Development and Validation of the Both Hands Assessment for Children With Bilateral Cerebral Palsy

Aims: To develop a hand function test for children with bilateral cerebral palsy (CP) measuring bimanual performance, including quantification of possible asymmetry of hand use. Method: The Both Hands Assessment (BoHA) content was developed through adaptation of the Assisting Hand Assessment (version 5.0). Data from 171 children with bilateral CP, 22-months to 13 years olds (75 females; mean age: 6 years and 6 months) classified at Manual Ability Classification System (MACS) levels I-III, was entered into Rasch measurement model analyses to evaluate internal scale validity and aspects of reliability. Results: Sixteen items (11 unimanual and 5 bimanual) exhibited evidence for good internal scale validity and item and person reliability when analyzed separately for children with asymmetric or symmetric hand use. By calibrating the BoHA logit measures into the same frame of reference through linking, the overall measure of bimanual performance is comparable between children with asymmetric or symmetric hand use, still allowing use of separate item difficulty hierarchies. Conclusions: The Both Hands Assessment (BoHA), showed strong evidence of internal construct validity for measuring effectiveness of bimanual performance and the extent of asymmetric hand use in children with bilateral cerebral palsy, MACS levels I-III.