ft c2 manajemen spastisitas
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MANAGEMENT SPASTICITY
(Pertemuan ke-2)
1.Pengertian spasticity
2. Patophysiology spasiticity3.Assessment spasticity
4. Management spasticity
Oleh
Drs. Soeparman SSt.FT
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PENDAHULUAN
Dampak spasticity atau spasm, selanjutnya kita sebutspastik, dapat menghancurkan individu :
1. Spastik, merupakan ganguan motorik tetapi sebagianmuncul juga, pain, stifness, bahkan kronik pain saat tidur,
mood, motivasi.2. Berdampak pd gangguan fungsi, termasuk mobilitasberjalan, menggunakan kursi roda, sering jatuh, sertagangguan fungsi ADL.
3. Semua aspek negatif tsb berlanjut pd pekerjaan dan
pendidikan yg dirasakan juga bagi orang tua, partner ataukeluarganya.
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Komplikasi.
Kurangnya pengetahuan tentang spasticity,cenderung terjadi kontraktur jaringan,
pemendekan otot, deformitas sendi, dan sekaliterjadi kontraktur sulit utk dikoreksi, termasukpersonal hygiene. Ini merupakan vicious cyrcles.
Jadi harus disadari oleh semua tim dlm
manjemen spasticity bersifat individu dan fokuspd fungsional, walaupun umumnya bertujuanmenurunkan spastik dan mencegah komplikasi.
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1.What is spasticity?
Ada yg berfikir sbg symtom dan akibatnya, ada ygberfikir sbg neurological impairment.
Definisi 1
Spasticity is a motor disorder characterised by a
velocity-dependent increase in tonic stretch reflexes(muscle tone) with exaggerated tendon jerks, resultingfrom hyperexcitability of the stretch reflex, as onecomponent of the upper motor neurone syndrome(Lance in 1980).
Disini mengkhususkan pada kenaikan tonus otot akibatpassive stretch reflex, tidak termasuk syndrom UMNlain termasuk clonus dan spasm
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Definisi 2.
Spasticity is disordered sensorimotorcontrol,
resulting from an upper motor neurone
lesion, presenting as intermittent or sustained
involuntary activation of muscles. (EURO-SPASMgroup).
Disini memayungi semua syndrom UMNtermasuk clonus dan spasm.
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UMN SYNDROM
POSITIVE NEGATIVE
Spasticity
Spasms
Clonus
Associated reactions
Positive support reaction
Brisk tendon reflexesExtensor plantar responses
Weakness
Reduced dexterity
Reduced postural responses
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MUSCLE TONE
Adalah ketegangan otot atau kekenyalan ototyang dipengaruhi oleh faktor non neural(viscoelastisitas jaringan) dan faktor neural yaitu
fast stretch reflexs. Ketegangan (resistance) akibat slow stretch ini
hanya melulu pengaruh kompunen visco-elastisitas jaringan.
Sedangkan fast stretch (high-velocity) secarareflex neurologis terjadi kenaikan tonus otot, danhanya brieff contraction
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STRETCH REFLEX
Otot skeletal jika distretch, muscle spindle
akan terangsang kemudian diteruskan oleh
afferen Ia ke spinal cord. Melalui monosynap
langsung dikirim ke alfa motor, terjadilah
kontraksi otot. Tetapi secara simultan terjadi
relaksasi antagonist (reciprocal inhibition).
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STRETCH REFLEX
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2.PATOPHYSIOLOGY SPASTICITY
Dalam keadaan normal, stretch reflex hanyamenghasilkan brieff-contraction, sedangspasticity stretch menghasilkan kontraksi lama.
Karena berkurangnya reciprocal inhibition dispinal cord.
Syndrom UMN termasuk, spasticity, weakness,spasm, clonus, meningkatnya tendon reflek ,
hilangnya gerakan halus dan hilangnyaketangkasan. Ini sering keliru bahwa semuagambaran tsb karena lesi traktus pyramidal.
