Anak Berkebutuhan Khusus

(ABK)
Presented by Ika Guslanda Bustam, S.Fis., M.Sc
Typical Children
Atypical Children
CEREBRAL PALSY
Presented By Ika Guslanda Bustam, S.Fis., M.Sc
 Cerebral Palsy

1. Muscles are unaffected

2. Brain is unable to send the
appropriate signals necessary to
instruct muscles when to contract
and relax
Cerebral Palsy Affect

• Movement
• Balance
• Posture
• Communicate
• Eat
• Sleep
• Learn
Definisi
• Merupakan suatu kondisi neurologi karena adanya kerusakan pada
otak yang mengakibatkan adanya gangguan yang berakibat pada
gangguan fungsi otak dan syaraf, gangguan pergerakan, gangguan
pendengaran, penglihatan kemampuan belajar dan berfikir, hingga
gangguan sensasi.
Tanda dan Gejala
1. Delays in reaching motor skill milestones, such as rolling over,
sitting up alone, and crawling.
2. Head control yang buruk
3. Variations in muscle tone, such as being too floppy or too stiff
4. Kesulitan berjalan
5. Neurological issues  seizures, blindness, intellectual disability
6. Consistent poor coordination
7. Hiper sensitive pada cahaya
8. Inkontinensia urin
Tanda dan Gejala
10. Scissoring of lower limbs and Toe walking
11. Persistence of primitive reflexes
12. Excessive drooling dan permasalahan saat menelan
13. Delays in speech development dan difficulty speaking
14. Spasticity, or stiff muscles and exaggerated reflexes
15. Ataxia atau lack of muscle coordination
16. Tremor atau involuntary movements
17. Mata  strabismus, gangguan koordinasi
18. Telinga  respon terhadap suara rendah bahkan kurang
Faktor Resiko / Patofisiologi (Masa Prenatal)

• Infeksi selama kehamilan

• Riwayat keluarga
• Terjadi Asphyxia atau
hypoxia baik selama masa
kehamilan maupun saat
proses kelahiran
berlangsung.
• Suplai oksigen ke otak bayi
kurang
Faktor Resiko / Patofisiologi (Masa Perinatal)
1) Letak Sungsang
2) Proses Persalinan Sulit
3) C-section delay
4) Trauma kepala (Forceps and/or
vacuum)
5) Kejang pada saat bayi baru lahir
6) Perdarahan / proteinuria berat
pada saat masa akhir kehamilan
dan atau saat proses kelahiran
7) BBLR
8) Kehamilan ganda
9) Lahir Prematur
Faktor Resiko / Patofisiologi (Masa Postnatal)

1. Apgar score rendah

2. Kejang
3. Persalinan dengan
komplikasi
Klasifikasi CP
• Topography
• Physiological
• Functional
Topographical Classifications
Types based on body parts affected
Location Description
Hemiplegia Upper and lower extremity on one side of body
Diplegia Four extremities,
legs more affected than the arms

Quadriplegia Four extremities plus the trunk, neck and face

Triplegia Both lower extremities and one upper
extremity

Monoplegia One extremity (rare)

Double hemiplegia Four extremities, arms more affected than the
legs
Klasifikasi CP
• Topography
• Physiological
• Functional
Physiological Classifications
 CP Type Spastic

• The commonest neurologic abnormality in CP 70-

80% of all affected
• Increased deep tendon reflexes
• Limb are usually underdeveloped
• Have stiff and jerk or awkward movement (stiff 
knees pulled together and bend  feet often turn
in)
• Flexor posture in upper limb and Extensor posture
in lower limbs
 CP Type Dyskinesia / Dyskinetik

• Jarang hanya sekitar 5% dari CP

• Memiliki Mixed muscle tone
• Postur yang tidak normal, gerakan berulang
• Sisi yang terkena akan mengalami gangguan motoric
halus
• Involuntary movements
• Has two types:
• Athetoid  Slow, continuous involuntary writhing movement
• Choreoathetosis  Rapid and jerky, have a writhing quality,
unpredictable, occur at rest or during normal
 CP Type Ataxic

• Ataxic gait (staggering, wide-based gait)

• Poor Coordination
• Intention tremor
• Hypotonus
• Gangguan pendengeran dan penglihatan
• Gangguan keseimbangan
Klasifikasi CP
• Topography
• Physiological
• Functional
Functional Classification
• Gross Motor Function Classification System (GMFCS)
• Manual Ability Classification System (MACS)
• Bimanual Fine Motor Function Scale (BFMFS)
• Functional Mobility Scale (FMS)
Gross Motor Function Classification System
(GMFCS)

GMFCS Level I
1. Can walk indoors and outdoors
and climb stairs without using
hands for support
2. Can perform usual activities
such as running and jumping
3. Has decreased speed, balance
and coordination.
Gross Motor Function Classification System
(GMFCS)

GMFCS Level II
1. Has the ability to walk indoors
and outdoors and climb stairs
with a railing
2. Has difficulty with uneven
surfaces, inclines or in crowds
3. Has only minimal ability to run
or jump.
Gross Motor Function Classification System
(GMFCS)

GMFCS Level III

1. Walks with assistive mobility
devices indoors and outdoors
on level surfaces
2. May be able to climb stairs
using a railing
3. May propel a manual
wheelchair (may require
assistance for long distances or
uneven surfaces).
Gross Motor Function Classification System
(GMFCS)

GMFCS Level IV
1. Walking ability severely limited
even with assistive devices
2. Uses wheelchairs most of the
time and may propel their own
power wheelchair
3. May participate in standing
transfers.
 Gross Motor Function Classification System
(GMFCS)

GMFCS Level V
1. Has physical impairments that restrict
voluntary control of movement and the
ability to maintain head and neck
position against gravity
2. Is impaired in all areas of motor
function
3. Cannot sit or stand independently, even
with adaptive equipment
4. Cannot independently walk, though
may be able to use powered mobility.
Manual Ability Classification System (MACS)
• The ability of children with CP from 4 – 18 years old
• handle objects in everyday activities
• Categorized into 5 levels using the Manual Ability Classification
System (MACS).
• MACS level is determined based on knowledge about the child’s
actual performance in daily life.
• It is not done by conducting a specific assessment, but by asking
someone who knows the child and how that child performs typically.
• MACS is based on the use of both hands in activities, not an
assessment of each hand separately.
Manual Ability Classification System (MACS)