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The Assisting Hand Assessment

You can’t improve what you don’t measure

The interaction between two hands in everyday activities is normal human behaviour – where the dominant hand is quicker and able to manipulate objects, while the non-dominant hand mostly holds and stabilises objects. The difference between the two roles of the hands is more evident in people with unilateral disabilities, such as children with one sided hemiplegia. Simple tasks such as playing with building blocks, getting dressed, or cutting paper, can become difficult to carry out with one hand. The various aspects of hand function include different types of grip, speed and dexterity, wrist and finger position, strength, range of movement, and quality of movement patterns, as well as bimanual use.

The Assisting Hand Assessment (AHA) is a well-established tool used to measure the use of the hemiplegic hand in bimanual function, in children with unilateral disabilities. It measures all aspects of function including general use of the affected hand and arm, initiation of use, grasp and release, fine motor skills, coordination, and pace.

With substantial research, it has been proven to have excellent inter-rater and intra-rater reliability (Holmefur et al., 2007), meaning that the same person carrying out the test with a child will repeatedly get similar results, and if various people carry out the test with that child they will also get consistent results.

It has also been proven to be a valid measure for hand function in children with hemiplegic cerebral palsy and obstetric brachial plexus palsy aged 18 months to 12 years (Krumlinde-Sundholm et al., 2007). It is currently being adapted to use with hemiplegic babies, teenagers and adults following stroke. It is sensitive to change, thus it is useful to use in research and clinical settings as it can accurately detect improvements in patients over time, such as when CIMT is used as a treatment intervention (Eliasson et al., 2005).

Most outcome measures used in CIMT measure the use of the affected hand alone. The AHA is the only tool that evaluates the function of the affected hand in relation to the dominant hand, therefore it provides the possibility of measuring the relationship and coordination between the two hands in bimanual tasks. Studies using the AHA to measure the effect of Constraint Induced Movement Therapy (CIMT) have had promising results (Eliasson et al., 2005).

Following this evidence, our specialist CIMT therapists have undergone the full training and are now accredited AHA assessors, able to evaluate upper limb function in children before, during, and after treatment programmes, in order to successfully measure the effect of CIMT.


  • Holmefur, M., Krumlinde-Sundholm, L. and Eliasson, A.C., 2007. Interrater and intrarater reliability of the Assisting Hand Assessment. American Journal of Occupational Therapy61(1), pp.79-84.
  • Krumlinde-Sundholm, L., Holmefur, M., Kottorp, A. and Eliasson, A.C., 2007. The Assisting Hand Assessment: current evidence of validity, reliability, and responsiveness to change. Developmental medicine and child neurology, 49(4), p.259.
  • Eliasson, A.C., Sundholm, L.K., Shaw, K. and Wang, C., 2005. Effects of constraint‐induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Developmental Medicine & Child Neurology47(4), pp.266-275.

Article written by Nikki

I love working as part of the CIMT team. Not only do I get to work in a therapy backed by evidence based research, but I also get to spend three weeks working closely with some amazing families and teach them that therapy really can make a difference to their children’s lives. Each families CIMT experience is unique and provides different challenges, this encourages me to be innovative and forward thinking in order to achieve the best for every child. Making therapy fun is important to me and seeing children laugh and giggle as they improve is the best part of my job.

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