PAK - GETARAN

ERWIN DN
• DEFINISI
• PENYEBAB
• PATHOGENESIS
• DIAGNOSIS
• TERAPI
• PROGNOSIS
• PENCEGAHAN
 PAK AKIBAT GETARAN
• Penyakit akibat getaran adalah penyakit
atau gangguan kesehatan akibat getaran
• PAK akibat getaran :
– PAK akibat getaran seluruh tubuh
– PAK akibat getaran setempat (segmented
vibration/ tool hand vibration)
 Whole Body Vibration
• Getaran mekanaik yang disampaikan
lewat tempat duduk (ex: alat berat) / lantai

• Getaraan dari alat berat  tempat

duduk tulang belakang supir
 WORKERS AT RISK
o Supir Traktor, truk, mobile crushers
o Fork-lifts
o Masinis, supir bus, taksi, motor boat,
helikopter, pesawat
o Mesin / Alat berat (hammering and
punching machinery)
o Orang yang bekerja di landasan yang
bergetar
Vibrations
 Vibration

• Exposure to vibration can occur

while using power tools or while
driving equipment.
• Vibration from power tools can
place stress on the tissues of
the fingers, hand and arms.
• Whole body vibration from
driving puts stress on the spinal
tissues.
Vibration Exposure
Whole Body

4 s/d7 % pekerja di
Eropa& USA
terpapar WBV yang
berbahaya bagi
kesehatannya
Terdapat berbagai faktor yang perlu
diperhatikan dalam menilai efek getaran
pada manusia , yaitu:

• Karakteristik fisik dari frekuensi dan

intensitas getaran
• Tipe dari sumber getaran
• Lamanya pemajanan
• Arah getaran
• Posisi tubuh
• Kerentanan individu
• Faktor lingkungan misalnya suhu udara,
kebisingan, beban kerja dll.
Efek fisik getaran Pada otot
skelet (4-12 Hz)
• getaran
• Ujung tulang rawan & sendi
• Perubahan gerakan tl rawan & sendi
(khususnya tl blk
• Sel tl. Rawan rusak
• Peradangan berulang menahun
• Kerusakan menahun pada sendi (arthritis)
Osteoarthritis
Osteoarthritis
Osteoarthritis
Osteoarthritis
 Efek getaran dan frekuensi
Frekuensi (Hz) Efek
4-12 Kerusakan sistem otot dan tulang
4-5 Kerusakan tulang belakang
5-20 (dg Perdarahan paru
intensitas
sangat tinggi
 Frekuensi-efek
Frekuensi (hz) efek
< 10 Rongga dada dan perut
>10 Organ dan jaringan perifer
 EFEK PADA KESEHATAN WBV

FREKUEN GANGGUAN KESEHATAN

SI(HZ)
4-12 -KERUSAKAN SEL TULANG RAWAN
(ARTHRITIS PERMANEN)
-SERUSAKAN SPINAL (HNPLBP)
-ABDOMINAL PAIN
-HEMATURIA
-PERDARAHAN PARU (5-10 HZ; 5-15G)
3-9 DADA & PERUT
10 LEHER, KEPALA, PINGGUL, PERINEUM, OTOT, TULANG
13-15 PHARYNX
6-10 TEKANAN DARAH, DENYUT JANTUNG, IO2 MAX
MENINGKAT
 GANGGUAN KESEHATAN
MENURUT FREKUENSI
EFEK FREKUENSI (HZ)
0,1-1 1-10 10-100 100-1000 1000- >10.000
10000
MABUK
GANGGUAN BICARA
MATA KABUR
GANGGUAN TUGAS

SPINAL RUSAK*(KRONIS)
GANGGUAN GI*(KRONIS)
REYNOD D**
 Respon fisiologis thd WBV yg masih dapat
ditolerir o/ manusia adalah :

• Denyut jantung meningkat (10 – 15x/mnt) pada

kondisi eksperimen yang normal, tanpa
memperhatikan frekuensi  pajanan kontinyu
pulih

• TD meningkat pd frek. ± 5 Hz
menurun pd frek. ± 10 - 20 Hz
• Tidal Volume : meningkat pada semua frekuensi
(maks. Pd frek. 5 – 7 Hz)

• RR meningkat linier dg intensitas

• Pd 5-7Hz : VC menurun
O2 Uptake meningkat.
• Efek WBV pd ginjal , darah & endokrin :
- Belum atau tidak terdapat bukti yg jelas

• Efek WBV pd keseimbangan :

- tgt kerentanan individu.
 Efek Getaran Pada Performance

• Ggn. Fgs. & ketajaman penglihatan 

- sebanding dg amplitudo getaran
- maksimum pd frek.10 -25 Hz.

