How do you prevent contractures

What is a contracture?

What measures are there to avoid contractures?

In most specialist books you will only find the two keywords “mobilization” and movement. This is surely correct, as the only way to avoid contractures is to move. This applies to all joints in the body. I would like to describe the measures here in more detail, so that you know how you can put mobilization and movement into practice. It is important to know that the prophylactic measures should be carried out 4-6 times per shift. This is the only way to effectively avoid contractures in nursing. You are probably thinking right now when you can take so much time for a resident. Think about what activities you still carry out during the day for the resident concerned. Often you can achieve a lot with just a few simple steps and link one task to the other.

1. Physiotherapy

In general, the consultation of a physiotherapist should be discussed with the doctor for every resident at risk of contractures. This is a good thing, especially for residents whose movement pattern has deteriorated. Many doctors are reluctant to do so because of the tight budget. Through physiotherapy and special exercises, the movement pattern is improved again, the resident has a better quality of life and contractures are avoided in the short and medium term

2. Promotion of self-movement

As far as possible, residents who are still mobile should be encouraged and motivated to take walks in the living area or within the facility. It often helps to point out and explain the dangers in mentally fit patients. With the in-house occupational therapy, special measures such as handicrafts, seated gymnastics and motor exercises can be discussed and planned. A hand or foot bath can help move your hands and feet. Since the hands are particularly at risk of contractures, it is advisable to put balls, washcloths, etc. into the resident's hands. You can then ask the resident to knead the object or the like. If necessary, this measure should be carried out under guidance or with the assistance of the PP if the resident can no longer cognitively implement this.

3. Avoid restraint if possible

Restraint is necessary for some residents due to the danger to themselves. You should really only use restraints if they are absolutely necessary. It should be checked regularly whether the fixation can be loosened or completely loosened. This gives the resident the opportunity to move more and the risk of contractures is reduced.

4. No need for a soft mattress or alternating pressure system

If the pressure ulcer risk is not too high, you should consider whether it makes sense to forego soft mattresses or alternating pressure systems. The deeper sinking in these mattresses restricts their own movements.

5. Storage

Care should be taken to ensure that storage is physiologically sensible. This can be achieved, for example, by not completely restricting mobility with pillows. Particularly when covering up, you should make sure that no pressure is exerted on the toes of the feet from above. Otherwise an equinus foot is promoted. Especially when it comes to equinus foot, it is advisable to place a pillow between the foot and the foot section of the bed so that the foot is upright in the bed. The foot should be angled about 90 ° as when standing.

6. Passive movement by the nursing staff

For residents who are bedridden, immobilized or no longer able to perform active movements, contracture prophylaxis is particularly important. Here the nursing staff takes on the active part of the work. The resident behaves passively. Every joint should be moved through at least twice a day, starting with the small to the large. It is essential to note that you must start with the small joints. When moving through the joints, the body is always kept close to the trunk (proximal) and moved away from the body (distal). For example, if you want to move the toe joints, you hold the foot on the verse with one hand and move the joints with the other hand. The stimuli on the joint from moving joints are preserved and the muscles are protected from atrophy. Shrinkage of the joint capsule is avoided.

Tip: Most of the measures can be perfectly planned for basic care