Mobility

Body Alignment or Posture

Allows for optimal balance without undue strain on joints, muscles, tendons, or ligaments.

This imposes less stress on the body.

Balance

Achieved when the center of gravity is close to its base of support, allowing for stability.

Coordinated Body Movement

Muscles working together for purposeful movement.

• Involves lifting, carrying, pushing, pulling, and moving objects.

Major muscle groups involved in coordinated movements

• Flexors and extensors of thighs.

• Flexors and extensors of knees.

• Flexors and extensors of upper and lower arms.

Postural Reflexes

Reflexes that maintain body position and equilibrium whether at rest or during movement.

Sensory organs in the inner ear…

…play a vital role in sensing position and movement.

Joint movements…

…stimulate nerve endings in muscles, tendons, and fascia to inform the brain of limb positions.

Visual cues…

…help maintain posture by alerting individuals to their spatial relationships with the environment.

Extensor muscle stimulation beyond a certain point…

…results in a reflex contraction aiding in reestablishing posture.

Infant (0-12 months) Development Considerations

• 3-6 months: Able to sit and control the head.

• 6-9 months: Sits steadily, rolls, creeps on all fours, and pulls to a standing position.

• 9-12 months: Progressing towards unassisted walking and capable of picking up small objects.

Toddler (1-3 years) Developmental Considerations

• By 15 months: Most can walk independently.

• By 18 months: Most can run; by 2 years, jump.

• By 3 years: Can stack blocks, dress, and do simple puzzles.

• Unique variations per child; safety of the environment is paramount.

• Reinforce and praise new skills

Child (3-5 years) Developmental Considerations

• By age 4: Climbing stairs, walking backward, and hopping.

• By age 5: Skipping, jumping rope, and using writing tools.

• Cultivation of attitudes toward body and exercise during this period is important.

Adolescent Developmental Considerations

• Undergo growth spurts and display secondary sex characteristics.

• Active individuals experience high energy and athletic performance; inactivity may lead to unhealthy habits.

• Regular screening for scoliosis is recommended.

• Encourage physical activity, counseling about exercise importance, and caution against overexertion.

Adult Developmental Considerations

• Erect posture with balanced, coordinated movements.

• Pregnancy shifts center of gravity; exercise is crucial for fitness.

Older Adult Developmental Considerations

• Increased kyphosis from disc shrinkage and decreased height.

• Loss of muscle tone is common; potential for arthritis and joint changes exists.

• Assess ease of movement and gaits regularly.

• Educate on regular exercise, high-protein, calcium, and vitamin D-rich diets.

• Use assistive devices correctly; safety-proof homes to prevent falls.

Nutritional Calcium Sources

Cheese, almonds, edamame, tofu, milk, yogurt, fortified orange juice.

Kyphosis

Increased curvature of the spine due to disk shrinkage, often seen in older adults.

Nutritional Vitamin D Sources

Egg yolks, red meat, fortified foods, milk, tuna, salmon, and other oily fish.

Congenital or acquired postural abnromalities

• Early detection and referral for these issues

• Education regarding safe independent activities- keeping clients as independent as possible

Problems with Bone Formation or Muscle Development

• Congenital, nutrition-related, disease-related, or age-related

• Education aimed at maximum mobility

• Ability to perform SPHM (safe patient handling movements) activities comfortabling

Problems affecting joint mobility

Inflammation, degeneration, and trauma impact joint mobility.

Arthritis

More than 100 different disorders affecting areas in or around joints, characterized by inflammation and pain.

Osteoarthritis

Most common type of arthritis, is a noninflammatory, progressive disorder of movable joints.

• Characterized by deterioration of articular cartilage

• Pain with movement

• Bone spurs may form after articular cartilage is damaged

Trauma

• Sprains: Twisting injuries causing partial tears.

• Dislocations: Bone displacement with ligament, tendon, and capsule tears.

CNS Issues

• Damage to brain or spinal cord can alter mobility.

• Conditions like stroke or head trauma may impair motor control.

Parkinson’s Disease

Affects motor skills, resulting in tremors and rigidity, impacting voluntary movements due to the progressive degeneration of the basal ganglia

• Basal ganglia intergrate movements such as walking, swimming, and laughing

Problems from other body systems

Disorders affecting oxygen levels (anemia, angina, heart failure) can decrease activity tolerance.

