The document outlines the concepts of mobility and immobility, defining mobility as the ability to move freely and immobility as a reduction in movement. It discusses factors influencing body alignment, mobility, and the impact of proper body mechanics on preventing physical complications, as well as the effects of immobility on various body systems. Additionally, it describes exercises and principles to maintain physical fitness and efficient body movement.

1. MOBILITY AND IMMOBILITY
UNIT XII

2. DEFINITION
 MOBILITY
The ability to move freely,
easily, rhythmically, and
purposefully in the environment.
 IMMOBILITY
Refers to a reduction in the
amount and control of
movement a person has.

3. BASIC ELEMENTS OF NORMAL MOVEMENT
 Body alignment (posture)
 Joint Mobility
 Balance
 Coordinated Movement

4. BODY ALIGNMENT
• Proper body alignment and posture bring body parts into
position in a manner that promotes optimal balance and
maximal body function whether the client is standing,
sitting, or lying down.
• Can help to prevent musculoskeletal problems.
• Proper body alignment enhances lung expansion and
promotes efficient circulation.

5. Posture

6. Postural Abnormalities
KYPHOSIS
It is an increased front-
to-back curve of the spine/ it
is an excessive forward
rounding of the upperback.

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LORDOSIS
An abnormal inward
curve of the lower back
either in cervical or in lumbar
area.
 SCOLIOSIS
An abnormal side-to-
side curve of the spine,
which can be C-shapedand
S-shaped curve.

9. JOINT MOBILITY
• Joint stability is defined as the ability to maintain or
control joint movement or position.
• It is defined as the degree to which an articulation ( where
two bones meet) can move before being restricted by
surrounding tissues ( ligaments/ tendons/ muscles etc)
• Range of motion of a joint is the maximum movement that
is possible for the joint.

10. Type of Joint Movement
 Felxion: Decreasing the anglef the joint.( eg ; bending the
elbow)
 Extension: Increasing the angle of the joint. ( eg.
straightening the arm at the elbow)
 Hyperextension: Further extension or straightening of a
joint. (eg. bending the head backward)
 Abduction: Movement of the bone away from the midline
of the body.
 Adduction: Movement of the bone toward the midline of
the body.

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 Rotation: Movement of the bone around its central axis.
 Circumduction: Movement of the distal part of the bone in
a circle while the proximal end remains fixed.
 Eversion: Turning the sole of the foot outward by moving
the ankle joint.
 Inversion: Turning the sole of the foot inward by moving
the ankle joint.
 Pronation: Moving the bones of the forearm so that the
palm of the hand faces downward when held infront of the
body.

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 Supination: Moving the bones of the forearm so that the
palm pf the hand faces upward when held in front of the
body.
 Plantar Felxion: Movement of the foot in a downward
motion away from the body.
 Dorsiflexion: Upward or backward bendin of a body part.

15. Inversion and Eversion

17. BALANCE AND COORDINATED MOVEMENT
• Body balance refers to a state of the body achieved
when the centre of gravity is balaned over a wide, stable
base of support and a vertical line falls from the centre of
gravity through the base of support.
• Ability to control the body position while moving or
standing.
• Coordination is the abilityto execute smooth, accurate,
controlled motor responses ( optimal interaction of muscle
function). It involves the cerebellum, the peripheral nerves
of the body, and the spinal cord.

18. FACTORS INFLUENCING BODY ALIGNMENT AND
MOBILITY
 Growth and Development
*As age advances, muscletone and bone density
decreases, particularly in women who have osteoporosis.
* A persons age and musculoskeletal and nervous system
development affect posture, body propotions, body mass
and body movements.
 Physical Health
*Physical illness or impairement has a direct effect on the
body alignment and mobility.

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*Fatigue causes energy depletion and thereby affect
physical illness.
chronic and acute illness
Examples
• MS : Congenital(scoliosis) and Acquired abnormalities (#
of lower limb, arthritis)
• NS: damage to any area of nervous system impair the
body alignment and mobility. Eg; stroke.
• affects normal metabolic functioning.

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 Mental Health
* Poor mental health (depressive patients,catatonic
patients)
* Stress
* Attitude (positive and negative)
 Nutrional status
- malnutrition, vita. d deficiency leads to musle
weakness
- obesity can effect the movementand stress joints

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 Environmental factors
humidity, weather,ventillation
 Prescribed Limitations
patient with plaster cast, breathing difficulty

22. BODY MECHANICS
Body mechanics is the coordinated effort of the
musculo-skeletal and nervous system to maintain
balance,posture and body alignment during lifting, moving,
positioning and performing activities of daily living( ADL).

