ASESMEN DAN DIAGNOSIS FISIOTERAPI

(1)

ASESMEN DAN DIAGNOSIS

FISIOTERAPI

Oleh: Sugijanto

(2)

KEPMENKES

1363

Fisioterapi adalah bentuk pelayanan

kesehatan yang ditujukan kepada

individu dan atau kelompok untuk

mengembangkan, memelihara dan

memulihkan gerak dan fungsi tubuh

sepanjang daur kehidupan dengan

menggunakan penanganan secara

(3)

KEPMENKES 1363 Pasal

12

(1)Fisioterapis dalam melaksanakan

praktik fsioterapi berwenang untuk

melakukan ;

a.

Asesmen fsioterapi

yang meliputi

pemeriksaan dan evaluasi

b.

Diagnosa

fsioterapi

c.

Perencanaan

fsioterapi

d.

Intervensi

fsioterapi

(4)

(2) Fisioterapis dalam melaksanakan

kewenangan sebagaimana dimaksud

pada ayat (1) berkewajiban untuk :

a.

Menghormati hak pasien;

b.

Merujuk kembali kasus yang tidak

dapat ditangani atau belum selesai

ditangani, sesuai sistem rujukan

yang berlaku;

c.

Menyimpan rahasia sesuai dengan

peraturan perundang-undangan

yang berlaku;

d.

Meminta persetujuan tindakan yang

akan dilakukan;

e.

Memberikan informasi dalam

lingkup asuhan fsioterapi;

(5)

Sistem

asuhan

 Himpunan yg t a beberapa komponen yg

saling berinteraksi utk mencapai suatu tujuan.

 Dlm sistem minimal ada komponen input,

proses, dan out put

input

proses

output

(6)

Sistem Asuhan

Fisioterapi

input

proses

output

Pasien PT is Peralatan Metode Kode etik SOP dll Assesment Diagnosis Planning Intervensi ReEvaluasi Kesembuhan klien PT is Pandai

Modif Peralatan

Pengembangan metode dll

standard praktik fisioterapi

(7)

ASESSMENT DIAGNOSE

PLANNING

INTERVENTION

REEVALUATION

COORDINATION, COMMUNICATION, DOCUMENTATION

STANDAR PRAKTEK FISIOTERAPI

PROSES FISIOTERAPI

(8)

E X A M I N A T I O N ( P E M E R I K S A A N )

d a t a g a t h e r i n g

E V A L U A T I O N ( E V A L U A S I ) a n a l i s i s & s i n t e s i s A S S E S M E N T

a s e s m e n

Asesmen (pengkajian) termasuk

pemeriksaan

pd

perorangan/kelompok, nyata/berpotensi terjadi

kelemahan, keterbatasan fungsi, ketidakmampuan atau

kondisi kesehatan lain dgn cara pengambilan data

(9)

HISTORY TAKING

•Anamnesis

•Pengambilan data relevan

Screening (Observasi = inspeksi)

Screening (pemeriksaan fungsi fisik)

Quick test

Tes Gerak aktif, gerak pasif, isometrik.

Pemeriksaan (pengambilan

data)

Tes khusus •Palpasi

•Joint play movement, tes provokasi, kinerja otot, •Tes stabilisasi sendi. •Muscle strength test, length test.

•Tes sensasi •Balance test, coordination test.

•Strength Duration Curve •dll

Pengukuran

Pengukuran subyektif _ obyektif: mis nyeri dgn VAS/VRS,

Pengukuran Mobilitas sendi/ ROM, Manual Muscle Test

Karakteristik antropometri Pengukuran postur

(10)

Algorithm in assessment and

intervension

(11)

Cervical and Shoulder

Examination

Algorithm

(12)

Shoulder

Examination and

Intervention

Algorithm

(Joe Godges, 2004)

(13)

Associated Upper Quarter

Impairment Examination

Algorithm (Joe Godges, 2004)

(14)

(15)

(16)

(17)

PAIN FROM TISSUE ORIGIN

SPECIFIC TISSUE

Inflammation

Ischemic

Contracture

Wound healing process

Nosisensoric sensitization

Inflammation

Hypoxia necrosis

necrosis

Fatique

(18)

PAIN FROM JOINT SURFACE

JOINT SURFACE

Penglupasn rawan sendi

Inflamasi tlg subchondrale

Tumbuh osteophyte Kompresi prmk

tulang

Nyeri kompresi sendi

Nyeri bl gerak

Lepasan fragmentasi

Penguncian grk sendi

Nyeri bl gerak ROM tertentu

(19)

PAIN FROM CAPSEL

Capsel Immuno reaction Sprain/ rupture Instability Contracture Inflamation Nyeri ssd aktifitas Nyeri regang

(20)

PAIN FROM MUSCLE

MUSCLE

Strain/ rupture

Weakness

Tightness/ Contracture Inflammation

Nyeri regang

Immobilsation Adhesion Myofascial contracture

Nyeri regang Atrophy

?!

