Mum is in 7th year of vasD and immobile now. We have noticed (and the care home staff have reported) that although she looks relaxed sitting in a chair, her arms and legs are completely rigid - for instance if we tell her to bend her knee so that we can lift her feet onto the wheelchair footrest, her legs are completely stiff and unyielding, and it's totally impossible to bend them. Ditto problem trying to get her arms into a cardi. This is a recent problem, and I was wondering if anyone else has experienced this, or should we maybe get GP to check her over?
Rigid Limbs?
- Thread starter mrsapple
- Start date
Hallo mrsapple (what a nice name!), I think this is called "contractures". My Mum has been immobile in bed for a year and she cannot move her legs by herself anymore. I think it must be something to do with brain function as well as the severe arthritis she has.
She can still move her arms but the range is limited and they are stiff too. I should have been exercising them more for her - you can gently extend them back and forth. Her legs are too painful to move at all. I think what also happens is that the hands can form a fist and the nails stick into the palm of the hands. I have read that you can get foam handles for this so I am going to look them up.
She can still move her arms but the range is limited and they are stiff too. I should have been exercising them more for her - you can gently extend them back and forth. Her legs are too painful to move at all. I think what also happens is that the hands can form a fist and the nails stick into the palm of the hands. I have read that you can get foam handles for this so I am going to look them up.
Worth while mentioning it to the GP but it is a common problem.
I had to get rid of anything that required arms to be put into sleeves, first arm difficult, second arm nigh impossible, and only use 'over the head' tops.
Feet that refuse to be at anything other than right angles to the leg also means wide leg trousers with the hems firmly stuck down with Wondaweb or similar so that toes don't catch,putting socks on first helps.
I had to get rid of anything that required arms to be put into sleeves, first arm difficult, second arm nigh impossible, and only use 'over the head' tops.
Feet that refuse to be at anything other than right angles to the leg also means wide leg trousers with the hems firmly stuck down with Wondaweb or similar so that toes don't catch,putting socks on first helps.
I found this on the internet which explains what a contracture is:-
A contracture is a chronic loss of joint motion caused by shortening of a muscle or tendon. In late stage Alzheimer’s disease, contractures of the knees, elbows, and hands form mostly from lack of movement- enhanced by neurologic changes in muscle tone making joints more resistant to passive movement.
Many people in the later stages of Alzheimer’s disease sit… a lot. They stay in one position with their knees and elbows bent. Frequently, if they are seated in a wheelchair with sling upholstery and poor pelvic support, their thighs and knees touch. They may even pull their arms in tight against their chest if they feel cold. Sitting in this position for several hours, and then being transferred back to bed curled up in this same position, leads very quickly to limited joint movement. This makes it very hard to clean, feed, and dress someone whose limbs don’t move well.
Prevention of contractures is easy, but it requires diligence and consistency. Simple range of motion exercises- moving the elbows, fingers, wrists, shoulders, knees, and ankles to the limits of their range- will prevent contractures and painful stiff joints. If someone becomes resistant to range of motion, which is common if a person is confused or in pain, then there are ways to “trick” them into active movement that can be helpful. We’ll save those techniques for another post.
A good wheelchair with appropriate limb, trunk, and pelvic support, and physical activities that engage the person to reach, shift position, or use his or her hands can make a tremendous impact. Frequent range of motion, encouraging extension in bed, and providing medication or modalities for pain modulation can be all it takes to prevent contractures.
A contracture is a chronic loss of joint motion caused by shortening of a muscle or tendon. In late stage Alzheimer’s disease, contractures of the knees, elbows, and hands form mostly from lack of movement- enhanced by neurologic changes in muscle tone making joints more resistant to passive movement.
Many people in the later stages of Alzheimer’s disease sit… a lot. They stay in one position with their knees and elbows bent. Frequently, if they are seated in a wheelchair with sling upholstery and poor pelvic support, their thighs and knees touch. They may even pull their arms in tight against their chest if they feel cold. Sitting in this position for several hours, and then being transferred back to bed curled up in this same position, leads very quickly to limited joint movement. This makes it very hard to clean, feed, and dress someone whose limbs don’t move well.
