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  • 1.
    Amer, Ahmed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Eliasson, Ann-Christin
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Peny-Dahlstrand, Marie
    Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Validity and test-retest reliability of Children's Hand-use Experience Questionnaire in children with unilateral cerebral palsy2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 7, p. 743-749Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the validity of the internet-based version of the Children's Hand-use Experience Questionnaire (CHEQ) by testing the new four-category rating scale, internal structure, and test-retest reliability.

    Method: Data were collected for 242 children with unilateral cerebral palsy (CP) (137 males and 105 females; mean age 9y 10mo, SD 3y 5mo, range 6-18y). Twenty children from the study sample (mean age 11y 8mo, SD 3y 10mo) participated in a retest within 7 to 14 days. Validity was tested by Rasch analysis based on a rating scale model and test-retest reliability by Kappa analysis and intraclass correlation coefficient (ICC).

    Results: The four-category rating scale was within recommended criteria for rating scale structure. One item was removed because of misfit. CHEQ showed good scale structure according to the criteria. The effective operational range was >90% for two of the CHEQ scales. Test-retest reliability for the three CHEQ scales was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91.

    Interpretation: The internet-based CHEQ with a four-category rating scale is valid and reliable for use in children with unilateral CP. Further studies are needed to investigate the validity of the internet-based version of CHEQ for children with upper limb reduction deficiency or obstetric brachial plexus palsy and the validity of the recommended improvements to the current version.

  • 2.
    Bejerot, Susanne
    Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The relationship between poor motor skills and neurodevelopmental disorders2011In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 53, no 9, p. 779-779Article in journal (Refereed)
  • 3.
    Edvinsson, Siv E.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Prevalence of orofacial dysfunction in cerebral palsy and its association with gross motor function and manual ability2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 4, p. 385-394Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the prevalence of orofacial dysfunction (OFD) and explore factors associated with OFD in young individuals with cerebral palsy (CP).

    Method: We conducted a cross-sectional study on a population with CP in a Swedish county (132 individuals, mean age 14y 2mo [SD 4y 5mo], range 5-22y) using the Nordic Orofacial Test - Screening (NOT-S), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). The NOT-S interview was completed by 129 individuals (76 males, 53 females) of whom 52 (30 males, 22 females) also agreed to complete the NOT-S examination.

    Results: OFD occurred in at least one NOT-S domain in about 80% of the individuals and was present in all subdiagnoses, GMFCS levels, and MACS levels. Prevalence of OFD increased with increasing levels of GMFCS and MACS from level I=55% to level V=100%. Within the 12 NOT-S domains, the prevalence of OFD varied between 19% and 69%, wherein seven of them were at least 40%: 'Drooling', 'Nose breathing', 'Chewing and swallowing', 'Face at rest', 'Oral motor function', 'Speech', and 'Facial expression' (in ascending order).

    Interpretation: OFD is common in CP. The use of OFD screening in health service planning would assist detection of areas in need of further evaluation.

  • 4.
    Eliasson, Ann-Christin
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy2015In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 57, no 1, p. 89-94Article in journal (Refereed)
    Abstract [en]

    Aim: There is evidence that modified Constraint-Induced Movement Therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim was to investigate whether or not a single block of mCIMT (2 hours/day during 2 months) at age 2-3 years influences the course of development of bimanual hand function at about 8 years of age.

    Methods: A convenience sample of 45 children (girls, n = 21) with unilateral CP and mean age 32 months was included (mCIMT group, n = 26; reference group, n = 19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model.

    Results: Children receiving mCIMT had an upper limit of development that was 8.5 AHA units higher than the reference group (p = 0.022). When controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant.

    Conclusion: mCIMT might have a positive impact on long-term development, but the results are inconclusive. 