Bedrest can cause its own issues due to the immobility

Can be impacted from mental health, lifestyle choices, and external factors

Isotonic Exercise

Muscle shortening and active movement, such as walking or cycling.

Increased muscle mass, tone, strength, improved joint mobilities, and cardiopulmonary function.

Isometric Exercise

Muscle contraction without shortening, e.g., holding a yoga pose.

Increases muscle mass, tone, strength, and circulation to that body part.

Aerobic Exercise

Sustained muscle movements that increase blood flow and oxygen demand, promoting cardiovascular conditioning.

Examples are swimming, walking, jogging, dancing, and cycling

Stretching Exercise

Movements designed to gently stretch muscles and joints through their full range of motion.

Examples are warmup/cooldown exercises, yoga, dance

Helps to increase ROM, circulation and posture, and relaxation.

Stretching and Endurance Exercise

Muscle-building programs

Examples include weight training, calisthenics, some isometric exercises

Helps to build strength and endurance, improving power of the entire body

Effects of exercise on CV System

Improves heart function, blood flow, and venous return.

Effects of exercise on Respiratory System

Enhances alveolar ventilation and reduces work of breathing.

Effects of exercise on Musculoskeletal

Builds muscle strength and flexibility, improving coordination, and preventing bone loss

Effects of exercise on Metabolism/GI Tract

Improves gastric motility and production of body heat

Improves appetite, intestinal tone, and weight

Effects of exercise on GU System

Improves blood flow to the kidney and with excretion of body wastes

Effects of exercise on Skin

Improves the health of skin, giving you that “healthy glow”

Effects of exercise on Psychosocial

Improves one’s energy and well-being, body image/self-concept, and positive health behavior

Could also promote more sleep

Cardiovascular risks of immobolity

Increased workload, venous stasis, and risk of thrombosis.

Potential for increased heart rate and orthostatic blood pressure issues.

Respiratory risks of immobility

Increased secretions, decreased breathing rate/volume, risk of atelectasis, and pneumonia.

GI effects of immobility

Decreased appetite, constipation, and slowed digestion due to reduced physical activity.

Activity Intolerance

A limitation in the physical ability to perform activities of daily living.

Actual/potential health problem

Outcome Identification and Planning

• Identify benefeits of regular exercise (5000-6000 steps per day)

• Demonstrate correct body alignment

• Be free from alterations in skin integrity

• List support systems or follow a regular exercise program

• Maintain muscle mass, tone, and strength

Ergonomics

The design of equipment and work tasks to fit the capabilities of the worker, aimed at preventing injury.

• Erect posture

• use the longest and strongest muscles of the arms and legs

• Working closely to something that needs to be lifted

• Avoid twisting

• Slide, roll, push, or pull- do not lift

• Broaden base of support

SPHM (Safe Patient Handling and Mobility)

Healthcare practices aimed at preventing musculoskeletal injuries among healthcare personnel.

• Majority of healthcare personnel face risks of musculoskeletal injuries from moving patients.

• 40.8% of nurse injuries relate to patient handling.

• SPHM equipment is best practice; never attempt lifting without adequate aids.

SPHM Guidelines

Maintain patient body alignment

Avoid friction when moving

Count before moving

Use bariatric devices when appropriate

Assistive Devices

Tools such as walkers, canes, or crutches are designed to aid mobility in patients.

• Other devices include wedges, pillows, mattresses, adjustable beds, trapeze bars, high-top sneakers, hand splints

• Gait belt, sit-to-stand, lateral-assist, and a transfer chair

ROM Exercises

• Active more than passive as possible

• Start gradually moving each joint until there is resistance but not pain

• Do this BID, doing each exercise 205 times

• For older adults, do this to the point where they can do ADLs

How much exercise to promote

• Children and adolescents: 60 minutes or more daily of mod-to-vigorous effort

• Adults: 2.5-5 hours per week of moderate effort

• Older adults: include exercises that maintain or improve their balance

What to evaluate

• general ease of movement and gait

• body alignment

• joint structure and function

• muscle mass, tone, and strength

• endurance