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In cerebral palsy, it is important that steps to prevent contractures be included in activities that help the total development of the child. Many of the corrective positions we have already suggested for activities such as lying, sitting, standing, and moving about are helpful in preventing contractures. When there are signs of developing contractures, give even more time and care to corrective positions.
Although the reasons contractures form in cerebral palsy and polio are different, many of the stretching and holding exercises discussed in Chapter 8, “Contractures,” and in Chapter 42, “Range-of-Motion and Other Exercises,” will be helpful. However, in cerebral palsy, take care to do exercises in ways that do not increase spasticity, but help to relax the spastic muscles.
RELAXING SPASTIC MUSCLES
To help relax spastic muscles, before beginning range-of-motion exercises try the following to see what works best for your child:
|1. Apply warm soaks to spastic muscles or have the child sit or lie in warm water.||2. Slowly twist or help the child to twist his body from side to side. This reduces spasticity throughout the body, and is a good first stretching exercise. Make it into a game.|
Slow, slow, over you go!
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In some countries, people and even therapists use massage, or rubbing, to try to relax spastic muscles. Although massage often helps relax muscle spasms, cramps, or tight muscles from other causes, in spasticity, massage usually increases the muscle tightness. As a general rule, DO NOT MASSAGE SPASTIC MUSCLES.
Pulling or pushing directly against spastic muscles causes them to tighten more. To correct abnormal positions, sometimes you can use ‘tricks’ to release or ‘break’ the muscle spasms.
Muscle tension in any part of the body is affected by the position of the head and body. Spasms that straighten the legs and pull the knees together can be partly relaxed by bending the head and back forward.
|Do not pick up the child like this. Her head will bend back and her whole body and legs stiffen more.||If you roll her a little to one side, it will be easier to bend her head and back forward. This relaxes her hips and legs so that they also bend.|
Whatever you do with the child, look for ways that will help relax and stretch the tight muscles. Here are some examples.
|Rosa’s body stiffens backward, while her knees straighten stiffly and press together.
To wash between her legs, do not try to pull her legs apart at the ankles.
This will make her legs pull together more tightly.
|Instead, put something under her head and shoulders to bend them forward. This helps to relax the stiffness in her whole body.
Then bend the legs and slowly separate them. If you hold them above the knees, they will open more easily.
|Washing will be easier with her knees bent. After washing her (with warm water, if possible) you can help stretch the tight muscles.|
Slowly open her legs as wide as they will go, and then gradually straighten her knees.
|When you try to feed the child, if her head and shoulders stiffen backward,||do not try to pull her head forward. It will push back more.
|You may find that her head relaxes more if you put your arm across the back of her neck and push her shoulders forward.||Or, you may find that raising the front of the chair seat keeps her hips bent, relaxes her in general, and gives her much more control.|
|When you want to help your child dress, if her arms press against her chest,||do not try to pull them straight. They will stiffen more.
|Try holding her arms above her elbows, and gently turning her arms out and straighten them at the same time.|
Note: These suggestions will work for some children but not for others. Keep trying different ways until you find what works best.