Children's Hand Skills Research Articles

Doing household chores prepares children for life!

Üsküdar University, Faculty of Health Sciences, Deputy Head of Child Development Department, Asst. Prof. Pınar Demir Asma touched upon the development of hand skills in children.

Validity and reliability of the Turkish versions of Assessment of Children's Hand Skills and Children's Hand-Skills Ability Questionnaire in children with hemiplegic cerebral palsy.

Assessment of Children's Hand Skills (ACHS) and Children's Hand-Skills Ability Questionnaire (CHSQ) are interconnected hand skills assessment tools that together contain parent questionnaire and observational assessment. With this quality, ACHS and CHSQ enable the therapist to obtain information about the child's real-life performances as well as to conduct a clinical observational assessment. The purpose of this study was to investigate the validity and reliability of the Turkish versions of ACHS and CHSQ in children with hemiplegic cerebral palsy (HCP). A total of 112 children with HCP between 2 and 12 years of age were included. All participants were subjected to ACHS, CHSQ, Shriners Hospital Upper Extremity Evaluation (SHUEE) and ABILHAND-Kids. Convergent construct validity was investigated through analysing the relationship between ACHS and SHUEE and between CHSQ and ABILHAND-Kids. Discriminative construct validity was investigated through analysing the differences between genders for CHSQ and ACHS. For reliability, test-retest interclass correlation coefficient (ICC) and internal consistency Cronbach's alpha were calculated and analysed. ACHS showed very strong relationships with SHUEE's spontaneous functional analysis (r = 0.86) and grip-release function (r = 0.86) parameters with a strong relationship with positional dynamic analysis (r = 0.78). CHSQ's leisure (r = 0.80), school/education (r = 0.75) and activities of daily living (r = 0.76) domains showed strong relationships with the ABILHAND-Kids. There was no difference between genders for ACHS and all domains of CHSQ (p > 0.05). All domains and total score of ACHS and CHSQ had perfect test-retest reliability (ICC > 0.90). ACHS had perfect internal consistency (Cronbach's α = 0.98); CHSQ had very high internal consistency (Cronbach's α = 0.84). The Turkish versions of ACHS (ACHS-TR) and CHSQ (CHSQ-TR) are valid and reliable hand skills assessment tools in children with HCP.

The effects of touch-screen technology usage on hand skills among preschool children: a case-control study

Background: Little is known on how time spent on touch-screen technology affects the hand skills development of preschool children. This study aimed to investigate the effects of touch-screen technology usage on hand skills among preschool children. Methods: Case-control design was employed to compare the hand skills of children who were engaged in touch-screen technology. A total of 128 participants aged between five and six years old who attended preschool were recruited and divided into two groups: high usage touch-screen technology (HUTSTG) and, low usage touch-screen technology (LUTSTG). Children's Hand Skills ability Questionnaire (CHSQ) and Assessment of Children's Hand Skills (ACHS) were used to evaluate the children's hand skills. Results: There were significant differences in the hand skills of preschool children between HUTSTG and LUTSTG. Results showed that preschool children in LUTSTG had better hand skills in all domains of CHSQ (p≤0.001) and ACHS (p<0.001) as compared to HUTSTG. Conclusion: Frequent use of touch-screen technology might cause disadvantages to the development of hand skills among preschool children.

The effects of touch-screen technology usage on hand skills among preschool children: a case-control study.

Background: Little is known on how time spent on touch-screen technology affects the hand skills development of preschool children. This study aimed to investigate the effects of touch-screen technology usage on hand skills among preschool children. Methods: Case-control design was employed to compare the hand skills of children who were engaged in touch-screen technology. A total of 128 participants aged between five and six years old who attended preschool were recruited and divided into two groups: high usage touch-screen technology (HUTSTG) and, low usage touch-screen technology (LUTSTG). Children's Hand Skills ability Questionnaire (CHSQ) and Assessment of Children's Hand Skills (ACHS) were used to evaluate the children's hand skills. Results: There were significant differences in the hand skills of preschool children between HUTSTG and LUTSTG. Results showed that preschool children in LUTSTG had better hand skills in all domains of CHSQ (p≤0.001) and ACHS (p<0.001) as compared to HUTSTG. Conclusion: Frequent use of touch-screen technology might cause disadvantages to the development of hand skills among preschool children.

Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy

Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy

Intra- and Inter-Rater Reliability of the Assessment of Children's Hand Skills Based on Video Recordings

Introduction: Hand skills are essential for children's occupational performance. The Assessment of Children's Hand Skills is a new assessment that utilizes naturalistic observations to capture children's actual hand-skill performance in everyday contexts. This study aimed to explore intra- and inter-rater reliability of the assessment based on video recordings, which are different from original naturalistic observations. Method: Two raters scored video recordings of 54 hand-skill activities performed by 12 children with developmental disabilities, twice in 2 weeks. Intra- and inter-rater reliability was examined at the individual hand-skill item scores, activity scores, and children's composite scores of the Assessment of Children's Hand Skills. Findings: Intra-rater reliability at item levels was generally acceptable, and both raters exhibited moderate to high agreement between the first and second evaluations (intraclass correlation coefficients = 0.61–0.93) at activity scores and children's composite scores. However, the agreement between the two raters was unacceptable for most hand-skill items and activity scores. After rater effects were adjusted by Rasch analysis in children's composite scores, the inter-rater reliability was improved (intraclass correlation coefficient = 0.81). Conclusion: This study shows that the Assessment of Children's Hand Skills based on video recordings is reliable within the same raters. Further research is required to confirm its inter-rater reliability by involving more training and raters with varied clinical experience.

Measures of participation outcomes related to hand use for 2‐ to 12‐year‐old children with disabilities: a systematic review

Many interventions have been used to improve children's hand-related impairments or hand skill performance in functional activities so as to promote life participation. There is thus a need to have suitable instruments assessing children's participation in life situations that specifically require hand use in order to support and evaluate such interventions. This systematic review investigated the availability of potential instruments that can be used to assess children's participation specifically in life situations requiring hand use. Clinical utility and evidence for psychometric properties were also sourced. Database searches initially identified measures that were used to evaluate participation of children aged 2-12 years, involved self- or proxy report or interview administration and had generic application for a range of disabilities/diagnoses. These measures were further evaluated to determine if they fulfilled the above inclusion criteria and contained at least 60% of the items involving hand use. Further searches for psychometric evidence were undertaken for the eligible measures. Fourteen measures were identified and nine met the inclusion criteria. However, none of these measures, except for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), contained all items related to hand use. Most of the included measures had limited psychometric properties. Only the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC), the School Function Assessment-Participation section (SFA-P) and the Children Participation Questionnaire (CPQ) revealed sufficient evidence of validity and reliability. The findings suggest a need for adapting existing participation measures or developing new ones that specifically assess participation in life situations requiring hand use to support interventions.

The contributing role of real‐life hand skill performance in self‐care function of children with and without disabilities

Children's hand skills when performing in real-life contexts have been commonly thought as a possible determinant of their self-care function; however, there is a paucity of research investigating this potential predictive relationship. The purpose of this study was to provide evidence regarding whether children's real-life hand skill performance is contributive to or predictive of their self-care function by considering other child and cultural factors. A total of 139 typically developing children and 114 with disabilities, ages 2-12 years from Australia and Taiwan, participated in the study. The outcome measures used were the Assessment of Children's Hand Skills (a measure of real-life hand skill performance) and the Personal Living Skills subscale of the Vineland Adaptive Behavior Scales - Classroom Edition (a measure of self-care function). Hierarchical regression analysis revealed that the children's demographic variables (age, gender, disability status, handedness and cultural context) accounted for 43% of the variance of the self-care function in the combined group of children with and without disabilities. Age, presence of disability and cultural context were the statistically significant independent factors. However, after the entry of the real-life hand skill performance factor, the contributing values of age and disability status decreased and the age factor became non-significant. The hand skill performance factor was found to be the strongest, and its addition led to significant increments of 24.6% of the explained variance for children's self-care function. Similar results were also found in the regression analyses based on separate groups of typically developing children or those with disabilities. The findings provide evidence that children's real-life hand skill performance is a contributing factor of their self-care function. The assessment of children's hand skill performance in real-life contexts is therefore needed.

