Definition
It is a syndrome characterized by physiological decompensation due to long-term inactivity of the body, such as prolonged bed rest, or prolonged immobilization in braces, splints or casts.
Causes]
1.Long-term bed caused by various reasons, the patient is basically inactive or insufficient movement.
2.Motor impairment caused by trauma or primary disease.
3.Reduced activity due to severe sensory impairment caused by reduced stimulation.
4.A variety of bone and joint diseases reduce the range of motion of the limbs.
Local and systemic manifestations
1.Local manifestations.
(1) Disuse muscle weakness and myasthenia gravis
Studies have shown that the isometric muscle strength of a limb that is not moving at all can decrease by 1% to 3% per day, 10% to 20% per week, and 50% in 3-5 weeks. This not only affects the local area, but also decreases the whole body muscle strength and leads to myasthenia gravis, with the lower extremities more prone to myasthenia gravis and myasthenia gravis than the upper extremities. In turn, muscle weakness and muscle atrophy can further restrict limb movement, resulting in a vicious circle.
(2) Joint contracture
Caused by lack of movement or restricted passive range of motion of joints, soft tissues, and muscles. The most common factors are: pain, limb motor dysfunction, spasticity, prolonged joint immobilization, and failure to rehabilitate in a timely manner.
(3) Disuse osteoporosis
The bone response is enhanced due to lack of stimulation of the bones by weight bearing, gravity and muscle activity. In addition, long-term inactivity affects the endocrine system, resulting in increased excretion of calcium in the urine, increased excretion of hydroxyproline, and increased excretion of calcium in the feces.
Osteoporosis is most pronounced under the periosteum, in contrast to senile osteoporosis, which occurs on the outside of the periosteum.
Prevention and treatment methods: weight-bearing standing, strength, endurance and coordination training, muscle isometric and isotonic contraction, etc.
2. Systemic disuse manifestations.
(1) Postural hypotension.
Normal people from lying to sitting or standing, under the action of gravity, 70% of the blood in the whole body is below the level of the heart, the venous return flow is reduced, the head blood pressure decreases because the position is higher than the heart. But at this time, the falling blood pressure can act on the arterial pressure receptors, stimulating the sympathetic nerves to reflexively induce the increase of heart beat output, arterial and venous contraction and redistribution of blood flow in each organ to ensure that the blood pressure does not fall below 20mmHg or more, so that the average blood pressure is almost at the same level with the horizontal position.
When this regulatory mechanism is impaired, a sudden change of position (especially standing) can reduce the return blood volume and heart beat output, leading to the appearance of cerebral ischemic symptoms such as vertigo, tinnitus, black eyes, and even confusion. The degree of upright hypotension caused by prolonged bed rest is related to the length of bed rest. In mild cases, only transient cerebral hypoperfusion occurs, while in severe cases, the ability to perform daily activities can be lost.
(2) Endocrine alterations: the relevant hormones and enzymes are reduced in response, and glucose tolerance is decreased. Changes in life rhythm, changes in body temperature and sweat excretion response, and changes in the regulation of thyroid, parathyroid, adrenal, and pituitary hormones.
(3) Neurological, emotional and cognitive alterations: poor attention, temporal and spatial orientation, disorders, ataxia, decreased cognitive function, emotional and behavioral disturbances.
(4) Metabolic and nutritional changes: imbalance in nutritional balance, increase in fat, inorganic and electrolyte deficiencies.
(5) skin changes: prevention and control methods are regular turning, appropriate limb passive activities, local massage, clean skin
(6) Deep vein thrombosis (see subsequent chapters)
3. Treatment of disuse syndrome.
(1) wasting muscular atrophy: ① gravity-resistant lower limb muscles are more prone to weakness and atrophy than upper limb muscles. (2) completely immobile limbs, isometric muscle strength decreases by 1%-3% per day and 10%-20% per week. If completely immobile 3-5 weeks muscle strength decreases by 50%.
Rehabilitation treatment.
① Daily exercise of 20%-30% of the maximum muscle strength of the body for a few seconds.
②It is more effective to do exercises of 50% of the maximum muscle strength for 1 second.
(iii) Neuromuscular electrical stimulation can also be prevented.
(2) Joint contracture pain and spasm Joint contracture is caused by prolonged immobilization, etc. Joint contracture can hinder the recovery of limb movement function and is also an important cause of disability. It is necessary to change the position regularly and carry out passive and active activities of the joints.
(3) Disuse osteoporosis Long-term lack of weight-bearing and muscle activity and other stimuli can cause serious loss of bone calcium. Exercise can regulate neuroendocrine and promote the absorption and utilization of calcium. Mainly weight-bearing exercise, including running, walking, weight lifting, etc. Because when weight-bearing, under the effect of pressure, it will increase the number of bone cells, thus increasing bone density. If the patient is unable to perform self-standing, he or she can be helped to lean against a wall and remain standing at 70° to 90° for at least 30 minutes. It is also possible to stand or walk inside a parallel bar or with the help of a support. Perform exercise training for strength, endurance and coordination to promote coordination and flexibility of muscles and motor organs to reduce the risk of fracture due to falls.
(4) Prevention and treatment of postural hypotension: change the position regularly, slowly at the beginning, and gradually increase the speed later. When lying down, make the head slightly higher than the feet, then gradually raise the upper body from 15°, 30°, 45° to 90° as much as the patient can tolerate. Do resistance exercise to the healthy side of the limb, trunk and head to increase the heart beat output.
Prevention and treatment methods: ① change the position regularly; ② move the limbs appropriately actively or passively; ③ sleep with the upper body slightly higher than the lower body; ④ do deep breathing, but it is prohibited for those with increased cranial pressure; ⑤ do resistance exercise to the healthy side limbs, trunk and head; ⑥ massage the limbs and rub the skin with cold water; ⑦ use elastic bandage for the lower limbs and abdomen; ⑧ most importantly, avoid long-term bed rest as much as possible and start sitting training as early as possible.
(5) Deep vein thrombosis Because of the slow blood flow in people who are bedridden or have lower limb paralysis, venous thrombosis is easily formed, and once the deep vein thrombosis is dislodged, it is easy to cause pulmonary or cerebral embolism. The prevention method is to elevate the lower limbs and move the lower limbs frequently, or use elastic stockings.
(6) Other dysfunctions such as cardiac function, respiratory function, urinary function, digestive function, endocrine, metabolic function, mental and cognitive function changes are all systemic abnormalities of the disuse syndrome.