Prevention of contractures is easy, but it requires diligence and consistency. Simple range of motion exercises- moving the elbows, fingers, wrists, shoulders, knees, and ankles to the limits of their range- will prevent contractures and painful stiff joints. If someone becomes resistant to range of motion, which is common if a person is confused or in pain, then there are ways to “trick” them into active movement that can be helpful. We’ll save those techniques for another post.
A good wheelchair with appropriate limb, trunk, and pelvic support, and physical activities that engage the person to reach, shift position, or use his or her hands can make a tremendous impact. Frequent range of motion, encouraging extension in bed, and providing medication or modalities for pain modulation can be all it takes to prevent contractures.
I've done the same as nitram and bought Mum nighties with button through fronts - I had to search on Amazon for them as her arms were too stiff and rigid to get into armholes easily. Better still, in the summer would be sleeveless as well. But this is not your problem yet.
It is the immobility which causes the shortening of the muscles, as your Mum is sitting in a chair with her legs stretched out, they have retained that position.
It is the immobility which causes the shortening of the muscles, as your Mum is sitting in a chair with her legs stretched out, they have retained that position.
Thank you all for the immediate replies!! Now that I've got a possible "diagnosis" I've been able to find out more about contractures online. I'm just astounded that the care home Senior who reported the problem to me seemed to have no idea what the cause might be - they are supposed to be dementia trained and must surely have come across this with others. I'll speak to her again about it on visit tomorrow. I've never seen any staff in the care home doing any sort of physio or gentle activity with residents. I hope it's not too late for me to try.
Please get your GP to see her! And have her bloods checked if possible.
"Contractures" are a semi-permanent bending of a limb, it is because the flexing part of the muscle is stronger than the straightening part (to simply) and is often seen after neurological damage such as strokes. What you describes sounds more like increased TONE of the muscle - where it is straight and having difficult to bend? You need to check and make sure that her calcium levels are normal. Please call your GP. TP is great at helping to point you in the right direction, but should never be used to make a "diagnosis".
"Contractures" are a semi-permanent bending of a limb, it is because the flexing part of the muscle is stronger than the straightening part (to simply) and is often seen after neurological damage such as strokes. What you describes sounds more like increased TONE of the muscle - where it is straight and having difficult to bend? You need to check and make sure that her calcium levels are normal. Please call your GP. TP is great at helping to point you in the right direction, but should never be used to make a "diagnosis".
It isn't that easy to prevent this happening and it is an ongoing struggle. My husband suffered his remaining knee being contracted in hospital after being unable to weightbear.
His fingers gradually curled inwards despite all the efforts the nursing home made with splints, balls etc. to prevent or delay it. Being a diabetic, He ended up with numerous pressure sores and infections and even a grade 4 pressure sore between thumb and forefinger. It is also difficult to get a sufferer with dementia to comply with excercise even if they are able to manage it which my husbands was certainly not.
His fingers gradually curled inwards despite all the efforts the nursing home made with splints, balls etc. to prevent or delay it. Being a diabetic, He ended up with numerous pressure sores and infections and even a grade 4 pressure sore between thumb and forefinger. It is also difficult to get a sufferer with dementia to comply with excercise even if they are able to manage it which my husbands was certainly not.
Following on from what Saffie has said, I recently asked the chiropodist (who cuts Mum's fingernails as well as her toe nails) why her nails appeared to be brown. She said that this was caused by her digging them into the palms of her clenched hands. The District Nurse said you could get foam handles to put there. I am not sure how well she would take to this but, doing a search online, these type of things are very expensive to buy and I'm not sure if they'd be worth it.
From what Saffie said, it doesn't sound like they worked. Has anyone had any success with them and what type did they use?
From what Saffie said, it doesn't sound like they worked. Has anyone had any success with them and what type did they use?
Foam handles could possibly be made out of that pipe cladding you can get from DIY stores. Wrapped in cotton wool or a fine foam and a gauze bandage wrapped round to keep it all together.
