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Published on: February 2, 2024
Validation of the Hand Assessment for Infants for bilateral and unilateral cerebral palsy
Ann-Kristin Gunnes Elvrum1,2, Lena Krumlinde-Sundholm3, Marika Wenemark3,4,5
1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
The Hand Assessment for Infants (HAI) is valid and reliable for assessing hand function in infants at risk of cerebral palsy (CP). This allows for comparable bimanual performance measures across CP subtypes without needing to determine the subtype beforehand.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) impacts hand function in infants.
- The Hand Assessment for Infants (HAI) is a tool used to evaluate infant hand use.
- Expanding the HAI's scope to infants at risk of CP is crucial for early intervention.
Purpose of the Study:
- Validate the internal scale structure and reliability of the HAI.
- Assess infants aged 3 to 12 months corrected age at risk of unilateral or bilateral CP.
- Establish the HAI's utility across different CP subtypes.
Main Methods:
- A test-validation study involving 274 HAI assessments from 221 infants.
- Infants were at risk of unilateral or bilateral CP.
- Rasch measurement model analysis was applied to 17 HAI items (12 unimanual, 5 bimanual).
Main Results:
- The HAI demonstrated strong internal scale validity and reliability for both unilateral and bilateral CP risk groups.
- Logit measures were linked to a common reference frame.
- Distinct item difficulty hierarchies were maintained while enabling comparable bimanual performance measures (HAI unit).
Conclusions:
- The HAI provides valid and reliable hand use measures for infants at risk of CP, irrespective of manual impairment severity.
- The linked HAI unit offers a comparable measure of bimanual performance across CP subtypes.
- CP subtype determination is not required prior to HAI data collection.
Aim:
To expand the scope of the Hand Assessment for Infants (HAI) by validating its internal scale structure and reliability in infants with a corrected age of 3 to 12 months who are at risk of bilateral or unilateral cerebral palsy (CP).
Method:
This test-validation study included 274 HAI assessments collected from 221 infants (mean age = 7 months, SD = 2.4 months, 132 males) at risk of unilateral (n = 123) or bilateral (n = 98) CP. Each assessment was scored on 17 HAI items (12 unimanual and five bimanual) and analysed using the Rasch measurement model.
Results:
Strong internal scale validity and person and item reliability were found for the HAI items when analysed separately for infants at risk of unilateral and bilateral CP. Logit measures for both scales were linked to a common reference frame, allowing comparable overall bimanual performance measures (HAI unit) while maintaining distinct item difficulty hierarchies.
Interpretation:
The HAI provides valid and reliable measures of hand use in infants at risk of bilateral and unilateral CP regardless of the severity of manual impairments. By linking the scales, the HAI unit provides a comparable measure of bimanual performance across CP subtypes. Thus, the subtype of CP does not need to be determined before data collection.
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