ortosis prostetic pada ekstremitas superior

ORTOSIS PROSTETIC PADA EKSTREMITAS SUPERIOR

Kelompok III

Riska Nur Amalia

Mustika

Nur Melia Rante

Ummu Laila Malik

Riska Pakombong

PENGERTIAN

Ortotik Prostetik

ilmu yang mempelajari tentang pengukuran,

pembuatan, pengepasan alat bantu dan alat ganti

anggota gerak tubuh manusia yang hilang atau

disabilitas.

• Pada dasarnya ortosis di bagi menjadi:

-Ortosis anggota gerak atas

-Ortosis anggota gerak bawah

-Ortosis spinal

• Sedangkan Prostesis dibagi menjadi:

-Prostesis anggota gerak atas

-Prostesis anggota gerak bawah

• Contoh Ortotis: brace, splint, dan alat support (knee

support, ankle support…dll).

• Contoh Prostetis: alat pengganti anggota gerak tubuh

yang hilang /amputasi seperti kaki & tangan palsu,

jari palsu.

PENGGUNAAN OP

• Conginental (bawaan sejak lahir)

• Penyakit

• Insidential

http://jani-orthoprost.com/pengertian-ortotik-prostetik.html

TUJUAN PENGGUNAAN ORTOTIK PROSTETIK

1.mengganti fungsi yang hilang

2.mencegah kecacatan

3.memperbaiki kecacatan

4.Kosmetik

http://poltekkesjakarta1.ac.id/file/dokumen/77jurnal1.pdf

ORTHOSIS CLINIC TEAM

• Orthotist

• Social worker

• Psychologist

• Patient

• Physical Therapist

• Occupational Therapist

SCOPE OF PRACTICE

Occupational Therapy (OT)

• Rehabilitasi Extremitas Atas

– Memaksimalkan fungsi yang masih dimiliki (sisa) dari

pasien pasca bedah, cedera, atau penyakit di ext. atas

Physical Therapy (FT)

• RA 5680 Section 16

– Mengassessment alat bantu apa yg dibutuhkan dan

melatih pasien tersebut

– Melatih pasien menuju kemandirian fungsional

STANDAR PELAYANAN OP

a. Asesmen

b. Diagnosis

c. Perencanaan

d. Pengukuran

e. Pembuatan ortosa-protesa

f. Fitting

g. Finishing

h. Pemasangan dan penyerahan

i. Evaluasi

j. Dokumentasi

http://osteosupport.blogspot.com/2008/09/rscm.html

Akibat jika OP tidak sesuai

• buruknya pola jalan normal (normal gait analysis)

• pola jalan yang melebar ke arah luar (abduction gait)

• langkah jalan yang memutar (circumduction gait pattern)

• kecenderungan untuk menumpu hanya pada kaki yang

sehat (vaulting gait)

• kondisi tulang belakang seperti posisi badan penderita yang

condong ke samping pada saat menumpukan berat tubuh

(lateral bending) dan lumbal lordosis.

ORTOTIS EXTREMITAS ATAS

UPPER EXTREMITY ORTHOSIS

CLASSIFICATION

Type

• Static

• Dynamic

Function

• Flexion

• Extension

• Abduction

• Adduction

• Rotation

Region

• Volar or Dorsal

• Joints crossed* Finger / thumb splint * Wrist Splint * Wrist Hand Orthosis

(WHO ) * Elbow (WHO) * Shoulder (Elbow- WHO)

SPLINT STATIS

TUJUAN PENGGUNAAN

Immobilisi atau

support/penyangga

Cegah deformitas

Cegah kontaktur jaringan

lunak

Memblok bagian tertentu/

mengontrol pergerakan sendi

tertentu

Name the components

Lumbrical BarMetacarpal bar

Deviation

Bar

Forearm trough Metacarpal bar

Orthosis Statis Berdasarkan regio :

