Methods of Contracture Management in Nursing Homes

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Residents in long term care facilities or nursing homes are often elderly and frail, which limits their mobility and range of motion. Medical conditions, weakened muscles and brittle bones often prevent them from receiving an adequate amount of physical exercise. Many are bedridden and unable to ambulate, which leads to degeneration and increased stiffness in the joints, leading to contracture, when the hands, feet, legs or arms slowly start to pull in toward the body and stiffen there. Treatments and techniques employed by nursing home staff help prevent or slow such contractures in a nursing home environment.

Positioning

Make sure patients are positioned properly in chairs, wheelchairs or beds. Modification of beds or wheelchairs may help provide proper positioning, such as extra cushions, chair trays or head rests. Seating and positioning evaluation forms are often utilized to make sure everything is being done for the comfort and mobility of the patient.

Splinting

Application of splinting devices such as special boots, wrist cushions and pads are often utilized to help prevent contracture of the hands and feet in nursing home environments. Orthopedic supports are designed to prevent and treat contractures caused by immobility and are often made of lightweight and padded materials. Knee and elbow braces are fitted with removable and washable liners and come with hinges that allow range of motion while preventing muscles from contracting and freezing. Special boots and splints help prevent plantar flexion.

Exercise

Exercise helps prevent and reduce contractions. Nursing staff, aides and physical therapy staff should be aware of the signs of contractures, which can develop in less than a week. Severe contractures may take up to a year to be resolved so that proper motion is restored. Range of motion exercise is very important in the prevention of contractures. In the nursing home environment, nursing staff must take the time to exercise the joints of residents unable to move themselves. For example, passive range of motion of the wrists may involve gently rotating the wrist joint clockwise and counterclockwise, or gently rotating the shoulder joint by holding onto and bracing or supporting the joint of the arm of the resident while helping the arm move in a circle. Passive range of motion exercise should be performed two to three times a day. Alert residents should be encouraged to engage in active range of motion exercise on a daily basis or be reminded to exercise their joints.

Check with the individual's physician to determine individual patients' best range of motion geared for their conditions and abilities.

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