PEMERIKSAAN

PADA
CEREBRAL
PALSY

MENEJEMEN FT PEDIATRI
Cerebral palsy

– Gangguan Gerak
– Gangguan Koordinasi
– Gangguan Tonus Otot
– Gangguan Kontrol motor
– Gangguan Kognitif (+/-)
 PEMERIKSAAN FT YANG
DIBUTUHKAN
– Pemeriksaan Tonus
– Pemeriksaan Refleks
– Pemeriksaan Postur
– Pemeriksaan sensorik dan motoric
– Pemeriksaan Disabilitas
– Pemeriksaan Skala pertumbuhan dan perkembangan (
DDST)
PROSEDUR PEMERIKSAAN
FT
– Keterlambatan Tumbang
– Koordinasi Menurun
– Kelainan Kognitif
– Kelainan Struktur jaringan lunak
– Kelainan Struktur Tulang (Deformitas)
– Refleks Patologis
– Mengurangi kontaktur
– Meningkatkan ambulasi, mobilitas, fungsi
– Penurunana spastis
Observasi
Menentukan sifat hipertonisitas
Menilai gangguan fungsi (gait) dan efek dari stres dan / atau kelelahan
Menilai pemendekan adaptif otot vs kontraktur ireversibel
Tes Khusus
– DDST
– Tes Refleks
– Endfeel  Atrofi
– Tes Stimulasi dan Respon
INTERVENSI FISIOTERAPI

– MODALITAS DAN METODA

– Muscle tightness/contracture , Functional massage; Contract relax stretching
– Pola abnormal  PNF, Latihan Fungsi Dasar
OTHER OBSERVATION

– Pergerakan Spontan
– Deformitas & Kontraktur
– Scar
– Poor Position
– Kesalahan / kelainan postural
– Gait Abnormal
ON EXAMINATION

– Integritas Gerak
– Spastik, hipotonus, dystonia, dll
– Kelemahan Otot
– Penurunan koordinasi
– Penurunan control
– Refleks
– Abnormal ???
– ROM
– Penurunan ROM
– Kontraktur, kaku ?
– Pengukuran Antopometri
– Berat dan Tinggi
– Penurunan ??
– Lingkar Kepala
– ROM
– Aktif kepala dan trunk
– Shoulder
– Elbow
– Wrist
– Hio
– Knee
– Foot
– Fleksi, Ekstensi, rotasi, lateral fleksi or dengan meraih sesuatu, merayap, berdiri, dll
Posture
– Poor postur pada semua tipe CP
– Kiposis, knock knee, deformitas, flat foot
SPASTISITAS

– Mempertahankan tonus otot / bulk

– Membantu mendukung fungsi peredaran darah
– Dapat mencegah pembentukan deep vein thrombosis
– Dapat membantu dalam aktivitas sehari-hari
– Dapat membantu dengan kontrol postural
FASILITASI SENSORY MOTOR
DEVELOPMENT (BODY IMAGE)

– Reaching, rolling, sitting, cwaling & transitional movement like standing & pre
walking are facilitated
– Bola Bobbath, Guling Bobath, Treadmil, tangga, matras, mainan, sitting table,
standing table
FASILITASI MOTOR
DEVELOPMENT
– Stabilitas Postural Kepala
– Lying prone (0-3 Bulan)
– Prone on forearm (0-3 bulan)
– On hand and on hand and kness ( 6 bulan)
– During crawling, half-kneeling hand support (9-11 bulan)
– Bear walk (Jalan blm semprna) (12 bulan)

– PRONE Position
– Dengan perlahan, alas busa/matras, di air hangat, ball
POSTURAL STABILITY OF
SHOULDER GIRDLE
– Bertumpu pada lengan bawah (3 bulan)
– On hand (6 bulan)
– On hand and knees & arms (5-6 bulan)  Stretch group otot, postural stability
– Pivot prone with arms (8-10)  ekstensi aktif stabilitasi
– Maintenance of half kneeling  support (graps dll) (9-12 bulan)
POSTURAL STABILITY OF
PELVIS
– On knees with hips (4 bulan)
– On elbow & knees & on Hand and kness (4-6 bulan)
– On half- kneeling and upgrade kneeling with support (9-12 bulan)
MAINTAINING AN UPGRAITH
POSITION
– Standing frame & sitting chair
– Orthosis  can be delayed
– Sitting on Swiss ball, vestibular board dll  improve challenges
PRESCHOOL PERIOD

– INCREASE FORCE GENERATION (STRENGTHENING)

– Buat program  tugas  consentric& eccentric work, gravity, transitional/ambualnsi
– Strenghtenging problem voluntary control in muscle group
– Electrical stimulatin / Strenghtening  Synergistic movement
REDUCE SPASTICITY

– Positioning in anti synergisting pattern

– Stretching of thigt Structures
– ROM Ecx
– Rhytmic Rotation
– Splinting & Serial Casting
INCREASE MOBILITY &
FLEXIBILITY
– ROM Exc
– Maintain Length Of Muscle  Stretching & Splinting  6 Jam
– Strenghtening EXC  Pimer ober of a Joint
PREVENT DEFORMITY

– Orthosis
– Splinting
– Taping
– Optimal function  Travel and sleep
IMPROVE PHYSICAL
ACTIVITY
– Exercise  intensive, challenging & meaningfull
– Intreresting  Playing
– Feedback
IMPROVE AMBULATORU
CAPACITY
– Weight bearing, balance,
– Walker & Crutch
– Treadmill Training Or body weight support treadmill training
– Adaptasi alat bantu  wheelchair
IMPROVE PLAY

– Motivating
– Enjoy
– Perception conceptual
SCHOOL AGE &
ADOLESCENCE

– IMPROVE ACTIVITY, MOBILITY, ENDURANCE

– Gait training
– Orthosis increase
– SCHOOL & COMMUNITY PARTICIPATION
– Positioning, lifting, transfer technique
– Partisipation In community
– Adapted game & athletic competition & Team participation
– Intriduce to community fitness program
– Transportation
– Injury prevention will limit impairment and disability
TRANSITION TO ADULTOOD

– IMPROVE FUNCTIONAL SKILL

– Maintain & Improve ardiovascular fitness
– Weight control, maintain integrity of joint & muscle, help prevent osteoporosis
– Fitness club, swimming, wheelccair aerobic & adapted sport sport are opton