stroke eka hsptl dr. julius (2)
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Stroke
ehabilitation
dr. Julius Aliwarga, Sp.KFR-K
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Comorbidities in Stroke Patients
• Hypertension & hypertensive heart disease
• Coronary heart disease
• Obesity • Diabetes mellitus
• Arthritis
• Left ventricular hypertrophy
• Congestive heart failure
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Disturbances• 1. Motor Control and Strength
•
2. Motor Coordination and Balance• 3. Spasticity
• 4. Sensation
• 5. Language and Communication
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Disturbances• 6. Apraxia
•7. Neglect Syndrome
• 8. Dysphagia
• 9 Uninhibited Bladder and Bowel
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Arch Phys Med Rehabil Vol 76, May 1995
The time course of recovery in stroke survivors shown as the cumulated rate
of patients have reached their best neurology outcome. The course of recovery
is given for patients whose initial stroke severity was mild, , moderate, ,
severe,*, very severe, •. All patient are representated by ▪.
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Our Stroke Rehabilitation
Team – Physiatrist / Spesialis Kedokteran
Fisik & Rehabilitasi
– Physiotherapist
– Occupational Therapist
– Speech Language Pathologist
– Orthotist
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PLASTICITY IN ADJACENT TISSUE
AFTER FOCAL DAMAGE TO M1
• A. Neuronal Plasticity• 1 Dendritic Plasticity
• 2. Synaptic Plasticity
• 3. Cytoskeletal Plasticity
• 4. neurochemical Plasticity
• B. Pemakaian jalur yang telah tidak
dipergunakan lagi
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Program Rehabilitasi Medik pada
Penderita Stroke
Fase awal
1.Mencegah komplikasi
sekunder
2. Melindungi fungsi yang
tersisa
1. Proper body positioning,
2. Latihan lingkup gerak sendi,
3. Stimulasi elektrikal dan
4. Penanganan masalah emosional
(sadar).
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Physical Therapy
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Stroke
Fisioterapi a. Stimulasi elektrikal untuk otot-otot dengan
kekuatan otot (kekuatan 2 kurang)
b. Diberikan terapi panas superficial (infra-red)untuk melenturkan otot/sendi.
c. Latihan gerak sendi bisa pasif, aktif dibantu
atau aktif tergantung dari kekuatan otot.d. Latihan untuk meningkatkan kekuatan otot.
e. Latihan fasilitasi / reedukasi otot
f. Latihan mobilisasi.
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Program Rehabilitasi Medik pada
Penderita Stroke
Fase Lanjut
1. Kemandirian fungsional
dalam mobilisasi dan
2. Aktifitas kegiatan
sehari-hari (AKS)
Waktu penderita secara medistelah stabil
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Terapi Okupasi
Aktifitas kehidupan sehari-
hari/AKS
Sebagian besar penderita stroke dapatmencapai kemandirian dalam AKS.
Dengan alat bantu yang disesuaikan,
AKS dengan menggunakan satu tangan
dapat dikerjakan secara mandiri .
Kemandirian dapat dipermudah dengan
pemakaian alat-alat yang disesuaikan
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Ortotik
Penderita stroke dapat
menggunakan alat bantu atau alat
ganti dalam membantu transfer dan
ambulasi penderita.
Alat-alat yang sering digunakan
antara lain : arm sling, hand sling,
walker, wheel chair, knee back slap,,cock-up splint, ankle foot orthotic
(AFO).
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Stroke
Terapi BicaraPenderita stroke bicara dan komunikasi dan menelan.
1. Latihan pernapasan ( pre speech training )
berupa latihan napas, menelan, meniup,latihan gerak bibir, lidah dan tenggorokan.
2. Latihan di depan cermin untuk
latihan gerakan lidah, bibir dan
mengucapkan kata-kata.3. Latihan pada penderita disartria lebih ditekankan
kepada artikulasi mengucapkan kata-kata.
4. Pelaksana terapi adalah tim rehab medik dan keluarga.