imobilizare spasticitate (1).ppt
TRANSCRIPT
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Sindromul de Sindromul de deconditionaredeconditionare
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Repausul Repausul
Pe scara larga :Pe scara larga : Traumatisme (fracturi)Traumatisme (fracturi) Bolile acute (IMA, AVC)Bolile acute (IMA, AVC) Decompensarile acute ale bolilor Decompensarile acute ale bolilor
cronice (PR, SM)cronice (PR, SM)
Asigura vindecareaAsigura vindecarea
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DAR !DAR !
Imobilizarea afecteaza segmentele Imobilizarea afecteaza segmentele indemne, neafectate de boalaindemne, neafectate de boala
Fractura
ConsolidareaConsolidarea
focarului defocarului de
fracturafractura
Articulatii - Articulatii - contracturicontracturi
Muschi - Muschi - hipotrofiehipotrofie
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Primele studiiPrimele studii
Astronautii in conditii de Astronautii in conditii de microgravitatiemicrogravitatie
Persoane imobilizate la patPersoane imobilizate la pat
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Indivizi la risc Indivizi la risc
VarstniciVarstnici Bolnavi croniciBolnavi cronici Persoane cu diferite dizabilitatiPersoane cu diferite dizabilitati
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Efectele imobilizariiEfectele imobilizarii
Nu se limiteaza la un singur aparat Nu se limiteaza la un singur aparat sau sistemsau sistem
Intregul organism sufera Intregul organism sufera consecintele imobilizariiconsecintele imobilizarii
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IMOBILIZAREAIMOBILIZAREA
DECONDITIONAREDECONDITIONARE
Diagnostic separat fata Diagnostic separat fata de suferinta initialade suferinta initiala
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Sisteme si aparate afectateSisteme si aparate afectate
Aparatul locomotorAparatul locomotor Aparatul cardio-respiratorAparatul cardio-respirator Aparatele genito-urinar si gastro-Aparatele genito-urinar si gastro-
intestinalintestinal Sistemul endocrin si metabolismulSistemul endocrin si metabolismul Capacitatile cognitive si Capacitatile cognitive si
comportamentulcomportamentul
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I. Sistemul musculoscheleticI. Sistemul musculoscheletic
Efectele negative sunt Efectele negative sunt Cele mai multeCele mai multe Cele mai evidenteCele mai evidente Cele mai severeCele mai severe
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Efecte negativeEfecte negative
ContracturiContracturi Scaderea fortei musculare, hipotrofii, Scaderea fortei musculare, hipotrofii,
atrofiiatrofii Osteoporoza de imobilizareOsteoporoza de imobilizare Hipercalcemia de imobilizareHipercalcemia de imobilizare
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Imobilizarea
activitatii musculare
capacitatii functionale a sistem musculoscheletal
Imobilizare
capacitatii functionale CV + alte sisteme
Deconditionare
Agravarea dizabilitatii
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Atrofia de neutilizareAtrofia de neutilizare
MicroscopicMicroscopic– Reducerea dimensiunilor fibrelor Reducerea dimensiunilor fibrelor
muscularemusculare MacroscopicMacroscopic
– Reducerea masei musculareReducerea masei musculare
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Atrofii musculare Atrofii musculare
Leziuni ale NMPLeziuni ale NMP Atrofie pe miotomAtrofie pe miotom
Suferinte primare Suferinte primare muscularemusculare
Musculatura Musculatura proximala (centuri)proximala (centuri)
Deconditionare Deconditionare Generalizata / Generalizata / limitata la muschii limitata la muschii imobilizati / imobilizati / predomina la mm predomina la mm antigravitationaliantigravitationali
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MecanismeMecanisme
Alterarea homeostaziei celulei Alterarea homeostaziei celulei muscularemusculare
sintezei de proteine muscularesintezei de proteine musculare– Scaderea masei musculareScaderea masei musculare
sintezei de colagensintezei de colagen Alterarea raportului colagen/proteinaAlterarea raportului colagen/proteina
