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RETARDASI MENTAL (RM)

Sam Lazuardi

7/6/15

DEFINISI RM:

D/ sebelum 18 th
IQ dibawah Normal (< 70)
Adaptive functioning kurang
Dasar D/ aspek motorik, bahasa,
menolong diri sendiri
RM ringan baru nampak pd usia
sekolah
RM 1 3 % penduduk
7/6/15

PENYEBAB RM (1) :

I. Tak diketahui (75 %)


II.Diketahui (25 %) :
II.1. Trauma (pre - & postpartum):
Perdarahan intrakranial pre / postpartum
Kurang O2 pre- /intra- /postpartum
II.2.Infeksi (intra - & postpartum):
rubella kongenital, meningitis, CMV
kongenital, toksoplasma kongenital, infeksi
HIV

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PENYEBAB RM (2)
II.3.KELAINAN KHROMOSOM
- Kelainan # khromosom (sindr.Down)
- Defek khromosom (fragile X sy,
Prader-Willi sy)
- Translokasi khromosom
- Kehilangan khrom (cri du chat sy)

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PENYEBAB RM (3)
Kelainan genetik & gg metabolik
heriditer
- Galaktosemia
- Fenilketonuria
- Peny. Tay-Sach
- Sindr Rett
- Tuberous Sclerosis
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PENYEBAB RM (4)
II.5.Metabolik : sindr Reye, hipotiriod
kongenital, hipoglikemia
II.6. Toksik : timah hitam,
metilmerkuri, keracunan IU thdp
alkohol, kokain, dsb
II.7. Nutrisi : malnutrisi
II.8.Lingkungan : kemiskinan, sindr
deprivasi, status sosioekonomi yg
rendah
II.9. Def. Jodium : RM ringan (kretin)
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GEJALA RM :

Adanya gangguan dalam :

Memahami sebab akibat


Menyelesaikan persoalan
Berpikir secara logis
Keinginan tahu
Perkembangan intelektual
Perilaku (kekanakan)

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DIAGNOSA DITEGAKKAN
DG :
Tes skrining anak Denver
Developmental Screening Test
(DDST)
Tes Inteligensi (IQ) - < 70
Perilaku dibawah Normal
Tes IQ mengukur kemampuan
anak dalam : bahasa, angka
(numeracy), problem solving
Tes dpt terganggu oleh : budaya,
depresi, ansietas
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WECHSLER ADULT INTELLIGENCE


SCALE (WAIS)
CLASS

IQ

Profound mental retardation below


20
Severe mental retardation
20
34
Moderate mental retardation 35
49
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PENGOBATAN / INTERVENSI
Meningkatkan potensi semaksimal
mgk
Pendidikan luar biasa
Intervensi dini
Defisiensi Jodium dg deteksi & terapi
dini hasil baik (juga pd kel
metabolik PKU)

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10

PROGNOSIS
Sebagian besar dapat hidup mandiri
Sebagian lagi harus dibantu melalui
structured environment

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11

KOMPLIKASI
Isolasi sosial
Tak dapat mengurus diri sendiri
Tak dapat melakukan interaksi dg
baik

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PENCEGAHAN (1)
1.Genetik :
- skrining prenatal terhdp defek genetik,
khromosom
- konseling genetik pd keluarga dg risiko tinggi
2. Sosial :
- perbaiki nutrisi, kesehatan & pengetahuan ibu
hamil
- perbaiki nutrisi pd usia balita
- program sosial utk kurangi retardasi
ringan
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PENCEGAHAN (2)
3. Toksik :
- program lingkungan utk mencegah
keracunan timah hitam, merkuri
4. Infeksi : pendidikan utk mencegah
toksoplasmosis, rubella kongenital

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14

IQ (Intelligent quotient)
Nilai IQ didapat dg membagi umur
mental seseorang dg umur mental
penduduk rata-rata dikalikan 100 :
IQ = Usia mental / Usia Kronologis X
100
IQ normal = 85 - 115