Construct validity of the Children's Hand-Skills ability Questionnaire (CHSQ) in children with disabilities: A Rasch analysis

The Children's Hand-Skill ability Questionnaire (CHSQ) is a new parent-report questionnaire that assesses children's manual ability in three domains: leisure and play, school/education, and activities of daily living. The CHSQ can be used with children presenting with a range of disabilities and works as a companion assessment before detailed performance-based observations of hand skill are completed. This study further investigated the internal and external construct validity of the CHSQ. Participants included 53 Australian children and 70 Taiwanese children with known disabilities ranging age from 2 to 12 years. Rasch analysis results confirmed the appropriateness of the CHSQ's 3-level rating scale in this combined group of children. Twenty-one of the 22 items in the CHSQ formed three individual unidimensional scales representing with the domains of leisure and play, school/education, and activities of daily living. The CHSQ also exhibited sufficient person-response validity (all the three domains) and item-difficulty range (all but one domain) when applied to children with disabilities. Less than half of the CHSQ items were found to exhibit differential item functioning with regards to gender (4 items) and cultural difference (7 items). In addition, moderate to high correlations (0.61 ≤ Pearson's r coefficients ≤ 0.76, p<0.01) were found with the assessments of self-care and hand skill performance. Therefore, the CHSQ exhibits preliminary evidence of construct validity for its clinical use in obtaining children's manual ability based on parent-report information.

Examining construct validity of a new naturalistic observational assessment of hand skills for preschool- and school-age children

The Assessment of Children's Hand Skills is a new assessment that utilises a naturalistic observational method to capture children's real-life hand skill performance when engaged at various types of daily activities in everyday living contexts. The Assessment of Children's Hand Skills is designed for use with 2- to 12-year-old children with a range of disabilities or health conditions. The study aimed to investigate construct validity of the Assessment of Children's Hand Skills in Australian children. Rasch analysis was used to examine internal construct validity of the Assessment of Children's Hand Skills in a mixed sample of 53 children with disabilities (including autism spectrum disorder, developmental/genetic disorders and physical disabilities) and 85 typically developing children. External construct validity was examined by correlating with three questionnaires evaluating daily living skills and hand skills. Rasch goodness-of-fit analysis suggested that all 22 activity items and 19 of 20 hand skill items in the Assessment of Children's Hand Skills measured a single construct. The Assessment of Children's Hand Skills items were placed in a clinically meaningful hierarchy from easy to hard, and the difficulty range of the items also matched the majority of children with disabilities and typically developing preschool-aged children. Moderate to high correlations (0.59≤Spearman's ρ coefficients≤0.89, P<0.01) were found with the assessments of daily living and fine motor skills. This study provided preliminary evidence supporting the construct validity of the Assessment of Children's Hand Skills for its clinical application in assessing children's real-life hand skill performance in Australian contexts.