Pipe cladding stuff I mean
http://www.diy.com/search/PIPE INSULATION/Climaflex-Pipe-Insulation-22mm-x-13mm-x-1m-9273771
Just an idea I had, no experience if it would work
Sent from my iPhone using Talking Point
Pipe cladding stuff I mean
http://www.diy.com/search/PIPE INSULATION/Climaflex-Pipe-Insulation-22mm-x-13mm-x-1m-9273771
Just an idea I had, no experience if it would work
Sent from my iPhone using Talking Point
Changing the subject I used that piping to go along the edge of Allens desk as he kept catching his legs on the corner and making them bleed,
All advice much appreciated! Kkerr, the problem is her knees are in continual bent position when seated in an armchair, but they're not relaxed so that when she's put in the wheelchair it's impossible to lift them any more to put her feet on the footrests. There doesn't seem to be any movement in her ankles or elbows either. When she's lifted to her feet to move her, she doesn't straighten her legs but they stay bent at the knees. I'll speak to CH Senior staff again, and also find out who her GP is as it seems as though the Nurse Practitioner is the one who is called out to the CH if residents have probs.
Incidentally, "mrsapple" is from "Tales From the End Cottage" a book I read as a child, and still read regularly now - life seems so much simpler there!!!
Incidentally, "mrsapple" is from "Tales From the End Cottage" a book I read as a child, and still read regularly now - life seems so much simpler there!!!
It's never too late to try Mrsapple. Water helps too, it can be eaiser to bend limbs in water - I try and bathe daily to prevent this and allow passive water movement when I can't mobilise.
It is astounding that the CH Senior had no idea?
Best wishes
Sue
I can only repeat that so many things were tried with my husband but nothing prevented to progress of the contracture. All that could be be done was to limit the effect as far as possible but even that proved problematic as those who are familiar with my earlier thread will know. The nursing home and the GP called in Occupational Therapists, Physiotherapists and community nurses, all to no avail.
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This is really interesting and helpful I wish I had known about this site years ago when my dad was at earlier stages. He is at severe stage now and has contractures in his hands, one of which is clenched and his legs/feet are quite fixed in a straightened position. Also, his neck and spine have become quite rigid.
This causes all sorts of problems with care - washing/dressing etc. On top of this he is resistant to care - despite his overall frailty he still has strength in his arms and won't allow his arms to be straightened to dress him. As his skin is so fragile he gets repeated bruising and sometimes skin tears to his arms despite the best efforts of staff not to harm him. To add to all this, he often chokes on his food as his swallow reflex is poor and because he won't bend at the waist it is hard to get him into a position so that back slaps can be performed.
I don't recall anyone doing any therapy with him to minimise the risk of contractures but perhaps it's inevitable like others have said.
This causes all sorts of problems with care - washing/dressing etc. On top of this he is resistant to care - despite his overall frailty he still has strength in his arms and won't allow his arms to be straightened to dress him. As his skin is so fragile he gets repeated bruising and sometimes skin tears to his arms despite the best efforts of staff not to harm him. To add to all this, he often chokes on his food as his swallow reflex is poor and because he won't bend at the waist it is hard to get him into a position so that back slaps can be performed.
I don't recall anyone doing any therapy with him to minimise the risk of contractures but perhaps it's inevitable like others have said.
Hi. I know your post is very old but what “tricks” can you advise me to try with mum who is late stage Alzheimer’s. her arm is always bent and she says it hurts. The gpis just going to increase her fentanyl patch.
Look forward to hearing from you
Lin
I'm not sure I know what to suggest to help @LinofSC . I tried various things to get my Mum more comfortable as she had chronic pain in the first place. I bought some small pillows and placed one under her elbow, which was crooked, and she was lying rather painfully on her side. I think we tried to position her so that she wasn't leaning heavily on it but a little leaning backwards.
She was actually more comfortable on her back but that caused a sacral pressure sore. The carers should have warned me about that - at that early bedbound stage I knew nothing about the importance of changing position. Each time she was turned, we moved the pillow to the other side under the other arm. It was trial and error really to try to get her in a more comfortable position and I am not sure I ever completely succeeded. She found it distressing to be moved at all.
She was actually more comfortable on her back but that caused a sacral pressure sore. The carers should have warned me about that - at that early bedbound stage I knew nothing about the importance of changing position. Each time she was turned, we moved the pillow to the other side under the other arm. It was trial and error really to try to get her in a more comfortable position and I am not sure I ever completely succeeded. She found it distressing to be moved at all.
