Why is my child Stiff and Inflexible?

From NNPDF Newsletter articles and family interviews.
This page is not intended as medical advice.
Consult with your physician before undertaking any treatment or therapy.

When the brain is affected in neurological degenerative diseases, the body may become more rigid and assume various abnormal positions referred to as postures. There are two type of postures which may be referred to, depending upon the site of damage to the brain and the appearances that the body position assumes.

Flexor posturing (decorticate posturing) refers to a body position in which the patient flexes one or both arms on the chest toward the chin, and may stiffly extend the legs with the toes pointing down. The elbows and the wrists are rigidly held in a flexed position.

Extensor posturing (decerebrate posturing ) refers to the body position in which the patient's arems are stiffly extended and internally rotated. The legs also may be stiffly extended.


What are contractures?

The term, contractures, refers to an abnormal fixation of a joint caused by a shortening of muscle fibers, atrophy (wasting), or immobility. The position the body is forced to assume due to the brain trauma may cause contractures to occur, leading to joint deformities and loss of range of motion.

It is important to try to maintain a normal range of motion in the event that functional movement may once again become possible.


Why should we be concerned about the occurrence and management of contractures in this early stage?

Early intervention may prevent more serious problems later. It is important to obtain the recommendations of a physiatrist (specialist in the field of rehabilitative medicine), an orthopedic surgeon, and a physical therapist and perhaps an occupational therapist as soon as possible if rigidity (stiffness) and contractures leading to joint deformity are occurring. Serial casting, splinting, and bracing may be recommended to prevent or reduce these problems.

Thoroughly investigate nonsurgical remedies for the prevention of joint deformities. Insist that nonsurgical techniques be used, if appropriate. Understand the application and removal of splints, and have all caregivers instructed. Follow the recommended schedule for splint application and removal; and check frequently for pressure points, skin redness, chafing or blistering.

In addition to contractures that may be a result of the stiffness which may occur after a trauma to the brin, subluxations, or dislocations of joints may occur. Subluxations and dislocations may be a result of the unremitting posturing.

Discuss the possibility of this condition thoroughly with your physicians, including any preventative measures which may be taken to keep subluxations and dislocations from occurring. Preventive measures may include the use of abduction wedges. These may be triangularly shaped, made of rigid or semirigid material, and covered with protective foam. A wedge may be placed between the legs to keep them separated. By keeping the legs separated, the hips may stay in their sockets. The wedge may help to counteract the pressure being exerted on the hip socket.

Other techniques which may be considered by the professional may be static or pneumatic splints for the hands, wrists, elbows, knees, ankles and feet.

Ask your physician for a consultation with an occupational and physical therapist or orthotist who is thoroughly familiar with tone-inhibiting casting and splinting techniques.


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