Maintaining/improving
range of movement
Preventing loss of range of movement is
a major part of the work of the orthotist
and physiotherapist, but should be
recognised and managed by every
member of the team. Contractures can
lead to pain, loss of mobility and
independence, loss of function and, in the
case of the hand, difficulties with hygiene
and, ultimately, tissue breakdown.
There is always the potential to lose
range and develop contractures in the
presence of muscle imbalance; this can
be caused by reduced or increased muscle
tone (spasticity). With increased tone,
materials need to be of sufficient rigidity
to resist the deforming forces and there is
higher risk of pressure problems. When
treating patients using rigid orthoses, a
pressure-monitoring diary should be
used to keep a check on skin integrity.
Nurses are involved in the 24-hour care
of patients, so can play an important role
in checking for pressure damage