Hand Assessment for Infants (HAI)
Updates
Test and Measure: Hand Assessment for Infants (HAI)
- This outcome measure is still in the late stages of development
Author: Lena Krumlinde-Sundholm
Source: Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden and Department of Developmental Neuroscience, Stella Maris Scientific Institute and University of Pisa, Pisa, Italy
Costs: A two-day course is available where participants will learn about the constructs underlying the HAI, test procedures, test objects used, and scoring of infants from video recordings. A HAI manual with detailed scoring criteria and a computer based scoring form will be provided. Courses range from ~$500-$750.
Purpose: This test is administered for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy.
Type of Test: Evaluative
Target Population and Ages: Infants with asymmetric hand use dysfunction. Infants 3-12 months old.
Time Requirements – Administration and Scoring: The test session takes 10-15 minutes to complete and the subsequent scoring approximately 30 minutes for an experienced rater.
Administration: The test will assess unimanual and bimanual actions in infants. Actions to be elicited are reaching, grasping, and holding performed in a sequence of actions during toy exploration. The evaluator will present the infant with toys to promote exploration and handling of these toys, which are presented from various places including from the evaluator’s hands and from the table. One study recommended video recording the infant for review at a later time. The administration of the play session with the selected toys is specified in the testing manual. The play session should be videotaped with the infants seated as upright as possible depending on sitting ability.
Scoring: A preliminary version of the HAI includes 31 test items: 13 x 2 unimanual test items, where each hand is given a separate score, and 5 bimanual test items in which the collaborative use of the two hands was rated. Each test item is rated on a 3-point rating scale: 0 to 2, with a higher number indicating higher ability. A quantification of a possible difference between hands is calculated from the unimanual sum scores of the better and the lesser functioning hands respectively, presented as an asymmetry index and reported as percentage with a greater value indicating a larger asymmetry. The asymmetry index is calculated as (1-lesser functioning hand sum score/better functioning hand sum score) x 100. The sum of all of the items together = a both hands sum score.
Type of information, resulting from testing: This test can provide information of unilateral as well as bimanual fine motor skills in the infant to assess asymmetry. If hand use can be measured at early age by reliable assessments it may serve as an important agent to identify early clinical signs of CP, predict outcome, follow development, and evaluate early intervention approaches.
Environment for Testing: None specified
Equipment and Materials Needed: Baby seat, a high chair with a suitable table, a collection of the selected toys, and a video camera
Examiner Qualifications: A short course is required in how to administer, score, and interpret test results reliably.
Standardization/normative data: No standardized/normative data available at this time. MCID is not available at this time.
Evidence of Reliability: Both person and item reliability coefficients were considered excellent (≥ 0.90).
Evidence of Validity: The Rasch measurement model analysis was used and demonstrated strong evidence of the HAI being a valid assessment tool of both hands use for infants with clinical signs of unilateral CP. A significant difference was found between the scores of the better and the lesser functioning hand, verifying that the HAI could quantify this asymmetry.
Resources:
- Krumlinde-Sundholm, Lena, et al. “Development of the Hand Assessment for Infants: Evidence of Internal Scale Validity.” Developmental Medicine & Child Neurology, vol. 59, no. 12, 2017, pp. 1276–1283., doi:10.1111/dmcn.13585.
- https://www.guysandstthomasevents.co.uk/the-hand-assessment-for-infants-hai-2018/
Article Review
Article: Development of the Hand Assessment for Infants: evidence of internal scale validity
- Krumlinde-Sundholm, Lena, et al. “Development of the Hand Assessment for Infants: Evidence of Internal Scale Validity.” Developmental Medicine & Child Neurology, vol. 59, no. 12, 2017, pp. 1276–1283., doi:10.1111/dmcn.13585.
Purpose: The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3-12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy.
Population: This study included 124 infants at 3-12 months corrected age (mean age 7.2 months) who were recruited from three different university hospitals in Sweden, Italy, and the Netherlands. All infants had been referred for physical or occupational therapy because of being at risk of CP with clinical signs of an asymmetric hand use with or without a known neonatal event affecting the brain. Exclusion criteria were severe visual impairment, seizures not controlled by antiepileptic drugs, or obvious clinical signs of bilateral involvement.
Methods: The Rasch measurement model analysis and non-parametric statistics were used to investigate the internal scale validity for the preliminary version of the HAI. A total of 156 assessments of infants from 124 infants with signs of asymmetric hand use were included in the analysis.
Results/Discussion: The Rasch analysis determined the HAI demonstrated a unidimensional construct and good fit to the Rasch model requirements. Unidimensionality was confirmed by principal component analysis, demonstrating that the first component explained 76.4% of the total variance and no other dimension explained more than 4.8%. The item difficulty calibrations of HAI were well-targeted to the range of the persons’ abilities, indicating that the difficulties of the items well covered the abilities of the infants in the sample. There was a significant difference (p<0.001) between the sum scores of the better functioning hands and the lesser functioning hands. There was a moderate positive correlation between age and result in the “both hands measure”. The correlation between age and the unimanual score of the lesser-functioning hand was weak (p=0.27), and for the better functioning hand strong (p<0.001). There were no significant differences between the results for males and females, for infants with the left or right hand affected, or for infants scored for Swedish, Italian, and Dutch infants. (p>0.05) It demonstrated excellent reliability (>.90) for both person and item reliability. These findings demonstrated strong evidence of the HAI having internal validity and being a valid assessment tool of both hands use for infants with clinical signs of unilateral CP, as well as detecting and quantifying a possible side difference between hands. The HAI produced a way to quantify possible asymmetry expressed as an asymmetry index by using an interval-level measure of bilateral hand use as well as unimanual scores of each hand.
Strengths:
- The ability to evaluate bimanual fine motor skills as well as unilateral motor skills
- The test is quick to administer
- The HAI fills a gap for both clinical use and research – there is currently no other clinically applicable test that evaluates bimanual hand use, or allows comparison of each hand separately
Limitations:
- Due to small sample size, an analysis of differential item functioning could not be performed (this would investigate whether individuals in different groups that are on the same level of performance differ in their response patterns)
- Further evaluations and more data are needed for investigating agreement within and between raters as well as defining the smallest detectable change
- No detailed description of methodology to perform the HAI test
Conclusion: The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of development unilateral cerebral palsy between 3-12 months of age.
2 responses to “Hand Assessment for Infants (HAI)”
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The HAI appears to be both a valid and reliable measure for infants at risk for CP. However, based on the cost of the courses in order to provide this assessment do you believe it would be a worthy investment for pediatric therapists in order to objectively quantify hand use. Also, can this test be administered by any professional who partakes in the course or is to specific to therapist.
After doing some research I found that the average cost for a “training” or continuing education course is $275-$375 per day per person and a one-week course can range from $995-$1,500. Therefore although this course does seem expensive, it is within the average cost! I would say if you are interested in learning more about this topic this would be a worthy investment for pediatric therapists because it could allow for an early diagnosis and therefore faster interventions for your patient. According to the course, the HAI is aimed for occupational therapists, physical therapists, and clinical researchers.