MEDICAL REHABILITATION IN THE DERMATOMUSCULO SKELETAL SYSTEM
SUSANTI DHARMMIKA,Physical Medicine & Rehabilitation DepartmentFaculty of MedicineBandung Islamic University -2012
CSG OF DMS SYSTEM1. DERMATOSIS (INFECTION, NEOPLASM)2. BURN 3. DENTAL PROBLEMS4. CONGENITAL MALFORMATIONS5. TRAUMA OF THE MUSCULOSKELETAL SYSTEM
(FRACTURE, DISLOCATION)6. SPINAL PROBLEMS7. JOINT PROBLEMS
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
MEDICAL DIAGNOSIS(IMPAIRMENT, DISEASE)
FUNCTIONAL DIAGNOSIS(DYSFUNCTION, DISABILITY)
FUNCTIONAL PROBLEM LIST
ASSESSMENT BY ALLIED HEALTH PROFESSIONS
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
FUNCTIONAL PROBLEM LIST1. COMMUNICATION2. MOBILIZATION3. ACTIVITIES OF DAILY LIVING4. VOCATIONAL & A-VOCATIONAL
ACTIVITIES5. PSYCHO-SOCIAL6. EDUCATION7. ETC: PAIN
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
LEARNING OBJECTIVES FOR THE STUDENTS1. UNDERSTAND THE SCOPE OF
IMPAIRMENTS, DISABILITIES AND HANDICAPS
2. UNDERSTAND THE DIFFERENCE BETWEEN MEDICAL CARE & REHABILITATION CARE
3. UNDERSTAND THE ROLE OF THE FAMILY & THE COMMUNITY
4. UNDERSTAND THE AFTER-CARE (HOME-CARE) OF DISABLING DISEASES
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
COMPETENCE OF THE GENERAL PRACTITIONER
1. PREVENTION OF DISABILITIES & HANDICAPS
2. AFTER CARE OF IMPAIRMENTS & DISABILITIES
3. PREVENTING OF 2ND DISABILITIES AND HANDICAPS
4. PROMOTING INDEPENDENCE IN ACTIVITIES OF DAILY LIVING
5. PROMOTING INTEGRATION IN THE COMMUNITYDr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of
Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
REHABILITATION APPROACHES
IMPAIRMENT
DISABILITY
HANDICAP
FUNCTIONAL REHABILITATI
ON
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
SCOPE OF PHYSICAL MEDICINE AND REHABILITATION
(MEDICAL REHABILITATION)
1. PROMOTIVE SERVICES :
- EDUCATION of HEALTHY LIVING
- EDUCATION IN PREVENTING AND AVOIDING DISABILITES
- INCREASING OVERALL CONDITION
2. PREVENTIVE REHABILITATION
- PREVENTION OF SECONDARY AND TERTIER DISABILITIES
3. CURATIVE SERVICES
- MEDICAMENTOSA
- REHABILITATIVE NURSING
- PHYSIOTHERAPY
- SPEECH THERAPY
- OCCUPATIONAL / VOCATIONAL THERAPY
- ORTHOTICS and PROSTHETICSDr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
PROBLEM LIST
BURN
IMMOBILIZATION
MUSCULOSKELETAL TRAUMA
PAIN
WOUND HEALING STIFFNESS & CONTRACTURES
SPINAL PROBLEM(DEFORMITIES,
INFECTION, TRAUMA
PARA/TETRAPLEGIA
MUSCLE IMBALANCE,
SPASM & PAIN
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
PROBLEM LIST
JOINT PROBLEM
IMMOBILIZATION
MUSCULOSKELETAL CONGENITAL
MALFORMATIONS (CLEFT PALATE)
AFTERCARE
Dr.Marina A.Moeliono, SpRM et.al., Dept. of Physical Medicine and Rehabilitation, Faculty of Medicine-Padjadjaran Univ., Hasan Sadikin Hospital
CASUISTIC IN THE DMS SYSTEM
BURN INJURY REHABILITATION
BURN INJURY IS NECROSIS AND DAMAGE OF TISSUE SECONDARY
