chapter 8
EXAMINING THE CHILD FOR CONTRACTURES
This is done through testing the ‘range of motion’ of different joints, as described
on p. 27 to 29. Most contractures will be obvious when you test for them. But hip
contractures can easily be missed.
This child can lie with his
right leg almost flat…
But if you test him with
his other knee bent up to
his chest...
Be sure to test for
contractures with the leg
lined up straight.
like this
79
…by arching his back. You
might think he has little or
no hip contracture.
... his back flattens and
you can see the amount of
contracture.
not like this
Also be sure joints do not dislocate when you test for contractures, because this can fool
you, too. For example:
This child’s
foot can
rest
on the
ground,
only
because it
dislocates
sideways.
tight
heel
cord
If you hold the foot so
it does not dislocate,
you will see that the
ankle has a severe
contracture.
How to tell contractures from spasticity
Spasticity (muscle tightening that the child does not control) is common when
there is damage to the brain or spinal cord. (See p. 89.) It is sometimes mistaken for
contractures. It is important to know the difference.
SPASTICITY
of ankle
joint
If at first it
resists under
steady pressure,
and then it
slowly yields,
it is probably
spasticity.
CONTRACTURES
of ankle
joint
If it resists
under steady
pressure,
and does
not yield, it
is probably a
contracture.
Spasticity often leads to contractures. For details, see p. 102 and 103.
MEASURING CONTRACTURES
This can be done by folding
a paper and measuring the
angle, as shown here,
and then tracing that angle
onto a record sheet.
You can record your
measurements with
stick figures.
Or an easier, more
fun way is to use a
flexikin (see p. 43).
Or use a ‘compass’.
Or make a simple instrument of
2 thin pieces of wood joined by
a bolt or rivet, tight enough so
that they move stiffly.
By keeping a record of
their child’s progress,
a family can see the
results and is more
likely to keep working
hard at exercises
to correct a child’s
contractures.
cp
disabled village children