Chedoke Arm And Hand Activity Inventory Research Articles

Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke

BackgroundStroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy.ObjectiveThis clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation.MethodsThe present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure.ResultsThere was medium to large correlation of the CAHAI and the MAL (ρ = 0.60–0.62, p < 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44–0.51, p < 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27–0.31, p < 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37–0.41, p < 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed.ConclusionThe CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.

A Comparative Efficacy Study of Robotic Priming of Bilateral Approach in Stroke Rehabilitation.

Background: Stroke survivors can remain impaired in body functions, activity, and participation. A novel rehabilitation regimen is required to obtain scientific evidence and to help clinicians determine effective interventions for stroke. Mirror therapy (MT) and bilateral upper limb training (BULT) are based on the tenet of bilateral movement practice; however, the additional effect of bilateral robotic priming combined with these two therapies is unclear.Objectives: This study examined the effects of two hybrid therapies, robotic priming combined with MT and robotic priming combined with BULT, in stroke survivors.Methodology: The study randomized 31 participants to groups that received robotic priming combined with MT (n = 15) or robotic priming combined with BULT (n = 16). Outcome measures included the Fugl–Meyer Assessment (FMA), the revised Nottingham Sensory Assessment (rNSA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and accelerometer data.Results: Both groups showed statistically significant within-group improvements in most outcome measures. Significant between-group differences and medium-to-large effect sizes were found in favor of the group that received robotic priming combined with MT based on the FMA distal part subscale scores, FMA total scores, and accelerometer data.Conclusion: Robotic priming combined with MT may have beneficial effects for patients in the improvements of overall and distal arm motor impairment as well as affected arm use in real life. Additional follow-up, a larger sample size, and consideration of the effect of lesion location or different levels of cognitive impairment are warranted to validate our findings in future studies.Clinical trial registration: www.ClinicalTrials.gov, identifier NCT03773653.

3-Dimensional printing in rehabilitation: feasibility of printing an upper extremity gross motor function assessment tool

BackgroundUse of standardized and scientifically sound outcome measures is encouraged in clinical practice and research. With the development of newer rehabilitation therapies, we need technology-supported upper extremity outcome measures that are easily accessible, reliable and valid. 3‐Dimensional printing (3D-printing) has recently seen a meteoric rise in interest within medicine including the field of Physical Medicine and Rehabilitation. The primary objective of this study was to evaluate the feasibility of designing and constructing a 3D printed version of the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT). The TRI-HFT is an upper extremity gross motor function assessment tool that measures function at the intersection of the International Classification of Function’s body structure and function, and activity domain. The secondary objective was to assess the preliminary psychometrics of this test in individuals with stroke.Results3D design files were created using the measurements of the original TRI-HFT objects. The 3D printed objects were then compared to the original test objects to ensure that the original dimensions were preserved. All objects were successfully printed except the sponge and paper which required some modification. The error margin for weight of the objects was within 10% of the original TRI-HFT for the rest of the objects. Nine participants underwent the following assessments: the Chedoke Arm and Hand Activity Inventory (CAHAI), Fugl Meyer Assessment-Hand (FMA-Hand), Chedoke McMaster stages of recovery of the arm (CMSA-Arm) and Chedoke McMaster stages of recovery of the hand (CMSA-Hand) and the 3D TRI-HFT for assessment of psychometric properties of the test. The video recorded assessment of the 3D TRI-HFT was used for reliability testing. Construct validity was assessed by comparing the scores on 3D TRI-HFT with the scores on CAHAI, CMSA-Arm, CMSA-Hand and FMA-Hand. The 3D TRI-HFT had high inter-rater reliability (Intra-Class Correlation Co-efficient (ICC) of 0.99; P < 0.000), high intra-rater reliability (ICC of 0.99; P < 0.000) and moderate-to-strong correlation with the CMSA-Arm, CMSA-Hand and FMA-Hand scores.ConclusionsThe TRI-HFT could be successfully 3D printed and initial testing indicates that the test is a reliable and valid measure of upper extremity motor function in individuals with stroke.

Safety, Feasibility, and Acceptability of a New Virtual Rehabilitation Platform: A Supervised Pilot Study.

