The Neurological Hand Deformity Classification for children with cerebral palsy
Melissa Georgiades1, Catherine Elliott, Judith Wilton
1Department of Occupational Therapy, Edith Cowan University, Joondalup, Western Australia, Australia.
Insights
The Neurological Hand Deformity Classification reliably tracks changes in hand deformities in children with cerebral palsy. Some children show no change, while others exhibit evolving patterns over time.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Developmental pediatrics
Background:
- Cerebral palsy (CP) frequently involves upper limb dysfunction, impacting hand posture and function.
- Hand deformities are common in children with CP, necessitating reliable assessment tools.
- Longitudinal data on the progression of hand deformities in pediatric CP populations are limited.
Purpose of the Study:
- To assess the reliability of the Neurological Hand Deformity Classification (NHDC).
- To utilize the NHDC to describe temporal changes in hand deformity in children with CP.
- To establish a baseline for understanding the natural history of hand deformities in pediatric CP.
Main Methods:
- Video analysis of upper limb tasks in 26 children with CP (aged 1-18 years) across multiple time points (3-8 sessions, ≥6 months apart).
- Classification of hand deformities using the NHDC by three independent observers.
- Statistical analysis of inter- and intra-observer reliability (Fleiss and Cohen's kappa) and investigation of temporal changes.
Main Results:
- High inter-observer (κ = 0.87) and intra-observer (κ = 0.91) reliability for the NHDC.
- Hand deformity was present in all participants at all assessed time points, including before age 2.
- No change in hand deformity classification was observed in 10 children; 8 showed increased wrist flexion, and 8 exhibited shifts between wrist flexion and extension.
Conclusions:
- The NHDC is a reliable tool for classifying hand deformities in children with cerebral palsy.
- Hand deformities can be present early in life and may remain stable or change over time in pediatric CP.
- Regular monitoring of upper limb involvement in children with CP is recommended due to potential changes in hand deformity.
Background/Aim:
The purpose of this study was to evaluate the reliability of the Neurological Hand Deformity Classification and use it to describe changes in hand deformity over time in children with cerebral palsy.
Methods:
We identified 114 video clips of 26 children with cerebral palsy, aged 1-18 years (mean = 8.4, SD = 4.2), performing upper-limb tasks at multiple time points (n = 3-8) at least 6 months apart. Using the Neurological Hand Deformity Classification, three observers classified hand deformity in the video clips. Inter- and intra-observer reliabilities were estimated using Fleiss and Cohen's kappa (κ) and the temporal changes in classification of hand deformity were investigated.
Results:
Inter- and intra-observer reliability respectively were κ = 0.87 and κ = 0.91. Hand deformity was identified in all children at all time points, even before the age of 2 years. Ten children did not change hand classification, wrist flexion increased in eight, and eight showed changes from wrist flexion to extension or vice versa.
Conclusions:
The Neurological Hand Deformity Classification is a reliable tool to classify hand deformity in children with cerebral palsy. For more than one-third of children hand deformity classification did not change. For the remaining children, two patterns of change in hand deformity over time were identified. It is recommended that children with cerebral palsy involving their upper limbs be monitored regularly.
Significance Of The Study:
This is the first study to document longitudinal changes in hand deformity in children with cerebral palsy.
