Mobilizing

Mobilizing - Motor function and the ability to move involve all parts of the motor nervous system. Injury, malformation or disease to any part of this system will therefore affect the individual’s ability to move. The motor nervous system includes:

• The central nervous system (CNS): this is composed of the brain and spinal cord and is responsible for initiating and co-ordinating movement.
• The peripheral nervous system: this consists of nerve pairings, which radiate to the various parts of the body from the CNS. These pairs of nerves send messages to and from the brain.
• Muscles, ligaments and tendons: these are located throughout the body and respond to sensory information. Muscles use the pulling forces of contraction and work in antagonistic pairs, that is, they oppose each other.
• The skeleton: this provides a system of support with a variety of joints that enable a wide range of movements.
• The spine and discs: these form a significant part of the skeleton and have particular notable functions:

Functions of the spine	Functions of the discs
Protects the spinal cord	Act as shock absorbers
Provides central support and stability	Vertebral spacers
Enables a range of movement	Reduction of friction
Ligament and muscle attachment	Limit over-extension/movement

It is therefore clear that the skills of movement are complex and involve both conscious decision-making and other subconscious changes such as reflex actions; together these enable us to move and complete everyday tasks such as cleansing, dressing and eliminating, as well as walking. As individuals, the ability to move and the range of movements we can undertake are learnt and developed from those basic functions present at birth. The degree of movement, and thus ability to function in all aspects of life, are unique to the individual. This ability can be affected by many factors not just by injury, malformation and disease.

The factors that may affect mobility may be:
• Physical arising from altered structures, function or processes of movement, for instance weakness arising from conditions such as anaemia, neurological or muscular impairment, or fractures.
• Psychological including depression, fear and anxiety (particularly in older people) and altered body image, for example stroke or amputation.
• Pain including that affecting general joint/muscle movement.
• Environmental/social such as poor housing, obstructions and other hazards, and social isolation.
• Politico-economic for example lack of finances for aids, adaptations and employed help.

Some of the risks associated with immobility include:
• Physical
increased risk of deep vein thrombosis
increased risk to skin integrity and pressure sore development
increased risk of development of chest infection/pneumonia
increased risk of urinary tract infection
increased risk of constipation
decreased joint and muscle movement resulting in muscle atrophy and increase in generalized aches and pains, for example drop foot and contractures

• Psychological
anxiety
depression
loss of independence
loss of self-esteem

• Sociocultural
increased social isolation and loneliness
increased inability to function independently in society
loss of social identity
forced changes in social activities

• Politico-economic
loss of income arising from an inability to work

• Environmental
forced changes in housing or living arrangements.

These are just some of the many possible consequences of prolonged immobility. Optimizing clients’ mobility is therefore an essential nursing skill and should be undertaken in collaboration with other members of the multidisciplinary team (MDT), which includes physiotherapists, social workers, occupational therapists, remedial gymnasts, appliance officers, as well as the client, carers and medical staff.

The remainder of this chapter gives the common terminology associated with the activity of mobilizing; some of the simple principles of safe manual handling; points to consider when assessing an individual’s ability to mobilize; moving; handling and positioning clients; care of an individual who is falling; and care following a fall. The chapter concludes with references and further reading.