23. PURPOSE OR IMPORTANCE OF MAINTAINING
PROPER BODY MECHANICS
 To prevents fatigue and deformities.
 It encourages circulation and digestion.
 It reduces the energy consumption and expenditure.
 It promotes physiological functions of the body as it aids
in circulation and digestion.
 It maintains body balance without strain and spasm.
 It reduces muscle fatigue, back pain and strain.
 Reduces the risk of injury to the musculo-skeletal system.

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 It mainatins the shape and size of the cavities such as
chest, abdominal, and pelvic cavities.
 It facilitates aesthetic well-being in terms of physical
fitness and shape.
 Maintains adequate muscle tone; thus contributing to
balance of the body.
 Prevents fatigue and deformities ( kyphosis, Lordosis)

25. Principles of Body Mechanics
1. Mainatain an aligned posture that puts pelvis in a
balanced position.
2. Keep the object close to the body to prevent strain on the
muscles.
3. Provide a wide base of support by keeping the feet apart
for better balane and stability.
4. Flex the knees and hips to take an object instead of
bending the back.
5. Sit close to the table while writing something.
6. Posture should be with natural gesture.

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7. Stand close to the area if something has to be picked
up from above head.
8. Use mechanical lifts and equipment for transfering a
a patient.
9. The lower the center of gravity, the grater the stability of
a nurse.
10. Face the direction of movement to prevent abnormal
twisting of the spine.
11. If an object has to be taken to another place roll, pull
push or slide it,if possible, instead of lifting the object.

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12. Reduce the friction between the object and the surface
on which it is moved so that less force is required to
move it.
13. The equilibrium of an object is maintained as long as
the line of gravity passes through its base of support.
14. The stronger the muscle group, the greater amount of
work can be safely done by it.
15. The wider the base of support, the greater the stability
of the nurse.
16. No twisting at the waist when lifting an object.

29. Complications of Improper Body Mechanics
• Muscle fatigue.
• Joint strain.
• Lower back injuries.
• Orthostatic hypotension.
• Decreased Basal Metabolic Rate.

30. EFFECTS OF IMMOBILITY
1. SYSTEMIC EFFECT
 Metabolic Changes
Endocrine system maintains homeostasis and
regulates energy metabolism.
Immobility decreases metabolic rate and alters the
metabolism of carbohydrate, fat, and protein.
GI Changes
immobility leads to GI disturbance and cause fluid,
electrolytes and calcium imbalances. It slows down
peristalsis causing constipation and decreases appetite.

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 Respiratory Changes
- Respiratory muscle weakness causing decreased lung
expansion and it affects the oxygen and carbon dioxide
exchange.
 Cardiovascular changes
Orthostatic hypotension, venous stasis leading to edema
varicose veins.
 Musculoskeletal system
Prolonged immobility causes loss of muscle mass and
strength and lead to permanent disability.
It also causes decreased balance and stability.

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 Excretory System
*Immobility decreases elimination of waste from skin.
* Urine doesnot flow from kidneys to ureters and then
to bladder by gravity leading to some amount of stasis.
Leads to sepsis.
 Integumentary Changes
Pressure ulcer due to immobility.
2. Developmental Changes
More visible in children due to muscle weakness and
loss of muscle mass.

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3. Psychosocial Changes
Immobility leads to many emotional, behavioural and
sensory alterations.
It decreases physical and mental well being. (decreased
self-esteem, depression.

34. Maintenance of Normal Body Alignment and Activity
Body alignment refers to the arrangements of joints,
tendons, ligaments, and muscles while in a standing,
sitting, or lying positions.
STANDING
 Head extended
 Shoulder slightly abducted
 Wrist extended
 Pull your abdomen in and up
 Thighs extended and slightly abducted
 Keep your back flat

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 Chest should be most forward apart.
 Elbows should be lightly flexed
 Fingers flexed
 Knees slightly flexed
 Feet parallel about 3 inches apart.
SITTING
 Head Straight
 Chin tucked in
 Shoulders abducted
 Wrist extended

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 Abdomen flat and relaxed
 Chest should most forward part
 Elbows flexed can be supported
 Fingers flexed
 Feet flexed at right angles to legs and supported on floor
or foot rest.
 Get up, stretch and relax hourly when you have to sit for a
long time.