Purpose:Stroke is the leading cause of disability in adults worldwide, with hemiparesis being the most prevalent consequence. The use of video games and movement sensors could contribute to improving patients’ chances of recovery. We performed a supervised pilot study to validate the safety, feasibility, and acceptability of a new virtual rehabilitation platform in patients with chronic post-stroke upper limb hemiparesis.Methods:The participants (n = 9) participated in 40 rehabilitation sessions, twice a week, for a period of 20 weeks. Their experiences with the platform were documented using a Likert-scale survey. Changes in motor function were evaluated using the Chedoke Arm and Hand Activity Inventory (CAHAI) and the Wolf Motor Function Test (WMFT).Results and conclusions:All participants expressed that they enjoyed the experience and felt comfortable using the platform. Preliminary results showed significant motor recovery (P = .0039) according to the WMFT scores. Patients with significant impairment showed no improvement in upper limb task-oriented motor function after therapy.The new platform is safe and well-accepted by patients. The improvement in motor function observed in some of the participants should be attributed to the therapy since spontaneous functional recovery is not expected in chronic stroke patients.

Hybrid Rehabilitation Therapies on Upper-Limb Function and Goal Attainment in Chronic Stroke.

This study examined the treatment effects between unilateral hybrid therapy (UHT; unilateral robot-assisted therapy [RT] + modified constraint-induced movement therapy) and bilateral hybrid therapy (BHT; bilateral RT + bilateral arm training) compared with RT. Thirty patients with chronic stroke were randomized to UHT, BHT, or RT groups. Preliminary efficacy was assessed using the Fugl-Meyer Assessment (FMA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and the goal attainment scaling (GAS). Possible adverse effects of abnormal muscle tone, pain, and fatigue were recorded. All groups showed large improvements in motor recovery and individual goals. Significant between-group differences were found on GAS favoring the hybrid groups but not on FMA and CAHAI. No adverse effects were reported. Hybrid therapies are safe and applicable interventions for chronic stroke and favorable for improving individual functional goals. Treatment effects on motor recovery and functional activity might be similar among the three groups.

Inter-rater reliability of the Chedoke Arm and Hand Activity Inventory.

The Chedoke Arm and Hand Activity Inventory (CAHAI) is an assessment of upper limb function designed for use in the stroke population. The CAHAI has strong reliability and validity in this population; however, it is unknown whether this measure can be used with other clinical populations such as acquired brain injury (ABI). The purpose of this study was to estimate the inter-rater reliability of the CAHAI when used with persons with ABI. The research design was an observational parameter estimation study. The administration of the CAHAI was videotaped for 6 persons with ABI. To estimate inter-rater reliability each video was assessed independently by 6 clinicians yielding a total of 36 assessments. A Latin square design was used to balance the order raters evaluated the videos. Shrout and Fleiss Type 2,1 intra class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to estimate inter-rater reliability of the CAHAI. Inter-rater reliability was high ICC = 0.96 (95% CL: 0.88, 0.99) and the SEM was 3.35 (95% CL: 2.63, 4.63) CAHAI points. These results suggest that the CAHAI, although designed for use in the stroke population, can be used reliably in the ABI population.

Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI

Purpose: To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements. Method: Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU. Results: P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to −1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU. Conclusion: The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns.Implications for RehabilitationYouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense.The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting.The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical activation patterns.

Efectos de la toxina botulínica tipo A y electroestimulación en la espasticidad flexora distal de la extremidad superior en el ictus. Ensayo clínico aleatorizado

