NEUROSCIENCE

Khabib Abdullah, SST.FT.,M.Kes

Curriculum Vitae
 Khabib Abdullah, SST.FT.,M.Kes
 Karanganyar 15-08-1984
 Griya Pesona Asri G-14 Medokan Ayu Rungkut
Surabaya
 081548337587
Pendidikan :
1. D3 Fisioterapi Poltekkes Surakarta 2002
2. D4 transfer Fisioterapi Poltekkes Surakarta 2009
3. S2 Ilmu Kesehatan Olahraga UNAIR Surabaya 2014
Pekerjaan :
1. Fisioterapi pediatri Siloam Hospitals Surabaya 2006-2016
2. Fisioterapi pediatri klinik prof Bambang, Sp.A 2011-2013
3. Founder AktiFisio Surabaya 2016-sekarang
4. Konsultan fisiopediatri klinik “Kids center” Mojokerto 2014-sekarang 2
Pelatihan
1. Pelatihan pediatri metode NSMRDS di PNTC Solo 2011
2. Pelatihan Internasional “Masgutova : Reflex primitive program” Jakarta 2011
3. Pelatihan Hidroterapi Pediatri di PNTC Solo 2012
4. Pelatihan New Bobath Concept Adult Series (Intro, Basic, Advance,
Musculosceletal) Surabaya, Solo, Lawang 2013-2018
5. Pelatihan Bobath concept pediatri Solo 2017
6. Pelatihan Internasional introductory bobath pediatric, Jakarta Januari 2018

Speaker dan trainer

1. Pelatihan Pediatri Pendekatan Motorik problem dan Reflek Primitive; IFI
Cabang Malang Maret dan April 2016
2. Pelatihan internal Fisiopedi Siloam Hospitals sby Oktober 2016
3. Penyuluhan peran fisioterapi pada ABK, DINKES Surabaya Maret 2017
4. Studi club PFAI Surabaya ‘konsep assessment dan treatment pada CP’,
Surabaya Maret 2017

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 5. WorkShop dan seminar Ft pediatri, IFI Jember Maret 2017
6. Seminar peran FT pada Cerebral Palsy, STIKES RKZ sby Juli 2017
7. WorkShop dan seminar Ft pediatri, IFI Lampung September 2017
8. Penyuluhan ABK pada kader Puskesmas Se Surabaya, Nov-Des 2017
9. Penyuluhan : Pengaruh gadget terhadap postur anak DS, POTADS Surabaya
Des 2017
10. Pelatihan internal Klinik Nameera Surabaya, konsep reflek primitif dan
postur pada anak ABK, Maret 2018
11. Seminar aktiFisio study club “capital flexion for cerebral palsy” RSU Haji
Surabaya, Maret 2018
12. Seminar IFI cabang malang “capital flexion for cerebral palsy”, Agustus 2018
13.Seminar IFI cabang Surabaya “ evidence based practice & pengantar
penelitian Fisioterapi”, Januari 2019
14.Pelatihan deteksi dini gangguan perkembangan balita, Jasmine day care SBY,
Mei 2019

Organisasi
1. Ketua PFAI (Perhimpunan Fisioterapi Anak Indonesia) cabang Surabaya (2018-
sekarang)
2. Sie DIKLAT Pediatri IFI cabang Surabaya (2017-sekarang)
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Prestasi
1. Wisudawan terbaik D3 Fisioterapi Poltekkes Surakarta 2005
2. Wisudawan terbaik D4 transfer Fisioterapi Poltekkes Surakarta 2010
3. Wisudawan terbaik S2 Fakultas Kedokteran Universitas Airlangga 2016
4. Best thesis presentation Departemen Ilmu Faal FK Unair November 2016
5. Juara 3 Lomba Cipta Lagu Se JATIM, Musicology records 2015

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Introduction
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 Brain &
active
movement

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 Perkembangan
elektrodiagnostik

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KONSEP BOBATH
KONSEP LAMA
Inhibisi aktivitas reflek abnormal dan relearning normal
movement dengan fasilitasi dan handling