• Finger and thumb Orthosis

– DIP

– PIP

• Hand Orthosis

– Volar or dorsal hand orthosis

– Universal Cuff

• WHO

– Cock - up splint

– Resting hand splint

– Thumb spica

– Antispasticity splints

Indikasi Diagnosis

• Fractures

• Tendon injuries

• Crush injuries

• Amputation

• Arthritis

• Carpal tunnel release

• Arthroplasty

• Tendon transfer

• Tumor excision

• Reconstruction of

congenital defects

• Overuse syndromes

• Cumulative trauma

disorders

Tujuan penggunaan

• Mencegah atau mengurangi edema

• Membantu proses penyembuhan jaringan

• Penurunkan nyeri

• relaksasi

• untuk otot yang tidak digunakan, salah gerak, dan

penggunaan berlebihan (misuse, disuse, overuse)

• Menghindari cedera

• Mengembalikan fungsi motorik dan sensorik

Finger Orthosis ( DIP )

• Tipe

– Static or dynamic

• Region

– Volar or dorsal

– Joint crossed

• Function

Static Volar

DIP Extension Splint

Finger Orthosis ( PIP )

Static Three point orthosis untuk deformitas boutonniere

Hand Orthosis

• Type

• Region

• Function

Static Dorsal

Hand Orthosis

With an MP

Block

Hand Orthosis

• Universal Cuff

Wrist Cock-Up Splint (WHO)

• Menjaga wrist berada pada posisi netral atau mildly

extended position

• Immmobilisasi wrist saat MCP dan ibu jari masih dapat

bergerak

Wrist Cock-Up Splint (WHO)

Contraindikasi:

• MCP synovitis aktif

• Peradangan sendi yang menghasilkan subluksasi volar dan

deviasi ulnar

Kekurangan:

• Mengganggu sensibilitas taktil pada permukaan tangan dan

palmar.

• Strap dorsal dapat menghalangi aliran limfa

Dorsal Wrist Cock-Up Splint

• Penyokong mekanik wrist

yg paling kuat dan memberi

ruang sensorik yang lebih

luas pada telapak dan

punggung tangan

• Penyebaran yg lebih luas

diarea permukan dorsal

wrist

• dapat mentoleransi udem

Hand Condition/ Suggested Wearing Schedule Position

NERVE COMPRESSION

Carpal Tunnel Syndrome

(median nerve compression)

Carpal Tunnel Release

Surgery

Radial Nerve Palsy

Wrist extensor tendinitis

Acute flare up stage: 4 to 6 weeks

continuously worn except for

cleaning/hygiene and ROM exercises

Gradually decreases in duration with

some doctors recommending

nighttime wear only

1 week post-surgery, fitting may

commence

Wearing schedule that applies

during sleep. Strenuous activities,

and for support throughout the

healing phase

Wrist kept in functional position and

the splint should substitute for the

loss of the radial nerve by placing

the wrist in extension

Continuous wearing followed by

gradual weaning of the splint

Volar, dorsal, or ulnar gutter splint

with the wrist in a neutral position

Volar splint with the wrist in a

neutral or slightly extended position

Volar or dorsal with wrist in 0 to 30

degrees in extension

Volar with 20-30 degrees of wrist

extension

Hand Condition Suggested Wearing Schedule Position

FRACTURES

Colle’s fracture

(closed reduction)

Indicated following removal of the

cast and healing of fracture

Discontinue use as soon as possible

to allow functional hand movement

Volar with maximum passive

extension that the patient can

tolerate- usually up to 30 degrees

RHEUMATOID ARTHRITIS

Periods of swelling and joint

inflammation

Worn continuously with established

periods for ROM exercises between

splint wearing schedule

Volar, in extension up to 30 degrees

based on patient tolerance

OTHER

Reflex Sympathetic

Dystrophy

Wrist joint synovitis or

tenosynovitis

Nighttime wearing

Worn during acute flare ups

Volar, in extension as tolerated by

patient

Volar, o to 15 degrees in extension

Resting Hand Splint (WHO)

