A clinical assessment tool developed at UHN helped motivate Melissa Charpentier through a “very long and slow” recovery.
Melissa lives with spinal cord injury and partial paralysis, sustained in a 2013 car accident. Early in her recovery, typical tasks — from eating and personal care to independently repositioning her body — were a challenge.
Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) is a tool that measures hand and arm function in people living with tetraplegia, a form of paralysis that affects all four limbs and the torso following damage to the cervical (neck) spinal cord.
Using real-life tasks, such as inserting a key into a lock, GRASSP helps measure incremental strength, sensation and grasping abilities in patients, like Melissa, who are recovering from spinal cord injuries.
For Melissa, who took part in a research study involving the tool at UHN’s Toronto Rehab Lyndhurst Centre, GRASSP was a positive experience compared to existing tests.
“It's a little more encouraging because, even if you're not completing the task, it gives you a breakdown of the task elements that you are able to accomplish, providing a more positive outlook," she said.
Dr. Sukhvinder Kalsi-Ryan, a clinician-scientist at UHN’s KITE Research Institute, working with an international multidisciplinary team, launched the tool in 2009.
“After creating something meaningful, we did not want it to sit on a shelf as a manuscript,” says Dr. Kalsi-Ryan.
“If you don’t actually get a tool into people’s hands in a scalable way, it’s not helping patients. That was always our guiding principle.”
GRASSP is used internationally in hospitals and rehabilitation centres to help clinicians tailor rehabilitation approaches and track recovery for individual patients. It’s also used as part of clinical trials to evaluate emerging therapies aimed at restoring hand and arm function.
Solving a critical problem in spinal cord injury research
In the early 2000s, spinal cord injury research was entering a new era. Experimental drugs, neurostimulation technologies, rehabilitation approaches and regenerative therapies were beginning to emerge.
But researchers lacked a sensitive, standardized way to measure whether these interventions improved hand and arm function in people with spinal cord injuries.
Existing assessment tools were often too broad or insufficiently responsive, and meaningful improvements in limb function could easily be missed or underestimated.
Sensitivity is especially important in spinal cord injury research and care. Even modest functional improvements can dramatically affect a person’s independence and quality of life.
“What makes GRASSP unique is that it doesn’t just tell you if someone is better, it tells you how much better and whether that change is meaningful,” says Dr. Kalsi-Ryan.
“That level of precision is critical, especially in clinical trials, because breakthroughs in health care aren’t driven by new drugs or devices alone, but by the tools that allow us to measure whether they truly work.”
The tool was validated through extensive international collaborations involving researchers and clinicians from UHN, the University of Toronto, University Hospital Balgrist in Zurich and leading spinal cord injury experts worldwide. More than 30 scientific publications in multiple languages support the tool.
Setting the gold standard for rehabilitation tools
With GRASSP, patients can see their recovery progress through tests.
“That creates a sense of hope and ownership in their recovery,” says Dr. Kalsi-Ryan.
Melissa was tested using GRASSP before, during and after the UHN[KS1.1]-led study[JV2.1][JA2.2] in 2023.
“I could see improvements,” she said. “It's important for researchers to know through GRASSP that small changes really do make a big difference in the life of someone living with paralysis.
“Even just being able to pick up food and put it in your mouth is really life changing."
Since its launch, the tool has evolved in response to real-world needs, including a virtual option. That has enabled assessments for patients in rural and underserved areas, those receiving at home care, and as part of research studies.
The tool is also embedded in cutting-edge research exploring wearable sensors, AI-assisted monitoring and neurostimulation, and is enabling researchers to build predictive models.
“We’re truly moving toward a future where we can predict recovery pathways and tailor treatment to each patient — and GRASSP is helping make that possible,” says Dr. Kalsi-Ryan.
GRASSP was first licensed in 2009, illustrating how UHN's commercialization model helps translate discoveries into real-world impact, while creating opportunities to support continued research and innovation.
“GRASSP is the full arc of what innovation should be: identifying an urgent unmet need, building a solution that’s rigorously validated, and making sure it reaches patients around the world,” says Dr. Kalsi-Ryan.
That can enable new therapies, better patient outcomes and independence for those living with injuries.
For Melissa — who can today feed herself, sit and stand unsupported, and walk with assistance — GRASSP was a contributor to her recovery. Contributing to research was also a way to give back.
“People in [the spinal cord injury] community are very interested in being involved and participating in research,” she said.
“Everyone that I’ve met works really hard at their recovery, so I think we’re appreciative of any research that comes along that might help with that.”