TO EXPOSURE TO AN EXTERNAL AGENT SUCH FLAME, RADIATION, OR OTHER AGENTS OF EXTREME TEMPERATURE
CAUSE COMPLEX LOCAL & SYSTEMIC RESPONSES INVOLVING THE CARDIOVASCULAR AND PULMONARY SYSTEMS, MICROCIRCULATION, METABOLISM, NUTRITION, ENDOCRINOLOGY, AND IMMUNOLOGY
CLASSIFICATION ETIOLOGY DEPTH OF INJURY
ACUTE BURN REHABILITATIONGOALS: PROMOTE WOUND HEALING PROMOTE COMPLICATIONS OF JOINT
CONTRACTURE, WEAKNESS, IMPAIRED ENDURANCE AND LOSS OF FUNCTIONAL ABILITY
INDIVIDUALIZED BY BURN LOCATION, DEPTH OF INJURY, PERCENT OF BODY SURFACE INJURED, ASSOCIATED INJURIES AND COMPLICATIONS
PATIENT AGE AS WELL AS PREVIOUS FUNCTIONAL LEVEL AND HEALTH ARE SIGNIFICANT
ACUTE BURN REHABILITATIONPROPER POSITIONING IS FUNDAMENTAL TO PREVENT
DEVELOPMENT OF CONTRACTURES AND AVOID COMPRESSION NEUROPATHIES
TYPICALLY POSITIONS OF EXTENSION AND ABDUCTION SHOULDE BE CHOSEN INDIVIDUALIZED ACCORDING TO SPECIFIC INJURY
The most common contractures are essentially identical to the most common position abnormalities produced with inadequate motion: Flexion: elbows, wrists, neck,
interphalangeal joints Adduction: shoulder Extension: feet, metacarpophalangeal
joints
ACUTE BURN REHABILITATIONSPLINTING IS USED TO PREVENT JOINT CONTRACTURES,
MAINTAIN PROPER POSITIONING, AND PROTECT NEW SKIN GRAFTS
ADD COST TO PATIENTS CARE UST BE USER FRIENDLY FOR PATIENTS AND
NURSES NONBURN AREA MAY REQUIRE SPLINTING
TO PREVENT ANKLE CONTRACTURES DUE TO PROLONGED BED REST
RESTING HAND SPLINT
WRIST EXTENSION 60-800 METACARPOPHALANGEAL
FLEXION FULL INTERPHALANGEAL
EXTENSION THUMB ABDUCTION
Ideal for post-op and burn patients. Helps prevent foot-drop and assists in positioning foot. Splint is for bed use.
ACUTE BURN REHABILITATIONEXERCISE REQUIRES UNDERSTANDING OF LOCATION, DEPTH, AND
EXTENT OF BURN ACCORDING TO PRE-EXISTING CONDITION INITIAL GOALS:
ACTIVE AND ACTIVE ASSISTED EXERCISE FOR ALLERT PATIENTS SLOW PASSIVE EXERCISE FOR OBTUNDED/ CRITICALLY ILL ROM EXERCISE CAN BE PERFORMED UNDER ANESTHESIA
(BECAUSE INTOLERATE TO PAIN) IF NORMAL ROM IS LOSS STRETCHING STRENGTHENING BEGIN AS TOLERATED (PROGRESSIVE-
RESISTIVE EXERCISE) ENDURANCE TRAINING MONITORING OF CP RESPONSE
ACUTE BURN REHABILITATIONEARLY AMBULATION MAINTAIN INDEPENDENCE, BALANCE, AND LOWER
EXTREMITY ROM, DECREASES RISK OF DEEP VENOUS TROMBOSIS
BEGIN WITH DANGLING OF LOWER EXTREMIIES AMBULATION
CHECK STATUS OF THE GRAFT: 5-7 DAYS AFTER GRAFTING (STABLE CIRCULATION TO GRAFT)
ELASTIC WRAPS AVOID VENOUS POOLING MONITOR GAIT DEVIATIONS (DUE TO PAIN,
WEAKNESS, CONTRACTURES, HYPESTHESIA, ETC)
POST ACUTE BURN REHABILITATIONWOUND AND SKIN CARE ONCE WOUND CARE IS NO LONGER MAJORITY
PRIORITY ; PRIMARY FOCUS SHIFTS TO MAXIMIZING PATIENT’S POTENTIAL FOR INDEPENDENCE IN WORK AND COMMUNITY LIVING
EDUCATION : WOUND CARE & DRESSINGS HEALED BURN SKIN IS FRAGILE, EASILY ABRADED,
SENSITIVE TO SUN & CHEMICALS SUN BLOCK, APPROPRIATE CLOTHING, LUBRICATIONS
