1. Chapter 38 Mobility and Biomechanics

2. 38-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Mobility Ability to engage in activity and free movement Walking, running, sitting, standing, lifting, pushing, pulling Activities of daily living (ADLs)

3. 38-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Mobility Enhances muscle tone, increases energy levels Psychological benefits of independence and freedom

4. 38-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Body Alignment (posture) Position of body parts in relation to each other Center of gravity is evenly distributed. Promotes balance, reduces strain and injury. Promotes efficient circulatory, renal, pulmonary, and gastrointestinal functions. Influences self-esteem and body image.

5. 38-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Body Alignment Client comfort Prevention of contractures Promotion of circulation Reduces stress on muscle, tendons, nerves, and joints Prevention of foot drop (plantar flexion)

6. 38-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Body Alignment Muscle Tone -Hypotonicity -Spasticity Muscle Shape -Hypertrophy -Atrophy

7. 38-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overview of Mobility  Body Mechanics involves the three basic elements of body alignment, balance, and coordinated movement (stability).  Range of motion reflects the extent to which a joint can move.

8. 38-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Mobility  Musculoskeletal System Bones Joints Tendons Ligaments Bursa Cartilage

9. 38-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiology of Mobility  Nervous System Proprioception -Tells us where our body is in space relative to other objects. Postural Reflexes (righting) -Maintain postural tonus.

10. 38-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Exercise  Any physical activity involving muscles that elevates the heart rate above resting levels  Reduces joint pain and stiffness.  Increases flexibility, muscle strength, and endurance.  Weight reduction and improved sense of well-being

11. 38-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Exercise  Types of Exercise Aerobic Strengthening Isometric Isotonic Isokinetic

12. 38-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Exercise  Range-of-Motion Exercise (ROM) Passive Active

13. 38-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Exercise  Physical Fitness Endurance and strength Joint flexibility Cardiorespiratory fitness Body composition Fitness in older adults

14. 38-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Mobility  Health Status  Developmental Stage Children Adolescents Adults

15. 38-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Mobility  Environment Attitudes and Beliefs Lifestyle

16. 38-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physiological Effects of Mobility and Immobility  Neurological Effects  Cardiovascular Effects  Respiratory Effects  Musculoskeletal Effects  Digestive Effects  Elimination Effects  Integumentary Effects

17. 38-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assessment  Health History ADLs Exercise patterns Activity tolerance Medications Alteration in health status

18. 38-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Physical Examination  Musculoskeletal Assessment Movement and Gait Alignment Endurance

19. 38-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Musculoskeletal Assessment  Muscle Impairments (common overuse injuries) Strain Tendonitis Bursitis Sprain

20. 38-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Pathological Alterations  Postural Abnormalities Scoliosis Kyphosis Lordosis List

21. 38-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Pathological Alterations  Contractures Contracture deformities occur when a muscle group is not moved for a period of time or if proper body alignment is not maintained.

22. 38-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Pathological Alterations  Musculoskeletal Trauma Fractures Amputation

23. 38-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Pathological Alterations  Central Nervous System (CNS) Any disruption in the CNS can impair mobility. Spinal cord injury can lead to partial paralysis or complete loss of mobility.

24. 38-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Neurological Assessment  Cranial Nerves  Motor System  Sensory System  Reflexes

25. 38-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Functional Assessment  Focuses on client’s ability to perform ADLs. Client’s ability to feed, dress, toilet, move, transfer, and ambulate self independently, or with assistance

26. 38-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnoses  Activity Intolerance  Impaired Physical Mobility  Risk of Disuse Syndrome  Self-Care Deficits  Altered Health Maintenance  Risks for Falls

27. 38-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Planning and Outcome Identification  Realistic Outcomes Consider Client’s Understanding of mobility status Values, thoughts, and concerns Health status in general Ability to solve problems

28. 38-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Planning and Outcome Identification  Interventions Bed Rest Restorative Nursing Care Health Promotion and Fitness

29. 38-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Meeting Psychosocial Needs  Applying Principles of Body Mechanics  Maintaining Body Alignment: Positioning Fowler’s Recumbent (supine) Prone Lateral Sim’s

30. 38-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Maintaining Body Alignment: Assistive Devices

31. 38-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Range-of-Motion Exercises Performed several times a day. Each joint is placed through its full functional motion.

32. 38-32 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Transfer Techniques Moving clients Logrolling the client Transferring from bed to chair Transferring from bed to stretcher Assistive devices

33. 38-33 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Assisting with Ambulation Preparing the client to walk Client education Preambulating exercise

34. 38-34 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assisting with Ambulation  Nurse promotes safety of a client using a quad cane.

35. 38-35 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Assisting with Ambulation  Assistive Devices Canes Walkers Crutches

36. 38-36 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Wellness Promotion Emphasizes the need for physical fitness.  Complementary Treatment Modalities Range from physical activity and relaxation exercises to herbs, yoga, acupuncture, acupressure, and biofeedback.

37. 38-37 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Transfer of skills and knowledge from the acute care hospital or rehabilitation facility to home Mobility status Activities of daily living capacity Use of appropriate adaptive devices Client’s ability to function within his or her own environment

38. 38-38 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Evaluation  Ongoing assessment in the home setting is important because compliance with home exercise programs may lessen over time after discharge.