Effects of Immobility

Immobility: Lacks movement, can be localized (e.g., fractured arm, paralysis: hemiplegia, paraplegia, quadriplegia, diplegia) or generalized (e.g., coma, acute illness).
Effects depend on extent and duration.
Physiotherapy/passive exercise and respiratory therapy can minimize adverse effects.
Supine position alters gravity-dependent functions (intestines, urinary tract), bone stress, blood circulation, respiratory, metabolic, digestive, and renal functions.

Inactive muscle loses strength, endurance, and mass rapidly (disuse atrophy).
Strength loss: Approx. 12\% per week; nearly 50\% after 3-5 weeks of bed rest.
Improper positioning leads to contractures (e.g., foot contractures), limiting joint function.
Flexor muscles are stronger than extensors; imbalance can cause abnormal joint positions without range-of-motion (ROM) exercises.
Tendons and ligaments shorten and lose elasticity; after 4-6 days of immobility, density increases, limiting range of motion.
Prolonged immobility replaces muscle cells with fibrous tissue, leading to muscle wasting, decreased flexibility, and potential irreversible deformities.
Lack of muscular activity impairs venous return, causing blood pooling, dependent edema, and decreased cardiac output.
Bone demineralization (osteoporosis) occurs due to reduced osteoblastic activity while osteoclastic activity continues, increasing fracture risk.
Breakdown of muscle and bone tissue elevates serum nitrogen wastes (creatinine) and calcium (hypercalcemia).
Hypercalcemia can cause renal calculi and decrease muscle tone (flaccidity).

Skin breaks down easily due to impaired circulation and reduced cell regeneration, especially over bony projections (ischial tuberosities, sacrum, greater trochanter, heels, elbows).
Pressure leads to ischemia and tissue necrosis, forming decubitus ulcers (pressure sores/bedsores).
Contributing factors: poor circulation, edema, inadequate subcutaneous tissue, loss of sensation, prolonged static positioning, mechanical irritation, excessive moisture, poor hygiene, inadequate nutrition/hydration, skin trauma.
Ulcers progress from redness to superficial breakdown, deep purplish-red discoloration, necrosis, and full-thickness damage with high infection risk.
Prevention involves protective padding (e.g., sheepskin), flotation devices, and frequent position changes.

Initially, horizontal body position increases venous return; prolonged immobility reduces venous return and cardiac output.
Orthostatic hypotension, characterized by dizziness/fainting, pallor, and rapid pulse, occurs with position changes.
Lack of skeletal muscle pump activity and reflex vasoconstriction impairs venous return, leading to blood pooling and increased capillary pressure, resulting in edema.
Persistent edema reduces arterial flow and nutrient exchange, predisposing to tissue necrosis and ulcers.
Blood stasis promotes thrombus formation in veins, particularly in the legs.
Virchow triad (venous stasis, hypercoagulability, blood vessel damage) significantly increases the risk of deep vein thrombosis (DVT).
Thrombi can lead to pulmonary emboli; prophylactic measures include antiembolic stockings, exercises, or anticoagulants.

Initially, less oxygen demand leads to slow, shallow respirations.
Supine position, body weight, and abdominal pressure restrict chest expansion, impeding deep breathing and coughing.
Reduced thoracic capacity and muscle weakness decrease ventilation and gas exchange.
Sedatives and analgesics depress respiratory control.
Secretions accumulate in airways due to ineffective cough mechanism, reduced ciliary action, and viscous mucus.
Stasis of secretions predisposes to hypostatic pneumonia, airway obstruction, and atelectasis (lung collapse).
Aspiration risk increases in immobilized or supine positions.
Respiratory therapy and breathing exercises (e.g., using respirometers) are beneficial.

Constipation is a major problem due to slowed fecal passage, muscle inactivity, body position, and reduced food/fiber/fluid intake.
Weakened muscles and awkward bedpan use further complicate defecation.
Reduced appetite leads to decreased dietary intake, negative nitrogen balance (protein deficit), low hemoglobin levels, and delayed healing.
Malnutrition can result, worsening fatigue and depression.
Nutritional support (liquid products, TPN, nasogastric tube) may be necessary.
Inactivity coupled with high caloric intake or increased snacking can lead to obesity.

Urine stasis in kidneys or bladder frequently causes infection or renal calculi (stones).
Supine position impedes gravity-dependent drainage, leading to residual urine in kidney calyces and incomplete bladder emptying.
Renal calculi risk increases with hypercalcemia (from immobility) and reduced fluid intake.
Cystitis (bladder infection) is common with calculi or catheter use.
Immobility can lead to increased diuresis and dehydration: blood shift to thorax stimulates ANP release and reduces ADH, increasing urine output.

Prolonged pressure causes pain by stimulating sensory receptors in the skin and tissues.
Tissue and nerve damage can lead to tingling and eventual loss of sensation, as well as muscle spasms.
Lack of environmental control contributes to negative psychological effects like depression, anxiety, confusion, and forgetfulness.
Increased stress linked to corticosteroid release, potentially causing widespread physiologic changes.

Normal growth is often delayed due to loss of physical movement required for bone and muscle development.
Catch-up growth is possible upon return to mobility.
Increased risk of developing deformities in hips, spine, hands, and feet.
Decreased sensory and experiential stimulations can lead to other developmental delays.