motorik baru sekali
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PEMERIKSAANMOTORIK
Dr. Moch. Bahrudin, SpS
NEUROLOGICAL SKILL
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Pemeriksaan Motorik Penting
Gerakan Piramidalis
Ekstra Piramidalis
Cerebellum
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Lesi UMN
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This classical pictureof the homunculi,based on the work ofWilder Penfield in the1930s and 1940s
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1. Cornu ant (poliomielitis akut & atrofi muskular spinalis progresif kronik) : selcornu mati shg paralisis flacid, atrofi otot yg disarafi
2. The peripheral nerve, (ventral and dorsal nerve roots i.e., radiculopathy ornerve i.e., neuropathy) : iritasi radikuler (parastesia dan nyeri dalam poladistribusi tertentu, bila berat gangguan sensorik dan motorik), yg diperiksakonduksi saraf.
3. Neuromuscular junction (miastenia gravis)
4. The muscle (i.e congenital myopathy, metabolic myopathy, inflammatorymyopathy)
Lesi LMN
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UMN LMN
Spasticity Flaccid
Increased tone Decreased tone
Increased muscle
stretch reflexes
Decreased muscle
stretch reflexes
Minimal muscle
atrophy (disuse
atrofi)
muscle atrophy
Fasciculations (-) Fasciculations (+)
Refleks patologis (+) Refleks patologis (-)
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1. INSPEKSI Jalan , Sikap , Atropi dll
2. TONUS
3. KEKUATA
4. KOORDINASI/ cerebellum
Alat & Persiapan :
@ Informasi pemeriksaan@ Perhatikan Dermatome otot
Pemeriksaan MOTORIS
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1. INSPEKSI : Jalan , Sikap , Atropi , Involuntary1.a. Jalan : - Hemiplegi gait - Ataxic gait
- Scissor gait - Walding gait
- Parkinson gait
1.b. Sikap : - Drop hand - Claw hand- Drop foot - Ape hand
- Dystonik - Wajah topeng
1.c. Involuntary : - Tremor - Chorea
- Athetose - Ballismus
- Kejang tonik / klonik / mioklonik
- Tics - Automatis
1.d. Atropi / Hipertrophy / Pseudohipertrophy
Pemeriksaan MOTORIS
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Pemeriksaan Inspeksi
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Atropi THENAR , “ Ape hand “
Hipestesia jari 123 ½ Volar
Parese Flexor Jari 123
Lesi n.Medianus
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Hipestesia Jari 45 Volar
Parese Flexor jari 45
Inter Ossei
Atropi Hipothenar
Lesi n.Ulnaris
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Lesi n.Radialis Hipestesia Dorsum tangan
jari 123
Parese Extensor tangan
Extensor jari 123Sikap Drop hand
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Lesi n.Peroneus
Hipestesia betis lateral
dorsum kaki
Parese Extensor kaki
Sikap Drop Foot
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Gower’s sign
DMP DUCHENE
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Palpasi : kelompok otot(biseps, triceps, deltoid,
quadriceps, hamstring)
TONUS : PENDERITA PASIF
Hipertonus (Spastis) : akibat
kontraksi otot, Lesi UMN
Rigiditas : ggn EPS
(Parkinson)
Flaksid (hilangnya tonus otot)
: Lesi LMN
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TONUS OTOT • Gerakan pasif semua sendi
• Px relax tidak melawan
• Yang dicari tahanan gerakan
KELAINAN TONUS :
SPASTIS :
Fenomena PISAU LIPAT :
=Ada tahanan awal
RIGIDITAS : Tahanan sepanjang gerakan yang hilang timbulDECORTICATE Rigidity
DCEREBRATE Rigidity
Fenomena PIPA TIMAH :
- Tahanan sepanjang gerakan
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Pemeriksaan TONUS OTOT
Decorticate
Rigidity
Decerebrate
Rigidity
Video Skill Motor Inspeksi Tonus
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Video Skill Motor Inspeksi Tonus
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Video Skill Motor Jalan
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Video Skill Motor Loncat
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Tehnik : 1. Perintahkan mengangkat sekuat2nya
melawan Gravitasi2. Mengukur KEKUATAN maksimal
Derajat Kekuatan :
5 Normal
4 Melawan Gravitasi , tahanan cukup
3 Melawan Gravitasi + , tahanan kecil
2 Gerak sendi + Tidak bisa melawan gravitas
1 otot kontraksi tetapi gerak Sendi -
0 Plegi
KEKUATAN MOTORIS
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0No muscle contraction is detected
1 A trace contraction is noted in the muscle by palpating the
muscle while the patient attempts to contract it.
