Immobility and Rehabilitation

Question 1

Causes of functional limitations?

Answer 1

Trauma, e.g: brain/spinal cord injury, multiple trauma, fractures, falls

Illness, e.g: stroke, cardiac failure, MI, cancer, infections (UTI, infections)

Long-term conditions, e.g: COPD, diabetes, arthritis, Parkinson’s disease, MS

Incidence increases in the ageing population

Question 2

Define sarcopenia?

Answer 2

Age-related loss of muscle mass and function. It includes low muscle mass and one of low muscle strength or low physical performance

Question 3

Describe the natural decline in muscle mass?

Answer 3

Starts to decline ~30 years of age and this accelerates after 60 years

Question 4

Describe the vicious circle of immobility

Answer 4

A decline in muscle function causes immobility and this leads to:
• Depression, isolation
• Illness, e.g: constipation, UTIs, chest infections
…both of which contribute towards continued immobility

Question 5

Types of sarcopenia?

Answer 5

Primary - age-related and occurs due to changes in sex hormones, apoptosis and mitochondrial dysfunction

Secondary - multi-factorial, e.g:
• Disuse 
• Inadequate nutrition/malabsorption
• Cachexia
• Neuro-degenerative disease
• Endocrine, e.g: corticosteroids, GH, IGF-1, abnormal thyroid function and insulin resistance

Question 6

Define sarcopenic obesity?

Answer 6

Loss of muscle mass associated with increased fat; there is a greater risk of cardiometabolic disorders, e.g: insulin resistance, metabolic syndrome, CV disease

Question 7

Consequences of sarcopenia?

Answer 7

Fat deposition, due to immobility, leads to insulin resistance and diabetes

Decreased exercise capacity and activity, leading to increased bone loss

Muscle weakness increases the risk of falls and fractures

…all of which lead to dependence on others

Question 8

Non-pharmacological interventions that prevent sarcopenia?

Answer 8

Exercise:
• Progressive resistance training increases strength, endurance and functional measures, e.g: gait speed, chair stands
• Aerobic training increases endurance
• Beneficial effects on BP, CV factors, mood, agility and cognition

Physical activity (same as for other adults) and monitoring:
• 150 mins/week of moderate intensity activity in bouts of 10 mins or more
• 30 mins of brisk walking 5 times/week ; 75 mins of vigorous activity spread across the week or a combo of moderate and vigorous activity
• Strength and balance work 2 times/week

Reduce sedentary time

Question 9

Pharmacological interventions that prevent sarcopenia?

Answer 9

Nutrition (Ca2+ & vit D, protein supplementation)

Use medications they are already on:
• ACEIs (increase activity)
• Allopurinol (increases cardiac and skeletal muscle function)

Question 10

Define rehabilitation?

Answer 10

Enables an individual to maximise their potential to live a full and active life within their family, social networks, education/training and the workplace

Question 11

Define reablement?

Answer 11

Active process of an individual regaining the skills, confidence and independence to enable them to do things for themselves

Question 12

Define habilitation?

Answer 12

Process of assisting an individual with achieving developmental skills when impairments have caused a delay or blocking of initial acquisition of these skills

May include cognitive, emotional/social, fine motor, gross motor, etc that contribute to mobility, communication, socialisation, performance of ADLs and QoL

Question 13

Risk factors for falls?

Answer 13

Demographic:
• Race
• Socioeconomic status

Biological:
• Age
• Sex
• Medical conditions
• Physical conditions

Behavioural:
• Sedentary lifestyle
• Medication intake
• Alcohol misuse
• Inappropriate shoes