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DETERMINING CLASSIFICATION LEVEL
HEALTH PLANS

‘Wrist and finger movement considerations of the NHDC’ decision tree is designed to guide hand deformity classification.

‘Distinction between classification levels’ diagram can be found in the manual. It is designed to help observers understand how to differentiate between the categories of the classification.

The following observations of the client’s wrist and hand movement guide classification and help differentiate between levels:

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4.1 Wrist movement  
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  • Is active wrist movement present?

  • Is passive wrist movement present?

    • Is movement into wrist extension achieved through force of the hand on the object?

    • Is movement into wrist extension driven by tight finger flexors when grasping/attempting to grasp the object?

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4.2 Wrist position
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  • Does the wrist flex past neutral (0°)?

  • What is the wrist position during finger movement?

  • Is the maximal degree of wrist flexion greater than 20°?

  • Does the wrist remain in a static position of flexion or extension?

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4.3 Finger movement
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  • Is there active finger flexion
    and extension?

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If there is a variation of wrist position during observation of the client’s movement, the maximum degree of wrist flexion observed at any stage of the movement determines the classification.

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Once the movements have been observed the hand deformity classification can be determined and documented.

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