Contractures.
This impairment can be one of the most crucial impairment to prevent. They are a result of the muscle and tendon shortening. Due to the shortening of the muscles, joints become immobile. Unfortunately, these contractures can be permanent and cause excruciating pain when stretched. Prevention of contractures can be as simple as performing range of motion exercises passively or actively. Once contractures set in, they can be managed via positioning techniques, stretching, or bracing. Commonly contracted joints include hands, elbows, knees and hips.
Stretching the Hand, Wrist, and Elbow
For the patient whose wrist and hand are contracted, the first step is to separate the thumb from the rest of the fingers. By doing this, the other digits become easier to mobilize individually. Then if the wrist is in an extended position with the hand in a fist, first extend the elbow then try flexing the wrist in order to push the hand into an open position followed by further opening the hand. But if the wrist is is in a flexed position, open the hand then extend the wrist in order to place it on a flat surface, then further extend the elbow. |
Bracing for the Hand, Wrist, and Elbow
Notice that the thumb is separated from the other digits with the wrist in slight extension which promotes an open hand position. Some braces also come equipped with separators between fingers to prevent finger adduction contractures. Notice for the elbow that there is a dial to help control the angle of the joint and immobilize it there, effectively stretching it continuously. |