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Jika lesi hanya terjadi di cortec primer,syndroma yg muncul hanya weakness danhilangnya dexterity (ketangkasan), tidak
muncul yg lain layaknya syndrom UMN. Syndroma UMN akan jelas jika lesi terjadi
pada parapyramidal pathway, terutama dorsalreticulo-spinal tract yg penting utk aktivasiinhibitori spinal dan mengendalikan nilaiambang alfa motor neuron.
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Pasien dgn kerusakan tsb, akan terjadipenurunan resiprocal inhibition danpresynaptic inhibition. Akibatnya terjadilah
spasticity. Perubahan jaringan sekitar sendi dapat
menimbulkan stiftness (pasif atau non neuralstiffness). Pd syndrom UMN , gerakan pasifcenderung meningkatkan tonus oki tak perludilakukan, misalnya pada kasus stroke.
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Thixotropy
Muscle dan conective tissue juga
menunjukkan adanya gejala tersendiri.
Bilamana dilakukan gerakan pasif berulang
maka dirasakan stifness semakin berkurang.
Demikian juga stifness awal gerakan akan
dirasakan semakin berkurang pada gerakan
selanjutnya. Penomena ini disebut thixotropy.
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PERBEDAAN PASSIVE STIFNESS DAN
NEURAL STIFNESS
Tardieu test, membandingkan slow stretch dg faststretch, dimana pd slow stretch tidak dirasakanstifness(non neural), tetapi pd fast stretch terjadistifness, ini kombinasi non neural dan neural
stifness. Treatmen non neural stifness dg stretching dan
splinting lebih baik dp farmakologi.
Botox lebih cocok utk neural stifness.
EMG lebih jelas pd neural stiffness
Intrathecal phenol therapy, blocking spinal cord,jelas hanya terjadi non neural stifness
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Co-contraction
Co-contraction terjadi bilamana secara simultankontraksi agonis dan antagonis, ini jugamenimbulkan stiffness.
Dalam keadaan normal ini diperlukan utkstabilitas sendi misalnya pada saatmempertahankan posture, saat tanganmemegang gelas/cangkir.
Pada lesi UMN abnormal co-contraction dgnpenomena nampak lebih lemah, gangguankoordinasi, hilangnya gerak tangkas (dexterity).
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Penomena itu timbul karena :
1. stretch antagonist
2. saat normal relaksasi, pd awal gerakanterjadi perubahan exitatory shg timbul co-
contraction agonist-antagonist.
3. abnormal stretch reflex seperti impairment
pd spinal cord shg mengganggu reciprocal
inhibitory.
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Mengendalikan co-contraction penting agar
aktivitas lebih efisien, misalnya dg
menggunakan botox pada antagonist.
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CLONUS
This is arhythmic pattern of contraction
occurring at a rate of several times persecond
and can be demonstrated by a sudden stretch of
a muscle. In the UMN syndrome, clonus is commonly
observed in the muscles of the leg, with rhythmic
contractions of both the gastrocnemius andsoleus muscles in response to dorsiflexion of the
ankle.
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SPASMS
Spasms, or sudden involuntary (often painful)movements, are frequently associated with spasticity,but physiologically their mechanism of action appearsto be different to the velocity- or stretch-dependent
hypertonia. Spasms may be clearlyprecipitated (menurun) by
muscle stretch, but may also be triggered via a variety
of peripheral, noxious and visceral afferents, including
pressure sores, bowel impaction, urinary retention or
infection.
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Non-nociceptive cutaneous stimuli such as
touch, bedclothes or tight garments may be
enough to trigger spasms.
So-called spontaneous spasms may well be
the result of as-yet unidentified stimuli; it is
therefore essential to search for any possible
trigger factors, which may be cutaneous or
visceral in nature.
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Kadangkala, spasticy dan spasm saling
befluktuasi tergantung trigger dan lokasi.
Spasm bisa terjadi pd fleksor, ektensor atau
kombinasi (tanpa adduktor).
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CONTRACTURES
Prolonged immobility of joints and muscles in ashortened state can lead to irreversible changesin the muscles, tendons and ligaments that result
in loss of passive range at joints. Within muscles,sarcomere number may be reduced andhistochemical changes resembling (mirip)denervation can occur.
