title: Defining the role of sensation, strength, and prehension for upper limb function in cervical spinal cord injury.
abstract: BACKGROUND
  Upper limb function plays a significant role in enhancing independence for individuals with tetraplegia. However, there is limited knowledge about the specific input of sensorimotor deficits on upper limb function. Thus the theoretical framework designed to develop the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) was used as a hypothetical model to analyze the impact of impairment on function.
  
  
  OBJECTIVE
  To define the association of impairment (sensation, strength, and prehension measured by the GRASSP) to upper limb function as defined by functional measures (Capabilities of Upper Extremity Questionnaire, Spinal Cord Independence Measure).
  
  
  METHODS
  A hypothetical model representing relationships by applying structural equation modeling was used to estimate the effect of the impairment domains in GRASSP on upper limb function. Data collected on 72 chronic individuals with tetraplegia was used to test the hypothetical model.
  
  
  RESULTS
  Structural equation modeling confirmed strong associations between sensation, strength, and prehension with upper limb function, and determined 72% of the variance in "sensorimotor upper limb function" was explained by the model. Statistics of fit showed the data did fit the hypothesized model. Sensation and strength influence upper limb function directly and indirectly with prehension as the mediator.
  
  
  CONCLUSIONS
  The GRASSP is a sensitive diagnostic tool in distinguishing the relative contribution of strength, sensation and prehension to function. Thus, the impact of interventions on specific domains of impairment and related contribution on clinical recovery of the upper limb can be detailed to optimize rehabilitation programs.
authors.affiliation: 1University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sukhvinder
authors.initials: S
authors.lastname: Kalsi-Ryan
authors.forename: Dorcas
authors.initials: D
authors.lastname: Beaton
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.forename: Susan
authors.initials: S
authors.lastname: Duff
authors.forename: Depeng
authors.initials: D
authors.lastname: Jiang
authors.forename: Milos R
authors.initials: MR
authors.lastname: Popovic
authors.forename: Claudia
authors.initials: C
authors.lastname: Rudhe
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Mary C
authors.initials: MC
authors.lastname: Verrier
mesh_terms: D002574:Cervical Vertebrae; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008962:Models, Theoretical; D053580:Muscle Strength / Q000502:physiology*; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology*; D012677:Sensation / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: function; hand; impairment; tetraplegia; upper limb