Transferring patients with contractures can present unique challenges for caregivers and healthcare providers. Contractures are common in patients who have conditions that limit joint movement and flexibility, causing discomfort and restricting a person’s ability to perform everyday tasks. Understanding how to manage transfers safely and comfortably is essential for both patient and caregiver well-being.
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What are Contractures?
Contractures refer to a limitation in the passive range of motion (ROM) of a joint. This happens due to structural changes in the connective tissues surrounding the joints, including tendons, ligaments, and muscles. These tissues become stiffer, more fibrous, and less stretchy over time, leading to reduced mobility and pain. As a result, the affected joints, often around the knees, hips, and ankles, may remain in a bent or contracted position, which makes it difficult to move them.
In addition to the physical challenges, contractures can cause functional impairments. Tasks like dressing, eating, and bathing become more difficult. The stiffness can lead to postural deformities, skin pressure issues, and even intense pain in some cases. These complications further emphasise the importance of using proper techniques when transferring patients with contractures to avoid injury.
Knee contracture
Causes of Contractures
There are several factors that can contribute to the development of contractures. One of the most common causes is static positioning over long periods of time. When a joint, such as the knee, remains in a flexed position for an extended period, the tendons and surrounding tissues can contract, making it harder to straighten the joint. It’s critical to reposition the patient frequently to prevent contractures from worsening. Moving the patient, even if it’s just a slight adjustment, can help maintain the flexibility of the joints.
Certain neuromuscular diseases, like muscular dystrophy or cerebral palsy, can also lead to contractures. These conditions impair muscle function and coordination, often causing the muscles to stiffen and contract in ways that limit movement.
How to Transfer Patients with Contractures
When transferring patients with contractures, it’s important to adopt specific techniques and use assistive devices that ensure the patient’s safety, comfort, and dignity. The goal is to reduce the strain on the joints and avoid unnecessary pain.
Slings and Hoists
Slings and hoists are crucial tools for transferring patients with limited mobility. A properly fitted sling can help lift the patient smoothly and without undue stress on the joints, especially when the patient cannot move on their own. A hoist can gently raise and transfer the patient from one surface to another, such as from a bed to a wheelchair. When using a sling, it’s important to ensure that the patient is positioned correctly, with the legs and arms supported and the head and neck aligned.
Transfer Boards
Transfer boards provide a stable surface for patients to slide across from one place to another. They are particularly useful when transferring from a bed to a wheelchair, or from a wheelchair to a car. For patients with contractures, transfer boards help minimise the need for lifting, which can strain both the caregiver and the patient. When using a transfer board, be sure to support the patient’s body as they slide, ensuring that the joints are not forced into an uncomfortable or painful position.
Seating Solutions for Patients with Contractures
Providing the right seating is a key aspect of managing patients with contractures. The right wheelchair or chair setup can help reduce strain on the patient’s body, accommodate their condition, and provide them with better comfort during transfers and daily activities.
Key Seating Features for Contractures
Certain features in seating solutions can significantly improve the experience of transferring and sitting for patients with contractures. These features help reduce discomfort, prevent skin breakdown, and improve posture.
Back Angle Recline
This feature allows the back of the chair to recline, which can help accommodate the patient’s posture and reduce pressure on the hips, especially if they have contractures.
Adjustable Seat Width/Depth
A chair with adjustable seat width and depth can help ensure the patient’s body is positioned comfortably. The adjustable settings allow the caregiver to customise the seating to the patient’s body shape and size.
The Lento chair range features fully adjustable seat dimensions, without the need for tools, to allow carers to adjust seat dimensions quickly and easily.
The Lento care chair has adjustable seat width, depth and height
Negative Leg Angle
This feature helps to ensure that the legs are not extended too far, reducing strain on the knees and hips. This is particularly important for patients with knee flexion contractures.
The Lento Neuro features a negative leg angle as standard, to accommodate patients with neurological disorders who may have muscle contractures as part of their condition.
The Lento Care Chair can also be adjusted to create a negative legrest angle, by replacing the legrest with a tapered cushion and bringing the seat cushion forward.
Transferring a Patient with Contractures into a Chair
When transferring a patient with contractures back into a chair, it’s crucial to use proper techniques and seating adjustments to prevent discomfort and reduce strain on the joints. Since contractures can limit joint movement, caregivers should take extra care to accommodate the patient’s unique posture and flexibility constraints.
Positioning the Chair Before Transfer
Ensure the chair is positioned close to the patient to minimise movement during the transfer.
If using a hoist, make sure there is enough space to manoeuvre the patient safely into the chair without forcing the limbs into unnatural positions.
If a standing transfer is possible, ensure the patient’s feet are positioned securely, and provide support to guide them into the correct seating position.
Using a Negative Leg Angle for Knee Contractures
Patients with knee flexion contractures may struggle to fully extend their legs when seated. A chair with a negative leg angle allows the lower leg section to be adjusted downward, preventing unnecessary pressure on the knees.
Before transferring, adjust the footrests and leg supports to match the patient’s natural knee bend, reducing strain during and after the transfer.
Adjusting the Back Angle for Hip Flexion Contractures
Some patients may not be able to sit upright due to hip flexion contractures. A back angle recline feature allows the chair to accommodate their posture by opening the hip angle.
Before lowering the patient into the chair, slightly recline the backrest to prevent forcing the hips into an uncomfortable position. Once the patient is seated, fine-tune the recline angle as needed for comfort and support.
Accommodating Knee Flexion with Seat Depth and Positioning
A patient with knee contractures may not be able to sit fully back in the chair due to their leg positioning. Reducing the seat depth ensures that they can be properly supported without excessive pressure on the back of the knees.
During the transfer, guide the patient’s hips as far back as their range of motion allows, then adjust leg supports to keep the knees comfortable and stable.
Final Adjustments After Transfer
Ensure that the patient’s weight is evenly distributed and that no excessive pressure is placed on the joints.
Adjust cushions, lateral supports, and footrests to maintain comfort and alignment.
If needed, use additional support aids to prevent pressure sores and improve posture.
By tailoring the chair’s settings before and after the transfer, caregivers can ensure a safer and more comfortable experience for patients with contractures, reducing the risk of pain and injury.
Summary
Transferring patients with contractures requires careful attention to technique and the use of proper assistive equipment. By utilising hoists, slings, transfer boards, and customisable seating options, caregivers can reduce the risk of injury and discomfort for the patient. Additionally, maintaining proper seating solutions that accommodate the patient’s specific needs, such as adjusting leg angles and back recline, will help ensure comfort and improve their overall quality of life.
FAQs
What should I do if the patient has severe contractures?
For patients with severe contractures, it may be necessary to seek the assistance of a healthcare professional to help with transfers. They may recommend specialised equipment or specific techniques to ensure safety.
Can contractures be reversed?
In many cases, contractures can be managed or improved with physical therapy, joint mobilisation, or stretching. However, if left untreated for long periods, they may become permanent.
How can I prevent contractures from forming?
Regular repositioning, stretching exercises, and maintaining joint mobility can help prevent the formation of contractures. It’s also important to provide the patient with proper seating and assistive devices to reduce static positioning.
Ralph has many years' experience in the healthcare sector. In a previous life he worked in finance, and his spreadsheet skills come in handy for all the analysis and research he does as he investigates topics and solutions for some of the world's most complex healthcare conditions and challenges. Aside from writing in-depth articles and organising webinars and interviews with top healthcare professionals, Ralph also administrates Vivid's "Healthcare Pioneers Board", a large group of healthcare specialists with multiple disciplines, who are working together to improve care for years to come.
