Grasp and Release Test
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Grasp and Release Test

Last Updated

Purpose

The GRT assesses basic unilateral hand performance with manipulating objects with and without a neuroprosthesis in individuals with C5 and C6 tetraplegia.

Link to Instrument

Instrument Details

Acronym GRT

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Spinal Cord Injury
  • Sports & Musculoskeletal Injuries

Populations

Spinal Injuries

Key Descriptions

  • Performance-based test
  • Unilateral manipulation of 6 objects representing different weights and sizes
  • 3 with lateral pinch (peg, weight, fork) and 3 with palmar grasp (block, can, videotape)
  • Standard sequence of movements for each object (grasp, lift and release) and for fork grasp depress handle, lift and release
  • Can, paperweight and videotape are placed upright on a box; Block and peg are dropped into a box; fork has different sequence (move hand from start position to the fork, grasping and depressing handle to indicator line, releasing handle and returning hand to start position).
  • Sequence is completed as many times as possible in 30 seconds, for each object. Reports of between three (Mulcahey et al, 1997; Mulcahey, Smith, & Betz, 2004; Hart, Kilgore, & Peckham, 1998) to five (Stroh-Woulle et al., 1994) trials for each object.
  • Scored by mean # of successful completions and # of failures performed in 30 seconds, for each object.
  • 30-second rest period between each trial.
  • Pretest practice permitted until successful trial is completed. If no successful trials for an object, that object was eliminated from the actual test.

Number of Items

6 tasks

Equipment Required

  • Block (2.5 x2.5 x 2.5 cm; 0.1 N)
  • Can (9.1 x 5.4 cm; 2.1N)
  • Videotape (20.4 x 12 x 3 cm; 3.49)
  • Peg (7.6 x 0.6 cm; 0.02 N)
  • Paperweight (5.0 x 1.4 cm; 2.59 N) – disk shaped
  • Fork (nylon handle attached to a spring loaded piston – requires 4.4N of force)
  • Test board (23 cm x 46cm) – half of test board is a box (23cm x 23cm x 4cm) with removable top

Time to Administer

90-150 minutes

Varies based on number of objects the participant is able to manipulate; 90-150 minutes including pretest (Stroh-Woulle et al., 1994).

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Instrument Reviewers

Initially reviewed by Cara Weisbach PT, DPT; Wendy Romney PT, DPT, NCS, and the SCI EDGE task force of the Neurology Section of the APTA in 04/2012.

Body Part

Upper Extremity

ICF Domain

Body Function
Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

SCI EDGE

NR

NR

NR

Recommendations based on SCI AIS Classification: 

 

AIS A/B

AIS C/D

SCI EDGE

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

SCI EDGE

No

No

Yes

Not reported

Considerations

  • Applies to a limited sub-set of individuals with SCI.
  • Participants with weak grip strength or tenodesis grip may be limited in the number of items based on the pre-assessment.

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Spinal Injuries

back to Populations

Test/Retest Reliability

C5 and C6 Tetraplegia:

(Mulcahey, Smith & Betz, 2004; n = 21 hands prior to surgical intervention; age = 7-20 years, average 6.5 days between test) 

  • Excellent test-retest reliability for each object 
    • Fork, paperweight and videotape ICC = 1.00; block ICC = 0.87; peg ICC = 0.93, and can ICC = 0.99, p < 0.01) 
    • Fork, paperweight and videotape had perfect correlations due to participants’ inability to complete test.

