Prepared by: Floriza P.
de Leon, PTRP
IMMOBILIZATION SYNDROME
Immobilization Syndrome refers to a group of s/sx due to prolonged bed rest or physical inactivity Deconditioning refers to the deleterious/bad effects of immobility on the different organ systems; a reduced functional capacity of the body systems (especially the musculoskeletal system due to immobility) Beneficial effects of Inactivity:
Management of traumas e.g. fractures, sprains Acute illnesses e.g. influenza, acute MI
Patients who are susceptible:
Chronically ill Elderly/aged
Effects of Inactivity to the Different Organ Systems
Musculoskeletal system (the most commonly affected organ system)) Contractures
Arthrogenic Soft tissue Myogenic
Intrinsic Extrinsic (most common)
Mixed
Muscle weakness and atrophy
Effects of Inactivity to the Different Organ Systems
Increased Collagen content
Decreased /
Cross linkages Mm strength Mm size
Mm enzymes # of sarcomere # of myofibrils Blood supply
/ / /
/ / / /
Effects of Inactivity to the Different Organ Systems
Immobilization osteoporosis
Decrease bone/skeletal density/mass Decrease osteoblastic activity Increase osteoclastic activity
Cardiovascular system Postural/Orthostatic Hypotension
Decrease venous return to the heart, decrease stroke volume and cardiac output result in decrease blood pressure Signs and symptoms
Increase in pulse rate Decrease systolic pressure
Reduction of blood and plasma volume Decreased cardiovascular performance Decrease stroke volume Decrease work capacity Decrease cardiac output and left ventricular function Thromboembolism Venous stasis and increase blood coagulability which causes clot formation DVT: (for stroke px, DVT is 10x more common on the affected extremities) calf veins is the most common site of DVT formation signs and symptoms: Homans sign is the most common definitive sign that the px has DVT pulmonary embolism
Effects of Inactivity to the Different Organ Systems
Respiratory System Increase mechanical resistance to breathing Decrease cough and bronchial ciliary activity Decrease tidal and minute volume Hydrostatic pneumonia Pulmonary embolism
Nervous System Sensory deprivation Confusion and disorientation Anxiety and depression Decrease in intellectual capacity Impaired balance and coordination
Additional Notes
UE: shoulder joints LE: hip joints These joints are the most commonly affected joints due to immobilization (arthrogenic contracture) Type I, Anti-gravity muscle fiber most susceptible to immobilization atrophy Quads and back extensors earliest to undergo atrophy due to immobilization Gastrocsoleus suffer the greatest loss of strength due to immobilization Hand muscles muscles with the least loss of strength due to immobilization
Effects of Prolonged Bed Rest and Immobility
Organ System
Musculoskeletal Cardiovascular Respiratory Metabolic Genitourinary Gastrointestinal Nervous Skin
Effects
Mm weakness, atrophy, contractures, immobilization osteoporosis Cardiovascular deconditioning, postural hypotension, thromboembolic phenomena Ventilator dysfunction, hypostatic pneumonia upper respiratory infections,
Androgen, growth hormone, parathyroid, insulin, electrolyte, protein, carbohydrate metabolism changes Stasis, UTIs, and stones Constipation, loss of appetite, loss of weight Sensory deprivation, anxiety, depression, confusion, intellectual dysfunction, incoordination, motor control loss. Pressure sores
Basic Principles in the Prevention and Treatment of Contractures
Prevention Proper positioning ROM exercises (active or passive) Early immobilization and ambulation Treatment Passive ROM exercises with terminal stretch at least 2x a day Prolonged stretch using low passive tension and heat Progressive (ex. Dynamic) splinting Treatment of spasticity (motor point or nerve block) Surgical release (ex. Tendon lengthening, osteotomies, joint replacement)
% muscle strength loss 1-3% 10-15% Duration of complete bed rest Day Week
50%
Month (3-5 wks)
