Mobility Notes

Comparison of Effects of Exercise and Immobility on Body Systems --BODY SYSTEM Cardiovascular System --EFFECTS OF EXERCISE ↑Efficiency of heart ↓Resting heart rate and blood pressure ↑Blood flow and oxygenation of all body parts --EFFECTS OF IMMOBILITY ↑Cardiac workload ↑Risk for orthostatic hypotension ↑Risk for venous thrombosis

--BODY SYSTEM Respiratory System --EFFECTS OF EXERCISE ↑Depth of respiration ↑Respiratory rate ↑Gas exchange at alveolar level ↑Rate of carbon dioxide excretion --EFFECTS OF IMMOBILITY ↓Depth of respiration ↓Rate of respiration Pooling of secretions Impaired gas exchange

Body Positions and Movements --Abduction Lateral movement of a body part AWAY from the midline of the body. Example: A person's arm is abducted when it is moved away from the body. --Adduction Lateral movement of a body part TOWARDS the midline of the body. Example: A person's arm is adducted when it is moved from an outstretched position to a position alongside the body.

--Circumduction Turning in a CIRCULAR motion; combines abduction, adduction, extension, and flexion. Example: Circling the arm at the shoulder, as in bowling or a serve in tennis. --Flexion The state of being bent. Example: A person's cervical spine is flexed when the head is bent forward, chin to chest.

Several types of freely movable joints include: --Ball-and-socket joint: ROUNDED head of one bone fits into a cuplike cavity in the other; flexion-extension, abduction-adduction, and rotation can occur Ex: shoulder and hip joints --Condyloid joint: OVAL head of one bone fits into a shallow cavity of another bone; flexion-extension and abduction-adduction can occur Ex: wrist joints connecting fingers to palm. -Gliding joint: Flat surfaces of the bone slide over one another; flexion-extension and abduction-adduction can occur Ex: carpal bones of wrist and tarsal bones of feet

--Hinge joint: A spool-like (rounded) surface of one bone fits into a concave surface of another bone; only flexion-extension can occur Ex: elbow, knee, ankle joints. --Pivot joint: A ring-like structure that turns on a pivot; movement is limited to rotation Ex: joints between the atlas and axis of the neck and between the proximal ends of the radius and the ulna at the wrist. --Saddle joint: Bone surfaces are convex on one side and concave on the other; movements include flexion-extension, adduction-abduction, circumduction, and opposition Ex: joint between the trapezium and metacarpal of the thumb.

--Extension The state of being in a straight line. Example: A person's cervical spine is extended when the head is held straight on the spinal column. --Hyperextension The state of exaggerated extension. It often results in an angle greater than 180 degrees. Example: A person's cervical spine is hyperextended when looking overhead, toward the ceiling. --Dorsiflexion Backward bending of the hand or foot. Example: A person's foot is in dorsiflexion when the toes are brought up as though to point them at the knee. --Plantar flexion Flexion of the foot. Example: A person's foot is in plantar flexion in the footdrop position.

--Rotation Turning on an axis; the turning of a body part on the axis provided by its joint. Example: A thumb is rotated when it is moved to make a circle. --Internal rotation A body part turning on its axis toward the midline of the body. Example: A leg is rotated internally when it turns inward at the hip and the toes point toward the midline of the body. --External rotation A body part turning on its axis away from the midline of the body. Example: A leg is rotated externally when it turns outward at the hip and the toes point away from the midline of the body.

Skeletal System The framework of bones, the joints between them, and cartilage that protects our organs and allows us to move. Functions of this system include: -Supporting the soft tissues of the body (maintains body form and posture) -Protecting crucial components of the body (brain, lung, heart, spinal cord) -Furnishing surfaces for the attachments of muscles, tendons, and ligaments, which, in turn, pull on the individual bones and produce movement -Providing storage areas for minerals (such as calcium) and fat -Producing blood cells (hematopoiesis)

-206 bones in the human body Classified by shape: Long bones (upper and lower extremities) (ex: humerus and femur), contribute to height and length. Short bones (wrist and ankle, contribute to movement. ---Flat bones are relatively thin (ex: ribs and several of the skull bones) and contribute to shape (structural contour). Irregular bones are all those bones not included in the preceding classifications -Bones are too rigid to bend without damage. (ex: bones of the spinal column and jaw). All movements that change the positions of the bony parts of the body occur at joints. --Articulation and joint refer to the area where a bone meets another bone. Diarthroses or synovial joints, joints in which there is a potential space containing lubricating synovial fluid between the articulating bones, are freely moving joints.

SAFE PATIENT TRANSFER Follow these recommended guidelines when moving and lifting patients: -Assess the patient. Know the patient's medical diagnosis, capabilities, and any movement not allowed. Apply braces or any device the patient wears before helping from bed. -Assess the patient's ability to assist with the planned movement. -Encourage patients to assist in their own transfers. Encouraging patients to perform tasks that are within their capabilities promotes independence. It is important to eliminate or reduce unnecessary tasks to reduce the risk of injury and increase the patient's self-esteem and mobility levels. -Assess the patient's ability to understand instructions and cooperate with the staff to achieve the movement. Patient cooperation during handling and movement is an important factor in preventing adverse events.

-During any patient-transferring task, if any caregiver is required to lift more than 35 lb of a patient's weight, consider the patient to be fully dependent and use assistive devices for the transfer. -Ensure that enough staff are available and present to safely move the patient. -Assess the area for clutter, accessibility to the patient, and availability of devices. Remove any obstacles that may make moving and lifting inconvenient. -Decide which equipment to use. Step-by-step protocols or algorithms are available to aid decision making to prevent injury to staff and patients. Use handling aids, transfer equipment, and assistive devices whenever possible to help reduce risk of injury to yourself and the patient. -Plan carefully what you will do before moving or lifting a patient. Assess the mobility of attached equipment. -You may injure the patient or yourself if you have not planned well. If necessary, enlist the support of another caregiver. This reduces the strain on everyone involved. -Communicate the plan with staff and the patient to ensure coordinated movement.

Protective Supine Position -Exaggerated curvature of the spine and flexion of the hips (Provide a firm, supportive mattress; use a bed board if necessary.) -Flexion contracture of the neck (Place pillows under the upper shoulders, neck, and head so that the head and neck are held in the correct position.) -Internal rotation of the shoulders and extension of the elbows hunched shoulders (Place pillows or arm supports under the forearms so that the upper arms are alongside the body and the forearms are pronated slightly.) -Flexion of the lumbar curvature (Place rolled towel or small pillow under lumbar curvature if needed.) -Extension of the fingers and abduction of the thumbs (Use hand-wrist splints if appropriate.)