2The patient is able to actively move the muscle when gravity is
eliminated.
3The patient may move the muscle against gravity but not
against resistance from the examiner.
4The patient may move the muscle group against some
resistance from the examiner.
5The patient moves the muscle group and overcomes the
resistance of the examiner. This is normal muscle strength.
Since this rating scale is skewed towards weakness, many clinicians
further subclassify their finding by adding a + or -, e.g., 5- or 3+.
Vid Skill M t K k t
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Video Skill Motor Kekuatan
Vid Skill M t KEKUATAN
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Video Skill Motor KEKUATAN
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C 537
C 45
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Shoulder Adduction (C 5 - T1):The main muscle of adduction isthe Pectoralis Major, though theLatissiumus and otherscontribute as well
Shoulder Abduction (C 5, 6):The deltoid muscle, innervatedby the axillary nerve,
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M. deltoids,
The deltoid
muscle is
innervated bythe C5 nerve
root via the
axillary nerve.
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C 5 6
38
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Shoulder Adduction (C 5 - T1):The main muscle of adduction isthe Pectoralis Major, though theLatissiumus and otherscontribute as well
Shoulder Abduction (C 5, 6):The deltoid muscle, innervatedby the axillary nerve,
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C 5 6
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Elbow Flexion (C 5, 6): the
Brachialis Muscle (along
with the Biceps Muscle).These muscles are
innervated by the
Musculocutaneous Nerve.
Elbow Extension (C 7, 8):
the triceps muscle. TheTriceps is innervated by
the Radial Nerve
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C 5 6
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C 6
C 6 7
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C 6
C 7 8
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C 8
C 8
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C 8
T 1
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C 5 6 7
Sk
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C45
C56
C7C6
C7
C8
C67
C71
T1
Skema
Myotome
Cervical
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L 123
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L5 S12
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L45 S1
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L 234
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L5 S12
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L5 S12
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L 45
S 12
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L5 S1
Skema
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L123
L45
L234
L5
L45S1 L5S1
S1
Skema
Myotome
Lumbo Sacral
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Fungsi CEREBELLUM :Fungsi Gangguan
Gerakan halus Ataxia
Keseimbangan Ataxia , Romberg ( )
Tepat jarak Dysmetri
Gerak ritmik Dysdiadokokinesia
Rem gerak Rebound fenomena
KOORDINASI MOTORIS
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KOORDINASI MOTORIK
Mata Terbuka diikuti
Tertutup
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KOORDINASI MOTORIK
Mata Terbuka diikutiTertutup
Dismetri
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•Finger to finger test
Dismetri
•Heel to knee test
KOORDINASI MOTORIK
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KOORDINASI MOTORIK
KOORDINASI MOTORIK
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KOORDINASI MOTORIK
KOORDINASI MOTORIK
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KOORDINASI MOTORIK
Video Skill Motor Romberg
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g
Video Skill Motor DYS DIADOKOKINESIA
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Video Skill Motor DYS DIADOKOKINESIA
Video Skill Motor DYSMETRIA
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Video Skill Motor DYSMETRIA
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Video Skill Motor DYS DIADOKOKINESIA
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Video Skill Motor Pronation Sign
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Pemeriksaan Koordinasi
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Tandem walking test
Pemeriksaan Koordinasi
R b t t
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Romberg test
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SELAMAT BELAJAR
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