Immobilization Syndrome

IMMOBILIZATION SYNDROME I. DEFINITION Immobilization syndrome refers to the effects of inactivity or immobility. There is reduced functional capacity of all systems including musculoskeletal, cardiovascular and pulmonary. II. EPIDEMIOLOGY People who are chronically ill, aged or disabled who are subjected to prolonged bed rest are prone to the effects of immobility. III. ETIOLOGY Inactivity of the body system due to prolonged bed rest or after trauma, or other, cases wherein there is no movement of the body for extended periods. IV. PATHOPHYSIOLOGY With contractures, there is shortening of the muscle belly and loose CT becomes dense. Muscles atrophy due to disuse, and osteoporosis is due to loss of weight-bearing. V. CRITERIA FOR DIAGNOSIS VI. COMPLICATIONS Muskuloskeletal - contractures - muscle weakness and atrophy - immobilization osteoporosis - immobilization hypercalcemia Cardiovascular and Pulmonary - redistribution of body fluids - orthostatic hypotension - reduction of cardiopulmonary functional capacity - thromboembolism - mechanical resistance to breathing - hypostatic pneumonia Genitourinary and Gastrointestinal - urinary stasis, stones and urinary infection - lose of appetite - constipation Metabolic and Endocrine - electrolyte alteration - glucose intolerance - increased parathyroid hormone production - other hormone alteration Cognitive and Behavioral - sensory deprivation - confusion and disorientation - anxiety and depression - decrease intellectual capacity - impaired balance and coordination VII. PROGNOSIS --- 5 TO 7 days of immobilization: shortening of the muscle belly --- with complete bed rest: muscle lose 10- 15 % of its strength per week or 1-3 % per day VIII. MEDICAL- SURGICAL MANAGEMENT Treatment of spasticity: pharmacological, motor point or nerve blocks using phenol, injection of botulinum toxin A Surgical intervention: tendon lengthening, osteotomies, joint replacement IX. PT ASSESSMENT X. PT MANAGEMENT

Principles in the prevention and treatment of contractures: PREVENTION: Proper positioning in bed, resting splints ROM exercises (active or passive) Early mobilization and ambulation CPM TREATMENT: Passive Rom with terminal stretch Polonged stretch using low passive tension and heat Progressive splinting, casting Treatment of spasticity Surgical interventions Pain management