REHABILITASI PADA PELAYANAN

DOKTER KELUARGA
dr. M. Khotibuddin, MPH
Schematic representation of the natural history of disease
 Tertiary Prevention
• It is used when the disease process has
advanced beyond its early stages.
• It is defined as “all the measures available to
reduce or limit impairments and disabilities,
and to promote the patients’ adjustment to
irremediable (tdk dpt diperbaiki) conditions.”
• Intervention that should be accomplished in
the stage of tertiary prevention are disability
limitation, and rehabilitation.
 A disability is defined as "any restriction or lack (resulting from
an impairment) of ability to perform an activity in the manner or
within the range considered normal for a human being."
 WHO DEFINITIONS
• Impairment ↔ Organ or Tissue

• Disability ↔ Whole Person

• Handicap ↔ Society
 Tertiary Prevention
• Disability Limitation, prevent chronicity,
sequelle, and handicap, even death.
– Host
• Adequate treatment
• Drug of choice and rational prescribing
• Evidence based treatment
– Agent (causation)
• Culture and sensitivity
– Lingkungan
• Ergonomic site
 Tertiary Prevention
• Rehabilitation is “ the combined and coordinated use
of medical, social, educational, and vocational
(keahlian/bakat) measures for training and retraining
the individual to the highest possible level of
functional ability.”

Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
 Tertiary Prevention
• Where the condition is not reversible, tertiary
prevention focuses on rehabilitation, assisting the
patient to accommodate to his disability.
• For reversible conditions, such as many types of
heart disease, tertiary prevention will reduce the
population prevalence, whereas for incurable
conditions it may increase prevalence if it
prolongs survival.
• The key goal for tertiary prevention is to enhance
quality of life.
 REHABILITATION
• Rehabilitation is the process of
helping a person to reach the
fullest physical, psychological,
social, vocational, avocational,
and educational potential
consistent with his or her
physiologic or anatomical
impairment, environmental
limitations, and desires and life
plans.
• Suatu program rehabiliatsi komprehensip
dikatakan berhasil baik apabila program tsb
mengandung 4 unsur yaitu :
– Pemulihan kondisi fisik
– Pemulihan kondisi psikologik
– Latihan provokasional dan pengalaman kerja
singkat guna membantu penderita
mengembalikan kepercayaan diri, dan
– Resosialisasi.
General Activities of Daily Living Scale
Indeks Barthel
 Mengukur Fungsi dan Kualitas Hidup
• ADL = activities of daily living;
• BI = Barthel Index (Barthel ADL)
• CRQ = chronic respiratory questionnaire;
• HUI = Health Utilities Index;
• Lawton IADL = instrumental activities of daily
living;
• ICC = intraclass correlation;
• SF 36= short form;
• Duke Activity Status Index (DASI)
 Post Acute Care
• FIM™ is functional independent measure.
• PF-10 is physical function index (10 items).
• MDS is minimum data set.
• OASIS is Standardized Outcome and
Assessment Information Set for Home Health.
Common Conditions
 Evaluation

physical exam and imaging

 Evaluation
electromyography

nerve
conduction study
 Problem List

• Neurogenic Bladder • Skin Breakdown

• Malnutrition • Heterotopic Ossification
• Dysphagia • Gait Dysfunction
• Ventilation • Seizures
• Constipation • Depression
• Pain • Insomnia
• Deep Vein Thrombosis
• Radiculopathy
• Spasticity and Contracture
• Permanent Impairment
Some SolutionsProblem List
• Neurogenic Bladder
• Malnutrition
• Dysphagia
• Ventilation
Orthoses
• Constipation
• Pain
• Skin Breakdown
• Heterotopic Ossification
• Gait Dysfunction
• Seizures
• Depression
• Insomnia
• Deep Vein Thrombosis
• Radiculopathy
• Spasticity and Contracture
• Permanent Impairment
 Some Solutions

• Neurogenic Bladder • Skin Breakdown

• Malnutrition • Heterotopic Ossification
electrical
• Dysphagia • Gait Dysfunction
• Ventilation
stimulation
• Seizures
• Constipation • Depression
• Pain • Insomnia
• Deep Vein Thrombosis
• Radiculopathy
thickening
• Spasticity and Contracture
• Permanent mixImpairment
 Some Solutions

• Neurogenic Bladder • Skin Breakdown

• Malnutrition • Heterotopic Ossification
• Dysphagia • Gait Dysfunction
• Ventilation • Seizures
• Constipation Gait Training
• Depression
• Pain • Insomnia
• Deep Vein Thrombosis
• Radiculopathy
• Spasticity and Contracture
• Permanent Impairment
 Some Solutions

• Neurogenic Bladder • Skin Breakdown

baclofen
• Malnutrition botox
• Heterotopic Ossification
• Dysphagia pump • Gait Dysfunction
• Ventilation • Seizures
• Constipation manual
• Depression
• Pain • Insomnia
therapy
• Deep Vein Thrombosis
• Radiculopathy
• Spasticity and Contracture
• Permanent Impairment
 Some Solutions