Akibatnya bisa terjadi neural/non-neuralhypertonia/stiffness, seperti sering dialami 2 blnsetelah stroke.
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Contracture juga bisa terjadi pada kasus lesi
perifer, GBS dsb.
Sekali terjadi contracturesulit dikoreksi
terpaksa dilakukan tindakan bedah. OKI
pencegahan adalah yg terbaik.
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ASCOCIATED REACTION
Bila aktivitas suatu otot kemudian diikutiaktivitas otot bagian tubuh yg lain disebutreaksi asosisi.
Pd pasien stroke saat berjalan diikuti denganfleksi elbow.
Kerasnya asosiasi dpt dilihat dari seberapa
keras/besar terjadi gerakan asosiasi,hypertonia anggota bawah dan seberapa kerasupaya melakukan aktivitas.
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The mechanisms underlying these reactions
are not clear, but probably include disturbed
descending supraspinal control, perhaps
through unaffected, but less focused,bulbospinal pathways taking on the role
of damaged corticospinal pathways.
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3.ASSESSMENT SPASTICITY
Soeparman
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a.ASHWRTH SCALE
Ashworth scale (Ash-worth, 1964), semula
dikembangkan utk multiple sclerosis, berdasarkan
resistance passive movement atau stretch.
Reliabilitynya tergantung dari kemampuan pengetesterhadap kontrol tingkat stretch dan perkiraan
resistance nya.
Meskipun penggunaannya sudah meluas tetapi
relatif sedikit data tentang reliability scale.
Soeparman
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Soeparman
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b.METODE TARDIEU SCALE
Dengan menggunakan :
1. Slow stretch, dimana tidak muncul reflex stretching.
2. Fast stretch, muncul reflex stretching (X)
3. Dicatat sudut terjadinya resistance (Y).
4. Diklasifikasikan seperti dlm Tabel 3.3
Penerapannya pd anggota atas posisi duduk sedang
pada anggota bawah berbaring terlentang.
Soeparman
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Soeparman
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Tardieu melakukan stretch pada ankle dorsi fleksi dan knee extensi. R1
pd fast stretch muncul resistance artinya ada spastic, R2 pd slow
stretch muncul resistance artinya contracture . Selisish R1-R2 indikasi
relative spastic. Perbedaan R1-R2 besar berarti spastic, dan perbedaan
kecil berarti contracture.
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c.METODE 9-HPT (HOLES PEGS TEST)
Pasien duduk menghadapi balok yang terdapat 9lubang dan 9pasak, kemudian pasien dimintauntuk memasukkan satu persatu pasak kedalamlubang tadi sampai habis dan kemudian pasak
dicabut lagi. Kemudian dihitung waktu yang diperlukan untuk
aktivitas tersebut, dikatakan baik bila kurang dari10 menit.
Tes ini lebih cocok untuk mengetahui fungsi jaridan tangan, semula digunakan pada MultipleSclerosis.
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d.METODE WATENBERG
Pelaksanaannya dengan pendulum
Semula digunakan pada anggota bawah,
dimana diawali dengan lutut lurus kemudian
dilepaskan dan jatuh terayun-ayun.
Pada orang normal ayunan terjadi osilasi 6x
sampai kaki diam. Artinya semakin sedikit
terjadi osilasi maka dinyatakan semakin
spastic.
Soeparman
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PERBEDAAN ISTILAH SPASTIC
Spasticity :A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone)with exaggerated tendon jerks, resulting from hyperreflexia ofthe stretch reflex as one component of the upper motor
neurone syndrome (Lance, 1980, p. 485). Hyperreflexia :A greater than normal reflex response (e.g.
the presence of reflex responses when a relaxed muscle isstretched at the speed of normal movement).
Tone :The resistance felt when moving a limb passivelythrough range due to inertia and the compliance of thetissues.
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Hypertonia ; A greater than normal resistance felt
when moving a limb passively through range.
Dystonia ; A movement disorder in which
involuntary sustained or intermittent musclecontractions cause twisting and repetitive
movements, abnormal postures or both (Sanger
et al ., 2003). Overactivity ; Excessive muscle activity for the
requirements of the task.
