IMPORTANCECerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.OBJECTIVES To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.

The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n=52], diplegia [n=70], tetraplegia [n=19], ataxia [n=6], dyskinesia [n=19], and unspecified CP [n=2]) between 4 and 18 years and between 25 parents and their children's therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96-0.98), and between parents and therapist was 0.96 (0.89-0.98), indicating excellent agreement.

The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n= 52], diplegia [n= 70], tetraplegia [n= 19], ataxia [n= 6], dyskinesia [n= 19], and unspecified CP [n= 2]) between 4 and 18 years and between 25 parents and their children's therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96–0.98), and between parents and therapist was 0.96 (0.89‐0.98), indicating excellent agreement.

The Assisting Hand Assessment (AHA) provides a new perspective of hand function evaluation relevant for children with unilateral upper limb disabilities. It measures how effectively the involved hand is actually used for bimanual activity, which, for these children, might be the most important aspect of their hand function. The aim of this paper is to report the conceptual framework and the evidence for validity, reliability, and responsiveness to change for the measures. Previously, the AHA has been evaluated for children aged 18 months to 5 years and excellent inter-and intrarater reliability was demonstrated. This paper reports further evidence of construct validity and reliability for the AHA measures involving an extended age range of children with hemiplegic cerebral palsy or obstetric brachial plexus palsy from 18 months to 12 years of age (mean age 4y 11mo [SD 2y 9mo] range 18mo-12y 8mo). A Rasch measurement model was used to analyze 409 assessments from 303 children (170 males, 133 females). The analysis generated a scale demonstrating large capacity to reliably separate and spread personal ability measures, indicating sensitivity to change and a hierarchy of the items ranging them from easy to hard. Aspects of item fit, relationship between age and ability measures, and development of assisting hand function are discussed.When hand function impairment leads to intervention, the overall aim is generally to increase the functional use of the hands for everyday task performance. Most activities in daily life normally involve the collaborative use of two hands together. However, instruments evaluating hand functioning commonly entail testing one hand at a time. Furthermore, they evaluate maximum capability in contrast to performance, i.e. what the person can do rather than what he/she actually does do.In bimanual performance, the two hands have different roles: the dominant hand manipulates objects to a higher extent and is also quicker than the non-dominant hand, which more often has a holding and stabilizing role. 1,2 Given a unilateral deficit, the difference between these roles becomes even more pronounced. It is natural for people with unilateral hand impairment from early age to use the well-functioning hand as a first choice whenever this is possible. Even though some activities can be performed one-handed, and compensatory strategies may be functional, the use of two hands together is often essential for successful task accomplishment. 3 The affected hand/arm can be described as a helper or an assisting hand rather than a non-dominant hand. 4 Characteristics that specify a useful assisting hand are, to our knowledge, not described elsewhere.The Assisting Hand Assessment (AHA) is a recently developed test intended for use with children who have a unilateral upper limb dysfunction, in particular children with hemiplegic cerebral palsy (CP) or obstetric brachial plexus palsy (OBPP). 4 The core concept of the AHA is based on recognition of the different roles the two hands play and the fact that an ass...

Krumlinde-Sundholm L, EliassonA-C. De6elopment of the Assisting Hand Assessment: a Rasch-built measure intended for children with unilateral upper limb impairments. Scand J Occup Ther 2003; 10: 16 -26.The purpose of this paper was to report on the first step in the development of a new instrument, the Assisting Hand Assessment (AHA), that measure the effectiveness with which a child with unilateral impairment makes use of his/her affected hand in bimanual activity performance. The assessment is intended for children with hemiplegic cerebral palsy or obstetric brachial plexus palsy, from age 18 months to 5 years. The AHA is conducted through observations of performance skills exposed during play where toys requiring bimanual handling are used. The validity and reliability of the measures were explored using a Rasch measurement model for analysis. In the AHA, 22 items consisting of observable actions are scored on a 4-point rating scale evaluating the quality of the performance. The Rasch analysis suggests that the test rationale, the usefulness of the assisting hand, does form a unidimensional construct and that the items represent the tested phenomenon well. The results show potential for the AHA to become a useful tool for both clinical practice and research.