Understanding Human Mobility

Mobility

• The state of being mobile or moveable defines mobility
• Immobility is defined as being impaired
• Purposeful physical movement includes gross simple movements, complex movements, and coordination
• Mobility depends on the musculoskeletal and nervous systems synchronized efforts
• Adequate oxygenation, perfusion, and cognition are required for mobility
• Mobility requires adequate muscle strength, skeletal stability, joint function, and neuromuscular coordination to carry out movement
• Deconditioning: loss of physical fitness
• Disuse leads to deconditioning

Normal Physiological Processes

• Optimal mobility requires bones, joints, articular cartilage, tendons, and ligaments
• Mechanics of muscle contraction and an intact neurologic system are critical for optimal mobility

Neurologic System

• The brain coordinates the neurologic system
• Sensing, integrating, and responding to internal and external data signals are complex processes of motor activity
• The motor cortex is located in the frontal lobe
• The cerebellum is located at the base of the brain

Musculoskeletal System

• Adults have 206 bones
• The skeleton acts as structural support, provides leverage, and protects tissues/internal organs
• The skeleton provides attachment sites for muscles and ligaments
• Bones are a storage center for calcium
• Red blood cells are produced within the bone marrow
• Bone remodeling: maintenance of bones by creating new cells, including osteocytes, osteoblasts, and osteoclasts

Joints

• Joints provide stability to bones allowing skeletal movement and positioning
• Diarthrosis: freely movable joint
• Synarthrosis: immovable joint
• Ampiarthrosis: slightly movable joint
• Flexion, extension, rotation, adduction, abduction, supination, and pronation are movements allowed by joints

Muscles

• Skeletal muscles are under voluntary control
• Optimal skeletal muscle function relies on 5 factors, including nerve impulses reaching muscles and muscle fiber response
• Proprioception, mechanical load, and joint mobility are factors that affect skeletal muscle function

Age-Related Differences

• The appendicular skeleton (arms/legs) grows faster than the axial skeleton in children
• Bones change in composition, grow in length/diameter, and undergo alignment changes in children
• Thinning vertebral disks, shortening of the spinal column, and onset of kyphosis come with age
• Bone density decreases and bones become brittle (more apparent in females), increasing the risk for fracture with age
• Cartilage becomes rigid and ligaments become less elastic and resilient with aging

Consequences of Immobility

• Reduced cardiac capacity and output, orthostatic hypotension, venous stasis, and deep vein thrombosis are related to cardiovascular issues
• Reduced lung expansion, atelectasis, and pooling of respiratory secretions can occur in the respiratory system
• Reduction in muscle mass and atrophy, contracture of joints, and bone demineralization are musculoskeletal consequences
• Skin breakdown of the integumentary system
• Reduced peristaltic motility causes constipation related to the gastrointestinal system
• Renal calculi, urinary stasis, and infection are urinary system issues

Populations at Risk

• Altered mobility affects all individuals regardless of age, ethnicity, race, or socioeconomic status
• Older adults are at most significant risk for impaired mobility, which increases the risk for falls
• Individual risk factors for changes in mobility often stem from acute/chronic conditions, chronic pain, and injury/trauma

Osteoarthritis

• A noninflammatory degenerative disorder of the joints
• The most common form of joint disease; also called degenerative joint disease
• Primary (idiopathic) osteoarthritis has no prior event or disease related, whereas secondary osteoarthritis results from joint injury/inflammatory disease
• Primary osteoarthritis does not involve autoimmunity or inflammation
• Autoimmune disorders can result in joint destruction
• Limited to the affected joints, with no systemic symptoms.

Pathophysiology

• Articular cartilage breaks down, causing bone damage and osteophyte formation (bone spurs)
• Joint space is narrowed results in decreased joint motion
• Joint can progressively degenerate
• Previously believed to be related to aging

Risk Factors

• Increasing age, being female, and obesity are all risk factors
• Specific occupations or sport activities that require laborious tasks are risk factors
• The most prominent modifiable risk factor for OA is obesity
• Diet and exercise can help minimize OA symptoms

Clinical Manifestations

• Pain, stiffness, and functional impairment are manifestations
• Joint pain is typically aggravated by movement/exercise
• Morning stiffness lasts less than 30 minutes
• Onset is insidious and progresses over years
• Enlargement of the affected joint and decreased ROM

Management of Osteoarthritis

• Decreasing pain and stiffness
• Exercise, especially cardiovascular and training
• Weight loss
• Occupational and physical therapy
• Pharmacological management to manage pain

Joint Arthroplasty

• Used for patients with osteoarthritis, severe joint pain, loss of function, degeneration by RA, trauma, congenital deformity, or certain fractures

Total Hip Arthroplasty Assessment

• Aimed at optimizing the patient's health for surgery
• Proactively manage risks and complications
• Bleeding, dislocation of the hip prothesis, venous thromboembolism (VTE), infection, and heel pressure injuries are potential risk
• Important to refer to chart 36-6

Total Hip Arthroplasty Goals

• The goal is to achieve pain relief, a stable hip joint pre and post-op
• Absence of complication in the post-operative phase
• Heterotopic ossification: bone formation in soft tissue

Nursing Interventions After Total Hip Arthroplasty

• To prevent the dislocation of hip prosthesis, correct positioning using a splint, wedge, or pillows
• Keep the hip in abduction when turning; avoid adduction when transferring
• Limit flexing of the hip to less than 90 degrees
• Patients usually start walking after surgery using a walker or crutches
• The amount of weight to bear is per orders of a physician
• Assess for bleeding and fluid accumulation where drained