REHABILITASI MEDIK

PASCA COVID-19

dr. Siti Chandra Widjanantie, SpKFR-K

FKUI – RSUP.Persahabatan

TEMA: WEBINAR AWAM LONG COVID-19 ; Sabtu, 3 April 2021; jam: 14.00 – 15.30 WIB
CURRICULUM VITAE
Nama: dr. Siti Chandra Widjanantie, Sp.KFR (K)
Jabatan:
• Dokter Spesialis Kedokteran Fisik & Rehabilitasi (SpKFR), Konsultan Rehabilitasi
Kardiorespirasi, FK Universitas Indonesia, RSUP. Persahabatan, Jakarta
• Kepala Kelompok Staf Medis (KSM) Rehabilitasi Medik, RSUP.Persahabatan,
Jakarta
• Kasubkomite Kredensial, RSUP.Persahabatan, Jakarta
• IPCD, Komite PPI, RSUP.Persahabatan, Jakarta
• Dokter Pendidik Klinis, PPDS IKFR, FKUI

Pendidikan & Pelatihan:

• Dokter Umum, FK Universitas Trisakti, Jakarta, lulus 2001
• Spesialis Kedokteran Fisik & Rehabilitasi (SpKFR), FK Universitas Indonesia, Jakarta, lulus 2006
• Japanese Association of Rehabilitation Medicine travelling Fellowship , Kobe, 2007
• Workshop Cardiopulmonary Rehabilitation, ARMA, Bangkok, 2009
• Critical Care Cardiopulmonary Workshop, Singapore, 2010
• Observer Fellowship, Gangnam Severance Hospital, Yonsei University, South Korea, 2017
• Observer Fellowship, NTUH, Taipei, Taiwan, 2017
• Konsultan Rehabilitasi Kardiorespirasi, Kolegium IKFRI, 2018
 PENDAHULUAN
• Pasien yang sembuh dari infeksi COVID-19 (terutama yg terkena gejala
berat, pasca ICU) sering memerlukan tatalaksana Kesehatan lanjutan
terkait gejala sisa yang ada.

• Apa saja gejala sisa nya:

• Fatigue (mudah Lelah) à 58%
• Sakit kepala, Sulit konsentrasi
• Batuk, sesak, sering nyeri dada
• Nyeri sendi dan otot
• Gangguan pencernaan

Polastri M, Nava S, Clini E, et al. COVID-19 and pulmonary rehabilitation: preparing for phase three.
Eur Respir J 2020; 55: 2001822 [https://doi.org/10.1183/13993003.01822-2020].
 • Gerak dinding dada saat bernapas
• Inspirasi (Tarik napas)
KINETIKA • Ekspirasi (Buang napas)
DINDING DADA • Korelasi antar bagian tubuh (thoracoabdominal)
• Efek dari postur tubuh

Thomas Meyer. Anatomi Train. Disitasi dari https://www.anatomytrains.com/

INSPIRASI (TARIK NAPAS)
EKSPIRASI (BUANG NAPAS)
 PASCA
COVID-19
More than 50 Long-term
effects of COVID-19:
a systematic review and
meta-analysis
Sandra Lopez-Leon MD, PhD1,*,
Talia Wegman-Ostrosky MD,
PhD2, Carol Perelman, BSc3,
Rosalinda Sepulveda MD PhD 4,
Paulina A Rebolledo, MD, MSc5,6,
Angelica Cuapio MD, Dr. Med7,
Sonia Villapol, PhD

https://doi.org/10.1101/2021.01.2
7.21250617
 COVID-19 AND PULMONARY REHABILITATION: PREPARING FOR PHASE THREE.
Polastri M, Nava S, Clini E, et al.
Eur Respir J 2020; 55: 2001822 [https://doi.org/10.1183/13993003.01822-2020].

