SPINA BIFIDA
PREVENTION and correction of contractures
Some children with spina bifida tend to develop contractures either because of
muscle imbalance (see p. 78) or, less often, because of spasticity (abnormal muscle
tightness). Contractures most often develop in the feet, hips, and knees. Range-of-
motion and stretching exercises, as discussed in Chapter 42, can help prevent and
correct early contractures.
171
CAUTION: Only do stretching exercises where there is stiffness or limited range of
motion. When joints are floppy, do not stretch them more where they already bend too
much. For example:
If the foot
do
YES But if the
avoid
NO
is stiff in
exercises
foot is
exercises
this to
floppy or
that would
position,
gradually
already
stretch it
bring the
bends up
even more.
foot up.
more than
(See p. 383.)
normal,
Because children with spina bifida have stronger muscles for bending than for
straightening the hips, they tend to develop hip contractures,
like this child. Stretching exercises (p. 385) and lying on the belly (p. 86) may help.
Also, make sure walking aids help correct rather than increase
the contractures.
angle of
contracture
Tight tendons
keep hip from
straightening.
Sometimes a
child stands
with hips
and knees
bent, partly
because his
feet bend up
too much.
This can lead to hip
and knee contractures.
This expensive metal ‘walker’
lets this child with spina bifida
‘walk’ with hips bent. It can
cause hip contractures and
make walking without aids less
possible.
Lightweight below-knee
braces that hold the
feet in a more firm
position may be all
the child needs to
stand straighter,
walk better—and
prevent contractures.
(See p. 550.)
When the child is changed to
parallel bars adjusted to the right
height, he walks more upright.
This helps prevent contractures and
increases the possibility of walking
without aids.
Do not let the child get fat.
Because the legs and feet of
a child with spina bifida are
weak, it is important that she
does not get too heavy. Even
for a child who does not walk,
moving will be easier if she is
not fat. Encourage her to eat
nutritious foods, but to avoid
a lot of sweets, fatty foods,
and sweetened drinks.
disabled village children