Immobilization Effects PDF

1 Therapeutic dose 2 Unit 1. Immobilization as a therapeutic agent. Adaptations to immobilization Definition "Restricting or physical limitation of the limbs and body to rotation, to sit, and to walk” The consequences of immobilization are independent of their cause Immobilization Total ...

1 Therapeutic dose 2 Unit 1. Immobilization as a therapeutic agent. Adaptations to immobilization Definition "Restricting or physical limitation of the limbs and body to rotation, to sit, and to walk” The consequences of immobilization are independent of their cause Immobilization Total  Immovilization Symdrome Local  Local Adaptations to immobilization Intensity of immobilization Adaptations to immobilization Immovilization Symdrome • Elderly patients • Patients with neurological deficit • Patients with musculoskeletal deficit The effects of immobilization further reduced functional capacity Effects of Prolonged immobilization • CNS – Decreased motor activity – Altered sensation – Autonomic lability – Depression, anxiety, disorientation Effects of Prolonged immobilization • Musculoskeletal System – Decreased muscle strength and endurance • Larger and antigravity muscles of the lower extremities Effects of Prolonged immobilization • Musculoskeletal System – Muscle disuse atrophy • It lost in a week of rest about 15% of its initial Strength • About 50% of muscle strength is lost in five weeks of inactivity, the greatest degree of loss occurs during the first week. • In upper motor neuron disease, muscular volume decreases by 30 to 35% because the increasing of the tone prevents the complete atrophy • In case of lower motor neuron disease with irreversible flaccid paralysis, muscle volume is reduced by 90-95% Effects of Prolonged immobilization • Musculoskeletal System – Joint Contractures • On periarticular soft tissue, structural reorganization of the connective tissue connective tissue (1 week) • Contracture clinically  ROM limitationJoint stiffness • Several factors contribute to intensify its formation: spasticity, paresis, antalgic position, edema, elderly, softtissue injury and muscle imbalance. • In an immobilized patient, the contractures they are more common in lower extremities. Effects of Prolonged immobilization • Musculoskeletal System – osteoporosis, pathological fracture • The loss of stress on the bones (weight, gravity, muscle activity) increases osteoclast activity. • Bone mass Reduction, especially in weight-bearing bones after 12 weeks of rest, bone density decreases 40-45% • After immobilization Periods, heterotopic ossifications may appear, usually in periarticular soft tissue. • Etiology not clear, exist some genetic predisposition. Be associated with an inflammatory reaction to a particular injury (trauma, tissue hypoxia, vascular stasis, infection). • The earliest sign is the limitation of joint ranges, then is added, erythema, edema and local heat. Effects of Prolonged immobilization • Cardiorespiratory system – Increase of the heart rate – Decrease of the cardiac efficiency – Orthostatic hypotension – Thrombophlebitis – Decrease of the vital and functional capacity – Pulmonary embolism, atelectasis, pneumonia Effects of Prolonged immobilization • Digestive system – Anorexia – Malnutrition – Constipation Effects of Prolonged immobilization • Renal Endocrine System – Hypercalciuria – increased of the natriuresis – Increased of the diuresis – Nephrolithiasis. Effects of Prolonged immobilization • Integumentary System – Pressure ulcers • More frequent in patients with impaired sensitivity, elderly, underfed and incontinence. • It occurs over bony prominences. • They occur when the pressure on the skin exceeds the capillary pressure of the tissue, resulting in deprivation of oxygen and nutrients (ischemia and hypoxia) Pressure ulcers grades of classification • Grade I  Limited to the epidermis • Grade II  Affect epidermis, dermis and extends to fatty tissue • Grade III  Affect surface structures, adipose tissue and muscular tissue • Grade IV  They destroy all soft tissue until bone. The joint structures can be exposed. Pressure ulcers Strategies to alleviate the immobilization • Bed Sores – Proper Patient positioning in bed – Using Anti-decubitus mattress, anti-equinus systems. – Frequent changes of position, every two hours. – Good skin hygiene, management of bladder and bowel least invasive as possible. Strategies to alleviate the immobilization • Thromboembolic phenomenon prevention – Using elastic bandage, intermittent pneumatic compression, low doses of heparin, • Adequate nutrition and hydration. • Carefully control of the signs and symptoms of hypercalcemia, pressure ulcers, urinary tract infection and pneumonia. • Stimulate and preserve the activities of daily living, sensory stimulation, integrate and educate the patient and family. Strategies to alleviate the immobilization • Physiotherapy: – As soon as possible • Progressive kinesitherapy of all joints, at least 1 time per day. • Orthostatic retraining, when the patient to be stabilized. • Isometric exercise and weight bearing (standing), help prevent osteoporosis • Respiratory physiotherapy – Deep breathing exercises, assisted coughing, chest percussion among others, to maintain the patient's ventilatory capacity. Local Adaptations to immobilization Bone • After 24 hours of immobilization, osteoblastic activity in healthy subjects increases. Muscle Connective tissue and capillarization • 3 weeks immobilization • Connective tissue increase – More in some muscles, if the immobilization occurs in stretch position (example Soleus 24% more). – A 65% Decrease of the capillarization Tendon Ligaments Intense exercise  Ligamentous hypertrophy ( Ø fibers)  > Resistance Immobilization  Ligaments atrophy  < Resistance Cartilage • Softening of the cartilage (chondromalacia) • Thinning + joint space reduction • Causing irregularities in the articular surface. These changes begin quickly and are permanent after 8 weeks of immobilization. Joint • Decreased final load • Decreased energy absorbed • Decreased modulus of elasticity Increased subperiosteal osteoclast activity  avulsion Physical deconditioning syndrome