REHABILITASI MEDIK PADA LANJUT USIA

Dr. Nasyaruddin Herry Taufik SpRM

REHABILITATION MEDICINE :
Is a branch of Medicine concerning with the comprehensive management of disability arising from disease or injury of Neuromusculoskeletal and Cardio-Respiratory systems and the Psycho-Socio-Vocational disruptions concomitant with them

1. 2.

IMPAIRMENT DISABILITY

3.

HANDICAP

: nyeri yang sangat mengganggu : tidak mampu melakukan kegiatan seperti situasi orang normal : tidak mampu berinteraksi dengan lingkungannya

REHABILITASI MEDIK

PROMOTIF

PREVENTIF

KURATIF

REHABILITATIF

AGING BODY

Rehabilitation Management of Common Neuromusculoskeletal Condition Lansia

WHO UU No.13 thn.1998 > 60 tahun

Organ Tubuh

MUSCLE

Sarcopenia

The age-related loss in skeletal muscle mass

Increases fat and Connective tissue Infiltration fat & CT within older muscle. Muscle Fiber

Tipe I slow twitch Tipe II fast twitch

Result
Decrease muscle mass Fiber type Motor neuron Loss in muscle strength

result

Change basal metabolic rate Altered thermoregulation Impaired glucose metabolism Skeletal health

OSTEOPOROSIS

The Silent Disease

NORMAL

OSTEOPOROSIS

Angka kejadian
Amerika - 44 juta - 10 juta - 34 juta Indonesia

Osteoporosis Hampir Resiko tinggi

10% -15 % usia > 60 thn

Apakah Dampak Osteoporosis ?

Kerusakan permanen mikro arsitektur & berkurangnya massa tulang Uni Eropa.. Patah tulang tjd tiap 30 jam Biaya rumah sakit 23 billion euros / thn Amerika .. Pt.tlg > 1.5 juta / thn Masalah kesehatan terbesar ke 2 pd wanita , setelah ca payudara

Osteoporosis adalah masalah Lansia Wanita menopause lebih banyak terkena Silent Disease Deteksi dini Penanggulangannya

Sifat khas dengan massa tulang rendah Perubahan mikroarsitektur Penurunan kualitas jaringan tulang

Resiko Mudah Patah Tulang

Tulang normal merupakan jaringan yg bertumbuh

Sel2 tulang Pemb. Darah kristal calsium & phosfat

Jenis Osteoporosis
Primer tipe 1 : Wanita menopause tipe 2 : Pertambahan usia Sekunder Penyakit tulang yg bersifat erosif Obat-obatan Idiopatik Wanita pra-menopause Pria dewasa muda/ paruh baya

Faktor resiko / penyebab

Lifestyle / Environmental Factors - Calcium deficient diets over a lifetime - Lack of exercise, immobility, sedentary - Excess alcohol intake - Cigarette smoking - Caffeine abuse (excessive phosphate? e.g. soda) - Vitamin D deficiency, lack of sunlight exposure (elderly)

Normal

Osteoporosis

Gambaran Klinis
Tidak khas
Perlu waspada bila ada

Nyeri tulang Patah tulang akibat trauma ringan Tinggi tubuh berkurang Masa menopause

Bone remodeling

Bertanggung jawab pada kekuatan tulang Di pengaruhi oleh banyak faktor (resiko) Osteoklast = Osteoblast Osteoporosis osteoklast >>> osteoblast

Kebutuhan kalsium per hari

Bayi : 300 400 mg Anak : 500 mg Remaja : 600 700 mg Dewasa : 500 - 800 mg Hamil & menyusui : 900 1200 mg

Kalsium

Fungsi :

- jantung - saraf - massa tulang ( cadangan Ca )

Loss : Kulit, kuku,rambut, keringat Kekurangan kalsium akan diambil dari massa tulang tulang keropos

Fracture
Vertebrae Pelvis-caput-

collum femurl Wrist

Diagnosa
Tanda / gejala Tulang patah tanpa sebab berarti Nyeri belakang berulang Perubahan postur X-Rays Bone Densitometry

Senam Osteoporosis

sederhana mudah aman menyenangkan indah mengikuti kaidah ilmiah

Pencegahan
Pola aktivitas sehari-hari (ADL) : - berjalan - naik turun tangga - mengangkat beban dengan benar - pembentukan postur - hindari jatuh Latihan Fisik : - berjalan, bersepeda, berenang - senam pencegahan osteoporosis

Latihan Pencegahan Ostepororosis

Latihan isotonik (dinamik), isometrik (statik) dan berulang. Aerobic low impact : - pemanasan - peregangan - ketahanan - pembebanan - pendinginan

Prinsip dasar program latihan

Prinsip Spesifisitas Prinsip Progresivitas Prinsip Reversibililitas Prinsip Nilai Awal Prinsip Batas Biologis.

HARI TUA

Degeneration of the articular cartilage characterized by pathological changes in hyalin cartilage, bone, and tissues around the joint, including synovial fluid, ligament, joint capsule.

Normal cartilage

Osteoarthritic cartilage

Cells Chondrocytes produce

Matrix (collagen & proteoglycans) Enzymes responsible for synthesis & degradation 1%-10% of cartilage volume Do not multiply in normal adult cartilage Tangential zone flat pararell to the surface transitional zone randomly arranged radial zone short columns perpendicular to the surface calcified zone pyknotic

The Structure and Composition of Articular Cartilage

The Chondrocytes and Molecules arrangement of Articular Cartilage

Water Magnet
Proteoglycan

Load

H2O H2O

Hyaluronic acid Type II Collagen

MATRIX

1. Collagen 50% of the dry 2. Proteoglycans 3. Water 70%

weight

Synovium & Synovial fluid

Cells: Type a: macrophage like cells Type b: fibroblast-like cells proteinase, collagenase hyaluronic acid, prostaglandin synovial fluid non newtonian characteristic

Anatomy of Normal Knee

In normal knee : mechanical ~ anatomical axis WB point : medial plateau+2 cm WB distribution : 70% medial plateau 30% lateral plateau

Radiographic changes:

1. Joint space narrowing

2. Subchondral bony sclerosis

3. Marginal osteophytes

4. Subchondral cystic lesion.

5. Deformity

Radiographic changes on OA

Note: X-ray changes may not bear any relationship to clinical feature.

Treatment of arthritis

Medicamentosa Analgetik Local steroid NSAID Chondrocyte enz inhibitors Hyaluronat acid Vit C Vit D

Rehabilitation

Rest Non- Farmacy

Reduce pain

ROM Exercise Gait training

Strengthening

Isometric Isotonic Isokinetic

Endurance Balance

Static / dynamic

Agility

Modalities

SWD MWD Ultrasound Laser TENS Hydroterapi Cool Tx.

Orthotic

Splint Brace Shoes corection m