Peran Rehab Medik Dlm Penanganan Komprehensif Kelainan Spinal.edit

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Peran Rehabilitasi Medik dalam Penanganan Komprehensif Kelainan Spinal Siti Annisa Nuhonni Department of Physical Medicine and Rehabilitation Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia FALSAFAH & TUJUAN REHABILITASI MEDIK Falsafah rehabilitasi medik ialah meningkatkan kemampuan fungsional seseorang   sesuai dengan potensi yang dimiliki   untuk mempertahankan dan atau meningkatkan Kualitas hidup  dengan cara mencegah atau mengurangi Impairment, Disability    dan handicap semaksimal mungkin General goals in rehabilitation of patients with spinal disorders Decrease spinal related pain Improve strength, flexibility, lifting capacity, and cardiovascular endurance Minimize spine-related disability Normalize activities of daily living Return to work and vocational activities Components in a non operative spine treatment program Education Local modalities Medication Injections Exercise Orthoses and assistive devices Complementary and alternative therapies Home environment modification Ergonomic modifications Lifestyle modification Common causes of cervical pain seen in a rehabilitation medicine Myofascial pain Cervical spondylosis Cervical sprain/strain Cervical disc herniation Cervical stenosis Cervical fractures Inflammatory conditions of the spine such as rheumatoid arthritis Common causes of lumbar pain seen in a rehabilitation medicine Lumbar sprain/strain Myofascial pain Fibromyalgia Lumbar spondylosis Lumbar radiculopathy Lumbar spinal stenosis Lumbar spondylolysis and spondylolisthesis DISH Spondyloarthropathy ( ex. Ankylosing spondylitis) Fracture Tumor Infection Balance Strength Flexibility Endurance Coordination Line motor Role function   Task or goal-oriented function (e.g., ADL, IADL) Specific physical Movements (e.g., 8-foot walk) Hierarchy of physical function Integration level III Integration level II Integration level I Basic component   Ruas Vertebra The Neck In Action POSTURE and Emotional Stress Posture has more to do with the neck than most people realize. The head and spine must balance in relation to the line of gravity. Low Back Pain is a symptom that can be caused by various disease entities and can affected by various psychosocial factors Objective The objective of any preventive or therapeutic rehabilitation program is to teach patients how to help themselves. They are taught how to be  ‘Kind to one’s back’    RISK FACTORS  Hard labor and heavy exertions  Lifting, pulling and pushing, twisting, slipping  Sitting for an extended period  Exposure to prolonged vibration  Persons who view their occupations as boring, repetitious or dissatisfying may also report a higher rate of low back pain •  OCCUPATIONAL FACTORS RISK FACTORS   Age  Sex   Anthropometric Factors  Postural Factors  Spine Mobility •  PATIENT - RELATED FACTORS  Muscle Strength  Physical Fitness  Smoking  Psychosocial Factors Mechanical units of the spine  Anterior segment (two adjacent vertebral bodies and the intervertebral discs between them) Posterior segment (neural arches) The anterior segment is primarily the weight bearing and shock  –  absorbing component The posterior segment protects the neural structures and direct movements of the units in flexion and extensions The amount of force exerted on the spine can very depending on the type of activity and posture. Muscle Supporting The Spine and Their Function Four groups of muscles : the extensor, the flexors, the lateral flexors, and the rotators of the spine The extensors and rotators are the main supportive muscles of spine The main role of the back muscles in erect posture is to resist gravity Once vertebral column is bent far enough in any direction, the muscles of the back that resist this movement must actively contract to provide smooth and controlled movements and also to prevent falling The abdominal muscles are significant flexors and lateral flexors of the trunk and also participate in rotation Muscle Groups Rehabilitation of Back Pain General Consideration Rest  –  Relax  Avoidance of stressful activities Use of back supports Exercise TYPES OF EXERCISE  Aerobic / Anaerobic Resistance / Weights  Antigravity Balance Stretching Cardiovascular conditioning Strength, tone, muscle mass Prevent osteoporosis Prevent falls Flexibility TYPE PURPOSE / EXPECTED BENEFIT Narrowing of the therapeutic window. This diagram portrays in a conceptual manner how the space between a therapeutic dose and a toxic dose narrows with age Therapeutic response Therapeutic window Toxic response Age Low back pain  –  mechanical strain Goal : - pain free - decrease soft tissue edema - maintained ROM & muscle strength Th/ : - cold pack during the first 48 hrs - heating modalities 20-35 minutes - stroking massage - Bed rest 2-3 days, not more than 2 weeks - use a firm mattress and soft top layer covering - Supine / side lying position, flexed hips & knees - Gentle ROM and isometric exercise ORTHOTICS The Reduction of motion in the lumbar spine can be achieved only if the support is extended from the lower thoracis spine to the greater trochanteric areas This immobilitation significantly decreases the pain and reduces the duration of bed rest ORTHOTICS Restriction on back motion results in weaknes of the low back supportive muscles Prolonged use of a back support is discouraged Rigid orthoses side effect: Muscles atrophy, accelerated, osteopenia, osteoarthritis   EXERCISE Isometric strengthening exercises (paraspinal & abdominal muscles) Back extension or flexion or combination exercise program ; depends on indications Pain free +, start daily activities, usually after 2-4 weeks William flexion exercise Mc Kenzie hyperextension exercise Thank you