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Passive stiffness ; The force required to
lengthen a muscle at rest (i.e. the slope of the
force-displacement curve).
Active stiffness ; The force required to
lengthen a muscle, which is active (i.e. the
slope(menanjak) ofthe active force-
displacement curve).
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Impairment ; Loss of body function or
problem in body structure (WHO, 2001).
Activity limitation ; Difficulty in execution of a
task or action (WHO, 2001).
Participation restriction ; Problems
experienced in involvement in life situations in
a societal role (WHO, 2001).
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MEKANISME HYPERTONIA
(ODwyer & Ada 1996.)
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4.MANAGEMENT PHYSICAL THERAPY
Minimise changes in the viscoelastic properties of
connective tissue, muscles and joints, with the
ultimate aim of maintaining range and preventing
the development of contractures. This may be
achieved by active and passive movement, stand-
ing, or stretching, or through the use of splints.
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Change patterns of spasticity or spasms to preventthem becoming self-perpetuating(permanen). Forexample, if extensor tone and spasms are a dominantproblem in the legs (stiff straight legs), then using a
wedge or T-roll under the knees for night-timepositioning may inhibit this pattern (by promoting a
flexed position of the legs) and impact beneficially
on the persons function and/or ease of care in the
morning.
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Maintain or improve the persons level of
function. A strengthening programme as well asconsidering cardiovascular fitness may be
relevant. Recognise when and how spasticity or its
associated features are useful functionally to a
person, but prevent this use from reinforcing
patterns of spasticity or contributing to increases
in non-neural tone.
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PHYSICAL MODALITIES
1. STANDING2. ACTIVE EXERCISE AND PROMOTION OF OPTIMAL
MOVEMENT PATTERNS
3. PASSIVE MOVEMENTS
4. STRETCHES
5. POSITIONING
6. SPLINTING AND THE USE OF ORTHOSES
7. FUNCTIONAL ELECTRICAL STIMULATION8. HYDROTHERAPY
9. WHEELCHAIR AND SEATING FOR PEOPLE WITHSPASTICITY
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1. STANDING
The usefulness of assisted standing has been
recognised in the Department of Health
National Institute for Clinical Excellence(NICE)
guidelines.
Beneficial effects of standing in spasticity
management are clearly complex, but are
postulated to include the following:
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Evidence base for standing
Promotion of anti-gravity muscle activity in thetrunk and lower limbs.
Maintenance or improvement in soft tissue andjoint flexibility, thereby reducing the risk of
contracture development. Modulation of the neural component of spasticity
through prolonged stretch and altered sensoryinput.
Reduction of lower-limb spasms. A positive psychological effect.
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Beneficial effects of standing
Promotion of anti-gravity muscle activity inthe trunk and lower limbs
Maintenance or improvement in soft tissueand joint flexibility, thereby reducing the riskof contracture development
Modulation of the neural component ofspasticity through prolonged stretch and
altered sensory input Reduction of lower-limb spasms
A positive psychological effect
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How long to stand for?
The duration of standing in reported studies
varies from 30 minutes to a maximum of
112 hours daily, often starting with shorter
times and building up.
From the results of the self-report surveys, it
appears that individuals were standing onaverage for 40 minutes, three or four times a
week.
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CONTROL ECCENTRIC & CONCENTRIC PLANTAR FLEXOR MUSCLE UTK
MENGURANGI SPASTICITY DAN MEMPERBAIKI FUNGSI BERJALAN.
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Application of a back slab
Ways to incorporate
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Ways to incorporate
(diklompokkan)standing into the
management plan The optimal standing position is in an extended
posture with neutral alignment of the trunk,pelvis and lower-limb joints.
Careful assessment is needed to determine howthis is best achieved and how it may beincorporated into an individuals daily routine.
Optimising safety and posture in standing can be
achieved through use of the environment or withspecialised equipment.
