Ft c2 Manajemen Spastisitas

7/28/2019 Ft c2 Manajemen Spastisitas

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MANAGEMENT SPASTICITY

(Pertemuan ke-2)

1.Pengertian spasticity

2. Patophysiology spasiticity3.Assessment spasticity

4. Management spasticity

Oleh

Drs. Soeparman SSt.FT


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PENDAHULUAN

Dampak spasticity atau spasm, selanjutnya kita sebutspastik, dapat menghancurkan individu :

1. Spastik, merupakan ganguan motorik tetapi sebagianmuncul juga, pain, stifness, bahkan kronik pain saat tidur,

mood, motivasi.2. Berdampak pd gangguan fungsi, termasuk mobilitasberjalan, menggunakan kursi roda, sering jatuh, sertagangguan fungsi ADL.

3. Semua aspek negatif tsb berlanjut pd pekerjaan dan

pendidikan yg dirasakan juga bagi orang tua, partner ataukeluarganya.


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Komplikasi.

Kurangnya pengetahuan tentang spasticity,cenderung terjadi kontraktur jaringan,

pemendekan otot, deformitas sendi, dan sekaliterjadi kontraktur sulit utk dikoreksi, termasukpersonal hygiene. Ini merupakan vicious cyrcles.

Jadi harus disadari oleh semua tim dlm

manjemen spasticity bersifat individu dan fokuspd fungsional, walaupun umumnya bertujuanmenurunkan spastik dan mencegah komplikasi.


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1.What is spasticity?

Ada yg berfikir sbg symtom dan akibatnya, ada ygberfikir sbg neurological impairment.

Definisi 1

Spasticity is a motor disorder characterised by a

velocity-dependent increase in tonic stretch reflexes(muscle tone) with exaggerated tendon jerks, resultingfrom hyperexcitability of the stretch reflex, as onecomponent of the upper motor neurone syndrome(Lance in 1980).

Disini mengkhususkan pada kenaikan tonus otot akibatpassive stretch reflex, tidak termasuk syndrom UMNlain termasuk clonus dan spasm


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Definisi 2.

Spasticity is disordered sensorimotorcontrol,

resulting from an upper motor neurone

lesion, presenting as intermittent or sustained

involuntary activation of muscles. (EURO-SPASMgroup).

Disini memayungi semua syndrom UMNtermasuk clonus dan spasm.


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UMN SYNDROM

POSITIVE NEGATIVE

Spasticity

Spasms

Clonus

Associated reactions

Positive support reaction

Brisk tendon reflexesExtensor plantar responses

Weakness

Reduced dexterity

Reduced postural responses


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MUSCLE TONE

Adalah ketegangan otot atau kekenyalan ototyang dipengaruhi oleh faktor non neural(viscoelastisitas jaringan) dan faktor neural yaitu

fast stretch reflexs. Ketegangan (resistance) akibat slow stretch ini

hanya melulu pengaruh kompunen visco-elastisitas jaringan.

Sedangkan fast stretch (high-velocity) secarareflex neurologis terjadi kenaikan tonus otot, danhanya brieff contraction


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STRETCH REFLEX

Otot skeletal jika distretch, muscle spindle

akan terangsang kemudian diteruskan oleh

afferen Ia ke spinal cord. Melalui monosynap

langsung dikirim ke alfa motor, terjadilah

kontraksi otot. Tetapi secara simultan terjadi

relaksasi antagonist (reciprocal inhibition).


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STRETCH REFLEX


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2.PATOPHYSIOLOGY SPASTICITY

Dalam keadaan normal, stretch reflex hanyamenghasilkan brieff-contraction, sedangspasticity stretch menghasilkan kontraksi lama.

Karena berkurangnya reciprocal inhibition dispinal cord.

Syndrom UMN termasuk, spasticity, weakness,spasm, clonus, meningkatnya tendon reflek ,

hilangnya gerakan halus dan hilangnyaketangkasan. Ini sering keliru bahwa semuagambaran tsb karena lesi traktus pyramidal.