-External rotation of the femurs (Place sandbags or a trochanter roll alongside the hips and the upper half of the thighs.) -Hyperextension of the knees (Place a pillow under the lower legs from below the knees to the ankles.) -Footdrop (Use a footboard or make an improvised firm foot support to hold the feet in dorsal flexion; high-top sneakers may also be recommended.)

Fowler's Position COMPLICATION TO BE PREVENTED SUGGESTED PREVENTIVE ACTIONS -Flexion contracture of the neck (Allow the head to rest against the mattress or be supported by a small pillow only.) -Exaggerated curvature of the spine (Use a firm support for the back; position the patient so that the angle of elevation starts at the hips.) -Dislocation of the shoulder (Support the forearms on pillows to elevate them sufficiently so that no pull is exerted on the shoulders.) -Flexion contracture of the wrist (Support the hand on pillows so that it is in natural alignment with the forearm.) -Edema of the hand (Support the hand so that it is slightly elevated in relation to the elbow.)

-Flexion contractures of the fingers and abduction of the thumbs (Provide hand-wrist splints if necessary.) -Impaired lower extremity circulation and knee contracture, pressure on heels (Elevate the knees for only brief periods; place one or two pillows under the lower legs from below the knees to the ankles; avoid pressure on the popliteal vessels; avoid using the knee gatch.) -External rotation of the hips (Use trochanter roll.) -Footdrop (Support the feet in dorsal flexion. Use footboard; high-top sneakers can also be used.)

Using Graduated Compression Stockings and Pneumatic GRADUATED COMPRESSION STOCKINGS Graduated compression stockings are often used for patients at risk for deep vein thrombosis and pulmonary embolism and to help prevent phlebitis. Manufactured by several companies, they are made of elastic material and are available in either knee or thigh-high length. By applying pressure, graduated compression stockings increase the velocity of blood flow in the superficial and deep veins and improve venous valve function in the legs, promoting venous return to the heart. By preventing pooling of the blood, clot formation is less likely. An order is required from the patient's health care provider for their use. When assisting with graduated compression stockings, follow these general nursing guidelines: -Modified lateral position (oblique position) is an alternative to the side-lying position and results in significantly less pressure on the trochanter area. -Measure the patient's legs to determine the proper size of stocking. -Each leg should have a correct fitting stocking; if measurements are different, then two different sizes of stocking need to be ordered to ensure correct fitting on each leg. The manufacturer whose stockings are being used gives directions for measuring. Some stockings fit either leg; others are designated right or left. An improperly fitting stocking is uncomfortable and ineffective and possibly even harmful. -Assess the skin condition and neurovascular status of the legs.

-Report abnormalities before continuing with the application of the stockings. -Be prepared to apply the stockings in the morning before the patient is out of bed and while the patient is supine. If the patient is sitting or has been up and about, have the patient lie down with legs and feet elevated for at least 15 minutes before applying the stockings. -Otherwise, the leg vessels are congested with blood, reducing the effectiveness of the stockings. -Do not massage the legs. If a clot is present, it may break away from the vessel wall and circulate in the bloodstream. -Check the legs regularly for redness, blistering, swelling, and pain. Some recommend checking the legs at least once every 8 hours; others recommend twice a day. Remove the stockings completely once a day to bathe the legs and feet. -Launder the stockings as necessary, but at least every 3 days. Soiled stockings irritate the skin. Dry the stockings on a flat surface to prevent them from stretching. If using a clothes dryer, set on low heat and remove as soon as the cycle is complete. The patient may need two pairs of stockings, to wear one pair while the second pair is being cleaned. -Always remove graduated compression stockings during morning care and inspect the legs. Then reapply the stockings before the patient is out of bed.

The stance and swing phases of normal gait. Observe alignment when a patient is standing, sitting, or lying. Note whether the patient is able to maintain correct alignment independently: -A patient's body is in correct body alignment in the standing position when: -The head is held erect and in the midline -The face is in the forward position, in the same direction as the feet -The chest is held upward and forward -The spinal column is upright, and the curves of the spine are within normal limits

-The abdominal muscles are held upward, with the abdomen comfortably tucked in and the buttocks downward -The arms hang comfortably at the sides -The knees are extended in a slightly flexed position—not bent or hyperextended in the knee-locked position -The feet are at right angles to the lower legs -The line of gravity goes through the midline, from the middle of the forehead to a midpoint between the feet; laterally the line of gravity runs vertically from the middle of the skull to the posterior of the foot -The base of support is on the soles of the feet, and weight is distributed through the soles and heels.

Application of Ergonomics to Prevent Injury: Techniques to prevent back stress that should be included routinely in injury-prevention programs include the following: -Develop a habit of erect posture (correct alignment). Slouching can strain neck and back muscles. When sitting, use the chair back to support the whole spine, keeping shoulders back but relaxed. -Balance the head over the shoulders, avoid leaning forward, and hold in the stomach muscles. -Use the longest and the strongest muscles of the arms and the legs to help provide the power needed in strenuous activities. The muscles of the back are less strong and more easily injured when used improperly. -Use the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling. The internal girdle is made by contracting the gluteal muscles in the buttocks downward and the abdominal muscles upward. It is helped further by making a long midriff by stretching the muscles in the waist.

-Work as closely as possible to an object that is to be lifted or moved. This brings the body's center of gravity close to that of the object being moved, permitting most of the burden to be borne by the leg and arm muscles, rather than the back. -Face the direction of your movement. Avoid twisting your body. -Use the weight of the body as a force for pulling or pushing, by rocking on the feet or leaning forward or backward. This reduces the amount of strain placed on the arms and the back. -Slide, roll, push, or pull an object, rather than lift it, to reduce the energy needed to lift the weight against the pull of gravity. -Use the weight of the body to push an object by falling or rocking forward and to pull an object by falling or rocking backward. -Push rather than pull equipment when possible. Keep arms close to your body and push with your whole body, not just your arms. -Begin activities by broadening your base of support. ---Spread the feet to shoulder width. -Make sure that the surface is dry and smooth when moving an object to decrease the effects of friction. -----Rough, wet, or soiled surfaces can contribute to increased friction, increasing the amount of effort required to move an object. -Flex the knees, put on the internal girdle, and come down close to an object that is to be lifted. -Break up heavy loads into smaller loads. Take breaks from lifting or moving to relax and recover.

