mobility

• mobility refers to purposeful movement, including gross simple movements, fine complex movements and coordination
• mobility is dependent on the synchronized efforts of the musculoskeletal, and nervous system, as well as adequate oxygenation, perfusion, and cognition
• ultimately, mobility is the state or quality of being mobile and movable
• scope of mobility

  • immobility
  • disuse syndrome
  • deconditional
• immobility: an inability to move, can be considered a negative state or therapeutic
• disuse syndrome: predictable adverse effect on body tissues and function associated with sedimentary lifestyle and inactivity
• deconditioned: a loss of physical fitness, applies to patients who experience extended periods of immobility
• the musculoskeletal system is made up of bones and joints of the skeletal system and the muscles, ligaments, tendons, and cartilage of the muscular system. these systems work together to support body height, control movements, and provide stability
• the MSK works in tandem with the circulatory system and nervous system
• alterations in MSK integrity have a detrimental effect on the individual's ability to perform activities of daily living, communication, and participation in recreational activties
• bones - a human skeleton consists of 206 bones that are divided into the axial skeleton and the appendicular skeleton. bones form the body structure, support soft tissue, protect vital organs, provide a point of attachment for muscles, store minerals and form blood cells
• muscles - three types of muscles are skeletal, smooth, and cardiac. skeletal muscles are critical for physical mobility and are attached to bones via tendons
• joints - are formed where two bones meet; they hold the skeleton together while providing mobility
• ligaments and tendons - ligaments connect bones to bones, tendons connect bones and muscles
• cartilage - a type of flexible connective tissue found throughout the body
• a state of complete immobility has a significant effect on the entire body and all body systems are affected:

  • cv system
  • respiratory system
  • msk system
  • integumentary system
  • gi system
  • gv system
  • psychological effects
• traumatic injury

  • brain
  • spinal cord
  • bones, joints, muslces
• a thorough msk assessment includes gathering history and assessing for common symptoms associated with altered mobility:

  • past medical history, family history, medications, lifestyle, occupation, ect
  • presence of pain with movement
  • recent changes in mobility or problems with balance
  • presence of fatigue
  • recent falls
  • recent changes in ability to complete adl's
• primary prevention in mobility:

  • regular physical activity
  • protection against injury
  • optimal nutrition
  • fall prevention measures
• secondary prevention in mobility

  • osteoporosis
  • fall assessment screening
• disuse atrophy: a condition characterized by reduced muscle mass and strength due to prolonged activity or immobility. it occurs when muscles are not used sufficiently leading to the degradation of muscle mass
• disuse atrophy is commonly seen in patients who are bedridden
• mechanical load in mobility - muscles require stimulation and mechanical load to maintain their size and shape. in the absence of physical activity, muscle fibers begin to shrink
• metabolic changes in mobility - physical activity stimulates protein synthesis in muscles. when activity levels drop, the rate of protein synthesis decreases, leading to muscle atrophy
• neurogenic factors in mobility : reduced activity can lead to decreased signaling from motor neurons to muscle fibers, impairing the maintenance of muscle mass
• hormonal and cellular responses:

  • levels of hormones like insulin like growth factor 1, and testosterone, which promote muscle growth, can decrease with inactivity
  • levels of catabolic hormones such as cortisol can increase, promoting muscle protein breakdown
  • inactivity can lead to increased production of inflammatory cytokines, which contribute to muscle degradation
• mitochondrial dysfunction - physical inactivity leads to decreased mitochondrial function and number, impairing energy production in muscle cells
• risk factors and causes of disuse atrophy

  • immobilization; post surgical recovery; injury; neurological conditions
  • sedentary lifestyle: modern work environments; technological advancements; aging populations
  • chronic illnesses: copd, heart failure, diabetes mellitus, cancer
• developmental dysplasia of the hip - A spectrum of conditions affecting the hip joint, where the acetabulum (hip socket) and the femoral head (thigh bone) are misaligned or improperly developed. Can range from a slightly shallow socket to a completely dislocated hip
• Degrees of DDH:

  1. Dysplasia: underdevelopment or malformation of the acetabulum
  2. Subluxation: partial displacement of the femoral head from the acetabulum
  3. Dislocation: complete displacement of the femoral head from the acetabulum
• pathophysiology of developmental dysplasia of the hip

  • Physiological factors: maternal hormone secretion; intrauterine positioning
  • Mechanical factors: breech presentation; multiple fetuses, oligohydramnios; LGA
  • Genetic factors: Family history
  • Postnatal factors: Swaddling practices
• Ortolani maneuver: With the infant's hips and knees flexed at 90 degrees, the examiner abducts the hips while applying gentle anterior pressure on the greater trochanters. A positive Ortolani test is indicated by a palpable or audible "clunk" as the femoral head relocates into the acetabulum, confirming a previously dislocated hip.
• Barlow maneuver: Performed by flexing the infant's hips and knees to 90 degrees and gently adducting the hips while applying pressure on the knees, directed posteriorly. A positive Barlow test is indicated by a palpable or audible "clunk" as the femoral head dislocates posteriorly from the acetabulum, suggesting hip instability.
• Galeazzi Sign: Used in older infants and children, the Galeazzi sign is assessed by placing the child in a supine position with the hips and knees flexed. A difference in knee height indicates a potential hip dislocation or subluxation on the lower side. Shortening of limb on affected side.
• clinical manifestation of developmental dysplasia of the hips infants

  • Shortening of limb on affected side (Galeazzi Sign)
  • Restricted abduction of hip on affected side
  • Unequal gluteal folds (best visualized with infant prone)
  • Positive Ortolani test (hip reduced by abduction)
  • Positve Barlow test (hip dislocated by adduction)
• clinical manifestation of developmental dysplasia of the hips older infant and children:

  • Affected leg shorted than the other
  • Telescoping or piston mobility of jointlly
  • Trendelenburg sign
  • Greater trochanter prominent and appearing above a line from anterosuperior iliac spine to tuberosity of ishium
  • Marked lordosis and waddling gait (bilateral dislocations)
• Therapeutic management of developmental dysplasia Newborn to 6 months: The hip joint is maintained by splinting. The Pavlik harness is the most widely used, and with time, motion, and gravity, the hip works into a more abducted, reduced position. Worn continuously until the hip is proved stable. Approx. 6 to 12 weeks. When there is difficulty stabilizing the hip, a surgical closed reduction and application of spica cast may be performed
• therapeutic management of developmental dysplasia 6 to 24 months: Dislocation may not be recognized until the child begins to stand and walk. In less severe DDH, use of hip abduction orthosis may be initiated. Surgical closed reduction of the hip is performed in cases of hip subluxation or dislocation. The child is placed in a spica cast for approx. 12 weeks
• therapeutic management of developmental dysplasia Older children: Correction of the hip deformity in older children is inherently more difficultrection of the hip deformity in older children is inherently more difficult.