Development of a Remote Version of the Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP): Validity and Reliability

Stephanie Voss, Andrea Adighibe, Emily Sanders, David Aaby, Rachel Kravitt, Gina Clark, Kelly Breen, Alexander Barry, Gail F. Forrest, Steve C. Kirshblum, Monica A. Perez, Sukhvinder Kalsi-Ryan, Masha Kocherginsky, William Zev Rymer, Milap S. Sandhu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. Objective: The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. Methods: Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman agreement plots. Results: The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) =.96, right ICC =.96). Concurrent validity for the domains was excellent for strength (left ICC =.96, right ICC =.95), prehension ability (left ICC =.94, right ICC =.95), and prehension performance (left ICC =.92, right ICC =.93), and moderate for sensibility (left ICC =.59, right ICC =.68). Inter-rater reliability for rGRASSP total score was high (ICC =.99), and remained high for all 4 domains. Bland–Altman plots and limits of agreements support these findings. Conclusions: The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.

Original languageEnglish (US)
Pages (from-to)83-93
Number of pages11
JournalNeurorehabilitation and Neural Repair
Issue number2-3
StatePublished - Feb 1 2023


  • physical functional performance
  • psychometrics
  • quadriplegia
  • rehabilitation
  • spinal cord injuries
  • telemedicine
  • upper extremity
  • virtual rehabilitation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Rehabilitation


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