  • 5.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Infant hand development in unilateral cerebral palsy: filling the knowledge gap.2019In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749Article in journal (Other academic)
  • 6.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm, Sweden.
    The influence of early CIMT training on longitudinal development of hand function in children with unilateral cerebral palsy2013In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 55, no s2, p. 18-18Article in journal (Refereed)
    Abstract [en]

    Introduction: There is evidence that Constraint-Induced Movement Therapy (CIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP). Secondary analysis from previous study of development of hand function was performed with the aim to investigate whether one period of CIMT (at age 2–3y) influences the course of development or not.

    Participants and Methods: A convenience sample of 45 children with unilateral CP was included at mean age 32 months (CIMT-group, n=24, non-CIMT group n=21) and mean age at start of intervention was 28.2 months. The children were measured repeatedly, at least once a year with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. A non-linear mixed effects model was used to create and compare development curves for the CIMT and non-CIMT groups.

    Results: Children who had CIMT had an upper limit of development that was 8,1 AHA-units higher than the children who had not have CIMT (p=0.028). Also when controlling for brain lesion characteristics there was a difference in limit of development in favour of the CIMTgroup, although not significant. Children with lower AHA-score at 18 months had seemed to gain more from CIMT than children with a higher AHA-score.

    Conclusion: This study shows that one period of CIMT at age 2–3 years in children with unilateral CP is associated with better development of hand function regardless of brain lesion characteristics. This is the first study describing long-term effects of CIMT.

  • 7.
    Holmefur, Marie
    et al.
    Örebro University, School of Health Sciences.
    Krumlinde-Sundholm, Lena
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Psychometric properties of a revised version of the Assisting Hand Assessment (Kids-AHA 5.0)2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 6, p. 618-624Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to scrutinize the Assisting Hand Assessment (AHA) version 4.4 for possible improvements and to evaluate the psychometric properties regarding internal scale validity and aspects of reliability of a revised version of the AHA.

    Method: In collaboration with experts, scoring criteria were changed for four items, and one fully new item was constructed. Twenty-two original, one new, and four revised items were scored for 164 assessments of children with unilateral cerebral palsy aged 18 months to 12 years. Rasch measurement analysis was used to evaluate internal scale validity by exploring rating-scale functioning, item and person goodness-of-fit, and principal component analysis. Targeting and scale reliability were also evaluated.

    Results: After removal of misfitting items, a 20-item scale showed satisfactory goodnessof- fit. Unidimensionality was confirmed by principal component analysis. The rating scale functioned well for the 20 items, and the item difficulty was well suited to the ability level of the sample. The person reliability coefficient was 0.98, indicating high separation ability of the scale. A conversion table of AHA scores between the previous version (4.4) and the new version (5.0) was constructed.

    Interpretation: The new, 20-item version of the Kids-AHA (version 5.0), demonstrated excellent internal scale validity, suggesting improved responsiveness to changes and shortened scoring time. For comparison of scores from version 4.4 to 5.0, a transformation table is presented.

  • 8.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Women and Child Health, Karolinska Institutet, Stockholm.
    Krumlinde-Sundholm, Lena
    Karolinska Institutet,Stockholm.
    Bergström, Jakob
    Karolinska Institutet, Stockholm.
    Eliasson, Ann-Christin
    Karolinska Institutet, Stockholm.
    Longitudinal development of hand function in children with unilateral cerebral palsy2009In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 51, no s5Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: Studies of longitudinal development of hand function in children with unilateral cerebral palsy (CP) are sparse. For children with unilateral CP the ability to use the affected hand as an effective assist to the dominant hand in bimanual tasks may be the most important aspect of hand function in daily life. This ability can be assessed with the assisting hand assessment (AHA). The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral CP between 18 months and 8 years of age.

    Design: This was a study of prognosis with a prospective longitudinal cohort design. Participants and Setting: Forty-three children with unilateral cerebral palsy participated (22 male, 21 female). They were recruited at local rehabilitation centres and constituted a convenience sample. Inclusion age was 18 months–5 years 4 months (mean 2 years 8 months). Manual ability classification system (MACS) levels: I [n=7], II [n=25], III [n=11].