• Penurunan performance pada tracking task

(pekerjaan mengikuti jejak misalnya jejak satelit,
pesawat udara dll)
- sebanding dengan amplitudo getaran
- maksimum pd frek. rendah (≤ 5 Hz)
HNP (Hernia Nucleus Pulposus)
• Tergelincirnya nukleus pulposus (anulus
fibrosus)/slipped disc
• Pathogenesis:
WBV  kerusakan tulang rawan  slipped
disc  tekanan pada radiks dorsalis
LBP
HERNIA NUCLEUS PULPOSUS
(SLIP DISC)
 Beberapa Faktor Risiko LBP
a. sikap tubuh yg jelek & kurang OR

- sikap berdiri yang membungkuk ke depan,

- dada kempes - pungung lordosis
- tidak tegap , - perut buncit

 tekanan BB jatuh ke depan sbg

kompensasi punggung hrs ditarik ke belakang --
 hiperlordosis lumbal jk lama  kelelahan
otot & rangsangan pd ligamen  nyeri.
Bad posture
b. Obesitas & kehamilan trimester akhir
 perpindahan tekanan BB ke depan
c. >>> duduk  otot hamstring kaku &
pendek
d. Panjang tungkai yang tidak sama
e. Sepatu tumit yang tinggi / pemendekan
tendon achilles titik Berat bergeser ke
depan
f. kelemahan otot dinding perut , gluteus maksimis &
ileopsoas serta pemendekan otot-otot ekstensor
punggug (otot yg penting u/ mempertahankan sudut
lumbosacralis pd posisi optimal (30º ))  kelemahan =
”unstable back”.

g. Merokok (blm jelas)

- tekanan intra diskus meningkat (batuk kronis)
- peregangan otot
- nikotin

h. Kesegaran jasmani
IKJ Baik  < berisiko LBP

i. Lama masa kerja

semakin lama (dg beban berat) risiko semakin
meningkat
 ACGIH TLVs and BEIs Handbook
Whole-Body Vibration Threshold Limit
Values (TLV’s)

Y
X
Y
Y
X

X Z

ax, ay, az = acceleration in the directions of the

x, y, z, axes
x axis = back - to – chest
y axis = right – to – left
z axis = foot (or buttocks) - to - head
 Pencegahan
• Hindari paparan WBV > NAB  pilih
peralatan/mesin yang anti getaran,
pemeliharaan mesin, gunakan peredam, sepatu
anti getaran
• Atur waktu kerja istirahat : 1 jam kerja-10 menit
istirahat
• Istirahat : stretching, massaging, relaxing
• Terapi sesuai gejala
• Hindari faktor risiko
• Jaga badan tetap hangat
 GETARAN SELURUH TUBUH

Paparan menahun (f=) Paparan akut (F=)

Gangguan aliran darah amplifikasi /resonansi
Di daerah ginjal dan saluran kencing
Kerusakan permanen pada sendi/tulang

Arthritis Peradangan/inflamasi

Slipped disc (L4-L5 atau L5 S1) Gangguan Fungsi

Ginjal dan
sal.Kencing, dg
indicator:
Hematuria
HNP BUN
Serum Creatini
LBP Urea
PAK –GETARAN SETEMPAT
 What is HAV (Hand-Arm Vibration)?

What is HAV (Hand-Arm Vibration)?

- transmitted from work processes into workers hands and

arms.
- It can be caused by operating hand-held power tools such as
: road breakers,
hand-guided equipment (ex:s lawn mowers)
holding materials being processed by machines such as
pedestal grinders.
 What injuries can HAV cause?

