AHA-family assessments

The Assisting Hand Assessment (AHA), and the group of related assessments (AHA-family), measure and describe how effectively individuals with a hand/arm impairment use their two hands together to perform bimanual tasks.

Since daily activities commonly require the use of both hands, bimanual performance is of vital importance when considering hand function. Recognising that a person with a unilateral impairment will have one well-functioning hand and one hand that is more or less affected by impairment is a central construct to the AHA-family assessments. These tests use the unique perspective of measuring how well a person with unilateral impairment uses his/her affected hand as an “assisting hand” when performing bimanual tasks. It is this performance that is often crucial as to whether bimanual tasks can be completed successfully.

AHA-family assessments are observation based, criterion referenced and responsive to change. The bimanual activities from which the test is scored are age related, relevant and semi-structured allowing interaction with the examiner. It is the person’s typical performance that is elicited in the test situation, as opposed to maximal capacity often measured in other tests. Results from the AHA-family assessments can be used to guide interventions and to measure change over time.

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Latest research on the AHA-family of assessments

Reliability evaluation of the Hand Assessment for Infants (HAI)

Ullenhag A, Ek L, Eliasson AC, Krumlinde-Sundholm (2021) Interrater and test-retest reliability of the Hand Assessment for Infants. Dev Med Child Neurol . 63 (12) , pp.1456-1461. DOI: 10.1111/dmcn.14967

In this study agreement between raters and stability of repeated assessment were evaluated.

HAI assessments of 55 infants, 25 of them with clinical signs of unilateral cerebral palsy (CP) and 30 typically developing infants were scored individually by three occupational therapists with extensive experience in using the HAI.

Interrater and test–retest reliability was excellent for the Both Hands Measure (BoHM) and the Each Hand Sum score (EaHS), with ICCs of 0.96 to 0.99. Interrater and test–retest reliability was good to excellent (ICC 0.81–0.99). The Smallest Detectable Difference (SDD) for the EaHS was 2 points, and for the BoHM the SDD it was 3 HAI units for infants with signs of unilateral CP.

Conclusion: The HAI results showed good to excellent reliability. The SDDs were low, indicating that results beyond these levels exceed the measurement error and, thus, can be considered true changes.


External validity of the Both Hands Assessment (BoHA)

Elvrum AG, Johansen GO, Vik T, Krumlinde-Sundholm L. (2021) External validity of the Both Hands Assessment for evaluating bimanual performance in children with bilateral cerebral palsy. Dev Med Child Neurol.  Dec 14.  DOI: 10.1111/dmcn.15127

In this study the external validity of the BoHA was evaluated, i.e. how well the results of the BoHA corresponds to outcomes of other test measuring the same concept.

Thirty-nine children with bilateral CP and manual ability corresponding to MACS levels I to III  completed the BoHA. Furthermore, unimanual capacity was assessed using the BFMF classification, the Box and Block Test (BBT), and the Melbourne Assessment 2 (MA2). Self-care skills were assessed with the Pediatric Evaluation of Disability Inventory (PEDI). Spearman’s correlation coefficient (q) suggested high correlation between the BoHA and MACS (p=0.89), BFMF classification (p=0.84), and BBT for the non-dominant (p=0.85) and dominant hand (p=0.72). The Spearman’s q between the BoHA and the MA2 subscales varied between 0.48 and 0.83, while the PEDI’s q was 0.51.

Conclusion; The BoHA provides valid measures of hand use as suggested by its high correlation with other activity-based measures of hand function.