I cannot tell you what a relief it was to find your website. My mother has had Alzheimer’s for years, and no one has presented the practical information in any way HALF as cogently and helpfully as you have. I only wish I had discovered you years ago.
Here’s my question. My mother is in late stage Alzheimer’s, and is relatively healthy. But she began developing contractures (which we never knew were called that) about 6 months ago in one hand, and now the other. My Dad took her to doctors. They never MENTIONED this, only said, She doesn’t have arthritis. They gave him no guidance. So, not knowing what to do, he left it alone.
She does not appear to be in pain, but the twists are getting worse, and for all the reasons you mention.
If the contractures have already begun, will physical therapy of the type you mention be helpful, or is it too late?
We need to talk more about this topic.
There is some interesting dialogue in the physical/occupational therapy world about the effectiveness of splinting and stretching interventions for contracture management in neurologically impaired individuals (1, 2). The results of this systematic literature review raised some eyebrows… the conclusion being “Regular stretch does not produce clinically important changes in joint mobility…in people with neurological conditions.”(1).
But let’s drill down to the neurological condition that is discussed routinely on this site- Alzheimer’s disease. I would even include Parkinson’s disease in this discussion due to the increased rigidity and tonal changes seen in that population. Contractures in these diseases are generally caused by disuse. The reason for the disuse is neurological, relating to apraxia, initiation deficits, and the re-emergence of primitive movement patterns. In a stroke patient, by contrast, you usually have a direct blow to the sensory-motor cortex, causing changes in tone that can be severe and difficult to inhibit.
In progressive neurological disorders, contractures don’t usually present with a dramatic, sudden onset. Joints usually contract over time, as purposeful use of the extremities decline. Sustaining active range of motion through the use of reflexive behavior (If I toss this balloon to you, you will probably try to deflect it with an open hand), will keep joints moving longer. Once active elicitation of purposeful movement is impossible, passive range of motion, stretching, and splinting can maintain joints in a position that PREVENTS further contracture. Full range of motion for some folks may not be realistic, but a healthy range where the joint is able to extend far enough that the skin on the inner surface of the joint can stay dry and open to air is a reasonable goal. Moist skin hosts bacteria. Bacteria leads to odor, skin breakdown, pain, and infection. Contracture management strategies should address those possibilities.
There is no denying the lack of objective evidence supporting the improvement of joint mobility through regular range of motion exercises and splinting for someone with a neurological condition. But there is a case to be made for contracture prevention and pain management through regular stretching and splinting for the progressive neurological diseases. The hand is less painful the more it is moved. The act of putting the splint on and off mobilizes the joints. The hand is easier to clean and keep dry if it’s easy to open. Mobilizing and stretching tight fingers and wrists may not have the support of research for “clinically important changes in joint mobility”, but if you want to slow the journey toward frozen, painful, and deformed joints, my experience says to keep them moving and stretched.
Common positioning devices for contractures:
1. Katalinic OM, Harvey LA, Herbert RD. Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review. Phys Ther. 2011;91:11–24. Abstract/FREE Full Text
2. Lannin NA, Ada L.. Neurorehabilitation splinting: theory and principles of clinical use. (1):21-8. doi: 10.3233/NRE-2011-0628.