Bedridden Patient Care: Preventing Bedsores & Mobility

Complications of Prolonged Immobility

When a patient is bedridden—whether due to a severe neurological injury like a stroke, a hip fracture, or an advanced illness—caring for them goes beyond basic hygiene and medication. Prolonged bed rest affects multiple body systems. Without proper physical management, it can lead to complications such as pressure sores (bedsores), joint contractures, muscle wasting, deep vein thrombosis (DVT), and respiratory infections.

Integrating structured bedridden patient care physiotherapy into daily care is essential. Regular movement and proper positioning protect skin integrity, maintain joint flexibility, and improve circulation, helping to prevent these complications and improve patient comfort.

Pressure Sore Stages and Physical Management

Pressure sores occur when prolonged pressure cuts off blood flow to the skin and underlying tissues, particularly over bony prominences. Early identification and relief of this pressure are critical:

| Pressure Sore Stage | Description | Physical Care and Rehabilitation Requirements | | :--- | :--- | :--- | | Stage 1 (Early) | Intact skin with non-blanchable redness, usually over a bony prominence. | Reposition immediately. Avoid placing weight on the area. Use pressure-relieving air mattresses. | | Stage 2 (Partial Thickness) | Open wound or blister showing damaged outer skin layers. | Apply protective dressings. Keep the wound clean and dry. Implement strict turning schedules. | | Stage 3 (Full Thickness) | Deep crater showing fat tissue; muscle and bone are not exposed. | Medical wound care required. Continue offloading pressure. Perform passive movements for surrounding joints. | | Stage 4 (Deep Tissue) | Severe damage extending to muscle, tendon, or bone. | Surgical evaluation often needed. High risk of infection. Maintain strict offloading and nutritional support. |

Key Physiotherapy Interventions for Bedridden Patients

Physiotherapists focus on several key areas to manage the effects of prolonged bed rest:

1. Positioning and Offloading Pressure

Proper positioning is the first line of defense against pressure sores. The body's bony areas—such as the heels, tailbone (sacrum), hips, elbows, and the back of the head—are most vulnerable.

• 30-Degree Lateral Tilt: Instead of laying the patient flat on their side, tilt them to a 30-degree angle. This distributes weight across the buttocks rather than putting direct pressure on the hip bones.
• Pillows for Support: Place pillows between the knees and ankles, under the arms, and under the lower legs to keep the heels lifted off the mattress.

2. Range of Motion (ROM) Exercises

When joints are not moved regularly, the surrounding muscles and tendons can shorten and stiffen, leading to permanent joint contractures.

• Passive Range of Motion: For patients who cannot move on their own, the caregiver or therapist gently moves each joint through its full range of motion. This maintains joint flexibility and stimulates blood flow.
• Active-Assisted ROM: If the patient has some movement, the therapist guides and supports the limb, encouraging the patient to use their own muscle strength as much as possible.

3. Circulatory Stimulation (DVT Prevention)

Immobility can cause blood to pool in the lower legs, increasing the risk of deep vein thrombosis (DVT). Exercises like passive ankle pumps (bending the feet up and down) and gentle knee bends help keep blood moving, reducing this risk.

4. Pulmonary Rehabilitation

Shallow breathing is common in bedridden patients, which can lead to fluid accumulation in the lungs and increase the risk of pneumonia. Physical therapists use techniques like deep breathing exercises, assisted coughing, and chest percussion to help clear mucus and keep the lungs clear.

Guidelines for Caregivers at Home

Caregivers play a vital role in the daily care of bedridden patients. Here are key practices to follow:

1. Use a Turning Schedule: Keep a simple log sheet to track turning the patient at least every 2 hours, switching between their back, left side, and right side.
2. Check the Skin Daily: Inspect bony areas for changes in skin color, temperature, or swelling during dressing changes or bathing.
3. Avoid Dragging the Patient: When repositioning, lift the patient using a slide sheet or draw sheet. Dragging can cause friction and tear fragile skin.
4. Incorporate Passive Exercises: Perform passive leg and arm stretches two to three times a day, keeping movements slow and within a pain-free range.