RETARDASI MENTAL (RM)

1/18/121RETARDASI MENTAL (RM)Sam Lazuardi1/18/1211/18/122DEFINISI RM:D/ sebelum 18 thIQ dibawah Normal (< 70)Adaptive functioning kurangDasar D/ aspek motorik, bahasa, menolong diri sendiriRM ringan baru nampak pd usia sekolahRM 1 3 % penduduk

1/18/1221/18/123PENYEBAB RM (1) :I. Tak diketahui (75 %)II.Diketahui (25 %) :II.1. Trauma (pre - & postpartum):Perdarahan intrakranial pre / postpartumKurang O2 pre- /intra- /postpartumII.2.Infeksi (intra - & postpartum): rubella kongenital, meningitis, CMV kongenital, toksoplasma kongenital, infeksi HIV

1/18/1231/18/124PENYEBAB RM (2)II.3.KELAINAN KHROMOSOMKelainan # khromosom (sindr.Down)Defek khromosom (fragile X sy, Prader-Willi sy)Translokasi khromosomKehilangan khrom (cri du chat sy)1/18/1241/18/125PENYEBAB RM (3)Kelainan genetik & gg metabolik heriditerGalaktosemiaFenilketonuriaPeny. Tay-SachSindr RettTuberous Sclerosis

1/18/1251/18/126PENYEBAB RM (4)II.5.Metabolik : sindr Reye, hipotiriod kongenital, hipoglikemiaII.6. Toksik : timah hitam, metilmerkuri, keracunan IU thdp alkohol, kokain, dsbII.7. Nutrisi : malnutrisiII.8.Lingkungan : kemiskinan, sindr deprivasi, status sosioekonomi yg rendahII.9. Def. Jodium : RM ringan (kretin)1/18/1261/18/127

GEJALA RM :

Adanya gangguan dalam :Memahami sebab akibatMenyelesaikan persoalanBerpikir secara logisKeinginan tahuPerkembangan intelektualPerilaku (kekanakan)

1/18/1271/18/128DIAGNOSA DITEGAKKAN DG :Tes skrining anak Denver Developmental Screening Test (DDST)Tes Inteligensi (IQ) - < 70Perilaku dibawah NormalTes IQ mengukur kemampuan anak dalam : bahasa, angka (numeracy), problem solvingTes dpt terganggu oleh : budaya, depresi, ansietas

1/18/1281/18/129WECHSLER ADULT INTELLIGENCE SCALE (WAIS)CLASS IQ

Profound mental retardation below 20Severe mental retardation 20 34Moderate mental retardation 35 49Mild mental retardation 50 69Borderline mental retardation 70 - 791/18/1291/18/1210PENGOBATAN / INTERVENSI Meningkatkan potensi semaksimal mgk Pendidikan luar biasaIntervensi diniDefisiensi Jodium dg deteksi & terapi dini hasil baik (juga pd kel metabolik PKU)1/18/12101/18/1211PROGNOSISSebagian besar dapat hidup mandiriSebagian lagi harus dibantu melalui structured environment1/18/12111/18/1212KOMPLIKASIIsolasi sosialTak dapat mengurus diri sendiriTak dapat melakukan interaksi dg baik1/18/12121/18/1213PENCEGAHAN (1)1.Genetik :skrining prenatal terhdp defek genetik, khromosomkonseling genetik pd keluarga dg risiko tinggi2. Sosial :- perbaiki nutrisi, kesehatan & pengetahuan ibu hamil - perbaiki nutrisi pd usia balita - program sosial utk kurangi retardasi ringan