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16

Pembagian RM menurut IQ
Borderline 70 85 slow learner - #
besar
RM ringan 55 70 educable 85 %
RM
RM sedang 40 55 trainable 10 %
RM
RM berat
25 40 nontrainable
5%
RM sangat berat < 25
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MASA PERKEMBANGAN ANAK


RM
ANAK MANIS, JARANG NANGIS,
BANYAK TIDUR, MENGHISAP LEMAH,
GANGGUAN MAKAN MENELAN,
BANYAK TERLENTANG, PERKEMBANGAN MOTORIK LAMBAT
(TENGKURAP, DUDUK,BERJALAN),
NGOCEH LAMBAT, PERHATIAN
KURANG RM RINGAN - SEDANG
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ROKOK PD KEHAMILAN BAYI


(termasuk 2nd hand smoker)
KEHAMILAN : abortus, gg plasenta,
abortus, BBLR, stillbirth
Bayi : SIDS, gangguan perilaku &
belajar, ADHD, asthma, infeksi
telinga

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Pengaruh ekstasi / methylamphetamine


Ibu : hipertensi, perdarahan
intrapartum, prematuritas, tak nafsu
makan
Bayi :kurang gizi, kelainan bawaan
pad mulut, BBLR, palatoschizis, kel
.jantung bawaan, kel.tungkai bawaan
(clubfoot).

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PENGARUH TIMAH HITAM


Ibu : infertilitas, hipertensi, abortus
Anak : gangguan perilaku (aggresif,
delingkuen), IQ menurun, gg belajar,

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KESIMPULAN RM
Penyebab RM terbesar adalah gol.
Sosiokultural ( retardasi ringanborderline)
dapat dicegah mll edukasi,
pengentasan kemiskinan
Gol. RM patologik (retardasi berat)
sedikit & pd sebagian dapat dicegah
melalui skrining metabolik, konseling
genetik, nutrisi waktu hamil, edukasi
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EDUCATION OF RETARDED
CHILDREN
Require a special educational setting with
more individual attention and support,
especially who has behavioral problems
Some can engage in non-academic
activities, such as sports, physical
education, art and singing with their
nonretarded peers.
Preparing retarded children for both lifelong
vocational pursuits and as much independence as possible is the major goal.

NATURE VERSUS NURTURE


NATURE GENES DNA
RESPONSIBLE FOR BASIC WIRING
PLAN (forming neurons & general
connections between different brain
regions)
NURTURE EXPERIENCE (responsible
for fine-tuning those connections &
adapt to particular environment to
which he belongs)
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DOES EXPERIENCE CHANGE THE


BRAIN STRUCTURE
Brain development is activitydependent
Cells that fire together, wire together

Those that are consistently turned on


over time will be strengthened, while
those that are rarely excited dropped
away, elimination of unused neural
circuits referred as pruning
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (1)
Animal studies certain windows of
time during which the young are
especially sensitive to their
environment
Babies require normal visual input or
may suffer permanent impairment
crossed eyes need prompt correction
Language development in the first
few years of life
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (2)
Language learning begins to close
around 5 years & ends around puberty
learning new language after puberty
speak it with a foreign accent
Musical ability (perfect pitch) is before age
of 7
Critical period for Social emotional
development depends on a positive,
nurturing attachment to a primary
caregiver
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (3)
Based on the higher frequency of
serious behavioral problems among
children who were severely
neglected during the first years of life
and with monkeys who are reared in
isolation
During the early years, the brain
over-produces connections about 50
% more than will be preserved in
adulthood
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (4)
During the critical period, a child
experience sensory, motor,
emotional & intellectual - determines
which of these synapses will be
preserved, through pruning of the
least useful connections
In this way, he becomes better tuned
to meet the challenges of his
particular environment
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (5)
A newborns brain is about a quarter
the size of an adults. It grows to
about 80 % by 3 yrs & 90 % by age 5
Each brain cell begins as a tiny
sampling & only gradually sprouts its
hundreds of long branching
dendrites. Brain growth is largely due
to the growth of dendrites, which
serve as receiving point for synaptic
input from other neurons
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CRITICAL PERIOD IN BRAIN


