Position of client supported seating system for classification of left side
Position of client sitting at table
for classification of right side
Set Up
Position of client
The client is seated in a chair at a table. The size of the chair must be such as to allow the client to have their feet on the floor and their bottom at the back of the chair. The table top should be approximately at waist height. If the client is not able to sit independently without support they can remain in a supported seating system; sit with support from a therapist or carer; or where appropriate sit on the lap of their parent or carer.
Objects to elicit wrist and hand movement
It is essential that objects of an appropriate shape and size are used to elicit movement of the wrist, fingers and thumb. The object should be spherical in shape and approximately the size of the client’s fist. Examples of objects (an apple and a ball) used to elicit wrist and hand movement are pictured.
The use of spherical objects (apple and ball) to elicit wristand hand movement for classification using the NHDC.
Position of object
The object is placed at a forearm’s distance from the edge of the table in the midline in front of the client. A “forearm’s distance” is the distance from the client’s elbow to wrist crease. The position of the object is important to avoid excessive reach. If the object is too far away, movement of the shoulder, elbow and forearm can compensate for a lack of wrist and finger motion.
If the client is in a supported seating system with a tray, the object can be placed on the tray. If the client is sitting with support from a therapist or carer the object should be placed on a stable surface in front of them.
Position of camera
If the client’s wrist and hand movement is to be videorecorded, the camera is placed one metre from the non-classified side of the client. The camera height should be level with table surface height. The camera zoom is used to focus on the wrist and hand. The wrist and thumb must be visible to capture the wrist and hand movement in action (see below).
Instructions
Once the client and camera are correctly positioned, place the object in front of the client. Ask the client to start with their hand on the edge of the table/tray in front of them before asking them to pick up and put the object down. This action may be repeated three times so that a consistent classification of hand deformity can be made. It is appropriate to explain to the client that you are only observing how the client’s wrist and hand muscles work together, not how successful they are in grasping and releasing the object.
Important points to remember
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It is the observation of wrist and hand movement in action that is important.
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Objects are used to elicit movement.
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Objects, as pictured, may be substituted with similar objects provided the objects used do elicit the movement required to classify hand deformity.
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An extended or flexed wrist position is taken from the neutral wrist position of 0°, as pictured in Figure 1.
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The success or type of grip observed is not relevant for classification.