– Alterarea proprietati elasticeAlterarea proprietati elastice Cresterea catabolismului proteinelor Cresterea catabolismului proteinelor
(secundar)(secundar)
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Zilele 1 2 10 14
50%
Steady-state
Rata sintezei proteiceRata sintezei proteice
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Rata excretiei de creatinaRata excretiei de creatina
Ziua 5 14
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Rata excretiei de creatinaRata excretiei de creatina
Persoana sanatoasa imobilizata 2g/ziPersoana sanatoasa imobilizata 2g/zi Indivizi cu factori de risc 12 g/ziIndivizi cu factori de risc 12 g/zi
– Malnutritie Malnutritie – Diabet zaharatDiabet zaharat– Distrofii musculareDistrofii musculare– HipertiroidismHipertiroidism– Stari febrileStari febrile
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Atrofia de neutilizareAtrofia de neutilizare
Musculatura MI > MSMusculatura MI > MS
Fibrele de tip IFibrele de tip I
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Sarcopenia Sarcopenia
= scaderea masei musculare si a fortei = scaderea masei musculare si a fortei musculare cu imbatranireamusculare cu imbatranirea
MecanismeMecanisme InactivitateaInactivitatea Reducerea motoneuroni alfaReducerea motoneuroni alfa Scaderea hormonilor de crestereScaderea hormonilor de crestere Aport redus de proteineAport redus de proteine Supraproductia citokinelor cataboliceSupraproductia citokinelor catabolice
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Sarcopenia Sarcopenia
Inactivitatea joaca rolul principalInactivitatea joaca rolul principal
Exercitii rezistive de intensitate mare Exercitii rezistive de intensitate mare – singurele care pot face sarcopenia – singurele care pot face sarcopenia reversibilareversibila
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Scaderea masei musculare Scaderea masei musculare
Scaderea fortei musculare Scaderea fortei musculare
Scaderea rezistentei musculare Scaderea rezistentei musculare (capacitatea de a sustine un efort (capacitatea de a sustine un efort prelungit)prelungit)
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Consecinte functionaleConsecinte functionale
ADL (ambulatia)ADL (ambulatia)
Durerea (lombara, membre)Durerea (lombara, membre)
Contractura = scurtare fixata a Contractura = scurtare fixata a muschi, tendon, ligg sau toate care muschi, tendon, ligg sau toate care impiedica miscarea normala a art impiedica miscarea normala a art sau segmentuluisau segmentului
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Modificarile testutului conjunctivModificarile testutului conjunctiv
Contracturi articulare Contracturi articulare
Localizare : articular + periarticularLocalizare : articular + periarticular
Limitarea mobilitatii articulareLimitarea mobilitatii articulare
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Contracturile - disfunctiiContracturile - disfunctii
Reducerea mobilitatiiReducerea mobilitatii ADL bazaleADL bazale Ingrijirea tegumentuluiIngrijirea tegumentului MI - MI - Ambulatia (schema de mers)Ambulatia (schema de mers)
– Mobilitatea in caruciorul cu rotileMobilitatea in caruciorul cu rotile– Transferurile Transferurile – Consum energetic crescut - obosealaConsum energetic crescut - oboseala
MS – autoingrijire, abilitati fineMS – autoingrijire, abilitati fine
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Osteoporoza de neutilizareOsteoporoza de neutilizare
Reducerea DMO (lipsa factor Reducerea DMO (lipsa factor mecanic)mecanic)
Situatii Situatii ImobilizareImobilizare TVMTVM
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Mecanismul osteoporozeiMecanismul osteoporozei
Modificarea turn-over (Modificarea turn-over ( resorbtia resorbtia osoasa - osteoclaste)osoasa - osteoclaste)
Os spongios (are turn-over Os spongios (are turn-over )) Factori de risc suplimentariFactori de risc suplimentari
– Carente de estrogeniCarente de estrogeni– Deficit de calciuDeficit de calciu