    Materials/Methods: The children were assessed with the AHA over a period of at least 3 years (mean 4.5 years), with 3–11 assessments per child. Children entered the study at different ages allowing evaluation of development from ages 18 months to 8 years. Estimated average motor development curves were fitted with a non-linear mixed effects model.

    Results: Individual differences in development were considerable. Children with a high AHA score at 18 months (over 40 raw scores) reached a significantly higher ability level and at a higher progression rate than the children with a low 18-month AHA score. The children with high 18-month AHA score reached 90% of their limit at average age 3 years whereas the children with a low 18-month AHA score reached 90% of their maximum level at a mean age of 7. Similarly, the maximum level of development differed between children in MACS level I–III. The rate of change was similar in levels I and II and significantly slower, in level III.

    Conclusions/Significance: This study shows that children with different ability levels all develop their way of using their hemiplegic hand during the preschool years. The AHA can be used to follow development over time and the AHA score at 18 months can be used for approximate prediction of development of assisting hand use.

  • 9.
    Holmefur, Marie
    et al.
    Örebro University, School of Health and Medical Sciences.
    Krumlinde-Sundholm, Lena
    Bergström, Jakob
    Eliasson, Ann-Christin
    Longitudinal development of hand function in children with unilateral cerebral palsy2010In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 52, no 4, p. 352-357Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral cerebral palsy (CP) aged between 18 months and 8 years.

    METHOD: A prospective longitudinal study of 43 children (22 males, 21 females) with unilateral CP was conducted. Inclusion age was 18 months to 5 years 4 months (mean 2y 8mo [SD 1y 1mo]). Children were assessed with the Assisting Hand Assessment (AHA) 3 to 11 times per child over a mean period of 4 years 6 months. Two models were used for grouping children: by AHA score at 18 months and by Manual Ability Classification System (MACS) levels. Estimated average motor development curves were fitted with a nonlinear mixed-effects model.

    RESULTS: Children with a high AHA score (high ability level) at 18 months reached a significantly higher ability level and at a higher progression rate than children with a low 18-month AHA score. Limits of development differed between the three MACS levels.

    INTERPRETATION: Results indicate that the AHA score at 18 months can be used to discuss future development of affected hand use in bimanual tasks in children with unilateral CP.

  • 10.
    Krumlinde-Sundholm, Lena
    et al.
    Karolinska Institutet.
    Holmefur, Marie
    Örebro University, Department of Nursing and Caring Sciences.
    Kottorp, Anders
    Karolinska Institutet.
    Eliasson, Ann-Christin
    Karolinska Institutet.
    The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change2007In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 49, no 4, p. 259-264Article in journal (Refereed)
    Abstract [en]

    The Assisting Hand Assessment (AHA) provides a new perspective of hand function evaluation relevant for children with unilateral upper limb disabilities. It measures how effectively the involved hand is actually used for bimanual activity, which, for these children, might be the most important aspect of their hand function. The aim of this paper is to report the conceptual framework and the evidence for validity, reliability, and responsiveness to change for the measures. Previously, the AHA has been evaluated for children aged 18 months to 5 years and excellent inter- and intrarater reliability was demonstrated. This paper reports further evidence of construct validity and reliability for the AHA measures involving an extended age range of children with hemiplegic cerebral palsy or obstetric brachial plexus palsy from 18 months to 12 years of age (mean age 4y 11mo [SD 2y 9mo] range 18mo-12y 8mo). A Rasch measurement model was used to analyze 409 assessments from 303 children (170 males, 133 females). The analysis generated a scale demonstrating large capacity to reliably separate and spread personal ability measures, indicating sensitivity to change and a hierarchy of the items ranging them from easy to hard. Aspects of item fit, relationship between age and ability measures, and development of assisting hand function are discussed.