Criterion Validity (Predictive/Concurrent)

Predictive Validity 

C5 and C6 Tetraplegia:

(Mulcahey, Smith, & Betz, 2004; post surgical intervention) 

  • Excellent predictive validity for fork and can objects of GRT for predicting 12-month FIM scores s/p tendon transfer or FES implantation (rho = 0.624, and 0.700, respectively; p < 0.01) 
  • Adequate predictive validity for videotape object of GRT for predicting 12-month FIM scores (rho = 0.503, p < 0.05) 
  • Non-significant correlations between peg, block, and paperweight objects of GRT and 12-month FIM score

Construct Validity

Convergent Validity

C6 and C7 Tetraplegia:

(Harvey, Kilgore,& Peckham, 2001; n = 47, 81 hands 1-16 years post complete or incomplete SCI) 

  • Excellent convergent validity of GRT and ADL test (Spearman rho = 0.80) 

 

Chronic Tetraplegia:

(Post, 2006; n = 12; mean age = 43.2 (12.7) years; mean time since injury 13.0 (11.2) years) 

  • Excellent convergent validity of GRT and Van Lieshout Test (Spearman correlation coefficient Left hand 0.87, right hand 0.90)

Responsiveness

Tetraplegia:

(Spooren et al., 2006; n = 34 AIS A and B; n = 26 AIS C and D; Assessed at start of active rehabilitation and at discharge, mean = 288 days) 

  • Highly responsive at detecting changes from start of active rehabilitation to discharge for Motor Complete (AIS A and B) and Motor Incomplete (AIS C and D): Standardized Response Mean = 1.05 (SRM > 0.80: large) 
  • Moderately sensitive: effect size (ES)=0.75

 

Tetraplegia:

(Spooren et al., 2006; n = 34, AIS A and B; n = 26 AIS C and D; assessed start of rehabilitation to 3 months, mean = 93 days) 

  • Highly responsive at detecting change from start of rehabilitation to 3 months for Motor Complete (AIS A and B) and Motor Incomplete (AIS C and D): SRM=0.93
  • Moderately sensitive: ES = 0.54

 

Tetraplegia:

(Mulcahey, Smith, & Betz, 2004) 

  • Change between mean baseline (before surgical intervention) GRT scores to mean post rehabilitation GRT scores is not significant for the peg, block and videotape
  • Sensitive to change for the objects fork, paperweight and can (z = 3.05, 2.83, 2.66, respectively; p < 0.01) Total # of GRT objects manipulated post surgery compared to pre-surgery (z = 3.40, p < 0.05)

Bibliography

Hart, R. L., Kilgore, K. L., et al. (1998). "A comparison between control methods for implanted FES hand-grasp systems." IEEE Transactions on Rehabilitation Engineering 6(2): 208-218. Find it on PubMed

Harvey, L. A., Batty, J., et al. (2001). "Hand function of C6 and C7 tetraplegics 1 - 16 years following injury." Spinal Cord 39(1): 37-43. Find it on PubMed

Mulcahey, M. J., Betz, R. R., et al. (1999). "A prospective evaluation of upper extremity tendon transfers in children with cervical spinal cord injury." Journal of Pediatric Orthopedics 19(3): 319-328. Find it on PubMed

Mulcahey, M. J., Betz, R. R., et al. (1997). "Implanted functional electrical stimulation hand system in adolescents with spinal injuries: an evaluation." Archives of Physical Medicine and Rehabilitation 78(6): 597-607. Find it on PubMed

Mulcahey, M. J., Smith, B. T., et al. (2004). "Psychometric rigor of the Grasp and Release Test for measuring functional limitation of persons with tetraplegia: a preliminary analysis." Journal of Spinal Cord Medicine 27(1): 41-46. Find it on PubMed

Post, M. W., Van Lieshout, G., et al. (2006). "Measurement properties of the short version of the Van Lieshout test for arm/hand function of persons with tetraplegia after spinal cord injury." Spinal Cord 44(12): 763-771. Find it on PubMed

Spooren, A. I., Janssen-Potten, Y. J., et al. (2006). "Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test." Spinal Cord 44(12): 772-779. Find it on PubMed

Taylor, P., Esnouf, J., et al. (2002). "The functional impact of the Freehand System on tetraplegic hand function. Clinical Results." Spinal Cord 40(11): 560-566. Find it on PubMed

Wuolle, K. S., Van Doren, C. L., et al. (1994). "Development of a quantitative hand grasp and release test for patients with tetraplegia using a hand neuroprosthesis." J Hand Surg Am 19(2): 209-218. Find it on PubMed

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