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Careplan

Mobility Impairment (Pediatric Inpatient)

Oct.01.2020

Mobility Impairment (Pediatric Inpatient)

Clinical Description

  • Care of the hospitalized child experiencing limitation in ability to independently and safely move self from one position or place to another.

Key Information

  • Development of mobility skills is a complex process involving multiple physiologic systems along with the environment. Mobility impairment is important to address early to avoid limitations in the child’s developmental need to explore and learn.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Optimal Mobility

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self-Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity, congenital anomaly
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • child and family/caregiver:
      • health literacy
      • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Mobility Impairment

Signs/Symptoms/Presentation

  • difficulty with transfers
  • motor skill limitation
  • muscle strength decreased
  • range of motion limitation
  • reluctance to attempt mobility
  • requires assistance with ambulation
  • shortness of breath during or after activity
  • unable to reposition self independently

Problem Intervention

Optimize Mobility

  • Assess mobility skills (e.g., bed, transfers, ambulation, gait, stair climbing, wheelchair) and factors influencing mobility, such as balance, safety, range of motion, strength, muscle tone, cognition and sensory processing.
  • Instruct in transfer and mobility techniques supporting highest level of independence while ensuring safety.
  • Consider any contraindications or precautions to individualize treatment plan (e.g., joint or ligament instability, weightbearing restrictions).
  • Encourage early mobilization and performance of daily activities, if able, while providing level of assistance needed for safety.
  • Schedule mobility activities when pain and fatigue are at a minimum to encourage optimal performance.
  • Pace activity; allow adequate time and rest periods to conserve energy.
  • Provide frequent encouragement, along with prompting and assistance as needed.
  • Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
  • Design and implement therapeutic interventions to address impairments (e.g., functional mobility training, mat and standing balance activities, strengthening).
  • Train in and reinforce use of adaptive equipment and assistive devices, such as a scooter or walker.
  • Encourage self-initiated mobility to facilitate growth and development.
  • Utilize appropriate modalities, devices or techniques to facilitate mobility (e.g., ankle foot orthosis, electrical stimulation, partial-weight-treadmill training).
  • Assess fall risk using standardized tool; implement appropriate interventions, such as behavioral or environmental modifications.

Associated Documentation

  • Activity Management
  • Assistive Device Utilized
  • Positioning/Transfer Devices

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self-Management

  • assistive/adaptive devices

  • energy conservation

  • home safety

  • joint mobility/strength

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Betters, K. A.; Hebbar, K. B.; Farthing, D.; Griego, B.; Easley, T.; Turman, H.; Perrino, L.; Sparacino, S.; deAlmeida, M. L. Development and implementation of an early mobility program for mechanically ventilated pediatric patients. Journal of Critical Care. 2017;41, 303-308. doi:10.1016/j.jcrc.2017.08.004 [Expert/Committee Opinion]
  • Case-Smith, J.; O'Brien, J. C. (2015). Occupational therapy for children and adolescents. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Damiano, D. L.; DeJong, S. L. A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation. Journal of Neurologic Physical Therapy. 2009;33(1), 27. [Metasynthesis,Meta-analysis,Systematic Review]
  • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Lefmann, S.; Russo, R.; Hillier, S. The effectiveness of robotic-assisted gait training for paediatric gait disorders: Systematic review. Journal of NeuroEngineering and Rehabilitation. 2017;14(1), 1. [Metasynthesis,Meta-analysis,Systematic Review]
  • Lehman, C. (2015). The specialty practice of rehabilitation nursing: A core curriculum. Chicago: Association of Rehabilitation Nurses. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Nettina, S. M. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Palisano, R. J.; Orlin, M. N.; Schreiber, J. (2017). Campbell's physical therapy for children. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Rathinam, C.; Bateman, A.; Peirson, J.; Skinner, J. Observational gait assessment tools in paediatrics-a systematic review. Gait & Posture. 2014;40(2), 279-285. [Metasynthesis,Meta-analysis,Systematic Review]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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