Children's Hand-use Experience Questionnaire Research Articles

Bimanual hand use in children and adolescents with unilateral spastic cerebral palsy: an exploratory study

BackgroundIndividuals with unilateral spastic cerebral palsy (USCP) often show difficulties using their hands during activities of daily living. ObjectiveTo investigate the factors that interfere with hand use during bimanual activities in children and adolescents with USCP. MethodsWe conducted a cross-sectional study with 102 children and adolescents with USCP, aged 6 to 18 years. We collected information with the caregivers about the classification of the child's manual ability, according to the Manual Ability Classification System (MACS); child's age; side of the involvement; Children's Hand-Use Experience Questionnaire- CHEQ2.0. Cluster analysis identified groups of children and adolescents who performed CHEQ activities with or without assistance. Multiple linear regression analyses identified the contribution of the factors: age, sex, MACS level, side of hemiparesis, and clusters of assistance, on the outcomes of efficacy, time, and feeling bothered. ResultsMACS and clusters of assistance explained the variance in efficacy (p<0.05; R2=0.31) and time (p<0.05; R2=0.37). MACS explained 22% of the variance in feeling bothered. Children and adolescents with increased difficulty to perform activities that involve hand use (i.e., MACS III) and who receive assistance during most bimanual activities showed less efficacy of use, were slower in their performance, and presented greater feeling of being bothered. ConclusionAssistance in bimanual activities and MACS level contributed to explain the efficacy of use, time, and feeling bothered in performing bimanual activities. Intervention strategies aimed at promoting the performance of bimanual activities in the daily routine of children with USCP should consider these outcomes.

Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study

PurposeThe aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT) and bimanual training (BIT) based on the International Classification of Functioning, Disability, and Health, Children and Youth (ICF-CY) conceptual framework. Research methodA total of 32 children (mean age 10.43 years [SD 2.9 years]; 15 girls, 17 boys) whose functional motor and communication levels, according to the Manual Ability Classification System, Gross Motor Function Classification System, and Communication Function Classification System, changed between level I and III were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequencies and intensities (10 weeks, 3 days/week, 2.5 h/day). Upper extremity body function outcomes (handheld dynamometer), activity outcomes (Quality of Upper Extremity Skills Test, The Children's Hand-use Experience Questionnaire, ABILHAND-Kids, Pediatric Upper Extremity Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks postintervention. The clinical trial number of the study is NCT04577391. ResultsmCIMT resulted in more significant improvements in all outcomes than BIT at the immediate postintervention period (T2), which were maintained in the mCIMT group throughout the 16-week postintervention period (p<0.001; dmCIMT > dBIT). ConclusionThe potential advantage of mCIMT versus BIT is the larger short-term effect sizes (ESs) and the more sustainable improvements.

The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days?

Purpose To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP). Materials and methods Thirty-three children (age range 5–18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment. Results Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05). Conclusions Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective. Implications for rehabilitation mCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP. The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment. The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment.

Analysis of dynamic elbow flexion deformity in children with hemiplegic cerebral palsy.

BackgroundCerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function. MethodsSixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured. FindingsFifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for “high speed stairs climbing” evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028). InterpretationDynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.

To Explore the Validity of Change Scores of the Children's Hand-use Experience Questionnaire (CHEQ) in Children with Unilateral Cerebral Palsy

ABSTRACTAims: To explore the validity of change scores of the Children's Hand-use Experience Questionnaire (CHEQ). Methods: Analysis of the CHEQ included 44 children (15 girls) between 6–16 years (median 9.0; IQR 8–11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected change were formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. Results: All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. Conclusions: Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population.

Assisting Hand Assessment and Children's Hand-Use Experience Questionnaire –Observed Versus Perceived Bimanual Performance in Children with Unilateral Cerebral Palsy

ABSTRACTAims: To explore the differences, relationship, and extent of agreement between the Assisting Hand Assessment (AHA), measuring observed ability to perform bimanual tasks, and the Children's Hand-Use Experience Questionnaire (CHEQ), assessing experienced bimanual performance. Methods: This study investigates a convenience sample of 34 children (16 girls) with unilateral cerebral palsy aged 6–18 years (mean 12.1, SD 3.9) in a cross-sectional design. Results: The AHA and CHEQ subscales share 8–25% of their variance (R2). Bland–Altman plots for AHA and all three CHEQ subscales indicate good average agreement, with a mean difference approaching zero but large 95% confidence intervals. Limits of agreement were extremely wide, indicating considerable disagreement between AHA and CHEQ subscales. Conclusion: AHA and CHEQ seem to measure different though somewhat related constructs of bimanual performance. Results of this investigation reinforce the recommendation to use both instruments to obtain complementary information about bimanual performance including observed and perceived performance of children with unilateral cerebral palsy.