• Immobilisasi untuk mengurangi gejala

• Posisi lumbrical (functional alignment)

• Memperlambat deformitas yg lebih lanjut

Resting Hand Splints (WHO)

Forearm through

Thumb through

Pan

C-bar

Hand Condition Suggested Wearing Schedule Position

RHEUMATOID ARTHRITIS

Acute Exacerbation

Fitted to maintain as close to a

functional (midpoint) position as

possible until exacerbation is over

Removed for hygiene and exercise

purposes

Worn during the day and at

nighttime as needed

WRIST: neutral or 20-30 degrees

extension depending on patient

tolerance

MCP: 15-20 degrees flexion and 5-

10 degrees ulnar deviation

THUMB: position of comfort in

between radial and palmar

abduction

TRAUMA

Crush injuries of the hand

Fitted after the injury to reduce

pain, edema, and swelling and to

provide rest to injured tissues

Worn at nighttime and worn as

needed

WRIST: extension of 0 to 30

degrees

MCP: 60-80 degrees of flexion

PIPs and DIPs: full extension

THUMB: palmar abduction and

extension

BURNS

Dorsal or Volar hand burns

Worn after the burn injury until

healing begins and removed for

dressing changes, hygiene, and

exercise

WRIST: Volar or circumferential

burn 30-40 degrees of extension;

Dorsal burn neutral position

MCP: 70-90 degrees of flexion

DIPs: full extension

THUMB: palmar abduction and

extension

Pertimbangan Khusus

• Mencegah infeksi : ketika luka terbuka mengandung

eksudat, bersihkan splint dengan air besabun, hydrogen

peroxide, atau alkohol.

• Untuk pasien ICU : gunakan bahan yg steril, dan ikuti

petunjuk pemakaian fasilitas

• Untuk pasien RA lebih baik menggunakan

thermoplast/plastik yg lebih tipis (< 1/8 inci)

Thumb Spica Splint (WHO)

• Menstabilkan sendi CMC, MCP dan IP

Thumb

Post•Volar

•Dorsal

•Radial

Gutter Opponens

Bar

Hand ConditionSuggested Wearing

SchedulePosition

SOFT TISSUE

INFLAMMATION

de Quervain’s

tenosynovitis

Acute flare-up: worn

continuously with removal for

hygiene and exercise

IP joint included only if pain is

present with IP flexion and

resisted IP extension

Long Forearm-based or Radial ulnar gutter

splint:

WRIST: 15 degrees of extension

THUMB CMC: palmar abduction 40-45degrees

THUMB MCP: 5 to 10 degrees of flexion

If with inflamed tendons, the the thumb CMC

joint is sometimes positioned in radial abduction

and extension instead of palmar abduction

RHEUMATOID

ARTHRITIS

Periods of pain and

inflammation in the

thumb joint

Worn continuously with

removal for hygiene and

exercise

Wearing schedule is adjusted

according to the patient’s pain

and inflammation levels

Long Forearm-based thumb spica splint

WRIST: 20-30 degrees of extension

THUMB CMC: palmar abduction 45 degrees; or

midway between radial and palmar abduction

depending on patient’s tolerance

THUMB MCP: if included, 5 degrees of flexion

TRAUMATIC

INJURIES OF THE

THUMB

Gamekeeper’s

thumb

Worn continuously for 3 to 4

weeks with removal for hygiene

Short opponens splint

MCP: joint immobilized and the thumb CMC

joint palmarly abducted 25 to 30 degrees

Upper Extremity Orthosis

Static

Dorsal

Elbow

Orthosis

Upper Extremity Orthosis

Balanced

Forearm

OrthosisForearm trough

Elbow dial

Rocker Assembly

Distal arm

Distal bearing

Proximal

bearing

Bracket

Upper Extremity Orthosis

Shoulder slings Humeral Fracture Brace

Upper Extremity Orthosis

Airplane Splints

SPLINT DIMANIS

TUJUAN PENGGUNAAN

Cocok untuk pasien yg kehilangan

fungsi motorik

Mengoriksi exiting deformity

Mengontol pergerakan

Dapat digunakan pada fracture

alignment dan penyembuhan luka

Pertimbangan Fisiologis

• Penguluran berlebih– lelah

– cedera

– kerusakan

• Penguluran kurang– Artrofi atau memperlemah

– kulit, tendon, ligament, dan

kapsul sendi akan semakin

memendek akibat tidak ada

pemberian tegangan yg

seperti biasanya.

