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Spasticity and Contracture (II) – Occupational Therapy

Spasticity and joint contracture not only directly affect the self-care abilities of an elder but also pose challenges to their carers. If carers fail to apply appropriate caring skills and precautions, they could get both themselves and the elder injured.

Occupational therapists provide training to carers on the application of the following skills and assistive devices in their care delivery process. This can enhance the self-care ability of the elder and alleviate stress and challenges faced by the carers.

  Function and Purpose: Remarks:
Preventive Splintage (Figure One) Preventive Splintage (Figure One)

Figure One: Preventive Splintage

Two mechanical principles are applied in preventive splintage: "sustained" and "external traction"

Through appropriate design, fitting and choices of materials, preventive splintage provides continuous external traction to increase the flexibility and length of soft tissue and keep the joint in position

The splints are made by thermoplastic materials. Velcro and straps are added to keep the splints in appropriate position. Padding is also added to ensure comfort and prevent frictional wounds.

Wearing Time: Wearing for six to eight hours a day is generally adequate; excessive wearing time may not provide extra benefit

Method: Use the "slow" and "stop" approach; then keep the limb in extended position by the splint; do not overstretch. Make sure the direction of spintage is correct; do not reverse the position

Maintenance and cleaning: Wipe the splint by alcohol or diluted detergent;
Do not disinfect with hot water as it would result in deformity

Clothing Adaptation (Figure Two) :Clothing Adaptation (Figure Two)
Figure Two: Adapted Clothing
The shirt can be opened in the armpit seam and trousers can be opened from the waistline down the seam

Adapted clothing focuses on function and appearance, but also provides appropriate protection. They can help the elders to maintain their dignity. Through the use of special tailoring techniques, Velcro, widened trouser leg/sleeves and other methods, carers can help the elder to dress and undress more easily.

Key points for clothing adaptation:

  • Use simple tailoring techniques
  • Use existing materials
  • Understand the need of elders. Be sensitive and creative.
Daily Living Skills (Figure Three) :Daily Living Skills (Figure Three)
Figure Three: Daily Living Skills - One-handed dressing technique

Use adaptive dressing techniques and procedures. For example, for upper garment, put on the sleeve of the weaker / affected side first during dressing, and take off the sleeve of the stronger / unaffected side first during undressing

Choose light and loose clothing , pants with elastic waistband and shoes with Velcro fastenings

Pay attention to safety, especially when dressing and undressing pants in sitting position - place a chair at the affected side to provide support, maintain balance and prevent falls

  • A comfortable and relaxed position can help the elders to reduce their muscle spasms
  • Avoid pulling the arms/hands of the elder so as not to strain the muscles or cause dislocation of the shoulder, elbow or wrist joint
  • When assisting the elders to dress or undress, carers should not pull the affected limb forcefully. Stretch the affected limb first with "slow" and "stop" approaches
Assistive Device (Figure Four):Assistive Device (Figure Four)
Figure Four: Assistive Device - Seat Cushion

Assistive device is a device or appliance that helps to achieve a specific task in daily living

Choosing a suitable chair, cushion, bed, lifting and transfer devices for elders can improve their sitting posture. It can also assist the lifting and transfer process and reduce the physical exertion of carers

When using pressure relieving seat cushions, specially designed seats/ wheelchairs, lifting and transfer devices, there should be careful assessment and guidance before application. The following should also be paid attention to:

  • the physical and mental state of the elder
  • the home environment
  • the carer's ability in caring for the elder