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Equipment for aid standing
Household equipment
Lower-limb splints
Oswestry standing frame
Motorised or hydraulically assisted standing
systems
Standing wheelchair Tilt table
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Oswestry standing frame
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Motorised or hydraulically assisted standing
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Tilt Table
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Implementasi Program Standing
Masukkan dlm daftar kegiatan 24 jam
Pilih alat yang memadai, terjangkau, aman
Periksalah alignment standing
Perhatikan mungkin ada bagian kulit yg tertekan
Kontrol efek negatif dan positif
Lakukan latihan selama berdiri
Mungkin diperlukan botox utk relaksasi otot yg
ter stretch.
2 ACTIVE EXERCISE AND PROMOTION
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2. ACTIVE EXERCISE AND PROMOTIONOF OPTIMAL MOVEMENT PATTERNS
Jika mungkin, lakukan latihan aktif utkmemperkuat otot, re-edukasi patternmovement, meningkatkan kebugaran kardio-
vaskuler. Tujuan utama manajemen UMN-syndrome utk
mengurangi spaticity dg harapan dptmeningkatkan fungsional. Sehingga sedikit
bahkan terabaikan problem lain, sepertiweakness.
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Perlu disadari bahwa weakness hampir selalu
terjadi pd otot antagonist, sehingga terjadi
keadaan muscle imbalance, selanjutnya terjadi
perubahan jaringan dan deformitas.
Perlu teknik khusus mungkin penggunaan
botox agar relaks, sehingga otot antagonist
bisa dilatih penguatan
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Utk re-education pattern movement, lakukan
gerakan aktif kombinasi disertai stretching, dan
jangan lupa perhatikan trunk muscle segabai
stabilisator proksimal agar gerakan lebih efisien. Ada kalanya spasm dpt membantu stabilitas
sendi, tetapi apakah penggunaan itu masih tetap
terkontrol, harus diingat bhw syndroma UMN
termasuk hilangnya kontrol/koordinasi, jd pentig
utk melatih kontrol gerakan.
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Evidence base strength trainning telah dilakukanoleh Dodd et al, melaporkan ada perbedaansignifikan efek strength training CP dptmemperbaiki gross motor, jalan, dan time up andgo, serta tidak ada kenaikan spastisitas ygbermakna.
Sedang pd pasien stroke, dpt memperbaiki
kekutan otot tungkai dan kecepatan jalan. Pada MS, strength trainning dpt mengurangi
fatique meningkatkan kemampuan berjalan.
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Metode strength trainning yg biasa dilakukan
seperti task sit to stand, step up, atau dgn
beban 60-80% beban maksimal.
Utk memperbaiki kardiovaskuler, lakukanaerobik . Ini sangat bermanfaat utk kasus
stroke, MS, GBS, dpt meningkatkan kecepatan
dan jarak berjalan.
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3. PASSIVE MOVEMENTS
Diyakini berdampak pd peningkatan
spastisitas dan tonus otot, tetapi dianjurkan
utk semua bagian tubuh digerakkan sebelum
melalkukan aktivitas, hanya terbatas padarom yang ada. (menghindari stretch reflex).
Ini dimaksud utk mencegah non neural
stiffness.
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Evidence base, pasif yg dilakukan pd elbow
oleh Schmit et al kasus TBI, dpt menurunkan
fleksor spasm.
Pd stroke, pasif pd sendi lutut dpt menurnkanspasticity sementara.
Pd MS dan SCI, tidak menunjukkan perubahan
spasticity yang berarti, tetapi secra subyektifpasien merasakan lebih nyaman.
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Pelaksanaan Passive Movement
Masukkan dlm program 24 jam misalnya
setiap pagi hari.
Ajarkan pd perawat, saat pergantian posisi,
memindahkan dr bed ke kursi roda dsb.
Lakukan slow stretch jangan menimbulkan
trigger stretch reflex pada otot anti gravity.
20-30 menit sebelumnya mungkin berikan
obat relaksasi misal botox.
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Lakukan pd posisi berbaring, tetapi dapat juga
duduk atau berdiri.
Jika perlu dgn alat bisa dipakai CPM.
Hati-hati jagan menimbulkan stimulasi stretch
reflex, luka pd kulit, cedera otot/tulang.
