Limitation in independent, purposeful physical movement of the

body or of one or more extremities


• Gait changes, postural instability; difficulty turning

• Limited ROM; ability to perform fine and gross motor skills

• Movement-induced tremor, uncoordinated or jerky movements

• Slowed and/or uncoordinated movements; reaction time.

• Substitution of other behaviors for impaired mobility (for instance,

increased attention to other’s activity and controlling behavior)


• Activity intolerance

• Decreased endurance; muscle

• Altered cellular metabolism

control, mass or strength

• Body mass index above

• Depressive mood state

75th percentile

• Deficient knowledge about

• Cognitive impairment

value of exercise

• Contractures

• Developmental delay

• Cultural beliefs regarding

• Discomfort

age-appropriate activity

• Disuse

• Deconditioning

• Joint stiffness

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Neurocognition


The patient will

• Maintain muscle strength and joint ROM.

• Be free from complications (e.g., contractures, venous stasis,

thrombus formation, skin breakdown, and hypostatic pneumonia).

• Achieve the highest level of mobility (will transfer independently,

will be wheelchair-independent, or will ambulate with assistive
devices such as walker, cane, and braces).

• Carry out mobility regimen.

• Use resources to help maintain level of functioning.


Ambulation; Ambulation: Wheelchair; Joint Movement: Hip; Joint

Movement: Shoulder; Mobility; Transfer Performance


Determine:  Identify level of functioning using a functional mobility

scale. Communicate patient’s skill level to all staff members to pro-

vide continuity and preserve identified level of independence.

Monitor and record daily any evidence of immobility

complications as they may be more prone to develop complications.


Perform:  Perform ROM exercises to joints, unless contraindicated, at

least once every shift to prevent joint contractures and muscular

atrophy. Turn and reposition patient every 2 hr. Establish a turning

schedule and post at bedside. Monitor frequency of turning to pre-

vent skin breakdown by relieving pressure. Place joints in functional

position. Use trochanter roll along the thigh, abduct thighs, use

high-top sneakers, and pull a small pillow under patient’s head to

maintain joints in a functional position and prevent musculoskeletal


Place items within reach of the unaffected arm if patient has one-

sided weakness or paralysis to promote patient’s independence.

Carry out medical regimen to manage or prevent complications

(e.g., administer prophylactic heparin for venous thrombosis). This

promotes patient’s health and well-being.

Provide progressive mobilization to the limits of patient’s

condition (bed mobility to chair mobility to ambulation) to maintain

muscle tone and prevent complications of immobility.

Inform:  Instruct patient and family members in ROM exercises,

transfers, skin inspection, and mobility regimen to help prepare for

discharge and promote continuity of care. Request return

demonstration to ensure use of proper technique.

Attend:  Help patient use a trapeze and side rails to encourage inde-

pendence in mobility. Instruct him to perform self-care activities to

increase muscle tone.

Encourage physical therapy sessions and support activities on the

unit by using the same equipment and technique. Request written

mobility plans for reference. Ensure all members of the healthcare

team are reinforcing learned skills in the same manner.

Manage:  Refer patient to a physical therapist for development of

mobility regimen to help rehabilitate musculoskeletal deficits.

Assist patient in identifying resources such as American Heart

Association to provide a comprehensive approach to rehabilitation.


Exercise Promotion: Strength Training; Exercise Therapy: Joint

Mobility; Exercise Therapy: Muscle Control; Positioning: Wheelchair


Gillis, A., & MacDonald, B. (2005, June). Deconditioning in the hospitalized

elderly. The Canadian Nurse, 101(6), 16–20.