April 14, 2015

Chedoke Arm and Hand Activity Inventory

The Chedoke is a bimanual hand test that captures additional data because it lets clients decide if they want their affected hand to 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 complete the task]?"  To be fair, insurance companies want therapists to document improved independence regardless of whether it comes from recovery or compensation.  Yet ignoring whether the affected hand does any work during a task defeats the purpose of working on recovery.  Clients deserve a test that gives us credit for transferring what we gained from 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). The Chedoke includes high level tasks that have been a part of hand evaluations for years such as buttoning, zipping, and cutting with a knife and fork.  This is disappointing because many advances target clients who do not regain function with traditional treatment.  How can researchers test the efficacy of new treatments if they use tests with poor basements that do not test when hand movement emerges?

After a stroke I discovered easier bimanual ADL tasks that show hand movements can be functional much earlier than clients think is possible.  Level 3 on the Test of Bilateral Hand Use (TEBHU) is being able to reach out and hold an object still as the other hand manipulates the object (4).  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 on the TEBHU evaluate hand simple movements able-bodied adults never use.  For example, the sound hand places a deodorant bottle in the affected hand which then places the bottle on the thigh and holds it still so the sound hand can remove the cap.  Hand-to-hand transfers done close to the body are easier than opening the hand as clients struggle to lift a heavy arm to table top height.

Bottom-Line: See easy bimanual tasks in the Hand Evaluation page 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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