Chapter 38

Mobility and Biomechanics

38-2Copyright 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)

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Overview of Mobility

Mobility• Enhances muscle tone, increases energy

levels• Psychological benefits of independence and

freedom

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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.

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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)

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Overview of Mobility

Body Alignment• Muscle Tone

- Hypotonicity- Spasticity

• Muscle Shape- Hypertrophy- Atrophy

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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.

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Physiology of Mobility

Musculoskeletal System• Bones• Joints• Tendons• Ligaments• Bursa• Cartilage

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Physiology of Mobility

Nervous System • Proprioception

- Tells us where our body is in space relative to other objects.

• Postural Reflexes (righting) - Maintain postural tonus.

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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

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Exercise

Types of Exercise• Aerobic• Strengthening• Isometric• Isotonic• Isokinetic

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Exercise

Range-of-Motion Exercise (ROM)• Passive• Active

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Exercise

Physical Fitness• Endurance and strength• Joint flexibility• Cardiorespiratory fitness• Body composition• Fitness in older adults

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Factors Affecting Mobility

Health Status Developmental Stage

• Children• Adolescents• Adults

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Factors Affecting Mobility

Environment• Attitudes and Beliefs• Lifestyle

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Physiological Effects of Mobility and Immobility

Neurological Effects Cardiovascular Effects Respiratory Effects Musculoskeletal Effects Digestive Effects Elimination Effects Integumentary Effects

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Assessment

Health History• ADLs• Exercise patterns• Activity tolerance• Medications• Alteration in health status

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Physical Examination

Musculoskeletal Assessment• Movement and Gait• Alignment• Endurance

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Musculoskeletal Assessment

Muscle Impairments (common overuse injuries)• Strain• Tendonitis• Bursitis• Sprain

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Pathological Alterations

Postural Abnormalities• Scoliosis• Kyphosis• Lordosis• List

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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.

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Pathological Alterations

Musculoskeletal Trauma• Fractures• Amputation

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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.

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Neurological Assessment

Cranial Nerves Motor System Sensory System Reflexes

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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

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Nursing Diagnoses

Activity Intolerance Impaired Physical Mobility Risk of Disuse Syndrome Self-Care Deficits Altered Health Maintenance Risks for Falls

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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

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Planning and Outcome Identification

Interventions• Bed Rest• Restorative Nursing Care• Health Promotion and Fitness

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Implementation

Meeting Psychosocial Needs Applying Principles of Body Mechanics Maintaining Body Alignment: Positioning

• Fowler’s• Recumbent (supine)• Prone• Lateral• Sim’s

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Implementation

Maintaining Body Alignment: Assistive Devices

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Implementation

Range-of-Motion Exercises• Performed several times a day.• Each joint is placed through its full functional

motion.

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Implementation

Transfer Techniques• Moving clients• Logrolling the client• Transferring from bed to chair• Transferring from bed to stretcher• Assistive devices

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Implementation

Assisting with Ambulation• Preparing the client to walk• Client education• Preambulating exercise

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Assisting with Ambulation

Nurse promotes safety of a client using a quad cane.

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Assisting with Ambulation

Assistive Devices• Canes• Walkers• Crutches

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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.

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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

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Evaluation

Ongoing assessment in the home setting is important because compliance with home exercise programs may lessen over time after discharge.