Initial Evaluation Super

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Written Report: Prolonged Immobilization
I. A. Definition
Defined as prolonged inactivity, bed rest and immobilization were widely used in the early days of rehabilitative science in the management of trauma and acute and chronic illness, before the physiologic effects were well understood. It was generally assumed that rest fostered healing of the affected part of the body. However, while it has beneficial effects to soft tissue healing and to bone healing after fractures among a myriad of other conditions, immobility and inactivity could also be harmful to the unaffected parts of the body. Problems arising from immobilization can complicate a primary disease or trauma and might actually become greater problems than the primary disorder. I.B. Definition of terms

* Deconditioning – the most deleterious effects of inactivity can which is defined as reduced functional capacity of musculoskeletal and other body systems. * Disuse atrophy – an alteration of metabolism and muscle cell homeostasis in response to muscle inactivity * PCSA – physiologic cross-sectional area. PCSA increases with pennation angle, and with muscle length. In a pennate muscle, PCSA is always larger than ACSA. In a non-pennate muscle, it coincides with ACSA. It is (Muscle Volume/Fiber Length). * Titin – a myofibrillar protein, appears to have a major role in providing resistance to passive elongation, increased in immobility * Myostatin – growth factor-beta protein that inhibits muscle synthesis and is increased during bed rest. * Sarcopenia – Muscle mass loss associated with aging

* VO2max – maximum oxygen consumption(L/min)
* Fitness – general term indicating a level of cardiovascular functioning that results in heightened energy reserves for optimum performance and well-being * Endurance – ability to resist fatigue

* Local endurance – aka “muscle endurance”, is the ability of a muscle to contract repeatedly against a load and resist a fatigue over an extended period of time * Total body endurance – aka “cardiopulmonary endurance”, associated with repetitive, dynamic motor activities which involves use of large muscles of the body * Interleukin-1 – inhibit production of proteoglycans necessary in the protection of cartilage * Wolff’s law – constant gravity loading facilitates bone remodeling and formation

I.C. Clinical Features
A. Musculoskeletal system;
a. Disuse atrophy
i. Generalized or localized to the immobilized limbs and more prominent in anti-gravity muscle ii. Whole body protein production significantly reduced and is considered the main contributor to muscle atrophy iii. Number of sarcomeres is reduced as a result of diminished chronic stretch and adaptation of new muscle length and vice versa c elongation iv. Number of sarcomeres in parallel is reduced contributing to the reduction of muscle fiber PCSA v. Affects type I and type IIa muscle fibers more prominently than type IIb vi. MRI reveals greater extent of atrophy at the lower limbs than the upper limbs vii. Synthesis of collagen fiber is reduced, resulting to increase in muscle collagen content and changes in mechanical elastic properties viii. Titin is increased, which increases resistance to passive stretch ix. Serum creatine kinase (CK) isomer and fibrolast growth factor release are both reduced during bed rest and is proportional to the reduction in muscle fiber size x. Myostatin is increased, which inhibits protein synthesis xi. Sarcopenia occurs to elderly patients, increasing risk to functional decline, falls, and increased dependency xii. Increased breakdown of nitrogen from the normal value of 2g/day to 12g/day for nutritionally depleted patients xiii. Excretion of creatine and creatinine, the mechanism is not well understood, however b. Loss of strength

xiv. The loss of...
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