Metabolic changes occur with bed rest. Diuresis occurs with a reduction in blood volume, which may contribute to postural hypotension. The lack of muscle activity contributes to carbohydrate intolerance
with reduced peripheral glucose uptake. The effect on carbohydrate metabolism can be partly ameliorated by isotonic exercise in large muscle groups.17 For the hemiplegic patient, there is some benefit from active exercise of the unaffected limbs. Immobility results in increased calcium
reabsorbtion from bone; in the elderly, this accelerates the development of osteoporosis.In the muscular system, weakness due to disuse progresses rapidly. With complete bed rest and muscle inactivity, a patient’s strength is lost at a rate of 10% to 15% a week.18 For hemiplegic patients, this secondary weakness involves affected and unaffected muscles and represents a considerable
comorbidity that limits their ability to physically compensate to overcome disability caused by the hemiplegia. The generalized weakness that accompanies deconditioning delays full, vigorous participation in an active therapeutic program when the patient is medically stable and leaves the
acute medical unit.
Metabolic changes occur with bed rest. Diuresis occurs with a reduction in blood volume, which may contribute to postural hypotension. The lack of muscle activity contributes to carbohydrate intolerancewith reduced peripheral glucose uptake. The effect on carbohydrate metabolism can be partly ameliorated by isotonic exercise in large muscle groups.17 For the hemiplegic patient, there is some benefit from active exercise of the unaffected limbs. Immobility results in increased calciumreabsorbtion from bone; in the elderly, this accelerates the development of osteoporosis.In the muscular system, weakness due to disuse progresses rapidly. With complete bed rest and muscle inactivity, a patient’s strength is lost at a rate of 10% to 15% a week.18 For hemiplegic patients, this secondary weakness involves affected and unaffected muscles and represents a considerablecomorbidity that limits their ability to physically compensate to overcome disability caused by the hemiplegia. The generalized weakness that accompanies deconditioning delays full, vigorous participation in an active therapeutic program when the patient is medically stable and leaves theacute medical unit.
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