DEVELOPMENT (6)
A newborns brain works more slowly
than an adult (sixteen times less
efficiently)
The speed increases during infancy &
reach its maximum at age 15, due to
the gradual myelination of nerve cell
axons.
Myelination begins at birth & is most
rapid in the first 2 yrs , but continues
till age 30
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NUTRITION & THE DEVELOPING


BRAIN (1)
Brain development is most sensitive
to a babys nutrition midgestation
till 2 yrs
Undernourished children
smaller brain (reduced dendritic
growth, reduced myelination &
glia) behavioral & cognitive
deficits slower language, fine
motor development, low IQ, poor
school performance
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NUTRITION & THE DEVELOPING


BRAIN (2)
Pregnant women should gain about 20 %
of ideal pre-pregnancy weight to insure
adequate fetal growth consume extra
300 calories per day, including 10 - 12
extra grams of protein
After birth brain growth depends on the
quality of the child nutrition
Breast milk is the best mix of nutrients,
provided iron supplementation around 6
mo whether or not mother are iron deficient
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NUTRITION & THE DEVELOPING


BRAIN (3)
Iron is critical for maintaining an
adequate oxygen-carrying rbc,
necessary to fuel brain growth
Bottle fed babies should receive
formula containing iron
Rapid pace of myelination in early
life, children need a high level of fat
in their diets, 50 % of total calories
until 2 yrs from breast or formula
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NUTRITION & THE DEVELOPING


BRAIN (4)
Whole cows milk can be introduced
after 1st birthday, provided an
excellent source of fat & protein in
the 2nd year
After 2 yr, children should begin
transitioning to a more heart-healthy
level of dietary fat (30 % of total
calories) including lower-fat cows
milk (1 2 %)
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MAKANAN IBU HAMIL


Kenaikan BB : 10 13 kg
Banyak sayur & buah (green leafy, nuts, seeds,
lentil, beans), cereal, whole grain bread
Moderate low fat diary ( milk, cheese), lean
meat, fish, chicken
Small amount of fatty, sugary & salty meal
Mediterranean diet
Folic acid :broccoli, cabbage, cauliflower, lentil,
spinach, oranges, peanut, potato. Tomato, strawberry, asparagus, dried beans, brussel sprouts

VITAMIN & MINERALS


Iron: developing foet draws Fe from mo
through 5 6 mo after birth 27 mg p
day (9 mg > nonpregnant ), depend prior
pregnancy storage (red meat + orange
vit C help absorption)
Vit A : fish, egg, milk excess supplement
birth abnormalities
Multivitamin : only for vegetarians, drug/
alcohol/ smokers
Ca : 1000 mg daily (dairy foods)
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MAKANAN TERBAIK
Beras merah, roti gandum
Sayuran mentah dicuci bersih, dapat
di blender & jangan jus, karena serat
hilang
Kurangi goreng, banyak di kukus,
jangan rebus, karena vitamin &
mineral hilang
Hindari processed food (sosis) &
barbeque
Jangan sering di microwave, vitamin
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Prenatal Nutrition, Postnatal Allergy Protection

when moms-to-be eat apples during


pregnancy, their offspring have lower
rates of asthma
Mothers who consume fish during
pregnancy may lower their child's
risk of developing the allergic skin
condition called eczema.
HEALTHDAY 4 Jan 2009
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CHILDBIRTH RISKIER IN POOR


COUNTRIES
Women living in poor countries are 300
times more likely to die during pregnancy
or childbirth than if they lived in rich
countries (UNICEF in Johannesburg, 15
January, 2009)
UNICEF said that about 80 percent of
maternal deaths could be prevented
if women had access to primary
health care or basic obstetrics.
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WHY ARE THE JEWS SO SMART -1


Thesis & research by Dr Stephen Carr Leon

Jews are ahead in all aspect of life & nearly


70 % world trade
A pregnant woman always sing, play music &
carry math books solving math problems
She love to eat almonds, nuts, dates with milk
& for lunch dinner fish without the head and
no meat with salad, nuts & fruits before meal
Smoking is a taboo, nicotine destroy
cells of the brain, affect the genes & DNA
resulting generation of moron

