Both Hands Assessment for children and adolescents with bilateral cerebral palsy: Content and construct validity

Gøril Okkenhaug Johansen; Annoek Louwers; Melanie Hessenauer; Kari Anne Indredavik Evensen; Guro Lillemoen Andersen; Ann-Kristin Gunnes Elvrum

doi:10.1111/dmcn.70139

Both Hands Assessment for children and adolescents with bilateral cerebral palsy: Content and construct validity

Dev Med Child Neurol. 2026 Jan 18. doi: 10.1111/dmcn.70139. Online ahead of print.

Authors

Gøril Okkenhaug Johansen^{1

2}, Annoek Louwers³, Melanie Hessenauer⁴, Kari Anne Indredavik Evensen^{2

5

6}, Guro Lillemoen Andersen^{2

7}, Ann-Kristin Gunnes Elvrum^{1

8}

Affiliations

¹ Clinic of rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
² Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
³ Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁴ Specialized Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic, Vogtareuth, Germany.
⁵ Children's Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
⁶ Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
⁷ Vestfold Hospital Trust HF, Tønsberg, Norway.
⁸ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

PMID: 41548110
DOI: 10.1111/dmcn.70139

Abstract

Aim: To investigate the content and construct validity of the Both Hands Assessment (BoHA) for children and adolescents with bilateral cerebral palsy (CP), classified in Manual Ability Classification System (MACS) levels I to III, aged 18 months to 18 years.

Method: In this cross-sectional study, we included 61 adolescents with bilateral CP (37 males, 24 females, mean age 15 years 6 months, SD = 2 years 3 months) who were assessed with the BoHA to investigate content validity. Their BoHA results were combined with data from 210 children (121 males, 89 females, mean age 6 years 4 months, SD = 3 years 1 month), resulting in 271 BoHA assessments for the Rasch measurement model analyses investigating construct validity.

Results: After revising the bimanual item 'orients objects', the BoHA items were suitable for scoring bimanual performance in adolescents. Strong internal scale validity and reliable item and person measures were demonstrated for the 16 BoHA items, analysed separately for individuals with asymmetric (n = 94) and symmetric (n = 177) hand use. The BoHA logit measures were linked to the same reference frame, enabling comparable overall bimanual performance measures while maintaining separate item difficulty hierarchies.

Interpretation: The BoHA scale can measure bimanual performance in individuals with bilateral CP, classified in MACS levels I to III, aged 18 months to 18 years. This allows for monitoring development and evaluating the effectiveness of intervention from early childhood to adulthood.

Abstract

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