April 14, 2015

Chedoke Arm and Hand Activity Inventory

The Chedoke is a bimanual hand test that captures lots of baseline data because it lets clients use the affected hand hold the jar or turn the lid (1).  Yet OTs who used the Chedoke wondered why they needed another ADL test (2).  One OT said "So am I really that worried about exactly how much effort the other one [hand] is putting in [to completing the task]?"  Ignoring whether the affected hand does any work during a task defeats the purpose of working on recovery (see photo).  When clients get to a step that requires two hands we deserve a test that gives us credit for the ability to transfer what we gained with exercise.

Unfortunately, OTs who gave the Chedoke to stroke survivors concluded it has too many high level tasks for clients with severe motor impairments (2, 3). Chedoke tasks are draw line with a ruler, pour glass of water, button, zip, cut with knife and fork, put toothpaste on toothbrush, dial 911, clean eyeglasses, open jar, dry back with towel, wring out cloth, carry bag up stairs, and place container on table. This conclusion is disappointing because many advances in stroke rehab target clients who do not regain hand function with traditional treatment.  How can researchers test the efficacy of new treatment approaches if they use tests with poor basements that cannot show what clients can do when hand movement first emerges?

After a stroke I discovered easier bimanual ADL tasks (4).  Level 3 is being able to reach out and hold an object still as the other hand manipulates the object.  Able-bodied adults do this dozens of time a day but take this skill for granted which is why it never appears on hand evaluations.
Levels 1 & 2 employ simple strategies able-bodied adults never use.  For example, have the sound hand place a deodorant bottle in the affected hand which places the bottle on the thigh and holds it still as the sound hand removes the cap.  Hand-to-hand transfers done close to the body are easier than opening the hand as you struggle to lift a heavy arm to table top height.  See nine easier bimanual tasks in Hand Evaluations at the top of my blog. 

1.  Barreca S, Stratford P, Lambert C, Maters L, Streiner D. Test-retest reliability, validity, and
     sensitivity of the Chedoke Arm an Hand Activity Inventory: A new measure of upper-extremity
     limb function for survivors of stroke. Archives of Physical Medicine and Rehabilitation. 2005;
     86:1616-1622.
2.  Gustafsson L, Turnpin M, Dorman C. Clinical utility of the Chedoke Arm and Hand Activity
     Inventory for stroke rehabilitation. Canadian Journal of Occupational Therapy. 2010;77:167-
     173.
3.  Rowland T, Gustafsson L, Turnpin M, Henderson R, Read S. Chedoke Arm and Hand Activity
     Inventory-9 (CAHAI-9): A multi-centre investigation of clinical utility. International Journal of
     Therapy and Rehabilitation. 2011;18 (5): 290-298.
4.  Dutton R. My Last Degree: A Therapist Goes Home After a Stroke, 2nd ed. Bangor, Maine:
     Booklocker; 2013:55-66.

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