COMMON DEVICES TO PROMOTE CORRECT ALIGNMENT: Foam Wedges and Pillows Mattresses Adjustable Beds Trapeze Bar

Additional Equipment -If top bedding must be kept off the patient's lower extremities, a device called a cradle is used. A cradle is usually a metal frame that supports the bed linens away from the patient while providing privacy and warmth. There are a number of sizes and shapes of cradles. If used, securely fasten the cradle to the bed so that it does not slide or fall on the patient. -Trochanter rolls are used to support the hips and legs so that the femurs do not rotate outward. Properly placed pillows can also be used to help prevent the thighs from turning outward, but they tend to slip out of place and require frequent adjustment to be effective. If a patient is paralyzed or unconscious, hand-wrist splints or hand rolls may be necessary to provide a means for keeping the thumb in the correct position, that is, slightly adducted and in apposition to the fingers. A hand roll can be created by folding a washcloth and rolling it. Once placed against the palm of the hand, it can effectively keep the hand in a functional position. A commercial plastic or aluminum splint also may be used to hold the thumb in place regardless of the hand position. Encourage patients who are not moving their fingers to do finger exercises, with special attention to having the thumb touch the tip of each finger. Side rails can assist the patient in rolling from one side to the other or to sitting up without calling for assistance. Using the side rails can help the patient retain or regain muscle efficiency. When using side rails, be sure to explain their use to patients and their families and follow the protocol of the health care facility. If a patient requests that side rails be raised for additional security, the patient must have the ability to raise and lower the side rails independently.

Before getting the patient out of bed, do the following: -Assess the patient's ability to walk and the need for assistance (one nurse or two nurses, walker, cane, walking belt, or crutches). -Explain to the patient exactly what is to be done: transfer technique from bed to erect position, projected distance to be ambulated, assistance available, and the correct manner of using it. Instruct the patient to alert the nurse immediately if feeling dizzy or weak. -Ensure that the patient has a clear path for ambulation. -Provide skid-proof footwear.

Assistance with ambulation. The nurse stands on the patient's weaker side and grasps the gait belt. General guidelines for helping patients who need the assistance of a walker, cane, brace, or crutches include the following: -Whenever possible, instruct the patient and family members in the correct use of the device before it is needed (e.g., before surgery). If family members are knowledgeable, they can reinforce the teaching as needed. -When ready to begin walking with the new device, make sure the patient is wearing rubber-soled, well-fitting shoes and that there is a clear path for ambulation (clean, flat, dry, well lit). Use a gait belt, especially if the patient is at high risk for falls. -Before moving, make sure the patient is steady on the feet when standing; instruct the patient to stand erect, looking straight ahead. The nurse should walk behind and slightly to one side of the patient (in cases of hemiparesis or hemiparalysis, walk on the patient's affected side). Should the patient lose balance, be prepared to grasp the patient's shoulder and the gait belt to steady the patient.

-Return the joint to a neutral position, that is, its normal position of alignment, when finishing each exercise. -Keep friction at a minimum when moving extremities to avoid injuring the skin. -Use range-of-motion exercises twice a day, and do the exercises regularly to build up muscle and joint capabilities. Perform each exercise two to five times. It is possible to perform many of the exercises when the patient is being bathed as part of that procedure. -Encourage routine tasks such as eating, dressing, self-bathing, and writing to help to put certain joints through range of motion. -Expect the patient's respiratory and heart rate to increase during exercise. These rates should return to usual resting levels within 3 minutes. If they do not, the exercises are probably too strenuous for the patient. -Use passive exercises as necessary, but encourage active exercises of the same kind when the patient is able to do so independently. -----Exercises should continue at home after a period of hospitalization, as necessary.

Caution is necessary when performing range-of-motion exercises with patients who are unresponsive because these patients are unable to report complaints of pain.

The pyramidal pathways of the nervous system convey voluntary motor impulses from the brain through the spinal cord by way of two major pathways: (1) the pyramidal pathway and (2) the extrapyramidal pathway. With trauma to the spinal cord, transection (severing) of these motor pathways results in complete bilateral loss of voluntary movement below the level of the trauma. Nurses caring for patients with injury to the CNS need to be knowledgeable about the pathology and clinical course of these diseases to provide appropriate patient education and counseling. Education and counseling are directed at addressing how the disease may progress and how it may affect the patient's functioning.

Chronic obstructive pulmonary disease and conditions such as ascites (accumulation of fluid in the peritoneal cavity) may alter posture. Any illnesses that interfere with oxygenation at the cellular level decrease the amount of oxygen available to the muscles for work and thus decrease activity tolerance. These illnesses include anemia, angina, cardiac arrhythmias, heart failure, and chronic obstructive pulmonary disease. Diseases characterized by a larger breakdown of protein than that which is manufactured, such as anorexia nervosa and certain cancers, lead to a negative nitrogen balance that results in muscle wasting and decreased physical energy for movement and work. Symptoms accompanying many illnesses, such as fatigue, muscle aches, and pain, may also lead to immobility. Bed rest is an important component of treatment for many diseases or trauma states, such as some surgeries and fractures. Although rest is essential for the healing process, immobility associated with bed rest may cause its own problems. Nurses need to be vigilant in determining the effects of any injury or illness on mobility and in providing care to facilitate optimal mobility as early as possible.

Balance A body in correct alignment is balanced. The center of gravity is located in the center of the pelvis about midway between the umbilicus and the symphysis pubis. The wider the base of support and the lower the center of gravity, the greater the stability of the object will be. Body balance increases when people spread the feet farther apart and flex the hips and knees. This broadens the base of support and lowers the center of gravity. These two simple maneuvers are important interventions that can decrease the musculoskeletal strain that occurs with excessive stretching or overexertion of a muscle or muscle-tendon unit. Musculoskeletal strain most commonly affects the lower back and cervical spine region.

Coordinated Body Movement Coordinated body movement is the ability of muscles to work together for purposeful movement. -Major muscle groups include the flexors, extensors, and abductors of the thighs; flexors and extensors of the knees; and flexors and extensors of the upper and lower arms. -For example, use of the arm bones as levers and the elbows as fulcrums facilitates lifting a weight against resistance, the force of gravity—the lever and fulcrum principle.