Convergent and Discriminant Validity of a Naturalistic Observational Assessment of Children’s Hand Skills

Objective/BackgroundThis study sought to investigate the convergent and discriminant validity of a new naturalistic observational Assessment of Children's Hand Skills (ACHS) in children with and without disabilities. MethodsThe participants were 134 children aged 2–12 years in Taiwan, and 70 had known disabilities. Outcome measures included the ACHS, one daily living skills questionnaire, and three instruments related to hand skills. Discriminant validity was assessed by comparing the ACHS scores between children with and without disabilities. Convergent validity was examined using a correlation analysis between the ACHS and daily living and hand skills measures. ResultsChildren with disabilities had significantly lower ACHS scores than typically developing children. The ACHS correlated moderately to highly with the daily living skills questionnaire and demonstrated a varied range of correlations with the three related instruments. ConclusionPreliminary evidence for the convergent and discriminant validity of the ACHS was established. The findings indicate that the ACHS can be used with confidence in measuring and differentiating children’s hand skill performance in real-life contexts.

Cross-cultural validity of a naturalistic observational assessment of children´s hand skills: A study using Rasch analysis

To investigate cross-cultural validity of a newly developed Assessment of Children's Hand Skills (ACHS) in children with and without disabilities. One group of 138 Australian children and 134 Taiwanese children, age range 2-12 years (a total of 149 typically developing children and 123 children with disabilities). Rasch model analysis was used to evaluate rating scale performance, person-fit, and item unidimensionality of pooled data from the ACHS. Rasch-based differential item functioning was used to evaluate differences in item difficulties between cultural groups. The appropriateness of the ACHS 6-level rating scale was confirmed in the pooled analysis. All 22 activity items and 19 of 20 hand skill items in the ACHS formed a unidimensional scale. The ACHS exhibited reasonable response patterns when applied to the composite sample of Australian and Taiwanese children. Differential item functioning was found in 7 activity items and 7 hand skill items. The ACHS can be used to assess and compare children's hand skills across Australian and Taiwanese cultural contexts with confidence. Adjustment for differential item functioning may be used when pooling or comparing ACHS data from these cultural groups.

Rasch analysis of the assessment of children's hand skills in children with and without disabilities

The Assessment of Children's Hand Skills (ACHS) is a new assessment tool that utilizes a naturalistic observational method to capture children's real-life hand skill performance when engaging in various types of activities. The ACHS also intends to be used with both typically developing children and those presenting with disabilities. The purpose of this study was to further investigate the construct validity of the ACHS using the Rasch analysis. Participants included 64 typically developing children and 70 children with disabilities in the age range of 2–12 years. Rasch analysis results confirmed the appropriateness of the ACHS's 6-level rating scale in this combined group of children. All 22 activity items and 19 of the 20 hand skill items in the ACHS formed a unidimensional scale and were ordered according to difficulty as clinically and developmentally expected. The ACHS also exhibited sufficient response validity and item-difficulty range when applied to children with disabilities as well as typically developing, preschool-age children. Furthermore, less than half of the ACHS items were found to exhibit differential item functioning with regard to gender (5 activity items) and disability (2 activity items and 7 hand skill items). Therefore, the ACHS shows preliminary evidence of construct validity for its clinical use in assessing children's hand skill performance in real-life contexts.

A framework of children's hand skills for assessment and intervention

BACKGROUND; Hand skill development or mastery has a huge influence on children's early development and participation in everyday activities. Assessment of difficulties with children's hand skills typically involves a systematic process considering all potential factors that may impact on hand skills. This helps identify key hand skill difficulties and select specific interventions that are relevant to the individual child. This paper describes the development of the Children's Hand Skills Framework (CHSF) that can be used as a conceptual guide to analyse and describe children's hand skills in the assessment and intervention process. A comprehensive literature review of the existing hand skill models and instruments was conducted to develop the CHSF content, and experts' reviews via an evaluation feedback questionnaire were used as a means to validate the CHSF. The literature review revealed that the functional repertoire of children's hand skills can be divided into six distinct categories. Manual gesture and body contact hand skills are two categories, in which the hands do not make contact with any object. Arm-hand use, adaptive skilled hand use and bimanual use are object-related hand skill categories where the hands do contact objects. The final category is related to the general quality of children's hand skills. Each of the six hand skill categories can be further broken down into three to seven subcategories. The feedback from the experts further demonstrated high levels of agreement for the inclusion of the CHSF subcategories. The CHSF offers a helpful guide to comprehensively describe the complexity of children's hand skills in the assessment process and has the potential to enhance and promote communication about functional use of children's hand skills among professionals. The CHSF is also conceptually compatible with the International Classification of Functioning, Disability, and Health, providing a holistic consideration of both children's hand skills and relevant International Classification of Functioning, Disability, and Health factors for further assessment and intervention planning.

