Contractures are painful, disfiguring deformities of the joints, caused by immobility, and often resulting in reduced range of motion. Muscles shorten when a person endures long periods of immobility. Infrequent use causes the muscles to become rigid or fixed. Joints do not move as freely or smoothly as they once did. Movement is painful when the joint is moved because the shortened muscles are being stretched beyond their ability.
Progression of Contractures
As contractures progress, a person loses all voluntary movement in the contracted joint. Bathing, dressing, and daily care become more difficult. It is harder to position a resident properly because the contracture creates pressure points that may lead to pressure sores
Symptoms of Contractures: The Four Stages
Contractures progress through four stages based on severity.
- Stage I contractures can develop in as few as four days.
- Stage II contractures develop after an additional week or two. Unfortunately, most contractures are not identified until they are at Stage III.
- Stage III contractures need many as 500 days (a year and a half) to work themselves out.
- Stage IV contractures exist when a nursing home resident’s muscles and joints are so stiff that the resident is folded into the fetal position.
Causes of Contractures
Joint movement is affected by age, body size, genetics, and the presence or absence of disease. The normal movement of the joints is called range of motion. Healthy people do range-of-motion movements many times each day during normal activities. Nursing home residents in long-term care facilities may not move each joint through its normal range each day. The muscles atrophy and eventually shrink leading to a reduced range of motion called a contracture.
Prevention of Contractures
For the prevention of contractures ask the nursing home staff about what type of exercises you can help the resident do. Check with qualified professionals before attempting new exercises or routines, and follow the general guidelines for exercises listed below. Encourage a nursing home resident who can still move independently to exercise frequently. Remind a nursing home resident with limited mental abilities when it is time to exercise in order to prevent contractures.
Nursing Home Staff and the Prevention of Contractures:
Nursing home staff members must exercise an immobile nursing home resident’s joints to prevent deformities. Nursing home staff should be trained to perform exercises on residents with various physical and mental conditions.
Active range-of-motion exercises are done independently by nursing home residents each day. Residents with limited mental ability may need reminders to exercise. Some may need to use stronger muscles and joints to exercise weaker ones. That’s O.K., as long as the exercises get done.
Range of Motion Exercises to Prevent Contractures
Active-assistive range-of-motion exercises may be started by the nursing home resident and completed with the help of a nursing home aide, or they may started by the aide and completed by the resident. A nursing home resident may use elastic bands, pulleys or other equipment to perform the exercise.
In passive range-of-motion exercises, a nursing home aide manually manipulates the joints of a resident who is physically or mentally incapable. Passive range-of-motion exercises should be performed two to three times a day to prevent contractures and deformities. These exercises maintain flexibility, but they do not strengthen muscle.
Preventative Exercises for Prevention of Contractures
Like pressure sores, contractures are much easier to prevent than to cure. Contractures are prevented by maintaining a resident’s range of motion. Range-of-motion exercises can be conducted without a physician’s order unless the resident has osteoporosis, severe arthritis or other joint or bone-related illnesses.
Range-of-motion exercises prevent contractures and atrophy. Range of motion exercises stimulate circulation (thereby reducing the risk of blood clots), and they improve the resident’s general sense of well-being.
Guidelines for Range-of-Motion Exercises:
- Check with a medical professional before performing range-of-motion exercises with a resident who has specific movement limitations, osteoporosis, arthritic deformities, or healing fractures.
- Do not exercise the resident’s neck without a physician’s order.
- If the resident physically resists range-of-motion exercises or has very stiff joints, it may be helpful to perform the exercises in a bathtub or whirlpool.
- Make enough space to accommodate a full range of movements.
- Position the nursing home resident on his or her back, in good body alignment, before beginning range-of-motion exercises.
- Respect the nursing home resident’s dignity. Cover the resident and expose only the part of the body being exercised.
- Encourage and help the resident to relax.
- Talk to the resident. Explain the range-of-motion exercise before doing it, even if the nursing home resident is mentally confused.
- Perform each range-of-motion exercise at least three to five times. The more active, the better, though beware of fatiguing the nursing home resident or causing injury.
- Work systematically from the top of the body to the bottom.
- Support each joint during the range of motion exercise by placing one hand above and one hand below the joint.
- Move each joint slowly and consistently.
- Stop briefly at the end of each range of motion exercise before repeating.
- Avoid pushing the joint past a point of resistance.
- If the nursing home resident has a muscle spasm, hold the joint in position for a few seconds, applying gentle pressure.
- Stop the range of motion exercise if the resident resists or complains of severe pain.
- Stop the range of motion exercise if the resident’s condition changes.
- There may be a problem if the nursing home resident experiences pain, shortness of breath, sweating, or a change in color.
WHAT YOU CAN DO:
- Visit often. Residents who have frequent visitors are less likely to be ignored by staff.
- Ask your loved one how they are.
- When you visit check for signs of injury or loss of mobility in their hands or elsewhere.
- Don’t be afraid to look under the sheets for the presence of bedsores. Bedsores usually develop on the lower back or buttocks and frequently are found on patients with contractures.
If you find any signs of contractures, injury or abuse, immediately bring it to the attention of the facility. Speak to the nurses, ask them what they know. Remember to document everything.
About the Author
Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.