Terapi Latihan Dasar dan Latihan Fungsi (1)

  Terapi Latihan Dasar

dan Latihan Fungsi

(1)

  Lenny Agustaria Banjarnahor, SSt, M. Fis Materi disampaikan pada mahasiswa/i Fisioterapi Program reguler UEU Jakarta 2013 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

  Pendahuluan 

  Terapi Latihan dapat membantu bagian tubuh cidera untuk kembali berfungsi secara normal.

  

  Ft memberikan terapi latihan dengan terlebih dahulu melakukan evaluasi, perencanaan, penyusunan dan memberikan program kepada pasien atas bagian tubuh yang fungsinya dipulihkan.

  

  Latihan/ Exercise:

   Menggunakan otot pada berbagai tipe usaha yang

menyebabkan bagian tubuh tertentu bergerak

  

  Terapi/ Therapeutic:

   Latihan/ Exercise menjadi bagian pengobatan di bawah pengawasan/ supervisi medis dan diresepkan dengan tepat oleh dokter

  Latihan/ Exercise? Aktivitas Fisik? Peregerakan tubuh yang dihasilkan oleh aksi otot

sehingga meningkatkan pengeluaran energi. Contoh :

activities of daily living such as shopping, gardening, house

keeping, child rearing, work-related activities, etc Latihan/Exercise? 

  Aktivitas fsik yang memiliki Perencananaan/ terencana, terstruktur, dilakukan berulang-ulang/ repetitive, dan memiliki tujuan tertentu . Contoh:

training for or performing athletics, sports, or recreational

activities such as jogging, roller-blading, ice skating, swimming, etc.

  

  Semua latihan/ exercise merupakan aktivitas fsik, namun tidak semua aktivitas fsik adalah latihan/ exercise

  Kebugaran fsii/ physical ftness?s Menunjukkan hubungan bagimana seseorang melakukan aktivitas fisik, yang tdd:

  

  Muscular strength

   Body composition

   

  Muscular Cardiorespiratory endurance

  endurance 

  Power 

  Flexibility

   Agility Therapeutic Exercise Versus Conditioning Exercise Conditioning Exercise Therapeutic Exercise

   Aktivitas-aktivitas

  

  Latihan/ Exercise

  digunakan untuk

  digunakan sebagai bagian

  meminimalisir cidera dan

  dari program rehabilitasi

  meningkatkan performance 

  Menggunakan conditioning exercise Prinsip dasar dari latihan kekuatan yang diterapkan di fase

• untuk mencegah cidera/

  rehabilitasi injury dan juga

  Training dan conditioning membatasi dan meminimalisir

• memulihkan dari kondisi

  kemungkinan cidera, sedangkan rehab bekerja untuk cidera mengembalikan agar dapat kembali bermain dan mencegah cidera berulang

  

Defnisi terapi latihan/ Therapeutic

Exercise (Therex) 

  Terapi latihan/ Therapeutic Exercise (Therex) adalah konerja/ capaian/

  performance yang sistematik dari pergerakan fsik yang terencana, postur dan aktivitas fsik lainnya yang bertujuan untuk memampukan pasien/ klien:

  

  ◦Remediate or prevent impairments

  

  ◦Enhance function

  

  ◦Reduce risk

  

  ◦Optimize overall health

  

  ◦Enhance ftness & well-being Jenis Therex: 

  ◦Agility training 

  ◦Balance training (static & dynamic) 

  ◦Body mechanics training 

  ◦Breathing exercises 

  ◦Coordination exercises 

  ◦Gait and locomotion training 

  ◦Neuromuscular re-education 

  ◦Postural stabilization 

  ◦ROM exercises & soft tissue stretching 

  ◦Relaxation exercises 

  ◦Strength, power & endurance exercises

  

Tujuan Terapi Latihan



  Tdd tujuan jangka pendek dan jangka panjang

  

  Pencegahan disfungsi, Mengembangkan, meningkatkan, mengembalikan & mempertahankan :

