Musculoskeletal and Neurological Systems: Key Concepts and Injury Prevention

Musculoskeletal System

The system that includes the muscles, bones, joints, tendons, cartilage, ligaments, and other connective tissue. It provides shape, support, and movement to the human body.

Cartilage

A flexible connective tissue, often found at the ends of bones in joints, that reduces friction.

Tendon

A tough, flexible cord of fibrous connective tissue that connects muscle to bone.

Ligaments

A tough, fibrous connective tissue that connects bone to bone, often stabilizing a joint.

Synovial Joints

Highly mobile joints that enable flexibility and motion between bones (e.g., knee, shoulder).

Peripheral Nervous System (PNS)

Composed of thousands of nerves that interface with the spinal cord. These nerves communicate with muscles and sensory receptors.

Proprioception (Kinesthesia)

The body's sense of self-awareness and body position. This feedback loop enables the body to coordinate, balance, and fine-tune body positioning and movement.

Body Mechanics

The combined effort of the musculoskeletal and nervous systems to maintain posture, alignment, and balance in daily life.

Body Alignment (Posture)

The positioning of the various parts of the body while performing activities. Optimal posture supports the spine, muscles, and joints.

Ergonomics

The study of body mechanics in relation to the demand and design of the work environment, focusing on designing, adjusting, and arranging items for safe and efficient work.

Mobility

The capacity to move about without restrictions.

Disuse Osteoporosis

Thinning and weakening of bones due to prolonged bed rest, often resulting in fragility fractures.

Sarcopenia

The loss of lean muscle mass and strength, particularly in the lower extremities, caused by deterioration of muscle fibers.

Joint Contractures

Abnormal fixations of the joints in a bent, nonfunctional position, caused by muscle imbalance and dense collagen fibers. Foot drop is a specific type of contracture.

Orthostatic Hypotension

A decrease in blood pressure (BP) and dizziness when sitting or standing, caused by fluid shifts and cardiac deconditioning (atrophy of heart muscle).

Deep Vein Thrombosis (DVT)

Blood clot formation, usually in the deep veins of the legs, due to venous stasis and increased blood viscosity from immobility. Can lead to a pulmonary embolism.

Atelectasis

Partial or complete collapse of the lung due to shallow breathing, reducing the surface area for gas exchange.

Constipation / Fecal Impaction

Hardened stool and blockages due to slowed peristalsis and decreased urge to defecate in a supine position.

Urinary Retention / Renal Calculi

Incomplete emptying of the bladder and stone formation, respectively, caused by interference with gravity-dependent drainage of the kidneys.

Activity Intolerance

Physical inactivity that leads to a loss of the ability to perform tasks, also called functional decline.

Activities of Daily Living (ADLs)

Basic essential skills a person performs independently every day related to personal care (e.g., dressing, bathing, toileting).

Kyphosis

An outward curvature of the thoracic area of the spine (a 'hunchback' posture), often seen in older adult females due to weakened vertebrae.

Skeletal System

Made of hard connective tissue (bones) that creates a rigid structure.

Support

Provide a solid and stable framework for the body.

Protect

Provide mechanical protection for vital internal organs (e.g., brain, spinal cord, heart, lungs).

Produce

Red bone marrow produces blood cells (red, white), platelets, and macrophages.

Storage

Provide storage for minerals like calcium, phosphorus, magnesium, iron, and lipids.

Movement

Bones act as levers that work with muscular attachments to create motion.

Nervous System

Coordinates movement and consists of the Central Nervous System (brain and spinal cord) and Peripheral Nervous System (nerves).

Motor Control

The brain coordinates muscle action; nerve cells in the spinal cord fire signals that cause muscles to contract.

Mechanism of Movement

Muscles shorten, pulling against the bone (the lever) to which they are attached, generating movement.

Feedback and Balance (Proprioception)

Information from sensory receptors is constantly sent back to the brain to create self-awareness and body position.

Proper Body Mechanics

Lowers the risk of injury by reducing stress and strain on the body.

Balance

Lower the center of gravity and widen the base by spreading feet shoulder-width apart and flexing the knees.

Body Movements

Efficient use of muscle power; keep the client or object as close to the body as possible.

