Mobility

Basic inpatient health promotion

Mobility

Being admitted to the hospital generally means being in a hospital bed watching TV. This routine and expected situation is unfortunately very bad for one’s health. A great irony for those admitted is the place they came to heal in fact makes them worse. Hospital-associated deconditioning (HAD) is a major problem and one I fight against daily. There are wide ranging studies from 30% to 68% of older adults admitted do the hospital will become deconditioned.

Some bad things HAD increases the risk of in the year after discharge: death, re-hospitalization, institutionalization, unable to walk ¼ mile, unable to manage medications, unable to drive, spend more money on healthcare.

I estimate about 25% of my community-dwelling patients are discharged temporarily to a skilled nursing facility rehab from the hospital instead of home. This is unfortunate, unnecessary, and preventable.

Once must make the effort from the time of admission to maintain strength. While the hospital has nursing staff, nursing assistant, physical therapy, occupational therapy, and a mobility team all with the goal of preventing deconditioning it is an ever-present foe and the patient must play an active role in order to succeed.

WARNING – falling in a hospital is easy to do and often results in injury. Progress through these steps with the guidance of staff (nurse, physical therapist, etc). They are guideline for instruction; not permission to move at will. Your treating physician determines the most appropriate level of mobility.

Action Items:

  1. If you are able to safely be out of bed you should be so regularly.
  2. Eat all your meals sitting in a chair (or at least sitting on side of bed)
  3. Watch TV sitting in the chair; not the bed
  4. WATCH TV COMMERCIALS STANDING UP!
    1. This is a big promotion of mine. When a TV commercial comes on, stand up from chair, walker in front if needed for stability. Sit back down when TV program comes back on. This frequent short interval standing is conditioning your thighs which you need to walk.
    2. If you are very capable and stable, stand up without using the arms of the chair.
    3. Bonus: use the incentive spirometer when you stand up to help atelectasis.

If you are already so weak in bed you can barely move your legs hope is not loss. A progressive exercise program can improve your strength. These 7 steps are a sequential increase in activity.

  1. Push against resistance in bed: Set of 5-10, repeat several times during the day
    1. Push against the bed footboard.
    2. If you have family present they can raise your leg supporting it one hand behind knee and one under calf. Keep hand behind knee and let go of calf; the patient tries to keep leg straight (engages the thighs).
    3. Pull back knee towards chest and try to straighten it out.
    4. Slide down in bed and try to push yourself back up against the footboard.
    5. Get an extra sheet, towel, or elastic therapy band and loop it around the bottom of the foot holding both ends tight. Push away with your foot so you have to hold resistance with your hand/arms.
  2. Sit on the side of the bed
    1. If able to do this, do it for all meals
    2. Stand up at side of bed with walker. Do not do this alone the first time; HIGH FALL RISK
  3. Transfer and sit in a chair
    1. Legs extended if you have leg swelling/edema
  4. Stand in front of the chair with a walker
    1. Stand in front of the chair with walker without using chair arms to stand
  5. Walk in the room with a walker
  6. Walk down the hall with a walker
  7. Walk down the hall without a walker.

Pointers to maximize above gains:

  • Each subsequent round of activity should be MORE THAN THE LAST.
  • Write down what you did. “That which gets measured gets improved.”
  • Focus on the task at hand; not the end goal. Someone too weak to get out of bed should not focus on walking at home; they should focus their immediate task. If you can barely sit up and want to walk each round of exercise is a “failure” because you couldn’t yet walk. However; if you completed the task at hand and did more than last time you succeeded. Success breads more success. Choose to succeed not fail every time.
  • Request “homework” from physical or occupational therapy so you know what to focus on.
  • If you have mobility equipment at home (walker, cane, rollator, etc) ask family to bring it in so you can use your own. If after working with the therapist they determine you need it ensure doctor orders it early so the social worker can submit the request.