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Jika lesi hanya terjadi di cortec primer,syndroma yg muncul hanya weakness danhilangnya dexterity (ketangkasan), tidak

muncul yg lain layaknya syndrom UMN. Syndroma UMN akan jelas jika lesi terjadi

pada parapyramidal pathway, terutama dorsalreticulo-spinal tract yg penting utk aktivasiinhibitori spinal dan mengendalikan nilaiambang alfa motor neuron.


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Pasien dgn kerusakan tsb, akan terjadipenurunan resiprocal inhibition danpresynaptic inhibition. Akibatnya terjadilah

spasticity. Perubahan jaringan sekitar sendi dapat

menimbulkan stiftness (pasif atau non neuralstiffness). Pd syndrom UMN , gerakan pasifcenderung meningkatkan tonus oki tak perludilakukan, misalnya pada kasus stroke.


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Thixotropy

Muscle dan conective tissue juga

menunjukkan adanya gejala tersendiri.

Bilamana dilakukan gerakan pasif berulang

maka dirasakan stifness semakin berkurang.

Demikian juga stifness awal gerakan akan

dirasakan semakin berkurang pada gerakan

selanjutnya. Penomena ini disebut thixotropy.


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PERBEDAAN PASSIVE STIFNESS DAN

NEURAL STIFNESS

Tardieu test, membandingkan slow stretch dg faststretch, dimana pd slow stretch tidak dirasakanstifness(non neural), tetapi pd fast stretch terjadistifness, ini kombinasi non neural dan neural

stifness. Treatmen non neural stifness dg stretching dan

splinting lebih baik dp farmakologi.

Botox lebih cocok utk neural stifness.

EMG lebih jelas pd neural stiffness

Intrathecal phenol therapy, blocking spinal cord,jelas hanya terjadi non neural stifness


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Co-contraction

Co-contraction terjadi bilamana secara simultankontraksi agonis dan antagonis, ini jugamenimbulkan stiffness.

Dalam keadaan normal ini diperlukan utkstabilitas sendi misalnya pada saatmempertahankan posture, saat tanganmemegang gelas/cangkir.

Pada lesi UMN abnormal co-contraction dgnpenomena nampak lebih lemah, gangguankoordinasi, hilangnya gerak tangkas (dexterity).


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Penomena itu timbul karena :

1. stretch antagonist

2. saat normal relaksasi, pd awal gerakanterjadi perubahan exitatory shg timbul co-

contraction agonist-antagonist.

3. abnormal stretch reflex seperti impairment

pd spinal cord shg mengganggu reciprocal

inhibitory.


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Mengendalikan co-contraction penting agar

aktivitas lebih efisien, misalnya dg

menggunakan botox pada antagonist.


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CLONUS

This is arhythmic pattern of contraction

occurring at a rate of several times persecond

and can be demonstrated by a sudden stretch of

a muscle. In the UMN syndrome, clonus is commonly

observed in the muscles of the leg, with rhythmic

contractions of both the gastrocnemius andsoleus muscles in response to dorsiflexion of the

ankle.


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SPASMS

Spasms, or sudden involuntary (often painful)movements, are frequently associated with spasticity,but physiologically their mechanism of action appearsto be different to the velocity- or stretch-dependent

hypertonia. Spasms may be clearlyprecipitated (menurun) by

muscle stretch, but may also be triggered via a variety

of peripheral, noxious and visceral afferents, including

pressure sores, bowel impaction, urinary retention or

infection.


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Non-nociceptive cutaneous stimuli such as

touch, bedclothes or tight garments may be

enough to trigger spasms.

So-called spontaneous spasms may well be

the result of as-yet unidentified stimuli; it is

therefore essential to search for any possible

trigger factors, which may be cutaneous or

visceral in nature.


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Kadangkala, spasticy dan spasm saling

befluktuasi tergantung trigger dan lokasi.

Spasm bisa terjadi pd fleksor, ektensor atau

kombinasi (tanpa adduktor).


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CONTRACTURES

Prolonged immobility of joints and muscles in ashortened state can lead to irreversible changesin the muscles, tendons and ligaments that result

in loss of passive range at joints. Within muscles,sarcomere number may be reduced andhistochemical changes resembling (mirip)denervation can occur.