Objective To evaluate the efficacy of the Neuromuscular Electrical Stimulation (NMES) associated to Botulinum Toxin (TB) type A in motor function, functional capacity and spasticity in chronic post-stroke upper limb (UL) spasticity. Patients and methods A randomized controlled clinical trial was performed in 25 ictus patients with more than 6 months evolution. After infiltration of 200 units of TB in the flexor muscle of the finger and wrist muscles, the patients were assigned to two groups: NMES in extensor muscles (group 1) and sham-stimulation (group 2). Patients were assessed at weeks 4/16 post-injection by standard motor function scales (Fugl-Meyer Motor Assessment (FMA), Medical Research Council Scale (MRC), Motricity Index for Motor Impairment after stroke and dynamometry), UL functional capacity (Chedoke Arm and Hand Activity Inventory (CAHAI), Box and Block Test (BBT) and muscular tone (Modified Ashworth Scale (MAS)). Results At week 4, significant improvement was observed in FMA 2.4 (SD 4.1) in UL component, MRC 0.2 (SD 0.4), CAHAI 4.2 and BBT 1.5 (SD 3.3), as well as a reduction in MAS 1.0 (SD 0.9) in the wrist and 1.2 (SD 1.4) in the fingers. At month 4, this effect was maintained in motor function but not in spasticity. No significant differences were observed in UL motor function, functional capacity between the groups. Conclusions TB type A injection in UL distal flexor spasticity enhances motor function, functional capacity and spasticity in chronic stroke patients. Adding a program of NMES for the extensor wrist/fingers muscles does not provide any additional benefits.

Clinical Utility of the Chedoke Arm and Hand Activity Inventory for Stroke Rehabilitation

The Chedoke Arm and Hand Activity Inventory (CAHAI) is an outcome measure that assesses upper limb ability after stroke. To explore the clinical utility of the CAHAI when used by occupational therapists in stroke rehabilitation. A qualitative study consisting of two focus groups was conducted with occupational therapists (Group A: n = 8; Group B: n = 5). Data were analysed inductively to identify themes. A range of perspectives on the clinical utility of the CAHAI were described. Themes that emerged were "instructions ambiguous and scoring unclear," "how we use it," "whole task versus motor components," "knowing when to use it," "detecting other impairments," and "changing the way clients do tasks." The clinical application of the CAHAI may be influenced by occupational therapy values, differences in training procedures, and organisational barriers. Training and strategies to address these issues may be beneficial.

Review of upper limb ability assessments in acute stroke care, from a practice perspective

Aims The purpose of this study was to compare three upper limb ability assessments – the Action Research Arm Test (ARAT), Arm Motor Ability Test (AMAT), and Chedoke Arm and Hand Activity Inventory (CAHAI) – in acute stroke occupational therapy practice during a 6-month period, to identify whether any or all were appropriate for use in acute stroke care. Methods Medical records of clients with stroke admitted to an acute stroke unit were reviewed retrospectively. Inclusion criteria were: (a) admission between March and August 2006, (b) new diagnosis of stroke, (c) upper limb involvement, and (d) assessed by an occupational therapist with ARAT, AMAT or CAHAI. Included records were reviewed and the following noted: diagnosis, upper limb weakness, gender, age, assessment score, when assessed, time to administer, test items completed, and qualitative notations. Findings Thirty three records satisfied the inclusion criteria. A range of stroke subtypes were assessed. The mean ARAT score was 21.4/45, CAHAI was 66.5/91 and AMAT was 3.0/5. The median number of days post-stroke when assessed was 9 days. Conclusions Overall, ARAT, CAHAI and AMAT were useful for assessment of upper limb ability. The results cannot specifically identify which assessment is most suited to the acute stroke setting. The findings do support the inclusion of ARAT, CAHAI and AMAT in standard clinical care.

A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation

More than 70% of individuals who have a stroke experience upper limb deficits that impact daily activities. Increased amount of upper limb therapy has positive effects; however, practical and inexpensive methods of therapy are needed to deliver this increase in therapy. This was a multi-site single blind randomized controlled trial to determine the effectiveness of a 4-week self-administered graded repetitive upper limb supplementary program (GRASP) on arm recovery in stroke. 103 inpatients with stroke were randomized to the experimental group (GRASP group, n=53) or the control group (education protocol, n=50). The primary outcome measure was the Chedoke Arm and Hand Activity Inventory (CAHAI), a measure of upper limb function in activities of daily living. Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time. Intention-to-treat analysis was performed. Group differences were tested using analysis of covariance. At the end of the 4-week intervention (approximately 7 weeks poststroke), the GRASP group showed greater improvement in upper limb function (CAHAI) compared to the control group (mean difference 6.2; 95% CI: 3.4 to 9.0; P<0.001). The GRASP group maintained this significant gain at 5 months poststroke. Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use. No serious adverse effects were experienced. A self-administered homework exercise program provides a cost-, time-, and treatment-effective delivery model for improving upper limb recovery in subacute stroke.