• Penguluran yang cukup

– Peningkatan ROM dalam seminggu, dengan rentang 1-10

derajat dapat diterima (Cummings et al 1992 )

– Penguluran intensitas tinggi durasi rendah meningkatkan

stiffness.

– Klien/pasien seharusnya merasakan adanya tension/tegangan

pada jaringan, tapi tidak ada nyeri yang timbul.

Dynamic Splints

• Dynamic finger extension splint

• Dynamic wrist extension splint

• Tenodesis training

• Dynamic ulnar nerve splint

• Capener

• Anti-microstomial splint

Dynamic Finger Extension Splint

• Dynamic radial nerve splint

• tujuan:

– Immobilisi wrist pada posisi

fungsional

– Secara pasif mengekstensikan

MCP sampai 0 derajat

– Memperbolehkan full aktif fleksi

MCP dan pergerakan IP tidak

terhalangi

• Indikasi:

– Paralysis of wrist, MCP, Finger

extensors

Finger Cuff

Dorsal Forearm Trough

Dynamic Springwire Assist

Dynamic Wrist Extension Splint

• Tujuan :

– Ekstensi pasif wrist

sementara tangan fleksi

– Mencegah kontraktur

– Menginervasi fleksor

wrist

• Indicasi:

– Kelemahan atau paralisis

wrist extensors

Metatarsal Bar

Dynamic Springwire Knucklebender Assist

Volar Forearm Trough

Tenodesis Training Splint

• tujuan:

– Untuk melatih genggaman

tenodesis

– Untuk melatih OS agar

dapat melakukan gerakan

menjepit (tripod pinch)

dengan wrist extension

– melatih finger membuka

dengan wrist flexion

• Indikasi:

– C6 quadriplegia with grade

3 strength of wrist

extensors

Finger Cuff

Thumb Spica

Forearm Cuff

Dynamic Elastic Band Assist

Dynamic Ulnar Nerve Splint

Dynamic anti-claw deformity

splint, Wynn Perry Splint

Tujuan :

Untuk mempasif flexikan MCP

ke 4 dan ke 5

Mencegah pemendekan

ligamen Collateral MCP

Melatih active IP flexion

Indikasi

Ulnar nerve lesion

Metacarpal Bar

Dynamic Springwire Knucklebender Assist

Lumbrical Bar

Capener Splint

Dynamic spring wire splint

untuk PIP extension

tujuan:

Untuk mempasif

ekstensikan PIP

Aktif IP fleksi

Menstabilkan PIP

restabilisasi lateral

bands and mencegah

ruptur central slip

Indikasi :

– kontraktur PIP fleksi

– dislokasi PIP dorsal

– Volar plate injury

– perbaikan tendon Flexor

akibat kontraktur

– Partial or complete tear of

the collateral ligament

– Boutonniere deformity

ThermoplastDynamic Springwire Finger Coil Assist

Anti-microstomial Splint

Tujuan :

Memungkinkan penguluran

jaringan sekitar oral cavity

Mencegah kontraktur bibir

jaringan buccal yg

menyebabkan limitasi saat

membuka mulut

Indikasi:

Facial and perioral burns

Aturan penggunaan :

Penggunaan continue

Diangkat hanya untuk

dibersihkan

Pencegahan :

Ujung bibir cenderung

mengalami kerusakan kulit jika

pemasangan dan tegangan

splint yang tidak tepat.