Akibatnya bisa terjadi neural/non-neuralhypertonia/stiffness, seperti sering dialami 2 blnsetelah stroke.


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Contracture juga bisa terjadi pada kasus lesi

perifer, GBS dsb.

Sekali terjadi contracturesulit dikoreksi

terpaksa dilakukan tindakan bedah. OKI

pencegahan adalah yg terbaik.


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ASCOCIATED REACTION

Bila aktivitas suatu otot kemudian diikutiaktivitas otot bagian tubuh yg lain disebutreaksi asosisi.

Pd pasien stroke saat berjalan diikuti denganfleksi elbow.

Kerasnya asosiasi dpt dilihat dari seberapa

keras/besar terjadi gerakan asosiasi,hypertonia anggota bawah dan seberapa kerasupaya melakukan aktivitas.


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The mechanisms underlying these reactions

are not clear, but probably include disturbed

descending supraspinal control, perhaps

through unaffected, but less focused,bulbospinal pathways taking on the role

of damaged corticospinal pathways.


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3.ASSESSMENT SPASTICITY

Soeparman


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a.ASHWRTH SCALE

Ashworth scale (Ash-worth, 1964), semula

dikembangkan utk multiple sclerosis, berdasarkan

resistance passive movement atau stretch.

Reliabilitynya tergantung dari kemampuan pengetesterhadap kontrol tingkat stretch dan perkiraan

resistance nya.

Meskipun penggunaannya sudah meluas tetapi

relatif sedikit data tentang reliability scale.

Soeparman


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Soeparman


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b.METODE TARDIEU SCALE

Dengan menggunakan :

1. Slow stretch, dimana tidak muncul reflex stretching.

2. Fast stretch, muncul reflex stretching (X)

3. Dicatat sudut terjadinya resistance (Y).

4. Diklasifikasikan seperti dlm Tabel 3.3

Penerapannya pd anggota atas posisi duduk sedang

pada anggota bawah berbaring terlentang.

Soeparman


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Soeparman


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Tardieu melakukan stretch pada ankle dorsi fleksi dan knee extensi. R1

pd fast stretch muncul resistance artinya ada spastic, R2 pd slow

stretch muncul resistance artinya contracture . Selisish R1-R2 indikasi

relative spastic. Perbedaan R1-R2 besar berarti spastic, dan perbedaan

kecil berarti contracture.


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c.METODE 9-HPT (HOLES PEGS TEST)

Pasien duduk menghadapi balok yang terdapat 9lubang dan 9pasak, kemudian pasien dimintauntuk memasukkan satu persatu pasak kedalamlubang tadi sampai habis dan kemudian pasak

dicabut lagi. Kemudian dihitung waktu yang diperlukan untuk

aktivitas tersebut, dikatakan baik bila kurang dari10 menit.

Tes ini lebih cocok untuk mengetahui fungsi jaridan tangan, semula digunakan pada MultipleSclerosis.


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d.METODE WATENBERG

Pelaksanaannya dengan pendulum

Semula digunakan pada anggota bawah,

dimana diawali dengan lutut lurus kemudian

dilepaskan dan jatuh terayun-ayun.

Pada orang normal ayunan terjadi osilasi 6x

sampai kaki diam. Artinya semakin sedikit

terjadi osilasi maka dinyatakan semakin

spastic.

Soeparman


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PERBEDAAN ISTILAH SPASTIC

Spasticity :A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone)with exaggerated tendon jerks, resulting from hyperreflexia ofthe stretch reflex as one component of the upper motor

neurone syndrome (Lance, 1980, p. 485). Hyperreflexia :A greater than normal reflex response (e.g.

the presence of reflex responses when a relaxed muscle isstretched at the speed of normal movement).

Tone :The resistance felt when moving a limb passivelythrough range due to inertia and the compliance of thetissues.


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Hypertonia ; A greater than normal resistance felt

when moving a limb passively through range.

Dystonia ; A movement disorder in which

involuntary sustained or intermittent musclecontractions cause twisting and repetitive

movements, abnormal postures or both (Sanger

et al ., 2003). Overactivity ; Excessive muscle activity for the

requirements of the task.


