GRASSP and Outcome Measures

GRASSP and Outcome Performance Measures

Neural Outcomes Consulting Inc works with health care professionals and researchers to aid the performance of cutting edge research with state-of-the-art trial design. We specialize in oncology, neurological and musculoskeletal disease. With a special interest and experience in the development and use of outcome measures, NOCI optimizes any clinical study or trial with the implementation of the most appropriate outcome measures.

GRASSP Version 1.0

The Graded Redefined Assessment of Sensation, Strength and Prehension (GRASSP) is a multi-domain outcome measure sensitive to the changes in the upper limb throughout disease progression. The GRASSP Research and Design Team, led by Dr. Kalsi-Ryan, has completed it’s development and established its psychometric properties of reliability, validity and responsiveness. GRASSP development and revisions are ongoing. Multi-national collaborations are also defining new analysis approaches for the use of GRASSP in SCI clinical trials. The European launch of GRASSP Version 2 occurred at the 2017 ISCoS Annual Meeting held in Dublin Ireland on October 24-26 while the North American launch took place at the 7th National Spinal Cord Injury Conference that was held on November 9-11, 2017 in Niagara Falls, Ontario. GRASSP Version 2 translated are now available in German, Italian, Czech, Spanish and English.

VERSIONS AND ONGOING DEVELOPMENT

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.

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 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:

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.

Toronto Rehab. Institute – Hand Function Test (TRI-HFT)

The TRI Hand Function Test is a clinical assessment tool designed to measure gross motor upper extremity function in individuals living with upper limb deficits as a result of spinal cord injury or stroke. The assessment is designed to measure the upper extremity performance after a stroke or spinal cord injury that has been treated with neuromodulation or tendon/peripheral nerve transfer. The test can be administered at various time points during the continuum of care to detect functional changes and determine interval improvements in arm-hand function. The TRI-HFT is intended to be administered in the clinical setting by a PT or OT clinician who has self-trained in the use of the measure. Standardized training is recommended for use in clinical trials. 

Grasp and Release Test (GRT)

The Grasp and Release Test (GRT) is designed to assess hand neuroprosthesis in individuals with C5-C6 SCIs but has also been used to assess hand function prior to and following tendon transfers in people with C6-7 level injuries. It assesses the ability to pick up, move, and release six objects of varying sizes, weights and textures using a palmar or lateral grasp. Each object was chosen to represent one or more objects routinely manipulated for activities of daily living (ADL) that represented a range of difficulties. Click to DOWNLOAD INSTRUCTION MANUAL.

Capabilities of Upper Extremity Test (CUE-T)

The Capabilities of the Upper Extremity Test (CUE-T) is a performance measure intended to assess upper extremity function following spinal cord injury (SCI). The CUE-T is an objective measure of the ability to complete actions and tasks involving the arm and hand in individuals with tetraplegia and can be used clinically, for research, and in clinical trials. While developed initially for adults, research supports the use of the CUE-T in people older than 6 years of age.

Neural Outcomes has partnered with Thomas Jefferson University (TJU) and its Jefferson Clinical Research Institute (JCRI) to govern the license of the CUE-T. This exclusive partnership empowers Neural Outcomes to manufacture, distribute, and provide education and training for the use of the CUE-T. Related manuals, scoresheets, data forms, and an educational video can be found at Jefferson’s CUE-T Resources. For clinical matters related to the CUE-T, please contact Dr. Sukhvinder Kalsi-Ryan, and for non-clinical queries, reach out to Timothy Ryan at the contact info given in the top row.

Chedoke-McMaster Stroke Assessment Test

The Chedoke-McMaster Stroke Assessment (CMSA) is a comprehensive tool designed to evaluate physical impairments and activity levels in individuals recovering from a stroke. It is divided into two main components: the Impairment Inventory and the Activity Inventory. The Impairment Inventory measures six domains, including shoulder pain and the stages of recovery for postural control, arm, hand, leg, and foot. Each domain is rated on a 7-point scale, ranging from Stage 1 (most impairment) to Stage 7 (no impairment). The Activity Inventory, previously known as the Disability Inventory, assesses functional abilities through 15 items, which are further divided into gross motor function (10 items) and walking (5 items). These items evaluate key activities such as rolling, sitting, transferring, standing, and walking, with scores ranging from 1 (complete dependence) to 7 (independence).

Neural Outcomes Consulting Inc. serves as the exclusive partner for delivering training and testing services related to the CMSA, ensuring standardized application and reliable outcomes.

SCIM III and SCIM IV Standardized Educational Training

The Spinal Cord Independence Measure (SCIM) is a tool used for functional assessment of spinal rehabilitation. It is a pivotal tool in the field of spinal cord injury assessment, designed to evaluate and quantify the functional independence of individuals with spinal cord injuries. Adopted by the International Spinal Cord Society, as a tool for routine evaluation of patients, and by The FDA as an evaluation tool in the research of innovative therapies, SCIM has been internationally verfied and globally recognzied.  Neural Outcomes Consulting has an exclusive training and education partnership with The Loewenstein Hospital and Rehabilitation Clinic to deliver SCIM education and training, guiding healthcare professionals and researchers towards informed treatment decisions and personalized interventions.

NeuRx Diaphragm Pacing System (DPS)®

The NeuRx Diaphragm Pacing System (DPS) is an innovative, implantable neurostimulation device designed to assist patients with diaphragm dysfunction caused by neuromuscular conditions. Approved by Health Canada, this state-of-the-art technology supports more natural breathing by providing ventilatory assistance for individuals with conditions such as high-level spinal cord injuries, central hypoventilation, or other neuromuscular respiratory impairments.

Engineered with a compact, noiseless design and no moving parts, the NeuRx DPS offers patients a discreet and reliable solution to improve their quality of life. By facilitating more natural respiratory function, it enables users to regain confidence and live with greater ease.

In Canada, Neural Outcomes Consulting Inc., in collaboration with Synapse Biomedical, serves as the exclusive distributor of the NeuRx Diaphragm Pacing System (DPS)® and its consumables.

RANGE OF MOTION ASSESSMENT TOOL KITS

The ROM Assessment Kit was developed for Daiichi Sankyo Development LTD (“DSI”): THE ENLIVEN STUDY.

The kit includes a 12 inch, 6 inch and digit goniometers along with a measuring tape. This is a complete kit that enables a clinician to perform any ROM testing. NOCI manufactures and distributes these kits for retail sales.