Classifications of patterns of wrist, finger and thumb deformities were originally developed by surgeons to select the most appropriate surgical intervention for individual patients (House, Gwathmey, & Fidler, 1981; Tonkin, Freitas, Koman, Leclercq, & Van Heest, 2008; Tonkin, Hatrick, Eckersley, & Couzens, 2001; Zancolli, 2003; Zancolli & Boyes, 1979; Zancolli, Goldner, & Swanson, 1983; Zancolli & Zancolli, 1981, 1984, 1987). Zancolli (2003) classified wrist flexion deformities, into one of three groups, based upon observation of degree of wrist flexion required to produce voluntary release of the fingers. House et al. (1981) developed a thumb deformity classification, with different static and dynamic components of thumb deformity described in four levels. 

 

Limitations were identified in the use of these surgical classifications to facilitate appropriate therapy treatment planning (Georgiades et al., 2014). The Zancolli classification is limited to patterns of wrist flexion deformity and does not include extension deformities, nor does it encourage the observer to consider the contributions of extrinsic and intrinsic finger and thumb musculature when describing deformity patterns. The House classification describes thumb deformity without reference to wrist position, whereas in surgical practice the wrist position and its impact on thumb deformity is considered prior to surgical intervention (House et al., 1981; Tonkin et al., 2008). A thorough search of the literature failed to yield instructions or guidelines for use of these classifications.

 

The Neurological Hand Deformity Classification (NHDC) was developed by Judith Wilton, occupational therapist, in recognition of limitations in the use of surgical classifications. The NHDC differs from these other classifications by observing dynamic movement of the whole hand and thumb, including flexion and extension deformities with concurrent thumb deformity. Clinical observations of consistent patterns of wrist and hand deformity during function in clinical practice (Georgiades et al., 2014; Wilton, 2003, 2013), the surgical classifications of spastic hand deformities in the wrist and fingers (Zancolli, 2003; Zancolli & Boyes, 1979; Zancolli et al., 1983; Zancolli & Zancolli, 1981, 1984, 1987) and patterns of thumb deformity (House et al., 1981) were utilised in the development of the NHDC.