Effective use of the assisting hand in adolescents with cerebral palsy

Part one of this thesis evaluates the development, validation and reliability of the Assisting Hand Assessment for adolescents (Ad-AHA). The scale showed good construct validity within the whole age range (18 months to 18 years). The Ad-AHA is a valid performance-based instrument to monitor development from childhood to young adulthood, evaluate interventions and guide intervention planning. The Ad-AHA has good-to-excellent interrater and test-retest reliability in adolescents with unilateral CP. Reliable AHA-scores can be generated by using different age-appropriate tests activities. The Ad-AHA can be used to evaluate change over time with a score change of 5 AHA-units.
Part two evaluates the effect of two interventions on the ability to perform daily activities in children and adolescents with CP. The performance of bimanual activities in children wearing a functional hand orthosis improved significantly. With evaluation on the level of individual AHA items, the therapist can decide in which activities the individual child will most likely be able to benefit most from the orthosis. The systematic review summarizes the clinical postoperative outcomes of upper extremity surgery (UES) on hand use in children and adolescents with CP. Considering the overall very low quality of the evidence, it is not possible to make clinical recommendations on the effect of upper extremity surgery. The outcomes of the clinical cohort study show that careful patient selection, based on multidisciplinary assessment and shared decision-making, results in clinically relevant improvements in patient-specific functional and/or cosmetic goals and manual ability after UES.