People who are bedridden need to exercise to prevent their muscles from atrophy and shortening. Muscle atrophy occurs when the muscles become thin and weak. The muscles shorten when they are not stretched or moved. Exercises that stretch and strengthen the muscles help prevent or minimize these complications, though some exercises require assistance from a caretaker. Unconscious and paralyzed patients also need caretakers to move them into different positions throughout the day to prevent bedsores.
Passive Mobilization Exercises
Passive mobilization exercises promote range of motion in the joints such as the ankles, knee, hips, elbows and shoulders. A caretaker moves the patient's joints in passive exercises. For example, the ankle plantarflexion-dorsiflexion exercise is a lower-body mobility exercise that maintains range of motion, comfort and blood circulation in the patient's ankles even if the patient cannot move the ankles himself. The patient lies on his back in bed and the caretaker holds the ankle and heel of one foot. The caretaker alternatively bends the foot forward into plantarflexion and then pushes the foot upward into dorsiflexion. Hold each position for five to 10 seconds.
Active Mobilization Exercises
A patient performs active mobilization exercises without help. These exercises require more strength from the patient than passive mobility exercises. An example of such an exercise is a wrist rotation. The patient places her arm palm down on the bed and then rotates her wrist toward her pinkie so that the thumb side of the hand lifts off the bed. Then she moves the hand in the opposite direction so that the pinkie side lifts off the bed. Her forearm remains still on the bed to isolate the wrist. She should hold each position for five to 10 seconds.
Muscle-strengthening exercises prevent muscle atrophy. It does not take a lot of time for muscles to become weak and thin when they're not being used. Strengthening the muscles allows patients to do as many functional activities as possible, such as walking and dressing. An example of a muscle-strengthening exercise is the single-leg hip lift to strengthen the thighs and glutes on one side of the body at a time. The patient lies on his back with one leg straight and the other bent with the foot flat on the bed. The patient then lifts his buttocks toward the ceiling, using the muscles of the bent leg, as high as possible.
Stretching the muscles lengthens them, thereby preventing the muscle shortening that occurs from leaving muscles in one position for prolonged lengths of time. A caretaker may assist with stretching exercises such as the hamstring stretch, which lengthens the muscles on the back of the thigh. The patient lies on her back with legs straight while the caretaker stands next to the bed. The caretaker lifts the leg closest to her off the bed and brings it toward the patient's chest, keeping the knee straight. Hold for 20 to 30 seconds. This exercise is important because tight hamstrings make moving a patient into different positions difficult.