Contraction

[i ? hershey ?????]

I have an elderly resident who is severly contracted in her arms and legs. Her family is really upset over this, and the nurses say there is not much that can be done.

I know i'm not a mt yet, but is there anything I can do for her, or maybe someone can point me in the right direction so I can make a suggestion to her family.

ROM is basically out of the question, one leg is stuck straight, and the other is more or less at a 45 degree angle.

Her arms are across her chest and are difficult to move. I know this is a result of not moving enough in the past, but any help is appreciated.

 

[georgemaddenbarcelona]

klauss are you sure she's not posturing?

My friend Gina did this the night before she died. Her fingernails turned greyish/blue and she drew her limbs up and they stayed in a contracted state. The CNA said it was a sign of brain damage.
I massaged her that night anyway (I hadn't went to MT school yet), and she came out of it enough to tell me, "Only you, like sister," before she fell asleep again... she was on high doses of morphine for the pain. (Gina died the next morning of heart failure, she was 25.)

 

[CARLY MCKENZY (MATHS)]

klauss are you sure she's not posturing?

My friend Gina did this the night before she died. Her fingernails turned greyish/blue and she drew her limbs up and they stayed in a contracted state. The CNA said it was a sign of brain damage.
I massaged her that night anyway (I hadn't went to MT school yet), and she came out of it enough to tell me, "Only you, like sister," before she fell asleep again... she was on high doses of morphine for the pain. (Gina died the next morning of heart failure, she was 25.)

I'm pretty sure it's not posturing, she has been like this for a while,, and it is mentioneed as well in her chart. Of course the chart could be wrong. Thanks for the reply.

 

[rkive87]

Having worked in a nursing home in the past and in the PT department, ROM is nessessary as much as possible. While you may not be able to get a full range right away, with time, patience, and persistance you should be able to get some range back, especially in the arms. I am assuming this person is bedbound, is she at home or in a nursing home? If in a home, have they talked to the PT department or the DON about the person's condition? If they are at home, you could teach the family to do the ROM with out much difficulty. As with any regular client you may have, do not attempt to go beyond the range they may have already. The real key to getting ROM back for some one in this case is to do the exercises daily. If they are done for a while and not continued further, the condition will reverse as it was before. You had mentioned the legs being stiff also, while it may be difficult, I would still try to slightly flex the knee and the hip to the patient's ability. You would be amazed at what can be done in a short period of time with ROM. Hope this helps!

 

[Buster Brown]

Thanks dodab

She is at the nursing home, which is actually a assisted living with a small alzheimers unit. Being assisted living, we have no pt department, and most of the aids are not certified CNA's. So the likley hood of them doing any rom for her is unlikley becasue I don't think they know how.

I will mention it do the don, and will show the family how to do it, fopr when they visit. I usally only have her room maybe once or twice a week.

thanks again.

 

[blueberry89]

I have had good results using jostling during ROM exercises.

For example: I hold onto client's hand and gently jostle the arm while extending elbow/shoulder/wrist. This always seems to encourage a larger release.

Good Luck,
Noel

 

[hindi.girl]

contraction

I've worked many years with people who have contractures. Due to stroke, long illness, a fall, general weakness, wheel chair or bed bound, people develop these. Once started, it's next to impossible to lengthen the arm or leg because you must massage/excercise it all the time. There aren't enough people at Nursing homes to do basic cares for people, let alone excercise their limbs. Nursing homes are filled with people who have contractures. Once you become imobile, you are at great risk of having contracted limbs.