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? Latihan/Exercise? 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 fisik 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 fisik, namun tidak semua aktivitas fisik adalah latihan/ exercise Physical activity is a bit broader term that includes not just exercise but things like … So all exercise is physical activity, but not all physical activity is exercise.

Kebugaran fisik/ physical fitness? Menunjukkan hubungan bagimana seseorang melakukan aktivitas fisik, yang tdd: Muscular strength Muscular endurance Flexibility Body composition Cardiorespiratory endurance Power Agility Fitness is a product. Most would agree it’s a product of exercise and/or physical activity and can be broken into components. Some of these components, like strength, muscular endurance, and flexibility, cardiorespiratory endurance and body composition relate more to health while others like power and agility have more to do with motor skill and performance.

Therapeutic Exercise Versus Conditioning Exercise Aktivitas-aktivitas digunakan untuk meminimalisir cidera dan meningkatkan performance Menggunakan conditioning exercise untuk mencegah cidera/ injury dan juga memulihkan dari kondisi cidera Latihan/ Exercise digunakan sebagai bagian dari program rehabilitasi Prinsip dasar dari latihan kekuatan yang diterapkan di fase rehabilitasi Training dan conditioning membatasi dan meminimalisir kemungkinan cidera, sedangkan rehab bekerja untuk mengembalikan agar dapat kembali bermain dan mencegah cidera berulang

Definisi terapi latihan/ Therapeutic Exercise (Therex) Terapi latihan/ Therapeutic Exercise (Therex) adalah konerja/ capaian/ performance yang sistematik dari pergerakan fisik yang terencana, postur dan aktivitas fisik lainnya yang bertujuan untuk memampukan pasien/ klien: ◦Remediate or prevent impairments ◦Enhance function ◦Reduce risk ◦Optimize overall health ◦Enhance fitness & 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 fitness (kebugaran) 3. Mobilitas & fleksibilitas 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 flexibility restoring or increasing strength maintaining levels of cardiovascular fitness 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 To facilitate proprioceptive neuromuscular function To improve respiratory capacity. To assist subject to control and improve his balance. To reduce pain. To help regaining of proper postural alignment (improve and correct posture). To increase and maintain flexibility of the muscles, tendons, ligaments, and fascia. To increase physical fitness. improve gait and ambulation (assist subject to walk properly). To improve circulation. To improve strength and power. To stimulate and increase sensory awareness of movement. To maintain and increase mobility of the joints 5. To restore the physiological properties of the muscle (excitability, contractility, and elasticity). 6. To improve co-ordination and neuromuscular control. 7. To increase muscle performance and functional capacity (endurance). 8. To gain relaxation (general or local).

Goal Setting Specific 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 Spot Reduction Can Reduce The Amount Of Fat In Certain Parts Of The Body Exercise, Even When Localized, Draws From All Of The Fat Stores Of 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 Calories

FACT vs FALLACY dalam Latihan Exercise And Sports Will Deter Bone Growth In Children Exercise Affects Primarily Bone Width, Density And Strength But Does Not Affect 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 When A Fat Baby Grows Up, Baby Fat Will Disappear Fat Babies Make Fat Adults Fat Cells Are Formed During 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 Strength Training Is Contraindicated In Children Prepubescent Children Can Improve Strength With 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 There Is An Increase In Metabolic Rate After Exercise ( Excessive Post Exercise Oxygen Consumption) Regardless Of The Type Of Exercise. E.P.O.C. Is Increased Depending On The Intensity Of Exercise

FACT vs FALLACY dalam Latihan 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 Some Health Fads Are More Effective Than Others The Most Important Factor In Weight Reduction Is The Development Of A Caloric Deficit While Maintaining A Complete Balanced Diet That Meets The Body Vitamins And Mineral Requirement

FACT vs FALLACY dalam Latihan Exercise Is An Appetite Stimulant Exercise Appears To Be A Mild Appetite Suppressant For The First Few Hours Following Intense Exercise Training Due To An Increase In Catecholamine

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, fisiologi & 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

Objective data (evaluasi klinis) 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

Examination of patient Format SOAP Assesmen 1) Identifikasi diagnosis & impairment 2) Identifikasi keterbatasan fungsional & disability 3)Identifikasi handicap 4) Buat referal yg tepat Examination of patient 1. Assessment Assessment includes: subjective information: - name, age, sex, address, occupation, diagnosis. - How the patient perceive his symptoms. - Describe the behavior of the symptoms. - Related History of any previous medical or surgical history.

Examination of patient Assessment Objective data: Goals of treatment - By Inspection (observation). - By palpation. - By measurement: Muscle palpation, muscle testing, functional ability, ROM, round and long measurement, muscle tone, special tests. according to assessment results. - Long term goals. Short term goals. Plane of treatment.

C. Implement Plan B. Develop Plan 1. Faktor-faktor yg mempengaruhi perencanaan 2. Menentukan tujuan & outcome yg diharapkan 3. Identifikasi tujuan jangka pendek 4. Mengembangkan rencana C. Implement Plan 1. Gunakan prosedur & teknik sesuai rencana & tujuan yg diharapkan 2. Libatkan pasien & keluarganya

E. Home Program D. Evaluate Plan 1. Bandingkan data asli dgn data terbaru 2. Identifikasi tujuan & hasil utk modifikasi E. Home Program Merupakan perluasan dr pengembangan perencanaan

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