TATALAKSANA

KEDOKTERAN FISIK
DAN REHABILITASI
PADA PEMAKAIAN
ORTOSIS

Pembimbing :

dr. Fatchur Rochman, Sp. KFR (K)

Ortosis

Suatu alat bantu/alat terapi dalam bidang

Kedokteran Fisik dan Rehabilitasi yang
dalam penggunaannya diletakkan secara
kontak langsung dengan permukaan luar
bagian/segmen tubuh tertentu untuk
meningkatkan fungsi bagian/segmen
tubuh tersebut.
An Orthoses (or brace)

Is an external device applied to body parts to

provide support or stabilization, improve
function by restricting or assisting motion,
correct flexible deformities, prevent
progression of fixed deformities, or reduces
pressure and pain by transferring load from
one area to another.

A temporary orthosis is reffered to as a splint

Berbagai alat bantu lain yang dibutuhkan dalam
bidang ilmu Kedokteran Fisik dan Rehabilitasi,
seperti :
 Kursi roda
 Sepatu/alat kaki khusus
 Alat bantu jalan
 Alat bantu makan
 Alat-alat lain termasuk prostesis yang
dibutuhkan untuk menjalankan aktifitas
kehidupan sehari-hari
 Tahun 2700 SM  bangsa Mesir  ortosis
untuk melindungi bagian tubuh tertentu dari
trauma atau cegah kerusakan lebih lanjut
 Abad pertengahan  baju perang  ortosis
spinal
 Ambroise Paree, ahli bedah Perancis 
pionir ortosis dan prostesis
 Lorenz Heister, abad 15  ortosis spinal
pertama
 Hugh Owen Thomas, abad 19 , ahli bedah
Ortopedi  ortosis servikal

 Abad 20  pengembangan ortosis 

pencegahan dan pengurangan dampak
poliomyelitis
Penggunaan ortosis :
 Keputusan medis
 Berdasarkan indikasi
 Diresepkan oleh dokter yang kompeten

kinesiologi, biomekanika anatomi,

mekanisme penyakit,
neurofisiologis dan patomekanika
yang mendasari disabilitas penderita,
sifat fisika materi/ bahan ortosis
 Penggunaan ortosis…
Dr.IKFR harus paham :
 Kondisi fisik pasien

gaya hidup pasien

 Kepribadian pasien

kemandirian ADL
The committee on Prosthethics and
Orthotics
Terminology ortosis standar

 Daftar dan definisi masalah yang dihadapi

 Anatomi diagram tulang dan sendi yang

dilalui ortosis

 Defisit biomekanik

 Disabilitas fungsional

 Tujuan terapi yang akan direkomendasikan

Ortosis pada kelainan neurologis :

 Biomekanika

 Neurofisiologik yang ‘dinamis’

memberikan lingkup gerak yang lebih leluasa

- fasilitasi tonus yang menurun

- inhibisi tonus yang tinggi

 Kriteria ideal ortosis
 Menghasilkan pola gerakan senormal
mungkin dan pencegahan gerakan abnormal
yang tidak dikehendaki

 Stabilitas sendi akurat

 Penggunaan energi seminimal mungkin

 Distribusi gaya yang baik

 Kenyamanan dalam pemakaian

Kriteria ideal ortosis…

 Mudah dipakai dan dilepas oleh penderita

sendiri

 Biaya terjangkau, tidak cepat rusak, secara

kosmetis baik serta mudah untuk diperbaiki
dan dimodifikasi
Orthosis should be :

 Lightweight with reasonable durability

 Acceptable cosmetically
 Easy to maintain and clean
 Easy to don/doff correctly and rapidly
 Adjustable to accommodate progression or
resolution of disorders
 Patient should be motivated to wear it (most
importantly)
Pertimbangan dalam preskripsi
ortosis
 Sensasi
 Gravitasi
 Kenyamanan
 Sederhana
 Ketahanan
 Utilitas/penggunaan
 Toleransi
 Kosmetik
 Sensasi tidak memberi sensasi,
menutup daerah kulit, mengurangi umpan balik
sensoris

