Makindo Medical Notes

Immobility is the state of reduced or absent ability to move, either temporarily or permanently. It is a syndrome with multi-system consequences, affecting physical, psychological, and social health. Recognition and prevention are crucial, as immobility leads to rapid deconditioning and increased morbidity/mortality.

📌 Causes of Immobility

• 🧠 Neurological: Stroke, Parkinson’s, multiple sclerosis, spinal cord injury, motor neurone disease.
• 🦴 Musculoskeletal: Hip fracture, osteoarthritis, rheumatoid arthritis, trauma, severe osteoporosis.
• ❤️ Cardiorespiratory: Heart failure, severe COPD, pneumonia.
• 🩺 Systemic illness: Sepsis, advanced cancer, severe frailty, sarcopenia.
• 🧠 Psychiatric: Depression, catatonia, severe anxiety.
• 🏥 Hospital-related: Prolonged bed rest, inadequate mobilisation after surgery.

⚠️ Complications of Immobility (Multi-System)

• 🫁 Respiratory: Atelectasis, hypostatic pneumonia, ↓ cough clearance.
• ❤️ Cardiac: Orthostatic hypotension, VTE (DVT/PE).
• 🦴 Musculoskeletal: Muscle wasting, contractures, osteoporosis, pressure ulcers.
• 🧠 Neurological: Delirium, sensory deprivation, depression, anxiety.
• 🩸 Metabolic: Insulin resistance, hypercalcaemia (from bone loss).
• 🚽 GI/GU: Constipation, urinary retention, infections, renal stones.

🧑‍⚕️ Clinical Assessment

• 📝 History: Onset of immobility, precipitating illness, pain, medications, psychosocial factors.
• 🩺 Examination: Frailty score, gait assessment, neurological exam, skin integrity check, postural BP.
• 📊 Tools:
  • Barthel Index (ADLs).
  • Tinetti Balance & Gait Test.
  • Braden Scale (pressure ulcer risk).

🔬 Investigations

• FBC, U&E, CRP (infection, anaemia, metabolic issues).
• CK (myopathy), calcium/vitamin D (bone health).
• Imaging: CXR (if pneumonia), X-ray/MRI (fracture, spinal pathology).
• Medication review for sedatives, opioids, antihypertensives.

🛠️ Management Principles

• ⚡ Early mobilisation: Physio involvement as soon as safe.
• 🛡️ Prevent complications: DVT prophylaxis, pressure relief mattresses, bowel/bladder care.
• 🏃 Rehabilitation: Strength training, balance therapy, OT for independence.
• 💊 Treat underlying cause: Stroke care, analgesia for arthritis, infection control.
• 👩‍👩‍👧 Multidisciplinary approach: Geriatricians, nurses, physios, OTs, dietitians, psychologists.

🌍 Wider Impacts

• 📉 Loss of independence → risk of institutionalisation.
• 💷 Increased healthcare costs due to long stays and complications.
• ❤️ Psychological burden: depression, anxiety, loss of confidence.
• 👨‍👩‍👧 Family/caregiver strain.

🧑‍⚕️ Case Examples

• Case 1: 82-year-old post-hip fracture, lying in bed for 1 week, develops pneumonia and new confusion. Lesson: immobility rapidly leads to respiratory and cognitive decline. Plan: chest physio, antibiotics, aggressive mobilisation.
• Case 2: 70-year-old with Parkinson’s, gradually stops walking due to freezing of gait and no getting medications on time. Now with constipation and pressure sores. Lesson: progressive neurological immobility requires medications on time and early MDT rehab + bowel/bladder plan.
• Case 3: 68-year-old with COPD admitted for pneumonia. Bedbound for 5 days, now with swollen calf. Lesson: always consider DVT prophylaxis in immobile patients.

🎯 Key Takeaways

• Immobility is a multi-system syndrome, not just a physical issue.
• Complications develop within days – prevention is critical.
• Requires holistic MDT management including physio, OT, dietetics, and psychological support.
• Always aim for early mobilisation to preserve independence and reduce harm.
• Bed rest is rehab for the coffin as my boss would say to those who refused to get up