DEVELOPMENTAL LEVEL Child • Greater gross and fine motor control. • By age 4: Negotiate stairs, walk backward, and hop on one foot. • By age 5: Skip, jump rope, and jump off heights of several steps. • Able to manipulate writing materials. ASSESSMENT PRIORITIES • Use developmental charts to assess gross and fine motor development. • Determine activity level and types of play that involve physical exertion. NURSING INTERVENTIONS • Teach parents that attitudes about the body and exercise are developed during this period. • Counsel as appropriate. • Assess safety issues and reinforce safety teaching at each stage.

DEVELOPMENTAL LEVEL Adolescent • Size increases: There is a growth spurt. • Secondary sex characteristics appear. • If physically fit: Can be a time of boundless energy and great athletic performance. • If inactive: May begin a lifelong pattern of unhealthy behavior. ASSESSMENT PRIORITIES • Determine activity level and type of regular exercise. • Evaluate safety of recreational choices. • Screen for scoliosis (lateral curvature of the spine). • Examine muscle mass, tone, and strength and joint mobility. NURSING INTERVENTIONS • Encourage physical activity, regular exercise, and limitation of sedentary hobbies. • Lifestyle counseling regarding the importance of exercise and fitness is critical. • Encourage to exercise regularly if necessary. • Caution about gauging physical limits and not "pushing too hard."

DEVELOPMENTAL LEVEL Adult • Stands and sits erect and is capable of balanced and coordinated purposeful movement. • During pregnancy: center of gravity shifts because of developing fetus. • Activity levels vary greatly. ASSESSMENT PRIORITIES • Assess balance between activity and rest in person's lifestyle. • Note any lifestyle factors or illnesses that interfere with mobility or ability to carry out activities of daily living. NURSING INTERVENTIONS • Fitness counseling is important. • Clarify misconceptions about exercise. • Design and monitor safe exercise programs. • Those with mobility alterations may require special care

DEVELOPMENTAL LEVEL Older Adult • Increased convexity in the thoracic spine (kyphosis) from disk shrinkage and decreased height • Loss of muscle tone • Subcutaneous fat loss • Arthritic joint changes may be present • Assess general ease of movement and gait. • Assess alignment. • Check joints and their function. ASSESSMENT PRIORITIES • Assess muscle mass, tone, and strength. NURSING INTERVENTIONS Teach and counsel about: • Importance of regular exercise • Need for high protein, calcium, and vitamin D-enriched diet • Pacing activities • Using assistive devices safely when needed • Safety-proof home to reduce falls

Activity Variations Based on Developmental Level: Assessment Priorities and Nursing Interventions: DEVELOPMENTAL LEVEL Infant • Periods of activity and alertness alternate with quiet periods and sleep. • 3 months: May raise chest and head when prone. • 5 months: Head control usually achieved. ASSESSMENT PRIORITIES Assess the following key developmental milestones at these ages: 3-6 months • Ability to sit • Head control 6-9 months • Sits steadily • Rolls over • Creeps on all fours • Pulls to a standing position • Has improved hand-eye coordination 9-12 months • Progresses toward unassisted walking • Is able to pick up small objects NURSING INTERVENTIONS • Encourage parents to examine their baby (count fingers and toes). • Respond to concerns that parents have about minor variations in newborn's appearance or behavior. • Emphasize that individual variation in activity patterns and neuromuscular development should be expected. • Account for any prematurity when discussing normal developmental progression of preterm infants.

DEVELOPMENTAL LEVEL Toddler • Gross and fine motor development continues rapidly. • By 15 months: Most can walk unassisted. • At 18 months: Most can run. • At 2 years: Most can jump • At 3 years: Most can stack blocks, work simple puzzles, and dress themselves. ASSESSMENT PRIORITIES • Assess progress in walking, running, and jumping. • Assess small-muscle coordination (ability to dress themselves, wash hands, brush teeth). • Distinguish slow developers who fall within normal range from those with developmental lags. NURSING INTERVENTIONS • Help parents to learn and accept their child's uniqueness. • Teach parents the importance of providing a safe environment. • Enthusiastically reinforce and praise toddler's mastery of new skills. • Set limits so that toddler does not overextend self in drive for mastery of skills.

Focused Assessment Guide MOBILITY AND EXERCISE Factors to Assess Daily activity level Questions and Approaches -Describe the activities you normally carry out during a routine day and types of physical exercise that are part of your daily lifestyle. -Activities of daily living -Type, frequency, duration of physical exercise -Past history of activity and exercise; recent changes Endurance Questions and Approaches -Describe how much and what type of activity makes you tired. -History of dizziness, dyspnea, frequent pauses in activity to rest, pounding heart, or marked increase in respiratory rate after moderate activity

Exercise/fitness goals Questions and Approaches -What exercise or fitness goals are you currently working on? -Attitudes about exercise and physical fitness -Knowledge of the benefits of exercise -Motivation to exercise Mobility problems Questions and Approaches -Do you experience any problems with movement or with more vigorous activity or exercise? If yes, please describe these problems. -Nature of the problem (including symptoms) -Onset of disturbance and frequency -Known causes -Effect of problem on everyday functioning -Interventions attempted and results

Physical or mental health alterations Questions and Approaches Are there any physical or mental health problems that may be affecting your mobility? -Decrease of strength or endurance (e.g., myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, cancer, gastrointestinal disorders) -Neuromuscular impairment (multiple sclerosis, Parkinson's disease, spinal injuries) -Musculoskeletal impairment (arthritis, fractures, muscular dystrophy) -Perceptual or cognitive impairment (cerebrovascular accident, brain tumor or trauma, vision disorders, dementia) -Pain or discomfort (burns, rheumatoid arthritis, chronic pain syndrome, postoperative pain) -Depression or severe anxiety (neurosis, schizophrenia)

External factors affecting mobility Questions and Approaches -Is there anything else you can think of that limits your ability to get around? -Environmental factors (stairs, lack of railings or other assistive devices, poor lighting, unsafe neighborhood) -Financial resources

Occupational Safety & Health Administration (OSHA) recommends a no-lift policy for all health care facilities. Implementing safe patient handling and movement programs improves the quality of patient care and reduces the risk of harm for patients and health care workers. Lift teams are groups of specially trained staff that provide safe patient transfers orthopedics: the correction or prevention of disorders of body structures used in locomotion

For example, a person who has a sedentary occupation and engages in little physical activity may have poorly developed muscles. A patient who is on complete bed rest is in danger of losing muscle tonus. Tonus- (slight contractions) If bed rest is prolonged, the patient is in danger of developing contractures (permanent contraction of a muscle) unless exercise, joint motion, and good posture are maintained. Positioning and movement, or lack thereof, also influence the functioning of various internal body processes.

