Use of the Neurological Hand Deformity Classification in clinical practice for children with cerebral palsy: a case study approach.

Abstract

Introduction: The management of hand deformities of people with neurological impairment is complex and challenging. The use of orthoses to manage hand deformity in clinical practice continues despite low level evidence. Understanding the purpose of an orthosis supported by a biomechanical framework, the Neurological Hand Deformity Classification (NHDC), to identify deforming forces and how to resolve them with appropriate orthotic intervention may reduce controversy surrounding orthosis use.

Methods: Detailed case descriptions were used to demonstrate how the NHDC can be clinically applied to aid orthotic decision making. In the description of the participants presented, the use of the NHDC provided structure to: observe and classify the dynamic movement of the wrist and hand musculature; identify the dynamic forces causing deformity; and guide decision making for intervention strategies.

Results: The identification of the structures involved in the deforming forces on the hand and how orthotic intervention to resolve the deforming forces was guided by the NHDC is discussed. Context is provided regarding the reason, purpose and description of the orthoses used, and timing and dosage of wear is outlined.

Conclusion: The NHDC can form part of a comprehensive upper limb assessment to inform intervention decisions including upper limb orthotic intervention.