From PhD Project to Global Impact: How a UHN Innovation is Transforming Spinal Cord Injury Rehabilitation

A made-in-Canada innovation developed at UHN’s KITE Research Institute is helping transform spinal cord injury rehabilitation around the world. The clinical assessment tool, known as the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), is used to measure 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.

Created by UHN clinician-scientist Dr. Sukhvinder Kalsi-Ryan and her team, GRASSP is now used internationally in hospitals, rehabilitation centres and as part of clinical trials, helping clinicians track recovery and evaluate emerging therapies aimed at restoring hand and arm function.

The idea tocreate GRASSP began as Dr. Kalsi-Ryan's doctoral research project at KITE inthe early 2000s.

“We wanted to create something that didn’t just sit on a shelf,” 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.”

Solving a Critical Problem in Spinal Cord Injury Research

In the early2000s, spinal cord injury research was entering a new era. Experimental drugs, neurostimulation technologies, rehabilitation approaches, and regenerative therapies were beginning to emerge. But there was a major obstacle: researchers lacked a sensitive, standardized way to measure whether these interventions actually improved hand and arm function in people with spinal cord injuries.

At the time, existing assessment tools were often too broad or insufficiently responsive for clinicians to detect clinically meaningful improvements in hand and arm function, and meaningful improvements in limb function could easily be missed or underestimated.

Recognizing this gap, Dr. Kalsi-Ryan, working with an international multidisciplinary team, set out to build a new kind of measurement system specifically designed for tetraplegia. The end result was GRASSP, a rigorous clinical assessment capable of measuring strength, sensation, and grasping ability in more detail than any previous tools. This is especially important in spinal cord injury research and care, where 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  , 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 other leading spinal cord injury experts worldwide.

Setting the Gold Standard

Since its clinical release in 2009, GRASSP has become widely adopted across the global spinal cord injury field.

Used across healthcare centres in North America, Europe and beyond, GRASSP is supported by more than 30 scientific publications, available in multiple languages, and routinely used in rehabilitation programs and clinical trials to measure upper limb recovery and evaluate the effectiveness of emerging therapies. Its influence is now so widespread that it is frequently regarded as the gold standard for upper limb assessment in people with cervical spinal cord injury.

“Patients relate to GRASSP because it measures real-life, daily tasks – things like picking up keys or holding a bottle of water,” says Dr. Kalsi-Ryan. “They can actually see their progress, and that creates a sense of hope and ownership in their recovery.”

The tool has continued to evolve in response to real-world needs. During the COVID-19 pandemic, the team developed a remote version of the assessment in collaboration with the Shirley Ryan Abilities Lab, allowing clinicians to guide patients virtually, even from home. This virtual option has enabled assessments in rural and underserved areas and patient participation in at-home care and research studies.

“Accessibility was always a priority,” says Dr. Kalsi-Ryan. “If a caregiver can assist and a clinician can guide remotely, we can bring this tool to far more people.” GRASSP was first licensed in 2009 using a copyright-based commercialization model designed to support broad international adoption while reinvesting back into UHN research to support ongoing refinement and development.

“At the end of the day, this is about patients,” says Dr. Kalsi-Ryan. “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. When you scale it thoughtfully, it doesn’t just measure progress; it enables new therapies, better outcomes, and real independence. Sometimes, the tools that make breakthroughs measurable become breakthroughs themselves,” she adds.

Looking to the future

More than a decade after its creation and as spinal cord injury treatment advances, GRASSP is not just keeping pace, it is helping lead the way. The tool is now embedded in cutting-edge research exploring wearable sensors, AI-assisted monitoring, neurostimulation, and home-based care, while also enabling researchers to build predictive mode. By providing a detailed picture of upper limb recovery, GRASSP helps clinicians tailor rehabilitation approaches to individual patients while giving researchers a rigorous tool to evaluate promising new treatments.

“We’re truly moving toward a future where we can predict recovery pathways and tailor treatment to each patient,” says Dr. Kalsi-Ryan. “And GRASSP is helping make that possible.”