Overview of Physical Assessment of Mobility Status General ease of movement --NORMAL FINDING Body movements are: • Voluntarily controlled (purposeful) • Fluid • Coordinated --SIGNIFICANT ALTERATIONS Involuntary movements: • Tremors • Tics • Chorea • Athetosis • Dystonia • Fasciculations • Myoclonus • Oral-facial dyskinesias

Gait and posture --NORMAL FINDING Head erect, vertebrae are straight. Knees and feet point forward. Arms at side with elbows flexed. Arms swing freely in alternation with leg swings. While one leg is in the stance phase, the other is in the swing phase. --SIGNIFICANT ALTERATIONS Abnormalities of gait and posture: • Spastic hemiparesis • Scissors gait • Steppage gait • Sensory ataxia • Cerebellar ataxia • Parkinsonian gait • Gait of old age • Use of assistive devices for ambulation

Precipitation of a Cardiac Event Although the risk of exercise precipitating a major cardiac event in a healthy person is minimal, the risk is much higher for people with known or suspected cardiovascular disease. Patients who have heart disease, asthma or lung disease, diabetes, kidney disease, or arthritis are advised to consult with a health care practitioner before beginning an exercise program. The American College of Sports Medicine recommends patients consult their health care practitioner before participating in vigorous exercise if two or more of the following apply: -a man older than 45 or a woman older than age 55 -family history of heart disease before age 55 in men and 65 in women -currently smoke or quit smoking in the past 6 months -have not exercised for at least 30 minutes, 3 days a week for 3 months or more -overweight or obese -high blood pressure or high cholesterol -impaired glucose tolerance

Hypostatic pneumonia is a type of pneumonia that results from inactivity and immobility. The situation worsens when the person is dehydrated or using pharmacologic agents that increase the tenacity of secretions, depress the coughing mechanism, and/or depress respirations.

Instruct a patient using a walker to do the following: -Wear nonskid shoes or slippers. -When rising from a seated position, use the chair arms for support. -Once standing, place one hand at a time on the walker and move forward into it. -Begin by pushing the walker forward, keeping the back upright. ------Place one leg inside the walker, keeping the walker in place. Then, step forward with the remaining leg into the walker, keeping the walker still. Repeat the process by moving the walker forward again. -Caution the patient to avoid pushing the walker out too far in front and leaning over it. Patients should always step into the walker, rather than walking behind it, staying upright as they move. -Never attempt to use a walker on stairs.

If the cane is used for stability, the patient may hold it in either hand. Ambulation proceeds in the following fashion: 1. The patient stands with weight evenly distributed between the feet and the cane. 2. The cane is held on the patient's stronger side and is advanced one small stride ahead. 3. Supporting weight on the stronger leg and the cane, the patient advances the weaker foot forward, parallel with the cane. 4.Supporting weight on the weaker leg and the cane, the patient brings the stronger leg forward to finish the step. Teach patients to position their canes within easy reach when they sit down so that they can rise easily.

Outcome Identification and Planning: Expected patient outcomes are directed toward the promotion of physical fitness. For example, the patient will: -Identify personal benefits of regular exercise -List support systems that will reinforce exercise efforts -Follow a program of regular physical exercise that improves cardiovascular function, endurance, flexibility, and strength Patients at high risk for specific mobility problems require different expected outcomes. For example, the patient will: -Demonstrate correct body alignment whenever observed (alignment) -Demonstrate full range of joint motion (joint mobility) -Demonstrate adequate muscle mass, tone, and strength to perform functional ADLs (muscle mass, tone, strength) Patients who are immobile require outcomes directed toward preventing complications related to inactivity and its effects on the body systems. For example, the patient will: -Be free from alterations in skin integrity -Show signs of adequate venous return -Be free of contractures

Implementing Techniques for the use of graduated compression stockings and pneumatic compression devices, as well as performing range-of-motion exercises, are discussed. It is important to remember that the Occupational Safety and Health Administration (OSHA, n.d.) recommends a no-lift policy for all health care facilities. Instead, they advise using patient handling aids and mechanical lifting equipment for patients who are unable to assist in their transfer. Incorporating these safe patient handling and movement strategies, techniques for turning and moving a patient in bed, moving a patient from bed to stretcher and from bed to chair, and logrolling a patient.

Special Movements Pronation The assumption of the prone position. Example: A person is in the prone position when lying on the abdomen; a person's palm is prone when the forearm is turned so that the palm faces downward. Supination The assumption of the supine position. Example: A person is in the supine position when lying on the back; a person's palm is supine when the forearm is turned so that the palm faces upward.

Inversion Movement of the sole of the foot inward (occurs at the ankle) Eversion Movement of the sole of the foot outward (occurs at the ankle) Opposition Rotation of the thumb around its long access (movement of the thumb across the palm to touch each fingertip of the same hand).

Alignment --NORMAL FINDING Independent maintenance of correct alignment: • In the standing and sitting position, a straight line can be drawn from the ear through the shoulder and hip. • In bed, the head, shoulders, and hips are aligned. --SIGNIFICANT ALTERATIONS Abnormal spinal curvatures Inability to maintain correct alignment independently Muscle mass, tone, and strength --NORMAL FINDING Adequate muscle mass, tone, and strength to accomplish movement and work --SIGNIFICANT ALTERATIONS Atrophy, hypertrophy Hypotonicity (flaccidity), spasticity Paresis or paralysis

Joint structure and function --NORMAL FINDING Absence of joint deformities Full range of motion --SIGNIFICANT ALTERATIONS Limitation in the normal range of motion Increased joint mobility Swelling or tenderness in or around the joint Heat or redness Crepitation Deformities Muscle atrophy, nodules, skin changes Asymmetry of involvement Endurance --NORMAL FINDING Ability to turn in bed, maintain correct alignment when sitting and standing, ambulate, and perform self-care activities --SIGNIFICANT ALTERATIONS Physiologic or psychological inability to tolerate an increase in activity: • Significantly increased pulse, respiration, blood pressure after rest • Shortness of breath, dyspnea • Weakness • Pallor • Confusion • Vertigo • Pain

Gait belt is a device used for transferring patients and assisting with ambulation. Gait belts also allow the nurse to assist in ambulating patients who have leg strength, can cooperate, and require minimal assistance. Do not use gait belts on patients with abdominal or thoracic incisions. Stand-Assist and Repositioning Aids Some patients need minimal assistance to stand up. With an appropriate support to grasp, they can lift themselves. Many types of devices can help a patient to stand. These devices can be freestanding or attached to the bed or wheelchair. Other aids have a pull bar to assist the patient to stand, and then a seat unfolds under the patient. After the patient sits on the seat, the device can be wheeled to the toilet, chair, shower, or bed.