Sedii : sold, vertebre, antebrat distalSedii : sold, vertebre, antebrat distal
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Aparat cardio-respiratorAparat cardio-respirator
Factori ce asigura hemodinamica Factori ce asigura hemodinamica normala in repaus, ortostatism si normala in repaus, ortostatism si mers :mers :
Distributia lichidelorDistributia lichidelor Vasoconstrictia in ortostatismVasoconstrictia in ortostatism Pompajul muscular al MIPompajul muscular al MI
Mersul = antrenament la efortMersul = antrenament la efort
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Imobilizarea – aparat CVImobilizarea – aparat CV
Creste AV repaus (cu 1bpm la 2 zile)Creste AV repaus (cu 1bpm la 2 zile) Tahicardie de imobilizare Tahicardie de imobilizare
Tahicardie excesiva la eforturi minime Tahicardie excesiva la eforturi minime - AV creste cu - AV creste cu
32% la 3 zile32% la 3 zile 62% la 7 zile62% la 7 zile 89% la 21 zile89% la 21 zile
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Imobilizarea – aparat CVImobilizarea – aparat CV
Ortostatismul Ortostatismul Hipotensiune ortostaticaHipotensiune ortostatica Tahicardie Tahicardie
Parametrii :Parametrii : Scade volumul bataieScade volumul bataie Scade debitul cardiacScade debitul cardiac Scade consumul O2 (VO2max)Scade consumul O2 (VO2max)
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Imobilizarea – aparat CVImobilizarea – aparat CV
Sindrom de adaptare cardiovascularaSindrom de adaptare cardiovasculara Agraveaza ischemia cardiaca (apare Agraveaza ischemia cardiaca (apare
angina)angina)
Preventie :Preventie : Incurajarea ambulatiei precoce (IMA Incurajarea ambulatiei precoce (IMA
de la 2 – 3 sapt la 2 – 3 zile)de la 2 – 3 sapt la 2 – 3 zile)
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Imobilizarea – aparat respiratorImobilizarea – aparat respirator
Alterarea balantei ventilatie-perfuzieAlterarea balantei ventilatie-perfuzie Reducerea clearance secretiiReducerea clearance secretii Reducerea eficientei tuseiReducerea eficientei tusei Respiratia devine superficialaRespiratia devine superficiala Polipnee Polipnee
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Tromboza venoasa profundaTromboza venoasa profunda
Factori predispozanti :Factori predispozanti : Staza venoasa Staza venoasa
– Lipsa pompei musculare (principal)Lipsa pompei musculare (principal)– ChirurgieChirurgie– ObezitateObezitate– ICCICC
Creste coagulabilitatea sangeluiCreste coagulabilitatea sangelui +/- leziuni perete venos +/- leziuni perete venos
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Tromboza venoasa profundaTromboza venoasa profunda
Embolia pulmonaraEmbolia pulmonara
Se suprapune peste celelalte Se suprapune peste celelalte modificari pulmonaremodificari pulmonare
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Aparat genitourinarAparat genitourinar
Litiaza renala si vezicalaLitiaza renala si vezicala– HipercalciuriaHipercalciuria– Staza urinaraStaza urinara
Infectii ale tractului urinarInfectii ale tractului urinar
Factori agravantiFactori agravanti Golirea incompleta a VU (TVM, DZ)Golirea incompleta a VU (TVM, DZ)
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Aparat gastrointestinalAparat gastrointestinal
Scade apetitulScade apetitul Scade absorbtiaScade absorbtia Reflux gastro-esofagian (in decubit)Reflux gastro-esofagian (in decubit) ConstipatieConstipatie
– ImobilitateImobilitate– VolitionalVolitional
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Metabolism, endocrinMetabolism, endocrin
Modificari electrolitice Modificari electrolitice (hiponatriemie, grava la varstnic, (hiponatriemie, grava la varstnic, hipopotasemie)hipopotasemie)
Intoleranta la glucide (creste Intoleranta la glucide (creste rezistenta la insulina)rezistenta la insulina)
Hiper-PTH-emie (prin hipercalcemie)Hiper-PTH-emie (prin hipercalcemie)
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Sistem nervosSistem nervos
Izolare socialaIzolare sociala Reducerea capacitatii de concentrareReducerea capacitatii de concentrare AnxietateAnxietate DepresieDepresie