Mini-Assisting Hand Assessment (Mini-AHA)

The Mini-Assisting Hand Assessment (Mini-AHA) measures how well young children with signs of unilateral or hemiplegic cerebral palsy (affecting one side of the body) use their more affected hand, when using both hands together to play1.

The main reasons therapists use Mini-AHA, 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
This assessment is used with infants and young children aged eight-months to 18-months-old who have hemiplegic cerebral palsy, or signs of hemiplegic cerebral palsy1.

The assessment of the infant occurs during an enjoyable play session. An AHA trained therapist (most commonly an occupational therapist) will seat the child securely at a small table and chair and offer them a variety of age-appropriate toys. The toys have been specially selected because they are things that children usually play with using two hands together2.

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 Mini-AHA assessment. 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 therapist 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 to administer, score and interpret the Mini-AHA. For information about courses contact: the Assisting Hand Assessment website or CPteaching™.

Cost

There are costs for training and certification to become qualified in the assessment. As part of the course, assessment kits including approximately 20 toys, in six categories, are compiled by therapists according to specific criteria they learnt in their training. (These details are also outlined in the test manual).

Method

When scoring the Mini-AHA from a videorecording, 20 items (such as reaches, releases, stabilises by grasp, moves forearm) are rated on a 4-point scale which is specific for each item, but with a generic basis (that is, 4 = Effective to 1 = Does not do)1. The scores are entered into an electronic spreadsheet which calculates a raw score (0-88) and a logit based Mini-AHA unit (0-100), which is then used to interpret and report the results.

Things to note

The Mini-AHA is a standardised, criterion-referenced assessment to examine how young children with hemiplegia use their affected hand with toys that provoke two-handed use (that is, it measures their typical performance, not their capacity). The Rasch analysis of the test produced a hierarchy of difficulty of test items1. Amongst the most difficult items are ‘bimanual manipulation’ and ‘varying grasp’. The easiest items are ‘holds an object’ and ‘make contact with an object’. Once an infant’s ability level on the hierarchy is determined, their strengths and weaknesses can be identified. Treatment can be designed to provide the “just right” level of challenge by targeting the movements and tasks which are more difficult.

Psychometric properties reviewed

Validity - the assessment was well designed1 with a strong theoretical and conceptual foundation. Toys included in the assessment were selected based on a review of literature and a conceptual model2. The capacity of the toys to elicit bimanual responses was confirmed and tested in play sessions conducted with typically developing children, compared to children with cerebral palsy. Data collected with over 100 infants was subjected to Rasch modelling to examine item and scale properties and provided evidence for uni-dimensionality and internal scale structure. Forty typically developing infants achieved maximum scores as expected. Evidence that there was a weak relationship between scores and age for the infants with cerebral palsy, combined with scores of typically developing infants, provided further evidence that the Mini-AHA tests ability of the affected hand and not developmental skills. This is important when considering change in scores following the intervention.

Reliability - no work has yet been reported on test-retest or inter- and intra-rater reliabilities.

Responsiveness - no work has been reported on responsiveness to change.

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: March 2016

  1. Greaves, S., Imms, C., Dodd, K., & Krumlinde-Sundholm, L. (2013). Development of the Mini-Assisting Hand Assessment: Evidence for content and internal scale validity. Developmental Medicine and Child Neurology, 55(11), 1030-1037. doi: 10.1111/dmcn.12212.
  2. Greaves, S., Imms, C., Krumlinde-Sundholm, L., Dodd, K., & Eliasson, A-C. (2012). Bimanual behaviours in children aged 8–18 months: A literature review to select toys that elicit the use of two hands. Research in Developmental Disabilities, 33, 240-250.
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.