  1. Kekuatan (strength)

  2. Daya tahan (endurance) & cardiovaskuler

  ftness (kebugaran)

  3. Mobilitas & feksibilitas

  4. Stabilitas

  5. Relaksasi

  6. Koordinasi keseimbangan & functional skills

  Tujuan jangka pendek

  Program yang dibuat untk rehabilitasi, relatif sederhana dan mencakup beberapa tujuan jangka pendek di bawah ini:

  

  Maintain ROM

  

  maintaining or improving/ Increase fexibility

  

  restoring or increasing strength

  

  maintaining levels of cardiovascular ftness

  

  re-establishing neuromuscular control

  

  Promote Endurance

  

  controlling pain Therapeutic Exercises 

  Tujuan jangka panjang Therex pada atlet adalah mengembalikan atlet yang cidera agar dapat kembali berlatih atau bertanding secepat dan seaman mungkin!

  

  Tujuan yang mau dicapai adalah agar atlet yang cidera dapat kembali berpartisipasi dalam berlatih dan bertanding secara penuh tanpa rasa nyeri

  

  Fokus Area :

   Pain Modulation Muscular Strength

   Normal ROM Endurance

   Kinematics Coordination

   Flexibility Power

  Tujuan Therapeutic Exercises 1. To improve circulation.

  9. To facilitate

  fexibility of the muscles, tendons, ligaments, and fascia.

  14. To increase and maintain

  proper postural alignment (improve and correct posture).

  13. To help regaining of

  12. To reduce pain.

  control and improve his balance.

  11. To assist subject to

  10. To improve respiratory capacity.

  proprioceptive neuromuscular function

  8. To gain relaxation (general

  2. To improve strength and power.

  8.

  7. To increase muscle performance and functional capacity (endurance).

  7.

  6. To improve co-ordination and neuromuscular control.

  6.

  5. To restore the physiological properties of the muscle (excitability, contractility, and elasticity).

  mobility of the joints 5.

  4. To maintain and increase

  sensory awareness of movement.

  3. To stimulate and increase

  15. To increase physical ftness. Goal Setting 

  Specifc and measurable

  

  Positive rather than negative

  

  Challenging yet realistic

  

  Established time table for completion

  

  Integration of short- intermediate- and long term goals

  

  Personalized and internalized

  

  Monitored and evaluated

  

LINKED TO LIFE

  GOALS!!!

  FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  

  Exercise, Even When

  Spot Reduction Can

  Localized, Draws From All

  Reduce The Amount Of

  Of The Fat Stores Of The

  Fat In Certain Parts Of

  Body

  The Body 

  Decrease In Girth Is A Result Of Increase In Muscle Tone

  

  High Intensity Aerobic Exercises Uses 65% Of The Body Energy Stores While Low Intensity Exercises Uses More Fat As An Energy Source But It Does Not Necessarily Lead To A Greater Expenditure Of FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  Exercise And Sports Will 

  Exercise Afects Primarily

  Deter Bone Growth In

  Bone Width, Density And

  Children

  Strength But Does Not Afect The Bone Length

  

  Exercise Along With Adequate Diet Is Essential For Proper Bone Growth

  

  Sports Only Contribute To About 23% Of Epiphyseal Injury In Children

  

  Competetitve Baseball, Tennis And Swimming Carry Higher Risks For Shoulder Injury In Children FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  When A Fat Baby Grows 

  Fat Babies Make Fat Adults

  Up, Baby Fat Will 

  Fat Cells Are Formed During

  Disappear

  The Fetal Development Up To Death

  

  Fat Hyperplasia Occurs When Existing Fat Cells Continue To Fill With Fat To A Certain Critical Volume FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  Strength Training Is 

  Prepubescent Children Can

  Contraindicated In

  Improve Strength With

  Children

  Resistance Training Due To Synchronization Of Motor Units Firing. It Is Only During Pubescent Period That Increase In Strength Is Due To Increase In Muscle Mass

  

  Resistance Training Is Allowed In Children With The Proper Guidance Of A Trained Weight Trainor FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  There Is An Increase In 

  E.P.O.C. Is Increased

  Metabolic Rate After

  Depending On The Intensity

  Exercise ( Excessive Post

  Of Exercise

  Exercise Oxygen Consumption) Regardless Of The Type Of Exercise. FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  Diet And Weight Resistance Training Are The Best Combination In Decreasing Body Weight.

