
  5. Shriners Hospitals for Children, Sacramento, CA, USA

    • Loren Davidson
  6. TIRR Herman Memorial, Houston, TX, USA

    • Heather Taylor
  7. Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA

    • Jackie Bultman

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Conflict of interest

Dr. Mulcahey receives research support from the Shriners Hospitals for Children, National Institute Neurological Disease and Stroke, The Craig H. Neilsen Foundation and The Rick Hansen Institute. She receives compensation for her role as Associate Editor for Topics in Spinal Cord Rehabilitation, royalties for the textbook “The Child and Young Adult with Spinal Cord Injury” and has received compensation as review panel chair/member for the Dept. of Defense and the Craig H. Neilsen Foundation. Dr. Vogel receives compensation for his role as Editor for Topics in Spinal Cord Injury Rehabilitation, royalties for the textbook “The Child and Young Adult with Spinal Cord Injury” and has received compensation as review panel chair/member for the Dept. of Defense. The remaining authors declare no conflict of interest.

Corresponding author

Correspondence to MJ Mulcahey.

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DOI

https://doi.org/10.1038/s41393-018-0084-0