The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change

Abstract

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...

Effect of parent‐delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial

“…Baseline assessments, specifically AHA, 12 Melbourne Assessment-2 (MA2), 17 and ABILHAND-Kids, 13 were used to establish areas of difficulty in manual activities for each child, such as reaching, grasp, and manipulating small items. These, along with the child's interests and abilities, informed the choice of intervention activities.…”

“…9 Children underwent 15 hour-long therapy sessions within 3 weeks. One week post-intervention, the intervention group had improved significantly more than controls on the Assisting Hand Assessment (AHA), 12 but the effect was not sustained. Interestingly, no betweengroup differences were observed in the MUUL.…”

Outcome assessment for Brachial Plexus birth injury. Results from the iPluto world‐wide consensus survey

“…No consensus was reached regarding Active Movement Scale (AMS)13 (61%), Force (MRC‐classification)14 (69%), Gilbert Shoulder Score (15%), Raimondi Hand Score15 (41%), Brachial Plexus Outcome Measure (BPOM)16 (39%), Assisting Hand Assessment (AHA)17 (29%), Semmes Weinstein filaments (31%), 2 point discrimination (29%), Pain Questionnaires (47%). Consensus was reached not to use the “nine hole peg test,”18 as 78% scored this as 1/2/3 (opposite consensus).…”

“…Tools to evaluate other domains of the ICF are readily available and used in some clinics, but these were not ranked high enough in the current rounds by the iPluto participants. Available tools for evaluation of the domain “Activities and participation” are for instance the AHA/mini‐AHA,17 BPOM,16 Children's Hand‐use Experience Questionnaire (CHEQ),30 Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure,31, 32 Hand Use at Home (HUH)33 and Pediatric Outcomes Data Collection Instrument (PODCI) 26, 34. For “Environmental Factors” the PedsQL Family impact module35 and PODCI34 are available.…”

The influence of early modified constraint‐induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy

“…16,17 The AHA was used to measure the children repeatedly over an average period of 4 years and 6 months (range 2y 2mo-7y 2mo), and this covered an age range from 18 months to 8 years. The mean age at the first assessment was 32 months (SD 13mo).…”