Immobilization and Positioning Flashcards
What are 4 forms of immobility?
- Best rest
- Casting/ splinting
- NWB status
- Issues related to injury
What are 4 benefits of immobility?
- Minimize motion of the body or body part
- Promotes healing and repair of tissues
- Allows clot formation for healing
- Decreases pain and swelling
What 6 muscle changes may occur as early as the first 10 hours of immobilization?
- Atrophy
- Decreased strength
- Reduced capillary to muscle fiber ratio
- Reduced muscle density/ mass
- Reduced endurance
- Contracture
What muscles are most affected by immobility?
Anti-gravity muscles.
What are the 2 main bone changes related to immobility?
- Loss of bone density
- Calcium deposits in joints
Where is bone mineral density loss the greatest?
- Calcaneous
- Femoral neck
- Spine
What are 2 tendon and ligament changes due to immobilization?
- Disorganization of cell structure leading to decreased tolerance for exertion
- Destruction of ligament fibers and decreased strength at the ligament insertion site
What are 3 cartilage changes that occur due to immobilization?
- Fibrofatty connective tissue adheres to cartilage.
- Loss of cartilage thickness
- Pressure necrosis at points of contact
What can happen to the nervous system due to immobilization?
- Compression neuropathy
What is a common position that causes the peroneal nerve to be damaged?
- ER of legs
- Compression at fibular head
What equipment can be used to prevent ER of the LE during immobilization?
- Podus Boot with anti rotation bar and holes cut at the heels that prevent skin breakdown.
What are 3 changes due to immobilization of the joints/ synovium/ menisci?
- Impaired ROM (due to joint changes and muscle shortening)
- Proliferation of fibrofatty CT in joint space
- Adhesions
What are 5 cardiovascular changes due to immobilization?
- Reduced CO with increased work of heart, and decreased SV
- Increased resting HR
- Reduced endurance (increased HR to submax exercise)
- Orthostatic hypotension
- Venous stasis
What are 6 lung/ respiratory changes due to immobilization?
- Decreased cough due to reduced airway clearance/ pooling of secretions
- Increased likelihood of pneumonia
- Reduced max ventilatory volume
- Decreased chest movement = decreased VC
- Respiratory acidosis (retained CO2)
- Increased respiratory rate at rest
What are 4 metabolic changes due to immobilization?
- Decreased metabolic rate
- Increased protein catabolism (wasting)
- Dilated blood vessels (increased heat/ sweating)
- Loss of electrolytes
What are 3 blood changes associated with immobility?
- Reduced hematocrit and plasma volume
- Reduced endurance
- Reduced temperature regulation
What is a normal hematocrit?
M: 45 - 52 %
F: 37 - 38 %
Below what percentage hematocrit is exercise contraindicated?
25 %.
What blood borne system increases with immobility, and why?
- The coagulation system increases due to an increase in fibrinogen levels.
What 3 bowel and bladder changes occur with immobility?
- Constipation
- Increased likelihood of UTI
- Increased likelihood of kidney stones
What causes an increased likelihood of UTIs in immobilized patients?
- Catheters
- Decreased fluids
- Stasis
What serious effect can a UTI have?
Decreased mental state.
What 4 mechanisms cause edema due to immobilization?
- Pooling of fluids
- Fluids produced for healing
- No skeletal muscle pump
- No synovial fluid movement.
What are 7 psychological changes due to immobility?
- Decreased sensory stimulation
- Altered body image
- Withdrawl
- Hostility
- Anxiety
- Isolation
- Depression
What are the two main causes of mortality in immobilization?
- DVTs
- PEs
What are the 4 goals of early mobilization of patients?
- Maintain function of non-injured tissue and body areas
- Preventing DVTs and Pulmonary Embolisms
- Decreased risk for developing pneumonia
- Patient education
How are 3 types of early mobilization?
- PROM
- AAROM
- AROM
One what type of patients would PROM be carried out?
When motion is not possible, severely limited, causes pain,is not safe, or if active movement causes CP distress.
What are 3 benefits of PROM?
- Maintain joint and soft tissue mobility
- Maintain joint and tissue nutrition
- Increase kinesthetic awareness
In what type of patients is AAROM used?
Patients who are weak, in pain, have abnormal tone, paresis, or have CP problems.
What are 3 benefits of AAROM?
- Maintain joint and soft tissue mobility
- Maintain joint and tissue nutrition
- Increase kinesthetic awareness
In what type of patients is AROM used?
When Pt can move without causing any stress on any body system.
What are 3 benefits of AROM?
- Maintain joint and soft tissue mobility
- Maintain joint and tissue nutrition
- Increase kinesthetic awareness
How does immobility cause skin problems?
- Skin compression
- Circulation interruption
- Skin breakdown due to shearing forces
How often must a patient be repositioned in acute and rehab phases when in bed?
Every 2 hours.
How often do patients need to be repositioned in acute and subacute stages when sitting?
Push-ups every 15 minutes.
How can PTs prevent skin shearing forces?
- Lift; don’t drag
What 2 methods can be used to control incontinence?
- Absorbent pads
- Scheduled toileting
What are 3 pressure relieving devices used to prevent skin breakdown?
- Alternating pressure air mattresses
- Splints
- Seat cushions
What non-therapeutic modification can be made to improve a patient’s skin condition?
- Promotion of good nutrition
What are 4 proper transfer techniques/ equipment?
- Draw sheets
- Trapeze
- Manual Lifts
- Electric Lifts
Since pressure decreases dispersed over larger areas, how can the patient’s environment be modified to apply this principle?
- Pad hollow areas
- Bridge bony areas
- Prevent bed linen wrinkles
When leaving a patient after treatment, what 5 principles should be followed when positioning them?
- Make them comfortable
- Promote proper alignment
- Prevent development of deformities and skin breakdown
- Provide access to their environment
- Provide positioning for treatment procedures
What are 5 common areas of pressure in the supine position?
- Back of the head
- Shoulder blades
- Elbows
- Sacrum/ coccyx
- Heels
Check book for positioning of supine –> prone
Check book for positioning of supine –> prone
What are 6 common areas of pressure in a prone patient?
- Cheek/ ear
- Shoulder
- Breasts (women)
- Genitals (men)
- Kneecaps
- Toes
What are 6 commons areas of pressure in a side-lying patient?
- Ear
- Shoulder
- Ribs
- Hip
- Knees (int/ext)
- Ankles (int/ext)
What are 6 areas of common pressure in a seated patient?
- Ischial tuberosity
- Sacrum
- Elbows, forearms, wrists
- Heels
- Hips
- Scapula
What are 12 PT interventions for immobilization?
- Positioning
- ROM
- Wound care
- Education
- Bed mobility
- Mobility
- Ambulation
- HEP
What are 4 PT responsibilities in immobilization?
- Monitor vitals closely
- Promote upright posture
- Promote early WB activities
- Build self-confidence
What the next step of graded mobilization after assisted bed mobility and AAROM?
Assisted sitting at EOB.
If the Pt has adequate LE strength and trunk control to safely stand, what is the next step?
Assisted sit-to-stands.
If the Pt does not have adequate LE strength and trunk control to safely stand
Partial WB exercise, and trunk control activities in sitting.
If the Pt can do assisted sit-to-stands, what is the next step?
Assisted transfers.
If the patient can perform an assisted transfer and is safe to begin GT with RW, what is the next step?
GT with RW
If the patient cannot perform an assisted transfer and is safe to begin GT with RW, what is the next step?
GT with platform walker
If the patient can perform GT with RW, what is the next step?
Balance and endurance training.
