Terapi Latihan Dasar dan Latihan Fungsi (3)

  TERAPI LATIHAN DASAR DAN LATIHAN FUNGSI (3) Lenny Agustaria Banjarnahor, SSt, M. Fis Materi disampaikan pada mahasiswa/i Fisioterapi

  KEPUSTAKAAN Wajib 

  Kisner, Carolyn & Allen Colby, Lynn Therapeutic Exercise (Foundations & Techniques) Penunjang 

  Basmajian, John V, Therapeutic Exercise (Third edition) 

  Hollis Margaret, Practical Exercise Therapy 

  Licth, Sidney, Therapeutic Exercise 

  Situs/web relevan

AD.1 KEKUATAN (STRENGTH)

  

  Kemampuan otot/grup memproduksi tegangan utk menghasilkan tenaga dgn upaya maksimal scr statis & dinamis

  

  Faktor-faktor pengaruh :

  1. Ukuran cross-sectional otot

  2. Hubungan length-tension otot saat kontraksi

  3. Rekruitmen motor unit

  

THE ACTIVATION OF MOTOR UNITS

THE ACTIVATION OF MOTOR UNITS

MOTOR UNIT

MOTOR UNIT

THE MOTOR NEURON

THE MOTOR NEURON ALL THE MUSCLE FIBERS

IT INNERVATES ALL THE MUSCLE FIBERS

  FG Fast-twitch Glycolytic (involved in phasic movement) FOG Fast-twitch Oxidative Glycolytic SO Slow-twitch Oxidative (involved in tonic movement) WHITE PINK

  NUMBER OF MOTOR UNIT & NUMBER OF MOTOR UNIT &

INNERVATION RATIO

  INNERVATION RATIO Innervation Number of Motor Muscle

  Ratio Unit

  2970

  9 Extensor Rectus 96 108 1st Lumbricals Brachioradialis

  333 410 445 562 Tibialis Anterior Gastrocnemius

  579 1934

RECRUITMENT ORDER

  

  4. Tipe kontraksi

• Isometrik - Isotonik - Eksentrik - Konsentrik - Isokinetik

  5. Distribusi fiber type

  6. Cadangan energi & suplai darah

  7. Kecepatan kontraksi

  8. Motivasi pasien

  Relationship between fiber type, motor unit type and

histochemical profiles of muscle fibers

  Fiber type

  I II

  IIB SO (Slow O.) FOG

  (Fast O & G) FG (Fast G.)

  Motor unit type S FR FF Histochemical profiles Myofib. ATPase Low High High NADH dehydro. High Medium-High Low

  SDH High Medium-High Low Glycogen Low High High Phosphorylase Low High High Capillary supply Rich Rich Sparse

  

MOTOR UNIT

MOTOR UNIT

  

  Perubahan sistem neuromuskular yg mengarah kpd peningkatan kekuatan

  1. Hipertropi

  2. Rekruitmen

  

  Perubahan kekuatan pd jaringan kontraktil

  AD.2 ENDURANCE &

CARDIOVASCULAR FITNESS

  

  Tipe endurance

  1. Muscular endurance

  2. General (total) body endurance

  

  Perubahan sistem muscular, cardiovascular & pulmonal

  AD. 3 MOBILITAS & FLEKSIBILITAS 

  Soft tissue mobility/flexibility

  

  Joint mobility

  

  AD. 4 STABILITAS 

  Koordinasi sinergis pd sistem neuromuscular utk dasar stabilisasi thd gerakan-gerakan fungsional & aktifitas

  

  Mengarah kpd struktur-struktur proksimal

  AD. 5 RELAKSASI 

  Usaha utk menurunkan ketegangan otot

  

  Penempatan pd posisi nyaman (comfortable posistion)

  AD. 6 KOORDINASI, KESEIMBANGAN & FUNCTIONAL SKILLS 

  Koordinasi Otot yg tepat pd waktu yg tepat dgn sekuensis & intensitas tepat

  

  Keseimbangan

  Mempertahankan COG 

  Functional skills Motor skills utk fungsi ADL

  

BASIC BIOMECHANICAL FACTORS

& CONCEPTS

  BIOMECHANICS 

  Biomechanics - study of the mechanics as it relates to the functional and anatomical analysis of biological systems and especially humans

   Necessary to study the body’s mechanical

characteristics & principles to understand its

movements

  BIOMECHANICS 

  Mechanics

• study of physical actions of forces

   Mechanics is divided into

   Statics

   Dynamics

  BIOMECHANICS 

  Statics - study of systems that are in a constant state of motion, whether at rest with no motion or moving at a constant velocity without acceleration

  

Statics involves all forces acting on the body

being in balance resulting in the body being in equilibrium

  BIOMECHANICS 

  Dynamics - study of systems in motion with acceleration

   A system in acceleration is unbalanced due to unequal forces acting on the body

  BIOMECHANICS 

  Kinematics & kinetics

   Kinematics - description of motion and includes consideration of time, displacement, velocity, acceleration, and space factors of a system‘s motion

   Kinetics - study of forces associated with the motion of a body

  BODY 

  Mechanical advantage 

  Load/effort or load divided by effort 

  Ideally using a relatively small force, or effort to move a much greater resistance 

  Musculoskeletal system may be thought of as a series of simple machines 

  Machines - used to increase mechanical advantage 

  Consider mechanical aspect of each component in analysis with respect to components’ machine-like function