Impaired force coordination during object release in children with hemiplegic cerebral palsy.

Recent studies on hand motor control in children with cerebral palsy (CP) have focused on the coordination of fingertip forces during the grasping and lifting of objects. However, little is known about the ability to replace and release an object from grasp, a function that is just as important for fine dexterity. The present study examines the coordination of fingertip forces during the replacement and release of an object (either 200 g or 400 g) from grasp in 14 children (aged between 7 and 13 years) with hemiplegic CP and in 14 age-matched typically developing children. The results indicate that children with hemiplegic CP abruptly replaced the object but had a prolonged and uncoordinated release of the grasp. Unlike what was seen in the control children, the grip and load forces decreased sequentially in the children with CP. However, all the children could appropriately scale the rate of force decrease based on somatosensory weight-related information from the ongoing lift. The results provide further information about the impaired hand skills in children with hemiplegic CP.

Impaired force coordination during object release in children with hemiplegic cerebral palsy

Recent studies on hand motor control in children with cerebral palsy (CP) have focused on the coordination of fingertip forces during the grasping and lifting of objects. However, little is known about the ability to replace and release an object from grasp, a function that is just as important for fine dexterity. The present study examines the coordination of fingertip forces during the replacement and release of an object (either 200 g or 400 g) from grasp in 14 children (aged between 7 and 13 years) with hemiplegic CP and in 14 age‐matched typically developing children. The results indicate that children with hemiplegic CP abruptly replaced the object but had a prolonged and uncoordinated release of the grasp. Unlike what was seen in the control children, the grip and load forces decreased sequentially in the children with CP. However, all the children could appropriately scale the rate of force decrease based on somatosensory weight‐related information from the ongoing lift. The results provide further information about the impaired hand skills in children with hemiplegic CP.

Parental hand preference and manual functional asymmetry in preschool children

Hand preference and hand skill in 1150 normal children between 3 and 6 years of age and hand preference of their parents were assessed to study the effect of parental hand preference on different dimensions of manual asymmetry in children. Children hand skill was measured with a computerized version of the Peg Moving Task which allowed us to split the overall performance into two components, a "transport time" and a "search time." Paternal and maternal left-handedness was significantly related to child left-handedness. Both components of hand skill asymmetry were reduced with mother's left-handedness. and one component (search time) with father's left-handedness. A significant impact of paternal and preference on child hand skill asymmetry, after controlling for child hand preference, was observed. When this analysis was limited to strong right-handed children, a greater paternal effect on child hand skill emerged. These results show the usefulness of performance tasks in detecting parent-child associations concerning manual functional asymmetry.

Bilateral Handskills in Children with Mild Hemiplegia

Bilateral Handskills in Children with Mild Hemiplegia

Bilateral Handskills in Children with Mild Hemiplegia

In treatment of the child with mild hemiplegia, one of the more persistent problems for the therapist and parent is the child's resistance to using the involved upper extremity in activity. A therapeutic focus on the affected arm often results in frustration and withdrawal from the activity. One indirect strategy of treatment is to adapt activities and toys in such a way that two hands must be used to successfully complete the activity. The resulting range of participation of the involved extremity may vary from that of only an assist to a more functional extremity. This paper describes the rationale and procedures for promoting bilateral use of the involved upper extremity in daily activity. It has been developed to serve as a guide for parents and teachers under the supervision of a therapist.