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4. STRETCHES
Otot yg diimmobilisasi dlm 2 hari saja sdhterjadi shorthening, karena itu perlu dilakukanstretching utk memanjangkan kembali shg
lebih flexibel. Stretch dilakukan sustaining 30 menit dua kali
setiap hari.
Atur posisi yg dikenal dg anti spasticpositioning sering ditrapkan pa kasus CP,dipertahankan selama 20 menit setiap hari.
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5. POSITIONING
Pada dasarnya posisikan dimana otot dlmkeadaan optimal lengthening, yg berartimeningkatkan rom sendi.
Manfaat positioning, diantaranya :a. memungkinkan jaringan terulur
b. merubah pola spastisitas karena diposisikan kearah yg berlawanan.
c. koreksi asymetris
d. support shg mencapai relaksasi.
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Pergantian posisi yang teratur sepanjang hari
jauh lebih baik dibanding membiarkan hanya
satu posisi yang memungkinkan problem kulit
juga cenderung terjadi kontraktur. Berikut contoh posisi utk spastisitas adduktor
hip, dengan menggunakan wedging dan T-roll.
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The Use a wedging in lying
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The Use a wedging in sitting
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The Use T-roll in lying
The Use T roll in side lying
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The Use T-roll in side lying
6 SPLINTING AND THE USE OF
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6. SPLINTING AND THE USE OF
ORTHOSES
Fungsi utama utk mengontrol gerakan tubuh sertamencegah atau memperbaiki kelainan bentuk ataudeformitas.
Sebagai tindakan terapi dengan cara :
a. mengontrol rom shg memperbaiki fungsib. stretching yg lama utk mencegah atau koreksijaringan yg memendek.
c. kompensasi dr deformitas
d. membuat lebih nyamane. penyesuaian /adaptasi thd prolong stretch pdsensori otot yg spasticity.
/
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Indikasi splint/ortose
Maintain joint range,soft tissue length andalignment
Increase soft tissue length and passive range
of movement Facilitate function (e.g.ankle-foot orthosis)
Facilitate hygiene (e.g.by enabling access to
palm) Increase comfort (e.g.sheepskin palm
protector,Figure 4.11)
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Precaution
Sensory impairment
Unstable intracranial pressure
Poor skin condition
Vascular disorder
Fracture or severe soft tissue injury
Behavioural/cognitive disorders Uncontrolled epilepsy
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Heterotrophic ossification
Oedema
Acute inflammation
Access to limb required for medical purposes
Medically unstable
Frequent spasms
l
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Wrist splint
l
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Palm protector
lb il
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Elbow spilnt
Below knee splint
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Below knee splint
L li b (k ) li
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Lower limb (knee) splint
7 HYDROTHERAPY
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7. HYDROTHERAPY
Sendi yg tak dapat digerakkan di darat, dapatdilakukan di dalam air.
Penelitian menunjuikkan bahwa 20 menit 3
kali perminggu latihan di dlm air dptmenurunkan spastisitas menurut scalaAsworth score.
Immerson dlm air hangat dapat mencapai
relaksasi, mensuport tubuh, memudahkanbergerak.
8. FUNCTIONAL ELECTRICAL
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8. FUNCTIONA CTRICA
STIMULATION (FES)
The Odstock dropped foot stimulator(ODFS) wasdeveloped in the early 1990s.
The ODFS is a single-channel neuromuscular
stimulator that corrects dropped foot by stimulating
the common peroneal nerve using self-adhesive skin
surface electrodes placed on the side of the leg.
The electrical stimulation causes dorsiflexion andeversion of the foot. When this is timed to the gaitcycle using foot switches placed in the shoe, walkingperformance can be significantly improved.
9. WHEELCHAIR AND SEATING FOR
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PEOPLE WITH SPASTICITY
Bagi mereka yg mobilitasnya sudah tergantungdari kursi roda, atau aktivitasnya sebgaiandilakukan dg kursi roda, maka postur danduduk yg tepat, sangat penting .
