The assisting hand assessment for children and youth with brachial plexus birth injury: a study of validity and item hierarchy of AHA-Plex.
Marie Holmefur, Ann-Kristin Gunnes Elvrum, Lena Krumlinde-Sundholm
PMID 37752629WHAT IT FOUND
A 15-item version of the Assisting Hand Assessment (AHA-Plex) reliably measures bimanual hand use in children with brachial plexus birth injury.
It correlates almost perfectly with the original 20-item test but scores faster and provides a difficulty hierarchy to guide therapy planning.
Key findings
01The new 15-item AHA-Plex scale showed excellent reliability and unidimensionality, correlating almost perfectly (r = 0.994) with the original 20-item AHA scale.
02The AHA-Plex provides a unique item difficulty hierarchy for brachial plexus birth injury, where arm movements like reaching and forearm movement are the most difficult tasks, unlike in cerebral palsy where hand manipulation is harder.
03Using the reduced 15-item scale significantly lessens the time required to score the assessment while maintaining valid measurement properties.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study used a convenience sample recruited from hospital OT departments and habilitation services, which may not represent the broader population of children with BPBI, particularly those not receiving specialized care. The sample included relatively few teenagers (only 10 participants aged 13-18 years), although the authors note no correlation between age and AHA scores. Data on the specific extent or level of nerve root injury (e.g., C5-C7 vs total plexus) was missing for many participants, so the analysis could not account for injury severity as a covariate. The study validates the measurement properties of the tool but does not test its sensitivity to change over time in a longitudinal intervention context.
Declared interests
The authors declared no conflicts of interest. The study was funded by grants from the Swedish Research Council, the Swedish Foundation for Strategic Research, and the Eriksson Foundation for Neurorehabilitation.
The easy way to misread this
Do not assume the AHA-Plex is interchangeable with the original AHA for all populations. The item difficulty hierarchy is specific to brachial plexus birth injury; using this tool or interpreting its hierarchy for children with unilateral cerebral palsy may lead to incorrect conclusions about their functional deficits, as the relative difficulty of arm vs. hand movements differs significantly between these groups.