1/18/12131/18/1214PENCEGAHAN (2)3. Toksik : - program lingkungan utk mencegah keracunan timah hitam, merkuri4. Infeksi : pendidikan utk mencegah toksoplasmosis, rubella kongenital1/18/12141/18/1215KESIMPULANRETARDASI MENTAL ADALAH SUATU KEADAAN YANG SEUMUR HIDUP PENCEGAHAN & DETEKSI INTERVENSI DINI SANGAT DIBUTUHKAN 1/18/12151/18/1216IQ (Intelligent quotient)Nilai IQ didapat dg membagi umur mental seseorang dg umur mental penduduk rata-rata dikalikan 100 :IQ = Usia mental / Usia Kronologis X 100IQ normal = 85 - 1151/18/12161/18/1217Pembagian RM menurut IQBorderline 70 85 slow learner - # besarRM ringan 55 70 educable 85 % RMRM sedang 40 55 trainable 10 % RMRM berat 25 40 nontrainable 5%RM sangat berat < 25 1/18/12171/18/1218MASA PERKEMBANGAN ANAK RMANAK MANIS, JARANG NANGIS, BANYAK TIDUR, MENGHISAP LEMAH, GANGGUAN MAKAN MENELAN, BANYAK TERLENTANG, PERKEM-BANGAN MOTORIK LAMBAT (TENGKURAP, DUDUK,BERJALAN),NGOCEH LAMBAT, PERHATIAN KURANG RM RINGAN - SEDANG1/18/12181/18/1219ROKOK PD KEHAMILAN BAYI (termasuk 2nd hand smoker)KEHAMILAN : abortus, gg plasenta, abortus, BBLR, stillbirthBayi : SIDS, gangguan perilaku & belajar, ADHD, asthma, infeksi telinga1/18/12191/18/1220Pengaruh ekstasi / methyl-amphetamine Ibu : hipertensi, perdarahan intrapartum, prematuritas, tak nafsu makanBayi :kurang gizi, kelainan bawaan pad mulut, BBLR, palatoschizis, kel .jantung bawaan, kel.tungkai bawaan (clubfoot).1/18/12201/18/1221PENGARUH TIMAH HITAMIbu : infertilitas, hipertensi, abortusAnak : gangguan perilaku (aggresif, delingkuen), IQ menurun, gg belajar, 1/18/12211/18/1222KESIMPULAN RMPenyebab RM terbesar adalah gol. Sosiokultural ( retardasi ringan- borderline) dapat dicegah mll edukasi, pengentasan kemiskinanGol. RM patologik (retardasi berat) sedikit & pd sebagian dapat dicegah melalui skrining metabolik, konseling genetik, nutrisi waktu hamil, edukasi1/18/1222EDUCATION OF RETARDED CHILDRENRequire a special educational setting with more individual attention and support, especially who has behavioral problemsSome can engage in non-academic activities, such as sports, physical education, art and singing with their nonretarded peers.Preparing retarded children for both lifelong vocational pursuits and as much indepen-dence as possible is the major goal.

1/18/1224NATURE VERSUS NURTURENATURE GENES DNA RESPONSIBLE FOR BASIC WIRING PLAN (forming neurons & general connections between different brain regions)NURTURE EXPERIENCE (responsible for fine-tuning those connections & adapt to particular environment to which he belongs)1/18/12241/18/1225DOES EXPERIENCE CHANGE THE BRAIN STRUCTUREBrain development is activity-dependentCells that fire together, wire together Those that are consistently turned on over time will be strengthened, while those that are rarely excited dropped away, elimination of unused neural circuits referred as pruning1/18/12251/18/1226CRITICAL PERIOD IN BRAIN DEVELOPMENT (1)Animal studies certain windows of time during which the young are especially sensitive to their environmentBabies require normal visual input or may suffer permanent impairment crossed eyes need prompt correctionLanguage development in the first few years of life1/18/12261/18/1227CRITICAL PERIOD IN BRAIN DEVELOPMENT (2)Language learning begins to close around 5 years & ends around puberty learning new language after puberty speak it with a foreign accentMusical ability (perfect pitch) is before age of 7Critical period for Social emotional development depends on a positive, nurturing attachment to a primary caregiver1/18/12271/18/1228CRITICAL PERIOD IN BRAIN DEVELOPMENT (3)Based on the higher frequency of serious behavioral problems among children who were severely neglected during the first years of life and with monkeys who are reared in isolation During the early years, the brain over-produces connections about 50 % more than will be preserved in adulthood

1/18/12281/18/1229CRITICAL PERIOD IN BRAIN DEVELOPMENT (4)During the critical period, a child experience sensory, motor, emotional & intellectual - determines which of these synapses will be preserved, through pruning of the least useful connectionsIn this way, he becomes better tuned to meet the challenges of his particular environment