Lateral-Assist Devices Lateral-assist devices reduce patient-surface friction during side-to-side transfers. Roller boards, slide boards, transfer boards, inflatable mattresses, and friction-reducing lateral-assist devices are examples of these devices, which make transfers safer and more comfortable for the patient. Friction-Reducing Sheets Friction-reducing sheets can be used under patients to prevent skin shearing when moving patients in bed and when assisting with lateral transfers. Mechanical Lateral-Assist Devices Mechanical lateral-assist devices include specialized stretchers and eliminate the need to slide the patient manually. Some devices are motorized, whereas others use a hand crank. A portion of the device moves from the stretcher to the bed, sliding under the patient, bridging the bed and stretcher.

--BODY SYSTEM Gastrointestinal System --EFFECTS OF EXERCISE ↑Appetite ↑Intestinal tone --EFFECTS OF IMMOBILITY Disturbance in appetite Altered protein metabolism Altered digestion and utilization of nutrients ↓Peristalsis Urinary System --EFFECTS OF EXERCISE ↑Blood flow to kidneys ↑Efficiency in maintaining fluid and acid-base balance ↑Efficiency in excreting body wastes --EFFECTS OF IMMOBILITY ↓Bladder muscle tone ↑Urinary stasis ↑Risk for renal calculi

Musculoskeletal System --EFFECTS OF EXERCISE ↑Muscle efficiency ↑Coordination ↑Efficiency of nerve impulse transmission --EFFECTS OF IMMOBILITY ↓Joint mobility, flexibility ↓Muscle size, tone, and strength Bone demineralization ↓Endurance, stability ↑Risk for contracture formation Metabolic System --EFFECTS OF EXERCISE ↑Efficiency of metabolic system ↑Efficiency of body temperature regulation --EFFECTS OF IMMOBILITY ↑Risk for electrolyte imbalance Altered exchange of nutrients and gases

THE NURSING PROCESS FOR ACTIVITY Assessing The comprehensive nursing assessment uses both interview and physical assessment skills to obtain data about the patient's mobility and activity status. When alterations in a patient's physical or mental health state result in impaired mobility, additional specific assessment skills are needed to determine the patient's physical limitations.

Nursing History During the nursing history, interview patients regarding their daily activity level, endurance, exercise and fitness goals, mobility problems, physical or mental health alterations that affect mobility, and external factors affecting mobility. Questioning patients about their fitness goals is important to provide an indication of the patient's view of health. This interviewing strategy communicates to patients that you expect them to be exercising and is itself a powerful teaching tool. When a problem exists, assess the nature of the problem, its onset and frequency, known causes, severity and symptoms, effects on everyday functioning, the interventions attempted by the patient, and the results.

When assessing endurance, evaluate the patient's ability to turn in bed, maintain correct alignment when sitting or standing, ambulate, and perform self-care activities. When a physical or psychological factor is believed to be affecting endurance, evaluate the following: -Vital signs while the patient is at rest -Ability to perform the activity (e.g., ambulation) -Patient's response during and after the activity -Vital signs immediately after the activity -Vital signs after the patient has rested for 3 minutes

Nursing diagnoses specifically addressing problems of mobility include: -Activity Intolerance related to fatigue, generalized weakness, and exertional discomfort -Impaired Transfer Mobility related to pain and musculoskeletal impairment -Risk for Injury related to altered sensation, unsteady gait, and confusion Examples of nursing diagnoses related to problems of mobility may include: -Risk for Constipation related to opioid use and decreased mobility -Toileting Self-Care Deficit related to weakness and impaired mobility -Risk for Ineffective Peripheral Tissue Perfusion related to sedentary lifestyle, tobacco use, obesity, and salt intake

Problems with muscle development may be genetic in origin, a disease-related problem, or an age-related problem. The muscular dystrophies are a group of genetically transmitted disorders that share a common progressive degeneration and weakness of skeletal muscles. Myasthenia gravis is a weakness of the skeletal muscles caused by an abnormality at the neuromuscular junction that prevents muscle fibers from contracting. Myotonic muscular dystrophy involves prolonged muscle spasms or stiffening after use. Duchenne muscular dystrophy involves a muscle decrease in size, as well as weakening of muscles over time.

Nursing responsibilities for patients with problems of bone formation and muscle development and functioning include the following: -Having a solid knowledge base about the underlying disease process -Careful collaboration with the physician and health care team to determine the motor capacities of the person -Patient and family education aimed at developing optimal mobility -The ability to position, transfer, and exercise the patient safely, with attention to patient comfort

TRAUMA TO THE MUSCULOSKELETAL SYSTEM Injury to the musculoskeletal system can result in fractures and soft tissue injuries. A fracture, a break in the continuity of a bone or cartilage, may result from a traumatic injury or some underlying disease process. Healing requires realignment of the bone fragment, immobilization, and restoration of the bone's function. Soft tissue injuries include sprains, strains, and dislocations. A strain (least serious) is a stretching of a muscle. Nurses need to be knowledgeable in first aid measures for musculoskeletal trauma as well as in acute and rehabilitative care.

PROBLEMS AFFECTING THE CENTRAL NERVOUS SYSTEM A problem in any of the principal parts of the brain or spinal cord involved with skeletal muscle control can affect mobility. The cerebral motor cortex assumes the major role of controlling precise, discrete movements. A cerebrovascular accident (stroke) or head trauma may damage the motor cortex and produce temporary or permanent voluntary motor impairment. Basal ganglia integrate semivoluntary movements such as walking, swimming, and laughing. In Parkinson's disease, there is progressive degeneration of the basal ganglia of the cerebrum, thus affecting walking and coordination. Unnecessary skeletal movements result in tremors and muscle rigidity, which interfere with voluntary movement. The cerebellum assists the motor cortex and basal ganglia by making body movements smooth and coordinated. In multiple sclerosis, the myelin sheaths of neurons in the CNS deteriorate to hardened scars or plaques. Plaque formation in the cerebellum may produce lack of coordination, tremors, and/or weakness.