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Passive stiffness ; The force required to

lengthen a muscle at rest (i.e. the slope of the

force-displacement curve).

Active stiffness ; The force required to

lengthen a muscle, which is active (i.e. the

slope(menanjak) ofthe active force-

displacement curve).


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Impairment ; Loss of body function or

problem in body structure (WHO, 2001).

Activity limitation ; Difficulty in execution of a

task or action (WHO, 2001).

Participation restriction ; Problems

experienced in involvement in life situations in

a societal role (WHO, 2001).


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MEKANISME HYPERTONIA

(ODwyer & Ada 1996.)


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4.MANAGEMENT PHYSICAL THERAPY

Minimise changes in the viscoelastic properties of

connective tissue, muscles and joints, with the

ultimate aim of maintaining range and preventing

the development of contractures. This may be

achieved by active and passive movement, stand-

ing, or stretching, or through the use of splints.


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Change patterns of spasticity or spasms to preventthem becoming self-perpetuating(permanen). Forexample, if extensor tone and spasms are a dominantproblem in the legs (stiff straight legs), then using a

wedge or T-roll under the knees for night-timepositioning may inhibit this pattern (by promoting a

flexed position of the legs) and impact beneficially

on the persons function and/or ease of care in the

morning.


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Maintain or improve the persons level of

function. A strengthening programme as well asconsidering cardiovascular fitness may be

relevant. Recognise when and how spasticity or its

associated features are useful functionally to a

person, but prevent this use from reinforcing

patterns of spasticity or contributing to increases

in non-neural tone.


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PHYSICAL MODALITIES

1. STANDING2. ACTIVE EXERCISE AND PROMOTION OF OPTIMAL

MOVEMENT PATTERNS

3. PASSIVE MOVEMENTS

4. STRETCHES

5. POSITIONING

6. SPLINTING AND THE USE OF ORTHOSES

7. FUNCTIONAL ELECTRICAL STIMULATION8. HYDROTHERAPY

9. WHEELCHAIR AND SEATING FOR PEOPLE WITHSPASTICITY


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1. STANDING

The usefulness of assisted standing has been

recognised in the Department of Health

National Institute for Clinical Excellence(NICE)

guidelines.

Beneficial effects of standing in spasticity

management are clearly complex, but are

postulated to include the following:


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Evidence base for standing

Promotion of anti-gravity muscle activity in thetrunk and lower limbs.

Maintenance or improvement in soft tissue andjoint flexibility, thereby reducing the risk of

contracture development. Modulation of the neural component of spasticity

through prolonged stretch and altered sensoryinput.

Reduction of lower-limb spasms. A positive psychological effect.


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Beneficial effects of standing

Promotion of anti-gravity muscle activity inthe trunk and lower limbs

Maintenance or improvement in soft tissueand joint flexibility, thereby reducing the riskof contracture development

Modulation of the neural component ofspasticity through prolonged stretch and

altered sensory input Reduction of lower-limb spasms

A positive psychological effect


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How long to stand for?

The duration of standing in reported studies

varies from 30 minutes to a maximum of

112 hours daily, often starting with shorter

times and building up.

From the results of the self-report surveys, it

appears that individuals were standing onaverage for 40 minutes, three or four times a

week.


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CONTROL ECCENTRIC & CONCENTRIC PLANTAR FLEXOR MUSCLE UTK

MENGURANGI SPASTICITY DAN MEMPERBAIKI FUNGSI BERJALAN.


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Application of a back slab

Ways to incorporate


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Ways to incorporate

(diklompokkan)standing into the

management plan The optimal standing position is in an extended

posture with neutral alignment of the trunk,pelvis and lower-limb joints.

Careful assessment is needed to determine howthis is best achieved and how it may beincorporated into an individuals daily routine.

Optimising safety and posture in standing can be

achieved through use of the environment or withspecialised equipment.


