Peran Rehab Medik Dlm Penanganan Komprehensif Kelainan Spinal.edit
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Transcript of Peran Rehab Medik Dlm Penanganan Komprehensif Kelainan Spinal.edit
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Peran Rehabilitasi Medik dalamPenanganan Komprehensif
Kelainan Spinal
Siti Annisa Nuhonni
Department of Physical Medicine and Rehabilitation
Dr. Cipto Mangunkusumo Hospital,
Faculty of Medicine,
University of Indonesia
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FALSAFAH & TUJUAN
REHABILITASI MEDIK
Falsafah rehabilitasi medik ialah
meningkatkan kemampuan fungsionalseseorangsesuai dengan potensi yangdimilikiuntuk mempertahankan dan ataumeningkatkan Kualitas hidupdengan
cara mencegah atau mengurangiImpairmen t, Disabi l i tydan handicapsemaksimal mungkin
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General goals in rehabilitation of
patients with spinal disorders
Decrease spinal related pain
Improve strength, flexibility, lifting
capacity, and cardiovascular enduranceMinimize spine-related disability
Normalize activities of daily living
Return to work and vocational activities
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Components in a non operative
spine treatment program
Education
Local modalities
Medication
Injections
Exercise
Orthoses and assistive devices
Complementary and alternative therapiesHome environment modification
Ergonomic modifications
Lifestyle modification
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Common causes of cervical pain
seen in a rehabilitation medicine
Myofascial pain
Cervical spondylosis
Cervical sprain/strainCervical disc herniation
Cervical stenosis
Cervical fractures
Inflammatory conditions of the spine such as
rheumatoid arthritis
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Common causes of lumbar pain
seen in a rehabilitation medicine
Lumbar sprain/strain
Myofascial pain
Fibromyalgia
Lumbar spondylosisLumbar radiculopathy
Lumbar spinalstenosis
Lumbar spondylolysisand spondylolisthesis
DISH
Spondyloarthropathy( ex. Ankylosingspondylitis)
Fracture
Tumor
Infection
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Balance Strength Flexibility EnduranceCoordination
Line motor
Role function
Task or
goal-oriented
function(e.g., ADL, IADL)
Specific physical
Movements
(e.g., 8-foot walk)
Hierarchy of physical function
Integration level III
Integration level II
Integration level I
Basic component
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Ruas Vertebra
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POSTURE and Emotional Stress
Posture has more
to do with the
neck than mostpeople realize.
The head and
spine mustbalance in
relation to the
line of gravity.
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Low Back Pain
is a symptom that can be caused byvarious disease entities and can affected
by various psychosocial factors
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ObjectiveThe objective of anypreventive or therapeuticrehabilitation program is toteach patients how to help
themselves.
They are taught how to be
Kind to ones back
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RISK FACTORS
Hard labor and heavy exertions
Lifting, pulling and pushing, twisting,slipping
Sitting for an extended period
Exposure to prolonged vibration
Persons who view their occupations asboring, repetitious or dissatisfying mayalso report a higher rate of low backpain
OCCUPATIONAL FACTORS
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RISK FACTORS
Age Sex
Anthropometric Factors
Postural Factors
Spine Mobility
PATIENT - RELATED FACTORS
Muscle Strength Physical Fitness
Smoking
Psychosocial
Factors
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Mechanical units of the spine
Anterior segment (two adjacent vertebral bodies andthe intervertebral discs between them)
Posterior segment (neural arches)
The anterior segment is primarily the weight bearingand shockabsorbing component
The posterior segment protects the neural structuresand direct movements of the units in flexion andextensions
The amount of force exerted on the spine can verydepending on the type of activity and posture.
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Muscle Supporting The Spine andTheir Function
Four groups of muscles : the extensor, the flexors, the lateralflexors, and the rotators of the spine
The extensors and rotators are the main supportive muscles ofspine
The main role of the back muscles in erect posture is to resistgravity
Once vertebral column is bent far enough in any direction, themuscles of the back that resist this movement must activelycontract to provide smooth and controlled movements and also toprevent falling
The abdominal muscles are significant flexors and lateral flexorsof the trunk and also participate in rotation
Muscle Groups
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Rehabilitation of Back Pain
General Consideration
Rest
Relax
Avoidance of stressful activities
Use of back supports
Exercise
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TYPES OF EXERCISE
Aerobic / Anaerobic
Resistance / WeightsAntigravity
Balance
Stretching
Cardiovascular conditioning
Strength, tone, muscle massPrevent osteoporosis
Prevent falls
Flexibility
TYPE PURPOSE / EXPECTED BENEFIT
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Narrowing of the therapeutic window. This diagram portraysin a conceptual manner how the space between a therapeuticdose and a toxic dose narrows with age
Therapeutic response
Therapeut ic window
Toxic response
Age
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Low back pain mechanical
strain
Goal : - pain free
- decrease soft tissue edema
- maintained ROM & muscle strength
Th/ : - cold pack during the first 48 hrs
- heating modalities 20-35 minutes
- stroking massage
- Bed rest 2-3 days, not more than 2 weeks
- use a firm mattress and soft top layercovering
- Supine / side lying position, flexed hips & knees- Gentle ROM and isometric exercise
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EXERCISE
Isometric strengthening exercises (paraspinal
& abdominal muscles)
Back extension or flexion or combination
exercise program ; depends on indications
Pain free +, start daily activities, usually after
2-4 weeks
William flexion exerciseMc Kenzie hyperextension exercise
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Thank you