Mobility Impairment (Pediatric Inpatient)

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

Overview

Self-Management

When to Seek Medical Attention

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