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Equipment for aid standing

Household equipment

Lower-limb splints

Oswestry standing frame

Motorised or hydraulically assisted standing

systems

Standing wheelchair Tilt table


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Oswestry standing frame


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Motorised or hydraulically assisted standing


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Tilt Table


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Implementasi Program Standing

Masukkan dlm daftar kegiatan 24 jam

Pilih alat yang memadai, terjangkau, aman

Periksalah alignment standing

Perhatikan mungkin ada bagian kulit yg tertekan

Kontrol efek negatif dan positif

Lakukan latihan selama berdiri

Mungkin diperlukan botox utk relaksasi otot yg

ter stretch.

2 ACTIVE EXERCISE AND PROMOTION


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2. ACTIVE EXERCISE AND PROMOTIONOF OPTIMAL MOVEMENT PATTERNS

Jika mungkin, lakukan latihan aktif utkmemperkuat otot, re-edukasi patternmovement, meningkatkan kebugaran kardio-

vaskuler. Tujuan utama manajemen UMN-syndrome utk

mengurangi spaticity dg harapan dptmeningkatkan fungsional. Sehingga sedikit

bahkan terabaikan problem lain, sepertiweakness.


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Perlu disadari bahwa weakness hampir selalu

terjadi pd otot antagonist, sehingga terjadi

keadaan muscle imbalance, selanjutnya terjadi

perubahan jaringan dan deformitas.

Perlu teknik khusus mungkin penggunaan

botox agar relaks, sehingga otot antagonist

bisa dilatih penguatan


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Utk re-education pattern movement, lakukan

gerakan aktif kombinasi disertai stretching, dan

jangan lupa perhatikan trunk muscle segabai

stabilisator proksimal agar gerakan lebih efisien. Ada kalanya spasm dpt membantu stabilitas

sendi, tetapi apakah penggunaan itu masih tetap

terkontrol, harus diingat bhw syndroma UMN

termasuk hilangnya kontrol/koordinasi, jd pentig

utk melatih kontrol gerakan.


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Evidence base strength trainning telah dilakukanoleh Dodd et al, melaporkan ada perbedaansignifikan efek strength training CP dptmemperbaiki gross motor, jalan, dan time up andgo, serta tidak ada kenaikan spastisitas ygbermakna.

Sedang pd pasien stroke, dpt memperbaiki

kekutan otot tungkai dan kecepatan jalan. Pada MS, strength trainning dpt mengurangi

fatique meningkatkan kemampuan berjalan.


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Metode strength trainning yg biasa dilakukan

seperti task sit to stand, step up, atau dgn

beban 60-80% beban maksimal.

Utk memperbaiki kardiovaskuler, lakukanaerobik . Ini sangat bermanfaat utk kasus

stroke, MS, GBS, dpt meningkatkan kecepatan

dan jarak berjalan.


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3. PASSIVE MOVEMENTS

Diyakini berdampak pd peningkatan

spastisitas dan tonus otot, tetapi dianjurkan

utk semua bagian tubuh digerakkan sebelum

melalkukan aktivitas, hanya terbatas padarom yang ada. (menghindari stretch reflex).

Ini dimaksud utk mencegah non neural

stiffness.


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Evidence base, pasif yg dilakukan pd elbow

oleh Schmit et al kasus TBI, dpt menurunkan

fleksor spasm.

Pd stroke, pasif pd sendi lutut dpt menurnkanspasticity sementara.

Pd MS dan SCI, tidak menunjukkan perubahan

spasticity yang berarti, tetapi secra subyektifpasien merasakan lebih nyaman.


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Pelaksanaan Passive Movement

Masukkan dlm program 24 jam misalnya

setiap pagi hari.

Ajarkan pd perawat, saat pergantian posisi,

memindahkan dr bed ke kursi roda dsb.

Lakukan slow stretch jangan menimbulkan

trigger stretch reflex pada otot anti gravity.

20-30 menit sebelumnya mungkin berikan

obat relaksasi misal botox.


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Lakukan pd posisi berbaring, tetapi dapat juga

duduk atau berdiri.

Jika perlu dgn alat bisa dipakai CPM.

Hati-hati jagan menimbulkan stimulasi stretch

reflex, luka pd kulit, cedera otot/tulang.


