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IV. Mobilization and Exercise. Mobilization is defined as therapeutic and prescriptive application of low-intensity exercise in the management of cardiopulmonary dysfunction Mobilization and exercise are the physical therapist’s (PT’s) “drug” . The prescriptions parameters should include .
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IV. Mobilization and Exercise Mobilization is defined as therapeutic and prescriptive application of low-intensity exercise in the management of cardiopulmonary dysfunction Mobilization and exercise are the physical therapist’s (PT’s) “drug”
The prescriptions parameters should include (1)the type or types of mobilization or exercise, (2) specific intensity (3) duration and (4) frequency. (5) the course of the prescription, that is the time over which the prescription is designed to produce its maximum benefit (6) the means of progression of the prescription .
*Physiological Effects of Mobilization and Exercise: 1- On the Cardiopulmonary System: • Ventilatory Effects: At the onset of physical exercise ↑ metabolic demand of the muscle, ↓in oxygen concentration; increases the oxygen diffusion gradient. The intercellular pH increased, and the arterial pH decreaed.
- ↑ of carbon dioxide - →facilitates the dissociation of oxygen from hemoglobin, ↑oxygen to the cells - increase systemic Co concentration. - Cardiac output (CO = SV X HR) increases commensurate with overall metabolic demand. - The increase in systemic CO results in increased venous return and pulmonary CO.
- To oxygenate a greater volume of blood in the lungs, an increased volume of air must be inspired. So, to effect an increase in minute ventilation (VE); the tidal volume (VT) and respiratory rate (RR) are increased.
B. Mechanical Effects: Rhythmic inflation and deflation of the lungs associated with physical activity has several clinicallyimportant physiologic effects: First, this action increases alveolar ventilation Second, exercise-induced lung motion facilitates lymphatic flow and drainage. Optimal lymphatic drainage is essential to maintain optimal lung fluid balance.
Third, the increased movement of the lung during exercise has a primary effect on mucociliary transport and mucus clearance. Finally, movement stimulates surfactant production and its distribution over parenchymal tissue .
2- On the Endocrine System: • Mobilization and exercise stimulate the endocrine system. • Catecholamine, released to support the cardiovascular system, sustain a given exercise work rate. - Increased sympathetic activity secondary to mobilization can help reduce the patient’s need for sypathomimetic pharmacologic agents.
3- On the Central Venous System: Central nervous system (CNS) responses to mobilization include arousal and priming of the various organ systems involved.
*Mobilization Testing:- • First: a mobilization challenge test: • - The patient is monitored before, during and after mobilization activities. • Relatively low intensity activities such as: bed exercises, moving in bed, changing body position, silting up, dangling over bed side, transfer to chair, chair exercises and short walks with assistance; constitute a sufficient stimulus to elicit the acute effects of exercise. • .
The degree of assistance required to perform the activity should be noted, since this significantly influences the patient’s individual effort
Second: If the patient status is unstable and oxygen transport is severely needed, then Monitoring a patient during standard care and procedure , such as - turning the patient, - ADLs, - nursing and - medical procedures, Can provide an indication of the patient’s physiological response to mobilization.
*Mobilization Training: -The patient should be rested. -Not have eaten heavily in the previous couple of hours. -Be as attentive and aroused as possible and be experiencing minimal pain or discomfort. -Review of a patient’s medication schedule will ensure that treatments are well timed with respect to pain medication, and medications that interfere with a good treatment response, such as narcotics.
-The patient’s clothing should not be restrictive, and any lines, leads, and catheters should not be taut. Any equipment, monitors, and IVs need to be appropriately positioned to avoid disconnections. -The patient is reassured and encouraged to relax and coordinate deep breathing and coughing with the activity.
- The priority of movements that are usually considered when mobilizing a patient is to perform as much activity as possible out of bed and in the upright position (i.e. ambulation, transferring, sitting upright in a chair, and chair exercise with or without hand weights or exercise band). The upright position is essential such that the spine is erect, upper body musculature relaxed, and the chest wall symmetrical.
