title: Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury: European Multicenter Responsiveness Study of the GRASSP.
abstract: OBJECTIVE
  To investigate the internal and external responsiveness and recovery profiles of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) instrument in revealing changes in upper limb function within the first year following cervical spinal cord injury (SCI).
  
  
  METHODS
  A European prospective, longitudinal, multicenter study assessing the GRASSP at 1, 3, 6, and 12 months after cervical SCI. Subtests of GRASSP were compared to the upper extremity motor (UEMS) and light touch scores (LT) according to the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), the Spinal Cord Independence Measure self-care subscore (SCIM-SS), as well as a clinician-rated outcome measure (CROM) of clinical relevance. Data were analyzed for GRASSP responsiveness and recovery rate over time.
  
  
  RESULTS
  Seventy-four participants entered the study. GRASSP subtests proved responsive (standardized response mean [SRM] ranged from 0.79 to 1.48 for strength, 0.50 to 1.03 for prehension, and 0.14 to 0.64 for sensation) between all examination time points. In comparison, UEMS and LT showed lower responsiveness (SRM UEMS ranged from 0.69 to 1.29 and SRM LT ranged from 0.30 to -0.13). All GRASSP subtests revealed significant, moderate-to-excellent correlations with UEMS, LT, and SCIM-SS at each time point, and changes in GRASSP subtests were in accordance with the CROM. GRASSP prehension and motor recovery was largest between 1 and 3 months.
  
  
  CONCLUSIONS
  The GRASSP showed excellent responsiveness, detecting distinct changes in strength and prehension relating to the severity of cervical SCI. It detected clinically significant changes complimentary to the ISNCSCI and SCIM-SS assessments.
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland inge-marie.velstra@paraplegie.ch.
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Velstra
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI).
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Angela
authors.initials: A
authors.lastname: Frotzler
authors.affiliation: Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Abel
authors.affiliation: Krembil Neuroscience Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sukhvinder
authors.initials: S
authors.lastname: Kalsi-Ryan
authors.affiliation: Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands.
authors.forename: Johan S
authors.initials: JS
authors.lastname: Rietman
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI).
authors.forename: Marc
authors.initials: M
authors.lastname: Bolliger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D066193:Cervical Cord; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D011446:Prospective Studies; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology; D012372:ROC Curve; D020127:Recovery of Function / Q000502:physiology*; D012677:Sensation / Q000502:physiology*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D013997:Time Factors; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: GRASSP; ISNCSCI; activities of daily living; outcome measures; responsiveness; spinal cord injury; tetraplegia; upper limb recovery