Regular exposure to HAV can cause a range of permanent

injuries to your hands and arms that are known as hand-arm
vibration syndrome (HAVS).
The injuries can include damage to the following:
 What injuries can HAV
cause?
o Blood Circulatory System (vibration white finger)
- >> tjd jika suhu tubuh/tangan dingin atau basah
- tanda awal: ujung jari putih (kadang2) , baal , seperti terusuk
jarum
- akhir serangan: jari putih  berubah merah & sangat nyeri

o Sensory Nerve Damage

- kerusakan syaraf di jari rasa raba & rasa suhu berkurang  baal
permanen, kesemutan di jari

o Damage to Muscle, Bones & Joints

- kekuatan tangan hilang
- nyeri di lengan & pergelangan tangan
Health Effects (bisanya
setelah 3-5th)
Hand Arm

Vascular and circulation problems.

Neurológical.
Muscular disorders
Others
 Symptoms – Advanced
Stages
• White or Blanched
Finger Tips
– Aggravated by cold
– Mistaken for frostbite
– Few minutes initially
• With Continued
Exposure
– Blanching spreads
– Attacks Increase in
• Frequency
• Intensity
• Duration
 Symptoms – Latter stages
• Occur in all seasons
• On and off job
• Triggered by
– Cold
– Vibrating objects
– Nicotine
• Severe Cases
– Gangrene
– Amputation
 Stockholm HAVS Classification
System (Vascular Assessment)
Stag Grade Description
e
0 --------- No attacks
1V Mild Occasional attacks affecting only
one or more fingers
2V Moderate Occasional attacks affecting distal
and middle phalanges (rarely also
proximal) of one or more fingers
3V Severe Frequent attacks affecting ALL
phalanges of most fingers
4V Very As in Stage 3, with trophic skin
Severe changes in the finger tips
Stockholm HAVS Classification
System (Sensorineural
Assessment)
Stage Symptoms
0SN Exposed to vibration but no symptoms

1SN Intermittent numbness, with or without

tingling
2SN Intermittent or persistent numbness,
reducing sensory perception
3SN Intermittent or persistent numbness,
reducing tactile discrimination and/or
manipulative dexterity
 Health Effects
Vascular Disorders

Muscle

Normal Damage
Artery Artery

Normal
flow
Flow
Restriction
 Typical HAV Sources

• Fastening Tools
• Cutting Tools
• Finishing Tools
• Gardening Tools
• Compaction Tools
• Drilling/Boring Tools
• And More
Vibration Exposure
Hand Arm
Vibration Exposure
Hand Arm
Vibration Exposure
Hand Arm
Hand Arm vibration
exposure
 What other factors can contribute to vibration injury?

o
o * How high the vibration levels

o * How long you use the tools and equipment

o * How awkward it is for you to use the equipment

o * How tightly you have to grip the equipment

o * How cold and wet you get when using the equipment
o Individual susceptibility - smokers are at a greater risk
 Upaya Pencegahan
• Jaga agar paparan tak melampaui NAB
• Atur waktu kera-istirahat (1 jam-10 mnt)
• Istirahat : massaging, swinging, shaking
• Pakai gloves (VIP)
• Jaga agar badan tetap hangat
• Hindari faktor risiko
Acceleration levels from Hand Arm Vibrations
Hand-arm vibration acceleration level Tool Type
(m/sec2)

1,183 Riveter, Caulker

424 Chipping Hammer

416 Motorcycle

339 Jack-Leg Drill

251 Grinder

195 Pavement Breaker

125 Pedestal Grinder

75 Chain Saw

59 Brush Saw

20 Hand Grinder
Tri-axial Measurements must be perform:

Basicentric Measurement: Measurement of vibration

directly from the tool.

Basicdynamic Measurement: Measurement of vibration

indirectly over a knuckle.
 2002/44/EC
Directive 2002/44/EC of the European
Parliament and of the Council
8-Hour Daily Exposure Limit Action Value Limit Value

Hand-Arm 2.5 m/s2 5 m/s2

Whole-Body 0.5 m/s2 1.15 m/s2

Whole-Body (vibration dose) 9.1 m/s1.75 21 m/s1.75

Vibrations on the Human body
QUESTIONS?