The Consequences of Immobilization

Consequences of Immobilization

• Immobilization is the restriction or physical limitation of limbs and body movement.
• The consequences of immobilization are independent of their cause and can lead to immobility syndrome and local adaptations.
• Elderly patients, patients with neurological or musculoskeletal deficits are more prone to immobility syndrome.
• Prolonged immobilization can lead to decreased motor activity, altered sensation, autonomic lability, depression, anxiety, and disorientation.
• Musculoskeletal effects of prolonged immobilization include decreased muscle strength and endurance, muscle disuse atrophy, joint contractures, osteoporosis, and pathological fractures.
• Immobilization can lead to cardiovascular and respiratory system issues, digestive system problems, renal endocrine system issues, integumentary system problems, and pressure ulcers.
• Pressure ulcers have four grades of classification, ranging from limited epidermis damage to destruction of soft tissue until bone and exposure of joint structures.
• Strategies to alleviate immobilization include proper patient positioning, anti-decubitus mattress, frequent changes of position, good skin hygiene, and management of bladder and bowel functions.
• Other strategies include thromboembolic phenomenon prevention, adequate nutrition and hydration, controlling signs and symptoms of hypercalcemia, pressure ulcers, urinary tract infection, and pneumonia.
• Physiotherapy can help alleviate immobilization, including progressive kinesitherapy of all joints, orthostatic retraining, isometric exercise, weight-bearing exercises, and respiratory physiotherapy.
• Local adaptations to immobilization include increased osteoblastic activity in healthy subjects after 24 hours of immobilization, increased connective tissue and capillarization after three weeks of immobilization, ligament atrophy and decreased resistance after immobilization, and softening and thinning of cartilage.
• Joint changes include decreased final load, energy absorbed, and modulus of elasticity, as well as increased subperiosteal osteoclast activity leading to avulsion. Immobilization can lead to physical deconditioning syndrome.