KONSEP BARU
Pendekatan penyelesaian masalah (problem solving) dengan
asesmen dan treatment dari individual dengan mempengaruhi
tonus, gerakan dan fungsi karena gangguan Sistem Saraf Pusat

The goal of treatment is to optimize function by improving

postural control and selective movement through
facilitation. (IBITA, 1995)
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Movement merupakan interaksi dari banyak
sistem (new concept)

Task Perception

Cognition Environment

Individual Action
Movement

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Movement process

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Sensory

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 Without information (sensory
input), there is no control, no
learning, no change, and no
improvement

(Mulder & Hochstenbach, 2003)

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Free nerve
ending

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Muscle spindle

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Golgi tendon organ

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Tractus ascenden (sensoris)

a) Posterior
column tractus

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b) Spinothalamic
tractus

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c) Spinocerebellar
tractus

Video jarwo

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Sensory information is the framework by which
the motor system plans, coordinates, and
executes
the motor programs responsible for purposeful
movements (Kandel et al 2013)

Input sensory akan membentuk orientasi terhadap

bagian tubuh (body image) dan orientasi tubuh
terhadap lingkungan (body awareness)

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  Orientasi
 Sumasi
 Guidance
handling,
no noising!

Clinical practice
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Clinical practice
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Motor

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 Ventromedial system

1. Uppermotor neuron
 Mainly hindbrain
 Polysegmental
 All segment of cord
2. Lower motor neuron
 Trunk, upper&lower limbs
 Mainly proximal muscles
 Mainly extensors
3. Mainly ipsilateral/uncrossed
4. Sinergistik
5. Aktif saat stand phase berjalan
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 1. Pontine reticulospinal tractus

1. Uppermotor neuron
 Supplementary motor area
 Pontine reticular nuclei
2. Lower motor neuron
 Trunk, upper&lower limbs
 polysegmental
3. Ipsilateral/uncrossed
4. Eksitasi ekstensor,
inhibisi fleksor postural

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 2. Vestibulospinal pathway

1. Uppermotor neuron
 Vestibular nucleus
2. Lower motor neuron
 All spinal segments
3. Ipsilateral/uncrossed
4. Eksitasi ekstensor,
inhibisi fleksor postural,
aktif saat stance

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 3. Tectospinal pathway

1. Uppermotor neuron
 Superior colliculus/tectum
2. Lower motor neuron
 Cervical (upper limb and
neck)/proximal girdle musle
3. Crossed
4. Berhub dengan input
visual  neck muscle
5. Orientasi dan navigasi

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Injury pada ventromedial sistem

1. Cannot reach
2. Forward slump
3. Axial immobility
4. Loss of righting reaction
5. Can flex elbow, carry food
to mouth
6. Can flex single digits
7. Collides with objects

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 DORSOLATERAL system
1. Uppermotor neuron
 Mainly cortex and midbrain
 Oligosegmental
 Mainly servical segments
2. Lower motor neuron
 Mainly upper limbs
 Mainly distal muscles
 Mainly flexors
3. Mainly contra lateral/crossed
4. Discrete movement
5. Aktif saat swing phase
berjalan
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1. Lateral corticospinal

1. Uppermotor neuron
 Motor cortex
2. Lower motor neuron
 Cervical segment  distal
muscles of limb, predominantly
upper limb flexor
3. Contra lateral
4. Fleksor jari2, single joint
5. Sangat aktif saat berjalan
dengan kompleksitas
yang tinggi

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 2. Rubrospinal

1. Uppermotor neuron
 Midbrain (red nucleus)
2. Lower motor neuron
 Cervical segment  distal
flexion shoulder girdle
3. Contra lateral
4. Aktif saat swing
(mengayun lengan)

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Injury pada dorsolateral sistem

1. Reach by circumduction at
shoulder
2. Axial posture normal
3. Elbow inactive
4. Righting reaction normal
5. Arms hang limply
6. Fingers flex together
7. Walking is normal

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Motor
control
RESUME

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Clinical practice
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Postural control

