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HAZARDS OF IMMOBILITY

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

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  1. HAZARDS OF IMMOBILITY Annual Home & Community Based Waiver Conference September 9, 2010 Presenters:Mary Rehberg, RN, LPCDebra Ziegler, OT/L, MPP

  2. 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

  3. IMMOBILITY From the Merriam-Webster Dictionary: • Incapable of being moved – fixed • Not moving - motionless

  4. 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??

  5. 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

  6. 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

  7. 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

  8. CURVATURES OF THE SPINE FRONT VIEW SIDE VIEW Kyphosis Concavity Convexity Compensatory curve Lordosis Pelvic tilt Pelvic tilt

  9. GERD

  10. 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

  11. Esophagus Diaphragm Fundus Lower esophageal sphincter Pylorus Antrum Mucosa Duodenum

  12. 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

  13. GASTROESOPHAGEAL REFLUX DISEASE • ASPIRATION • Chronic upper respiratory infections • Reactive air-way disease -- “Asthma” • Acute aspiration pneumonia • Recurrent pneumonia • Obstructive air-way disease • Premature death

  14. 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

  15. 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

  16. BODY ALIGNMENT IS CRUCIAL FOR PERSONS WITH IMPAIRED MOBILITY

  17. 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

  18. 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

  19. 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.

  20. 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

  21. THERAPEUTIC POSITIONS PRONE-RESTING Pelvis in neutral position Hips fully extended Thighs abducted, ext. rotation Shoulders at mid-range Elbows supported Knees slightly flexed

  22. 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

  23. THERAPEUTIC POSITIONS ELEVATED QUADRUPED Head in midline Neck extended Shoulders & pelvis level & non-rotated Forearms & knees support weight

  24. THERAPEUTIC POSITIONS KNEE-STANDING Pelvis is stabilized Forearms are free for activities Hips extended Knees & lower legs support weight

  25. REMEMBER…. The Quality of the position is as (if not more) important as the Quantity of positions

  26. 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

  27. 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.

  28. SURE, THIS SOUNDS GOOD AND MAKES SENSE, BUT AT MY AGENCY……

  29. TIME TO TRY OUT WHAT YOU’VE LEARNED

  30. What do you think about the quality of this position? Would you change anything? What health issues might occur over time?

  31. What do you think about the quality of this position? Would you change anything? What health issues might occur over time?

  32. What do you think about the quality of this position? Would you change anything? What health issues might occur over time?

  33. What do you think about the quality of this position? Would you change anything? What health issues might occur over time?

  34. What do you think about the quality of this position? Would you change anything? What health issues might occur over time?

  35. RESOURCES • Positioning for Health and Function by Jody Winter, RPT http://www.mcgowanconsultants.com/pubscatalog.jsp

  36. 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

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