PREVENTION
For example, consider a child with polio or cerebral palsy who at first is unable to walk.
She gradually loses the normal range-of-motion of joints in her legs. Shortened muscles,
called ‘contractures’, keep her legs from straightening. This secondary disability may
limit the child’s ability to function or to walk even more than the original paralysis:
17
This child, after polio,
gradually developed
contractures in her
hip,
The contractures (not the
original paralysis) kept
her from being able to
stand or walk.
If the contractures had been
prevented through early and
continued range-of-motion
exercises, the child would have
been able to stand and walk.
foot, and knee.
Most contractures can be
corrected. But it may take a
long time and a lot of
expense—perhaps even
surgery. It is far better to:
PREVENT CONTRACTURES BEFORE THEY START.
Because contractures develop as a common complication in many disabilities, we discuss
them in a separate chapter (Chapter 8). Range-of-motion exercises to help prevent and
correct contractures are described in Chapter 42. Use of plaster casts to correct contractures
is described in Chapter 59.
Many other secondary disabilities will also develop unless preventive measures are
taken. Some examples are pressure sores in children with spinal cord injury (see Chapter
24), spinal curve in a child with a weak back or with one leg shorter than the other (see
Chapter 20), head injuries due to seizures (see p. 235). Preventive measures for many other
secondary disabilities are discussed in the chapters on the specific disabilities.
In several places we discuss problems or disabilities that are commonly caused by
medical treatment or orthopedic aids. For example,
• The medicine for seizures, phenytoin, produces serious swelling of the gums in
some children. This can partly be prevented by brushing the teeth regularly. (See
p. 238.)
• Crutches that press hard under the armpit can damage nerves and gradually paralyze
the hands. Shorter crutches, or lower-arm crutches (like those shown above) prevent this
problem. (See p. 393.)
• Surgery is sometimes done to remove contractures that actually help a child to move
or function better. So worse difficulties result. The benefits or possible harm of surgery
should be carefully evaluated before it is done. (See p. 530.)
• Some braces or aids that help a child at first, may later actually hold her back. (See
p. 526 to 529.)
To prevent these mistakes, it is essential to evaluate the needs of each child carefully,
and repeat evaluations periodically. We must take great care to prevent further disability
caused by treatment.
The first responsibility of a
rehabilitation worker or parent, like
the healer, should be to: DO NO HARM
disabled village children