Validity and test-retest reliability of Children's Hand-use Experience Questionnaire in children with unilateral cerebral palsy.

To investigate the validity of the internet-based version of the Children's Hand-use Experience Questionnaire (CHEQ) by testing the new four-category rating scale, internal structure, and test-retest reliability. Data were collected for 242 children with unilateral cerebral palsy (CP) (137 males and 105 females; mean age 9y 10mo, SD 3y 5mo, range 6-18y). Twenty children from the study sample (mean age 11y 8mo, SD 3y 10mo) participated in a retest within 7 to 14 days. Validity was tested by Rasch analysis based on a rating scale model and test-retest reliability by Kappa analysis and intraclass correlation coefficient (ICC). The four-category rating scale was within recommended criteria for rating scale structure. One item was removed because of misfit. CHEQ showed good scale structure according to the criteria. The effective operational range was >90% for two of the CHEQ scales. Test-retest reliability for the three CHEQ scales was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91. The internet-based CHEQ with a four-category rating scale is valid and reliable for use in children with unilateral CP. Further studies are needed to investigate the validity of the internet-based version of CHEQ for children with upper limb reduction deficiency or obstetric brachial plexus palsy and the validity of the recommended improvements to the current version.

Intensive upper limb intervention with self-management training is feasible and promising for older children and adolescents with unilateral cerebral palsy

This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8–18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts – determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d=2.09 and d=2.42, respectively). The effect size was large for the ABILHAND-Kids (d=0.86), moderate for the CHEQ (d=0.70) and Box and Block Test (d=0.56), and small for the VOAA-DDD-R (d=0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.

Validity and test‐retest reliability of Children's Hand‐use Experience Questionnaire (CHEQ) in children with unilateral cerebral palsy

Validity and test‐retest reliability of Children's Hand‐use Experience Questionnaire (CHEQ) in children with unilateral cerebral palsy

Upper limb function in everyday life of children with cerebral palsy: description and review of parent report measures

Purpose: To determine the role, in clinical practice and measurement of outcomes of upper limb interventions, of cerebral palsy-specific self- or parent-report measures of upper limb performance in everyday activities. Method: Search of databases and handsearching for information on test development procedures, psychometric properties or relevant studies to inform study objectives. Results: Children's Hand-use Experience Questionnaire holds most promise for guiding treatment planning but requires more psychometric evidence. ABILHAND-Kids has the strongest evidence for reliability, validity and sensitivity to change; evaluates impact of intervention on bimanual performance and can be used for children with unilateral or bilateral cerebral palsy. The original and revised versions of the Pediatric Motor Activity Log (PMAL) evaluate unilateral rather than bimanual upper limb performance. Neither ABILHAND-Kids nor PMAL offer information to assist treatment planning. PMAL-R is the only measure for the 2–5-year age group. No measure was adequate for children younger than 2 years to ascertain parents' perception of upper limb function in everyday activities. Conclusions: Understanding upper limb performance in everyday life, as perceived by children with cerebral palsy and their families, informs a comprehensive assessment and acknowledges the importance of the perspectives of child and family.Implications for RehabilitationCerebral palsy-specific self- or parent-report measures of upper limb performance in everyday life complement observational assessments in understanding upper limb performanceCHEQ provides clinical information, ABILHAND-Kids is validated for children with unilateral and bilateral cerebral palsy and possesses the most robust psychometric properties, Revised PMAL measures unilateral upper limb use. No adequate measure for children under 2 years exists.

