Management of Spasticity and Contracture in Elderly (I) – Physiotherapy
What is Spasticity and Contracture?
Spasticity
Spasticity is a common condition in the elderly who is suffering from stroke, head or spinal cord injury. It is induced by over-activity of muscles when the central nervous system is damaged. It is characterized by muscle stiffness, impaired range of movement and muscle strength which may affect the patients' mobility and self-care abilities. Furthermore, if the muscle remains in a spastic status, the chance of developing contracture could also be increased.
Contracture
Contracture is common in the elderly with impairment of functional ability. Following a long period of immobilization, contracture will emerge due to shortening and loss of flexibility of the muscles, ligaments and other connective tissues surrounding an inactive joint, leading to an impairment of range of movement. Without proper interventions, the condition will deteriorate and progress into irreversible damages; such as causing permanent fibrotic changes of surrounding connective tissues and damage of the cartilage, ending up with stiffness and joint deformity that seriously affects the patients' mobility and activities of daily living. The major risk factors related to development of contracture include immobility, being bedridden, or spasticity induced by neurological diseases or injuries of the central nervous system.
Physiotherapy for Spasticity and Contracture:
Through guidance of physiotherapists, carers and the patients can practise the following physiotherapy skills effectively and safely so as to improve joint mobility and prevent deformity:
| Positioning: | The risk of developing contracture and pressure sores, and severity of spasticity can be reduced by using pillows with good support, adopting proper positioning for sleeping and sitting postures, and changing position regularly |
| Rehabilitation exercises: | Mobility can be improved by active participation in rehabilitation exercises such as muscle strengthening, balance training exercises and functional training |
| Stretching: | Apart from improving the flexibility of muscles, ligaments and corresponding connective tissues, stretching is particularly important to patients suffering from spasticity in the early stage as it helps prevent shortening of tendons and attenuate spasticity |
| Passive joint mobility exercise: | Passive joint mobility exercise, administered either manually or through specialized equipment, can help maintain range of movement of joint by increasing the flexibility of muscles, ligaments and the corresponding connective tissues |
| Electrical therapy: | Electrical therapy applied together with appropriate rehabilitation exercise can reduce spasticity, joint and muscle pain, and prevent or delay loss of muscle strength |
| Heat therapy / Cold therapy: | Heat therapy can help reduce spasticity and soothe chronically painful joints. Cold therapy is used in acute joint inflammation (i.e. the affected part is red, hot, swollen and painful). You can also refer to the pamphlets "Home Physiotherapy Series: Heat Therapy" and the "Home Physiotherapy Series: Cold Therapy" |
Points to be noted for the Carers
- Carers should take extra precautions on manually handling the patients; the movement and force applied should be gentle enough that you should feel only a slight stretch or mild resistance. Avoid forcefully pulling on their limbs; it may lead to pain and even fractures.
- Prevention is better than cure. Once contracture has been developed, it is very hard to be reversed. Hence, it is important to prevent it by proper caring skills and rehabilitation.
- Through guidance and training by physiotherapists, carers can safely and effectively apply the above different skills of physiotherapy so as to enhance the effectiveness of the patient's home rehabilitation programme.