Immobilization Syndrome

Definition:

Immobilization syndrome is a set of physiological and pathological changes that occur due to prolonged immobility or a significant reduction in body movement. It affects multiple body systems, including the muscular, skeletal, cardiovascular, respiratory, urinary, skin, digestive, and nervous systems.

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Epidemiology:

• Mainly affects elderly people, neurologically impaired patients, post-surgical individuals, or those confined to bed for a long time.

• Common in hospitals, nursing homes, or home care settings.

• More frequent in individuals with frailty, multiple comorbidities, and reduced autonomy.

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Pathogenesis:

Prolonged immobility leads to:

• Muscle tone reduction and atrophy

• Joint stiffness and limited mobility

• Decreased cardiac output and venous stasis (risk of thrombosis)

• Reduced lung ventilation (risk of pneumonia)

• Urinary stasis (risk of infections)

• Pressure ulcers (bedsores)

• Constipation

• Depression, apathy, and cognitive decline

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Main Causes:

• Bone fractures (e.g. femur, hip)

• Stroke, Parkinson’s, Alzheimer’s

• Major surgeries

• Brain or spinal trauma

• Advanced cancer

• Severe chronic illnesses (e.g. heart failure, respiratory failure)

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Risk Factors:

• Advanced age

• Poor nutritional status

• Incontinence

• Cognitive impairment (e.g. dementia, delirium)

• Prolonged use of sedatives or psychotropic drugs

• Depression

• Previous episodes of immobility

Diagnosis:

• Clinical observation: reduced or absent movement, patient is bedridden.

• Comprehensive geriatric assessment

• Imaging tests (MRI, CT if neurological damage or fractures are suspected)

• Nursing and physiotherapy evaluation: muscle strength, skin integrity, respiratory and cardiovascular status.

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Treatment:

Goal: Restore mobility and prevent complications.

Medical treatment:

• Management of underlying conditions (e.g. infections, organ failure)

• Early and consistent physical therapy

• Medications (e.g. anticoagulants to prevent thrombosis, laxatives, antibiotics)

• Adequate nutrition (with supplements if needed)

• Proper hydration

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Nursing Care:

• Early mobilization, even passive if the patient is not cooperative

• Frequent position changes (every 2 hours) to prevent pressure ulcers

• Personal hygiene: keep skin clean and dry

• Monitoring skin integrity regularly

• Fall prevention strategies

• Monitoring bowel and urinary function

• Psychological support: active listening, cognitive stimulation

• Patient and family education on movement and immobility risks

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Advice and Prevention:

• Avoid prolonged bed rest – even short walks help

• Use mobility aids (e.g. walkers, canes, wheelchairs)

• Personalized rehabilitation programs

• Balanced diet and good hydration

• Involve family or caregivers in daily activities

• Encourage social interaction and light mental activity

• Health education: explain the risks of prolonged immobility

• Regular screening for ulcers, infections, depression, and malnutrition.