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Kids-Assisting Hand Assessment (Kids-AHA)

Kids-Assisting Hand Assessment (Kids-AHA)1 measures how well children with hemiplegic, or unilateral cerebral palsy (affecting one side of the body) use their affected hand, when using both hands together during play.

The main reasons therapists use Kids-AHA1,2 are to:

  • Describe how a child with unilateral cerebral palsy is using their affected (assisting) hand
  • Carefully plan therapy aimed at each child’s level of ability
  • Measure whether therapy or intervention has been effective

Kids-AHA is for children with hemiplegic cerebral palsy. There are two versions of the assessment which are used for children of different ages1:

  • Small-Kids AHA – for younger children, aged 18 months to five-years-old
  • School-Kids AHA – for older children, aged six-years-old to 12-years-old.

A version for infants aged from eight to 18 months old, called the Mini-AHA is also available.

  • Younger children – the child is presented with a series of toys in a play session. The toys have been specially selected to provoke the child to play using two hands together
  • School-aged children – the child is invited to play one of two adventure-themed board games in the session. The same specially selected toys are used - but this time the toys are used as part of the board games. The goal remains the same – to provoke the child to play using two hands together.

The child is videorecorded as they play. The therapist will later score their performance from the recording.

The assessment session will take between 30 – 60 minutes and includes 15 minutes for the play-based Kids-AHA assessment1. It takes a further 60 minutes for a therapist to score the assessment from the videorecording. Feedback about the assessment can be written in a report or given verbally depending on family preference. A written report takes approximately 30 minutes to complete and a face to face feedback session also takes approximately 30 minutes.

Fees will apply for a health professional to conduct the assessment. You should also check with your provider to confirm if there will be any additional costs to develop a home program, travel to the session/s or prepare reports. The cost will vary depending on the service provider.

You can ask your health care provider if you are eligible for funding to assist with the assessment fees. People with disability living in Australia may also be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Training

Health professionals must undertake training and certification in order to administer, score and interpret both versions of the Kids-AHA. For information on completing the training course, visit the Assisting Hand Assessment website or CPteaching™.

Cost

There are costs for training and certification to become qualified in giving this assessment. As part of the course, a test manual is supplied. Assessment kits can also be purchased.

Method

A therapist scores the videorecording of each child’s performance on 20 items, according to a four-point scale1. The scale is specific for each item, but with a generic basis (that is, 4 = Effective to 1=Does not do). Scores are entered into an electronic spreadsheet, which calculates a raw score (20-80) and logit based AHA units (0-100). These are then used to interpret and report the results1.

Things to note

The current version of this assessment is Kids-AHA V5.01,3

Kids-AHA was developed using Rasch measurement modelling as a standardised, criterion-referenced assessment to examine a child’s typical performance using both hands together - not their capacity2. What this means is that it assesses how children typically use their more affected upper limb in two-handed activities (performance) – and does not describe or measure their best ability (capacity).

A hierarchy of difficulty of items was produced by the Rasch analysis. A child’s level on the hierarchy allows the therapist to gain a profile of their strengths and weaknesses. Their treatment can be designed to provide the “just right” level of challenge by targeting the movements and tasks which are more difficult.

  • Validity – Kids-AHA has good evidence for construct validity4
  • Reliability – Kids-AHA has excellent inter-rater and intra-rater reliability4, and test-retest reliability5. The two board games used in the School-Kids AHA possess strong alternate-form reliability with each other and also with the Small-Kids AHA5. Results of the different forms of the AHA can, therefore, be compared with one another over time
  • Responsiveness – evidence from Rasch analysis4 and changes in Kids-AHA scores when used to evaluate the effects of intervention in clinical research suggests the assessment is responsive to change6. Data for the standard error of measurement2 and smallest detectible difference5 is available to assist in identifying meaningful change after intervention for individual children.
NOTE: Assessments should have strong psychometric properties. These properties refer mainly to i) validity – whether the tool measures what it is meant to measure, ii) reliability – whether the results of the tool are stable under different conditions and, for tools which measure outcome iii) responsiveness – whether the test is responsive to change.

Date of literature searches: October 2015

  1. Krumlinde-Sundholm, L., Holmefur, M., & Eliasson, A. (2014). Manual: Assisting Hand Assessment – Kids, 18 months to 12 years, β-version 5.0, English. Stockholm: Karolinska Institutet. No access available.
  2. Krumlinde-Sundholm, L. & Eliasson, A. C. (2003). Development of the Assisting Hand Assessment: A Rasch-built measure intended for children with unilateral upper limb impairments. Scandinavian Journal of Occupational Therapy, 10, 16-26. See abstract
  3. Holmefur, M., & Krumlinde-Sundholm L. (Early view, October 28 2015). Psychometric properties of a revised version of the Assisting Hand Assessment (Kids-AHA 5.0). Developmental Medicine and Child Neurology.
  4. Krumlinde-Sundholm, L., Holmefur, M., Kottorp, A., & Eliasson, A. C. (2007). The Assisting Hand Assessment: Current evidence of validity, reliability and responsiveness to change. Developmental Medicine and Child Neurology, 49, 259-264.
  5. Holmefur, M., Aarts, P., Hoare, B., & Krumlinde-Sundholm, L. (2009). Test-retest and alternate forms reliability of the Assisting Hand Assessment. Journal of Rehabilitation Medicine, 41, 886-891.
  6. Urlic, K. & Wallen, M. (2009). The Assisting Hand Assessment is a reliable and valid measure of assessing hand function for children with hemiplegic cerebral palsy and obstetric brachial plexus palsy
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.