Inactivity/Immobility

Question 1

Inactivity:

Answer 1

Lack of movement or reduced physical activity

Question 2

Immobility

Answer 2

Physical restriction of movement

Question 3

Local effects of inactivity on Muscular System

Answer 3

• Muscle atrophy – after 3-5 days of bed rest, 58% strength
• Decrease Strength >Weakness
• Contractures/adhesions of soft tissue.
• Connective Tissue – dense CT contractures in non-inflamed joints takes 6-7 wks.
  • Increased fibroblast activity with immobility

Question 4

effects of inactivity on energy System

Answer 4

• Decreased glycogen stores
• Decreased ATP production
• Decreased muscle endurance (slow twitch fiber loss)
  
  • Extensor muscles
• Decreased vascularization
  
  • (↓ total blood volume, plasma volume, heart volume)
• Decreased reaction time/coordination

Question 5

• Skeletal System
  
  • Early stages of disuse/immobility

Answer 5

• Reabsorption of bone matrix resulting in decalcification of vertebral and cortical bones.
• Decrease bone mineral density
• Bone remodeling occurs more rapidly in cancellous bone.
• Calcium leaves bone within 3 days traveling to kidneys, muscles and other soft tissue
• Greater decrease in bone mineral density is seen in weight bearing bones.

Question 6

CV System (Clinical signs of deconditioning)

Answer 6

• Heart muscle disuse atrophy
• ↑ HR rest and exercise (sympathetic system)
• ↑ BP (diastole is when heart gets O2)
• ↑ VO2; decreased Max VO2
• Functional work capacity low vs. maximum potential
• Orthostatic hypotension or POTS
• Thrombophlebitis and PE

Question 7

CV System (Deconditioning/Immobility)

Answer 7

• Decrease in Total blood volume and plasma volume
• Muscles increase O2 consumption
• Decrease VO2 max
• CV less efficient
• Risk of Orthostatic hypotension or Postural Orthostatic Tachycardia (POTS)

Question 8

Effects of inactivity on Respiratory System

Answer 8

• ↓ Vital Capacity
• ↑ RR; decreased Max RR
• Atrophy muscle – caused less air volume per breath
• Weak or ineffective cough reflex
• Increase risk of infection (pneumonia)

Question 9

Integumentary System

Answer 9

• Lose skin “turgor” caused by decreased perfusion
  
  • –> fluid imbalance
  • –> Decrease subcutaneous fat

Question 10

Clinical sign of pressure injuries

Answer 10

redness or pain (>15 min) =concern

Question 11

Neuromuscular deconditioning

Answer 11

• Central nervous system CNS
• Peripheral nerves PNS
• Decreased proprioception
• Neuromuscular efficiency

Question 12

GI system effects

Answer 12

• Constipation
  
  • No gravity assistance
  • Decreased peristalsis
  • Decreased water intake
• Decreased Food Intake
  Decreased metabolic activity
• Immobility
  
  • Decreases glucose transport to skeletal muscles & increases insulin resistance

Question 13

Urinary System Effects

Answer 13

• Urinary stasis
  infection, stone formation
• Increased UTIs
  Discomfort, systemic infection (sepsis)
• Kidney stones
  Pain, obstruction, possible infection
• Bladder dysfunction
  Retention or incontinence
• Electrolyte/fluid imbalance
  Altered kidney function, risk of complications
• Decreased renal perfusion
  Reduced filtration

Question 14

Clinical Reasoning Immobilized with muscle shortened

Answer 14

• Decrease length of sarcomeres (seen within 5 days)
• Catabolism – especially Type I (ST) mm fibers
• Reconditioning ~14 – 60 days (weight and protein content).
• Peak tension shifts and decreases

Question 15

Clinical Reasoning Long term effects of Immobilization

Answer 15

Extensor mm groups

LE mm group weakness

• Positioning
  
  • Casted or suspended limbs
  • Tight hip flexor
  • A stretched muscle
• Increase dietary calcium intake to
  1000mg a day

Question 16

Clinical implications General effects of immobility

Answer 16

• Increased stress to the muscle system
• ↑ workload on uninvolved parts of body
• Immobilization should be minimized to the need to safely care for the patient.

Question 17

Physiology of Inactivity

Answer 17

• Increased risk for common metabolic diseases
  
  • Insulin resistance
  • Altered substrate utilization
  • Muscle atrophy
  • Reduce CV function

Question 18

Treatment for Immobility

Answer 18

• Passive, active assistive and active ROM
• Muscle performance
• Short/long positioning strategies
• Orthotic intervention - tilt table
• Skin hygiene
• Nutrition/fluid intake

Question 19

General Guidelines

Answer 19

Explain procedures to the patient
Maintain normal spinal alignment as much as possible
Use good body mechanics
Consider the environment
Provide a way for the patient to call for help