immobility

Etiology

• musculoskeletal disorders
  • arthritis
  • sarcopenia
  • osteoporosis, fractures (especially hip & femur)
  • podiatric (foot) problems
  • Paget's disease
• neurologic disorders
  • stroke
  • Parkinson's disease
  • cerebellar disorders
  • neuropathies
• cardiovascular disease
  • severe congestive heart failure (CHF)
  • coronary artery disease (frequent angina)
  • peripheral vascular disease (frequent claudication)
• pulmonary disease
  • severe COPD
• sensory impairment
  • visual impairment
  • fear of falling
• environmental causes
  • forced immobility (nursing home, hospital)
  • inadequate aids for mobility
• generalized weakness
  • severe systemic illness (i.e. widespread malignancy)
  • deconditioning (after prolonged bedrest)
  • malnutrition
• other
  • pain
  • depression
  • adverse pharmaceutical effects (antipsychotic-induced rigidity)

History

• nature & duration of disabilities causing immobility
• medical conditions contributing to immobility
• drugs that can affect mobility
• motivation & other psychological factors
• environment

Physical examination

• skin
• cardiopulmonary status
• musculoskeletal assessment
  • muscle tone & muscle strength
  • joint range of motion
  • foot deformities & lesions
• neurological deficits
  • focal weakness
  • sensory & perceptual evaluation
• levels of mobility
  • bed mobility
  • ability to transfer (bed to chair)
  • wheelchair mobility
  • standing balance
  • gait

Complications

• skin -> pressure ulcers
• musculoskeletal
  • muscular deconditioning & muscular atrophy
  • contractures
  • bone loss (osteoporosis)
• cardiovascular
  • deconditioning
  • orthostatic hypotension
  • venous thrombosis, embolism
• pulmonary
  • decreased ventilation
  • atelectasis
  • aspiration pneumonia
• gastrointestinal
  • anorexia
  • constipation
  • fecal impactation, fecal incontinence
• genitourinary
  • urinary tract infection
  • urinary retention
  • bladder calculi
  • urinary incontinence
• metabolic
  • altered body composition -> decreased plasma volume
  • negative nitrogen balance
  • impaired glucose tolerance
  • altered drug pharmacokinetics
• psychological
  • sensory deprivation
  • dementia, delirium
  • depression

Management

• physical therapy
• occupational therapy if appropriate
• individualize specific goals
• prevention & treatment of pressure ulcers

More general terms

• sign/symptom

Additional terms

• immobilization
• prolonged sitting