Measures and Products


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.


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 below:

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 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.


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.

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