Movement without moving

Proven content

It would seem that you cannot exercise while lying down. Nothing could be more wrong. You can and you have to. Besides, the stakes are high. This is a chance to improve the prognosis for the further course of the disease.

There are injuries and illnesses that are impossible to predict. Their consequences can be dire. Complicated fractures or neurological diseases for many months, years, and even for the rest of their lives may cause limited or complete disability. How to counteract it? The key is rehabilitation.

Absolute necessity

“Attachment” to the bed, contrary to appearances, does not mean that we cannot afford to exercise. On the contrary – in order to have any hope of recovery or “normal” functioning, physical activity is a necessity. To the question “Can it be worse?”, Each physiotherapist will answer: yes. Lack of exercise inevitably leads to a drastic deterioration in health. And it is not about being in a poor condition and unnecessary kilograms, as the effects of a sedentary lifestyle are generally perceived, but about the inability to perform everyday activities efficiently. The ability to function independently in the future may depend on the degree of improvement of the person who suffered from the need to stay in bed.

The need to stay in bed all the time has many other negative consequences. We are not made to lie down. The result of this situation may be general weakness of the body, the formation of pressure ulcers in places constantly in contact with the mattress due to deterioration of blood circulation, gradual and progressive muscle atrophy. Various diseases, including pneumonia, which is particularly dangerous for the elderly, can also occur much more easily. Besides, although it is difficult to imagine, after 10 days of bed rest, muscle and joint contractures may form.

In order to avoid or at least reduce the negative effects of bed rest, it is necessary to be physically active. In hospital conditions – with the help of a physiotherapist, at home – depending on the patient’s condition and financial possibilities – with the participation of a physiotherapist, relatives or on their own.

Difficult beginnings in the hospital

What physiotherapists call activity may seem like a meaningless activity to non-disabled people. Lifting the leg, simple bending and straightening the fingers or breathing therapy with difficulty, in the common understanding, qualify for physical activity. However, people with a fractured hip bone, stroke, or another MS attack have no way to do anything else.

Initially, and in many cases for the next long months, the so-called passive exercises. This means that the movement, e.g. bending or straightening, is performed by the patient not alone, but with the active help of a physiotherapist. What does it do? Basically, this is to prevent muscle contractures, improve skin condition – its elasticity and firmness, stimulate blood circulation thanks to massage and re-teach the patient certain motor skills. Equally important are breathing exercises and patting to prevent possible respiratory diseases, as well as postural therapy, i.e. anti-bedsore therapy. During hospital stay, rehabilitation is recommended twice a day for one hour.

What disease, such rehabilitation

Depending on the reason for which the patient has been hospitalized, rehabilitation must be adapted to the patient’s disease, condition and individual characteristics. Different types of exercises are performed in a conscious patient with a serious fracture, and different in partially paralyzed or unconscious patients.

In the case of patients with a serious leg fracture, the limiter is certainly a cast or a lift on which they “hang”. However, this does not mean that patients do not move until the plaster is removed. During this time, they strengthen the muscles of other parts of the body, including the other leg, pelvis, torso and upper limbs. In addition, they perform exercises based on muscle synergism to prevent muscle relaxation under the cast. It consists in stimulating them with muscles further located. So, if the toes are not covered with the cast, straightening and bending them automatically causes the muscles of the entire leg to tighten. The next step is to try to take the first step. For many it is very difficult because of the lack of a sense of space and the constant fear of falling. Here, too, the help of a rehabilitator turns out to be indispensable. His support, both physical and mental, plays a vital role. After removing the plaster, the weight of the exercises is transferred to the previously immobilized leg in order to strengthen it. To accelerate bone union, physical procedures are performed, such as magnetostimulation. After leaving the hospital, one must not forget about the need to continue exercising – be it in rehabilitation centers or at the patient’s home.

In the case of neurological diseases, the matter becomes much more complicated. Contact with the patient is often difficult, which makes any cooperation impossible. Automatic rehabilitation of such a patient takes much longer, often for the rest of his life, and the effects are less visible.

Rehabilitation of people suffering from neurological diseases, especially in the initial phase, focuses on passive exercises. Verbal stimulation on the part of the physiotherapist is also necessary. Each movement is a signal sent to the brain – followed by a word to perpetuate the habit. It is often because it is learning everything from scratch. Purpose – the ability to keep a spoon or fork, move independently around the apartment. While this may not be enough for some people, it is no mean feat for people with severe brain damage. Depending on the degree of paralysis (one- or two-sided), appropriate rehabilitation is recommended – the paralyzed side must be intensively exercised. The type of infestation is equally important. In the case of flaccid muscles paralysis, it is difficult to make them tense. Such a patient is often poured over his hands. Therefore, it is necessary to intensify them intensively. In contrast, in spastic paralysis, which is manifested by stiffening, the therapist is concerned with relaxing the patient’s muscles. To do this, he often has to use force. From the point of view of therapy, however, this situation is more advantageous for the patient, as it gives the patient a chance to upset him faster. The ability to stand and maintain balance is the overriding goal.

Back home

Despite the change in the environment, rehabilitation must continue. Preferably with a physiotherapist who knows which movements are allowed and which are prohibited. However, if you cannot afford such visits, it is worth learning how to exercise with someone who is sick. And most importantly – not to neglect what has already been achieved. A two-week break in exercise is an irreparable loss.

Rehabilitation in a hospital is the beginning of a long road

An interview with Agnieszka Rudnicka, a physiotherapist from the Bielański Hospital in Warsaw.

Let’s live longer: Why is the rehabilitation of bedridden patients so important?

Agnieszka Rudnicka, MA: The fact that it is important should be constantly emphasized. Patients and their families are not always aware of this. They think about the present moment, the future takes a backseat. And she can be dramatic. A person previously fit suddenly cannot function independently. This weighs on her and her family.

Is early rehabilitation a guarantee of full fitness?

AR: Nobody will give such a guarantee. If it were up to us, many people would recover. However, we have no influence on, for example, the extent of the stroke, but it is certain that a quick and regular rehabilitation will improve efficiency. Besides, the lack of exercise will not keep the patient at a given level. His condition will worsen.

What is rehabilitation in a hospital?

AR: Rehabilitation in a hospital is just the beginning of a long road. The team of doctors sets goals – immediate and long-term. The effects of lying down quickly take effect. Hence the importance of time. Besides, the patient has to get used to the new situation. This is what we are here for – to help, support and motivate.

Is there a pattern you use when practicing with patients?

AR: It is not only the type of disease, but also the individual characteristics that determine the type of exercise. And it is not only about efficiency, but also about psyche and determination. We approach each one individually.

Is exercise immediately after surgery?

AR: The acute state must pass. People with high fever and unstable blood pressure are not trained. Exercise must not worsen the patient’s condition. This does not mean that we do not rehabilitate severe cases, e.g. in the ICU. In patients with severe pneumonia, rehabilitation is postponed. Once it is possible, respiratory therapy is introduced.

Is it fatal to stop exercising?

AR: Yes. Then all your hard work is wasted. Rehabilitation must continue, preferably under the supervision of a physiotherapist. Besides, the patient should exercise himself. Each additional minute of exercise increases the chance of improving fitness.

Text: Marta Lenkiewicz

Consultation: Agnieszka Rudnicka, MA in rehabilitation, Bielański Hospital in Warsaw

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