Hand function in children with radial longitudinal deficiency

BackgroundIn children with hypoplasia or aplasia of the radius (radial longitudinal deficiency) manual activity limitations may be caused by several factors; a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited range of motion in the fingers and impaired grip strength. The present study investigates the relation between these variables and activity and participation in children with radial dysplasia.MethodsTwenty children, age 4–17 years, with radial longitudinal dysplasia Bayne type II-IV were examined with focus on the International Classification of Functioning and Health, version for Children and Youth (ICF-CY) context. Body function/structure was evaluated by measures of range of motion, grip strength, sensibility and radiographic parameters. Activity was examined by Box and Block Test and Assisting Hand Assessment (AHA). Participation was assessed by Children’s Hand-use Experience Questionnaire (CHEQ). Statistical correlations between assessments of body function/structure and activity as well as participation were examined.ResultsThe mean total active motion of wrist (49.6°) and digits (447°) were less than norms. The mean hand forearm angle was 34° radially. Ulnar length ranged from 40 to 80% of age-related norms. Grip strength (mean 2.7 kg) and Box and Block Test (mean 33.8 blocks/minute) were considerably lower than for age-related norms. The mean score for the AHA was 55.9 and for CHEQ Grasp efficiency 69.3. The AHA had significant relationship with the total range of motion of digits (p = 0.042). Self-experienced time of performance (CHEQ Time) had significant relationship with total active motion of wrist (p = 0.043). Hand forearm angle did not show any significant relationship with Box and Block Test, AHA or CHEQ.ConclusionIn radial longitudinal deficiency total range of motion of digits and wrist may be of more cardinal importance to the child’s activity and participation than the angulation of the wrist.

The relationship between arm posturing and gait deviation in teenagers and young adults with spastic unilateral cerebral palsy

This study explored the feasibility and preliminary effectiveness of a short (one week) intensive intervention combining Constraint Induced Movement Therapy (CIMT) and bimanual training (BiT) to improve upper limb capacity and bimanual performance guided by individual goal setting in children and adolescents with unilateral cerebral palsy aged 8–18 years. Self-management training was added to the intervention to maximize the effect of training and to empower the participants in self-monitoring the effective use of their affected hand. Functional goals (Canadian Occupational Performance Measure), unimanual capacity (Box and Block Test), bimanual performance (ABILHAND-Kids, Children's Hand-use Experience Questionnaire (CHEQ)) and amount of use (Video Observation Aarts and Aarts – determine developmental disregard (VOAA-DDD-R)) were measured at baseline, one week and four months post intervention. Twenty children (mean age 9.5 years) participated. Repeated measures ANOVA was used to measure effects over time. Compared to baseline, there were significant improvements on all outcome measures. The largest effect sizes were found for the COPM-performance and COPM-satisfaction (Cohen's d = 2.09 and d = 2.42, respectively). The effect size was large for the ABILHAND-Kids (d = 0.86), moderate for the CHEQ (d = 0.70) and Box and Block Test (d = 0.56), and small for the VOAA-DDD-R (d = 0.33). All effects were retained at the four months post intervention assessment. The results of this study indicate that one-week (36 h) intensive CIMT-BiT combined with self-management training is a feasible and promising intervention for improving the capacity of the upper limb and its use in bimanual activities in older children and adolescents with unilateral CP.

Development and evidence of validity for the Children’s Hand-use Experience Questionnaire (CHEQ)

To describe the development of the Children's Hand-use Experience Questionnaire (CHEQ), and investigate the evidence of its validity based on test content and internal structure of the three scales in it. The selection of items and questions was based on a literature review, expert opinion, and interviews with families. Data on the final questionnaire were collected from 86 children and adolescents (42 males, 44 females) aged 6 to 18 years (mean 12 y, SD 3 y), with unilateral cerebral palsy, upper limb reduction deficiency, or obstetric brachial plexus palsy. After item reduction and evaluation, CHEQ was designed to include 29 bimanual activities, each rated on three scales of perceived efficacy of the grasp, time taken to perform the activity, and degree of feeling bothered. The appropriateness of the included activities was confirmed by their reported relevance and bimanual nature. The internal structure of the scales was confirmed by Rasch analysis. CHEQ can be used to assess children and adolescents with a unilateral hand dysfunction on their experiences of using the affected hand to perform bimanual tasks. In clinical work, CHEQ has the potential to become a useful tool for treatment planning and follow-up.