  • 11.
    Louwers, Annoek
    et al.
    Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
    Beelen, Anita
    Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Krumlinde-Sundholm, Lena
    Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Development of the Assisting Hand Assessment for adolescents (Ad-AHA) and validation of the AHA from 18 months to 18 years2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 12, p. 1303-1309Article in journal (Refereed)
    Abstract [en]

    Aim: To develop and evaluate a test activity from which bimanual performance in adolescents with unilateral cerebral palsy (CP) can be observed and scored with the Assisting Hand Assessment (AHA), and to evaluate the construct validity of the AHA test items for the extended age range 18 months to 18 years.

    Method: A new test activity was developed and evaluated for its ability to elicit bimanual actions in adolescents with (n=20) and without (n=10) unilateral CP. The AHA scores of 126 adolescents (mean age 14y 3mo, SD 2y 6mo; 71 males, 55 females) and 157 children with unilateral CP (mean age 6y 1mo, SD 2y 10mo; 102 males, 55 females) were analysed using the Rasch measurement model.

    Results: The test activity elicited bimanual actions in 100% of typically developing adolescents and in 96.8% and 57.9% of adolescents with unilateral CP (moderately and severely limited hand function respectively). The scale demonstrated good construct validity; thus the same scoring criteria can be used for the age range studied.

    Interpretation: The new Assisting Hand Assessment for adolescents (Ad-AHA) activity is valid for use with 13- to 18-year-olds to elicit bimanual performance in adolescents with unilateral CP. The same AHA scoring criteria can be used both for children and for adolescents within the age range 18 months to 18 year

  • 12.
    Nordstrand, Linda
    et al.
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Holmefur, Marie
    Örebro University, School of Health Sciences.
    Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 10, p. 1042-1048Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to describe the development of hand function, particularly the use of the affected hand in bimanual tasks, among children with unilateral cerebral palsy aged 18 months to 12 years.

    Method: A convenience sample of 96 children (53 males, 43 females) was assessed with the Assisting Hand Assessment (AHA) at regular intervals from the ages of 18 months to 12 years. The children ranged from 17 to 127 months (median age 24mo) at recruitment. Subgroups were created to identify differences in development using the child’s AHA at 18 months and the Manual Ability Classification System (MACS). A nonlinear mixed effects model was used to analyze data according to a ‘stable limit’ development model.

    Results: The results were based on 702 AHA sessions. The children showed a rapid development at a young age and reached 90% of their stable limit between 30 months and 8 years. The subgroups, based on the 18-month AHA and the MACS levels respectively, had distinctly different patterns of development.

    Interpretation: The AHA at 18 months may be used to make a crude prediction of future development.

  • 13.
    Sköld, Annika
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences. Centre for Rehabilitation Research.
    Krumlinde Sundholm, Lena
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christine
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Development and evidence of validity for the children’s hand-use experience questionnaire (CHEQ)2011In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 53, no 5, p. 436-442Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the development of the Children's Hand-use Experience Questionnaire (CHEQ), and investigate the evidence of its validity based on test content and internal structure of the three scales in it.

    METHOD: The selection of items and questions was based on a literature review, expert opinion, and interviews with families. Data on the final questionnaire were collected from 86 children and adolescents (42 males, 44 females) aged 6 to 18 years (mean 12 y, SD 3 y), with unilateral cerebral palsy, upper limb reduction deficiency, or obstetric brachial plexus palsy.

    RESULTS: After item reduction and evaluation, CHEQ was designed to include 29 bimanual activities, each rated on three scales of perceived efficacy of the grasp, time taken to perform the activity, and degree of feeling bothered. The appropriateness of the included activities was confirmed by their reported relevance and bimanual nature. The internal structure of the scales was confirmed by Rasch analysis.

    INTERPRETATION CHEQ can be used to assess children and adolescents with a unilateral hand dysfunction on their experiences of using the affected hand to perform bimanual tasks. In clinical work, CHEQ has the potential to become a useful tool for treatment planning and follow-up.

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