  BODY 

  Machines function in four ways

   balance multiple forces

   enhance force in an attempt to reduce total force needed to overcome a resistance

   enhance range of motion & speed of movement so that resistance may be moved further or faster than applied force

   alter resulting direction of the applied force

  BODY 

  Musculoskeletel system arrangement provides for 3 types of machines in producing movement

   Levers (most common)

   Wheel-axles

   Pulleys

  LEVERS 

  Humans moves through a system of levers

  

  Levers cannot be changed, but they can be utilized more efficiently

   lever - a rigid bar that turns about an axis of rotation or a fulcrum

   axis - point of rotation about which lever moves

  LEVERS 

  Levers rotate about an axis as a result of

  force (effort, E) being applied to cause its

  movement against a resistance or weight

  

  In the body

   bones represent the bars

   joints are the axes

   muscles contract to apply force

  LEVERS 

  Resistance can vary from maximal to minimal

   May be only the bones or weight of body segment

  

  All lever systems have each of these three components in one of three possible arrangements

  LEVERS 

  Three points determine type of lever & for which kind of motion it is best suited

   Axis (A)- fulcrum - the point of rotation

   Point (F) of force application (usually muscle insertion)

   Point (R) of resistance application (center of

gravity of lever) or (location of an external

resistance)

  LEVERS _st 

  1 class lever – axis (A) between force

  (F) & resistance (R) _nd 

  2 class lever – resistance (R) between axis (A) & force (F) _rd

  

  3 class lever – force (F) between axis

  (A) & resistance (R) _{McGraw-Hill. biomechanics, ed 4, 2003,} Modified from Hall SJL Basic

  LEVERS | Force Arm | | Resistance Arm |

• F

  FAR

  R 1st

  A | Resistance Arm |

• | Force Arm |

  ARF

  2nd R

  F A | |

  Force Arm AFR

• | Resistance Arm |

  3rd R F

  LEVERS 

  The mechanical advantage of levers may be determined using the following equations: Mechanical advantage = Resistance

  Force or

  Mechanical advantage = Length of force arm Length of resistance arm

FIRST-CLASS LEVERS

  

  Produce balanced movements when axis is midway between force & resistance (e.g., seesaw)

  

  Produce speed & range of motion when axis is close to force, (triceps in elbow extension)

  

  Produce force motion when axis is close to resistance (crowbar) _{Basic biomechanics, ed} Modified from Hall SJ:

FIRST-CLASS LEVERS

  

  Head balanced on neck in flexing/extending

  

  Agonist & antagonist muscle groups are contracting simultaneously on either side of a joint axis

   agonist produces force while antagonist supplies resistance _{Modified from Booher JM, Thibodeau GA: Athletic injury assessment, ed 4, 2000,} McGraw-Hill

FIRST-CLASS LEVERS

  

  Elbow extension in triceps applying force to olecranon (F) in extending the non-supported forearm (R) at the elbow (A)

FIRST-CLASS LEVERS

  

  Force is applied where muscle inserts in bone, not in belly of muscle

   Ex. in elbow extension with shoulder fully flexed & arm beside the ear, the triceps applies force to the olecranon of ulna behind the axis of elbow joint

   As the applied force exceeds the amount of forearm resistance, the elbow extends

FIRST CLASS LEVER

   A lever in which the muscular force and resistance force act on opposite sides of the fulcrum

• A see-saw

SECOND-CLASS LEVERS

  

  Produces force movements, since a large resistance can be moved by a relatively small force

   Wheelbarrow

   Nutcracker

   Loosening a lug nut

   Raising the body up on the toes

  Modified from Hall SJ: _{Basic biomechanics, ed 4, 2003, McGraw-Hill}

SECOND CLASS LEVER

   A lever in which the muscular force and resistance force act on the same side of the fulcrum, but the resistance force acts at a point closer to the fulcrum than the muscular force

SECOND-CLASS LEVERS

   Plantar flexion of foot to raise the body up on the toes where ball (A) of the foot serves as the axis as ankle plantar flexors apply force to the calcaneus (F) to lift the resistance of the body at the tibial articulation (R) with the foot

  

  Relatively few 2 ^nd class levers in body

  Modified from Booher _{JM, Thibodeau GA: Athletic injury assessment, ed 4, 2000, McGraw-Hill}

THIRD-CLASS LEVERS

   Biceps brachii in elbow flexion Using the elbow joint (A) as the axis, the biceps brachii applies force at its insertion on radial tuberosity (F) to rotate forearm up, with its center of gravity (R) serving as the point of resistance application _{Modified from Booher} JM, Thibodeau GA: _{Athletic injury assessment, ed 4, 2000, McGraw-Hill}

THIRD-CLASS LEVERS

  rd 

  Brachialis - true 3 class leverage  pulls on ulna just below elbow

   pull is direct & true since ulna cannot rotate

   Biceps brachii supinates forearm as it flexes so rd its 3 class leverage applies to flexion only

   Other examples

   hamstrings contracting to flex leg at knee while in a standing position

   using iliopsoas to flex thigh at hip

THIRD CLASS LEVER

   A lever in which the muscular force and resistance force act on the same side of the fulcrum, but the muscular force acts at a point closer to the fulcrum than the resistance force

FACTORS IN USE OF ANATOMICAL LEVERS

  

  Anatomical leverage system can be used to gain a mechanical advantage

  

  Improve simple or complex physical movements

  

  Some habitually use human levers properly

  

  Some develop habits of improperly using human levers