Graded Repetitive Arm Supplementary Program (GRASP)

Original Editor - Arnold Fredrick D'Souza Top Contributors - Arnold Fredrick D'Souza

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Top Contributors - Arnold Fredrick D'Souza  

Description[edit | edit source]

The Graded Repetitive Arm Supplementary Program (GRASP) is an inexpensive, self-administered supplement to inpatient rehabilitation. It was developed by Janice Eng, PhD, PT/OT and Jocelyn Harris, PhD, OT with Andrew Dawson, MD, FRCP and Bill Miller, PhD, OT[1] based on a previous community-based group exercise study for chronic stroke by Marco Y Pang, Jocelyn Harris and Janice Eng.[2]

There are two GRASP protocols[3]:

  • Hospital GRASP: It lasts four weeks and occurs alongside inpatient rehabilitation. The sessions need to be monitored and the patient must be receive encouragement as they progress. There are three levels after which the patient is discharged and continues the program at home. The levels involve the practice of progressively intensive practice of gross and fine motor skills.
  • Home GRASP: It can last two months and will be prescribed in a face-to-face meeting after which a follow-up over the phone will suffice. There are no levels here since the patient's condition is not expected to change much in this period.

The exercises included in the GRASP are divided into 5 sections[3]:

1. Stretching

2. Arm Strengthening

3. Hand Strengthening

4. Coordination

5. Hand Skills

Each section has six components[3]:

  1. Range of motion
  2. Strengthening
  3. Repetitions of the stroke-affected arm and hand
  4. Weight-bearing
  5. Trunk control
  6. Repetitions using both arms

The exercises are described in the manual linked below. Each treatment session can last up to an hour a day.

Equipment needed[edit | edit source]

The GRASP requires inexpensive, readily available equipment such as[3]:

  • Buttoned shirt
  • Target board
  • Tennis ball
  • Bean bag
  • Wrist weight (0.5-1 lb)
  • Hand gripper (5 lb)
  • Knife and fork
  • Towel
  • Cup
  • Popsicle sticks and toothpicks
  • Various sizes of LEGO®
  • Blocks of various sizes
  • Poker chips, pennies and dimes
  • Clothes pins of various sizes
  • Paper clips of various sizes
  • Theraputty
  • Jars of various sizes

Indication[edit | edit source]

GRASP is effective and safe for use in sub-acute stroke.[1]

Clinical Presentation[edit | edit source]

To initiate GRASP, subjects must have a grade 1 score for wrist extensors and demonstrate active scapula elevation against gravity.[3]

The GRASP can be progressed based on the Fugl-Meyer Assessment Upper Extremity score.[3]

  • Level 1: 10 - 25
  • Level 2: 26 - 45
  • Level 3: 46 - 58

Research[edit | edit source]

According to a pilot sham controlled, double-blinded randomized trial, the addition of transcranial random noise stimulation improves motor outcomes of GRASP in sub-acute stroke.[4] The use of a tablet computer was feasible in monitoring the usage of GRASP and ensuring adherence.[5] Virtually delivered GRASP was effective in a small sample[6] and the implementation of GRASP in community settings has been equally effective.[7]

Resources[edit | edit source]

Videos[edit | edit source]

Manuals[edit | edit source]

Instructor’s Manual for Hospital & Home GRASP

Home GRASP Participant Exercise Manual

Hospital GRASP Patient Exercise Manual

GRASP Exercise Log

Target board for GRASP

GRASP equipment kit

References[edit | edit source]

  1. 1.0 1.1 Harris JE, Eng JJ, Miller WC, Dawson AS. A self-administered Graded Repetitive Arm Supplementary Program (GRASP) improves arm function during inpatient stroke rehabilitation: a multi-site randomized controlled trial. Stroke. 2009 Jun 1;40(6):2123-8.
  2. Pang MY, Harris JE, Eng JJ. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2006 Jan;87(1):1-9.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Neurorehabilitation Research Program, UBC. GRASP Instructor Manuals. Available from: (Accessed May 2, 2021)
  4. Arnao V, Riolo M, Carduccio F, Tuttolomondo A, D’Amelio M, Brighina F, et al. Effects of transcranial random noise stimulation combined with Graded Repetitive Arm Supplementary Program (GRASP) on motor rehabilitation of the upper limb in sub-acute ischemic stroke patients: a randomized pilot study. J Neural Transmis. 2019 Dec;126(12):1701-6.
  5. Levy T, Killington M, Lannin N, Crotty M. Viability of using a computer tablet to monitor an upper limb home exercise program in stroke, Physiother Theory Pract. 2021 37:2, 331-41
  6. Yang CL, Waterson S, Eng JJ. Implementation and evaluation of the virtual Graded Repetitive Arm Supplementary Program (GRASP) for individuals with stroke during the COVID-19 pandemic and beyond. Phys Ther. 2021
  7. Yang CL, Bird ML, Eng JJ. Implementation and evaluation of the Graded Repetitive Arm Supplementary Program (GRASP) for people with stroke in a real world community setting: Case Report. Phys Ther. 2021