Staying in bed for a long time due to brain damage , stroke , spinal cord paralysis , MS disease, fracture, surgery or another serious illness causes many secondary problems besides the main illness. Problems related to immobility can be examined under the title of immobility syndrome.
The Harms of Inactivity
Heart and circulatory system: Blood pooling in the veins, decreased circulation, clot formation in the leg veins (deep vein thrombosis), increased edema, weakening of the heart, decrease in blood pressure when standing upright. Anticoagulant therapy can be started for people who are at high risk of clot formation.
Hormonal system: Since the muscles do not work, sugar tolerance deteriorates and body fat increases. The risk of diabetes increases. Salt and water balance may be disturbed.
Digestive system: Backflow of gastric juice and food into the esophagus (reflux), food leakage into the lungs ( aspiration ), loss of appetite, weight loss due to malnutrition, weight gain due to inability to use energy, decreased bowel movements, constipation .
Urinary tract: Due to bone resorption, urinary calcium excretion from the kidneys increases and kidney stones may form. The position in bed can make it difficult to void and empty the bladder completely. There may be frequent urination or incontinence. The accumulation of urine in the bladder increases the risk of urinary tract infection.
Wound opening in the skin: Normally, the person changes his position at certain intervals while lying down. Even when we are asleep, we move every 10-12 minutes, even if we are not aware of it. In people who lose their ability to change positions due to paralysis or coma, the circulation of the skin tissue, which is exposed to constant pressure on the lower side, is impaired. The skin cannot get enough oxygen and tissue damage occurs. The folds in the sheets and hard surfaces increase this risk. In order to prevent the opening of pressure sores or pressure ulcers, the patient’s position should be changed at least every 2 hours and the skin should be examined regularly.
Musculoskeletal system: Muscle mass decreases due to inactivity, muscle wasting occurs. The muscles are shortened and held. It becomes more and more difficult and painful to move. The range of motion of the joint decreases, and fixed limitations called contractures may occur within a few weeks. Bone resorption and associated abnormal fractures can be seen.
Nervous system: The sleep cycle may be disrupted. While a person sleeps during the day, he cannot sleep at night. Weakness, loss of independence, inability to move can lead to psychological problems such as depression, anxiety, distress, and irritability . Being in the same environment all the time and the lack of different stimuli can lead to the deterioration of the person, environment and time awareness called delirium.
Respiratory system: Lung capacity may be reduced. Cough weakens, sputum may not be enough. As a result of the accumulation of sputum, the airways are blocked, the alveoli in the lung cannot be ventilated and shrink. Oxygen-carbon dioxide exchange is disrupted, the oxygen level in the blood decreases. The risk of pulmonary edema, infection (pneumonia) increases. Respiratory problems can be fatal.
Prevention and Treatment
In order to prevent the negative effects of bedridden inactivity, physical therapy movements should be performed from the early period. In-bed passive range of motion exercises , breathing exercises, proper positioning are taken care of from the first day. With robotic bed technology , people who cannot stand up due to stroke, brain damage, spinal cord paralysis can be brought to an upright position in the early period and leg movements can be performed. Being upright and putting a load on the legs are beneficial in terms of normalizing blood pressure, preventing osteoporosis and intravascular clot formation. Moreover, sending sensory stimuli to the spinal cord and brain with walking exercises ensures that the movements are not forgotten and relearned.