Module 6 Flashcards
Scope of mobility
full mobility –> impaired mobility –> complete immobility
Systems affecting mobility
Neurological Musculoskeletal Cardiovascular Respiratory Gastrointestinal
Physiological changes of aging
vertebral discs thin –> spinal column compression –
> kyphosis
bone density decreases –> frail, higher risk of fall injury
cartilage becomes rigid –> less protective
rigid ligaments –> reduce range of motion
decreased muscle mass
osteoblasts decrease mitotic activity
parathyroid hormone increases
calcitonin decreases
CV Consequences of immobility
reduced cardiac capacity –> reduced cardiac output
orthostatic hypotension
venous stasis –> deep vein thrombosis
Respiratory Consequences of immobility
reduced lung expansion –> reduced total lung capacity
atelactasis
pooling of respiratory secretions
Musculoskeletal consequences immobiilty
reduction of muscle mass (atrophy) contracture of joints and muscles --> stiffening bone demineralization (weight-bearing exercise important)
Integumentary consequences of immobility
skin breakdown –> pressure ulcers over bony prominences
exacerbated by incontinence
GI consequences of immobility
reduced intestinal peristalsis
constipation
Urinary consequences of immobility
renal calculi - urinary stasis UTIs urinary retention impaired voiding
Determinants of mobility
nervous system
musculoskeletal system
adequate perfusion + gas exchange
adequate nutrition
Definition of mobility
state or quality of being mobile or movable
Definition of deconditioning
loss of physical fitness as a consequence of reduced activity
Function of cerebellum
coordination, balance, muscle tone, procioception
Motor cortex
located in the frontal lobe
generates nerve impulses –> motor neurons –> effectors (skeletal muscle)
Functional classification of joints
synarthrosis = not movable amphiarthrosis = slightly movable diarthrosis = completely movable
Structural classification of joints
fibrous = held together by connective tissue cartilaginous = held together by cartilage synovial = in a fluid filled cavity
Joint
where bones join together
Determinants of skeletal muscle function
1) motor nerve impulses reaching muscle fibers
2) muscle fiber response to nerve stimulus
3) proprioception
4) mechanical load
5) joint mobility
Mechanical load
physical stress on muscles. increase muscle load = increased requisite strength
Procioception
sensation of position and movement
required for accuracy in motion
Definition of mobiliity
ability to independently and voluntarily move around in one’s environment / state of mobility
Peak Bone Mass
maximal amount of bone mass in the body at the end of skeletal maturation
bone growth peaks ~30
Secondary Osteoporosis Factors
endocrine disorders malabsorption disorders malignancies alcoholism medications
Endocrine disorders
hypothyroidism hyperthyroidism hyperparathyroidism Cushing's syndrome Diabetes mellitus Child development
Factors impacting bone growth (adolesence –> early adulthood)
nutrition age vitamin d receptor physical activity hormonal status
Functions of bone remodelling
replace old, worn-out bone
maintain bone health
strengthen bone in areas of stress
mineral homeostasis
Non-modifiable risk factors
age
gender
genetics (body frame size)
ethnicity (asian, caucasian)
Modifiable risk factors
low peak bone mass dietary (calcium, vitamin d intake) sedentary lifestyle hormonal factors medication (glucocorticoids, anticonvulsants) alcohol smoking
Key Hormones
Parathyroid Hormone
Calcitonin
Vitamin D
Estrogen
Parathyroid Hormone Function
produced by the parathyroid glands
increase number and activity of osteoclasts –> promote bone resorption –> release calcium/phosphate into blood
promote phosphate excretion by kidneys
promote calcium retention by kidneys
promote activation of vitamin D in kidneys –> promote calcium absorption in GI tract
Calcitonin Function
released by the thyroid glands
inhibits activity and number of osteoclasts –> decrease bone resorption
Vitamin D Function
produced by the integumentary system/diet
Vitamin D is converted into calcitriol in the kidneys
calcitriol promotes the absorption of calcium in the GI tract
Estrogen Function
estrogen inhibits bone resorption
estrogen decreases number and activity of osteoclasts
increase osteoclast apoptosis
Sources of estrogen
estrogen = produced by the ovaries
post-menopause estrogen is provided through the conversion of androgens –> estrogen via aromatase
Glucocorticoid function
anti-inflammatory drug
