Contractures and Cerebral Palsy

Contractures

If we cannot fix it...

What can WE [nurses] do about it?

What exactly is a Contracture?

A contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged spasticity in a concentrated muscle, such as in the tightest muscles of people with conditions like spastic cerebral palsy.

Contractures are muscles or tendons that have remained too tight for too long, thus becoming shorter. Once they occur they cannot be stretched or exercised away.

My Patient

Pertinent Life History

• Born and Raised in Utah
• Mormon
• Family visits at least once a weak
• Has parents, siblings, nieces, nephews nearby
• Best Friend/Biggest Support: Golden Retriever

Demographics

Age: 33

Gender: Male

Race: White

"Contractures in Nursing Home Residents"

Published by Laura M. Wagner in Feb 2010 in the JAMDA

"Immobility is the common denominator in contracture development."

"...decreases functional ability, thereby increasing caregiving demands."

"With an increasing frail nursing home population, the incidence of contractures is likely to increase."

"...contractures become permanent sources of disability and disfigurement."

*A nurses work is likely to get more difficult

*It is permanent, prevention is vital

*Not just a problem for patient with cerebral palsy.

History of Present Illness

My Care:

• Cerebral Palsy
• Immobile due to Cerebral Palsy
• Came from his home
• Grew up living at home, may have become difficult to care for as he grew older...required more nursing care
• Expected to stay long term

Nursing Dx:

-Impaired Verbal Communication

-Risk for Disuse Syndrome

Nursing Interventions:

-Assess for quality of movement, ADL function, presence of spasms.

-Perform ROM exercises

-Assess condition of skin

-"No Lift" Policy

Caring Strategies

• patience in communication
• humor
• should have been more sincere
• should have listened more

PREVENT IT!

Spiritual Assessment

• LDS
• RM
• expressed concern about getting to Heaven, said he hates Satan and wishes he would just go away

Cause of Contractures:

Contractures are muscles or tendons that have remained too tight for too long, thus becoming shorter.

• Get the patient moving!
• ROM exercises
• Consistent Physical Therapy

What can we do if the patient already has contractures?

The only way to fix it is surgery to lengthen the muscle

However, if the patient has impaired mobility then contractures are likely to occur despite a nurse's best efforts, so there is not much you can do...

Contractures and Cerebral Palsy Study

"Characteristics of Associated Reactions in People with Hemiplegic Cerebral Palsy"

~Published July 22, 2021 in Wiley Online Library

"Associated Reactions": involuntary associated movements observed in people with neurological conditions

Spasticity: "motor disorder resulting from hyperexcitability of the stretch reflex characterized by exaggerated tendon jerks"

Contractures: "measured as loss of maximum passive joint range in a standardized position

"the relationship between associated reactions and spasticity, contracture, and coordination"

participants blinded

"Neither contracture nor coordination was associated with associated reactions"

"Associated reactions in this population were not strong enough to contract muscles into their shortened position for long enough to produce contracture"

Acute and Chronic Conditions

• Cerebral Palsy
• UTI nos
• Anxiety Disorder
• Dysphagia
• Contracture of Tendon

*Associated reactions do NOT cause contractures

*The only thing causing contractures in people with cerebral palsy is impaired mobility

*Nurses can definitely prevent contractures in people with cerebral palsy.

*Teach parents of children with cerebral palsy