The role of lateralization in the functional outcome of patients after middle cerebral artery stroke

Event Abstract Back to Event The role of lateralization in the functional outcome of patients after middle cerebral artery stroke Sanja Draca1*, Aleksandra Stefanovic1, Aleksandra Dragin1, Biljana Ljesevic1 and Dalibor Paspalj1 1 Clinic "Dr M.Zotovic", Russia Objective: To test the influence of lateralization (right vs. left hemisphere lesion) to the motor and behavioral sequels in patients after middle cerebral artery (MCA) territory infarct. Materials and methods: This study included a total of 31 patients with chronic stroke (1 year post stroke) of MCA origin, aged 54-78 years. The study included the patients with right MCA infarction (14 patients), or left MCA infarction (17 patients). All patients were treated with conventional physical and occupational therapy during 2 months following stroke. Measures: Upper extremity (UE) spasticity was assessed by the Modified Ascworth Scale (MAS), UE motor functions by the Fugl-Meyer Motor Impairment Scale (FMA)-upper extremity portion, and the performance of the paretic arm in the of activities of daily living by the Chedoke Arm and Hand Activity Inventory (CAHAI). The Beck Depression Inventory (BDI)-II was used as a screening instrument for depression. Results: No significant difference was found for MAS score (2, 3 vs. 2, 1), FM score (20, 9 vs. 27, 8), as well as the CAHAI score (43, 3 vs. 49, 6) between patients with right vs. left MCA infarction. Nevertheless, the patients with left hemisphere lesion had a significantly increased BDI-II scores compared to patients with right hemisphere lesion (8, 7 vs. 16, 2, p < 0, 05). Conclusion: These results indicate that UE motor recovery did not differ between patients with right or left MAC infarction. However, an increased rate of PSD in patients with left hemisphere lesion (both cortical and subcortical) compared to patients with right hemisphere lesion, indicates a need for depressive symptoms screening in stroke patients. Conference: 41st European Brain and Behaviour Society Meeting, Rhodes Island, Greece, 13 Sep - 18 Sep, 2009. Presentation Type: Poster Presentation Topic: Poster presentations Citation: Draca S, Stefanovic A, Dragin A, Ljesevic B and Paspalj D (2009). The role of lateralization in the functional outcome of patients after middle cerebral artery stroke. Conference Abstract: 41st European Brain and Behaviour Society Meeting. doi: 10.3389/conf.neuro.08.2009.09.137 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 09 Jun 2009; Published Online: 09 Jun 2009. * Correspondence: Sanja Draca, Clinic "Dr M.Zotovic", Belgrade, Russia, odracha@EUnet.rs Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Google Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Google Scholar Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj PubMed Sanja Draca Aleksandra Stefanovic Aleksandra Dragin Biljana Ljesevic Dalibor Paspalj Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Review of upper limb ability assessments in acute stroke care, from a practice perspective

Aims: The purpose of this study was to compare three upper limb ability assessments - the Action Research Arm Test (ARAT), Arm Motor Ability Test (AMAT), and Chedoke Arm and Hand Activity Inventory (CAHAI) - in acute stroke occupational therapy practice during a 6-month period, to identify whether any or all were appropriate for use in acute stroke care. Methods: Medical records of clients with stroke admitted to an acute stroke unit were reviewed retrospectively. Inclusion criteria were: (a) admission between March and August 2006, (b) new diagnosis of stroke, (c) upper limb involvement, and (d) assessed by an occupational therapist with ARAT, AMAT or CAHAI. Included records were reviewed and the following noted: diagnosis, upper limb weakness, gender, age, assessment score, when assessed, time to administer, test items completed, and qualitative notations. Findings: Thirty three records satisfied the inclusion criteria. A range of stroke subtypes were assessed. The mean ARAT score was 21.4/45, CAHAI was 66.5/91 and AMAT was 3.0/5. The median number of days post-stroke when assessed was 9 days. Conclusions: Overall, ARAT, CAHAI and AMAT were useful for assessment of upper limb ability. The results cannot specifically identify which assessment is most suited to the acute stroke setting. The findings do support the inclusion of ARAT, CAHAI and AMAT in standard clinical care.

