Stroke Rehabilitation
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Transcript of Stroke Rehabilitation
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STROKE REHABILITATION
DR. dr. Noer Rachma SpRM
FAK. KEDOKTERAN UNIV. NEGERI SEBELAS MARETSURAKARTA
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HIRSCHBERG (1963): Few physician take an active interest in the rehabilitation of their hemiplegic patients because they are uncertain of the prognosis and the technics of rehabilitation apropriate to the individual patient
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Risk Factor For StrokeAgeHypertensionCardiac ImpairmentTIAHyperlipidDiabetesObesitasHeavy smokerStress
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Stroke Rehabilitation 2 Pola1.Compensatory 2.NeuroDevelopmental pendekatan unilateral pendekatan bilateral sisi yg sehat sisi yg.sakit Hemiplegic NeuroDevelopmental gait Aprroach(NDA) NeuroplasticityCollateral sprouting Mekanisme UnmaskingReactive synaptogenesis Aktivasi Saraf (Bach-y-Rita)
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Pendekatan NeuroDevelopmentalDasar:Inhibisi reaksi postural yang abnormalFasilitasi reaksi postural yang normalRe - learning
Aplikasi : Mengenal Perkembangan reflek2 dan reaksi keseimbangan (phylogenetik)
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Anterior cerebral arteryLesion site
Bladder & bowel
incontinentia
Impairment judgement & insight
Ataxia & typical defisit
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Middle cerebral arteri
Contralateral hemiplegi , face paralysis
Contralateral monoplegi , cortikal hypesthesiaHemianopsia, Dysphasia, Agnosia
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Posterior cerebral artery
AlexiaVisual agnosiaCortical blindnessParalisis nervus IIIMemory impairmenthemianopsia
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TIA TERDAHULUSAKIT KEPALA SAAT SERANGANCT SCANTrombotik50%20%iskhemikEmboli10%10%superficialLacunar30%5%N/kecil dalamhemorrhagi5%35%Massa hiperdens
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Jenis%SeranganKomaFibrilasi atriumTrombotik40Bertahap5%10%Emboli30Mendadak1%35%Lacunar20Bertahap atau mendadak0%5%hemoragi10Mendadak25%5%
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Basic Guidelines for Post StrokeMgg.1 : NON HEMORRHAGE. >Mgg. 2: HEMORRHAGE
Day 1-3BedsidePositioningPressure areasBegin PROM & AROM etc
Day 3-5Evaluate ambulationEvaluate ST/OTProvide Sling if Shoulder Subluxed
Day 7-10Transfer ActivitisPre gait ActivitisADL Practise : CarePshycological EvaluationCommunication ,Swallowing
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2 - 3 weeksTeam /family planningTherapeutik home evaluation
3 - 6 weeksHome programIndependent ADL & Transfer & Mobility
10 -12 weeksFollow-upReview Functional AbilitiesDiscuss of rehabilitation Team and Family
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Masalah2 Khusus Program Post Stroke
Positioning
Berbaring sisi yang sakit Edema & kontraktur dini kontraktur: - Shoulder - Hip - Elbow - Knee - Wrist - AnkleTurning
Rubah posisi @ 2jam hindari ulkus dekubitus Rom exercise
Pasif &AktifChest Physical Teraphy
Breathing Exercise
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Okupational terapy ADLSpeech Terapy bicara
makan menelan cepat resiko aspirasi Infus tdk pd sisi yang sakit,sbb:
- Terganggu pasif ROM - Predisosisi phlebitis - KontrakturBladder tdk kateterBowel konstipasiRetraining KognitifLain lain a.l.
- Hydroterapy - Tx rekreasi - Senam stroke
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Depresi Post Stroke
Lesi Hemisfer Sinistra >>> Dextra -Apatis Hub dgn kegembiraan tdk tepat -Acuh tak acuhTanda depresi :Penye,buhan lambat tdk konsistenKerjasama burukPenurunan klinis neurologisMenangis atau tertawa yang tdk sesuai
Tx : -anti depresan -dukungan psikologi psikiater
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SELESAITerima kasih..