Orthotic intervention considering hand deformity classification
Once the primary structures causing hand deformity have been identified, therapists need to determine the course of intervention/s, with orthotic intervention being only one potential option. It is essential that orthotic intervention includes clear understanding and description of the primary purpose of the orthosis (Garbellini, Robert, Randall, Elliott, & Imms, 2017).
Orthosis Considerations utilising the NHDC
‘Orthosis considerations’ utilising the NHDC identify orthoses that may be considered for each pattern of hand deformity. The Orthosis Diagram, accessed via the link below, is provided as a tool to facilitate therapists’ clinical decision making. It is essential that the choice of orthosis is individually determined and goal directed.
Clinical example
A client with an NHDC of F4 is portrayed in Figure 9 below. The client presented with a flexed wrist posture greater than 20° and active finger flexion. Active wrist and finger extension were absent. Comparison of previous clinical examination identified increasing loss of the client’s composite passive wrist and finger extension.
The dorsal/volar wrist and hand mobilising orthosis, as pictured for the same client in Figure 10, is designed to address passive range of motion deficit and is worn at night to provide a low load, long duration stretch to flexor compartment musculature. The orthosis can be serially adjusted over time to accommodate any changes in range of motion. After consistent night wear, for at least 6-8 hours in duration a day and a period of three months, it would be anticipated that the client’s passive range of motion would be greater than when orthosis wear commenced.
Wrist and Hand Othosis
F4 Classification