Immobilization Syndrome

..
 Immobilization Syndrome
Unfortunate consequences of
prolonged bed rest and inactivity.
 Deconditioning
Concepts
1800 - early 20th century
: prolonged bed rest is good for ill
person

After WWII
: early ambulation is recommended

3
Vicious cycle of inactivity

4
Effect of aging & exercise

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 Organs Systems affected with
Immobility
Cardiovascular
Genitourinary
Respiratory
Integumentary
Muscle
Endocrine
Skeletal
Neurological
Joint & CTD
Psychological
Gastrointestinal
 Muscle atrophy & weakness

Progressive decrease in muscle strength

/ endurance
Strength declines 1-3%/day
10-25% per week (plateaus at 35-50% in 3-5 wks)
Greater in antigravity muscles (quadriceps, back
extensors, plantar flexors)
Type 1 (slow twitch, oxidative) muscles
glycogen, oxidative enz, mitochondrial
function
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 Muscle atrophy & weakness

Decrease in muscle mass & tension

Decreased size of muscle fibers and reduction of
muscle mass
Reduction of muscle protein synthesis
Reduction of the synthesis of collagen fibers
Increase Titin
 Muscle atrophy & weakness

Prevention/Treatment
daily isometric contractions can prevent deterioration
Note: it may take 2-3 times longer to regain lost muscle
mass & strength

30-50% of maximal contraction for 2 to 5 min, three

tomes a week.
ES at 20-30% of maximal contraction
Endurance exercise at target HR
 Contracture

Contracture
decreased PROM of joint
(arthrogenic, myogenic
and soft tissue)

one of the most function-limiting complications

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 Contracture

Myogenic contracture: a shortening of resting

muscle length. Limiting full ROM.
Arthrogenic contracture: pathologic process
involving joint components, or synovial
inflammation.
Soft-Tissue contracture: cutaneous,
subcutaneous and loose connective tissue
around the joint may become contracted
 Contracture
Prevention
1. Positioning
2. ROM exercise
3. Early mobilization
and ambulation
Treatment
1. Fixed: surgery
2. Non-fixed: rehabilitation role
 Disuse Osteoporosis
Skeletal mass: mechanical loading applied to bone
by tendon pull and the force of gravity
Increased osteoclast activity
Decreased rate of bone formation
Can lead to fracture, even with minor trauma
Prevention: weight-bearing & resistive strengthening
exercise
 Immobilization Hypercalcemia

Immobility Hypercalcemia
Symptoms: N/V, abdominal pain, anorexia,
constipation, confusion and coma
Treatment: hydration and diuresis with
furosemide
 Effect on Cardiovascular System

Decrease stroke volume

Increase resting heart and cardiac output
rate Decrease VO2 max
Increase heart rate NO CHANGE : SBP, MBP
response to Deep vain thrombosis
submaximal exercise
Orthostatic
hypotension

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 Prevention and treatment

Early mobilization and ambulation

Progressively increasing activities
Maintained upright position
Graded conditioning exercise
Rx of orthostatic hypotension and deep vein
thrombosis
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 Effect on respiratory system

Decrease diaphragmatic and chest wall

movement
Weakness of respiratory and abdominal
muscles
Contracture of chest wall
Potential decrease in lung volumes and
impaired cough

Risk for atelectasis and pneumonia

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 Prevention and treatment

Early mobilization and ambulation

Frequent position change
Diaphragmatic and deep breathing
Thoracic expansion exercise
Postural drainage
Percussion, vibration, assisted cough
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 Gastrointestinal

Loss of appetite
Slow rate of absorption
Increased transit time in esophagus, stomach and
small bowel
Constipation

Rx: adequate in take of fluid, fiber-rich diet , avoid

narcotics, regular timed bowel program
 Genitourinary

Diuresis
Urinary retention
Bladder or renal stone, UTI
hypercalciuria

Rx: adequate fluid intake, upright positioning,

acidification of the urine
 The Nervous System

Sensory deprivation
Alteration in mental concentration, orientation to
space and time and other intellectual function
Restlessness, anxiety, decrease pain tolerance,
irritability, insomnia and depression
Judgment, problem solving and learning ability,
psychomotor skills and memory
 The Nervous System

Sensory deprivation
Affect the patients ability to achieve the highest
possible level of functioning and independence
Prevention and treatment
Early physical and psychological stimulation
De Lisa,J. et. Al. (2005). Physical Medicine&Rehabilitation
4th edition--Chapter 68: Immobility and Inactivity:
Physiological and Functional Changes, Prevention and
Treatment.Page1447