Measuring Change
Assessment Options
Measuring change is important to ensure that therapy is benefiting the child and family. In this section, we present options for assessment for young children with cerebral palsy. Our team prioritizes assessment of goal attainment and hand function, with emphasis on attainment of caregiver-identified goals to ensure therapy results in meaningful change for the child and caregiver.
To measure change, assessments are completed before starting therapy and after a treatment block.
Individualized Goal Attainment
The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) are two options to assess goal attainment. These measures do not require certification for administration and scoring.
Canadian Occupational Performance Measure (COPM)
The COPM can be used to guide identification of caregiver goals. The importance of identified goals are ranked and then scored by the caregiver on a scale of 1 to 10 for both Performance (how well the goal is performed) and Satisfaction (how satisfied caregivers are with goal performance). More information about the COPM can be found at https://www.thecopm.ca/
Goal Attainment Scaling
Using GAS, COPM goals can be transformed into objectively measurable goals that can be targeted by the intervention. GAS goals are scored on a standardized -2 to +2 scale, with -2 being much less than expected, 0 being expected outcome post-intervention, and +2 being much greater than expected. Criteria for each score are set at baseline, and then scored post-intervention. Scores are transformed into a T-score for statistical analysis. The GAS manual can be found here.
Hand Function Assessments
A series of manual assessments have been developed for young children with asymmetric hand use due to cerebral palsy. The three assessments listed below examine hand function in a video-recorded play-based session lasting 10-15 minutes. Videos are scored after the assessment is complete. Results of the three assessments can also be used to identify target movements for therapy.
These assessments require training and certification. Details on courses can be found on the CP Teaching website.
The Hand Assessment for Infants (HAI)
The HAI is for infants aged 3 to 12 months. The HAI measures both hands individually, as well as measuring how both hands perform together. The HAI is scored on 17 items (12 unimanual and 5 bimanual) using a 3-point rating scale for each item.
The Mini-Assisting Hand Assessment (mini-AHA)
The Mini-AHA is for ages 8 to 18 months. The mini-AHA measures how effectively children use their more affected (assisting) hand to assist their preferred hand during bimanual tasks. The play-based session is scored based on 20 items with a four-point rating scale. The outcome is a logit-based measure of assisting hand function, with a higher score indicating better function.
The Assisting Hand Assessment (AHA)
The AHA is for children 18 months to 18 years old. Similar to the mini-AHA, the AHA assesses assisting hand use during bimanual play and has 20-items with a four-point rating scale. The AHA toy kit and play session differ from the mini-AHA.