REHABILITASI

PASCA TRAUMA
Dr. Nasyaruddin Herry Taufik, Sp.RM

Trauma

Skin
Vesel, nerve
Muscles
Ligament
Cartilage
Joint
Bone

1.Ankle Sprains
Pain
Lateral
Medial

Swelling
Difficult weight
bearing
Limping
Unstable
Limited motion

Anterior Drawer Test

Foot in neutral position

Fix tibia
Draw calcaneus forward
Normal 3 mm

Physical Therapy

Rest
Ice,
compression,
elevation
Bracing
Crutches, cane

Physical Therapy

ROM Exercise
Stretching
Strengthening
Isometric
Isotonic
isokinetic

Proprioception
Balance exercise

2. Ant. Cruciate Lig. Tear

Landing from a jump

Foot fixed, valgus stress
Audible pop heard or felt
Effusion
Pain and tense swelling
Limited motion

Special Test ACL

X-rays
Non diagnostic

Lachmans test
Sensitivitas 81,8 %
Specificitas 96,8 %

Anterior drawer test at 90

Sensitivitas 40,9 %
Specificitas 95,2 %

Therapy

Bandaging
Bracing
NSAID
Physical therapy
Icing, ultrasound
Hamstring strengthening
Proprioceptive exercise

Referral to orthopaedics
Crutches

3. Meniscus tear
McMurray classic
Pain med / lat. genu

X-rays
Joint space narrowing

MRI, specific examination

4.Medial Collateral Lig Tear

Valgus stress to partially flexed knee

Blow to lateral leg
Pain medially
Unstable with valgus

5. Fracture
5.a.Definisi
Terputusnya kontinuitas struktur
jaringan tulang atau tulang rawan
yang umumnya disebabkan oleh
trauma pada tulang yang dapat
bervariasi tergantung pada jenis,
kekuatan dan arah trauma baik
langsung maupun tidak langsung
(Appley & Solomon ).

5.b. Diagnosis

Anamnesa
Pemeriksaan Fisik
Inspeksi
Palpasi
Gerak

Radiologi
Arteriografi
Laboratorium

Tatalaksana
Medikamentosa
Reposisi, Fiksasi, Imobilisasi
*
Rehabilitasi
ROM exercise
Strengthening
Axial loading
Desensitisasi
TENS

Splint

6. Amputasi
Hilangnya bagian tubuh
Tim bedah dan rehabilitasi
Insidens amputasi AGB: 75%
penyakit vaskular, 20% trauma
( USA )
Program rehabilitasi dimulai
sejak pre amputasi

Etiology
Disease
Peripheral vascular disease

Trauma
29-33 % of all case, young adult

Tumor
5 % all case osteosarcoma

Congenital Limb deficienc

LEVEL

AMPUTASI

AGB

Rehabilitation
Pre Amputation
Cardiovascular, Respiratory

Cognitive
Level amputation
Muscles strength
Joint
Social, Environment and
vocational

Terapi Latihan pasca Amputasi

Memperbaiki penyembuhan stump

Mempertahankan / meningkatkan
kekuatan otot dan luas gerak sendi

Adaptasi terhadap perubahan

propioseptif/ kinestetik/ sensoris

Stimulasi / meningkatkan koordinasi

integrasi stump pd aktifitas
fungsional

Melatih/Meningkatkan toleransi
latihan

Energy Expenditure
AMPUTATION
LEVEL

ENERGY
INCREASE

UNILATERAL
TRANSTIBIAL

10 20 %

BILATERAL
TRANTIBIAL

20 40 %

UNILATERAL
TRANSFEMORAL

60 - 70 %

BILATERAL
TRANSFEMORAL

> 200 %

Parallel Bars

POST AMPUTATION
STUMP CONDITION
Shape, Length
State of healing,scar
Soft tissue coverage
ROM
Joint stability
Muscles strength

Manage
Proper positioning, ROM ex. ,
bandaging
Breathing exercise
Muscle strengthening exercise
Balance exercise : sitting, standing
Walking : Parallel bar, walker ,
Crutch
Simptomatic
Prosthesis
Gait training

Peroneal nerve injuries

Peroneal nerve injuries recover
very poorly
Peroneal nerve is a branch of the
sciatic nerve that wraps around
the fibular head near the knee
and then innervates muscles
that lift the foot and toes.

Diagnosis
History of present illnes
Examination
General
neurological
Localized
High-resolution 3-T MRI

Confirmed with electrical testing.

Treatment
Peroneal nerve has a poor
chance of recovery, with or
without surgery.
Physical therapy
Electrical stimulation
Custom-made orthotic (foot
splint).
ROM exercise ankle