Paretic Upper-Limb Strength Best Explains Arm Activity in People With Stroke

The purpose of this study was to determine the relationship among variables of upper-limb impairment, upper-limb performance in activities of daily living (activity), and engagement in life events and roles (participation) in people with chronic stroke. The subjects were 93 community-dwelling individuals with stroke (> or =1 year). This study, which was conducted in a tertiary rehabilitation center, used a cross-sectional design. The main measures of impairment were the Modified Ashworth Scale, handheld dynamometry, sensory testing (monofilaments), and the Brief Pain Inventory. The main measures of activity were the Chedoke Arm and Hand Activity Inventory (CAHAI) and the Motor Activity Log (MAL). The main measure of participation was the Reintegration to Normal Living (RNL) Index. Paretic upper-limb strength (force-generating capacity) (r=.89, P<.01), grip strength (r=.69, P<.01), and tone (resistance to passive movement) (r=-.80, P<.01) were the impairment variables that were most strongly related to activity. Tone (r=-.23, P<.05) and CAHAI scores (r=.22, P<.05) had a significant, but weak, relationship to participation. Upper-limb strength accounted for 87% of the variance of the CAHAI scores and 78% of the variance of the MAL scores. In the participation models, tone and CAHAI scores accounted for 5% of the variance of the RNL Index scores. Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living. Grip strength, tone, and sensation also were factors of upper-limb performance in activities of daily living. Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation.

Validation of Three Shortened Versions of the Chedoke Arm and Hand Activity Inventory

Purpose: To estimate the reliability and validity of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI). Method: The study sample consisted of 39 individuals who had had a stroke. Twenty-four individuals were classified as acute and 15 as chronic. The CAHAI-13 was administered three times: an initial assessment, a second assessment within 36 hours, and a final assessment two to six weeks after the initial assessment. The Action Research Arm Test (ARAT) and the Chedoke-McMaster Stroke Assessment were administered at the first and third time points. Based on the clinical judgment of four therapists, seven-, eight-, and nine-item versions of the CAHAI were produced. Test–retest reliability and cross-sectional and longitudinal validity (sensitivity to change) were evaluated. Results: Test–retest reliability varied from 0.96 for the CAHAI-7 to 0.97 for the CAHAI-8 and CAHAI-9. Cross-sectional validity for the ARAT was 0.95, 0.95, and 0.94, and longitudinal validity was 0.97, 0.93, and 0.94 for the seven-, eight-, and nine-item versions of the CAHAI, respectively. Conclusions: All shortened versions maintained the same high degree of reliability and construct and longitudinal validity as the original CAHAI-13. Therapists and researchers may select from three valid, shorter versions of a new upper limb functional measure to facilitate effective standardized assessment within limited time and resources.

Comparing 2 Versions of the Chedoke Arm and Hand Activity Inventory With the Action Research Arm Test

The Chedoke Arm and Hand Activity Inventory (CAHAI) is a new, validated upper-limb measure that uses a 7-point quantitative scale in order to assess functional recovery of the arm and hand after a stroke. The purposes of this study were: (1) to determine whether the longitudinal validity of scores on 2 versions of a new upper-limb measure, the CAHAI (CAHAI-9 and CAHAI-13), was greater than that of scores on the Action Research Arm Test (ARAT) and (2) to determine whether the cross-sectional and longitudinal validity of the CAHAI-13 scores was greater than that of the CAHAI-9 scores. One hundred five people with upper-limb dysfunction following a stroke were stratified into 2 impairment groups (mild to moderate and severe), which were expected to change by different amounts. The CAHAI-13 and ARAT were administered twice (time between assessments varied from 2 to 6 weeks). Receiver operating characteristic curves, Pearson product moment coefficient of correlation, and regression analyses were used. Receiver operating characteristic curve areas (CAHAI-13=0.86, CAHAI-9=0.82, ARAT=0.72) were significantly greater for the CAHAI versions. Scores on both CAHAI versions had identical levels of cross-sectional validity. Both CAHAI versions demonstrated more sensitivity to change than the ARAT. It remains unclear whether the CAHAI-9 provides precise estimates of CAHAI-13 scores at the individual level.