  

  Diet And Aerobic Exercise Decreases Body Weight And Percentage Body Fat But Maintains Free Fat Mass FACT vs FALLACY dalam Latihan

FACT FALLACY

   The Most Important Factor In

   Some Health Fads Are

  Weight Reduction Is The More Efective Than

  Development Of A Caloric Others

  Defcit While Maintaining A Complete Balanced Diet That Meets The Body Vitamins And Mineral Requirement FACT vs FALLACY dalam Latihan FALLACY

  FACT 

  Exercise Is An Appetite 

  Exercise Appears To Be A

  Stimulant

  Mild Appetite Suppressant For The First Few Hours Following Intense Exercise Training Due To An Increase In Catecholamine I. Pendekatan Evaluasi dan Program Pada Pasien (Problem Solving Process Pierson, Burnett & Kisnerr, 1986)

  ASSES _NEEDS ^DEVELOP _PLAN ^IMPLEMENT _PLAN ^EVALUATE _PLAN

A. Asses Needs

  1. Impairment kehilangan/abnormalitas fungsi psikologi, fsiologi & struktur anatomi

  2. Functional limitation keterbatasan krn suatu impairment & berhubungan dgn fungsi normal

  3. Disability Ketidakmampuan melakukan ADL normal

  4. Handicap Ketidakberuntungan sosial akibat impairment/ disability sehingga membatasi/mencegah seseorang thdp pekerjaan/ lingkungan & setting sosial

  Format SOAP Subjective information (riwayat kasus)

  Objective data (evaluasi klinis)

  1. Gambarkan simptom/mekanisme injuri

  2. Bagaimana simptom yg dirasakan

  3. Gambarkan keadaan simptom thd ADL

  4. Gambarkan keadaan kondisi sebelumnya

  5. Gambarkan riwayat penanganan sebelumnya

  6. Gambarkan keadaan kesehatan secara umum 1) Inspeksi 2) Provokasi tes a) AROM

  b) PROM

  c) Joint integrity

  d) Resisted test 3) Palpasi 4) Neurologic test 5) Tes-tes tambahan 6) Tes-tes khusus thdp limitation, disability & handicap Format SOAP 

  Assesmen Examination of patient

  1) Identifkasi

  1. Assessment diagnosis & 

  Assessment includes: impairment  subjective information: 2) Identifkasi

• name, age, sex, address, keterbatasan occupation, diagnosis.

  fungsional &

• How the patient perceive his

  disability symptoms.

  3)Identifkasi

• Describe the behavior of the

  handicap symptoms.

  4) Buat referal yg

• Related History of any previous tepat medical or surgical history.

Examination of patient Assessment Objective data: Goals of treatment

  

• - By Inspection according to assessment

  (observation). results.
• By palpation. - Long term goals.

   - By measurement: Short term goals.

  

  Muscle palpation,  Plane of treatment. muscle testing,

  

  functional ability, ROM, round and long measurement, muscle tone,

   special tests.

B. Develop Plan

  1. Faktor-faktor yg mempengaruhi perencanaan

  2. Menentukan tujuan & outcome yg diharapkan

  3. Identifkasi tujuan jangka pendek

  4. Mengembangkan rencana

C. Implement Plan

  1. Gunakan prosedur & teknik sesuai rencana & tujuan yg diharapkan

  2. Libatkan pasien & keluarganya

D. Evaluate Plan

  1. Bandingkan data asli dgn data terbaru

  2. Identifkasi tujuan & hasil utk modifkasi

E. Home Program

  Merupakan perluasan dr pengembangan perencanaan