Mobility

Mobility, Normal Movement, and Alignment

Body Alignment or Posture: Essential for optimal balance without undue strain on joints, muscles, tendons, or ligaments.
Balance: Achieved when the center of gravity is close to its base of support. Stability increases with a wider base and lower center of gravity.
- The wider the base, the greater the stability.
- Stability can be increased by spreading feet apart and flexing hips and knees.
Coordinated Body Movement: Muscles working together for purposeful movement.
- Involves lifting, carrying, pushing, pulling, and moving objects.
- Major muscle groups involved include:
  - Flexors and extensors of thighs.
  - Flexors and extensors of knees.
  - Flexors and extensors of upper and lower arms.

Postural Reflexes

Postural Reflexes: Reflexes that maintain body position and equilibrium during rest or 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.

Factors Affecting Movement and Alignment

Developmental Considerations:
- Infant (0-12 months):
  - 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):
  - 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.
- Child (3-5 years):
  - 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:
  - 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:
  - Erect posture with balanced, coordinated movements.
  - Pregnancy shifts center of gravity; exercise is crucial for fitness.
- Older Adult:
  - 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 Considerations

Calcium Sources:
- Cheese, almonds, edamame, tofu, milk, yogurt, fortified orange juice.
Vitamin D Sources:
- Egg yolks, red meat, fortified foods, milk, tuna, salmon, and other oily fish.

Muscular, Skeletal, or Nervous System Issues

Problems Affecting Joint Mobility:
- Inflammation, degeneration, and trauma impact joint mobility.
- Arthritis: Over 100 disorders affecting joints. Symptoms include inflammation, pain, stiffness, and decreased range of motion (ROM).
  - Osteoarthritis: Most common form; characterized by progressive cartilage deterioration and pain during movement.
- 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.
Effects from Other Body Systems:
- Disorders affecting oxygen levels (anemia, angina, heart failure) can decrease activity tolerance.

Exercise Principles

Types of Exercise:
- Isotonic: Muscle shortening with active movement.
  - Activities include ADLs, ROM exercises, walking, and cycling.
- Isometric: Muscle contraction without shortening (e.g., yoga poses).
- Isokinetic: Muscle contractions with resistance (e.g., weightlifting).
Exercise Based on Body Movement:
- Aerobic: Sustained activities that increase CV conditioning (e.g., swimming, jogging).
- Stretching: Gentle movements increasing flexibility and improving circulation.
- Strength & Endurance Exercises: Enhance muscle strength and body power, including common daily activities.

Effects of Exercise on Body Systems

CV System: Improves heart function, blood flow, and venous return.
Respiratory System: Enhances alveolar ventilation and reduces work of breathing.
Musculoskeletal: Builds muscle strength and flexibility, improving coordination.

Risks of Exercise and Effects of Immobility

Cardiovascular Risks:
- Increased workload, venous stasis, and risk of thrombosis. Potential for increased heart rate and orthostatic blood pressure issues.
Respiratory Risks:
- Increased secretions, decreased breathing rate/volume, risk of atelectasis, and pneumonia.

Patient Handling and Safety

Safe Patient Handling and Mobility (SPHM):
- Majority of health care 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 a lifting task without adequate aids.
Ergonomics Application: Design work environments to prevent injury, utilizing correct posture and body mechanics.

Patient Positioning and Assistive Devices

Various tools (like Gait Belts, Transfer Chairs) enhance safe patient movements.
Regular evaluations of the patient’s capabilities and needs promote effective recovery and mobility improvement.