Nyeri diam

Muscle spasm

Nyeri kontraksi

(21)

PAIN FROM PERIPHERAL

NERVE

Entrapment

Systemic Inflamation

Anoxia

Inflamation

Fibrosis

Neuropathic pain

Paresthesia intermittent

Paresthesia menetap

Neuropathic pain

Paresthesia menetap

(22)

EVIDENCE BASE PRAKTIS



Penggunaan hasil penelitian

(23)

(24)

Screening

questionair

(25)

Red fag for

thoracic

spine

(26)

(27)

Red

fag

(28)

L B P MEDICAL SCREENING

QUESTIONAIR

No

1 Have you recently had a major trauma, such as a vehicle accident or a fall from a height?

2 Have you ever had a medical practitioner tell you that you have osteoporosis? 3 Do you have a history of cancer?

4 Does your pain ease when you rest in a comfortable position? 5 Have you recently had a fever?

6 Have you recently lost weight even though you have not been attempting to eat less or exercise more?

7 Have you recently taken antibiotics or other medicines for an infection?

8 Are you currently taking steroids or have you been on prolonged steroid therapy? 9 Have you been diagnosed with an immunosuppressive disorder?

10 Have you noticed a recent onset of difficulty with retaining your urine?

11 Have you noticed a recent need to urinate more frequently?

12 Have you noticed a recent onset of numbness in the area of your bottom where you would sit on a bicycle seat?

13 Have you recently noticed your legs becoming weak while walking or climbing stairs?

(29)

HISTORY TAKING

(Anamnesis)



Keluhan utama, beberapa contoh:

◦ Sensasi/Nyeri?  Jenis, distribusi, dugaan

penyebab, provokasi & peringanan.

◦ Mobilitas sendi? _ Pembatasan, kelemahan.

◦ Kinerja otot?  Kelemahan, tegang, pemicu,

pengurang

◦ Gangguan ambulasi?  Berjalan,

penggunaan alat, dugaan penyebab, dll

(30)

ANAMNESIS (lanjutan)

 Riwayat keluhan kini termasuk mulainya,

perjalanan sakit, gangguan terhadap regio/ organ/sistem lain.

 Riwayat sakit dahulu yg mungkin

berpengaruh pd keluhan kini.

 Pengobatan dan pembedahan yg telah

dijalani

 Riwayat status kesehatan famili yg

relevan.

(31)

Juga data lain yg relevan:



Diagnosis medik



Riwayat medik yg berkaitan



Status sistem, organ lain yg relevan



Status fungsional dan tingkat

aktiftas

(32)

Screening

(pengambilan

data dr Observasi =

inspeksi)



Dinamik:

◦ Gait analisis, fungsional dasar, ADL, dll



Statik:

Prinsip umum inspeksi statik:

◦ Status kesadaran dan status psikologis umum

◦ Analisis total, quadrant, lokal.

◦ Kondisi kulit, posture, posisi sendi dan penyimpangan,

(33)

Screening

(dr

pemeriksaan fungsi

fsik)



Pemeriksaan fungsi gerak dasar

muskuloskeletal:

◦ Quick test gerak sendi

◦ Gerak aktif, gerak pasif, isometrik.



Pemeriksaan fungsi dasar

kardiovaskuler-pulmonal:

◦ Telaah sistemik Vital sign

(34)

Screening

(pemeriksaan

fungsi lanjutan)



neuromuskular:

◦

Pola jalan, keseimbangan dan

lokomotor.

◦

Tes sensorik integrasi, nyeri,

fungsi motorik, refeks,

keseimbangan, koordinasi,

perkembangan motorik.



integument

◦

Tes sensasi

(35)

Tes khusus

 Palpasi

 Joint play movement, tes

provokasi, kinerja otot,

 Tes stabilisasi sendi.

 Muscle strength test, length

test.

 Tes sensasi

 Balance test, coordination

test.

 Strength Duration Curve

 Tes ventilasi, kapasitas paru  Tes tonus integument

(36)

PENGUKURAN



Pengukuran subyektif



obyektif: mis nyeri dgn

VAS/VRS,



Pengukuran Mobilitas sendi/

ROM,



Manual Muscle Test



Karakteristik antropometri



Pengukuran postur



Keseimbangan/Balance scale



Aktiftas sehari-hari/IADL

(37)

EVALUASI

Evaluation

of the results of the examination

through

analysis and synthesis

within a process

of

clinical reasoning

.

