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Disabled Village Children

A guide for community health workers,

rehabilitation workers, and families

PART 1

WORKING WITH THE CHILD AND FAMILY:

Information on different Disabilities

E. Exercises and Techniques

367

CHAPTER 42

Range-of-Motion and Other Exercises

All children need exercise to keep their bodies strong,

flexible, and healthy. Most village children get all the

exercise they need through ordinary daily activity:

crawling, walking, running, climbing, playing games,

lifting things, carrying the baby, and helping with

work in the house and farm.

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As much as is possible, disabled children should

get their exercise in these same ways. However,

sometimes a child's disabilitydoes not let him use ormove his body, or parts of it, well enough to get the

exercise he needs. Muscles that are not used regularly

grow weak. Joints that are not moved through their

full range of motion get stiff and can no longer be

completely straightened or bent (seeChapter 8on

contractures). So we need to make sure that the

disabled child uses and keeps strong whatever

muscles he has, and that he moves all the parts of his

body through their full range of motion. Sometimes a

child may need help with these exercises. But as much

as possible, he should be encouraged to do them

himself, in ways that are useful and fun.

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Different exercises for different needs

Different kinds of exercises are needed to meet the

special needs of different children. Onthe next two

pageswe give an example of each kind of exercise.

Then we look at some of the different exercises in

more detail.

Purpose of exercise

To maintain or increase joint motion

To maintain or increase

strength

To improve

position

To

improve

control

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368

DIFFERENT KINDS OF EXERCISES

AND WHEN TO USE THEM

1. Range-of-motion exercises (ROM)

Ram is 2 years old. Two weeks ago he became s

and both legs becameparalyzed.

Ram needs range-of-motion exercises to keep the fuhis joints, so they will not develop contractures (see

At least 2 times a day, his mother slowly bends, straigmoves all the joints as far as they normally go.

All these are exercises for his knee. For other ROM exneeds,seePage 378 to 381.

2. Stretching exercises

Lola, who is now 4, had polio at age 2. She did

exercises to keep the range of motion in her jo

has severe contractures especially of the kne

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Lola's mother does stretching exercises s

day, to straighten the joints a little m

Stretching exercises are like ROM exercis

held with firm, steady pressure in a positstretches it.

3. Strengthening exercises withmotion

Chon was 6 years old when he got

his clothes and body wet with a

poison his father used to kill weeds.

A week later his legs became so

weak he could not stand. Now, 2

months have passed, and Chon is a

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little stronger. But he still fails when

he tries to stand.

To help strengthen the weak

muscles in his thighs, Chon can

raise and lower his leg like this-

first without added weight and

later with a sandbag on his

ankle. As his leg gets stronger

the weight can be increased.

4. Strengthening exercises

without motion

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Clara, who is 9 years old,

has a very painful knee. It

hurts her to move it and

her thigh muscles have

become so weak she

cannot stand on the leg.

She cannot do exercises

like Chon does because it

hurts her knee too much.

But Clara can do

exercises to strengthen

her leg without moving

her knee. She holds it

straight and tightens the

muscles in her thigh.

For more information

on 'exercises without

motion', seePage

140.

369

5. Exercises to

improve position

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Ernesto is 8 ye

dystrophy. Amo

swayback.

Ask Ernes

stomach s

wall as poway, and

Becaus

stomac

by doin

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still do

them tw

It

(W

do

6. Exercises toimprovebalance and

control

Celia is 3

and still

cannot walk

without

being held

up. She has

poor

balance.

Many

exercises

and

activities

might help

her improve

her balance

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and control

of her body.

Here are 2

ideas for

different

stages in

her

developmen

t. For other

possibilities,

seeChapter

35on EarlyStimulation.

Play

games

with her

to see if

she can

lift oneleg, and

then the

other.

This

will

help

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her

shift

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weig

ht

from

side

to

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and

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herbala

nce.

A

f

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at in persons with arthritis, Down syndrome, or neck injury. Do not use any force

relaxed bypositioning the child in a certain way before trying to exercise the limb.

