Mobilization is a classic technique used by physiotherapists for the functional recovery of a joint or limb. It is also used post-surgery (immediately after the intervention in a hospital setting) or in the intensive care unit to reduce muscle loss, decrease joint stiffness, and counter the consequences of prolonged bed rest. This is referred to as early mobilization.
What is early mobilization?
Early mobilization is a physiotherapy technique that intervenes earlier than usual in the patient's rehabilitation process, immediately after orthopedic surgery, for example, or in the intensive care unit, either during the intensive care phase or post-intensive care. The goal of early mobilization is to allow the patient to recover their functional capabilities more quickly. It is determined by the medical team, which establishes an individualized protocol for each patient.
Early mobilization applies to patients who have just undergone surgery (traumatology, orthopedics) or patients in intensive care or post-intensive care.
In the first case, it involves restoring mobility and strengthening the muscles of the operated joint. In the second case, early mobilization is primarily aimed at preventing or addressing the negative effects of prolonged immobilization (respiratory complications, muscle atrophy, bedsores), which can occur rapidly.
What are the benefits?
Early mobilization is now recognized as beneficial in postoperative or intensive care settings in that it allows the patient to recover their functional capabilities more quickly, thereby reducing the length of hospitalization.
It also helps reduce the risks and complications associated with prolonged immobilization (respiratory complications, muscle atrophy, bedsores) as well as the risk of nosocomial diseases by reducing the time spent in the hospital.
Different types of mobilization
As early mobilization occurs postoperatively or in intensive care, it requires a more specific approach from the physiotherapist. The physiotherapist must integrate two additional variables into their usual protocol: the increased need for patient assistance and the higher risk of falls for patients undergoing rehabilitation, especially for the lower limbs.
It allows for the quick mobilization of postoperative or post-intensive care patients. In some cases, it can be applied to unconscious patients in intensive care.
Passive mobilization helps prevent complications related to prolonged immobilization. In this technique, as the name suggests, the patient does not perform any voluntary motor action. The movement of the affected joint is performed by the physiotherapist, with or without equipment. Administered manually by the physiotherapist, it allows for the assessment of changes in muscle tone and range of motion. Additionally, it can be complemented by mechanized passive mobilization using motorized devices. This increases the repetition of movements performed by the patient while physically relieving the physiotherapist in their work.
Common devices include Kinetec and motorized ergocycles. They allow for continuous programmed passive mobilization by the physiotherapist, which can occur without their presence after the patient is set up on the device.
For post-intensive care patients, the DPA Med Satisform can also be used. It is a lower limb mobilization device that reproduces a figure-eight movement, inducing a dissociation of the pelvic and scapular girdles.
This movement is essential in walking. The work is performed passively by the patient, with weight offloading. It can also be done actively as the patient's abilities progress.
Early active mobilization
It often occurs in a second phase, just after a period of early passive mobilization. Its essential role is to combat muscle loss and regain autonomous functional ability, especially walking. It can be implemented when the patient can exert action on their muscles and thus control their movements.
Early active mobilization can be performed using simple devices such as walkers for walking recovery, or utilizing gravity, weights, and can be complemented by motorized equipment to facilitate exercise repetition and physically relieve the physiotherapist's work. In all cases, it is controlled by the physiotherapist, who precisely tailors the workload based on the patient's needs and capabilities.
In early active mobilization devices, there are the following types of rehabilitation devices:
Some ergocycles can be used on the hospital bed, such as Supine RT300 or MOTOmed Letto2-RECK, and others in the rehabilitation room, such as Kinetec. This allows for mobilization work with or without resistance depending on the patient.
Isokinetics is a technique that allows the patient to perform muscle contraction exercises at a constant speed against resistance that adapts based on the patient's muscle force. Examples include Con-trex by Athlex or Biodex.