Pengumpulan

Data - data

P

emeriksaan

•

Analisis

• Sintesis

Evaluasi

(38)

Fragment Assessment Diagnose

Anamnesis Inspeksi Pemeriksaan Tes khusus & P’ukuran Muskulo skeletal Keluhan utama, Riwa peny. Diagno dan riwa medik Stat fungs dan tingkat aktifitas Dinamik, Statik Analisis total, kuadran, lokal. Pem. fungsi gerak dasar Tes cepat, gerak aktif, pasif dan isometrik Palpasi, JPM, Provokasi, pengukuran 2

Jaringan / organ

Patologi

Gg gerak

Neuro muskular Pengobatan status kes famili Pekerjaan-sosial Tes sensasi, motorik, keseimbang, koordinasi, Perkembang an motorik Motoric function & sensoric test Pengukuran 2 Sistem Patologi

Gg gerak

(39)

Proses evaluasi analisis

sintesis (lanjutan)

Fragmentasi Assessment Diagnose

Anamnesis Pemeriksaan Tes khusus & Pengukuran Kadio vaskuler pulmonal Keluhan utama, Riwayat peny. Diagnosis dan riwayat medik Status fungsional dan tingkat aktifitas Vital sign, Pengembangan dada-abdomen, ventilasi paru, kapasitas paru Tes ventilasi, kapasitas paru Gas arteri Pengukuran2 Sistem Patologi Gg gerak Integumen Pengobatan

status kes famili Pekerjaan-sosial Tes sensasi, konsitensi kulit, turgor, Tonus kulit Kedalaman gang. kulit. Pengukuran2 Sistem Patologi

(40)

Diagnosi

s



Merupakan pernyataan, label,



Menggambarkan multi dimensi

pasien/klien



Dari tingkat basis (sel) > tertinggi fungsi



Umumnya : ‘menyangkut kondisi

(41)

Diagnosi

s



Menggambarkan keadaan pasien



menuntun menentukan prognosis



menuntun rencana intervensi

(diagn kerja)

◦

Mengindikasikan disfungsi

(42)

Shoulder Pain

 ICD-9-CM code: 726.19 Subacromial bursitis

 ICF codes: Activities and Participation Domain codes:

◦ d4452 Reaching (Using the hands and arms to extend outwards and touch and grasp something, such as when reaching across a table or desk for a book.)

◦ d4300 Lifting (Raising up an object in order to move it from a lower to a higher level, such as when lifting a glass from the table.)

◦ d4305 Putting down objects (Using hands, arms or other parts of the body to place an object down on a surface or place, such as when lowering a container of water to the ground.)

◦ d4451 Pushing (Using fngers, hands and arms to move something from oneself, or to move it from place to place, such as when pushing an

animal away.)

◦ d4452 Reaching (Using the hands and arms to extend outwards and touch and grasp something, such as when reaching across a table or desk for a book.)

◦ d4300 Throwing (Using fngers, hands and arms to lift something and propel it with some force through the air, such as when tossing a ball.)

◦ d4550 Crawling (Moving the whole body in a prone position from one place to another on hands, or hands and arms, and knees.)

◦ d4551 Climbing (Moving the whole body upwards or downwards, over surfaces of objects, such as climbing steps, rocks, ladders of stairs, curbs or other objects.)

 Body Structure code: s7201 Joints of shoulder region

(43)

Isi diagnose

fsioterapi

 Minimal berisi :

◦ Pernyataan masalah pasien, misal : Gangguan mobilitas sendi, fungsi motor, kinerja otot,

dan ROM, gait, locomotion, balance, sensory integration, ventilasi, respirasi/gas exchange, aerobic capacity/indurance

◦ Hubungan dgn jaringan/organ/sistem terkait, misal : connective tissue, ligament, otot,

tulang, sendi, Central nervus system, peripheral nerve, vaskuler, respirasi,

(44)

ISI DIAGNOSIS



Gangguan gerak & fungsi

(function ICF)



Pada ‘body structure’ (Anatomic)

(45)

Diagnosa Musculoskeletal (1)

1.

Prediksi gangguan

system muskulo skeletal

2. Gangguan

Sikap

3. Gangguan

performans otot

4. Gangguan

mobilitas sendi

,

motor function

,

kinerja otot

, dan

ROM

yg disebabkan oleh

connective tissue

.

5. Gangguan

mobilitas sendi, motor function,

kinerja otot, dan ROM

yg disebabkan

(46)

Diagnosa Musculoskeletal (2)

6.