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ce more equal.

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he muscles that most need it.

raighten them.

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is helps loosen her stiff back and neck. Also, sometimes they throw the ball high so

n that often makes range-of-motion exercises seem like punishment. But this way

t to move the part through its full range of motion. Here we show the basic exercises

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should be very gentle, with no force, especially when exercising a stiff neck. (See

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ly to do them-and do them right.

ey show some of the home exercises that we have found are needed most often.

ed practice. Instead, give them to the family after you teach them how to do

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are included in this book. Better still, make sheets showing exercises and

the life of the community. (SeeChapters 1and2.)

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T (TO CORRECT A'TIPTOE' CONTRACTURE)

e foot upward.

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unting slowly to 25. Relax, then do it again. Repeat this exercise 10 to 20 times-in

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NEE CONTRACTURE)

self (if he can do it at all). Then help him slowly straighten it as far as it will go.

ssible while you count slowly to 25. Repeat several times. Do this exercise 3 times a

p while you stretch the cord behind the knee.

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with the hip extended, gradually lift the leg higher, keeping the knee straight.

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e leg by pulling the

could dislocate the

pecially great when

annot walk.

HIP CONTRACTURE

ght cords and cannot

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d support the leg with your arm.

e leg up while counting slowly to 25.

is exercise 3 or more times a day.

with the leg in a straight line with the body.

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ps are against the table and that they do not

is lifted.

POSITIONS TO HELP AVOID PRESSURE SORES AND CONTRACTURES

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o spend a lot of time lying or sitting, or have lost feeling in their butts, should NOT

DAY SITTING DOWN. This can cause pressure sores, contractures of the hips and

ack deformities.

NT THIS

ressure sores

NT THIS

Contractures

ou spend time sitting in a wheelchair (or any chair) lift yourself up with your arms

and count to 25 every 15 or 20 minutes.

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ting up often is especially important for people who do not have feeling in their butt,

that they do not get sores on their bottom.

Spend a part of the day lying down with your shoulders up like this. (For other

designs seePage 199and500.)

You can do schoolwork lying down. Try to arrange things with the teacher so

that you can spend part of your day lying down.

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If the child cannot straighten enough to lie on the floor, he can lie on a

table, and work or play with his hands at a lower level, as shown here.

BE CAREFUL: To avoid sores, it is important to put foam rubber

cushions to protect the body where bones press against skin-

especially if you cannot feel in parts of your body.

387

EXERCISE FOR A STRAIGHTER BACK

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PROBLEM

The upper back bends forward (in older persons this is acommon cause of high back pain). Often the shoulders and

shoulder blades are also stiff.

Lie face down and move the arms as shown. This helps keep the

shoulder blades and upper back flexible.

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Put a strap around the upper body and bend backward as

far as you can.

Or put pressure against the middle of the upper

back and have the child try to straighten

against it .

CAUTION: Bending back like this usually bends th

too much and does little or nothing to help straigh

back. It may make the problem worse.

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Stay in this position while you count to 25.

Do the exercise 2 or 3 times a day.

Also, for at least half an hour a day,

lie with a rolled up towel or cloth

under the middle of the curve in your

back. Breathe deeply, and every time

you breathe out, try to let your body

bend backward over the roll.

Note: Some experts believe that

the exercises that bend the back

up and back, as shown above,

may also help keep a mild

sideways curve of the spine(scoliosis) from getting worse.

But the exercises will not help

much if the curve is severe.

388

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STRENGTHENINGEXERCISES - TO GET ARMSREADY TO WALK WITH

CRUTCHES

OBJECTIVE

These exercises help

you can walk with cru

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Sit like this and lift your

Go up and down un

lift yourself anothe

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To practice for using cru

Or use a sawed-off

Or you can do

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Do these exercises

3 or 4 times a

day. Every day try

to lift yourself

more times

without resting,

until you can do it

50 times.

389

STRENGTH

ENINGEXERCISES

-TO HELPYOUR

CHILDHAVESTRONGER

THIGHS

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