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 Postural control

 Mengontrol posisi badan agar tetap dalam keseimbangan dengan

tujuan untuk orientasi dan stabilisasi (shumway-cook and
woolacott 2012)

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Anticipatory postural adjustment (A.P.A)
 Strategy prediksi/awalan
 Pusat stabilisasi/core stability
 Sebagai dasar melakukan gerakan selektif pada
ekstremitas

(Hodges & Richardson 1997)

 Sepermili detik sebelum memulai gerakan, otot
Transversus abdominis harus aktif

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Core muscles control
 Konsep local and global muscles
 Local muscles : maintain mechanical stiffness of the spine
 Global muscles : intra abdominal pressure between thoracic cage and
pelvis
(Bergmark, 1989)

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Local and global muscles work

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No Local muscles Global muscles
1 Slow twitch muscle fibers Fast twitch muscle fibers
2 Intrinsic located extrinsic located
3 High density of muscle spindle Spanning numerous spinal segment
4 Provide segmental control, stability Larger masses and longer moment arm
of force
5 Response to changes posture Function as prime mover, force
movement
6 No ROM, endurance Produce ROM, Fatique

7 Muscles : inter transversari, Muscles : rectus abdominis, erector

interspinalis, lumbar multifidus, spinae, latisimus dorsi, quadratus
transversus abdominis, psoas lumborum
posterior fibers, internal oblique
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Kinetic
chain

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Clinical practice

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Motor unit

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Size principle
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Clinical practice
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Locomotion

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 Initial contact (0~2 %)

 Start of stance
 Floor contact by the heel
 Hip 30º flex
 Knee ext
 Ankle neutral dorsi flex
 Activity quadriceps, hamstrings,
pre tibial muscles
 Tibialis anterior eccentric 
gradually “ease down” the foot
and keep it from slapping down
the floor 60
 Loading response (0~10%)

 Initial double limb stance

 Hip not over 30º flex
 Knee 18º flex
 Ankle 7º plantar flex, subtalar
valgus
 Activity quadriceps and gluteus
max
 Gluteus medius : isometric
contraction to stabilize the pelvis
 Hamstring off  release
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 Mid stance (10~30%)

 CoG : Highest point

 Hip 30º flex to 30º ext (due to pelvic
anterior tilt), gluteus off
 Knee ext
 Ankle 7º plantar flex to 4º dorsi flex
 Only extensor muscle active
(quadriceps and soleus)
 Late interval  eccentric soleus to
press forefoot to keep knee extend
without need quadriceps  if not
happened, back knee pathology
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 Terminal stance (30~50%)

 Hip ext
 Knee ext  0-5º flex
 Ankle 10º dorsi flex
 Activity gastroc  concentric to
accelerate the body forward

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 Pre swing (50~60%)

 Terminal double support

 Hip ext to neutral position
 Knee 40º flex
 Ankle 20º plantar flex
 Metatarso phalangeal joint dorsi
flex
 Calf muscle off
 New activity by adductor longus
and rectus femoris

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 Initial swing (60~73%)
 Limb advancement
 Hip 20º flex
 Knee 60º flex
 Ankle : reduced plantar flex
 Activity of illiacus, short head of
biseps and pre tibial muscles to
freely swinging leg

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 Mid swing (73~87%)

 Hip 30º flex

 Knee 60º to 30º flex
 Ankle : neutral or little dorsi flex
 Continued action of hip flexors
and ankle dorsiflexors
 Contination of the passive
pendulum action of the leg

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 Terminal swing (87~100%)
 Initial double limb stance
 Hip 30º flex
 Knee extend
 Ankle : neutral
 Activity hamstring, quadriceps and
pre tibial muscle
 Hamstrings : eccentric, decelerate
the limb  slows hip flex and knee
extend (to counter pendulum
effect)
 Quadriceps : early activity for
preparing to accept weight
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 Kinetic and
potential
energy during
locomotion

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Clinical practice

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Interneuron medulla
spinalis

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 Clinical practice

Video 1

Video 2

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Conclusion

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Jazakumullahu khairan katsiran

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