1/18/12291/18/1230CRITICAL PERIOD IN BRAIN DEVELOPMENT (5)A newborns brain is about a quarter the size of an adults. It grows to about 80 % by 3 yrs & 90 % by age 5Each brain cell begins as a tiny sampling & only gradually sprouts its hundreds of long branching dendrites. Brain growth is largely due to the growth of dendrites, which serve as receiving point for synaptic input from other neurons1/18/12301/18/1231CRITICAL PERIOD IN BRAIN DEVELOPMENT (6)A newborns brain works more slowly than an adult (sixteen times less efficiently)The speed increases during infancy & reach its maximum at age 15, due to the gradual myelination of nerve cell axons.Myelination begins at birth & is most rapid in the first 2 yrs , but continues till age 301/18/12311/18/1232

1/18/12321/18/1233NUTRITION & THE DEVELOPING BRAIN (1)Brain development is most sensitive to a babys nutrition midgestation till 2 yrsUndernourished children smaller brain (reduced dendritic growth, reduced myelination & glia) behavioral & cognitive deficits slower language, fine motor development, low IQ, poor school performance1/18/12331/18/1234NUTRITION & THE DEVELOPING BRAIN (2)Pregnant women should gain about 20 % of ideal pre-pregnancy weight to insure adequate fetal growth consume extra 300 calories per day, including 10 - 12 extra grams of proteinAfter birth brain growth depends on the quality of the child nutritionBreast milk is the best mix of nutrients, provided iron supplementation around 6 mo whether or not mother are iron - deficient1/18/12341/18/1235NUTRITION & THE DEVELOPING BRAIN (3)Iron is critical for maintaining an adequate oxygen-carrying rbc, necessary to fuel brain growthBottle fed babies should receive formula containing ironRapid pace of myelination in early life, children need a high level of fat in their diets, 50 % of total calories until 2 yrs from breast or formula1/18/12351/18/1236NUTRITION & THE DEVELOPING BRAIN (4)Whole cows milk can be introduced after 1st birthday, provided an excellent source of fat & protein in the 2nd yearAfter 2 yr, children should begin transitioning to a more heart-healthy level of dietary fat (30 % of total calories) including lower-fat cows milk (1 2 %)1/18/1236MAKANAN IBU HAMILKenaikan BB : 10 13 kgBanyak sayur & buah (green leafy, nuts, seeds, lentil, beans), cereal, whole grain breadModerate low fat diary ( milk, cheese), lean meat, fish, chickenSmall amount of fatty, sugary & salty mealMediterranean dietFolic acid :broccoli, cabbage, cauliflower, lentil, spinach, oranges, peanut, potato. Tomato, straw-berry, asparagus, dried beans, brussel sprouts1/18/1238VITAMIN & MINERALSIron: developing foet draws Fe from mo through 5 6 mo after birth 27 mg p day (9 mg > nonpregnant ), depend prior pregnancy storage (red meat + orange vit C help absorption)Vit A : fish, egg, milk excess supplement birth abnormalitiesMultivitamin : only for vegetarians, drug/ alcohol/ smokersCa : 1000 mg daily (dairy foods)1/18/12381/18/1239MAKANAN TERBAIK Beras merah, roti gandumSayuran mentah dicuci bersih, dapat di blender & jangan jus, karena serat hilangKurangi goreng, banyak di kukus, jangan rebus, karena vitamin & mineral hilangHindari processed food (sosis) & barbequeJangan sering di microwave, vitamin & mineral akan hilang1/18/12391/18/1240Prenatal Nutrition, Postnatal Allergy Protection