Goal of Ergonomics

To adapt products, tools, tasks, and the environment to fit the worker's needs to increase work satisfaction, maximize productivity, and decrease the risk of injury and fatigue.

Examples in Health Care

Height-adjustable beds, client transfer devices, two-person lifts, modifiable workstations, and 'minimal lift' policies.

Systemic Effects of Immobility

Prolonged immobility has profound physiological, psychological, and cognitive effects on a client.

Cardiac Deconditioning / Orthostatic Hypotension

Monitor lying, sitting, and standing vital signs (BP drop of 20/10 mm Hg within 3 min).

Pulmonary Embolism

A blockage in one of the pulmonary arteries in the lungs, usually caused by blood clots that travel to the lungs from the legs.

Pneumonia

An infection that inflames the air sacs in one or both lungs, which may fill with fluid.

Constipation

A condition characterized by infrequent bowel movements or difficulty passing stools.

Fecal Impaction

A severe form of constipation where a large mass of stool becomes stuck in the colon or rectum.

Malnutrition

A condition resulting from inadequate intake of nutrients, leading to health problems.

Gastroesophageal Reflux

A chronic digestive condition where stomach acid or bile irritates the food pipe lining.

Urinary Retention

The inability to completely empty the bladder, resulting in a build-up of urine.

Urinary Tract Infection (UTI)

An infection in any part of the urinary system, including the kidneys, bladder, or urethra.

Renal Calculi

Solid mineral deposits that form in the kidneys, commonly known as kidney stones.

Pressure Injury

Localized damage to the skin and underlying tissue, usually over a bony prominence.

Depression

A mood disorder that causes persistent feelings of sadness and loss of interest.

Social Isolation

A state where an individual has minimal contact with others, leading to feelings of loneliness.

Borg Rating of Perceived Exertion (RPE) Scale

A subjective tool for clients to rate their effort level during activity (6=effortless, 20=maximal effort).

Posture Changes

Alterations in body alignment, such as Kyphosis, that can affect mobility.

Mobility Assessment

An evaluation to determine how well a client can move and identify assistive needs.

Incentive Spirometer

A device used to help patients improve the functioning of their lungs.

Sequential Compression Devices (SCDs)

Devices used to promote blood flow and prevent DVT by applying pressure to the legs.

High-Fiber Foods

Foods that are rich in fiber, which can help promote regular bowel movements.

Nutrient-Dense Foods

Foods that are high in nutrients relative to their calorie content.

Bedside Mobility Assessment Tool (BMAT / MAT)

A standardized, objective, four-step process that assigns a level of assistance based on the client's ability to perform specific tasks.

Level 1 Mobility

Client extends arm to shake hands AND client moves to sitting on edge of bed and maintains for at least 2 minutes. Client unable to perform both activities: Assign Level 1 Mobility. 2 or more personnel (Equipment: Mechanical lift, Slide boards)

Level 2 Mobility

Client places feet on floor AND performs leg/ankle extensions/flexions. Client unable to perform all activities: Assign Level 2 Mobility. 2 or more personnel (Equipment: Mechanical sit-to-stand lifts, Ambulation assistive devices)

Level 3 Mobility

Client can rise self from a seated position using an assistive device AND maintain a standing position for at least 5 seconds. Client unable to perform all activities: Assign Level 3 Mobility. 1 to 2 personnel (Equipment: Gait belt, Ambulation assistive devices)

Level 4 Mobility

Client can march in place AND step forward and backward. Client unable to perform all activities OR requires the use of assistive devices: Assign Level 3 Mobility. 0 to 1 personnel (Equipment: None)

Timed Up & Go (TUG) Assessment

Procedure: Client stands from a chair, ambulates 10 feet, turns, returns to the chair, and sits down. Monitoring: The nurse observes balance, stride, posture, and gait. Risk: An older adult client who takes longer than 12 seconds to complete the test is at an increased risk of falling.

Gross motor skills

Use of large muscle groups for movement that develop throughout childhood and decline in older adulthood.

Infancy Mobility Changes

Motor skills develop sequentially (sitting, standing, ambulation).

Childhood Mobility Changes

Fine-tuning of gait (ages 5-7), narrowing the base, lengthening the stride. Strength and endurance improve, peaking in late adolescence.

