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HAZARDS OF IMMOBILITY. Annual Home & Community Based Waiver Conference September 9, 2010. Presenters: Mary Rehberg, RN, LPC Debra Ziegler, OT/L, MPP. TODAY’S FOCUS. Define Immobility and the relationship to health Identify common health issues for people who are immobile

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hazards of immobility

HAZARDS OF IMMOBILITY

Annual Home & Community Based Waiver Conference

September 9, 2010

Presenters:Mary Rehberg, RN, LPCDebra Ziegler, OT/L, MPP

today s focus
TODAY’S FOCUS
  • Define Immobility and the relationship to health
  • Identify common health issues for people who are immobile
  • Learn about therapeutic positions that can improve health and mobility
  • Discuss professionals who may play a role in addressing immobility
immobility
IMMOBILITY

From the Merriam-Webster Dictionary:

  • Incapable of being moved – fixed
  • Not moving - motionless
humans are designed to move
HUMANS ARE DESIGNED TO MOVE
  • “Move it or Lose it”
  • “Use it Right or Lose it”
  • What causes people to not be able to use their muscles right?? What can happen??
common causes of immobility in dd
COMMON CAUSES OF IMMOBILITY IN DD
  • Neuromuscular disorders that impair mobility – e.g., cerebral palsy, especially with really high tone (spasticity)
  • Out-dated approach that “rest” is good and “comfort” is the desired outcome
immobility can lead to many health issues
IMMOBILITY CAN LEAD TO MANY HEALTH ISSUES
  • Joint contractures & curvature of spine
  • Breathing problems and pneumonia
  • Problems with swallowing and digestion, chronic heartburn, vomiting, and aspiration
  • Chronic urinary tract infections, constipation and bowel impaction
  • Weak bones and fractures
slide7

IMPAIRED MOBILITY

SUPINE POSITION

IMPAIRED

PULMONARY

FUNCTION

GASTRO-

ESOPHAGEAL

REFLUX

SCOLIOSIS

TRACHEOSTOMY

G-TUBE

FEEDING

CHRONIC

RECURRENT

PNEUMONIA

ASPIRATION

CHRONIC

UTI & BOWEL

IMPACTIONS

SUDDEN DEATH

NON-WEIGHT

BEARING

FRACTURES

EMBOLI

BONE LOSS

slide8

CURVATURES OF THE SPINE

FRONT VIEW

SIDE VIEW

Kyphosis

Concavity

Convexity

Compensatory

curve

Lordosis

Pelvic

tilt

Pelvic

tilt

gastroesophageal reflux disease
GASTROESOPHAGEAL REFLUX DISEASE
  • REFLUX occurs when stomach contents escape into the esophagus -- “REFLUX = BACKFLOW”
  • REFLUX ESOPHAGITIS is the inflammation caused by the material refluxed from the stomach
  • REFLUX DISEASE is the complex of symptoms and consequences to the esophagus resulting from reflux damage
slide11

Esophagus

Diaphragm

Fundus

Lower esophageal sphincter

Pylorus

Antrum

Mucosa

Duodenum

signs symptoms of swallowing problems or aspiration
SIGNS & SYMPTOMS OF SWALLOWING PROBLEMS OR ASPIRATION
  • Drooling
  • Increased coughing or choking
  • Wet, raspy voice
  • Nasal regurgitation
  • Food escaping from mouth
  • Delayed or slow swallow reflex
gastroesophageal reflux disease13
GASTROESOPHAGEAL REFLUX DISEASE
  • ASPIRATION
    • Chronic upper respiratory infections
    • Reactive air-way disease -- “Asthma”
    • Acute aspiration pneumonia
    • Recurrent pneumonia
    • Obstructive air-way disease
    • Premature death
gastroesophageal reflux disease14
GASTROESOPHAGEAL REFLUX DISEASE
  • SUPPORTIVE TREATMENT
    • Modify diet, improve body positioning, and modify medications
  • MEDICAL TREATMENT
    • Drugs to lower stomach acid and to increase Lower Esophageal Sphincture pressure, esophageal clearance, and stomach emptying
gastroesophageal reflux disease15
GASTROESOPHAGEAL REFLUX DISEASE
  • SURGICAL TREATMENT
    • Reserved for those in whom medical treatment has failed or who have significant complications
    • Gastrostomy Tube or Jejunostomy tube
    • Nissen Fundoplication
slide16

