Mobility, the ability to engage in activity and free movement, enhances muscle tone, increases energy levels, and improves self-esteem and the body image. Body mechanics is the purposeful and coordinated use of body parts and positions during activity and involves body alignment, balance, and coordinated movement.

Body alignment refers to the position of body parts in relation to each other. Proper body alignment (posture) results in balance, the ability to maintain equilibrium. In good posture, the center of gravity is evenly distributed over the body’s foundation points or base of support. Muscle tone is the normal state of balanced tension present in the body. Hyptonicity (flaccidity) is a decrease in muscle tone. Spasticity is an increase in muscle tension. Muscle hypertrophy is an increased muscle size and shape due to an increase in muscle fibers and muscle atrophy is a reduction in muscle size and shape. Range of motion is the extent to which a joint can move.

Mobility is regulated by coordination between the musculoskeletal and neurological systems. The musculoskeletal system is comprised of bones, cartilage, joints, tendons, ligaments, bursa, and muscles. Muscles (smooth, cardiac, and skeletal) provide energy for mechanical work. Joints work with the muscles to provide motion in that the skeletal muscles overlying the joint exert opposing forces and cause movement. Muscles maintain body alignment by surrounding body parts and supporting the body’s weight. The nervous system controls muscle contractions. The myoneuronal junction is the point at which nerve endings come into contact with muscle cells. Proprioception is the awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and resistance of objects in relation to the body.

Exercise is any physical activity involving muscles that elevates the heart rate above resting levels. The advantages of exercise include reduced joint pain and stiffness; increased flexibility, muscle strength, and endurance; weight reduction; and an improved sense of well-being (through the production of endorphins). Health benefits are attained in proportion to the duration, frequency, and intensity of exercise. The types of exercise are aerobic, strengthening, isometric, isotonic, isokinetic, and range of motion exercise.

The factors affecting mobility are the client’s overall health status, developmental stage, environment, attitudes, beliefs, and lifestyle. The physiological effects of mobility are increased energy and sense of well-being, increased cardiac output and efficiency, increased respiratory capacity, stronger muscles, more joint flexibility, greater muscle endurance, increased appetite and thirst, more efficient bowel and urinary elimination, and enhanced oxygenation of skin and hair.

The physiological effects of immobility are decreased sense of well-being and competence, anxiety and depression, increased cardiac workload, orthostatic hypotension, formation of thrombi, increased respiratory effort with altered gas exchange, hypostatic pneumonia, decreased bone density, increased risk of fracture, contractures, muscle atrophy, increased joint and muscle pain, decreased appetite, stress ulcers, constipation and impaction, urinary stasis, urinary tract infection, urinary calculi, pressure ulcers, and prolonged healing.

The nursing assessment of mobility includes a health history to determine the client’s usual activities of daily living (ADLs), exercise patterns, lifestyle, activity tolerance, and use of medications. The physical examination should be an observation of musculoskeletal functioning, specifically body alignment; body mechanics; posture; range of motion; muscle strength, endurance, and tone; the size and contour of joints; and condition of the skin. The skin, muscles, and joints should be palpated if indicated. Possible findings include muscle impairments, postural abnormalities, contractures (muscles that are unable to flex or extend due to the development of fibrous tissue in the muscle), trauma, and central nervous system damage. A neurological assessment includes the size, strength, and tone of muscles; presence of involuntary movements; balance, gait (the way one walks), and coordination; proprioception; and fine and gross motor function. The functional assessment focuses on the client’s ability to perform ADLs. Subjective data include gait pain, joint stiffness, muscle cramping, fatigue, weakness, exercise habits, and environmental variables. When examining a child, the nurse should compare findings with norms for the child’s age.

The nursing diagnoses relevant to clients experiencing mobility impairments are Activity Intolerance, Impaired Physical Mobility, Risk for Disuse Syndrome, Self-Care Deficits, Ineffective Health Maintenance, Risk for Falls, Disturbed Body Image, and Situational Low Self-Esteem. The client should be included in the process of goal setting and intervention planning. One goal should be for the client to achieve as much independence in ADLs as possible. Bed rest is common in clients with acute injuries, followed by a long period of restorative nursing care often extending into the home. The client and caregivers should be included in all teaching.

Nursing implementation includes meeting psychosocial needs, using body mechanics, maintaining body alignment, performing range-of-motion ROM exercises, transferring clients, assisting with ambulation, promoting wellness, using complementary treatment approaches, and documentation. Common positions used are Fowler’s (head up), dorsal recumbent (supine), prone, lateral, and Sim’s (semi-prone). Clients who are on skeletal and skin traction for fractures require special monitoring while hospitalized. Body position is important, as well as keeping the traction weights free falling and the traction rope unobstructed. The immobilized body part should be kept in alignment with the rest of the body, the skin around any pins should be observed for redness, drainage, or edema; and the skin should be protected from breakdown.