Chedoke Arm and Hand Activity Inventory (CAHAI)

Purpose of the measure

The Chedoke Arm and Hand Activity Inventory (CAHAI) is a functional assessment of the recovering arm and hand after stroke. The CAHAI compliments the Chedoke-McMaster Stroke Assessment (Barreca, Stratford, Masters, Lambert, Griffiths, and McBay, 2006).

Available versions

The CAHAI was developed by Barreca, Gowland, Stratford, Huijbregts, Griffiths, Torresin, Dunkley, Miller, and Masters in 2004 to address the need for a valid, clinically relevant, and responsive functional assessment of the recovering paretic upper limb.

Three shortened versions of the CAHAI were developed by Barreca, Stratford, Masters, Lambert, Griffiths, and McBay in 2006. The shortened versions have 7, 8 or 9 items and are identified as CAHAI-7, CAHAI-8, CAHAI-9, respectively.

Features of the measure

Items:
The original CAHAI consists of 13 functional items that are non-gender specific, involve both upper limbs, and incorporates a range of movements and grasps that reflect stages of motor recovery following stroke. The following items were generated from a review of the scientific literature on stroke, as well as from input from individuals with stroke and their families (Barreca et al., 2004):

  1. Open a jar of coffee
  2. Dial 911
  3. Draw a line with a ruler
  4. Pour a glass of water
  5. Wring out a washcloth
  6. Do up five buttons
  7. Dry back with a towel
  8. Put toothpaste on a toothbrush
  9. Cut medium consistency putty
  10. Clean eye glasses
  11. Zip up a zipper
  12. Place a container on a table
  13. Carry a bag up the stairs

The CAHAI-7 utilizes the first 7 items, CAHAI-8 the first 8 items, and CAHAI-9 the first 9 items. The 13 items together represent the original CAHAI (Barreca et al., 2006). On average, clients with stroke consider items 1, 2, 4 and 12 easy to perform; items 8, 10, 11, and 13 moderately difficult; and items 3, 6, 7, and 9 the most difficult (Barreca et al., 2004).

Detailed administration guidelines are in the development manual that can be obtained can be obtained by visiting the official website: http://www.cahai.ca

Scoring:
Each item of the CAHAI is scored on a 7-point quantitative scale, similar to the scale used in the Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987)

A score of

1 = client needs total assistance and the weak upper limb performs less than 25% of the task;

2 = client needs maximal assistance and the weak upper limb performs 25% to 49% of the task. There are no signs of arm or hand manipulation, only stabilization;

3 = client needs moderate assistance and the weak upper limb performs 50% to 74% of the task. Begins to show signs of arm or hand manipulation;

4 = client needs minimal assistance (light touch) and the weak upper limb performs more than 75% of the task;

5 = client requires supervision, coaxing, or cueing;

6 = client requires use of assistive devices or requires more than reasonable time, or there are safety concerns; and

7 = total independence in completing the task.

The minimal possible score for the CAHAI is 13 and the maximum is 91, with higher scores indicating greater functional independence (Barreca et al., 2004; Barreca, Stratford, Lambert, Masters, & Streiner, 2005; Barreca, Stratford, Masters, Lambert, & Griffiths, 2006b).

The affected limb is also scored according to its positioning and functioning during test performance. The therapist should record the performance of the affected limb on each item by checking the appropriate box. The scoring table for the CAHAI is as follows: (Barreca et al., 2004):

Items Affected Limb
1) Open a jar of coffee Holds jar Holds lid
2) Call 911 Holds receiver Dials phone
3) Draw a line with ruler Holds ruler Holds pen
4) Put toothpaste on toothbrush Holds toothpaste Holds brush
5) Cut medium consistency putty Holds knife Holds fork
6) Pour a glass of water Holds glass Holds pitcher
7) Clean a pair of eyeglasses Holds glasses Wipes lenses
8) Zip up the zipper Holds zipper Holds zipper pull
9) Dry back with towel Reaches for towel Grasps towel end

Note: Standardized instructions on scoring can be obtained by visiting the official website: http://www.cahai.ca

Time:
The time to administer and score the CAHAI is approximately 25 minutes (Barreca et al., 2004; Barreca et al., 2006).

Subscales:
None

Equipment required:

CAHAI-7
Version (Items 1-7) requires all items in Equipment List A

Equipment List A

  • height adjustable table
  • chair/wheelchair without armrests
  • dycem
  • 200g jar of coffee
  • push-button telephone
  • 12″/30cm ruler
  • 8.5″ x 11″ paper
  • pencil
  • 2.3L plastic pitcher with lid filled with 1600 ml. Water
  • 250 ml plastic cup
  • wash cloth
  • wash basin (24.5 cm. in diameter, height 8 cm.)
  • Pull-on vest with 5 buttons (one side male & one side female), buttons (1.5 cm. In diameter, 7 cm. apart)
  • bath towel (65cm X 100cm)

CAHAI-8
Version (Items 1-8) requires all items in Equipment List A and B

Equipment List B

  • 75ml toothpaste with screw lid, >50% full
  • toothbrush

CAHAI-9
Version (Items 1-9) requires all items in Equipment List A, B, and C

Equipment List C

  • dinner plate (Melamine or heavy plastic, 25 cm. in diameter)
  • medium resistance putty
  • knife and fork
  • built up handles the length of the utensil handle

CAHAI-13
Version (Items 1-13) requires all items in Equipment List A, B, C, and D

Equipment List D

  • 27″/67cm metal zipper in polar fleece poncho
  • eyeglasses
  • handkerchief
  • Rubbermaid 38L container (50 x 37 x 27cm)
  • 4 standard size steps with rail
  • plastic grocery bag holding 4lb/2kg weight

Training:
Training may be provided by the authors as a half-day workshop. There is a training DVD available in English for a cost of $29.00 Canadian including shipping. Only cheque or money orders are processed.

Alternative forms of the CAHAI

CAHAI-7, CAHAI-8, CAHAI-9

Client suitability

Can be used with: Clients with stroke.

Should not be used in: To date, there is no information on restrictions of using the CAHAI.

In what languages is the measure available?

English, French, German, Hebrew, Italian