peran rehab medik dlm penanganan komprehensif kelainan spinal.edit

8/10/2019 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

peran rehab medik dlm penanganan komprehensif kelainan spinal.edit

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