• Neurogenic Bladder • Skin Breakdown

• Malnutrition • Heterotopic Ossification
• Dysphagia heat/cold
• Gait Dysfunction
• Ventilation • Seizures
• Constipation •water
Depression
• Pain • Insomnia
therapy
• Deep Vein Thrombosis
• Radiculopathy
transcutaneous
• Spasticity and Contracture
electrical
• Permanent nerve
Impairment
stimulation
 Some Solutions

• Neurogenic Bladder • Skin Breakdown

• Malnutrition • Heterotopic Ossification
• Dysphagia • Gait Dysfunction
• Ventilation • Seizures
• Constipation • Depression
• Pain • Insomnia
• Deep Vein Thrombosis
prostheses
• Radiculopathy
• Spasticity and Contracture
• Permanent Impairment
 Goal
-= Overall Enhancement =-

Maximize
physical
– Independence psychological
– Dignity social
– Quality of Life vocational
educational
 Interdisciplinary Team
Medical Professionals
• Critical Care • Neurosurgery
• Intensive Medicine • Orthopedics
• General Surgery • Psychiatry
• Neurology • Urology
 Interdisciplinary Team (cont’d)
Allied Health Professionals
• Dietetic • Physical Therapy
• Rehabilitation Nurse • Prosthetics & Orthotics
• Occupational Therapy • Psychology
• Recreational Therapy • Respiratory Therapy
• Social Worker
• Speech & Language
Therapy
• Vocational Counseling
 Additional Resources

American Academy of Physical Medicine & Rehabilitation

www.aapmr.org

Association of Academic Physiatrists

www.physiatry.org

Archives of Physical Medicine and Rehabilitation

www.archives-pmr.org

American Congress of Rehabilitation Medicine

www.acrm.org
REHABILITASI KEDOKTERAN KELUARGA

DISEASES ILLNESS
• Ukuran Fungsi Biologis • Disfungsi Keluarga
– ADL – APGAR Score
– GADL
– IB
– Dll
• Terapi
– CEA keluarga
• Rehabilitasi Medik
– Fisik/Medis
– Vokasional
– Sosial
– Psikologis
– Edukasi
 Penanganan Rehabilitasi Medik pada
OA
1. Stadium akut:
– Obat-obatan pain killer
– Istirahat
– Terapi dingin ( Cold pack, Cryoterapi)
2. Stadium sub akut dan kronik:
– Terapi panas: IR, Hot pack, Short Wave Diatermi
(SWD), Ultra Sound Diatermi (USD), Micro Wave
Diatermi (MWD)
– TENS
– Low Laser
– Biofeedback
3. Massage/ tehnik manual
4. Terapi latihan:
– Latihan gerak sendi
– Latihan peregangan
– Latihan penguatan
– Latihan aerobik
5. Hidroterapi
6. Koreksi dan proteksi sendi dengan ortosis
7. Latihan Aktifitas Kehidupan Sehari-hari
8. Edukasi Proper Body Mechanic
9. Pendekatan Fisiko-Psiko-Sosio-Vokasional
 Exercise
1. Quadriceps exercise
– Secara bermakna mengurangi nyeri, memperbaiki
kekuatan quadriceps dan fungsinya
– Isometrik / isotonik / resistive
– Latihan dilakukan 20-30 menit/hari
– Evaluasi dilakukan selama 6 minggu
– Biofeedback
2. Latihan lingkup gerak sendi aktif : panggul, lutut dan
ankle
3. Gait training:
– Instruksi normal gait
– +/- alat bantu
4. Physical reconditioning
– Supervisi
– Individual
– Gradual
– Instruksi harus jelas: frekuensi, intensitas dan durasi
– Memperbaiki tonus otot, kekuatan, ketahanan,
kapasitas aerobik, fungsi sendi dan
fungsional&vocasional

5. Pool therapi
 Walking Aid

• Tongkat pada tangan kontralateral

• Walker
 Edukasi dan manajemen pola hidup

• Pentingnya latihan

• Alat bantu untuk Aktifitas kehidupan sehari-

hari

• Penyesuaian aktivitas, proteksi sendi dan

pemeliharaan energi
 Aktifitas fisik yang dihindari

• High impact activities ( joging, lari, naik turun

tangga)

• Hindari jongkok, menyilangkan tungkai saat

duduk, dan berdiri terlalu lama
Hindari !!!!
Dianjurkan !!!!!
 Self management program

• Dukungan petugas kesehatan profesional:

• - Tatap muka

• - Via telepon
 Pengurangan berat badan

• Menurunkan obesitas

• Program komprehensif: diet dan olah raga

 Knee braces

• Jika terjadi tibiofemoral instability