Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy)

Abstract

BACKGROUND Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients’ subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function. OBJECTIVE 1) To characterize arm and hand function in DCM; and 2) To develop and validate Graded Redefined Assessment of Strength, Sensibility, and Prehension Version-Myelopathy (GRASSP-M), a clinical assessment that quantifies upper limb impairment. METHODS A total of 148 DCM patients (categorized into mild, moderate, and severe based on mJOA grade) and 21 healthy subjects were enrolled. A complete neurological exam, the mJOA, the QuickDASH, grip dynamometry, and the GRASSP-M were administered. RESULTS Strength, sensation, and manual dexterity significantly declined with increasing DCM severity (P ≤ .05). Impairment in hand dexterity showed better discrimination between mild, moderate, and severe DCM categories than strength or sensation. The GRASSP-M was found to be both a reliable (intraclass correlation coefficient >0.75 for intra- and inter-rater reliability) and valid (with both concurrent and construct validity) tool. CONCLUSION These results demonstrate that patients’ subjective reporting of functional status, especially in the mild DCM category, may underrepresent the extent of functional impairment. The GRASSP-M is an objective tool designed to characterize patients’ functional impairment related to the upper limb, which proves useful to diagnose and quantify mild dysfunction, monitor patients for deterioration, and help determine when patients should be treated surgically.

Clinical outcomes of nonoperatively managed degenerative cervical myelopathy: an ambispective longitudinal cohort study in 117 patients

“…These findings support the use of GRASSP-M for upper-extremity motor function and spatiotemporal gait analysis, which have been previously demonstrated as useful measures of clinical impairment in patients with DCM. 11,22 However, many of the measurements we used require specialized equipment and training, such as a grip dynamometer, GRASSP-M toolkit, 11 and pressure-sensing walkway. The use of these tools in a standard clinic setting may not be feasible for some practitioners, but the results nonetheless highlight areas that should be assessed during history-taking physical examination and via alternative clinical instruments (e.g., 10-m timed up-and-go test).…”

Handgrip Strength Correlated with Falling Risk in Patients with Degenerative Cervical Myelopathy

“…In a study by Kalsi-Ryan et al, [ 14 , 15 ] a more specific hand assessment study was suggested. Unfortunately, in this study, the patients were enrolled from March 2017 to August 2019, and therefore the specific test was not yet available.…”

“…Surgical treatment for both cervical and lumbar stenosis have been shown to decrease the risk of falling by improving physical performance, including walking and balancing [ 1 , 2 , 3 , 4 , 5 ]. There are many reported studies on prevalence, results of conservative or surgical treatment, gait patterns, hand dexterity–functional impairment and predictors of degenerative cervical myelopathy (DCM) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. A recent study reported that hand grip strength (HGS) might be a useful surrogate marker with which to predict the risk of falls and clinical outcomes in patients with lumbar stenosis [ 19 ].…”

Development and Evaluation of a New Assessment Tool for Myelopathy Hand Using Virtual Reality

“…Due to its clinical signi cance, several symptom-based grading scales and performance tests had been developed in order to objectively and quantitatively assess the impaired hand function or predict the clinical outcomes of decompression surgery [2,3,[5][6][7][8][9][10][11][12][13][14][15]. However, these are commonly complained of low sensitivity or low practicability for clinical use.…”