Hesperian Health Guides

Prevention of Contractures

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HealthWiki > Disabled Village Children > Chapter 27: Amputations > Prevention of Contractures


A child with an amputated leg does not use his leg normally. He usually keeps it bent, and he tends to develop contractures of the hip or knee (or both).

Therefore, special positioning and exercises are needed to prevent contractures and maintain full range of motion (see Chapter 42).

A child with contactures on limb that is amputated below the knee
Contractures here and here will need to be straightened before this child can be fitted with a limb.

POSITIONS

Encourage positions that keep the joints stretched, and avoid those that keep the joint bent.

CORRECT CORRECT WRONG CORRECT
Girl lying on belly on borad with wheels moving with the supprot of hands
Boy with above the knee stump lying on his stomach on wedge and supporting elbows.
Mother carrying uncomfortable child with above the knee stump held horizontally.
Mother carrying happy looking child with above the knee stump hanging downward.
WRONG WRONG CORRECT
Child with two above the knee stumps sitting awkwardly in front of TV with cushion behind him.
Child with one leg amputated above the knee and one below, lying flat on side, using one hand to play with toy.
Child with one leg amputated above the knee and one below, lying on side supported by shoulder, playing with one hand.
padded post
ONLY WHEN NECESSARY FOR MOVING ABOUT Child wheeling himself in wheelchair, with one leg amputated above the knee and one below. BETTER

(But it can still cause hip contractures.)
A girl in a wheelchair with a board that is keeping her amputated leg straight CORRECT
child in a homemade wheel chair that allows her to lay on her belly while moving around
If contractures have already developed, try to position the child in ways that stretch them.
A boy lying on belly as tire tube holds his amputated leg straight
car tire inner tube pulling joints straighter
A boy laying on his back with a water pail hanging from amputated leg with support of a cloth
weight

STRETCHING EXERCISES

Boy with both legs amputated above the knee lifting one stump up while lying on belly
boy with amputated legs walking on hands while a person holds his stumps up
Be sure hips are straight.
Boy liying on side lifting amputated leg up
child lying on back lifting amputated leg up


STRENGTHENING EXERCISES

Try to strengthen especially those muscles that straighten the joints, and those muscles needed for walking.

Child lying on table, one leg bent and other leg amputated below the knee with bucket pulling it down.
lift
weight
Boy lying on side with tube across upper legs, lifting leg amputated above knee.
strip of inner tube
Boy lying on stomach lifting leg amputated above the knee with weight wrapped around it.
sand bag or other weight


Girl sitting on stool lifting leg amputated below the knee, with band attached to stool.
Small child lying on stomach, kicking ball backward with above the knee amputated leg.
Girl on stool with both legs amputated below the knee, about to kick a ball.
Kick the ball with your stump.
Boy with legs amputated below the knees, kneeling, and man holding his shoulder speaking to him.
Don't let me push you backward.

WARNING! about walking aids

Boy standing resting bent stump with hand held crutch, boy with bent stump tied to pole.
Walking aids or artificial limbs, like these, that keep the stump bent may be useful until the child can get a limb that keeps the joint straight.


However, it is very important that the child do stretching and strengthening exercises daily if he uses a bent-joint aid.

Girl exercising, pole on stump.
With a well-fitted stump-in-socket limb, normal activity usually provides all the stretching and exercise that are needed.

Instructions for making simple stump-in-socket limbs using bamboo and other local materials are in Chapter 67.



This page was updated:21 Nov 2019