Coordinated Movement Balanced, smooth, purposeful movement is the result of proper functioning of the cerebral cortex, cerebellum, and basal ganglia. cerebral cortex: operates movements. not muscles. cerebellum: coordinates muscles involved in voluntary movement. translates the instructions from cortex into action basal ganglia: helps maintain posture Exercise Physical activity: bodily movement that enhances health. Exercise: type of physical activity defined as a planned, structured, and repetitive bodily movement performed to improve health and maintain fitness to achieve an optimal state of health. Functional strength: ability of the body to perform work. Activity tolerance: type and amount of exercise or daily living activities an individual is able to perform without experiencing adverse effects. Types of Exercise Isotonic (dynamic) exercises: muscle shortens to produce muscle contraction and active movement. ex. running, walking, swimming, cycling, ADL’s and active ROM. ex. pushing or pulling against a stationary object a trapeze to lift body off the bed, lifting buttocks off the bed by pushing with the hands, or pushing the body to a sitting position. Isometric (static or setting) exercises: muscle contraction without moving the joint (therefore muscle length does not change) useful in strengthening abdominals, gluteal, and quadricep muscles. ex. squeezing a or pillow between knees Isokinetic (resistive) exercises muscle contraction or tension against resistance. ex. resistance training Aerobic exercise amount of oxygen taken into body is greater than that used to perform the activity. ex. CV conditioning and physical fitness. Intensity of exercise can be measured in ways: 1. Target HR 2. Talk Test
Providing appropriate degree of assistance lowers risk of muscle strain and body injury to both client and nurse. Assessment of UE very important for clients who use assistive devices such as walkers or crutches. Activity Tolerance Determine appropriate activity level for client and predict whether the client can endure activities that require similar amounts of energy expenditure. Useful in encouraging independence in pt’s with: CV and respiratory problems immobilized for a prolonged period decreased muscle mass or musculoskeletal disorder inadequate sleep pain depressed, anxious, or unmotivated Most useful measurements of predicting activity tolerance: Heart strength, rhythm, and rate Respiratory depth, rhythm, and rate BP measure these before, during, immediately after, 3 minutes after activity Activity should be stopped immediately in the event of: sudden facial pallor dizziness or weakness change in LoC dramatic change in HR or RR from baseline dramatic change in heart or respiratory rhythm weakening of pulse Dyspnea, SOB, chest pain DBP change of 10mmHg or more Activity considered safe if client tolerates and vitals return to baseline levels within 5 minutes of activity. Problems Related to Immobility Take/understand assessment findings and lab values establish a baseline and compare with later values Clients at risk of developing complications of immobility: poorly nourished existing CV, pulmonary, or neuromuscular problems decreased sensitivity to pain, temperature, or pressure ALOC