Sebelumnya perlu diasses secara menyeluruhutk menentukan postur dan duduk yg benar.
Amati adakah triger spasm, artinya pd saat
duduk jika ada yg tidak nyaman cenderungtimbul spasm.
Goals of seating in patients with
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g p
spasticity
Facilitate function for example improved use of headand upper limbs
Reduce the risk of biomechanical changes in muscles,tendons and joints that can impact on health andhygiene
Accommodate to contractures or bony deformities thatmay already be established
Increase comfort
Minimise effects of fatigue on posture
Reduce work of breathing and improve quality of
speech
St bilit i l
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Stabilitas proximal
Landasan utama agar bagian distal dptbergerak bebas jika bagian proximal tetap
stabil.
Pd posisi duduk pelvis harus cukup stabil agarspine, neck, head dpt bergerak bebas. Jadi
landasan duduk serta sandaran hrs firm,
pelvis dlm posisi normal tidak tilting upwardmaupun backward.
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This can be illustrated by altering the seatbase to promote a slight anterior tilt of the
pelvis: this assists in reducing extensor tone by
encouraging hip flexion, abduction andexternal rotation as well as extension of the
trunk.
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However, it is important to consider thatchanges in one aspect of a seating system mayinfluence others: by reclining the back rest,flexion at the hips may be reduced, which cancause problems with extensor tone.
Often, if possible, a tilt-in-space chair is thebestoption, as it tips the entire seating system
back, not just the backrest, thus avoidingextension at the hip joints.
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Reclining the back rest : slightly allows gravityto hold the upper trunk and head supporting
surfaces. This reduces the workload of the
muscles and can reduce spasticity and spasmsin the trunk and limbs
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Tilt-in-space options have also been found to
improve respiration and reduce kyphosis for
people with various neurological conditions; in
addition, reduction in effort or work ofspeaking and breathing for people with MS
(multiple sclerosis) has been reported.
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Additional supports such as head rests andtables can help reduce the risk of fatigue
impacting on postural alignment by
supporting the weight of the head and arms. Frequent rests from the upright sitting
position using the tilt-in-space mechanism can
also help with managing fatigue andredistributing pressure.
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Some people will benefit greatly from the useof static seating systems (e.g. Kirton chairs)
that have a tilt-in-space mechanism and
adjustments to allow leg position to bechanged.
Lanjutkan dengan mempelajari pengukuran
spasticity dgn :Sasticity Outcome Measures Form
CONTOH STRETCHING
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CONTOH STRETCHING
Spasticity can be described as involuntarymuscle stiffness. People with spasticity
describe their muscles as feeling stiff, heavy
and difficult to move. Spasms can be described as sudden
involuntary contractions of muscles. They can
make your arms, legs or body move indifferent ways.
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Contractures are when a limb becomes fixedin one position. This occurs if spasticity and
spasms persist, restricting movement and
causing limbs to be held in set positions. Clonus is a repetitive up-and-down
movement, often of the feet. It may be
observed as a constant tapping of a foot onwheelchair footplates.
STRETCHING EXERCISE
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STRETCHING EXERCISE
All of these stretches are best performedslowly, and the end-position should be held
still. None of the stretches should cause you
any pain or discomfort.
Back Stretch
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Back Stretch
Quadriceps stretch
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Quadriceps stretch
Hip flexor stretch in prone
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Hip flexor stretch in prone
Hip flexor stretch in lying
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Hip flexor stretch in lying
Hamstring stretch
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Hamstring stretch
Hip adductor stretch
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Hip adductor stretch
Calf muscle Gastrocnemius stretch
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Calf muscle Gastrocnemius stretch
Calf muscle Soleus stretch
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Calf muscle Soleus stretch
Wrist and fingers stretch
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Wrist and fingers stretch
Assisted calf stretch
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Assisted calf stretch
Assisted back stretch
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Assisted back stretch
Assisted Adductor stretch
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Assisted Adductor stretch
Assisted Hamstring stretch
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Assisted Hamstring stretch
Clonus trying stretch
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Clonus, trying stretch
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TERIMA KASIH
ATAS PERHATIANNYA