102 chapter 9
PREVENTING CONTRACTURES
In cerebral palsy, it is important that steps to prevent contractures be included in
activities that help the total development of the child. Many of the corrective positions we
have already suggested for activities such as lying, sitting, standing, and moving about are
helpful in preventing contractures. When there are signs of developing contractures, give
even more time and care to corrective positions.
Range-of-motion exercises
Although the reasons contractures form in cerebral palsy and polio are different, many
of the stretching and holding exercises discussed in Chapter 8, “Contractures,” and in
Chapter 42, “Range-of-Motion and Other Exercises,” will be helpful. However, in cerebral
palsy, take care to do exercises in ways that do not increase spasticity, but help to relax
the spastic muscles.
RELAXING SPASTIC MUSCLES
To help relax spastic muscles, before beginning range-of-motion exercises try the
following to see what works best for your child:
1. Apply warm soaks (see
p. 132) to spastic muscles
or have the child sit or lie in
warm water.
2. Slowly twist or help the child to
twist his body from side to side.
This reduces spasticity throughout
the body, and is a good first
stretching exercise. Make it into a
game. (See p. 304.)
CAUTION
ABOUT MASSAGE
In some countries, people
and even therapists use
massage, or rubbing, to try
to relax spastic muscles.
Although massage often helps
relax muscle spasms, cramps,
or tight muscles from other
causes, in spasticity, massage
usually increases the muscle
tightness. As a general rule,
DO NOT MASSAGE SPASTIC
MUSCLES.
Pulling or pushing directly against spastic muscles causes them to tighten more.
To correct abnormal positions, sometimes you can use ‘tricks’ to release or ‘break’ the
muscle spasms.
Muscle tension in any part of the body is affected by the position of the head and body.
Spasms that straighten the legs and pull the knees together can be partly relaxed by
bending the head and back forward.
Do not pick up
the child like
this. Her head
will bend back
and her whole
body and legs
stiffen more.
WRONG
If you roll her
a little to one
side, it will be
easier to bend
her head and
back forward.
This relaxes her
hips and legs so
that they also
bend.
RIGHT
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