c.
d.
BOBATH EXERCISE
(By. Terapi Latihan yang disusun oleh : Suharto, RPT Tahun 2000)
1. PENDAHULUAN
Tehnik Bobath pertama kali ditemukan oleh Bertha Bobath, seorang fisioterapis. Metode ini juga
dikenal dengan sebutan NDT Neoro Developmental Treatment. Tehink ini sering dignakan
pada kasus-kasus gangguan motorik dan keseimbangan akibat post trauma cerebri dan post
immobilisasi lama. Dalam pertumbuhan dan perkembangan motorik dikenal dua terminology, yatu
keterlambatan perkembangan motorik atau motor delay dan kelainan motorik (motorik disorder).
Keterlambatan perkembangan motorik dapat disebabkan oleh kurangnya stimulasi, social emosi,
malnutrisi syndrom down dan microsefalus dan sebagainya.
Dalam metode ini, factor yang sangat penting adalah righting rection dan equilibrium
reaction yaitu penggunaan pola perkembangan motoris yang normal.
2. PRINSIF DASAR METODE BOBATH
a.
Inhibisi.
Inhibisi atau menghambat. Yaitu menghambat pola gerak abnormal atau sikap tubuh abnormal.
Tekniknya disebut juga RIP (Refleks Inhibiting Postur). Dengan mengatur posisi penderita kita
dapat menghambat aktifitas reflex abnormal tertentu, misalnya untuk menghambat spastisitas
ekstensor , kita mengatur posisi anak dalam posisi fleksi.
Fasilitasi.
Teknik ini kita kenal sangat banyak, namun pada saat ini, kita contohkan adalah memberikan
posisi dan gerakan normal.
Stimulasi.
Dari namanya berarti menstimulir atau merangsang daerah tertentu untuk mendapatkan reaksi
atau respon dari penderita. Teknik ini biasanya diberikan pada keadaan placid/hypotonus.
Tekniknya dapat berupa kompressi, tapping, atau stroking. Dalam beberapa kasus sering juga
diberikan goresan-goresan batu es. Dalam perkembangannya ketiga teknik tersebut dapat
dikombinasikan.
Key Point Of Control (KPOC)
KPOC adalah tempat tempat tertentu yang paling efektif untuk memberikan inhibisi, fasilitasi
dan stimulasi. Biasanya sendi proximal, seperti panggul, bahu dan sebagainya. Meskipun yang lain
juga dapat diberikan KPOC.
3.
PEMBAHASAN
Pada Metode Bobath ada beberapa jenis gerakan yang dapat diberikan antara lain:
1)
Reaksi mengangkat/menegakkan.
2)
Reaksi keseimbangan.
Namun
untuk
postingan
kali
ini,
penulis
hanya
akan
membahas
reaksi
mengangkat/menegakkan. Karena pada tahap ini saja sangat banyak gerakan yang perlu
diperhatikan. Oleh karena itu postingan berikutnya kita akan melanjutkan dengan Reaksi
keseimbangan.
1.
REAKSI MENGANGKAT/MENEGAKKAN.
Yakni reaksi yang pertama kali muncul sejak lahir pada usia 10 - 12 bulan. Righting reaction
terdiri dari :
a.
Neck Righting reaction.
Dengan memutar kepala secara aktif atau pasif ke salah satu sisi, dalam posisi terlentang, maka
akan terjadi rotasi seluruh tubuh ke sisi yang sama. Dengan gerakan ini diharapkan anak dapat
melakukan gerakan miring atau rolling secara mandiri.
b.
Labirithine reaction.
Reaksi yang terjadi adalah menegakkan kepala dalam posisi telungkup. Reaksi ini mula-mula
lemah dan makin lama makin kuat, sehingga anak-anak dapat mengangkat kepala mereka
sehingga muka vertical dan mulut horizontal. Reaksi ini timbul pada usia 1 6 bulan.
c.
Reaksi vertibular
Reaksi ini timbul pada saat anak terlentang yakni dengan mengangkat kepala, sehingga dengan
reaksi ini anak dapat mempertahankan kepalanya pada waktu diangkat ke posisi duduk.
d.
e.
Body Rigting reaction.
Reaksi ini terdapat pada usia 6 8 bulan. Merupakan modifikasi dari Neck Righting reaction.
Dengan memutar kepala ke samping diikuti oleh rotasi bahu, kemudian dikuti oleh pelvic atau
sebaliknya. Dengan reaksi ini memungkinkan anak dapat membalikkan badan dari posisi
tengkurap ke posisi terlentang.
f.
CEREBRAL PALSY
LauraRogersandEricWong
Editors:AlexaCaturayandSultanChaudhry
Facultyreviewer:Dr.PeterRosenbaum,Professor,Pediatrics(McMasterUniversity)
Definition
Etiology
Antenatal(~7080%ofcauses)
Prematurity and low birth weight
Infections
Multiple gestation
Perinatal
Postnatal
Non-accidental injury
Head trauma
Meningitis/encephalitis (including cerebral malaria in the developing
world)
Cardiopulmonary arrest
Obstetricalcare(protectivefactors)
Pathophysiology
Arch Dis Child Fetal Neonatal Ed. 2008 Mar;93(2):F153-61.
