PT 539: The Effects of Deconditioning and Bed Rest

what is deconditioning?

a physiological decline in function due to inactivity or immobility

what are the primary causes of deconditoning?

prolonged bed rest or hospitalization

chronic illness

sedentary lifestyle

what is the onset of deconditioning?

effects can begin within 24-48 hours of immobility

why does deconditioning matter?

falls due to muscle weakness

constipation and incontinence

pressure ulcers from skin breakdown

blood clots

chest infections

stiff joints and reduced mobility

confusion or disorientation

up to ___ % of older adults experience decline in fucntion during hospital stays

65

how can we prevent deconditoning?

sit out of bed regularly

eat and drink frequently

use the dayroom for social and physical activity

dress in own clothes and footwear

move often (with support if needed)

complete your exercise program daily

what happens in days 1-3 of deconditioning?

loss of plasma volume

decreased CO

decreased neuromuscular control. increased risk of thromboembolism

progressive orthostatic intolerance

increased risk of pneumonia

what happens in days 4-7 of deconditoning?

muscle atrophy begins; insulin resistance increases -> controls levels -> pulls glucose from blood into cells, decreased cardiac output

what happens in 2+ weeks of deconditioning?

all of the above continues and bone demineralization

what are the effects of deconditioning syndrome?

muscle and joint stiffness, leading to reduced ability to walk

increased risk of falls due to muscle weakness

constipation and incontinence

skin breakdown, leading to pressure ulcers

increased confusion or disorientation

pneumonia due to prolonged bed rest

further immobility due to inactivity

increased risk of swallowing problems leading to pneumonia

clots in the legs and lungs

appetite and digestion can be affected

what is the strength loss with bed rest?

loss of strength of 1-2 % per day

- 2-5 % in the presence of pathology, age, or medications (corticosteroids or other meds can affect this even more)

what are the cardiovascular effects of deconditoning?

decreased SV and CO

increased resting heart rate

decreased VO2 max

orthostatic hypotension due to baroreceptor desensitization

venous stasis -> increase risk of DVT

what is the PT role in deconditioning of the cardio system?

early mobilization

gradual reconditioning through upright positioning and exercise

what are the effects of deconditioning on muscles?

decreased muscle cross sectional area

type 1 fiber atrophy (endurance loss) -> type 2 goes down first, then type 1 (which is a bigger hit)

what are the effects of deconditioning on bones?

decreased mechanical loading -> increased osteoclast activity

risk of osteoporosis, fractures

what is the PT role of managing the MSK effects of deconditoning?

resistance training -prescribed correctly

weight bearing activities - not just in session!

neuromuscular re-ed

what are the effects of deconditioning on respiratory system?

decreased lung volumes (especially FRC and VC) -> sounds restrictive

decreased diaphragm strength -> especially if they are on the ventilator

increased risk of atelectasis and pneumonia

what is the PT role in managing the respiratory affects of deconditioning?

incentive spirometry

deep breathing exercises

optimize airway clearance

early ambulation and upright positioning

what are the effects of deconditioning on the metabolic and endocrine systems?

increased insulin resistance, protein breakdown, decreased protein synthesis, increased inflammatory cytokines, increased risk of pressure injuries due to poor perfusion and nutrition

what is the PT role in managing the respiratory and endocrine effects of deconditioning?

promote muscle protein synthesis through activity

educate on nutrition/exercise interface

what are the effects of deconditioning on the neurologic and cognitive systems?

sensory deprivation -> cognitive decline

sleep wake cycle disruption

neuromuscular junction degradation -> decreased coordination

what is the PT role in managing the effects of deconditioning on the neurologic and cognitive effects?

functional mobility training

engagement

cognitive stimulation through tas-oriented activities

what are the effects of deconditioning on psychological system?

depression, anxiety

decreased motivation and engagement

learned helplessness

what is the PT role in managing the effects of deconditioning in the psychological system?

encourage autonomy - decision making and mobility

set achievable goals

promote social interaction through group activities (when possible)

what is the general cycle of deconditioning?

immobility, deconditioning, reduced function, more immobility

how can we as PTs break the cycle off deconditoning?

early progressive, goal oriented PT intervention

- intervene early and often

- evidence based exercise prescription - if not intense enough then not worth your time

- ICU patients: early mobilization reduces ICU hospital length of stay and improves long term functional outcomes

- post surgical: mobilization within 24 hours reduces complications

why is bed rest bad?

muscle mass decreased by 1.5-2% per day during bed rest

increased risk for development of thromboembolic disease

increased risk for atelectasis that may contribute to pneumonia

raising the head of the bed causing greater pressure on the skin in the sacral region

one study found 61/155 patients who survived a critical illness had contractures

to prevent bed rest, if your patient can walk, what should you do?

walk patient to the bathroom instead of using the bedside commode

encourage family and friends to walk the patient

take a walk down the hall before each meal

to prevent bed rest, if your patient cannot walk, what should you do?

help patient to use the bedside commode instead of the bed pan

increase total amount of time spent outside of bed

help patient to sit in a chair for all meals

what is the goal for discharge?

safe and efficient transition from hospital to home or next level of care

what is the PTs role in discharge?

functional mobility assessment

gait and balance evaluation

fall risk assessment

determine DME needs (walker, commode)

home safety recommendations

communicate with interdisciplinary team (nursing, case management, OT, MD)

what are the discharge options?

home with or without services

inpatient rehab

- acute rehab, sub acute, swing beds

skilled nursing facility

long term acute care hospital

what is the goal of PT in the ICU?

safe and efficient transition from hospital to home or next level of care

what is the PTs role in the ICU?

functional mobility assessment

gait and balance evaluation

fall risk assessment

determine DME needs (walker, commode)

home safety recommendations

communicate with interdisciplinary team (nursing, case management, OT, MD)

what are the benefits of PT in the ICU?

decreased ventilator days

decreases ICU/hospital length of stay

increased functional independence at discharge

what is the main focus in the ICU?

early mobilization to prevent complications

- ICU acquired weakness

what are some common challenges in the ICU?

intubation/mechanical ventilation

sedation/delirium

hemodynamic instability

what is the role of a PT in the ED?

assess and treat MSK complaints

prevent unnecessary admissions

decrease wait times and improve throughout

what is the common pt population in the ED?

falls, back pain, dizziness/vertigo, minor injuries, unsafe discharge

what are the PT tasks in the ED?

functional mobility screening

determine need for imaging or referral

provide education and HEP

what is the collaboration that needs to happen in the ED?

works directly with ED physicians, nurses, case managers