Managing Immobility
Immobility has always been a cause for concern, particularly with the advancement of age although in earlier years, it was considered to be a problem commonly encountered with the elderly in the present day, with advancements in medical treatment, particularly emergency medicine, many people of the younger generations may face a similar problem. Road traffic accidents, spinal injuries, cerebrovascular accidents (stroke) and even infections have been known to result in immobility, though its generally for a defined period of time.
The loss of function poses a handicap to both the individual, as well as the surrounding family members. For the individual, the sudden curtailing of freedom of movement and independence can be a source of irritation, frustration and disappointment, which can sometimes progress to depression. From the family and care givers point of view, there is a lot of work involved in keeping the confined person healthy and it requires a lot of time, patience and dedication.
Though immobility is considered inevitable in many cases, particularly in geriatric conditions, there are some simple measures which can help prevent/delay its occurrence. And under the circumstances that it is already present, a few precautions can go a long way in preventing complications and discomfort in the patient thereby making his/her condition easier to live with.
Factors Predisposing to Immobility
Knowing the causes of immobility can make simple its remedy. It can be broadly considered under two categories: short term and long-term, depending on the severity and availability of treatment. An early diagnosis is always desirable.
Loss of Movement/ Function May Result From:
Weakness:
from disuse of muscles, myopathies, malnutrition, anaemia, electrolyte disturbances, and neurological disorders.
Stiffness:
Osteoarthritis being the most common cause Parkinson's disease, gout and antipsychotic drugs such as haloperidol may also contribute
Pain:
This may arise from:-
- Bone : osteoporosis, osteomalacia, trauma, metastatic bone cancer
- Joints - osteoarthritis, rheumatoid arthritis, gout
- Bursa - Inflammations
- Muscle - polymyalgia rheumatic, intermittent, claudication
- 5. Nerve involvement and decreased blood supply, especially to the legs and feet
Imbalance and Fear of Falling:
This may arise from general debility, neurological causes such as stroke, vertigo, reduced hearing or vision, postural hypotension neuropathy due to diabetes, alcohol or malnutrition and sometimes also following prolonged bed rest
Psychological Causes:
These include severe anxiety and depression
Resulting Effects
- The consequences of lack of movement are several
- Muscles undergo atrophy, weakness and shortening
- The incidence of deep vein thrombosis and pulmonary embolus is high
- Mechanical pressure, moisture and function can result in pressure sores
- There is decreased cardiac output and decreased oxygen update with find shifts and fluid loss.
As a result, within a short while of being confined to bed, the risk of postural hypotension, falls and skin breakdown rises and the several of these changes would take several weeks to months.
Preventive Measures:
Prevention is an important step towards management and a better quality of life. The best measure would be to avoid bed rest, if possible, but if absolutely required, the following measures may help improve the consequences.
- Patients should be positioned close to the upright position, as frequently as possible
- Consultation with a physical therapist for active exercise and physiotherapy is helpful in maintaining muscle mass and joint mobility and in preventing deep vein thrombosis. Pressure graded stockings are also useful in DVT
- Patients should as far as possible, assist in their own positing and self care
- Skin over pressure points should be frequently examined for the early detection and prevention of bed sores
- As the patient shows improvement in mobility with exercise, gradual ambulation should be encouraged
- In patients confined to a wheel chair, sing shaped devices to prevent pressure sores are best avoided, as they can increase the risk by causing venous congestion
Additional measures such as installing handrails, lowering the bed, the use of tilt tables, providing chairs of adequate height with arms and rubber skid guards, the use of comes and walkers, heaving aids, the use of spectacles for visual connection and the use of appropriate footwear, can go a long way in instilling confidence and independence in these patients and assure their safety by avoiding untoward accidents and there by complications.
Steps in Management:
Treatment of the cause is always a primary concern and rightfully so as the underlying disease is treated, with the sense of well being comes an active interest in getting back to a relatively, normal way of life. Patience and positive encouragement by the family members and care givers is also an essential aspect of management.
The treatment of pressure ulcers depends on the stage. The general management includes eliminating excess pressure, ensuring adequate nutrition and hygiene, and the use of moist dressings and their regular change. Topical antibiotic applications may be helpful. When complicated with cellulites, ostcomydites or sepses, such patients may require hospital care with intravenous antibiotics and surgical debridement, depending on the severity.
Special mattresses such as water-beds and static air/foam mattresses are available, that reduces pressure and thereby reduces the incidence/worsening of pressure sores.
In addition, daily multivitamins, especially in cases of malnourishment and impairment to intake of a regular health diet, can be beneficial for the general well being of the person.