Muscular, Skeletal, or Nervous System Problems: CONGENITAL OR ACQUIRED POSTURAL ABNORMALITIES Examples of patients experiencing one of these abnormalities include a newborn with developmental hip dysplasia, torticollis (inclining of head to affected side) or a clubfoot; a teenager with lordosis (exaggerated anterior convex curvature of the spine) or scoliosis (lateral curvature of the spine); and an older adult with kyphosis (increased convexity in the curvature of the thoracic spine). Nursing responsibilities may include the following: -Early detection of and referral for these problems -Exploration and selection of patient education, counseling, and support as treatment options -Careful attention to positioning, transfers, and exercise -Education of the patient and family regarding safe self-care activities

PROBLEMS WITH BONE FORMATION OR MUSCLE DEVELOPMENT: -Congenital problems, such as achondroplasia, in which premature bone ossification (bone tissue formation) leads to dwarfism or osteogenesis imperfecta, which is characterized by excessively brittle bones and multiple fractures both at birth and later in life -Nutrition-related problems, such as vitamin D deficiency, which results in deformities of the growing skeleton (rickets) -Disease-related problems, such as Paget's disease, in which excessive bone destruction and abnormal regeneration result in skeletal pain, deformities, and pathologic fractures -Age-related problems, such as osteoporosis, in which bone destruction exceeds bone formation and in which the resultant thin, porous bones fracture easily

Transfer Chairs Chairs that can convert into stretchers are available. These are useful with patients who have no weight-bearing capacity, cannot follow directions, and/or cannot cooperate. The back of the chair bends back, and the leg supports elevate to form a stretcher configuration, eliminating the need for lifting the patient. Some of these chairs have built-in mechanical aids to perform the patient transfer, as detailed previously. Powered Stand-Assist and Repositioning Lifts These devices can be used with patients who can bear weight on at least one leg, can follow directions, and are cooperative. A simple sling is placed around the patient's back and under the arms. Some devices come with breathable slings that can remain under the patient, reducing the risk for the nurse in turning the patient to position the sling. The patient rests the feet on the device's footrest and places the hands on the handle. The device mechanically assists the patient to stand, without any assistance from the nurse. Once the patient is standing, the device can be wheeled to a chair, the toilet, or bed. Some devices have removable footrests and can be used as a walker. Some have scales incorporated into the device that can be used to weigh the patient. The duration of time spent in slings should be limited to reduce risk for pressure injury, especially for vulnerable populations.

Powered Full-Body Lifts These devices are used with patients who cannot bear any weight to move them out of bed, into and out of a chair, and to a commode or stretcher. A full-body sling is placed under the patient's body, including head and torso, then the sling is attached to the lift. As mentioned previously, some of these slings are made to stay under the patient to decrease strain on the staff during placement. The device slowly lifts the patient. Some devices can be lowered to the floor to pick up a patient who has fallen. These devices are available on portable bases and ceiling-mounted tracks. The duration of time spent in slings should be limited to reduce risk for pressure injury, especially for vulnerable populations.

Postural reflexes are the group of reflexes (automatic movements) that maintain body position and equilibrium, whether at rest or during movement. Postural tonus, the sustained contraction of select skeletal muscles that keeps the human body in an upright position against the force of gravity, depends on the functioning of several postural reflexes: Labyrinthine sense: The sensory organs in the inner ear provide this sense of position, orientation, and movement. Body movement (e.g., changes in head position) stimulates the sensory organs, which then transmit these impulses to the cerebellum.

Proprioceptor or kinesthetic sense: This informs the brain of the location of a limb or body part as a result of joint movements stimulating special nerve endings in muscles, tendons, and fascia. Visual or optic reflexes: Visual impressions contribute to posture by alerting the person to spatial relationships with the environment (nearness of ceilings, walls, furniture, condition of floor, etc.). Extensor or stretch reflexes: When extensor muscles are stretched beyond a certain point (e.g., when knees buckle under), their stimulation causes a reflex contraction that aids a person to reestablish erect posture (e.g., straighten the knee).

-Explain to the patient what you plan to do. Then use what abilities the patient has to assist you. This technique often decreases the effort required and the possibility of injury to you. -If the patient is in pain, administer the prescribed analgesic sufficiently in advance of the transfer to allow the patient to participate in the move more comfortably. -Elevate the bed as necessary so that you are working at a height that is comfortable and safe for you. -Lock the wheels of the bed, wheelchair, or stretcher so that they do not slide while you are moving the patient. -Be sure the patient is in good body alignment while being moved and lifted to protect the patient from strain and muscle injury. -Support the patient's body properly. Avoid grabbing and holding an extremity by its muscles. -Avoid friction on the patient's skin during moving. -Use friction-reducing devices whenever possible, especially during lateral transfers. -Move your body and the patient in a smooth, rhythmic motion. Jerky movements tend to put extra strain on muscles and joints and are uncomfortable for the patient. -Use mechanical devices such as lifts, slides, transfer chairs, or gait belts for moving patients. Be sure that you understand how the device operates and that the patient is properly secured and informed of what will occur. If you are not comfortable with the operation of the equipment, obtain assistance from a caregiver who is. Patients who do not understand or are afraid may be unable to cooperate and may cause injury to the staff as well as suffer injury as a result. -Ensure that the equipment used meets weight requirements. -Bariatric patients (BMI >50) require bariatric transfer aids and equipment. Bariatric transfer aids and equipment are designed to be used with people who are obese.

Safe Handling of Patients With Dementia -Be aware that communication problems and weakness can make the handling of patients with dementia challenging. -Face the patient when speaking. -Use clear, short sentences. -Call patient by name. -Use calm, reassuring tone of voice. -Offer simple, step-by-step instructions. -Repeat verbal cues and prompts as necessary; this is helpful when thought processes are delayed. -Determine if the patient experiencing dementia has receptive aphasia. This inability to understand what is being said results in noncompliance with verbal instructions. -Phrase instructions positively. For example, remind the patient to "Stand up" until the chair is correctly positioned, instead of saying "Don't sit down." The patient may not register the "Don't" and will try to sit too early. Positive instructions are more likely to result in successful maneuvers. -Ask one question at a time, allow the patient to answer, and repeat the question if necessary. -Allow the patient to focus on the task; avoid correcting the process of the action unless it would be dangerous to the patient not to do so. -Identify the patient's established patterns of behavior, customs, traits, and everyday habits and try to incorporate these habits into desired activities. For instance, a patient with dementia may resist or become frightened when a morning shower is attempted if the patient was accustomed to evening baths. Another patient may have difficulty getting out of bed in the morning for the simple reason that he is being asked to get out on what he considers the wrong side of the bed.

