ADMINISTRATION
Classification of hand deformity is determined by observing the client’s wrist and hand in action during movement towards and attempted grasp and release of objects. The classification is based upon the analysis of active wrist and finger movement in relation to the extended or flexed position of the wrist.
Figure 1: The extended or flexed wrist position is determined from a neutral (0°) wrist position
2.2 REAL TIME CLASSIFIACTION OR VIDEO RECORDING
Classification of hand deformity can be made either at the time of live clinical observation or completed at a later time from recorded footage. Regardless of the timing of classification, it is recommended that the client’s wrist and hand movement be recorded. Footage of the individual client’s wrist and hand movement allows comparison of the details of their movement over time.
2.3 NUMBER OF ATTEMPTS
Observation of three attempts of wrist and hand movement in action may be required to make a classification. If there is variation in the different attempts of movement, classification is based upon the most consistent movement described during the three attempts.
2.4 CLASSIFICATION FOR YOUNG CHILDREN
For young children observation of the wrist and hand movement in action will be elicited through play. If the young child is not cooperating, consider slowly demonstrating the action that you want the child to complete, and engage the child in a game or ask the parent to demonstrate the action. The non-involved upper limb may need to be gently restrained to encourage movement of the limb for classification.
2.5 CLIENTS WITH LIMITED OR NO ACTIVE MOVEMENT
If the client is unable to approach, grasp or release the object on the table, the therapist must create a situation where attempted action of wrist and hand movement can be elicited and observed. This may be achieved by asking a parent or carer to present the object to the child. Observe any attempts of active movement noting the position of the wrist to determine classification level. If there is no active wrist or finger movement, the client will be classified as an E2 or F5 depending on whether the wrist is in an extended or flexed position.