Immobility and Rehabilitation

Question 1

Give examples of ADLs that patients may begin to struggle with if they develop immobility?

Answer 1

Getting dressed themself (buttons, shoelaces etc)
Going to the toilet
Getting up and down from/to a chair
Walking certain distances

Question 2

What is the most likely disability that patients >65 years tend to develop?

Answer 2

Immobility

Question 3

What medical problems can cause functional limitations for patients?

Answer 3

Trauma - e.g. falls/ fractures/ nerve injury
Illness - stroke, MI, cancer
Long term conditions - Arthritis, COPD, diabetes

Question 4

What amount of physical activity is recommended throughout a week?

Answer 4

150 minutes of moderate exercise per week

Muscle strengthening activities 2 days per week

Question 5

What are the two main consequences of immobility?

Answer 5

Sarcopenia - Age related loss of muscle mass and function

Osteopenia - Age related loss of bone mass

Question 6

At what age does muscle mass tend to decline?

Answer 6

Starts around age 30

Accelerates at age 60

Question 7

What replaces the decreased muscle mass?

Answer 7

Fat

Question 8

What cardio/pulmonary problems are created by secondary immobility (i.e. bed rest)?

Answer 8

• Lower blood vol
• higher heart rate
• postural hypotension
• DVT
• Pneumonia infection (due to decrease in residual volume and total lung capacity)

Question 9

What MSK problems can arise from secondary immobility (bed rest)?

Answer 9

• Loss of Strength (especially Antigravity muscles)
• Increase in non-contractile tissue (collagen in stiff joints)
• Risk of contractures
• Loss of bone density

Question 10

What common bowel habit is associated with immobility?

Answer 10

Constipation

Question 11

What is the aim of the “Love Activity, Hate Exercise” physiotherapy campaign?

Answer 11

Promotes elderly people to take part in activities and groups that they will enjoy and which will improve their fitness

=> it doesnt feel like exercise

Question 12

What is the aim of the PJ Paralysis campaign?

Answer 12

Encouragement for patients in hospitals to get up out of bed + dressed
=> wont lose mobility and independence

Question 13

How are levels of immobility measured?

Answer 13

• Outcome tests (Walking tests, Strength and Balance assessment)
• Physical Activity monitors (pedometers, smart watches etc.)
• Life Curve - shows optimal curve of how mobility should decline

Question 14

What task on the LifeCurve is a significant functional limitation which prompts healthcare intervention?

Answer 14

Patients not being able to cut their own toenails

Question 15

What are the main principles of patient rehabilitation?

Answer 15

• Person centred
• Follows the SMART goals
• In collaboration with patient
• MDT working with the patient and family

Question 16

What are the SMART goals associated with patient rehabilitation?

Answer 16

Specific: State what you want to accomplish

Measurable: using the outcome measures (e.g. ADLs)

Achievable: Make goals reasonable

Realistic: (see above)

Timely: Set based on likely progress and hospital inpatient time

Question 17

What various pieces of equipment are used to assist patients in rehabilitation?

Answer 17

Hoist 
Zimmer frame
Wheelchair
Toilet frame (makes it higher so they can toilet independently)
Leg lifter to help them get into bed

Question 18

What interventions are physiotherapists and Occupational therapists involved in with regards to rehabilitation?

Answer 18

• Strengthening, Balance and Gait based exercises
• Transfer practice (Sit to stand, lie to sit etc)
• Kitchen assessment
• Environmental/Home visits
• Wheelchair Skills
• Splinting of limbs if required

Question 19

What takes place in a kitchen assessment?

Answer 19

Patients are asked to make a cup of tea/ ready meal to see whether or not they are competent enough to function in a kitchen at home

Question 20

What takes place in a home visit by an occupational therapist?

Answer 20

• Check for clutter in home environment
• Consider aids such as banisters, chairlifts etc
• Reassess kitchen tasks in patient’s own home
• Check patient can make sit-stand, lie-sit transfers in own home