In active exercise, the patient independently moves joints through their full range of motion (isotonic exercise). In active-assistive exercise, the nurse may provide minimal support, whereas in passive exercise, the patient is unable to move independently, and the nurse moves each joint through its range of motion. Both active and passive exercises improve joint mobility and increase circulation to the affected part, but only active exercise increases muscle mass, tone, and strength and improves cardiac and respiratory functioning. Thus, exercises should be as active as the patient's physical condition permits. It is also helpful to teach isometric exercises to patients to increase muscle mass, tone, and strength.

The following are basic guidelines to follow when helping to put the patient's joints through range of motion: -Teach the patient what exercise is being undertaken, why, and how it will be done. A show-and-tell technique is often helpful. -Avoid overexertion and continuing exercises to the point that the patient develops fatigue. The exercises are not meant to exhaust or tax the patient. It may be necessary to delay certain exercises until the patient's condition allows. -Avoid neck hyperextension and attempts to achieve full range of motion in all joints with older adults. These movements may prove painful. Encourage adequate range of motion in those joints necessary to perform ADLs. -Start gradually and work slowly. All movements should be smooth and rhythmic. Irregular and jerky movements are uncomfortable for patients. -Move each joint until there is resistance but not pain. Report uncomfortable reactions and stop exercises until further instructions are obtained.

Isotonic exercise involves muscle shortening and active movement. Examples include carrying out ADLs, independently performing range-of-motion exercises, and swimming, walking, jogging, and bicycling. Potential benefits include increased muscle mass, tone, and strength; improved joint mobility; increased cardiac and respiratory function; increased circulation; and increased osteoblastic or bone-building activity.

These benefits do not occur when the nurse or family member performs passive range-of-motion exercises for a patient because the patient's muscles do not exert effort. Therefore, although still beneficial, the overall potential benefits are reduced.

PROBLEMS AFFECTING JOINT MOBILITY Inflammation, degeneration, and trauma can all interfere with joint mobility. The term arthritis describes more than 100 different diseases that affect areas in or around joints. Arthritis is characterized by inflammation, pain, damage to joint cartilage, and/or stiffness. The most common type is osteoarthritis, also termed degenerative joint disease. Osteoarthritis is a noninflammatory, progressive disorder of movable joints, particularly weight-bearing joints, characterized by the deterioration of articular cartilage and pain with motion. Once the articular cartilage is damaged, bony deposits (bone spurs) may form in the joints, causing more pain with movement of the joint.

Trauma to a joint may result in a sprain or a dislocation. A sprain occurs with the wrenching or twisting of a joint, resulting in a partial tear or rupture to its attachments. A dislocation is characterized by the displacement of a bone from a joint with tearing of ligaments, tendons, and capsules. Any condition restricting joint mobility has potentially crippling effects. Nurses caring for patients with joint problems work collaboratively with physicians and other advanced practice professionals, physical therapists, and other health care professionals to maintain joint mobility. Patient education is directed to the patient's mastery of an exercise and care program, which fosters tissue repair and maximal independence in ADLs.

Integument --EFFECTS OF EXERCISE Improved tone, color, and turgor, resulting from improved circulation --EFFECTS OF IMMOBILITY ↑Risk for skin breakdown and formation of pressure injuries Psychological Well-Being --EFFECTS OF EXERCISE Energy, vitality, general well-being Improved sleep Improved appearance Improved self-concept Positive health behaviors --EFFECTS OF IMMOBILITY ↑Sense of powerlessness ↓Self-concept ↓Social interaction ↓Sensory stimulation Altered sleep-wake pattern ↑Risk for depression Risk for learned helplessness

Types of Exercise Exercise can be divided into two major types. -muscle contraction occurring during the exercise -type of body movement occurring and the health benefits achieved. -Type of muscle contraction involved as being isotonic, isometric, or isokinetic

-ergonomics: practice of designing equipment and work tasks to conform to the capability of the worker and providing a means for adjusting the work environment and work practices to prevent injuries -patient care ergonomics: practice of designing equipment and work tasks to conform to the capability of the worker in relation to patient care It is very important to incorporate patient care ergonomics into nursing practice and patient care.

Variables that can lead to back injuries or back pain for health care workers include: -Uncoordinated lifts -Manual lifting and transferring of patients without assistive devices -Lifting when fatigued -Lifting after recent recovery from a back injury -Repetitive movements such as lifting, transferring, and repositioning patients -Standing for long periods of time -Transferring patients from beds to stretchers and chairs, wheelchairs, or operating tables; repositioning patients in bed -Repetitive tasks -Transferring/repositioning uncooperative or confused patients

Use inspection and palpation to examine joints, their range of motion, and the surrounding tissue. Range of motion is the maximum degree of movement of which a joint is normally capable. When assessing joint mobility, note the following: -Size, shape, color, and symmetry of joints: note any masses, deformities, or muscle atrophy -Range of motion of each joint -Any limitation in the normal range of motion or any unusual increase in the mobility of a joint (instability); range of motion varies among people and decreases with aging -Muscle strength when performing range-of-motion exercises against resistance -Any swelling, heat, tenderness, pain, nodules, or crepitation (palpable or audible crunching or grating sensation produced by motion of the joint) -Comparison of findings in one joint with those of the opposite joint

flaccidity: decreased muscle tone; synonym for hypotonicity spasticity: increased muscle tone Test muscle strength by asking the patient to move actively against resistance. For example, instruct the patient to push the examiner's palms apart or to push the foot against the examiner's palm. When comparing muscle groups, remember that a person's dominant side tends to be stronger. paresis: impaired muscle strength or weakness paralysis: absence of strength secondary to nervous impairment Hemiparesis refers to weakness of one half of the body, Hemiplegia is paralysis of one half of the body. Paraplegia is paralysis of the legs Quadriplegia is paralysis of the arms and legs.