SCARING ( 3 MONTHS AFTER DEEP PARTIAL THICKNESS AND FULL THICKNESS INJURY)
POST ACUTE BURN REHABILITATIONSCARING SCARING ( 3 MONTHS AFTER DEEP
PARTIAL THICKNESS AND FULL THICKNESS INJURY)
SCAR SUPRESSION CONTINOUS PRESSURE FACILITATES A PARALLEL ARRANGEMENT OF COLLAGEN DURING MATURATION CUSTOM FITTED ELASTIC GARMENT (25 MMhG, 23HOURS/DAY)
POST ACUTE BURN REHABILITATIONSCARING SCARING ( 3 MONTHS AFTER DEEP
PARTIAL THICKNESS AND FULL THICKNESS INJURY)
SCAR SUPRESSION CONTINOUS PRESSURE FACILITATES A PARALLEL ARRANGEMENT OF COLLAGEN DURING MATURATION CUSTOM FITTED ELASTIC GARMENT (25 mmHg, 23HOURS/DAY)
POST ACUTE BURN REHABILITATIONJOINT FUNCTION IMMOBILITY AND SCARRING LEAD TO JOINT
CONTRACTURES ACTIVE EXERCISE PROPER POSITIONING SPLINTING
EXERCISE: 3-4 TIMES/DAY PATIENTS AND FAMILY TEACHING IS IMPORTANT TO REINFORCE JOINT EXERCISE
JOINT CONTRACTURE THAT FAILS NON SURGICAL TREATMENT CONSIDER TO SURGERY
POST ACUTE BURN REHABILITATION EXERCISE SHOULD CONTINUE GOALS:
ACHIEVING AND MAINTAINING JOINT ROM, NORMAL STRENGTH, NORMAL CARDIOPULMONARY FUNCTION,AND ENDURANCE
GAIT AND MOBILITY FOCUS ON INDEPENDENCE ON ALL SURFACES, PROGRESSING TO GAIT WITHOUT ASSISTIVE DEVICE
POST ACUTE BURN REHABILITATION PSYCHOLOGICAL ADJUSTMENT
PSYCHOLOGICAL HEALTH AFTER INJURY COSMESIS AND APPREARANCE SPECIAL
MAKEUP, PLASTIC SURGERY RETURN TO SCHOOL AND WORK OUTPATIENTS REHABILITATION DISCHARGE
PLANNING IF INDEPENDENT IN ALL ASPECTS OF CARE OR HAVE APPROPRIATE HOME OR COMMUNITY SERVICES IN PLACE --. FOLLOW UP MEDICAL CARE
FRACTURE REHABILITATION
THE GOAL OF REHABILITATION OF FRACTURES IS TO RESTORE FUNCTIONAL ABILITIES OF THE INDIVIDUAL (SALTER).
THE DURATION AND TYPE OF REHABILITATION TREATMENT REQUIRED FOLLOWING A FRACTURE ARE RELATED TO THE ASSOCIATED SOFT TISSUE INVOLVEMENT, AS WELL AS THE LOCATION AND TYPE OF FRACTURE AND THE METHOD OF STABILIZATION (CHAPMAN).
PROTOCOLS FOR REHABILITATION MUST BE BASED UPON STABILITY OF THE FRACTURE AND FRACTURE MANAGEMENT (OPERATIVE, NONOPERATIVE).
REHABILITATION EMPHASIZES RESTORING FULL RANGE OF MOTION, STRENGTH, PROPRIOCEPTION, AND ENDURANCE, WHILE MAINTAINING INDEPENDENCE IN ALL ACTIVITIES OF DAILY LIVING (BUCHOLZ).
COLD AND OTHER MODALITIES MAY BE USED IN CONTROLLING PAIN AND EDEMA (SALTER).
THE INDIVIDUAL SHOULD BE ENCOURAGED TO CONTINUE FUNCTIONAL ACTIVITIES TO PREVENT COMPLICATIONS OF INACTIVITY AND BED REST. DEPENDING ON THE STABILITY OF THE FRACTURE, RANGE OF MOTION EXERCISES OF THE ADJACENT JOINTS MAY BE STARTED IMMEDIATELY AND PROGRESSED TO STRENGTHENING EXERCISES AS INDICATED (CHAPMAN).
• BONE HEALING MAY OCCUR WITHIN 6 TO 20 WEEKS; HOWEVER THE BONE STRENGTH AND THE ABILITY OF THE BONE TO SUSTAIN A HEAVY LOAD MAY TAKE UP TO SEVERAL YEARS (CHAPMAN).
• ONCE HEALING HAS OCCURRED, THE INDIVIDUAL MAY RESUME FULL ACTIVITIES OF DAILY LIVING. RESUMPTION OF PRE-INJURY STATUS IS THE GOAL, WITH CONSIDERATION OF ANY RESIDUAL DEFICIT.
