chapter 8 81
PREVENTION AND EARLY MANAGEMENT OF CONTRACTURES
Contractures can often be prevented by (1) positioning, and (2) range-of-motion
exercises.
cp
POSITIONING
If a child is likely to develop contractures or has begun to develop them, try to position
her to stretch the affected joints. Look for ways to do this during day-to-day activities: lying,
sitting, being carried, playing, studying, bathing, and moving about.
During a severe illness (such as acute polio), or a recent spinal cord injury,
contractures can develop quickly. Therefore, early preventive positioning is very
important:
CORRECT
Lying and sleeping straight
helps prevent contractures.
Put a pillow
between
legs to hold
knees apart.
CORRECT
WRONG
Also use pillows for
side-lying to keep a
good position.
Lying and sleeping with the
legs in a twisted or bent
position causes contractures.
Letting feet
hang over
edge helps
prevent ankle
contractures.
Lying part of the time face
down helps stretch hips
backward.
A pillow here
helps stretch
knees.
A foot board helps
to prevent ankle
contractures.
The foot support can be
leaned forward a little so
that the child can stretch
his feet by pushing against
it. (Be sure to pad it.)
Support
feet at
right
angles.
leg separator
if needed
If knee contractures might
develop, keep the knees
straight as much as possible.
WRONG
A child who spends most of the time sitting should spend
part of the day lying or standing (on a frame if necessary).
This will help prevent contractures of the hips and knees.
BETTER
BEST
Foot hanging
can lead
to tiptoe
contractures.
foot lifts
Figure out ways to help the child stay
in contracture-preventing positions.
child-sized furniture
For a child with spasticity whose legs press together or cross, look for
For more examples of ways to prevent
ways to sit, lie, or carry him with his legs separated. Here are a few examples. ‘knock-knee’ contractures, see p. 100.
For more ideas about special seating and positioning, see Chapter 65.
disabled village children