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4. STRETCHES

Otot yg diimmobilisasi dlm 2 hari saja sdhterjadi shorthening, karena itu perlu dilakukanstretching utk memanjangkan kembali shg

lebih flexibel. Stretch dilakukan sustaining 30 menit dua kali

setiap hari.

Atur posisi yg dikenal dg anti spasticpositioning sering ditrapkan pa kasus CP,dipertahankan selama 20 menit setiap hari.


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5. POSITIONING

Pada dasarnya posisikan dimana otot dlmkeadaan optimal lengthening, yg berartimeningkatkan rom sendi.

Manfaat positioning, diantaranya :a. memungkinkan jaringan terulur

b. merubah pola spastisitas karena diposisikan kearah yg berlawanan.

c. koreksi asymetris

d. support shg mencapai relaksasi.


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Pergantian posisi yang teratur sepanjang hari

jauh lebih baik dibanding membiarkan hanya

satu posisi yang memungkinkan problem kulit

juga cenderung terjadi kontraktur. Berikut contoh posisi utk spastisitas adduktor

hip, dengan menggunakan wedging dan T-roll.


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The Use a wedging in lying


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The Use a wedging in sitting


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The Use T-roll in lying

The Use T roll in side lying


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The Use T-roll in side lying

6 SPLINTING AND THE USE OF


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6. SPLINTING AND THE USE OF

ORTHOSES

Fungsi utama utk mengontrol gerakan tubuh sertamencegah atau memperbaiki kelainan bentuk ataudeformitas.

Sebagai tindakan terapi dengan cara :

a. mengontrol rom shg memperbaiki fungsib. stretching yg lama utk mencegah atau koreksijaringan yg memendek.

c. kompensasi dr deformitas

d. membuat lebih nyamane. penyesuaian /adaptasi thd prolong stretch pdsensori otot yg spasticity.

/


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Indikasi splint/ortose

Maintain joint range,soft tissue length andalignment

Increase soft tissue length and passive range

of movement Facilitate function (e.g.ankle-foot orthosis)

Facilitate hygiene (e.g.by enabling access to

palm) Increase comfort (e.g.sheepskin palm

protector,Figure 4.11)


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Precaution

Sensory impairment

Unstable intracranial pressure

Poor skin condition

Vascular disorder

Fracture or severe soft tissue injury

Behavioural/cognitive disorders Uncontrolled epilepsy


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Heterotrophic ossification

Oedema

Acute inflammation

Access to limb required for medical purposes

Medically unstable

Frequent spasms

l


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Wrist splint

l


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Palm protector

lb il


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Elbow spilnt

Below knee splint


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Below knee splint

L li b (k ) li


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Lower limb (knee) splint

7 HYDROTHERAPY


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7. HYDROTHERAPY

Sendi yg tak dapat digerakkan di darat, dapatdilakukan di dalam air.

Penelitian menunjuikkan bahwa 20 menit 3

kali perminggu latihan di dlm air dptmenurunkan spastisitas menurut scalaAsworth score.

Immerson dlm air hangat dapat mencapai

relaksasi, mensuport tubuh, memudahkanbergerak.

8. FUNCTIONAL ELECTRICAL


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8. FUNCTIONA CTRICA

STIMULATION (FES)

The Odstock dropped foot stimulator(ODFS) wasdeveloped in the early 1990s.

The ODFS is a single-channel neuromuscular

stimulator that corrects dropped foot by stimulating

the common peroneal nerve using self-adhesive skin

surface electrodes placed on the side of the leg.

The electrical stimulation causes dorsiflexion andeversion of the foot. When this is timed to the gaitcycle using foot switches placed in the shoe, walkingperformance can be significantly improved.

9. WHEELCHAIR AND SEATING FOR


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PEOPLE WITH SPASTICITY

Bagi mereka yg mobilitasnya sudah tergantungdari kursi roda, atau aktivitasnya sebgaiandilakukan dg kursi roda, maka postur danduduk yg tepat, sangat penting .

Sebelumnya perlu diasses secara menyeluruhutk menentukan postur dan duduk yg benar.

