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Chapter 38
Mobility and
Biomechanics
Overview of Mobility
 Mobility
• Ability to engage in activity and free
movement
• Walking, running, sitting, standing, lifting,
pushing, pulling
• Activities of daily living (ADLs)
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Overview of Mobility
 Mobility
• Enhances muscle tone, increases energy
levels
• Psychological benefits of independence and
freedom
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Overview of Mobility
 Body Alignment (posture)
• Position of body parts in relation to each
other
• Center of gravity is evenly distributed.
• Promotes balance, reduces strain and injury.
• Promotes efficient circulatory, renal,
pulmonary, and gastrointestinal functions.
• Influences self-esteem and body image.
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Overview of Mobility
 Body Alignment
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Client comfort
Prevention of contractures
Promotion of circulation
Reduces stress on muscle, tendons, nerves,
and joints
• Prevention of foot drop (plantar flexion)
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Overview of Mobility
 Body Alignment
• Muscle Tone
- Hypotonicity
- Spasticity
• Muscle Shape
- Hypertrophy
- Atrophy
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Overview of Mobility
 Body Mechanics involves the three basic
elements of body alignment, balance,
and coordinated movement (stability).
 Range of motion reflects the extent to
which a joint can move.
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Physiology of Mobility
 Musculoskeletal System
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Bones
Joints
Tendons
Ligaments
Bursa
Cartilage
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Physiology of Mobility
 Nervous System
• Proprioception
- Tells us where our body is in space relative to
other objects.
• Postural Reflexes (righting)
- Maintain postural tonus.
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Exercise
 Any physical activity involving muscles
that elevates the heart rate above resting
levels
 Reduces joint pain and stiffness.
 Increases flexibility, muscle strength, and
endurance.
 Weight reduction and improved sense of
well-being
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Exercise
 Types of Exercise
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Aerobic
Strengthening
Isometric
Isotonic
Isokinetic
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Exercise
 Range-of-Motion Exercise (ROM)
• Passive
• Active
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Exercise
 Physical Fitness
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Endurance and strength
Joint flexibility
Cardiorespiratory fitness
Body composition
Fitness in older adults
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Factors Affecting Mobility
 Health Status
 Developmental Stage
• Children
• Adolescents
• Adults
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Factors Affecting Mobility
 Environment
• Attitudes and Beliefs
• Lifestyle
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Physiological Effects of Mobility
and Immobility
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Neurological Effects
Cardiovascular Effects
Respiratory Effects
Musculoskeletal Effects
Digestive Effects
Elimination Effects
Integumentary Effects
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Assessment
 Health History
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ADLs
Exercise patterns
Activity tolerance
Medications
Alteration in health status
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Physical Examination
 Musculoskeletal Assessment
• Movement and Gait
• Alignment
• Endurance
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Musculoskeletal Assessment
 Muscle Impairments (common overuse
injuries)
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Strain
Tendonitis
Bursitis
Sprain
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Pathological Alterations
 Postural Abnormalities
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Scoliosis
Kyphosis
Lordosis
List
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Pathological Alterations
 Contractures
• Contracture deformities occur when a
muscle group is not moved for a period of
time or if proper body alignment is not
maintained.
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Pathological Alterations
 Musculoskeletal Trauma
• Fractures
• Amputation
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Pathological Alterations
 Central Nervous System (CNS)
• Any disruption in the CNS can impair
mobility.
• Spinal cord injury can lead to partial
paralysis or complete loss of mobility.
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Neurological Assessment
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Cranial Nerves
Motor System
Sensory System
Reflexes
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Functional Assessment
 Focuses on client’s ability to perform
ADLs.
• Client’s ability to feed, dress, toilet, move,
transfer, and ambulate self independently, or
with assistance
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Nursing Diagnoses
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Activity Intolerance
Impaired Physical Mobility
Risk of Disuse Syndrome
Self-Care Deficits
Altered Health Maintenance
Risks for Falls
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Planning and Outcome
Identification
 Realistic Outcomes Consider Client’s
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Understanding of mobility status
Values, thoughts, and concerns
Health status in general
Ability to solve problems
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Planning and Outcome
Identification
 Interventions
• Bed Rest
• Restorative Nursing Care
• Health Promotion and Fitness
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Implementation
 Meeting Psychosocial Needs
 Applying Principles of Body Mechanics
 Maintaining Body Alignment: Positioning
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Fowler’s
Recumbent (supine)
Prone
Lateral
Sim’s
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Implementation
 Maintaining Body Alignment: Assistive
Devices
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Implementation
 Range-of-Motion Exercises
• Performed several times a day.
• Each joint is placed through its full functional
motion.
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Implementation
 Transfer Techniques
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Moving clients
Logrolling the client
Transferring from bed to chair
Transferring from bed to stretcher
Assistive devices
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Implementation
 Assisting with Ambulation
• Preparing the client to walk
• Client education
• Preambulating exercise
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Assisting with Ambulation
 Nurse promotes
safety of a client
using a quad cane.
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Assisting with Ambulation
 Assistive Devices
• Canes
• Walkers
• Crutches
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Implementation
 Wellness Promotion
• Emphasizes the need for physical fitness.
 Complementary Treatment Modalities
• Range from physical activity and relaxation
exercises to herbs, yoga, acupuncture,
acupressure, and biofeedback.
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Evaluation
 Transfer of skills and knowledge from the
acute care hospital or rehabilitation
facility to home
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Mobility status
Activities of daily living capacity
Use of appropriate adaptive devices
Client’s ability to function within his or her
own environment
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Evaluation
 Ongoing assessment in the home setting
is important because compliance with
home exercise programs may lessen
over time after discharge.
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