Hesperian Health Guides

Contractures in Cerebral Palsy

Abnormal muscle tightness often leads to contractures (muscle shortening and reduced motion of joints). In time, the muscles that keep a limb bent become shortened so that the limb cannot straighten even when the muscles relax. But with care, contractures can often be prevented.

Without care to prevent it:
(Uncontrolled tightening of muscles ——— > (Fixed shortening of muscles)

The typical contractures of cerebral palsy are similar to the abnormal positions of cerebral palsy. They can include:

a list of typical contractures
neck contractures that pull the head back or to one side
sway back
bent-hip contracture
bent-knee contracture
‘tiptoe’ contracture
An arm and hand that are always bent may cause contracture of elbow and wrist.
‘knock-knees’ contracture
Ankle and foot contractures may bend IN, DOWN, UP or OUT depending on the spasticity.
DVC Ch9 Page 101-2.png
Stretching the knees apart you can see and feel the very tight cord in the groin.

Chapter 8 discusses contractures, and ways to prevent and correct them. See how to tell spasticity from contractures.

Spasticity and contractures combined

Decreased range of motion may be caused partly by spasticity and partly by contractures. Therefore, whenever a child has spasticity, check to see if contractures are also forming, and if so, how much.

This girl with cerebral palsy has spastic muscles that hold her knees tightly together.
a child with spasticity and contractures
When she is helped to relax and her legs are slowly separated, they will only open this far.
Normally her legs should open this far. This means she has contractures on the inner side of her thighs (groin).
One way to record spasticity and contractures:
stick figure drawings record spasticity and contractures
You can use a flexikin to record the positions. DVC Ch9 Page 101-5.png

This page was updated:21 Nov 2019