title: The Neurological Hand Deformity Classification for children with cerebral palsy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  This is the first study to document longitudinal changes in hand deformity in children with cerebral palsy.
authors.affiliation: Department of Occupational Therapy, Edith Cowan University, Joondalup, Western Australia, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Georgiades
authors.forename: Catherine
authors.initials: C
authors.lastname: Elliott
authors.forename: Judith
authors.initials: J
authors.lastname: Wilton
authors.forename: Eve
authors.initials: E
authors.lastname: Blair
authors.forename: Marie
authors.initials: M
authors.lastname: Blackmore
authors.forename: Simon
authors.initials: S
authors.lastname: Garbellini
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003943:Diagnostic Techniques, Neurological / Q000295:instrumentation*; D018450:Disease Progression; D004421:Dystonia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006226:Hand Deformities / Q000145:classification* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D009788:Occupational Therapy / Q000379:methods*; D015203:Reproducibility of Results; D014743:Videotape Recording; D014904:Western Australia
keywords: cerebral palsy; classification; hand deformity; occupational therapy; rater reliability