Factors Affecting Mobility Practice Flashcards
Lifestyle and Habits Influencing Mobility
General Maintenance of Function: Regular exercise and optimal nutrition are considered essential prerequisites for maintaining mobility and musculoskeletal functioning.
The Law of Usage: The principle of "use it or lose it" is particularly applicable to the musculoskeletal system; regular usage is required to maintain physiological function.
Conditioning Requirements: Optimal conditioning requires regular, ongoing exercise.
Specific Threshold: Approximately of strenuous aerobic exercise executed $3\times$ weekly is necessary to promote conditioning.
Risks of Inconsistent Exercise: A sedentary individual who attempts a sudden burst of several hours of vigorous exercise once a month may overtax an unconditioned body due to a lack of ongoing conditioning.
Integrity of the Musculoskeletal System
System Requirements: Mobility depends on muscle strength, bone resiliency and strength, and the full range of motion (ROM) of the joints.
Muscle Strength Factors: Influenced by fluid and electrolyte levels, exercise, conditioning, nutrition, and the physiological condition of tendons, ligaments, and soft tissue.
Hypertrophy and Tone: Exercise is responsible for increasing muscle tone, mass, and strength, while simultaneously enhancing the condition of other musculoskeletal tissues and body organs.
Bone and Joint Resilience:
The function of bones and joints is dependent on the mineral content of the bones.
Resilience and skeletal integrity require adequate dietary intake of calcium, phosphorus, and vitamin B.
Joint Functionality: Vital for free movement; joints must be capable of moving through their entire ROM to maintain mobility.
Traumatic Injury: Accidental injury to joints, tendons, ligaments, muscles, or bones can impair mobility.
Minor Trauma: Strains (caused by overexerting a muscle) or sprains (caused by twisting a joint) may affect mobility temporarily.
Extensive Trauma: Includes dislocated joints, torn tendons, or broken (fractured) bones.
Management: Immobilizing devices are utilized to maintain proper alignment of healing body parts.
Bone Demineralization: Conditions such as osteoporosis result in demineralization, significantly increasing the risk of bone fractures.
Pain-Related Limitations: Specific diseases limit mobility due to the pain associated with movement:
Rheumatoid arthritis.
Degenerative joint disease (osteoarthritis).
Gout.
Nervous System Control and Coordination
Neurological Integrity: Smooth movement control requires an intact nervous system.
Motor Ability Pathways: Depends on the integrity of multiple synapse pathways involving afferent and efferent nerves and central integration within the cerebral cortex.
Physiological Requirements for Conduction: Nerve conduction requires adequate circulation and an appropriate balance of fluids and electrolytes.
Balance and Stability: These are products of equilibrium. Stability can be impaired by:
Specific medications.
Fatigue.
Temporary impairment of vision.
Disruption of input to the vestibular system located in the semicircular canals of the ear.
Progressive Neurological Disorders: Certain disorders slowly erode and eventually destroy the capability for normal movement, often leading to confinement in a bed or wheelchair:
Muscular dystrophy.
Parkinson disease.
Multiple sclerosis.
Neurological Impairments and Paralysis
Central Nervous System (CNS) Disruptions: Movement control can be disrupted by infectious processes (e.g., meningitis), tumors, or cerebrovascular accidents (strokes).
Spinal Cord and Brain Injuries: Damage to these structures can cause permanent and severe dysfunction.
General Paralysis: Occurs below the level of a severed or severely damaged spinal cord.
Paraplegia: Defined as decreased motor and sensory function specifically involving the legs.
Hemiplegia: Refers to paralysis of the arm and leg on one side of the body (e.g., right-sided hemiplegia).
Tetraplegia (Quadriplegia): Describes paralysis of the arms, legs, and all muscle movement below the level of the injury.
Circulation, Oxygenation, and Metabolism
Oxygen Requirements: Skeletal muscles require adequate oxygen for optimal function.
Respiratory Role: The lungs must supply oxygen and remove (carbon dioxide), which is the by-product of aerobic metabolism.
Cardiac Role: The heart must pump enough blood to muscles and other organs to meet increased demands during exercise.
Vascular Shunting: During extreme exercise, the vascular system redirects larger amounts of blood to the muscles, often shunting flow away from the gastrointestinal tract (the gut).
Chronic Limiting Conditions:
Cardiovascular: Heart failure or peripheral vascular disease limits effective blood flow, particularly during increased need (aerobic exercise).
Respiratory: Lung disorders decrease the total oxygen delivered to body tissues.
Hematolocial: Anemia decreases the amount of hemoglobin available for oxygen binding.
Metabolic Processes: Energy for muscle contraction is derived from oxygen and food breakdown products.
Aerobic Metabolism: Occurs in the mitochondria; most efficient for long-term activity. By-products are (water) and .
Anaerobic Metabolism (Glycogenolysis): Converts stored glycogen to energy when oxygen is inadequate or delayed. The by-product is lactic acid. This produces fatigue quickly and is only useful for short bursts of energy.
Energy Depletion: Conditions such as cancer can strain nutritional stores and deplete the energy required for movement.
Congenital and Developmental Problems
Cerebral Palsy: A condition present at birth that cannot be cured; treatment focuses on maximizing functional mobility and minimizing complications.
Hip Dysplasia:
Screening: Should occur at birth and during routine health visits throughout the infant's first year of life.
Effectiveness: Corrective treatment is highly effective and prevents long-term disability.
Clinical Symptoms: Asymmetry of the gluteal and thigh folds, limited hip abduction, differences in leg length, and difficulty with crawling.
Affective Disorders and Psychology
Psychological Barriers: Severe affective disorders like depression and catatonic states result in limited mobility due to a lack of desire to move, rather than physical impairment.
Fear-Related Restriction:
Fear of pain during movement may cause individuals to restrict activity.
In older adults, the fear of falling increases as cognitive and physical functions decline, leading to avoidance of mobility activities.
Therapeutic Modalities and Bed Rest
Therapeutic Immobilization: Limiting movement is sometimes a prescribed treatment using restrictive devices such as casts, braces, and splints to promote healing.
Bed Rest as Treatment: Mobility is restricted for various therapeutic benefits, including:
Promotion of healing and tissue repair by decreasing metabolic needs.
Relief of edema.
Reduction of the body's oxygen requirements.
Decreasing pain.
Supporting patients suffering from weakness, exhaustion, or fever.
Prevention of dislodging a deep vein thrombosis (DVT).
Definitions of Bed Rest: Variations exist in clinical practice; some providers allow bedside commode use, while others require strict confinement to bed.
Risks of Prolonged Bed Rest: Significant risk factor, particularly for older adults, leading to deconditioning or the formation of pressure injuries, both of which adversely affect future mobility.