Amati adakah triger spasm, artinya pd saat

duduk jika ada yg tidak nyaman cenderungtimbul spasm.

Goals of seating in patients with


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g p

spasticity

Facilitate function for example improved use of headand upper limbs

Reduce the risk of biomechanical changes in muscles,tendons and joints that can impact on health andhygiene

Accommodate to contractures or bony deformities thatmay already be established

Increase comfort

Minimise effects of fatigue on posture

Reduce work of breathing and improve quality of

speech

St bilit i l


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Stabilitas proximal

Landasan utama agar bagian distal dptbergerak bebas jika bagian proximal tetap

stabil.

Pd posisi duduk pelvis harus cukup stabil agarspine, neck, head dpt bergerak bebas. Jadi

landasan duduk serta sandaran hrs firm,

pelvis dlm posisi normal tidak tilting upwardmaupun backward.


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This can be illustrated by altering the seatbase to promote a slight anterior tilt of the

pelvis: this assists in reducing extensor tone by

encouraging hip flexion, abduction andexternal rotation as well as extension of the

trunk.


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However, it is important to consider thatchanges in one aspect of a seating system mayinfluence others: by reclining the back rest,flexion at the hips may be reduced, which cancause problems with extensor tone.

Often, if possible, a tilt-in-space chair is thebestoption, as it tips the entire seating system

back, not just the backrest, thus avoidingextension at the hip joints.


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Reclining the back rest : slightly allows gravityto hold the upper trunk and head supporting

surfaces. This reduces the workload of the

muscles and can reduce spasticity and spasmsin the trunk and limbs


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Tilt-in-space options have also been found to

improve respiration and reduce kyphosis for

people with various neurological conditions; in

addition, reduction in effort or work ofspeaking and breathing for people with MS

(multiple sclerosis) has been reported.


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Additional supports such as head rests andtables can help reduce the risk of fatigue

impacting on postural alignment by

supporting the weight of the head and arms. Frequent rests from the upright sitting

position using the tilt-in-space mechanism can

also help with managing fatigue andredistributing pressure.


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Some people will benefit greatly from the useof static seating systems (e.g. Kirton chairs)

that have a tilt-in-space mechanism and

adjustments to allow leg position to bechanged.

Lanjutkan dengan mempelajari pengukuran

spasticity dgn :Sasticity Outcome Measures Form

CONTOH STRETCHING


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CONTOH STRETCHING

Spasticity can be described as involuntarymuscle stiffness. People with spasticity

describe their muscles as feeling stiff, heavy

and difficult to move. Spasms can be described as sudden

involuntary contractions of muscles. They can

make your arms, legs or body move indifferent ways.


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Contractures are when a limb becomes fixedin one position. This occurs if spasticity and

spasms persist, restricting movement and

causing limbs to be held in set positions. Clonus is a repetitive up-and-down

movement, often of the feet. It may be

observed as a constant tapping of a foot onwheelchair footplates.

STRETCHING EXERCISE


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STRETCHING EXERCISE

All of these stretches are best performedslowly, and the end-position should be held

still. None of the stretches should cause you

any pain or discomfort.

Back Stretch


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Back Stretch

Quadriceps stretch


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Quadriceps stretch

Hip flexor stretch in prone


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Hip flexor stretch in prone

Hip flexor stretch in lying


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Hip flexor stretch in lying

Hamstring stretch


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Hamstring stretch

Hip adductor stretch


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Hip adductor stretch

Calf muscle Gastrocnemius stretch


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Calf muscle Gastrocnemius stretch

Calf muscle Soleus stretch


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Calf muscle Soleus stretch

Wrist and fingers stretch


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Wrist and fingers stretch

Assisted calf stretch


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Assisted calf stretch

Assisted back stretch


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Assisted back stretch

Assisted Adductor stretch


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Assisted Adductor stretch

Assisted Hamstring stretch


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Assisted Hamstring stretch

Clonus trying stretch


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Clonus, trying stretch


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TERIMA KASIH

ATAS PERHATIANNYA

Ft c2 Manajemen Spastisitas

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