Stroke Rehabilitation

STROKE REHABILITATION

DR. dr. Noer Rachma SpRM

FAK. KEDOKTERAN UNIV. NEGERI SEBELAS MARETSURAKARTA

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

Risk Factor For StrokeAgeHypertensionCardiac ImpairmentTIAHyperlipidDiabetesObesitasHeavy smokerStress

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)

Pendekatan NeuroDevelopmentalDasar:Inhibisi reaksi postural yang abnormalFasilitasi reaksi postural yang normalRe - learning

Aplikasi : Mengenal Perkembangan reflek2 dan reaksi keseimbangan (phylogenetik)

Anterior cerebral arteryLesion site

Bladder & bowel

incontinentia

Impairment judgement & insight

Ataxia & typical defisit

Middle cerebral arteri

Contralateral hemiplegi , face paralysis

Contralateral monoplegi , cortikal hypesthesiaHemianopsia, Dysphasia, Agnosia

Posterior cerebral artery

AlexiaVisual agnosiaCortical blindnessParalisis nervus IIIMemory impairmenthemianopsia

TIA TERDAHULUSAKIT KEPALA SAAT SERANGANCT SCANTrombotik50%20%iskhemikEmboli10%10%superficialLacunar30%5%N/kecil dalamhemorrhagi5%35%Massa hiperdens

Jenis%SeranganKomaFibrilasi atriumTrombotik40Bertahap5%10%Emboli30Mendadak1%35%Lacunar20Bertahap atau mendadak0%5%hemoragi10Mendadak25%5%

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

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

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

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

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

SELESAITerima kasih..