Contracture Prevention After Spinal Cord Injury

WHAT YOU SHOULD KNOW:

Contracture Prevention After Spinal Cord Injury (Discharge Care) Care Guide

  • After a spinal cord injury (SCI), muscles, tendons, and ligaments may shorten. Shortening of a muscle, tendon, or ligament is called a contracture. Contractures result in less movement of a joint, such as your wrist, elbow, shoulder, or ankle. Joints are the places where your bones meet in your arms and legs. Contractures can begin developing as soon as one week after your spinal cord injury.

  • There are things you can do to help prevent contractures. You will be taught how to do range of motion exercises to help prevent contractures. Your family and assistants may also be taught how to help you with these exercises. Splints and other positioning devices may be used to hold your limbs in the correct position. Caregivers will teach you how to sit and lie down in ways that will help prevent contractures. Caregivers will also help you control spasticity. Spasticity is a condition causing your limbs (arms or legs) to move without your wanting them to. Your arms and legs may also resist being moved. Spasticity may lead to contractures.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

  • Caregivers may give you anti-spasm medicine to decrease muscle tone. This makes it easier to move your joints in their full range of motion.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

What can be done to prevent contractures?

  • Specially trained caregivers called physical therapists (THER-ah-pists) teach you and your family how to perform range of motion exercises. These exercises help prevent contractures.

  • Other caregivers, such as occupational (ok-u-PA-shun-al) therapists also help you use splints and other pieces of equipment called positioning devices. These devices hold your limbs in the correct position to help prevent contractures.

  • Making sure that you lie and sit correctly can help prevent contractures.

  • Caregivers also will help you control spasticity.

What are range of motion exercises?

Range of motion is how well each joint can move. These exercises help your joints move as well as they did before the SCI. These exercises cannot make your paralyzed muscles move on their own but they can help prevent contractures. You may need someone else to perform the range of motion exercises if you are unable to do them yourself. Most people have to perform range of motion exercises one time each day. You may need to do it two times if you have contractures. Ask your caregiver for more information about doing range of motion exercises. The following are general guidelines for doing range of motion exercises:

  • Move each joint in all its normal directions just past its natural tightness or until it is uncomfortable. Use only as much force as your physical therapist taught you. Do not force the motion unnaturally.

  • Repeat each motion 10 times or as many times as your physical therapist has instructed you to do.

  • Perform the exercises slowly so that you do not cause your muscles to have a spasm.

  • Tell caregivers if you cannot move a joint as much as before. You may need to perform the exercises more often.

What kind of splints might I need?

You may need to use one or more of the following splints:

  • Dorsal wrist splint.

  • Elbow extension (eks-TEN-shun) splint.

  • Wrist-driven flexor hinge splints.

  • Short leg brace.

  • Molded ankle/foot orthosis.

  • Scott-Craig brace.
There are many different kinds of splints. It is important to take good care of your skin under and around any splint. Take off the splint as often as your caregiver instructed. Look for signs of pressure sores developing like reddened or blistered skin. If an area is red but returns to normal color within 10 to 15 minutes, you can continue to wear the splint. If your skin does not return to normal within 10 to 15 minutes, do not put the splint back on. Then tell your caregiver about the problem. Do range of motion exercises when you remove the splint.

What is functional electrical stimulation?

Functional electrical stimulation (FES) is a treatment used to stimulate a muscle with electricity to make it move. Electrodes may be placed on your skin or put into your muscle during surgery. Electrical signals are sent to your muscles, which makes the muscle move. The electrical stimulus may help with some activities, such as sitting upright, finger movement, or walking. FES helps prevent contractures, decreases spasticity, and helps maintain muscle tone. Depending on the type of spinal cord injury that you have, you may not be able to use this treatment. Ask your caregiver if FES is a treatment that is right for you.

Can anything be done if a joint has started to contract?

Serial casting is a treatment that may be done to help your joints extend more. It may also stop your muscles from getting shorter. Casts are applied over joints. The casts will be applied, removed, and re-applied over several weeks. Each time the casts are removed and re-applied, caregivers will help your joints extend further. Serial casting may be an option to help reverse a contracture. The goal is that every three to five days caregivers are able to extend the joint a little more until the contracted joint returns to its correct length. Ask caregivers if serial casting can work for you if you already have a contracture.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. Accepting that you have a SCI is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a SCI.

  • You may want to join a support group. This is a group of people who also have a SCI. Ask your caregiver for the names and numbers of support groups in your town. You may contact one of the following national organizations for more information:
    • Paralyzed Veterans of America
      801 Eighteenth Street NW
      Washington, DC , 20006
      Phone: 1- 800 - 424-8200
      Web Address: www.pva.org
    • National Spinal Cord Injury Association
      1 Church Street, Suite 600
      Rockville , MD 20850
      Phone: 1- 800 - 962-9629
      Web Address: www.spinalcord.org
    • American Spinal Cord Association
      2020 Peachtree Road, NW
      Atlanta, Georgia , 30309-1402
      Phone: 1- 404 - 355-9772
      Web Address: www.asia-spinalinjury.org

CONTACT A CAREGIVER IF:

  • You see that a joint is beginning to contract.

  • You have trouble performing your range of motion exercises.

  • You are having problems with spasticity.

  • You have problems that may be caused by a splint or positioning device, such as:

    • Change in feeling, such as numbness, pain, or burning.

    • Color changes, such as fingers turning blue, red, or white.

    • Edema (swelling).

    • Signs of a pressure sore, such as redness, blisters, or skin breakdown

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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