Experiences with the Assisted Hand Assessment (AHA) in children with cerebral palsy under treatment with botulinum toxin A

Objectives: Assisted Hand Assessment (AHA) is a standardized and validated test to evaluate how effective children with hemiplegic cerebral palsy use their affected hand (assisting hand) in bimanual activity performance. The practicability and sensitivity of the test in comparison with the well established goal attainment scaling (GAS) in children with hemiplegic cerebral palsy under a therapy with botulinum toxin A (BTA) of the upper extremity was evaluated.

Material and Methods: 17 children (mean age=5,65 years) with hemiplegic cerebral palsy were investigated with the AHA test starting in january 2004 up to now. For 7 children results before and after therapy with BTA are available. The results of the AHA tests were compared with the results of the goal attainment scaling (GAS).

Results: The test gained recognition at therapists and investigated children. In rare cases the test results were negatively influenced by poor motivation. Anyway a learning effect can not be excluded in repetitive testing. The expenditure of time for testing and subsequent analysis averages about one hour. The mean score of the AHA tests before BTA-therapy was 47.71±10.06 (mean±SD), and six weeks after therapy 53±7.55 (mean±SD). This significant improvement (p=0.037) correlated with a GAS-score of –0,14. Furthermore the test results were useful for further planning of the therapy.

Conclusions: The AHA test can be recommended as a differentiated tool for evaluating the therapy of the upper extremity in children with hemiplegic cerebral palsy. The planned expansion of the test for children >12 years is required, because in older children the tasks of the test were found to be too simple.