What is a contracture?
Increased muscle tone is commonly associated with Cerebral Palsy. This may impact an individual’s ability to stretch a muscle passively to its proper length. If sustained over time, this may have the potential to develop into what is known as a contracture. A contracture is a permanent shortening of a muscle-tendon unit resulting in a loss of functional range of motion (the ability of a joint to move). This may eventually restrict joint (e.g. the elbow) mobility and incur abnormal joint positioning.
How does it happen?
When a muscle is placed in a static position for a prolonged period, changes in the muscle fibres occur. There is a decrease in the number and length of muscle fibres in order to create a new, optimal, force producing length. In neuromuscular conditions (e.g. cerebral palsy), spasticity (the involuntary tightening of muscles) can result in a muscle imbalance across a joint, leading to abnormal positioning.
Why come to the Centre of Movement to see an Exercise Physiologist?
Here at the Centre of Movement, we view movement as fundamental aspect in a child’s development. Our team of Exercise Physiologists are qualified and trained to identify muscle imbalances that may have the potential to manifest into a contracture. Early intervention is key to reducing the risk.
A muscle imbalance across a joint (e.g. knees and/or hips) may be alleviated by implementing exercises that strengthen the opposing, lengthened/weakened muscles. In addition, targeted exercise and movement encourage the joints and muscles to undergo an increase in range of motion that may not normally occur during a child’s day-to-day activities.
See below for some easy tips and tricks to implement at home!
At Home-Prevention Strategies
Below are two easy to apply at-home strategies to help prevent contractures in children with cerebral palsy that may be used in conjunction with Exercise Physiology treatment.
Look for ways to position the affected joint(s) during day-to-day activities:
- Back Lying
- Pillow between legs to hold knees apart
- Padded footboard at the end of the bed to encourage a neutral foot position
- Side Lying
- Pillow under elbows for optimal arm and shoulder positioning
- Stomach lying
- Pillow under knees to encourage knee extension
- Blocks under feet to eliminate hanging and encourage a neutral foot position
- Being Carried
- Child’s legs either side of the person conducting the carrying
- Place the child on an inclined surface so the feet are orientated upward to stretch the calf muscles
Passive Range of Motion
- Movement applied to a joint solely by another person.
- Exercise all joints that the child does not move through normal range of motion during their day-to-day-activities.
- Research suggests a minimum of 10-mintues of passive range of motion per joint- the longer the better. In a busy world though, this may not be possible. So just remember that something is better than nothing!
- Do not conduct if pain or swelling is present or is triggered.
"Alone we can do so little; together we can do so much"
– Helen Keller