Adulthood Mobility Changes

Muscle mass and strength reach their maximum. Overall performance typically remains stable until late adulthood.

Older Adulthood Mobility Changes

Significant decline in ambulation/movement in the seventh decade due to postural changes (Kyphosis), poor balance/reflexes, joint stiffness, decreased muscle mass/strength, and reduced vision/depth perception. Exercise can help preserve mobility.

Ambulation Benefits

Ambulation improves muscle and joint strength, prevents complications of immobility, and decreases a client's length of stay.

Pre-Ambulation

Perform mobility assessment. Instruct the client to dangle (sit on the side of the bed) for a few minutes prior to standing to monitor for orthostatic hypotension. Ensure non-skid footwear and a clear pathway.

Gait Belt

Used for stability, alone or with other devices. Placed snugly over the client's clothing at the waist.

Cane

Increases stability and improves gait. Types: Single-point or four-point (quad canes). Fit: Top of the cane should be level with the inside of the wrist when standing. Elbow should be bent 20º to 30º.

Walker

Provides a wide, stable base. Types: Standard (no wheels, maximum support), two-wheeled (minor support), three/four-wheeled (balance). Fit: Top of the walker should be at wrist level. Elbow bent at approximately 15º. The client should move the walker and then step with the weaker leg first.

Crutches

Typically used by younger clients with upper extremity strength. Fit: Crutch pads rest 1 to 2 inches below the axilla. Hand grips should be at hip level, with elbows bent 20º to 30º.

Crutch Safety

Body weight must be supported by the hands on the grips, not the axilla, to prevent nerve damage (crutch palsy).

Promotion

Comfort, safety, dignity, frequent position changes.

Prevention

Strain, injury, and skin breakdown.

Proper positioning

Involves aligning the body in a neutral position, supporting natural curves, and eliminating pressure points.

Repositioning

Clients unable to change positions independently must be repositioned frequently (e.g., every 2 hours) to prevent immobility complications.

Prone

Lying on abdomen with the head turned to one side; hips are unflexed. Allows for full extension of the hip and knee joints to prevent contractures. Promotes drainage of secretions.

Supine or Dorsal Recumbent

Lying flat on the back. Enables visualization of the client for examination.

Lateral (Side-lying)

Side-lying; the hips and knees are flexed with a pillow separating the knees/legs. Promotes spinal alignment. Reduces pressure on the sacrum and heels.

Fowler's

Semi-seated or reclined position with the head of the bed elevated 45 degrees. Promotes lung expansion.

Lateral Semi-prone Recumbent

Between prone and lateral, with the top leg flexed up toward the chest and supported. Reduces pressure on the sacrum and hips. Promotes drainage of secretions.

Trendelenburg

Lying flat on the back, with the foot of the bed above the head of the bed. Promotes venous return.

Reverse Trendelenburg

The foot of the bed is lower than the head of the bed. Promotes drainage of the lower lobes of the lungs.

Maximum Assistance (Level 1)

Client cannot bear weight or assist. Use a total mechanical lift or sling.

Moderate Assistance (Level 2)

Client can maintain seated position, has some upper strength, but lacks lower strength. Use mechanical sit-to-stand lifts.

Minimum Assistance (Level 3)

Client can rise from seated position and sustain a steady stand. Use a gait belt and ambulation assistive devices.

No Assistance (Level 4)

Client is independent.

Slide or Transfer Board

Used for lateral (horizontal) transfers of immobile or acutely ill clients (e.g., bed to gurney). Requires a minimum of three to four staff members.

Pivot Disc

Used for sitting or standing transfers for cooperative clients with weight-bearing capabilities who have difficulty moving their feet.

Mechanical Lift (Total/Powered Lift)

Required for clients who cannot support their weight.

Range of Motion (ROM)

The movement of a joint in any direction, which increases joint function and flexibility.

Passive ROM (PROM)

Movement of a joint by another person without the client's assistance. This preserves joint flexibility but does not prevent muscle mass loss or bone demineralization.

Active ROM (AROM)

Voluntary movement of a joint by the client without assistance.

Flexion

Bend; reduce the angle between the bones.

Extension

Straighten the limb.

Abduction

Move away from baseline (midline).