 Gravitasi penting pada ortosis extremitas

atas, gravitasi dan beban dapat mengganggu
sendi

 Kenyamanan tekanan didistribusikan

ke daerah seluas mungkin

 Sederhana memudahkan pemakaian

 Ketahanan tidak mudah rusak,
pemeliharaan mudah

 Utilitas bermanfaat, mencapai tujuan

 Toleransi makin rumit  sulit diterima

pasien, cenderung tidak dipakai

 Kosmetik terutama untuk ektremitas atas

Orthotic prescription

Should include :
 Medical diagnosis (e.g. compressive peroneal
nerve palsy)
 Current impairment and any disability (e.g.
flaccid drop foot)
 Type of orthosis (e.g. plastic ankle-foot orthosis
[AFO] with flexible ankle held in neutral position)
 Orthotics goal (e.g. toe-clearence during swing-
through and prevention of foot slap during early
stance)
Orthoses constructed from :

 Metal
 Plastic
 Leather
 Synthetic fabrics
 Any combination
 Metal orthoses :
 Adjustable
 But heavy
 Not cosmetically pleasing
 Commonly used metal include : stainless steel and
aluminium alloys

 Stainless Steel :
 widely used in prefabricated joint, metal up right,
metal band and cuffs, springs and bearing.
Relatively inexpensive, easy to work with, and
fatigue-resistant ; however :
 Heavy, needs expensive alloys to prevent corrosion
Aluminium alloys :
 corrosion resistant
 have high strength-to-weight ratio
 commonly used in upper limb orthoses
because of its lightweight nature.
 static loading strength is good
 lower endurance limit compared to
steel
 Leather

Type : Cattle hides –

 vegetable-tanned for texture
 to prevent skin irritation
Recommanded for shoe construction
because :
Conduct heat well, absorp water from
the moist air surrounding the foot, draw
prespiration away, stretch as the shoe
becomes moist
Plastic

 Lighter
 Can provide a closer fit (it can be molded,
extruded, laminated, or hardened into any
desired form)
 Unaffected by fluids
 Radioluscent
 Not adjustable in length
 Not as durable as metal (hence not commonly
used as joints)
 Classified into : thermosetting and thermoplastic
materials
Thermosetting

 Develop a permanent shape when heat and

pressure are applied
 Cannot be softened when reheated
 More difficult to use than thermoplastic
 Cause more body irritation / allergic reaction
Epoxy resin
Polyurethane foam
Thermoplastic
 Soften (and become moldable) when heated and
harden when cooled
 Divided into Low – High temperature

LOW-temperature thermoplastics
(Orthoplast, Aquaplast, Bioplastics, Glassona, Hexcelite, Kay-splint,
Lightcast, Polysar, Warm-N-Form)
 Can be molded at temp just above body temp
(<80⁰C or <180 ⁰F), be shaped directly to the body
without cast,
 Can be fabricated easily and rapidly
 Mainly used in upper limb (low stress activity)
HIGH temperature thermoplastics
(acrylic, polyethylene, polypropylene, polycarbonate, acrylonitrile-
butadiene-styrene [ABS] and the group of vinyl polymers and copolumers
include PVC, PVA, polyvinyl acetate)

 Require up to 150-160⁰ C (300-350⁰ F) to become

moldable
 Must be shape over a plaster replica/cast
 Creep resistant (not easily change in shape w
continued stress and heat)
 Ideal for long-term or permanent use especially
when high stress is anticipated (e.g. in lower
limb orth. and in spastic limbs)
Jenis Ortosis
1. Statik
- Rigid

- Memberi support tanpa gerakan

- Mengistirahatkan segmen/bagian tubuh pasca trauma,

bedah

- Mengistirahatkan sendi dan tendon

- Khas mengikuti bentuk yang mengakomodasi posisi

statik yang ada

- Dapat dibuat tidak mengikuti bentuk

Jenis Ortosis…

2. Dinamik
- Memberikan/mengakomodasi gerakan pada derajat
tertentu

- Meregangkan kontraktur
Ortosis fungsional :
- Memperbaiki fungsi
- Digunakan pada pasien dengan disfungsi
sisa yang permanen pasca cedera, kondisi
pemulihan lambat, penyakit kronis.
Terima Kasih