Pediatric Ophthalmology: Current Thought and a Practical Guide, 1E (Wilson)
Preterminfants
The premature neonatal brain is susceptible to two main
pathologies: intraventricular hemorrhage (IVH) andperiventricular
leukomalacia (PVL). Although both pathologies increase the risk of CP,
PVL is more closely related to CP and is the leading cause in preterm
infants. The term PVL describes white matter in the periventricular region
that is underdeveloped or damaged (leukomalacia). Both IVH and PVL
cause CP because the corticospinal tracts, composed of descending
motor axons, course through the periventricular region.
Intraventricularhemorrhage(IVH)
IVH describes bleeding from the subependymal matrix (the origin of fetal
brain cells) into the ventricles of the brain. The blood vessels around the
ventricles develop late in the third trimester, thus preterm infants have
Periventricularleukomalacia(PVL)
IVH is a risk factor for PVL, but PVL is a separate pathological process. The
pathogenesis of PVL arises from two important factors:
(1) ischemia/hypoxia and (2) infection/inflammation.
Terminfants
Clinicalfeatures
Uppermotorneuron(UMN)
Includes neurons in the brain and spinal cord (central nervous system,
CNS) that control movement of muscles. UMN synapse onto lower motor
neurons at the ventral horn of the spinal cord at the level which the neuron
leaves the cord. Upper motor neurons travel through the pyramidal
tracts (i.e., corticospinal tracts).
UMN lesions can cause positive or negative signs:
o
Positive signs include muscle overactivity and spasticity,
generally due to reduced descending inhibitory signals from the brain.
o
Negative signs include weakness or loss of dexterity, generally
due to reduced descending excitatory signals from the brain.
o
Note that lesions in the extrapyramidal tracts do not cause these
UMN signs. The extrapyramidal tracts link the cerebellum and basal
ganglia with LMN. They function to modulate and refine movement rather
than directly cause movement, unlike the upper motor neurons in the
pyramidal tracts.
o
Spasticity is defined as a velocity-dependent increase in the tonic
stretch reflex. It is characteristic of an UMN lesion where there is
disturbance of the supraspinal excitatory and inhibitory neurons, leading
to a net disinhibition of the spinal reflexes.
Lowermotorneuron(LMN)
ComparisonofUMNandLMNlesionclinicalpresentations
Upper motor neuron lesion
Spasticity
Flaccid paralysis
Increased tone
Hyperactive deep reflexes
Clonus
Babinski sign
Commonclinicalpresentations
Spastic hemiplegia
Affects one side of the body more than the other (though both sides may
be affected).
Upper limb affected more than lower.
Hand preference obvious at an early age.
Delayed walking (18-24 months) with a circumductive gait.
o
Circumductive gait: one leg is stiff and upon stepping it is rotated
away from the body, and then towards it (i.e., a semicircle shape). The
stiffness in the affected leg limits flexion and the patient has to raise the
pelvis to swing the leg out to lift the leg enough to clear the ground.
On exam:
o
Circumductive gait.
o
On affected side:
Babinski sign.
Spastic diplegia
Bilateral spasticity of the limbs with legs more affected than arms.
First clinical signs appear around the time when the child starts to crawl.
o
Commando crawl: the child uses arms in a normal reciprocal
manner but drags legs behind rather than using legs as well.
On exam:
o
Spasticity of the legs.
o
Brisk reflexes.
o
Ankle clonus.
o
Bilateral Babinski sign.
o
Scissoring posture of legs when held in the air supported by the
axillae due to spasticity in the hip adductor muscles.
o
Tiptoe walking.
o
Atrophy and impaired growth of legs in severe cases.
Strongly associated with white matter damage in utero between 20-34
weeks of gestation.
Most common neuropathologic feature is PVL.
Minimal risk of seizure disorder.
Normal intellectual development is common, but many children still have
learning disabilities.
Other deficits in sensory areas, like vision, may be present.
o
o
o
o
Diagnosis
Generalassessment
Functionalassessment
CharacteristicfeaturesofCPbasedonage*
Age
< 6 months
> 6 months
Asymmetric tonic neck reflex: reaches with one hand while the
other is in a fist
> 10 months
Additional tests
Management
Children with CP often have multiple developmental issues that are best
managed by a multidisciplinary team of health care professionals.
Child Development Teams act as excellent liaisons between the
different health care professionals, and are able to provide a structured
program for treatment, suitable to each childs needs.
Health care professionals usually involved in the care of children with CP
include:
o
Developmental pediatricians
Prognosis
The use of the GMFCS (in the Ontario Motor Growth Study) has been
shown to be an effective tool in assessing outcomes for individuals with CP.
o
Motor assessments have been used alongside growth charts to
characterize gross motor development over time.
o
These trends can be divided into 5 distinct motor development
curves which children can be categorized into to assist with providing
further prognostic information for parents.
o
Prognosis for motor function depends on the type and severity of
motor impairment.
o
Individuals with CP on average have a life expectancy that is 44%
of normal (this can be applied to countries with varying life expectancy
rates).
o
o