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Development of the Hand Assessment for Infants: evidence of internal scale validity
Lena Krumlinde-Sundholm1, Linda Ek1, Elisa Sicola2
1Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
The Hand Assessment for Infants (HAI) is a valid tool to measure infant hand use and asymmetry. This assessment is crucial for infants at risk of unilateral cerebral palsy.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Rehabilitation medicine
Background:
- Early detection of upper limb dysfunction is critical for infants at risk of unilateral cerebral palsy.
- Existing assessments may not adequately capture nuanced hand function in this population.
Purpose of the Study:
- To develop and validate the Hand Assessment for Infants (HAI), an evaluative tool for infant upper limb function.
- To assess the internal scale validity of the HAI for infants aged 3-12 months at risk of unilateral cerebral palsy.
Main Methods:
- Developed test items and scoring criteria for the HAI.
- Investigated internal scale validity and reliability using Rasch measurement model analysis on 156 infant assessments.
- Infants were aged 3-12 months corrected age with signs of asymmetric hand use.
Main Results:
- The HAI demonstrated a unidimensional construct and good fit to Rasch model requirements.
- Achieved excellent person reliability, enabling separation into six ability strata.
- Produced interval-level measures of bilateral hand use and an asymmetry index.
Conclusions:
- The Hand Assessment for Infants (HAI) is a valid tool for assessing bilateral hand use in infants.
- The HAI effectively quantifies hand use asymmetry in infants at risk of unilateral cerebral palsy.
Aim:
The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3 to 12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy.
Method:
The concepts of the test items and scoring criteria were developed. Internal scale validity and aspects of reliability were investigated on the basis of 156 assessments of infants at 3 to 12 months corrected age (mean 7.2mo, SD 2.5) with signs of asymmetric hand use. Rasch measurement model analysis and non-parametric statistics were used.
Results:
The new test, the Hand Assessment for Infants (HAI), consists of 12 unimanual and five bimanual items, each scored on a 3-point rating scale. It demonstrated a unidimensional construct and good fit to the Rasch model requirements. The excellent person reliability enabled person separation to six significant ability strata. The HAI produced an interval-level measure of bilateral hand use as well as unimanual scores of each hand, allowing a quantification of possible asymmetry expressed as an asymmetry index.
Interpretation:
The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy.
What This Paper Adds:
The Hand Assessment for Infants (HAI) measures the use of both hands and quantifies a possible asymmetry of hand use. HAI is valid for infants at 3 to 12 months corrected age at risk of unilateral cerebral palsy.