when moms-to-be eat apples during pregnancy, their offspring have lower rates of asthma Mothers who consume fish during pregnancy may lower their child's risk of developing the allergic skin condition called eczema. HEALTHDAY 4 Jan 20091/18/12401/18/1241CHILDBIRTH RISKIER IN POOR COUNTRIESWomen living in poor countries are 300 times more likely to die during pregnancy or childbirth than if they lived in rich countries (UNICEF in Johannesburg, 15 January, 2009)UNICEF said that about 80 percent of maternal deaths could be prevented if women had access to primary health care or basic obstetrics. Women living in poor countries are 300WHY ARE THE JEWS SO SMART -1Thesis & research by Dr Stephen Carr LeonJews are ahead in all aspect of life & nearly 70 % world tradeA pregnant woman always sing, play music & carry math books solving math problemsShe love to eat almonds, nuts, dates with milk & for lunch dinner fish without the head and no meat with salad, nuts & fruits before mealSmoking is a taboo, nicotine destroy cells of the brain, affect the genes & DNA resulting generation of moronWHY ARE THE JEWS SO SMART -2Thesis & research by Dr Stephen Carr LeonMakanan si anak harus dibawah pengawasan ortu, terut buah dg almond dan cod liver oilSi anak harus menguasai 3 bahasa : Ibrani, Arab dan InggerisIa harus mempelajari piano atau biola, karena vibrasi musik akan merangsang otaknyaDalam sekolah dasar mereka harus mendalami business math dan scienceWHY ARE THE JEWS SO SMART -3Thesis & research by Dr Stephen Carr LeonDi bidang atletik mereka dilatih dalam archery, shooting & running dg target agar otaknya bisa fokus dan tepat sasaranHarga rokok di luar negeri mis Singapore $ 7, sedangkan di Indonesia hanya $ 0.70MEROKOK DAN AKIBATNYAASAP ROKOK : MENGANDUNG LEBIH DARI 4000 BAHAN KIMIA RACUN & 43 BAHAN PENYEBAB KANKERROKOK = NARKOBA YG DILEGALKAN -> KETAGI-HAN & SUKAR MELEPASKANKOMPLIKASI MEROKOK : 24 PENYAKIT FATAL (JANTUNG, KANKER, PERNAFASAN, KANDUNGAN, IMPOTENSI)AKIBAT PEROKOK PASIF 43 JUTA ANAK MEN-DERITA GG PERNAFASAN & PERTUMBUHAN FISIK DAN MENTALROKOK MEMBUNUH 13.500 ORANG/H

ROKOK MENGHANCURKAN KEHIDUPAN ORANG MISKINPenelitian Herien di Bogor & Krawang : penge-luaran utk merokok melebihi pengeluaran utk kebutuhan pokok ( makanan, pendidikan anak) 25 Mei, 2011Orang miskin perokok dicabut jaminan kesehatannyaPabrik rokok sponsor utama program olahraga & musik, sambil menjaring para remaja sbg anggota baru

WHO : Rokok membunuh 5 juta orang tiap tahun (Kompas, 10 Des 2009)Tembakau akan membunuh 6 juta orang, termasuk 600.000 perokok pasif.Who mendesak pemerintah utk menanda-tangani dan melaksanakan perjanjian kontrol tembakauRokok, penyebab kematian terbesar ketiga di IndonesiaRokok baik utk ekonomi adalah propaganda DetikForum, 21 Nov 2010Indonesia peringkat 5 dunia utk jumlah anak pendek (Kompas, 12 Jan 2012)Sebanyak 35.6 % anak Indonesia berumur kurang dari 5 th mempunyai tinggi badan kurang dari normalIbu kurang gizi menyebabkan 11.1 % bayi dg berat badan kurang dari 2.500 GrKemiskinan dan kurang pengetahuan yg menyebabkan tubuh pendek dan otak kurang berkembang (slow learner & retardasi ringan)ANAK KURANG GIZI

KEMISKINAN, MEROKOK DAN KECERDASANDengan banyaknya merokok pada orang miskin, maka hari depan generasi mendatang sangatlah suram !Sebagai calon dokter, tolong berikan saran tertulis mencari solusi utk persoalan ini dlm rangka belajar membina masyarakat kita ! -(maksimal 1 lembar halaman ketik dlm 2 minggu)

ANAK SEHAT DAN CERDAS

NEGERI AUTOPILOT Media Indonesia 16 Jan 2012Pimpinan INDO melakukan NATO (No Action, Talk Only)Anggaplah INDO libur panjang dari 2009 hingg 2014Sikap Diam lebih KEJAM dp Sikap KritisMayday Mayday.any body hear ???Melakukan Autopilot = tidak kompeten54