External validity of the Both Hands Assessment for evaluating bimanual performance in children with bilateral cerebral palsy

Abstract

To investigate the external validity of the Both Hands Assessment (BoHA), a new test evaluating bimanual performance in children with bilateral cerebral palsy (CP), by analysing its relationship to established measurements of hand function and self-care skills.METHOD In this cross-sectional study, we recruited children with bilateral CP and manual ability corresponding to Manual Ability Classification System (MACS) levels I to III attending three habilitation units in Norway. All participants completed the BoHA. Unimanual capacity was assessed using the Bimanual Fine Motor Function (BFMF) classification, the Box and Block Test (BBT), and the Melbourne Assessment 2 (MA2). Self-care skills were assessed with the Pediatric Evaluation of Disability Inventory (PEDI).RESULTS Thirty-nine children (19 males, 20 females; mean age 8y 2mo, SD 2y 8mo; age range 2y 8mo-12y 6mo) were included. Spearman's correlation coefficient (q) suggested high correlation between the BoHA and MACS (p=0.89; 95% confidence interval [CI] 0.79-0.94), BFMF classification (p=0.84; 95% CI 0.71-0.91), and BBT for the non-dominant (p=0.85; 95% CI 0.68-0.95) and dominant hand (p=0.72; 95% CI 0.53-0.85). The Spearman's q between the BoHA and the MA2 subscales varied between 0.48 and 0.83, while the PEDI's q was 0.51 (95% CI 0.33-0.67).

Self‐care and hand function in preschool children with unilateral or bilateral cerebral palsy: A cross‐sectional study

“…Burgess et al (2021) found a strong positive correlation between self‐care capabilities and bimanual performance for 74 children (aged 8–12 years) with UCP and BCP, for children classified with MACS I–III. The strongest correlations were found among children with BCP, and this finding was further supported by the results of a cross‐sectional study of children aged 2–12.5 years by Elvrum et al (2022).…”

“…The results of this study show considerable variation in PEDI scores among our cohort of preschool-aged children with CP, a finding that mirrors the rapid development of both hand function and self-care capabilities during the early years, both among children with CP and their typically developing peers (Burgess et al, 2020;Elvrum, et al, 2022;Haley et al, 1992;Klevberg et al, 2018Klevberg et al, , 2021Öhrvall et al, 2010;World Health Organization, 2007) The assessment of children's self-care capabilities is complex. Examining only manual abilities or hand use during bimanual performance does not provide sufficient information; thus, more variables should be included.…”

“…The large positive correlation was therefore expected, and this result is consistent with the findings of Burgess et al (2021). The content of the BoHA moderately aligns with the self‐care tasks included in the PEDI (Elvrum et al 2022), and increasingly strong correlations are to be expected with higher ages. Nevertheless, the BoHA scores explained only 34.81% of the variation in the PEDI scores for children with BCP in our study, indicating that other individual and environmental factors are important and should be included in future studies to investigate additional predictors of self‐care capability in this group.…”

School readiness of children at high risk of cerebral palsy randomised to early neuroprotection and neurorehabilitation: protocol for a follow-up study of participants from four randomised clinical trials

“…104 105 The Both Hands Assessment (BoHA) has been adapted from the AHA, and measures how children with bilateral CP use their hands in bimanual activities. 106 Rasch measurement modelling showed strong evidence of internal construct validity 106 and scores on the BoHA are highly correlated with measures of upper limb capacity (Melbourne Assessment 2 subscales=0.48-0.83, Box and Blocks Test=0.85, n=39) 107 and measures of selfcare performance (PEDI-CAT r=0.73, n=44). 108 Paediatric Evaluation of Disability Inventory-Computerised Assessment Test PEDI-CAT is a standardised, norm-referenced assessment of independence in self-care, mobility, social cognitive and responsibility domains.…”

“…The Both Hands Assessment (BoHA) has been adapted from the AHA, and measures how children with bilateral CP use their hands in bimanual activities 106. Rasch measurement modelling showed strong evidence of internal construct validity106 and scores on the BoHA are highly correlated with measures of upper limb capacity (Melbourne Assessment 2 subscales=0.48–0.83, Box and Blocks Test=0.85, n=39)107 and measures of self-care performance (PEDI-CAT r=0.73, n=44) 108…”