Ch. 59 Physical inactivity

Question 1

Adverse effect of bed rest

Answer 1

MSK: atrophy - weakness - stiffness - decrease mobility
Joints: contracture - decrease mobility
Bone: osteoporosis - heterophic ossification - fracture
CVS: stroke vol - decondition - CAD - embolism
Resp: blood perfusion - impairs cough - aspiration -pnuemonia - PE
GI: constipation - reflux - slowed absorption
Uro: retention - calculi - infection
Skin: ulcer
Neuro: depression - sleep-awake cycle
Metabolic: immobilization hypercalcemia - impairs glucose utilization - increase insulin resistance

Question 2

Contracture? risk of acceleration?

Answer 2

Decreased in passive ROM due to reduction in muscle fiber length.

Trauma - Bleeding & Edema - Infection & Inactivity - Medical coomorbidities.

Question 3

Treat contracture?

Answer 3

Prevention > stretch, mobility
Control > spasticity, antagonist muscle
Increase ROM > Dynamic splint, heat, serial casting
If non > Surgical release

Question 4

How do you stimulate osteoblastic activity to prevent osteopenia? (post op)

Answer 4

Muscle pull & weight bearing.

Question 5

Back ache after prolonged bed stay? (Anatomy)

Answer 5

Joint > IV joint stiffness
Muscle > Paraspinal muscle weaknes
Bone >Vertebral osetoparosis

Question 6

Orthostatic hypotension lost during long bed rest?

Answer 6

Drop of pressure in upright position is detached by carotid baroreceptors which send signals to sympathetic center to vasocontrict muscle layers of small arterioles Which can be atrophied after long horizontal stay and weightless state.

Question 7

When to consider bed rest is beneficial?

Answer 7

• CHD, MI
• Fracture
• Trauma
• Sepsis

Question 8

What can be gained from exercise?

Answer 8

CVS: Stroke - VO2 max - HR.
MSK: Blood - oxygen - strength - balance - endurance.
Metabolic: Sugar - Lipid - DM - Weight
CNS: Depression - Dementia
Cancer: longevity - fatigue

Question 9

How to prevent complications from immobility

Answer 9

• Position Q2 Hrs
• Air mattress
• Emollients to unbroken skin
• Relieve pressure free on bony prominence
• Bed side exercise / passive ROM
• Compression device / spirometry