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78 chapter 8
Why is it important to know about contractures?
• Most contractures can be prevented through exercise and other
measures.Yet in many communities, at least half of the physically
disabled children already have contractures.
hand paralysis
with contractures
• Contractures make rehabilitation more difficult. Often they must be corrected before
a child can walk or care for himself.
• Correction of contractures is slow, costly, and often very uncomfortable or
painful.
• It is best not to let contractures develop, and if they do begin to develop, to
correct them as soon as possible. Early contractures often can be easily corrected
at home, with exercises and positioning. Advanced, old contractures are much
more difficult to correct, and may require gradual stretching with plaster casts, or
surgery.
For all these reasons . . .
Every family with a disabled child should understand
how contractures develop, how to prevent them, and how
to recognize and correct them when they first begin.
Muscle imbalance—a major cause of contractures
When the muscles that bend or pull a limb in one direction are much stronger than
cp those that pull it in the opposite direction, we say there is a ‘muscle imbalance’. When
paralysis, painful joints, or spasticity (see p. 89) cause a muscle imbalance, contractures
are much more likely to develop.
WITHOUT MUSCLE IMBALANCE—
CONTRACTURES LESS LIKELY
WITH MUSCLE IMBALANCE—
CONTRACTURES MORE LIKELY
cp
A leg that is completely paralyzed is
not very likely to develop contractures.
The knee may even straighten more
than normal.
If the muscles that
straighten the knee and
lift the foot are very weak,
Muscle imbalance causing contractures
can result from spasms, or spasticity,
that increase the pull of certain
muscles (cerebral palsy and spinal cord
injury).
muscles
equally weak
on both sides
no contracture
and
the muscles
that bend the
knee and lower
the foot are
strong,
contractures are very
likely to develop.
‘knock-knee’
contracture
of hips
For example, the
bent elbow and
crossed legs of
this child with
spastic cerebral
palsy can lead
to contractures
so that his
legs cannot be
spread apart
or his elbow
straightened.
To check for muscle imbalance, test and compare the strength of the muscles that bend
a joint, and of the muscles that straighten it. (See muscle testing, p. 30.)
Disabled village Children
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