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RehabMeasures Instrument

Chedoke Arm and Hand Activity Inventory

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Purpose

The CAHAI  evaluates the functional ability of the paretic arm and hand to perform tasks.

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Instrument Details

Acronym CAHAI

Area of Assessment

Activities of Daily Living
Upper Extremity Function

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • The CAHAI is a performance test using functional items. It is not designed to measure the client’s ability to complete the task using only their unaffected hand, but rather to encourage bilateral function.
  • This test consists of 13 functional tasks to complete:
    1) Open jar of coffee
    2) Call 911
    3) Draw a line with a ruler
    4) Put toothpaste on toothbrush
    5) Cut medium consistency putty
    6) Pour a glass of water
    7) Wring out washcloth
    8) Clean pair of eyeglasses
    9) Zip up a zipper
    10) Do up 5 buttons
    11) Dry back with towel
    12) Place container on table
    13) Carry bag upstairs

Number of Items

13

Equipment Required

  • Jar of coffee
  • Phone
  • Ruler and pen
  • Toothpaste and toothbrush
  • Knife
  • Fork
  • Putty
  • Glass of water
  • Wet washcloth
  • Eyeglasses
  • Jacket and zipper
  • Shirt with 5 buttons
  • Towel
  • Rubbermaid 38 liter container (50x37x27cm) with 10lb. weight
  • Plastic grocery bag with 4 lb. weight

Time to Administer

30 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initially reviewed by Dorian Rose and the Stroke Edge Taskforce of the Neurolgy Section of the APTA. Updated by Maggie Bland PT,DPT,NCS and Nancy Byl, PT, MPH, PhD, FAPTA and the StrokEdge II Task Force of the Neurology Section of the APTA in 2016.

Body Part

Upper Extremity

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

 (SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

NR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

NR

NR

NR

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

Yes

No

Not reported

Considerations

  • Client should have some active movemtn capacity in the involved arm
  • All three shortened versions of the CAHAI-13 demonstrated strong psychometric properties and can be used as a functional measure for assessment for UE function (especially with limited time and resources). The CAHAI-7 maintained the highest level of longitudinal validity and cross-sectional validity.
  • CAHAI is inexpensive and transportable compared to the ARAT. Whereas the ARAT bilaterally examines upper limb function, the CAHAI takes a bilateral approach to analyzing basic functional tasks.

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Movement and Gait Disorders

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Minimal Detectable Change (MDC)

Upper Extremity Paralysis

(Barreca et al, 2005)

  • MDC (90) = 6.3 points

Minimally Clinically Important Difference (MCID)

Upper Extremity Paralysis

(Siven et al, 2011) Systematic Review

MCID (chronic) = 6.3 points

 

Test/Retest Reliability

Upper Extremity Paralysis:

("Psychometric properties: Reliability")

  • Excellent reliability (ICC = 0.96)

Interrater/Intrarater Reliability

Upper Extremity Paralysis:

(Barreca et al, 2005)

  • Excellent reliability (ICC = 0.98)

Internal Consistency

Upper Extremity Paralysis:

("Psychometric properties: Reliability")

  • Excellent reliability (ICC = 0.95)

Stroke

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Interrater/Intrarater Reliability

(Schuster, 2010; n = 23 patients (Mean age 69.4, SD 12.9: 6 females; Mean time post-stroke: 1.5y (2.5y))

  • Excellent reliability (ICC = ranges from 0.96-0.99 for CAHAI-G 13, 9, 8, 7)

Internal Consistency

(Barreca et al, 2006) Comparison of the CAHAI-13 to other measures in people 20-108 days post-stroke

("Psychometric properties: Reliability")

Excellent Internal consistency: r=0.98

 

Construct Validity

(Barreca et al. , 2006)

  • Excellent correlation with Action Reach Arm Test: r=0 .93

  • Excellent correlation with Chedoke-McMaster Stroke

(Baker, et al 2011) Systematic review of key assessment of hand/arm outcome tools to measure change following robotic therapy in stroke rehabilitation (45 measures identified)

  • Chedoke Arm and Hand Inventory was one of 3 measures that met all domains of the ICF framework and incorporated a mixture of clinical-rated and patient reported outcome measures

  • None of the scales were considered to be sufficient on their own to capture all important outcome domains

(Schuster et al, 2010; n = 23 post stroke patients with minimal motor function in the upper extremity, 26 days[EE1] to 8 years post-stroke, validation of the CAHAI in German; CAHAI-G)

  • Excellent correlation between the Chedoke-McMaster Stroke Assessment subscale hand and CAHAI-G 13 (r = .74)

  • Excellent correlation between the Chedoke-McMaster Stroke Assessment subscale arm and CAHAI-G 13 (r = .67)

  • Excellent reliability (ICC = 0.99) for CAHAI-G 13


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Bibliography

Baker K, Cano SJ, Playford D. Outcome measurement in stroke: A scale selection strategy (2011) Stroke ; 42:1787-1794. Find it on PubMed

Barreca, S., Gowland, C. K., et al. (2004). "Development of the Chedoke Arm and Hand Activity Inventory: theoretical constructs, item generation, and selection." Top Stroke Rehabil 11(4): 31-42. Find it on PubMed

Barreca, S. R., Stratford, P. W., et al. (2005). "Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke." Arch Phys Med Rehabil 86(8): 1616-1622. Find it on PubMed  

Schuster, C., Hahn, S. & Ettlin, T. (2010). Objectively-assessed outcome measures: a translation and cross-cultural adaptation procedure applied to the Chedoke McMaster Arm and Hand Activity Inventory (CAHAI). BMC Medical Research Methodology, 10, 106. Find it on PubMed

Barreca SR, Stratford PW, Masters LM, Lambert CL, Griffiths J (2006). Comparing 2 versions of the Chedoke Arm and Hand Activity Inventory with the Action Research Arm Test. Phys Ther; 86:245-253.

Schuster, C., Hahn, S., Ettlin, T. (2010). “Objectively-assessed outcome measures: a translation and cross-cultural adaptation procedure applied to the Chedoke McMaster Arm and Hand Activity inventory (CAHAI).” BMC Med Res Methodol 10: 106. Find it on PubMed

Sivan, M., O’Connor, R.J., et al. (2011). “Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke.” J Rehabil Med 43: 181-189. Find it on PubMed

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