top of page
Clinical application

 

The NHDC is designed to guide consideration of the structures involved and enhance clinical decision making in the management of hand deformity. The NHDC should not be used in isolation to determine intervention for a client with neurologically-based upper limb impairment. “The Neurological Hand Deformity Classification” outlines the structural and functional movement impairments associated with hand deformity. Identification of the dominant muscles and forces driving the pattern of deformity are considered and can be used to guide further clinical assessment and clinical intervention decision making. A comprehensive assessment is essential when considering any upper limb intervention. Assessment of upper limb impairment should include observation of posture and movement patterns and measurement of passive and active range of motion (Wilton, 2013).

Clinical reporting
​

Having observed the client’s movement, a classification level (e.g. F2, F4 or E1) is recorded. The following are examples of how this information may be documented as part of a comprehensive report or communicated to relevant people involved in the client’s care.

F2 classification example:

 

The NHDC was used to classify (client’s name) left hand deformity at an F2 level. (Client’s name) remained in wrist flexion during the approach, grasp and release of objects and released objects to the table top with his/her wrist position flexed at 45°. During the observed movement (client’s name) demonstrated active wrist and finger extension on approach to the object.

F4 classification example:

 

The NHDC was used to classify (client’s name) right hand deformity at an F4 level. Objects were presented to (client’s name) while seated in their supported seating system, which included a tray. On presentation of each object (client’s name) extended their fingers in an attempt to grasp the object. His/her wrist remained at 70° of wrist flexion. No active wrist extension or passive movement driving wrist extension was observed. See the clinical example of a client classified with an NHDC level of F4 in section 11.1. In this case the information was used to prescribe an orthotic intervention as illustrated.

E1 classification example:

 

The NHDC was used to classify (client’s name) right hand deformity at an E1 level. (Client’s name) approached the object with their wrist in extension. Active finger flexion and extension was observed but the wrist remained in extension during grasp and release of the object.

This structure can be followed for other levels of the classification.
​

This information will be useful to:

​

  • Report the client’s wrist and hand movement in action during a task;

  • Maintain a record of the client’s wrist and hand movement in action over time in a consistent format;

  • Use the reported information for comparison with information gained from future use of the NHDC; and

  • Prompt the clinician to consider intervention strategies to match the client’s current level of active movement, for example if the client is classified with an NHDC F1 level, bimanual therapy or goal directed training may be an appropriate intervention to consider.

bottom of page