Hesperian Health Guides
Preventing Secondary Disabilities
So far we have talked mainly about preventing original or ‘primary’ disabilities, such as polio or spinal cord injury. But the prevention of ‘secondary’ disabilities is also very important, and is one of the main concerns of rehabilitation.
By ‘secondary’ disabilities we mean further disabilities or complications that can appear after, and because of, the original disability.
For example, consider a child with polio or cerebral palsy who at first is unable to walk. She gradually loses the normal range-of-motion of joints in her legs. Shortened muscles, called ‘contractures’, keep her legs from straightening. This secondary disability may limit the child’s ability to function or to walk even more than the original paralysis:
|This child, after polio, gradually developed contractures in her||The contractures (not the original paralysis) kept her from being able to stand or walk.|
foot and knee
|If the contractures had been prevented through early and continued range-of-motion exercises, the child would have been able to stand and walk.
Most contractures can be corrected. But it may take a long time and a lot of expense—perhaps even surgery. It is far better to:
PREVENT CONTRACTURES BEFORE THEY START
Because contractures develop as a common complication in many disabilities, we discuss them in Chapter 8. Range-of-motion exercises to help prevent and correct contractures are described in Chapter 42. Use of plaster casts to correct contractures is described in Chapter 59.
Many other secondary disabilities will also develop unless preventive measures are taken. Some examples are pressure sores in children with spinal cord injury (see Chapter 24), spinal curve in a child with a weak back or with one leg shorter than the other (see Chapter 20), head injuries due to seizures. Preventive measures for many other secondary disabilities are discussed in the chapters on the specific disabilities.
In several places we discuss problems or disabilities that are commonly caused by medical treatment or orthopedic aids. For example,
- The medicine for seizures, phenytoin, produces serious swelling of the gums in some children. This can partly be prevented by brushing the teeth regularly.
- Crutches that press hard under the armpit can damage nerves and gradually paralyze the hands. Shorter crutches, or lower-arm crutches (like those shown above) prevent this problem.
- Surgery is sometimes done to remove contractures that actually help a child to move or function better. So worse difficulties result. The benefits or possible harm of surgery should be carefully evaluated before it is done.
- Some braces or aids that help a child at first, may later actually hold her back.
To prevent these mistakes, it is essential to evaluate the needs of each child carefully, and repeat evaluations periodically. We must take great care to prevent further disability caused by treatment.
The first responsibility of a rehabilitation worker or parent, like the healer, should be to: DO NO HARM
In addition to secondary disabilities that are physical, others may be psychological or social (affecting the child’s mind, behavior, or place in the community).
Some disabled children develop serious behavior problems. This is often because they find their bad behavior brings them more attention and ‘rewards’ than their good behavior. Chapter 40 discusses ways that parents can help prevent tantrums and bad behavior in disabled children.
The biggest secondary handicap for many disabled children (and adults) usually comes from the lack of understanding and acceptance by other people. PART 2 of this book talks about how the community can be involved in taking a more active, supportive role in relating to the disabled and helping them to meet their needs. In PART 2 we also discuss what disabled persons and their families can do, in the community, to promote better understanding and prevent disability from becoming a serious handicap.
Prevention of secondary disability is a basic part of rehabilitation.