Mobility

Provide Support to meet Personal Care Needs – CHCICS301A

Ambulation

• The act of walking – perhaps with varying degrees of assistance!

• Encouraged to :

- prevent immobility complications

- promote sense of equilibrium

- enhance self-confidence and independence

Issues

• May just need some steadying – ie hand rails or carer support for added stability

• May need to completely re-learn to walk, perhaps with a different technique

• May need assistive aids

• May undergo progressive ambulation – slowly increasing difficulty or distance

Principles of Safe Ambulation

• Ensure client wears well-fitting footwear with non-slip soles, laces tied securely

• Monitor client for ill-effects – faintness, fatigue, pain – rest if distressed

• If the resident begins to fall, try to ease down the wall onto floor, or into chair – try to avoid “catching” client

• Ensure environment is uncluttered throughout – floor surface clean and dry, no equipment in thoroughfares

Supporting Ambulation

After obtaining verbal consent :• Walk with client, taking their arm, and

providing support underneath elbow and hand

• Support is enhanced, by keeping your body in close to theirs

• Place hand at base of lower back to provide support & sense of security for the resident

• Establish client’s pace – allow time and ensure client isn’t being lead or “dragged”

• If one-sided weakness exists, support on the affected side

• Use environment – client close to railed wall, rest chairs positioned strategically

• Ensure any attachments or tubing cannot leak or dislodge

Walking Aids

• Act to broaden base of support, therefore increase stability

• Type used depends on client’s condition, type of disability, and amount of support required

• Important, whatever aid is utilised, that it is appropriately selected, is safe, and proper instruction in the use of the aid has occurred (ideally by a physiotherapist)

Walking Sticks

• Used with one-sided weakness or injury, occasional loss of balance, or to reduce weight-bearing on a hip or knee

• Stick provides balance or support, and reduces fatigue and strain on joints

• Should extend from client’s hip bone, to floor, and needs rubber tip to prevent slipping

• Either single point, tripod or 4 point stick – sticks with more points provide broader base and greater stability

• Stick is held close to body on unaffected side, taking weight off affected side – ie stick and affected leg are moved first, followed by unaffected leg

Walking Frames

• Often provide greater sense of support and security than a stick

• Height should allow 15-30 degree flexion of elbows, when hand grips are held

• Can get attachments (baskets, trays, seats) to promote greater independence

• Need to pick up frame and advance it – not push or carry it!!

• Client needs to use steps to walk right into frame - if too far in front, causes stability problems

Any Walking Aid

• Client needs assistance and supervision until ambulating confidently

• Still need safe shoes with non-slip soles

• Need to ensure floor surfaces are even, and unnecessary articles (ie loose mats) are removed from path

Common Musculoskeletal Disorders that can Affect Mobility

• Most disorders of the musculoskeletal system cause :

- difficulty with movement (mobility), loss of function and range of motion

- pain, stiffness and inflammation

• Some musculoskeletal disorders are acute, others form slowly and with degeneration

• Some may be cured, some may be modified with treatment, others may require surgical intervention, and some have little effective treatment available

Arthritis

• Inflammation of a joint, which affects its movement, flexibility and stability

• Causes pain• Can affect any joint in the body• Very common in the elderly• 2 main types : osteoarthritis, and

rheumatoid arthritis

Osteoarthritis

• Most common form, usually associated with ageing, but can affect younger age groups

• “Wear and tear” arthritis – caused by deterioration of joint cartilage, and damage to bone ends, progressively leading to joint deformity

• Can be caused initially by a traumatic injury

• Often r/t repetitive overuse, strain r/t obesity, and ageing changes

• Very common in weight bearing joints – hips, knees, cervical and lumbar spine

• Also in small joints – fingers, hands

Rheumatoid Arthritis

• Less common disease of joints, which is known as “systemic” – also affects other body systems

• Classified an auto-immune disorder (antibodies made that break down normal joint tissue), and commonly affects younger people (especially women)

• Not related to injury, or “wear and tear”

• Unknown cause - ? family, ? Viral

• Eventually causes gross joint damage and deformity, with pain, inflammation and swelling – often affects small joints initially, wrists, hands and feet

• Characterised by remissions and flare-ups

Problems with arthritis

• Pain – pain and aching around affected joint• Stiffness – often worse in the morning with RA,

more common after use/exercise with OA• Joint swelling, redness, heat• Impaired mobility – muscle weakness/fatigue• Altered body image – r/t joint deformity and

loss of function• With RA, other body symptoms, ie fever,

general fatigue

General Treatment Principles

• With acute inflammation, aim to decrease pain and inflammation, utilising rest, analgesic and anti-inflammatory medications, splinting etc

• With chronic inflammation, need to achieve a balance between activity and rest (modification of ADL’s), medications, and supportive care, ie warmth

• Long term/destructive problems may need surgery

Supportive care

Pain relief• Ensure adequate rest of joint, gentle mobilisation• Comfortable position, perhaps elevated, or

supported by pillows, or special splints• Often more comfy with joint in slightly flexed

position – less pressure than extension• Application of warmth – to improve circulation

and relieve muscle spasm

Use of Warmth

• Need to check suitability of client first, and agency policy

• Contraindicated in an area of acute inflammation

• If OK, apply for short periods only• Ensure safety with temperature• Perhaps therapeutic use of warm water

Supportive Care

Impaired mobility• Encourage range of motion exercises, to keep

joints and muscles as flexible as possible• Important to keep things moving, but rest if joint

is acutely inflamed• Encourage use of mobility aids for stability• Balanced diet – to avoid obesity, prevent

increased stress on weight-bearing joints

Osteoporosis

• Condition in which bones lose calcium and phosphate – leading to “thinning” of the skeleton, which becomes porous, brittle and vulnerable to fracture

Contributing causes

• Prolonged negative calcium balance (insufficient dietary intake of calcium)

• Inactive lifestyle – immobility, or lack of weight bearing exercise

• Oestrogen deficiency – most common in post-menopausal and older women

• Long term corticosteroid therapy• Excessive nicotine and caffeine intake

Osteoporosis

• Common for osteoporotic change to occur in spine, but also in long bones, ie femur

• Causes chronic pain, especially lower back, hips, neck

• Causes pathologic fractures – a break in bone with no traumatic episode or apparent cause - and poor bone healing ability, if a break does occur

• Causes loss of stature – height loss, stoop forward

Supportive care

• Emphasis on prevention of osteoporosis – by modifying known risks early in life

• Screening tests – Dexascan for people at risk

• Safety – gentle handling of client, promotion of safe environment to minimise risk of falls

• Comfort and management of pain – positioning, warmth to affected areas

• Encourage continuation of weight bearing exercise and ambulation as able

• Medical treatment includes calcium supplements

• Other medications which inhibit/slow down bone reabsorption

Fractures (#)

• Fracture = break in the continuity of a bone, but may involve other structures – muscles, nerves, blood vessels

• Usually associated with traumatic injury (ie fall/ forceful blow), or repeated minor stress

• In older people, often occur r/t osteoporosis - heal very slowly, and risk immobility problems

Amputation

• Commonly, below knee or above knee

• Extensive surgery, and post-operative bleeding common

• Stump wound infection/breakdown common

• May have problems with phantom limb pain and sensation