Validation of Three Shortened Versions of the Chedoke Arm and Hand Activity Inventory

Purpose: To estimate the reliability and validity of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI).

Test-Retest Reliability, Validity, and Sensitivity of the Chedoke Arm and Hand Activity Inventory: A New Measure of Upper-Limb Function for Survivors of Stroke

Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL. Test-retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke. Objectives To estimate the test-retest reliability and validity of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to test whether the CAHAI was more sensitive to change in upper-limb function than the Impairment Inventory of the Chedoke-McMaster Stroke Assessment (CMSA) and the Action Research Arm Test (ARAT). Design Construct validation process. Setting Inpatient/outpatient rehabilitation facilities. Participants Stratified sample of 39 survivors of stroke: 24 early (mean age, 71.4y; mean days poststroke, 27.3) and 15 chronic (mean age, 64.0y; mean days poststroke, 101.7). Intervention Regular therapy. Main Outcome Measures Intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC), standard error of measurement, and correlation coefficients. Results High interrater reliability was established with an ICC of .98 (95% confidence interval [CI], .96–.99). The minimal detectable change score was 6.3 CAHAI points. Higher correlations were obtained between the CAHAI and the ARAT and CMSA scores compared with the CMSA shoulder pain scores (1-sided, P=.001). Areas under the ROC curves were as follows: CAHAI, .95 (95% CI, 0.87–1.00); CMSA, .76 (95% CI, .61–.92); and ARAT, .88 (95% CI, 0.76–1.00). Conclusions High interrater reliability and convergent and discriminant cross-sectional validity were established for the CAHAI. The CAHAI is more sensitive to clinically important change than the ARAT.

Development of the Chedoke Arm and Hand Activity Inventory: Theoretical Constructs, Item Generation, and Selection

The Chedoke Arm and Hand Activity Inventory (CAHAI) was developed to address the need for a valid, clinically relevant, responsive functional assessment of the recovering paretic upper limb. The purpose of this article is to describe the development of the measure including its theoretical constructs, item generation, and item selection. From the literature, survivors of stroke, and their caregivers, 751 items were generated. Using factor analyses stem leaf plots, clinical judgment, and pilot testing on individuals with stroke, the list was reduced to 13 bilateral, real-life items. Research continues to provide evidence of the CAHAI’s test-retest and interrater reliability as well as construct, concurrent, and longitudinal validity.

Bilateral Wilm's nephroblastoma.

<h3><b>Background and Purpose</b></h3> The purpose of this study was to determine the relationship among variables of upper-limb impairment, upper-limb performance in activities of daily living (activity), and engagement in life events and roles (participation) in people with chronic stroke. <h3><b>Subjects</b></h3> The subjects were 93 community-dwelling individuals with stroke (≥1 year). <h3><b>Methods</b></h3> This study, which was conducted in a tertiary rehabilitation center, used a cross-sectional design. The main measures of impairment were the Modified Ashworth Scale, handheld dynamometry, sensory testing (monofilaments), and the Brief Pain Inventory. The main measures of activity were the Chedoke Arm and Hand Activity Inventory (CAHAI) and the Motor Activity Log (MAL). The main measure of participation was the Reintegration to Normal Living (RNL) Index. <h3><b>Results</b></h3> Paretic upper-limb strength (force-generating capacity) (<i>r</i>=.89, <i>P</i>&lt;.01), grip strength (<i>r</i>=.69, <i>P</i>&lt;.01), and tone (resistance to passive movement) (<i>r</i>=−.80, <i>P</i>&lt;.01) were the impairment variables that were most strongly related to activity. Tone (<i>r</i>=−.23, <i>P</i>&lt;.05) and CAHAI scores (<i>r</i>=.22, <i>P</i>&lt;.05) had a significant, but weak, relationship to participation. Upper-limb strength accounted for 87% of the variance of the CAHAI scores and 78% of the variance of the MAL scores. In the participation models, tone and CAHAI scores accounted for 5% of the variance of the RNL Index scores. <h3><b>Discussion and Conclusion</b></h3> Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living. Grip strength, tone, and sensation also were factors of upper-limb performance in activities of daily living. Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation.