December 12, 2012

NEBULIZER

Posted in Health at 2:42 am by Edwin

Nebulizer

Nebulizer adalah alat yang dapat mengubah obat yang berbentuk larutan menjadi aerosol secara terus- menerus dengan tenaga yang berasal dari udara yang dipadatkan atau gelombang ultrasonik.
1. Tujuan pemberian Nebulizer
Untuk mengurangi sesak pada penderita asma, untuk mengencerkan dahak, bronkospasme berkurang/ menghilang.
2. obat-obat Nebulizer:
Pulmicort: kombinasi anti radang dengan obat yang melonggarkan saluran napas
Nacl : mengencerkan dahak
Bisolvon cair : mengencerkan dahak
Atroven : melonggarkan saluran napas
Berotex : melonggarkan saluran napas
Inflamid :untuk anti radang
Combiven : kombinasi untuk melonggarkan saluran napas
Meptin : melonggarkan saluran napas.

Kombinasi yang dianjurkan:
* Bisolvon-Berotec-Nacl
* Pulmicort-Nacl
* Combivent-Nacl
* Atroven-Bisolvon-Nacl
2. Indikasi dan kontraindikasi Nebulizer:

* Indikasi Nebulizer:
Untuk penderita asma, sesak napas kronik, batuk, pilek, dan gangguan saluran pernapasan.

* Kontraindikasi Nebulizer:
Pada penderita trakeotomi, pada fraktur didaerah hidung.

5. Macam-macam Nebulizer:
* § Nebulizer mini
Adalah alat genggam yang menyemburkan medikasi atau agens pelembab, seperti agans bronkodilator atau mukolitik menjadi partikel mikroskopik dan mengirimkannya kedalam paru-paru ketika pasien menghirup napas.
* § Nebulizer nebulizer jet-aerosol
menggunakan gas bawah tekanan
* § Nebulizer ultrasonik
menggunakan getaran frekuensi-tinggi untuk memecah air atau obat menjadi tetesan atau partikel halus.

6. Cara pemberian Nebulizer
a. Persiapan alat :
1) Tabung oksigen lengkap dengan flowmeter, humidifier
2) Masker Nebulizer
3) Obat yang akan diberikan
4) Spuit 2 cc (sesuai dengan jumlah obat yang diberikan)
5) Alat tulis

b. Persiapan pasien :
* Menjelaskan prosedur yang akan dilakukan
o Menyiapkan lingkungan yang aman untuk klien dan memasang sampiran
c. Langkah- langkah :
* Memberi posisi yang nyaman pada klien
* Mengontrol flowmeter dan humidifier
o § Mencuci tangan
+ Menyambungkan masker nebulizer dengan tabung oksigen k/p dengan selang penghubung
o § Mengontrol apakah selang dan masker berfungsi dengan baik
+ Menghisap obat sesuai instruksi medik dan memasukkannya ke dalam tabung masker nebulizer
o § Memasang masker sesuai wajah klien
o § Mengalirkan oksigen sesuai indikasi medik
o § Mengevaluasi respon klien (pola napas)
o § Merapihkan pasien
o § Cuci tangan
o § Dokumentasi

- Jenis obat dan jumlah liter oksigen yang diberikan
– Waktu pemberian
– Reaksi pasien

d. Sikap
* Teliti
* Sabar
* Hati-hati
* Tanggap terhadap reaksi pasien

July 19, 2012

Autism Aquatic Therapy

Posted in physiotherapy tagged at 1:11 am by Edwin

Some have self stimulating behaviors, others have self injuries behaviors, and yet others have no awareness of the danger that going to the deep end may bring.

• Some quickly adapt to the water and find immediate joy in being immersed • Others are clingy due to unfamiliarity with the new environment, yet willing to try given a little coaxing from their therapist and parents.

• Other present with extreme fear, either due to a traumatic experience (e.g.; previously got thrown in the pool) or to a severe sensory processing issue such as gravitation insecurity.

• All have sensory processing issues that have either been successfully or unsuccessfully addressed by land based therapies

Purposeful activities in the water have many physical, psychological, sensory, cognitive, and react ional benefits.

1. The health benefits of engaging in water activities include improvement in strength endurance, coordination, balance.

2. It develops a positive mental attitude and promotes self-esteem, preparing the child to successfully engage in interpersonal relations.

3. It calms the child’s sensory system (e.g.; reducing hyperactivity, decreasing tactile sensitivity, decreasing self stimulatory behaviors and repetitive behaviors) so that he can cope with everyday demands.

Example: A boy ; not communicate, had feeding problem, presented with self injuries behaviors (such as biting himself, pinching and slapping), poor attention span and impulse control were a hindrance to learning basic concepts and communication skills.

Upon first engaging in AT, he was hesitant, fearful, and in fact threw several temper tantrums. After a few sessions, his speech therapist noted a decrease in aggressive behaviors towards himself and others, an improvement in his focusing abilities, and a remarkable improvement in his ability to communicate. Furthermore, he learned how to do proper strokes by watching the therapist’s demonstration.

4. It improves the child work behaviors (attention span, concentration, ability to follow instruction, etc) thereby making a more reception learner.

5. By engaging in regular recreational activities in the water, children can have a fun activity to lock forward to. 6. Lifestyles disease, such as high cholesterol, obesity and diabetes can be avoided.

June 5, 2012

Knowing Your Feet

Posted in physiotherapy, Uncategorized tagged at 6:46 am by Edwin

A car performs poorly when its springs have metal fatigue or its shock absorbers are worn-out.This results in an uncomfortable ride, tires that wear unevenly, and, eventually, structural damage involving the suspension, engine mounts and frame. A car’s springs/ shocks don’t repair themselves. The damage
will continue unless the springs/ shocks are supplemented or replaced. The arches of a person’s feet are their springs/shocks. They, too, need periodic inspection andmaintenance.Just as the balance and the ride of a loaded automobile depend upon its suspension, the standing body relies upon the strength and integrity of its foot arches for its balance and alignment.

Role of Arches

Normal foot arches are strong and springy. They hold the shape of the foot, balance the body and acts as shock absorbers. The long arch raises and tilts the inside of the foot to ensure proper body balance over the center of the foot, while the side ways arch stabilizes the front of the foot and prevents the toe bones from rubbing.

Arch structure is genetic. Although arch-related problems are more common in people with low arches, they frequently develop in people with normal or high arches depending upon how they are used. Movements muscle of shins, thighs, hips and back normally only fine-tune balance. If arches sag or go flat, they must hold the body in balance over the feet as well as perform their regular work. As a result, they become strained and prone to injury. Common Types of Arch-related problems include:

Foot pain

The foot bones are held in their arched shape by a webbed strapping. When the strapping tears under the heel, pain and inflammation results (plantar fascitis).Healing occurs at night. Re-tearing comes with getting up or with extra hard usage. Repeated tearing and healing create heel spurs.

Ankle Sprain

When arches low and fat, the ankle ligaments are stretched and become vulnerable to tearing (sprain). Meanwhile, the overactive shin muscles cause the foot to twist (to be continue)

August 2, 2011

THE ROLE OF SPINDLE AND GOLGI TENDON ORGAN

Posted in physiotherapy tagged at 2:56 am by Edwin

SKELETAL MUSCLE ACTIVATION, α & γ CO-ACTIVATION

Sensory Mechanism To Muscle Activation

Introduction

Neural control skeletal muscle are control by motor neuron which lie beneth in spinal cord and axons in motor nerves. They get sensory feedback from muscles and tendon to work. The proprioceptors are sensors that provide information to muscles and tendons about joint angle, muscle length and tension, which is integrated to give information about the position of limb.

Muscle spindle is types of proprioceptor that provide information about changes in muscle length and for a finer limb control (if there’s more spindles). Therefore muscle spindles has significant role to provide proprioceptive feedback for the movement, position and extension of muscles. Meanwhile golgi tendon organ is types of propriocetor that give information about changes in muscle tension (monitorize tension of the muscle).Golgi tendon organ located in muscle tendon, has a simple anatomy, sensitive to tension in tendon, and signal force produced from muscle. Muscle spindles are small sensory reseptors that are enclose within a capsule in belly of the muscle. Its contain specialized muscle cells and sensory and motor nerve ending.

Muscle spindles convey information to the central nervous system via sensory neuron. The respones of muscle spindles to changes in length also play an important role in regulating the contraction of muscle.

Muscle spindles are encapsulated by connective tissue, and are aligned parallel is extrafusal muscle fibers (all the remaining regular skeletal muscle cells in the muscle). Within a muscle spindle there are several small, specialized muscle fibers known as intrafusal fibers (Muscle cells inside the muscle spindle). Intrafusal muscle fibers are innervated and activated by efferent neuron known as gamma motor neurons. Axons of gamma motor neurons terminate in muscle spindles, and then gamma motor neurons make synapses at both of the ends of the intrafusal muscle fibers and regulate the sensitivity of the sensory afferents which are located in the non-contractile central region.

The role of gamma motor neurons is to maintain and enhance muscle spindles sensitivity, regardless of muscle length. Gamma motor neurons also tighten the spindles and maintain muscle tone. Gamma motor neurons also regulate the gain of the stretch reflex by adjusting the level of tension in the intrafusal muscle fibers of the muscle spindle. The function of the gamma motor neurons is not to supplement the force of muscle contraction provided by the extrafusal fibers, but to modify the sensitivity of the muscle spindle sensory afferents to stretch.

While intrafusal motor neurons is innervated by gamma motor neuron, the efferents that innervate extrafusal fibers are known as alpha motor neurons. The connection between the alpha motor neurons and extrafusal muscle fiber is called as a neuromuscular junction.

Anatomically extrafusal fiber is more bigger and numerous than intrafusal fiber its due to muscle contraction. The contraction muscle is promoted by alpha motor neuron. Therefore, the main job or role of alpha motor neuron is to contracting the muscle.

An alpha motor neuron and the muscle fibers it innervates is a motor unit. This motor unit contains the cell bodies of all the alpha motor neurons involved in contracting a single muscle. Alpha motor neuron lies beneath in brainstem and spinal cord.

Most of alpha motor neurons lies in the spinal cord due to brainstem only innervated muscle in the head and neck only, meanwhile alpha motor neurons that innervated by spinal cord are the remaining the rest of the body. In spinal cord, alpha motor neurons located in the grey matter that forms the ventral horn. These alpha motor neurons provide the motor component of the spinal nerves that innervate muscles of the body.

Alpha motor neurons pathways is not cross section, therefore it means the stimulus from one side of brainstem or spinal cord innervate muscle in the same side of body. Like another neurons, alpha motor neuron have both afferent (incoming input) and efferent (outgoing input) connections.

Alpha motor neuron recieve input from many sources, including upper motor neuron, sensory neurons and interneurons. Upper motor neurons send input to alpha motor neurons via several pathways, including corticospinal tracts and rubrospinal tracts. These tracts are commonly encountered in studies of upper motor neurons and lower motor neurons connectivity in the control of voluntary movements. The sensory input to alpha motor neurons is extensive and has its origin in golgi tendon organs, muscle spindles and other sensory neurons in the periphery. These connections provide the structure for the neural circuits that lie beneath reflexes.

The most extensive input to alpha motor neurons is from interneurons, which are the most nemurous type of neuron in the spinal cord. Among their roles, interneurons synapse on alpha motor neurons to create more complex reflex circuitry.

In the meantime the output of alpha motor neurons (Efferent) send fibers that mainly synapses on extrafusal muscle fiber. Other fibers from alpha motor neurons synapse on Renshaw cells, which role is inhibitory interneurons that synapse on the alpha motor neuron and limit its activity in order to prevent muscle damage. This afferent and efferent connectivity is required to achieve coordinated muscle activity.

The effects of damage or injury in alpha motor neurons is paralysis. It happened due to the alpha motor neurons provide the only voluntary innervation to extrafusal muscle fibers. Losing of alpha motor neurons effectively severs the connection between the brainstem and spinal cord and the muscle they innervate. Without this connection voluntary and involuntary ( reflex) muscle control is impossible.

Voluntary muscle control is lost because alpha motor neurons relay voluntary signals from upper motor neurons to muscle fibers. Meanwhile loss of involuntary control results from interruption of reflex circuits.

A consequence of reflex interruption is that muscle tone is reduced, resulting in flaccid paresis. Another consequences is the depression of deep tendon reflexes, which causing hyporeflexia. Muscle weakness and muscle atrophy also consequences of alpha motor neuron lesion as well. Its due to muscle size and strength are related to the extent of their use, denervated muscles are prone to atrophy.

A secondary cause of muscle atrophy is that denervated muscles are no longer supplied with alpha motor neuron that suppose to innervate them. In condition muscle has contraction actively (produced by activating alpha motor neurons only) the intrafusal muscle fibers go slack and both sensory neurons ( I and II) stop discharging or decrease firing, and it’s not very useful. Mean while if gamma motor neurons (motor neurons that innervate only muscle spindles) are activated at the same time as alpha motor neurons, the intrafusal fiber will takes up slack and the muscle spindles becomes taut, and it will adjust muscle spindle sensitivity to muscle length. its due to intrafusal muscle fibers are in paralel with extrafusal muscle fibers. This active muscle contraction mechanism called as alpha – gamma coactivation (Extrafusal fibers have been stimulated to contract by alpha motor neurons activation (produces the force for movements), the gamma motor neuron is simultaneously excited). In alpha-gamma coactivation, the gamma motor neurons stimulates contraction in the two ends of the intrafusal fiber, readjusting its length and keeping the central of the intrafusal fiber taut, which is necessary to keep the muscle spindle afferent responsive. Thus alpha-gamma coactivation forms a mechanism for telling the diffrence between desired position or movement (set by gamma activity) and actual position or movement, if you move your arm or leg with regular muscle cell and spindle muscle cells contracting at the same rate, you can tell if you encounter an obstacle or pertubration it depends on your environment.

The golgi organ or golgi tendon organ is a proprioceptive sensory receptor organ that is located at the insertion of skeletal muscle fibers into the tendons of skeletal muscle. The Golgi tendon organ is an elongated encapsulated structure where the extrafusal muscle fibers are attached to the collagen fibers of the organ. The golgi tendon organ provides the sensory component of the golgi tendon reflex.

The sensory dendrites of the golgi tendon organ afferent are interwoven with collagen fibrils in the tendon. Each golgii tendon organ is innervated bay a single myelinated axon, that becomes unmyelinated after it penetrates the tendon organ. There is no efferent connection from the CNS to the tendon organ. When the muscle contracts, the collagen fibrils are pulled tight, and this actives golgi tendon organ afferent, changes in muscle tension will provide different degree of pull on the tendon so that the golgi tendon organ provides information about muscle tension. So when we think that muscle which stretch would also pull on the tendons and stimulate the golgi tendon organ afferent, unfortunately it false, the truth is when we stretch the muscle , most of the force is absorbed by the muscle itself, so a muscle contraction is a much better stimulus for the golgi tendon organ.

In stroke condition theres many circumstances that happend with muscle activation. Its resulting from a lesion of the upper motor neurone in terms of an interference of normal postural control. In this circumstances we are dealing with abnormal condition of motor patterns of coordination in which the patterns of normal and abnormal postural control against gravity. Sherington (1947) states that normal movements need a background of normal tonus. It has to be of moderete intensity, not to high as to interfere movement, but high enough to make movement against gravity possible. Therefore the role of muscles spindle and golgi tendon organ in active muscle activation has significant role in interfere normal movement.

The abnormal types of postural tone and the stereotyped total motor patterns we see in our patients are the result of disinhibition (release of lower patterns of activity from higher inhibitory control). Its has shown that spasticity is due to a release of a facilitory centre within the reticular substance of the brain stem acting on the gamma motor neurons system from higher inhibitory control. Flaccidity, on the other hand, is due to excessive inhibition of gamma activity from the cerebellum with lack of postural tone against gravity (Magoun and Rhines (1946, 1948)).

The brain damaged patient suffer from a lack of inhibitory contol over his movements. This shows itself in the release of tonic reflex activity. As a result of his brain damage, is more or less dominated by his released abnormal reflex activity which interferes with normal activity. This lack of inhibitory will result or affect the patient so that the tonus will increase and it will come spasticity. Spasticity are seen to be lengthening and shorthening reactions, thie view has been supported by the discovery of the dual innervation of muscle; alpha motor system and gamma motor system.

Spasticity is now considered to be due to the release of the gamma motor neurons system and very rarely the alpha motor neurons system, from higher inhibitory control. Spasticity often associated with exaggerated tendon jerks, and is often accomponied by abnormal cutaneus and autonomic reflexes, muscle weakness, lack of dexterity, and co-contraction of agonist and antagonist muscles. Beside the importance role of inhibition in muscle activation there is one more that interfere normal motor activity, its reciprocal innervation.

Resiprocal innervation provides for the control of agonist and antagonist muscles. Reciprocal innervations describe skeletal muscles as existing in antagonistic pairs, with contraction of one muscle producing force opposite to those generated by contraction of the other. In order to reach optimum efficiency, contraction of opposing muscles must be inhibited while muscles with the desired action are excited.the reciprocal innervation occurs so that the contraction of a muscle results in the simultaneous relaxation of its corresponding antagonist.

Based on all explanation above muscle spindles and golgi tendon organ are often work together to make muscle activation. Muscle spindles work to make tension and contraction meanwhile golgi tendon organ make an inhibition to muscle contraction so that the muscle can adjust with the stimulus and adapted with the environment. Thus, both types of proprioceptor have complementary function in informing the CNS bout the mechanical status of the muscle at any given point or period of time. The golgi tendon organ provides afferent input regarding muscle tension. It also enables the organism to compensate for muscle fatigue by adjusting the motor effort apllied. The spindle is important for psture, since the length of the muscle will vary with the angle of the joint it is acting on, thus enabling the CNS to be aware to relative limb segment position. Meanwhile the difference between the nature of the response of the spindles and tendon organs can be explained in terms of the diffrent anatomical arrengement of the two proprioceptors. Spindles are arranged in paralel with extrafusal muscle fiber. Whereas tendon organs arearranged in series with the extrafusal fibers. Also, the collagen fibers of the tendon organ are less elastic than the intrafusal fiber spindles. Therfore the muscle fibers take up most of the stretch exerted. On the other hand, when the muscle fibers contract, they pull on the tendons directly. In case stroke patient which have spasticity in their limb, the work of muscle spindle that involve alpha motor neurons and gamma motor neurons and so golgi tendon organ are not activated meaningfully. So that there must be a stimulus in movement in affected limb. The movement must be selective and each movement facilitated must be recognize by muscle spindle and golgi tendon organ.

References

Adult in hemiplegia Wikipedia Encyclopedia

Selzer. Michael E, Clarke. Stephanie, Cohen. Leonardo ; Textbook of Neural Repair and Rehabilitation, Volume II Medical Neurorehabilitation, 2006, Cambridge University

Latash. Mark L, Lesstiene. Francis,Motor Control and Learning, 2006, Springer Montgomery.

Patricia, Connolly. Barbara, Clinical Applications for Motor Control, 2003, Slack Incorporated

January 4, 2011

Aquatic Therapy/Hydrotherapy Home Care Private Practice

Posted in physiotherapy tagged at 3:04 am by Edwin

Aquatic therapy/ Hydrotherapy merupakan salah satu cabang fisioterapi yang berfokus pada media air sebagai modalitas terapinya. Dengan dibantu oleh media air fase latihan pada orang sakit atau orang sehat dengan tujuan yang ingin dicapai dapat di fascilitasi sehingga tercapai hasil yang maksimal dengan menghindarkan nyeri yang berlebihan.

Aquatic therapy dapat membantu:

  • meningkatakan dan mempertahankan kekuatan otot
  • meningkatkan dan mempertahanakan fleksibilitas otot
  • membantu meningkatakan koordinasi, keseimbangan postur
  • membantu dan menjaga lingkup gerak sendi
  • meringankan latihan atau proses gerak
  • meningkatkan endurance kardiovasculer,dll

keluhan keluhan yang dapat dibantu oleh Aquatic tehrapy:

  • Sakit leher
  • sakit pinggang bawah
  • sakit bahu
  • sakit lutut
  • cedera tulang belakang
  • stroke
  • cerbral palsy

Bila anda memerlukan terapi ini anda dapat menghubungi:

lennez_oddz@yahoo.com/08129375199

alat bantu yang diperlukan sudah disediakan, anda tinggal mencari kolamrenang yang cocok buat anda untuk melakukan latihan.

syarat kolam renang:

  • Sarana pendukung keselamatan yang lengkap
  • Ada kedalaman 1/2 meter
  • Ada kedalaman 1 meter -1,5 meter
  • Ada kedalaman 2 meter lebih

November 12, 2010

Shoulder Test for PT

Posted in physiotherapy tagged at 6:35 am by Edwin

To test specifically for an anterior impingement syndrome The Neer test is performed by internally rotating and passively flexing the patient’s shoulder while keeping the arm inthe scapular plane . This maneuver reduces the space between the acromion and greater tuberosity and may elicit pain in rotator cuff tendonitis. Pain is typically elicited at greater than 90° of flexion.

In the Yocum test, the patient’s shoulder is abducted to 90°, and the elbow is flexed to about 60°. Using the hand and elbow as a fulcrum, the arm is forcibly put into internal rotation (Photo 12). This maneuver jams the supraspinatus tendon into the anterior surface of the coracoacromial ligament and acromion process. Pain is elicited in supraspinatus tendonitis.

When bicipital tendonitis is suspected, Speed’s test is performed. In this test, the patient is instructed to supinate the arm, and the examiner resists the patient’s shoulder flexion. The test is repeated with thepatient’s elbow flexed to 90° (Photo 13). The test is positive when pain is elicited in the bicipital groove

To test more specifically for a SLAP lesion, and to differentiate it from an AC joint injury, the O’Brien test is performed. In this test, the patient stands with the shoulder flexed to 90° and the elbow in full extension. The patient’s shoulder is then put into 10–15° of adduction. With the patient’s hand supinated, the examiner puts an inferiorly directed force on the patient’s hand. The patient is then instructed tofully pronate the hand (such that the thumbs are pointing own) andthe examiner again places an inferiorly directed force onto the patient’s forearm (Photo 15). When the maneuver elicits pain insidethe shoulder when the hand is in supination, but not when the hand is in pronation, a SLAP lesion is suspected. However, this maneuveralso stresses the AC joint. Therefore, if this maneuver elicits pain in the AC joint, pathology should be suspected in the AC joint and not in the labrum.

High Heel Effect

Posted in physiotherapy tagged at 6:15 am by Edwin

Sepatu ber-hak tinggi merupakan salah satu perlengkapan kewajiban wanita sebagai bagian dari berbusana ke kantor. Selain sebagai perlengkapan berbusana, sepatu ber-hak tinggi juga dapat menimbulkan kepercayaan diri (self-confidence) bagi seseorang wanita dalam performanya ke kantor. Anda mungkin tidak menyadari efek buruk dari pemakaian sepatu ber-hak tinggi untuk para wanita. Walaupun berakibat dalam jangka panjang, hal-hal ini akan berakibat pada sistem kerja tubuh sehari-hari.

Sistem kerja otot otot tubuh manusia sangat berhubungan satu sama lain, bilamana salah satu group otot ada yang tidak baik fungsi kerjanya, group otot yang lain pasti akan menyokong fungsi kerja tersebut. Hal ini begitu juga terjadi pada otot otot kaki anda. Dalam kasus pemakaian sepatu hak tinggi, otot otot yang terlibat sebagai penopong adalah otot paha, lutut, otot betis dan terutama otot-otot dan tulang pada kaki. Semakin tinggi hak yang anda kenakan semakin tinggi pula tekanan yang akan didapatkan pada otot otot kaki.

Efek buruk yang diakibatkan oleh sepatu ber-hak tinggi anatara lain pada bagian:

Tulang Punggung(Posture)
Pemakaian hak tinggi akan berpengaruh pada postur dalam jangka panjang. Perubahan yang akan terjadi terutama pada bagian pinggang bawah yang mana tulang pinggang akan mengalami peningkatan derajat kurva kelengkungan (Hyperlordosis) yang berakibat kakunya otot otot pinggang dan berkurangnya flexibilitas otot otot tersebut yang pastinya akan menyebabkan sakit pinggang berkepanjangan..

Lutut
Lutut sangat berperan dalam menampung berat badan tubuh selain tulang punggung. Pusat titik berat gravitasi pada manusia berada pada ruas pinggang ke-2 dan ke 3 dan lutut. Bila anda memakai sepatu ber-hak tinggi akan berakibat melencengnya titik gravitasi tersebut. Sehingga yang seharusnya tidak terlalu penuh untuk menampung berat badan, lutut anda akan bekerja extra 2x lipat. Semakin mobile anda dalam bekerja semakin besar pula kerja otot-otot tungkai bawah anda.

R.I.C.E PRINCIPLES

Posted in physiotherapy tagged at 12:54 am by Edwin

RICE principles atau prinsip RICE dikenal sebagai prinsip penanganan cedera pertama kali pada cedera olahraga atau cedera aktifitas yang berakibat pada gejala objektif yang dirasakan dan perlu penanganan prinsip RICE. RICE merupakan kepanjangan dari Rest (Istirahat), Ice (Es), Compression (Kompres) dan Elevation (Elevasi). Komponen RICE mempunyai peranan masing – masing karena mempunyai fungsi tertentu sehingga saling melengkapi untuk penanganan cedera. Penanganan cedera pada masa dini sangat signifikan fungsinya sebagai faktor penentu lamanya proses kesembuhan penderita cedera. Apabila ada tindakan pertama yang salah dalam penanganan cedera, hal itu akan berefek pada lama dan proses penyembuhan cedera tersebut. Untuk itu prinsip RICE ini sangat berperan dalam segala macam penanganan cedera, apakah itu cedera olahraga, cedera pekerjaan ataupun cedera aktifitas keseharian. Berikut penjabaran komponen komponen dari prinsip RICE Rest (Istirahat)

Komponen pertama dari RICE adalah rest (istirahat) yang mempunyai arti mengistirahatkan fungsi bagian extremitas yang cedera untuk meminimalkan cedera ataupun penambahan cedera. Agar seseorang penderita cedera tidak bertambah keluhannya, anjuran yang disarankan adalah istirahat. Istirahat sangat berarti untuk menghimpun tenaga ataupun mengistirahatkan tubuh. Istirahat akan meminimalkan nyeri yang di derita, mengurangi pembengkakan, menghindari gerakan yang tidak diperbolehkan dan menjaga sistem otot (muscular), sendi dan rangka (tulang), yang terlibat. Rest dapat diaplikasikan dengan cara splint (lengan), berbaring (punggung), tidur dan lebih jelasnya tidak melakukan kegiatan yang melibatkan bagian yang cedera terlebih dahulu. Ice (Es)

Komponen kedua dari RICE adalah Ice atau Es. Pemakaian medium es sebagai salah satu penanganan dari prinsip RICE adalah sangat mutlak peranannya. Penggunaan es sangat diperlukan saat cedera terjadi karena saat cedera terjadi pembengkakan atau rusaknya pembuluh darah pasti terjadi, dan penanganan yang tepat adalah dengan es. Es dapat mengurangi terjadinya pembengkakan dan meluasnya kerusakan jaringan yang berlebih. Selain mengurangi pembengkakan dan menghindari kerusakan yang berlebih medium es juga dapat mengurangi nyeri untuk sementara. Es dapat mengurangi nyeri karena es bersifat analgetik bila dipakaikan ke bagian tubuh secara kontak langsung yang mana jaringan yang dipakaikan akan menjadi tebal (seperti di bius atau di anasthesi). Pengecualian pemakaian medium es adalah bila adanya luka terbuka pada cedera. Pengaplikasian cara ini dapat dengan cara kompres es (kontak langsung – tidak lebih dari 10 menit) atau dengan cloride ethyl spray (vapocoolant spray). Compression (Kompres)

Komponen ketiga dari RICE adalah Compression/kompresi. Kompresi merupakan tindakan pembalutan bagian yang cedera dengan alat perban atau bandage untuk menghindari penumpukan cairan yang disebabkan oleh pembengkakan. Selain untuk menghindari pembengkakan metode kompresi dapat juga sebagai penyangga atau peng-fiksasi gerakan extremitas yang cedera agar tidak bergerak sehingga tidak meluasnya jaringan yang rusak karena cedera. Elevation (Elevasi)

Komponen ke empat dari RICE adalah Elevation/Elevasi. Elevasi merupakan komponen terakhir yang berfungsi atau mempunyai tujuan sebagai fasilitator suplai darah melalui pembuluh darah balik (vena) dari extremitas (lengan atau tungkai) ke arah jantung. Pembengkakan di extremitas biasanya terjadi kerena tidak lancarnya pembuluh darah balik tersebut. Untuk mengurangi pembengkakan atau menghindari pembengkakan yang lama untuk itu dilakukan elevasi extremitas. Elevasi mempunyai arti meninggikan posisi atau mengubah posisi ke yang lebih tinggi dari posisi jantung sehingga terjadi aliran kebawah yang akan memfasilitasi pembuluh darah balik dalam bekerja.

July 9, 2010

Scoliosis

Posted in physiotherapy tagged at 1:17 am by Edwin

Scoliosis adalah suatu kelainan keadaan tulang belakang yang tidak normal dimana ada perubahan pada struktur kurva dari tulang belakang ke arah samping. Perubahan ini banyak berkembang pada masa kanak kanak, yang berakibat berubahnya struktur dari tulang belakang menjadi tidak normal. Scoliosis, bila mana tidak terdeteksi atau diobati selama fase perkembangan akan berakibat sangat buruk, lebih drastis akan mengurangi harapan hidup seseorang.

Berdasarkan faktor penyebabnya scoliosis terbagi menjadi 2 yaitu, scoliosis structural dan scoliosis non-structural. Scolisis struktural merupakan scoliosis yang terbentuk dari lahir atau faktor kelainan bawaan (genetic). Sedangkan scoliosis non-structural merupakan scolisosis yang terbentuk karena pengaruh posisi dari postur tubuh atau kebiasaan (habitual).

Beberapa gejala yang ditimbulkan scolosis

  • Kedua pundak memiliki perbedaan tinggi (salah satu tulang pundak lebih menonjol daripada yang lainnya).
  • Kepala tidak sejajar langsung dengan panggul.
  • Terlihat dinaikkan/tonjolan pinggul atau punggung (disertai sering sakit kepala, kram, kesemutan dan gejala lainnya).
  • Condongnya seluruh bagian tubuh ke satu sisi.
  • Sesak napas
  • Tulang rusuk di ketinggian yang berbeda.
  • Pinggang yang tidak seimbang.
  • Sikap berjalannya miring disebabkan pinggulnya tinggi sebelah
  • Perubahan penampilan atau texture kulit disepanjang tulang belakang.

Beberapa akibat yang akan ditimbulkan scoliosis

  • Deformitas(perubahan bentuk) berat terjadi terutama kalau tidak diterapi selama masa pertumbuhan
  • Memperburuk penampilan secara drastis
  • Gangguan keseimbangan otot seperti nyeri, gampang lelah, kelemahan otot
  • Penyakit sendi degeneratif
  • Gangguan kapasitas paru-jantung terutama pada scoliosis berat
  • Memperpendek umur terutama pada scoliosis berat

Penangananan pada penderita Scolisosis dikategorikan berdasarkan derajat scoliosisnya, yakni:

  • Scolisis ringan: cukup diterapi dengan latihan dan modalitas
  • Scoliosis sedang : selain latihan dan modalitas dianjurkan memakai spinal brace
  • Scoliosis berat : umumnya tidak dapat ditangani dengan latihan dan modalitas dan pemakaian spinal brace, pada stuasi ini penderita memerlukan operasi.

Bedasarkan bentuknya scoliosis dibagi menjadi 2 yakni:

  • Bentuk Kurva C-Panjang, biasa terjadi dari bagian tulang belakang bagian dada sampai pinggang.
  • Bentuk kurva S, paling sering terjadi karena faktor genetic/idhiopathic

Berdasarkan tingkat besarnya derajat kemiringan kurva dari tulang belakang, scolisosis dibagi menjadi 3 yaitu:

  • Mild scoliosis, kurva kemiringan kurang dari 20 derajat, kurva kurang dari 10 derajat dianggap dalam batas normal dan tidak memerlukan pengobatan
  • Modereate scoliosis, kurva kemiringan diantara 20—50 derajat, modereate scoliosis menandakan akan adanya perubahan pada struktur dari tulang belakang dan tulang iga
  • Severe scoliosis, kurva kemiringan lebih dar 50 derajat. Severe scoliosis akan menimbulkan perubahan bentuk yang signifikan dari tulangbelakan dan tulang iga. Pada orang dewasa kurva lebih dari 40 derajat akan menimbulkan kesakitan dan terjadinya penyakit degenerasi sendi tulang belakang dan fungsi paru yangberkurang sehingga terjadi sesak nafas.

Informasi pemeriksaan yang di kira perlu dalam menentukan scoliosis

  • Pemeriksaan fisik

Dalam pemeriksaan ini, akan ditemukan beberapa kelainan pada struktur tulang belakang yang seperti di jabarkan sebelumnya pada gejala yang ditimbulkan.

  • Pemeriksan X-Ray/Rontgen

Pemeriksaan rontgen akan menunjukan struktur kurvatura tulang belakang yang melengkung tergantung dari beratnya scoliosis.

  • Tes fungsi Paru

Pada tes ini akan menujnukan turunnya nilai kapasitas fungsi paru yang biasanya terlihat pada scoliosis modereate (sedang) dan scoliosis severe (berat).

June 10, 2010

Best Health

Posted in Health at 2:15 am by Edwin

Beberapa herbal yang telah diteliti dan terbukti sangat bermanfaat bagi tubuh diantaranya sebagai berikut :
1. Tebu
Kandungan : vitamin B2, Sacharum officinarum
Khasiat : daunnya digunakan untuk menyembuhkan demam, sedangkan sari tetes tebunya digunakan sebagai terapi anti diabetes, meredakan batuk, meredakan panas tinggi, menyembuhkan pegal linu dan mengatasi kerusakan gigi.
2. Singkong
Kandungan : bagian umbi mengandung vitamin (A, B1, C), kalsium, fosfor, protein, lemak, amilum, sedangkan bagian daunnya mengandung Vitamin (A, B17, dan C), Kalsium, Fosfor, Protein, Lemak, Hidrat arang dan Zat besi. Khasiat : dapat mencegah kanker dan tumor.
3. Nangka
Kandungan : bagian buah mengandung albuminoid dan karbohidrat, sedangkan bagian batang banyak mengandung morin, sianomaklurin (zat samak), flavon, tanin.
Khasiat : daunnya digunakan sebagai terapi antidiabetes, sedangkan bijinya sebagai obat batuk.
4. Sawo
Kandungan : bagian kulit banyak terkandung zat tannin, pada bijinya terkandung saponin (senyawa beracun), serta bagian buahnya banyak mengandung kalium, energi, karbohidrat, vitamin (A, C, B6), magnesium serta fosfor.
Khasiat : bagian daun digunakan untuk mengobati demam, serta obat luka dan borok. Bagian bunga mengandung ramuan rempah untuk wanita yang melahirkan, sedangkan bagian kulitnya dapat digunakan sebagai obat diare dan demam.
5. Anggur
Kandungan : Karotenoid dan likopen, mangan, vitamin C, B6, K dan B1, Resveratrol (kemungkinan dapat mencegah kanker). Khasiat : Menjaga kestabilan gula darah, mengatasi kelelahan, mengatasi influenza, membantu mengatasi polio dan herpes.
6. Air Kelapa
Kandungan : nitrogen, fosfor, kalium, kalsium, magnesium dan besi. Khasiat : sebagai oralit alami, penawar racun, memperlancar saluran pencernaan, mengontrol tekanan darah, meningkatkan kekebalan tubuh dan menggantikan cairan tubuh alami.
7. Labu Siam
Kandungan : protein, lemak, kalsium, fosfor dan besi. Khasiat : menurunkan kadar kolesterol serta mencegah hipertensi.
8. Pandan
Kandungan : alkoida, flavonoida, tanin, plifenol serta saponin. Khasiat : daun pandan wangi dapat membunuh larva nyamuk aedes aegypti.
9. Sambiloto
Kandungan : daun dan cabangnya banyak mengandung zat deoksiandrogarafoli d, andrografolid, homoandrofilid, flavonoid, alkane, keton dan damar. Khasiat : sebagai pengontrol darah tinggi, kanker paru, diare, thypus dan kencing nanah.
10. Jeruk Nipis
Kandungan : vitamin c, fosfor, zat besi, hidrat arang, lemak, kalori dan protein. Khasiat : batuk, kelelahan, batu ginjal, bau badan serta diare.
11. Jarak
Kandungan : bagian buah banyak mengandung glikosida, tanin, pitosterol, flavonoid serta steroid sapogenin. Sedangkan pada bagian daunnya terkandung apigenin, vitexin, isovitexin. Khasiat : obat sakit gigi, obat malaria, rematik, dan nyeri otot. Selain itu akar jarak dapat digunakan sebagai penawar racun ular.
12. Arbei
Kandungan : Saponin, Favonoida, Polifenol (berfungsi sebagai antioksidan) , serta Vitamin C
Khasiat : obat sariawan, mengobati maag ( buah dibuat jus lalu diminum), membantu melawan tifus, meringankan gejala diare.
13. Rumput Mutiara
Kandungan : entriacontane, sitisterol-D- glucoside, stigmasterol, ursolic acid, oleanolic acid, Beta-sitosterol, p-coumaric acid, baihuasheshecaosu serta flavonoid glycosides.
Khasiat : radang usus buntu, bisul, sumbatan saluran sperma, pereda demam, tonsilis, gondongan, pneumonia serta infeksi saluran kemih.
14. Serai
Kandungan : mintak atsiri, citronnelal, geraniol, sitral, eugenol, kadine serta kadinol
Khasiat : meringkankan nyeri, batuk dan kelelahan.
15. Kemangi
Kandungan : sitral (penghasil aroma khas pada kemangi).
Khasiat : antiperadangan, mencegah diabetes serta dapat mengurangi bau keringat.

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