• THE TREATING PHYSICIAN SHOULD GUIDE THE RESUMPTION OF HEAVY WORK AND SPORTS; IT IS IMPORTANT TO INSTRUCT THE INDIVIDUAL NOT TO OVERLOAD THE FRACTURE SITE UNTIL THE BONE HAS REGAINED ITS FULL STRENGTH.
THERAPEUTIC EXERCISE AND RANGE OF MOTION THE ULTIMATE PURPOSE OF AN
EXERCISE PROGRAM IS TO RESTORE: FUNCTION PERFORMANCE MUSCLE STRENGTH ENDURANCETO PRETRAUMA LEVEL
RANGE OF MOTION FULL RANGE OF MOTION FUNCTIONAL RANGE OF MOTION ROM EXERCISE:
ACTIVE ROM ACTIVE-ASSISTIVE ROM PASSIVE ROM
MUSCLE STRENGTH UNCOMPLICATED FRACTURES DO NOT
PRESENT NEUROLOGIC PROBLEMS MUSCLE SURROUNDING THE SITE OF FRACTURE ARE WEAKER, USUALLY SECONDARY TO DIRECT TRAUMA, IMMOBILIZATION, OR REFLEX INHIBITION
STRENGTHENING EXERCISE
STRENGTHENING EXERCISE INCREASE THE AMOUNT OF FORCE THAT A MUSCLE CAN GENERATE
BASIC STRENGTHENING EXERCISE: ISOMETRIC ISOTONIC ISOKINETIC
HIGH PERFORMANCE STRENGTHENING EXERCISE CLOSED-CHAIN EXERCISE OPEN CHAIN EXERCISE
FUNCTIONAL/TASK SPECIFIC EXERCISE
MODALITIES USED THERAPEUTIC HEAT THERAPEUTIC COLD HYDROTHERAPY ELECTRICAL MODALITIES SPRAY AND STRETCH
GAIT ALTER GAIT PATTERN AFTER FRACTURE ASSISTIVE DEVICES
ADAPTIVE EQUIPMENT
THE REHABILITATION OF CLEFT PALATESPEECH
THE REHABILITATION OF CLEFT PALATE SPEECH IDEALLY REQUIRES AN INTEGRATED, TEAM APPROACH INCORPORATING THE PROFESSIONAL EFFORTS OF:• PLASTIC AND RECONSTRUCTIVE SURGERY• SPEECH AND LANGUAGE PATHOLOGY• DENTISTRY AND ORTHODONTIA THE IMPACT A CLEFT PALATE HAS UPON SPEECH
PRODUCTION CANNOT BE OVERSTATED. A NUMBER OF THE MAJOR ORGANS OF SPEECH
HAVE INTERRUPTED FUNCTION DUE TO THIS DEFORMITY.
EVEN WITH SURGICAL CORRECTION, SPEECH MAY NOT PROCEED NORMALLY WITHOUT THERAPEUTIC HELP.
OTHER PROBLEM : FEEDING : SUCKING, CHEWING&
SWALLOWING
If surgical correction of the cleft lip and/or palate is done before 1 year of age, there
is a good likelihood that speech development will be normal. However, if such correction occurs after 1 year of age or the age of speech onset, a significant
number of children may still require speech therapy in order to overcome their incorrect method of sound production. Even with children who have had cleft lip and
palate repair before the onset of speech, as many as 25% of them may have the need
for some speech therapy Historically, such correction has been problematic in developing nations. There
are many reasons for this: economic, geographical and availability of speech
therapy services. The conventional methods of speech therapy require that an individual
be
PAIN
DEFINITIONS OF PAIN THE INTERNATIONAL ASSOCIATION FOR THE
STUDY OF PAIN "AN UNPLEASANT, SUBJECTIVE, SENSORY AND
EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE
" PAIN, HOWEVER, IS MUCH MORE THAN A PHYSICAL SENSATION CAUSED BY A SPECIFIC STIMULUS. IT IS A COMPLEX MECHANISM WITH PHYSICAL, EMOTIONAL, AND COGNITIVE COMPONENTS. IT IS SUBJECTIVE, AND HIGHLY INDIVIDUAL.
PAINMANAGEMENT OF PAIN
MEDICATION (NSAID ETC) PHYSICAL MODALITIES HEAT, COLD,
WATER, MASSAGE, ELECTRICAL MOVEMENT & MOBILIZATION EXERCISES ROM EXC, STRETCHING EXC