PENDAHULUAN ORTOSIS

Pembimbing : dr. Fatchur Rochman, Sp. KFR (K)

ORTOSIS

• Suatu alat bantu/alat terapi dalam bidang Kedokteran Fisik dan Rehabilitasi yang dalam penggunaannya diletakkan secara kontak langsung dengan permukaan luar bagian/segmen tubuh tertentu untuk meningkatkan fungsi bagian/segmen tubuh tersebut

TUJUAN

• Menstabilkan sendi atau segmen yang lemah atau lumpuh

• Men-support sendi atau segmen yang rusak atau sakit

• Membatasi atau menambah gerak di seluruh sendi

• Mengkontrol gerakan abnormal atau spastik• Unload distal segments

• Tahun 2700 SM bangsa Mesir ortosis

untuk melindungi bagian tubuh tertentu dari

trauma atau cegah kerusakan lebih lanjut

• Abad pertengahan baju perang ortosis

spinal

• Ambroise Paree, ahli bedah Perancis pionir

ortosis dan prostesis

• Lorenz Heister, abad 15 ortosis spinal

pertama

• Hugh Owen Thomas, abad 19 , ahli

bedah Ortopedi ortosis servikal

• Abad 20 pengembangan ortosis

pencegahan dan pengurangan

dampak poliomyelitis

Penggunaan ortosis :

• Keputusan medis

• Berdasarkan indikasi

• Diresepkan oleh dokter yang kompeten

kinesiologi, biomekanika anatomi,mekanisme penyakit,

neurofisiologis dan patomekanika yang mendasari disabilitas penderita,

sifat fisika materi/ bahan ortosis

Penggunaan ortosis…Dr.IKFR harus paham :

• Kondisi fisik pasien

gaya hidup pasien

• Kepribadian pasien

kemandirian ADL

Kriteria ideal ortosis• Menghasilkan pola gerakan senormal

mungkin dan pencegahan gerakan abnormal yang tidak dikehendaki

• Stabilitas sendi akurat• Penggunaan energi seminimal mungkin• Distribusi gaya yang baik• Kenyamanan dalam pemakaian

Kriteria ideal ortosis…

• Mudah dipakai dan dilepas oleh penderita sendiri

• Biaya terjangkau, tidak cepat rusak, secara kosmetis baik serta mudah untuk diperbaiki dan dimodifikasi

Orthotic prescription

Should include :• Medical diagnosis• Current impairment and any disability (e.g.

flaccid drop foot)• Type of orthosis (e.g. plastic ankle-foot orthosis

[AFO] with flexible ankle held in neutral position)• Orthotics goal

Jenis Ortosis1. Statik

- Rigid

- Memberi support tanpa gerakan

- Mengistirahatkan segmen/bagian tubuh pasca

trauma, bedah

- Mengistirahatkan sendi dan tendon

- Khas mengikuti bentuk yang mengakomodasi

posisi statik yang ada

- Dapat dibuat tidak mengikuti bentuk

Jenis Ortosis…

2. Dinamik- Memberikan/mengakomodasi gerakan pada derajat

tertentu

- Meregangkan kontraktur

Ortosis fungsional :

- Memperbaiki fungsi

- Digunakan pada pasien dengan disfungsi

sisa yang permanen pasca cedera, kondisi

pemulihan lambat, penyakit kronis.

Terima Kasih

Orthoses constructed from :

• Metal• Plastic• Leather• Synthetic fabrics• Any combination

• Metal orthoses :– Adjustable– But heavy– Not cosmetically pleasing– Commonly used metal include : stainless steel

and aluminium alloys

– Stainless Steel : – widely used in prefabricated joint, metal up

right, metal band and cuffs, springs and bearing. Relatively inexpensive, easy to work with, and fatigue-resistant ; however :

– Heavy, needs expensive alloys to prevent corrosion

Aluminium alloys :• corrosion resistant• have high strength-to-weight

ratio• commonly used in upper limb

orthoses because of its lightweight nature.

• static loading strength is good• lower endurance limit compared

to steel

Leather

Type : Cattle hides – vegetable-tanned for texture to prevent skin irritationRecommanded for shoe construction because :Conduct heat well, absorp water from the moist air surrounding the foot, draw prespiration away, stretch as the shoe becomes moist

Plastic• Lighter• Can provide a closer fit (it can be molded,

extruded, laminated, or hardened into any desired form)

• Unaffected by fluids• Radioluscent• Not adjustable in length• Not as durable as metal (hence not commonly

used as joints)• Classified into : thermosetting and

thermoplastic materials

Thermosetting

• Develop a permanent shape when heat and pressure are applied

• Cannot be softened when reheated• More difficult to use than thermoplastic• Cause more body irritation / allergic

reaction• Epoxy resin• Polyurethane foam

Thermoplastic• Soften (and become moldable) when heated

and harden when cooled• Divided into Low – High temperature

LOW-temperature thermoplastics(Orthoplast, Aquaplast, Bioplastics, Glassona, Hexcelite, Kay-splint, Lightcast, Polysar, Warm-N-Form)

• Can be molded at temp just above body temp (<80⁰C or <180 ⁰F), be shaped directly to the body without cast,

• Can be fabricated easily and rapidly• Mainly used in upper limb (low stress activity)

HIGH temperature thermoplastics(acrylic, polyethylene, polypropylene, polycarbonate, acrylonitrile-

butadiene-styrene [ABS] and the group of vinyl polymers and copolumers include PVC, PVA, polyvinyl acetate)

• Require up to 150-160⁰ C (300-350⁰ F) to become moldable

• Must be shape over a plaster replica/cast• Creep resistant (not easily change in shape

w continued stress and heat)• Ideal for long-term or permanent use

especially when high stress is anticipated (e.g. in lower limb orth. and in spastic limbs)