Assisting Hand Assessment Scores Research Articles

Relationships between activities of daily living, upper limb function, and visual perception in children and adolescents with unilateral cerebral palsy.

This study examined relationships between activities of daily living (ADL) motor and process skills, unimanual capacity, bimanual performance, and visual perception in children with unilateral cerebral palsy (CP). Participants were 101 children with unilateral CP (51 males, 50 females; mean age 11y 9mo [SD 2y 5mo; range 8-17y]; Manual Ability Classification System [MACS] level I=24; level II=76; level III=1). Measures were (1) Assessment of Motor and Process Skills (AMPS), (2) Jebsen-Taylor Test of Hand Function (JTTHF), (3) Assisting Hand Assessment (AHA), and (4) Test of Visual Perceptual Skills, 3rd edition (TVPS-3). Regression models were constructed with the AMPS motor scale and AMPS process as the dependent variables. The AHA and JTTHF dominant upper limb score together explained 57% of the variance in AMPS motor scale scores. TVPS-3 Visual Sequential Memory, TVPS-3 Visual Closure, and JTTHF dominant upper limb score together explained 35% of the variance in AMPS process scale scores. Bimanual performance and unimanual capacity of the dominant upper limb are significantly associated with ADL motor skills in children with unilateral CP. Process skills of ADL are related to visual perceptual ability and dominant upper limb unimanual capacity, which may reflect motor planning required to perform daily tasks.

Neonatal neuroimaging predicts recruitment of contralesional corticospinal tracts following perinatal brain injury

Unilateral perinatal brain injury may result in recruitment of ipsilateral projections originating in the unaffected hemisphere and development of unilateral spastic cerebral palsy (USCP). The aim of this study was to assess the predictive value of neonatal neuroimaging following perinatal brain injury for recruitment of ipsilateral corticospinal tracts. Neonatal magnetic resonance imaging (MRI) and cranial ultrasound scans of 37 children (20 males, 17 females; median [range] gestational age 36 wks(+4) [26(+6) -42wks(+5) ] and birthweight 2312 g ([770-5230g]) with unilateral perinatal arterial ischaemic stroke (n=23) or periventricular haemorrhagic infarction (n=14) were reviewed and scored for involvement of the corticospinal trajectory. Hand function was assessed using the Assisting Hand Assessment (AHA) and transcranial magnetic stimulation (TMS) was performed (age range 7y 4mo-18y and 7mo) to determine the type of cortical motor organization (normal, mixed or ipsilateral). Neuroimaging scores were used to predict TMS patterns. Eighteen children developed USCP with ipsilateral corticospinal tract projections in 13 children (eight mixed, five ipsilateral). AHA scores decreased with increased ipsilateral projections. Asymmetry of the corticospinal tracts seen on neonatal MRI was predictive of development of USCP and recruitment of ipsilateral tracts (positive and negative predictive value of 73% and 91%). Neonatal neuroimaging can predict recruitment of ipsilateral corticospinal tracts. Early knowledge of the expected pattern of cortical motor organization will allow early identification of children eligible for early therapy.

Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy

New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use. Fifteen children (four females, 11 males; age range 6-12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity. Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p<0.001) and were strongly correlated with the AHA scores (r=0.93; p<0.001). AHA scores were significantly correlated with FreqE (r=0.80; p=0.001) and the range of wrist extensions/flexions (r=0.70; p=0.008). The multivariate linear regression combining the FreqE and range of wrist extensions/flexions yielded a strong correlation with AHA scores (r=0.84; p=0.0043). The wearable wrist monitor may offer a convenient, valid alternative to observer reports for functional assessments of the hemiplegic hand in everyday contexts.

Immediate effect of a wrist and thumb brace on bimanual activities in children with hemiplegic cerebral palsy

The aim of this study was to determine the immediate effect of wearing a wrist and thumb brace on the performance of bimanual activities in children with spastic hemiplegic cerebral palsy. In a pre- and post-test cohort study of 25 children (age range 4-11y; mean age 8y 4mo [SD 2y 2mo]; 16 males, 9 females) with spastic hemiplegic cerebral palsy with a Zancolli classification hand score of I, IIA, or IIB (mild and moderate hand dysfunction; children with a Zancolli classification of III - severe hand dysfunction - were excluded from this study), performance of bimanual activities was evaluated with the Assisting Hand Assessment (AHA) on three occasions: one assessment with a static wrist and thumb brace placed on the affected hand and two other assessments without a brace. The differences between AHA scores obtained at the three assessments were evaluated using the repeated measures analysis of variance. Performance of bimanual activities while wearing the brace improved significantly compared to performance without the brace (p<0.001). With the brace, the mean AHA score increased by 3.2 (95% confidence interval 2.1-4.3) from 59.1 to 62.3. The scores of the two assessments without the brace did not differ significantly. In children with spastic hemiplegic cerebral palsy, bracing of the wrist and thumb immediately improves spontaneous use of the affected upper limb in bimanual activities, possibly because bracing permits a more functional hand position.

