Hesperian Health Guides

Prevention of Secondary Problems

We have already discussed some ways to prevent new problems or complications in a child with paralysis. In summary, important measures include:

  • Prevent contractures and deformities. Begin appropriate range-of-motion exercises as soon as the paralysis appears.
  • At the first sign of a joint contracture, do stretching exercises
    2 or 3 times a day—-every day.

Stretching exercises work better if you stretch the joint firmly and continuously for a few moments,

a woman pushes on a child's thigh and lifts her ankle
steady push
steady lift

... instead of ‘pumping’ the limb back and forth.

a woman pumps a child's leg at the knee
We emphasize this point because in many countries parents are taught the pumping method—which does very little good.

For more details, see “Contractures,” Chapter 8.

  • Evaluate the child’s needs regularly, and change or adapt aids, braces, and exercises to meet her changing needs. Too little or too much bracing can hold the child back or create new problems.
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  • Be sure crutches do not press hard under the arms; this can cause paralysis of the hands.
  • Try not to let the child’s physical disability hold back her overall physical, mental, and social development. Provide opportunities for her to lead an active life and take part in games, activities, school, and work with other children.


Marcelo Acevedo was disabled by polio. He and his family lived in a village 2 days from the closest road. Village health workers from Project Piaxtla helped Marcelo get surgery for his knee contractures. After surgery he got braces and went to school. Then they trained him as a village health worker, and he returned to serve his village.

Marcelo at age 4, sitting with his older brother who was temporarily disabled when a tree fell on his leg.
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Marcelo training at Project Piaxtla.
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DVC Ch7 Page 76-3.jpg When PROJIMO was formed, Marcelo joined as a village rehabilitation worker. He studied brace-making as an apprentice in 2 brace shops in Mexico City.
Marcelo making a plastic leg brace.
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Marcelo and other villagers make a plaster body mold of a young boy’s chest. The child had polio and has a severe curve of the spine. With his plastic body brace, made by Marcelo, the child can sit much straighter.
Marcelo is now one of the leaders in PROJIMO, and has gained the respect of the whole village. He has recently married a village woman.

This page was updated:21 Nov 2019