contribute to osteoporosis
decrease number and activity of osteoblasts
decreases osteoclast apoptosis
inhibits OPG –> increased RANKL expression on osteoblasts –> increased osteoclast differentiation
Factors affecting peak bone mass
Genetics
Hormones
Nutrition
Lifestyle
Risk Factors for Older Adults
Sarcopenia (reduced muscle mass) Chronic Pain Injury/Trauma Nutritional deficiencies Obesity Chronic Illness
Renal Calculi
mineral and salt deposits that form in the kidneys
Sarcopenia
Reduced skeletal muscle mass, strength and function
Consequences of immobility
dehydration bronchial pneumonia contractures deep vein thrombosis constipation pressure ulcers incontinence hypothermia Iatrogenic complications Disability Institutionalization Loss of independence Isolation & Depression
Disorders affecting mobility
ostoeporosis gait disorders parkinson's stroke arthritic conditions
Non-disorders affecting mobility
Paresthesia amputations neuromotor disturbances fractures (injury) joint problems illness (fatigue)
Paresthesia
burning or prickling sensation in the extremities
Iatrogenic
illness resulting from medication or treatment
Intrinsic Fall Factors
age gender (women at higher risk) gait balance/coordination poor vision cognition dizziness/vertigo orthostatic hypotension medication depression dementia incontinence --> rushing to the bathroom
Extrinsic Fall Factors
tripping hazards poor lighting lack of bathroom safety footwear improper use of mobility aids
Basic Activities of Daily Living Definition
basic self-care tasks that are performed daily.
basic functional capacity
Instrumental Activities of Daily Living Definition
tasks that enable a person to live independently. more complex than basic ADL’s and require adequate cognitive and physical function.
BADL examples
feeding continence transferring toileting dressing bathing
IADL examples
using the telephone shopping food preparation housekeeping doing laundry using transportation handling medications handling finances
Signs/Symptoms of Osteoporosis
height loss (>2cm - could indicate spine fracture) reduced range in motion fragility fractures
Anticonvulsants
causes changes in bone and calcium metabolism –> decreased bone mass
may contribute to osteoporosis
Typical fracture sites for osteoporosis
Hips
Wrists
Shoulder
Fragility Fracture
spontaneous fracture that occurs from non-intense activity (sneezing, coughing, twisting, etc)
Paresthesia
burning/prickling sensation in the limbs
Normal height loss
1 cm every 10 years after age 60
Abnormal height loss
2-3 cm in a short timeframe
could indicate spinal fracture
Osteopenia
loss of bone density but not to the point of fragility
-1 to -2.5 on the bone density scale
Osteoporosis
condition in which excessive demineralization causes bones to become porous, weak, fragile
caused by an imbalance between bone resorption and bone formation
less than -2.5 on the bone density scale
What part of the bone does osteoporosis impact
Spongy bone
Spongy bone is higher in surface area so tends to have more dramatic bone loss
May be thinning of the compact bone as well
Osteoporosis Exercise Guidelines
strength exercise x2/week
posture exercise - daily (5-10 min)
balance exercise - daily
weight-bearing aerobic physical activity - 150min/week
Physiological changes of aging
loss of muscle mass loss of bone density loss of articular cartilage rigidity of cartilage joint stiffening loss of elasticity of ligaments compression of IV discs --> kyphosis
Primary level of prevention
regular exercise diet/nutrition weight falls prevention programs environmental safety
Secondary level of prevention
women over 65
mobility screening
osteoporosis screening
fall risk assessments
Tertiary level of prevention
medial intervention surgery exercise therapy medication (anti-inflammatory, anagelsics, vitamin d/calcium supplements) diet exercise physiotherapy, occupational therapy weight loss
Treatment for immobile patient
change bed position every 2 hours head elevation bed exercises range of motion exercises ambulate patient as much as possible treat pain to encourage movement encourage deep breathing/coughing incentive spirometer
Diagnosis of Osteoporosis
bone density scan (2cm is abnormal)
Primary Osteoporosis
forms majority of cases
osteoporosis occurs without an identifiable cause
Recommended calcium intake
1000 mg/daily for men and women
500 mg twice daily
Recommended calcium intake for post-menopausal women
1200 mg/daily
600mg twice daily
Recommended Vitamin D Intake
600-800 units/daily