Longitudinal development of hand function in children with unilateral cerebral palsy

The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral cerebral palsy (CP) aged between 18 months and 8 years. A prospective longitudinal study of 43 children (22 males, 21 females) with unilateral CP was conducted. Inclusion age was 18 months to 5 years 4 months (mean 2y 8mo [SD 1y 1mo]). Children were assessed with the Assisting Hand Assessment (AHA) 3 to 11 times per child over a mean period of 4 years 6 months. Two models were used for grouping children: by AHA score at 18 months and by Manual Ability Classification System (MACS) levels. Estimated average motor development curves were fitted with a nonlinear mixed-effects model. Children with a high AHA score (high ability level) at 18 months reached a significantly higher ability level and at a higher progression rate than children with a low 18-month AHA score. Limits of development differed between the three MACS levels. Results indicate that the AHA score at 18 months can be used to discuss future development of affected hand use in bimanual tasks in children with unilateral CP.

Two hands are better than one: bimanual skill development in children with hemiplegic cerebral palsy

Children with hemiplegic cerebral palsy (CP) have unilateral sensory and motor impairments that may lead to developmental disuse of the affected upper extremity and ⁄or reduced ability to use the affected upper extremity during tasks requiring two hands. Since many functional activities do require the coordinated use of both hands (e.g. dressing, self-care), these impairments may dramatically impact daily function. Thus, understanding the development of bimanual upper extremity use in this population is important, however, such knowledge is largely lacking. In an exciting and ambitious new study, Holmefur and colleagues at the Karolinska Institute report the findings of a prospective longitudinal study of bimanual upper extremity use in 43 children with hemiplegic CP. Children were followed on average 4 and a half years using the Assisting Hand Assessment (AHA), a Rasch-based measure that effectively describes how the affected upper extremity is used as a non-dominant assist during bimanual activities. Overall they found that bimanual proficiency did improve during the course of development, but that the developmental rate and subsequent plateau depended on the initial score at 18 months of age. Specifically, children with higher (better) AHA scores in early childhood developed bimanual skills faster and reached their limit earlier than children with lower AHA scores. Interestingly, the development of bimanual upper extremity use differs from that of gross motor activities, where mildly affected children reach their limit later. Thus importantly, gross motor function cannot be used as a proxy for predicting bimanual hand use. While this is not the first study of hand development in children with CP, this is the first study of bimanual hand use using a standardized measure. The findings of the AHA differ from those of the Manual Ability Classification System in the same children, which is in line with the other developmental studies to date indicating that various aspects of hand development progress with different time courses and rates. It is at first disheartening to think that prognosis may be predetermined early on. However, the ‘glass half-full’ view is that this information may be clinically important for treatment decisions such as when and how often to engage children in conventional treatments and intensive therapies such as constraint-induced movement therapy and bimanual training. Holmefur et al. have taken an important step in understanding the ontology of hand function in children with hemiplegic CP. However, it should be noted that the development of hand function in children with hemiplegic CP younger than the study participants (<18mo) is largely unknown. Being able to detect early signs of impairments and relate them to subsequent development is critical since hemiplegia is typically diagnosed between 4 and 6 months of age, only after one upper extremity begins to demonstrate visible impoverished movement. This is correlated with the simultaneous strengthening of ipsilateral projections and retraction of contralateral projections of the corticospinal tract to the spinal cord. Using an animal model of hemiplegia, Martin et al. at Columbia University have shown that such structural changes in neural substrates are exacerbated by reduced activity in the contralateral motor cortex, associated with the emerging disuse of the affected extremity. Conversely, such damage can be circumvented if sufficient activity is provided at a young enough age. Thus, objective quantification and predictive development of hand function at an early age is imperative in order to begin targeted treatment to break this vicious cycle whereby

Gross motor outcomes in children with hemiparesis involved in a modified constraint-induced therapy program

Constraint-Induced Therapy (CIT) has been used in pediatric rehabilitation and targets upper extremity (UE) outcomes. The purpose of this study was to measure concurrent gross motor and lower extremity functional changes using the Gross Motor Function Measure (GMFM) before and after a modified UE CIT program. The Assisting Hand Assessment (AHA) was used to evaluate upper extremity outcomes. Before-after trial design of a 19-day outpatient CIT program at Seattle Children's Hospital in Seattle, WA, USA of six ambulatory children with spastic hemiparesis between the ages of 5 and 11 years with GMFCS scores of 1. GMFM Section D (Standing) and E (Walking, Running, Jumping) and AHA scores were obtained before and after a modified CIT program. Significant differences were found between pre and post-CIT AHA and GMFM section D and E scores (p < 0.05). All children improved from baseline, yet the child with the lowest initial scores revealed the greatest improvements. Improvements in GMFM and AHA scores were noted after a modified CIT program. Such data suggests that CIT may also influence rehabilitation outcomes not only specific to the upper extremity and warrants further investigation.

Hand Function and Activity Performance of Children with Longitudinal Radial Deficiency

The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two. We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined. The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance. Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.