37. BENDING
 Place one foot in front of the other
 Bend the knees as well as the hip
 Squat while keeping the back straight to pick up an object
from floor.
LIFTING WEIGHTS
 Stand with both feet placed firmly on the floor and wide
apart
 Stand close to the weight
 Use the stronger leg muscle for lifting
 Bend knees and hip slightly, keep back straight

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 Lift straight upward, in one smooth motion
 Hold the weight close to the body while lifting
 Avoid twisting the trunk
 Stand high enough to avoid lifting above waist
 Better to push rather than lifting
CARRYING
 Place both feet on the floor
 Hold the objects close to the body near the center of
gravity
 Hold head erect and spine straight.

39. PUSHING
 Stand close to the object
 Place yourself in proper body alignment
 Tense muscle and prepare for movement
 Hold the object close to the body near the centre of
gravity
 Lean towards the object
 Push away from utilizing body weight to add force
PULLING
 Lean away from the object to pull it towards you

40. EXERCISES
 Exercise is a type of physical activity involving the
muscles, performed to maintain or improve physical
fitness.
OR
 Exercise is the performance of physical activities for
improvement of health or for the correction of physical
deformity

41. TYPES OF EXERCISE
1. Active Exercises
The exercise done by the person without any
assistance.
Eg.
o Deep breathing and coughing exercise which facilitate
lung expansion.
o Range of motion of limbs like flexion, extension,
adduction, abduction, and rotation
o Foot exercise to prevent foot drops.
o Changing the position.

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2. Passive Exercises
* The exercise or the activities of a patient is carried out
by another person.
* Useful for the patient who are unconscious or those
with restricted movements or deformities.
Guidelines for providing passive exercise
• Ensure that the patient understands the reason for
passive exercise.
• Make patient wear loose garments and cover the body
with bath blanket.

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• Use correct body mechanics to prevent strain for both
patient and nurse.
• Adjust the height of the bed appropriately.
• Expose only the limbs being exercised.
• Use a firm and comforting grip when handling limbs.
• Move the body parts smoothly, slowly, and rhythmically.
• Avoid fast movements which cause spasticity and rigidity.
3. ISOTONIC EXERCISES
 It involves muscle contracting and shortening while
overcoming resistance.

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 also known as dynamic or muscular contraction
 Examples; squats, pull-ups, push-ups, walking,
swimming, running etc…
 Beginners should perform this at a low intensity with high
repetition for 6-12 weeks.
Advantages
Building muscular strength.
 Build up bone density.
Maintains joint flexibility and circulation.

45. Disadvantages
 Musculo-skeletal injuries ; improper technique, excessive
exercise, or using too much weight can lead to muscle
tears, sprains, and strains.
Cardiovascular strain
Equipment related injuries
4. ISOMETRIC EXERCISE
 It is a static exercise that involves contracting a muscle
without moving the joint that the muscle is attached
 Examples; planks, wall sits, knee extension, squat holds

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Advantages
• Muscles activation
• Improve flexibility
• Strengthening abdominal and
gluteal muscles.
• Improve stability
• Muscle rehabilitation
• No equipment and no need
of specific location.

47. 5. Isokinetic exercises
• Involves specialized machines.
• Movement at a constant speed regardless of the
resistance applied.
Advantages
 improves muscle strength and ROM
Injury prevention
Rehabilitation
Used to train athletes for physical conditioning

48. RANGE OF MOTION OF EXERCISE(ROM)
Range of motion is the maximum amount of movement
available at a joint.
ROM exercise is aimed at improving movement of a
specific joint.
Purpose ;
• To promote health by improving functioning of the
circulatory system and lungs.
• To prevent stiffness of the joint.
• To restore the muscle function in injuries and deformities.
• To promote physical mobility and improve gait.

49. TYPES OF ROM EXERCISE
Active ROM exercises
Patient is able to move the joint independently
It helps to increase and reach full range of motion for a
joint.
Helps to improve joint function.
Starting with neck stretches.
Avoid fast movements.
Passive ROM exercises
 Passive range of motion is defined as the ROM that is
achieved when an outside force causes a movement of
joint.

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 It is used for patients who have no voluntary motor
control.
General points;
1. Assess the patient for joint stiffness, swelling, pain, and
unequal movements.
2. Plan exercise along with other care.
3. Provide adequate support and encourage active exercise
4. Move the joints in full ROM if not contraindicated
5. Never over strain a joint beyond its capacity.
6. Repeat each movements 5 times during exercise.

53. Beneficial effects of exercise
(text)

54. ASSISTIVE DEVICES