Development and Validation of the Both Hands Assessment for Children With Bilateral Cerebral Palsy
Ann-Kristin G Elvrum1,2, Britt-Marie Zethræus3, Torstein Vik2
1a Department of Clinical Services, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway.
Insights
The Both Hands Assessment (BoHA) effectively measures bimanual hand function and asymmetry in children with bilateral cerebral palsy (CP). This new tool validates bimanual performance across different hand use patterns.
Area of Science:
- Pediatric Rehabilitation
- Occupational Therapy
- Movement Science
Background:
- Bilateral cerebral palsy (CP) significantly impacts hand function, affecting daily activities.
- Quantifying bimanual performance and hand use asymmetry is crucial for targeted interventions.
Purpose of the Study:
- To develop and validate the Both Hands Assessment (BoHA) for children with bilateral CP.
- To measure bimanual performance and quantify hand use asymmetry.
Main Methods:
- Adapted the Assisting Hand Assessment (AHA) to create the BoHA.
- Utilized Rasch measurement model analyses on data from 171 children (22 months–13 years) with bilateral CP (Manual Ability Classification System levels I-III).
- Evaluated internal scale validity and reliability for symmetric and asymmetric hand use.
Main Results:
- The BoHA comprises 16 items (11 unimanual, 5 bimanual) with good internal scale validity and reliability.
- Bimanual performance measures are comparable between children with asymmetric and symmetric hand use.
- Separate item difficulty hierarchies were maintained for different hand use patterns.
Conclusions:
- The BoHA demonstrates strong internal construct validity for assessing bimanual performance effectiveness.
- The BoHA accurately measures the extent of asymmetric hand use in children with bilateral CP (MACS I-III).
- This assessment provides a reliable tool for evaluating bimanual function in pediatric CP populations.
Aims:
To develop a hand function test for children with bilateral cerebral palsy (CP) measuring bimanual performance, including quantification of possible asymmetry of hand use.
Method:
The Both Hands Assessment (BoHA) content was developed through adaptation of the Assisting Hand Assessment (version 5.0). Data from 171 children with bilateral CP, 22-months to 13 years olds (75 females; mean age: 6 years and 6 months) classified at Manual Ability Classification System (MACS) levels I-III, was entered into Rasch measurement model analyses to evaluate internal scale validity and aspects of reliability.
Results:
Sixteen items (11 unimanual and 5 bimanual) exhibited evidence for good internal scale validity and item and person reliability when analyzed separately for children with asymmetric or symmetric hand use. By calibrating the BoHA logit measures into the same frame of reference through linking, the overall measure of bimanual performance is comparable between children with asymmetric or symmetric hand use, still allowing use of separate item difficulty hierarchies.
Conclusions:
The Both Hands Assessment (BoHA), showed strong evidence of internal construct validity for measuring effectiveness of bimanual performance and the extent of asymmetric hand use in children with bilateral cerebral palsy, MACS levels I-III.