WHY ARE THE JEWS SO SMART -2


Thesis & research by Dr Stephen Carr Leon

Makanan si anak harus dibawah


pengawasan ortu, terut buah dg
almond dan cod liver oil
Si anak harus menguasai 3 bahasa :
Ibrani, Arab dan Inggeris
Ia harus mempelajari piano atau
biola, karena vibrasi musik akan
merangsang otaknya
Dalam sekolah dasar mereka harus
mendalami business math dan

WHY ARE THE JEWS SO SMART -3


Thesis & research by Dr Stephen Carr Leon

Di bidang atletik mereka dilatih


dalam archery, shooting & running
dg target agar otaknya bisa fokus
dan tepat sasaran
Harga rokok di luar negeri mis
Singapore
$ 7, sedangkan di
Indonesia hanya $ 0.70

MEROKOK DAN AKIBATNYA


ASAP ROKOK : MENGANDUNG LEBIH DARI 4000
BAHAN KIMIA RACUN & 43 BAHAN PENYEBAB
KANKER
ROKOK = NARKOBA YG DILEGALKAN -> KETAGIHAN & SUKAR MELEPASKAN
KOMPLIKASI MEROKOK : 24 PENYAKIT FATAL
(JANTUNG, KANKER, PERNAFASAN, KANDUNGAN,
IMPOTENSI)
AKIBAT PEROKOK PASIF 43 JUTA ANAK MENDERITA GG PERNAFASAN & PERTUMBUHAN FISIK
DAN MENTAL

ROKOK MEMBUNUH 13.500


ORANG/H

ROKOK MENGHANCURKAN KEHIDUPAN


ORANG MISKIN
Penelitian Herien di Bogor & Krawang :
penge-luaran utk merokok melebihi
pengeluaran utk kebutuhan pokok
( makanan, pendidikan anak) 25 Mei,
2011
Orang miskin perokok dicabut jaminan
kesehatannya
Pabrik rokok sponsor utama program
olahraga & musik, sambil menjaring para
remaja sbg anggota baru

WHO : Rokok membunuh 5 juta orang


tiap tahun (Kompas, 10 Des 2009)
Tembakau akan membunuh 6 juta
orang, termasuk 600.000 perokok pasif.
Who mendesak pemerintah utk
menanda-tangani dan melaksanakan
perjanjian kontrol tembakau
Rokok, penyebab kematian terbesar
ketiga di Indonesia
Rokok baik utk ekonomi adalah
propaganda DetikForum, 21 Nov 2010

Indonesia peringkat 5 dunia utk


jumlah anak pendek (Kompas, 12 Jan 2012)
Sebanyak 35.6 % anak Indonesia
berumur kurang dari 5 th mempunyai
tinggi badan kurang dari normal
Ibu kurang gizi menyebabkan 11.1 %
bayi dg berat badan kurang dari 2.500 Gr
Kemiskinan dan kurang pengetahuan yg
menyebabkan tubuh pendek dan otak
kurang berkembang (slow learner &
retardasi ringan)

ANAK KURANG GIZI

KEMISKINAN, MEROKOK DAN


KECERDASAN
Dengan banyaknya merokok pada
orang miskin, maka hari depan
generasi mendatang sangatlah
suram !
Sebagai calon dokter, tolong berikan
saran tertulis mencari solusi utk
persoalan ini dlm rangka belajar
membina masyarakat kita ! (maksimal 1 lembar halaman ketik
dlm 2 minggu)

ANAK SEHAT DAN CERDAS

NEGERI AUTOPILOT Media Indonesia 16


Jan 2012
Pimpinan INDO melakukan NATO (No
Action, Talk Only)
Anggaplah INDO libur panjang dari 2009
hingg 2014
Sikap Diam lebih KEJAM dp Sikap Kritis
Mayday Mayday.any body hear ???
Melakukan Autopilot = tidak kompeten

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