BODY ALIGNMENT IS CRUCIAL FOR

PERSONS WITH IMPAIRED MOBILITY

proper positioning is important to maintaining good health
PROPER POSITIONING IS IMPORTANT TO MAINTAINING GOOD HEALTH
  • Let gravity work for you, not against you
  • Minimum of four (4) functional positions throughout the day
  • Maximum of two (2) hours in any one (1) position
why avoid supine
WHY AVOID SUPINE?
  • Laying on your back for long periods of time:
    • stimulates primitive reflexes → increased spasticity and scoliosis
    • increases gastroesophageal reflux
    • impedes swallowing and cough reflex
    • reduces lung vital capacity & O2 saturation goes down
    • slows the digestive process
simple techniques
SIMPLE TECHNIQUES
  • A slight adjustment in the position can often make all the difference.
  • Using equipment properly can help the person maintain a good position when he cannot support himself.
therapeutic positions

40

THERAPEUTIC POSITIONS

SITTING

Head in midline,

neck slightly flexed

> 120 = Supine

Shoulders in midrange,

without rotation

Forearms supported on firm

surface

Seat:back = 960

Pelvis stabilized, parallel with

floor, slight anterior tilt,

derotated, weight equally

distributed along thighs

slide21

THERAPEUTIC POSITIONS

PRONE-RESTING

Pelvis in neutral position

Hips fully extended

Thighs abducted, ext. rotation

Shoulders at mid-range

Elbows

supported

Knees slightly

flexed

slide22

THERAPEUTIC POSITIONS

Head in midline

Neck slightly flexed

Lower shoulder slightly forward

Pelvis parallel with shoulders

SIDE-LYING

300

Weight evenly

distributed

Top Hip & knee

flexed

slide23

THERAPEUTIC POSITIONS

ELEVATED QUADRUPED

Head in midline

Neck extended

Shoulders & pelvis

level & non-rotated

Forearms & knees

support weight

slide24

THERAPEUTIC POSITIONS

KNEE-STANDING

Pelvis is

stabilized

Forearms

are free for

activities

Hips extended

Knees & lower legs

support weight

remember
REMEMBER….

The Quality of the position

is as (if not more) important

as the Quantity of positions

health professionals have a role in assisting the person to address the hazards of immobility
HEALTH PROFESSIONALS HAVE A ROLE IN ASSISTING THE PERSON TO ADDRESS THE HAZARDS OF IMMOBILITY
  • Nurse
  • Occupational or Physical Therapist
  • Dietician, especially for people with gastrostomy or jejunostomy tube feedings
how do we get equipment
HOW DO WE GET EQUIPMENT?
  • Work with a therapist (PT or OT) to help determine the best equipment
  • Exhaust private insurance resources before requesting Medicaid funding
  • Mental health funding may be available if all other resources have all denied – assistive technology or specialized medical equipment. Follow your agency’s procedures.
slide30
What do you think about the quality of this position?

Would you change anything?

What health issues might occur over time?

slide31

What do you think about the quality of this position?

Would you change anything?

What health issues might occur over time?

slide32

What do you think about the quality of this position?

Would you change anything?

What health issues might occur over time?

slide33

What do you think about the quality of this position?

Would you change anything?

What health issues might occur over time?

slide34

What do you think about the quality of this position?

Would you change anything?

What health issues might occur over time?

resources
RESOURCES
  • Positioning for Health and Function by Jody Winter, RPT

http://www.mcgowanconsultants.com/pubscatalog.jsp

contact information
CONTACT INFORMATION

Deb Ziegler, HSW Program Manager

zieglerd@michigan.gov or 517-241-3044

Mary Rehberg, HSW Nurse Consultant

contact Deb or Heather Sturtz, HSW Assistant at sturtzh@michigan.gov or 517-335-6489