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)