• Patients who have successfully recovered from the acute COVID-19 pneumonia will require health support to define and quantify
the consequences of the disease.
• The follow-up is currently the new challenge as it was in the beginning for ICUs.
• Indeed, it is not clear if COVID-19 will leave permanent lung and/or physical damage and, if so, to what extent.
• Alterations of lung tissue such as ground-glass opacities, consolidation, vascular thickening, bronchiectasis, pleural effusion, crazy
paving pattern and irregular solid nodules à may progress in over 80% of patients.
• Persisting limitations in respiratory function and gas exchange will likely be more pronounced in the subgroup of ICU survivors.
• In addition, as in non-COVID-19 related acute respiratory distress syndrome (ARDS)
• we can anticipate a high incidence of ICU acquired weakness that is associated with poor short- as well as long-term outcomes.
• It has been found that cognitive impairment in ARDS survivors ranges from 70% to 100% at hospital discharge and 20% at 5 years,
while mood deterioration including depression and post-traumatic stress disorder were also present.
• Patients with COVID-19 seem to be prone to movement-related fatigue, similar to ARDS patients.
• even in those subjects not developing a critical illness.
• Therefore, the rehabilitation community is calling for action preparing for post-intensive care syndrome (PICS) in COVID-19
patients
 PROBLEM TERKAIT REHABILITASI MEDIK
MASA AKUT & RAWAT INAP
• sesak (dyspnea)
• Gangguan gerak rongga dada
(thoracic activity)
• Aktivitas otot diafragma
• Kekuatan otot-otot pernapasan
(respiratory muscle strength,
maximal inspiratory & expiratory
pressures)
• Pola pernapasan dan nadi (terkait
fungsi pernapasan dan jantung)
MASA POST AKUT & RAWAT JALAN
• Gangguan otot-otot inspirasi
• Gangguan pengembangan rongga
dada, kekakuan dinding/sangkar dada.
• Gangguan fungsional diafragma
• Kekakuan otot-otot terkait
pernapasan
• Gangguan bersihan jalan napas
(banyak dahak, batuk)
• Kelelahan secara umum (fatigue)
• Gangguan psikologi, konsentrasi,
atensi
 REHABILITASI PASCA COVID-19
• Disfungsi Kardiorespirasi :
• Lelah • Teknik Konservasi Energi , Relaksasi,
• Batuk Latihan Kebugaran bertahap sesuai
kondisi
• Sesak • Latihan batuk efektif
• Dahak • Latihan mobilitas dinding dada

• Disfungsi Musculoskeletal:
• Nyeri sendi • Modalitas Rehabilitasi Medik
• Exercise untuk stretching keluhan terkait
• Nyeri otot • Koreksi postur

• Post ICU Syndrome • = Disfungsi kardiorespirasi

• CIPNM (kelemahan neuromuscular)
• PTSD
REHABILITASI RESPIRASI
Koreksi Postur
Mobilisasi dada
Latihan Pernapasan
Latihan Expansi Dada
Relaksasi dan Konservasi Energi
Latihan otot pernapasan
Latihan kebugaran umum
PARAMETER IDEAL: 6MWT
KLINIS: SIT TO STAND, BREATH COUNT TEST
EDUKASI LATIHAN PERNAPASAN

• Latihan pernapasan COVID-19

https://youtu.be/h5goR4f95Vs

• Latihan batuk coughing - huffing

https://youtu.be/BcitS0FPU9k

• Latihan pernapasan untuk pasien (breath

count test, breath stack)
https://youtu.be/oqin8Edbyfc
 PENUTUP
• Rehabilitasi Medik pada pasien pasca COVID-19 disesuaikan dengan
kemampuan fungsional yang dimiliki serta gejala yang tersisa.

• Rencana program disusun secara individual diterapkan bertahap yang

berfokus pada :
• Pemulihan fungsi seoptimal mungkin
• Memilimalisir disabilitas yang timbul
• Kembali aktif dalam komunitas (return to activity in society)
• Meningkatkan kualitas hidup pasien pasca COVID-19
Polastri M, Nava S, Clini E, et al. COVID-19 and pulmonary rehabilitation: preparing for phase three.
Eur Respir J 2020; 55: 2001822 [https://doi.org/10.1183/13993003.01822-2020].
TERIMA KASIH
Email : sitichandraw@gmail.com