Gangguan

mobilitas sendi, motor function, kinerja otot,

dan

ROM

yg disebabkan kerusakan spinal

.

7. Gangguan

dan

ROM

yg disebabkan fraktur

.

8.

Gangguan

dan

ROM

yg disebabkan Arthroplasti sendi

.

9.

Gangguan

dan

ROM

yg disebabkan bedah tulang atau jaringan

lunak

.

(47)

Diagnosa Neuromuskular (1)

1. Prediksi

gangguan

kinerja system neuromuskuler

2. Gangguan

Perkembangan Neuromotor

3.

Gangguan

motor function

dan

sensory integration

yg disebabkan Non progressive disorder CNS –

congenital

atau pada

bayi

dan masa

anak

.

4.

Gangguan

motor function dan sensory integration

yg disebabkan Non progressive disorder CNS

– pada

usia

dewasa

(48)

Diagnosa Neuromuskular (2)

5. Gangguan

Peripheral nerve integrity dan motor

function

yg disebabkan Peripheral Nerve Injury

.

6.

Gangguan fungsi

motorik dan sensory integration

yg disebabkan Acute /Chronic Polyneuropathies.

8. Gangguan

fungsi motorik dan Peripheral nerve

integration

yg disebabkan Non progressive disorder

Spinal Cord.

9. Gangguan

kesadaran , ROM, Motor Control

yg

(49)

Diagnosa Cardiovascular /Pulmonary (1)

1. Prediksi

gangguan

kinerja system

cardiovascular-pulmonary

2. Gangguan kapasitas aerobik/ketahanan

yg disebabkan deconditioning syndrome

3.

Ganguan

ventilasi, respirasi/gas exchange, aerobic

capacity/indurance

yg disebabkan Airways clearance

dysfunction

.

4.

Gangguan

kapasitas aerobik/ketahanan

yg

(50)

Diagnosa Cardiovascular /Pulmonary (2)

5.

Ganguan

capacity/indurance

yg disebabkan Ventilatory Pump

Dysfunction or Failure

.

6.

Ganguan

capacity/indurance

yg disebabkan Respiratory Failure

.

7. Ganguan

capacity/indurance

yg disebabkan Respiratory Failure

pada neonatus

(51)

Diagnose Integumentary (1)

1. Prediksi

gangguan kinerja system integument

2.

Gangguan

integumenary integrity

yg disebabkan

Superficial skin

involvement

3.

Gangguan

integumenary integrity

yg disebabkan

partial thickness skin

involvement

4. Gangguan integumenary integrity yg disebabkan Full Thickness skin involvement

(52)

Prognose



Ketetapan perkembangan optimal

yg mungkin dicapai dgn intervensi

dlm periode waktu.



Sebagai hasil analisis dan sintesis

terhadap hasil history taking dan

data gathering.



Digunakan utk penetapan target

(53)

Perencanaan

terapi

SKEMA HUBUNGAN DIAGNOSIS DAN INTERVENSI

Diagnosis Tes khusus Prosedur

Intervensi Kemungkinan resiko Tools Reevaluasi Jaring

an Patologi gerak & Gang fungsi Capsul e- Ligame nt Contractu re Non capsular / Capsular-pattern Joint Play Movement (JPM) Joint Mobilization Manipulation Mobilization exc. Unstable joint Cidera, unstable Skala nyeri (VAS,VRS), ROM dan End feel

Laxity Hypermob ile Passive test, Active stab. test Active (NM) stabilization exc. Cidera sendi/jar lunak ROM, End feel, stabilization Unstable JPM,

(54)

Inflamasi lokal Kontraktur entrapment Obstruksi

Capsule-ligament SWD, joint stabilisation SWD, Joint mobilisation _--

--

Tendo-muskular US, transverse friction US, stretching _--

--Saraf perifer Rest Mobilisasi saraf Manipulasi/

traksi

--Saraf pusat Fasilitasi

proprioceptor _-- _--

--Paru / respirasi Rest, breath exc Mobilisasi dada

--Inhalasi, PD, pursed breath

Contoh penetapan program:

(55)

Capsuloligamentair

Inflamasi lokal

Aktualitas rendah Aktualitas tinggi

ROM terbatas, firm, JPM nyeri/terbatas/ firm

SWD Sub thermal, lat. Mobilisasi-

stabilisasi aktif,latih fungsional

ROM terbatas, springy, JPM nyeri/ terbatas/ springy

Kontraktur immobilisasi

PRICE, SWD non thermal, isometric exc, functional train.

(56)