BSNC 1000 – MOBILITY LATEST UPDATE GRADED A

BSNC 1000 – MOBILITY LATEST UPDATE GRADED A Mobility Being mobile/movable Scope of Mobility Full Mobility - Partial/Impaired Mobility - Immobility Someone who is both mobile and immobile? - Partial paralysis - Advanced age - Weakness - Fractures - Pregnancy - Stroke - Hemiplegia - Paraplegic When is immobility beneficial? - After injury - Recovering from illness - Both reduce risk of aggravation What is impaired mobility due to? - Neurologic conditions (brain, spinal, nerves) - Skeletal conditions - Muscle conditions - Joint conditions (cartilage, tendons, ligaments) Age-Related Changes: Neurologic System Thinning of intervertebral discs causing spinal nerve compression Age-Related Changes: Bone - Decreased bone density and risk of fracture - Vertebral collapse (kyphosis) Age-Related Changes: Joints - Degeneration of articular cartilage causing osteoarthritis - Stiffening of ligaments and joints Age-Related Changes: Muscles - Decreased muscle mass and strength Risk factors for impaired mobility - Advanced age - Chronic pain - Injury/trauma - Congenital deformities - Nutritional deficiencies - Stroke - Cardiovascular/respiratory disease - Advanced dementia - Cancer - Meds - Obesity - COPD - Spinal Injuries - Diabetes Osteoporosis - Reduction of total bone mass - Due to imbalance in bone remodelling - Resorption > Formation Bone Remodelling -Existing bone is broken down and replaced by new bone Activation: Osteoclasts stimulated by PTH, stress, glucocorticoids, etc. Resorption: Osteoclasts break down bone and form a resorption cavity Reversal: Switch from resorption to bone formation and the macrophages clear the cavity Formation: Osteoblasts are recruited and function in the synthesis of new bone (3-4 monthhs ;) Factors regulating bone growth/remodelling - Nutrients - Hormones - Physical activity (promotes osteoblast activity) How do hormones regulate bone growth/remodelling? - Control rate of mineral deposition - Regulate calcium ion concentration in fluids Parathyroid hormone - Breaks down bone (osteoclasts) to release calcium levels into blood stream - Prevents serum calcium levels from falling below - Prevents serum phosphate levels from rising above - Stimulates calcium production Vitamin D - Stimulates absorption of calcium - Kidney needs to activate it - Sources: Intestinal absorption and skin production - Fish/liver/milk - Sun converts it into its useable form Calcitonin - Decreases blood calcium - Released from C cells of thyroid - Inhibits release of calcium from bones - Inhibits osteoclasts Reduces renal absorption of calcium/phosphate Requirements for mobility and the function of neurologic and musculoskeletal structures related to mobility: - Gas exchange: Moves O2 into blood then transports O2 into muscle - Perfusion: Delivers blood to lungs to pick up O2 and delivers it to muscle + removes wastes - Mobility: Improves blood flow through skeletal and respiratory muscle activity and improves gas exchange through chest cage expansion Modifiable Risk Factors for Osteoporosis - Low peak bone mass - Low Ca2 or Vit. D intake - Physical inactivity - Hormonal factors - Medications - Alcohol - Cigarette Smoking Effect of osteoporosis on mobility: - Pathologic Fractures - Choice to be less mobile due to fear of falling - Pain from fractures Non-Modifiable Risks for Osteoporosis - Age - Gender - Genetics - Ethnicity Peak Bone Mass 30 years Factors influencing peak bone mass? Genetics + Endocrine + Nutrition + Lifestyle After 30 - Bone resorption slowly exceeds bone formation Age-Related Changes (Osteoporosis) - Post menopause (after 50): Accelerated bone loss because of estrogen deficiency - Age: Reduced proliferative capacity of bone cells and decreases Vit. D activation - Bones become thinner/weaker/brittle with age Estrogen Deficiency - Estrogen inhibits osteoclasts to slow rate of bone resorption - Bone loss at its greatest during early menopause Diagnosing Osteoporosis - Bone Mineral Density (BMD) - T Score: How much one's bone density is higher/lower than the bone density of a healthy 30-year-old adult Consequences of Osteoporosis - Bones weaken - Fractures Function of bone remodeling - Maintenance of bone health - Release of mineral stores - Strengthening of bones in areas of stress Where does most of the remodelling primarily occur? Surface of trabeculae of spongy bone Assessing Mobility: - Inspect/Observe - Interview/Ask - Measure/Count - Palpate - Test Inspect/Observe Assessment - Appearance - Posture - Skeleton and extremities - Joints - Muscles - Gait - ROM - Use of mobility assistive devices - Capability and effort required to change position - Chest expansion Interview/Ask Assessment - Risk Factors - Health history - LOC - History of falls Measure/Count Assessment High BMI = Higher force on joints Small BMI = Greater risk of osteoporosis Palpate Assessment - Muscle - Joints - Bones Test Assessment Muscle strength Signs/Symptoms of Impaired Mobility - Guarding - Warmth/redness - Edema - Skeletal deformities - Joint deformities - Diminished ROM - Unstable gait - Muscle atrophy/weakness - Pain - Numbness/Tingling - Instability - Fear of falling - Decreased QOL Managing Osteoporosis - Increase amount of calcium you eat - Weight bearing exercise - Screening - Smoking cessation - Fall prevention - Reduce caffeine Primary Prevention Increased calcium intake Weight bearing exercises Secondary Prevention Screening using DEXA cams Tertiary Prevention Smoking Cessation Regular weight bearing exercise Alcohol/Caffeine Decrease calcium absorption 5 P's Pain Paralysis Paresthesia Pallor Pulselessness