patofisiologi gangguan aktivitas akibat gangguan neurologis

ARIF SETYO UPOYO

PATOFISIOLOGI GANGGUAN AKTIVITAS AKIBAT GANGGUAN

MUSCULOSKELETAL, CARDIOPULMONAL DAN

NEUROLOGIS

Mahasiswa dapat menjelaskan patofisiologi gangguan aktivitas akibat gangguan musculoskeletal, cardiopulmonal dan neurologis

CAPAIAN PEMBELAJARAN

MUSCULOSKELETAL SISTEM

04/22/23

04/22/23

Kerusakan, gangguan, infeksi, trauma pada otot, tulang dan sendi serta jaringan ikat sekitarnya

Kerusakan mobilitas fisik

Nyeri, ketidakstabilan, gangguan keseimbangan dan koordinasi

JANTUNG

04/22/23

04/22/23

Gangguan pada jantung: disritmia, kelainan katub, gagal jantung, infeksi,SKA

Penurunan Cardiac Output

Perfusi jaringan menurun

Hipoksia

Metabolisme an aerob

Penurunan energi

Intoleransi aktivitas

PULMONAL

04/22/23

04/22/23

Gangguan, infeksi, trauma pada jalan nafas, paru, dinding dada, pusat pernafasan

Perubahan pertukaran Gas

Hipoksemia

Hipoksia

Metabolisme an aerob

Penurunan energi

Intoleransi aktivitas

REVIEW

UPPER MOTOR NEURONLOWER MOTOR NEURON

MOTOR NEURON

• Upper motor neurons (UMN) are responsible for conveying impulses for voluntary motor activity

• UMN send fibers to the LMN, and that exert direct or indirect supranuclear control over the LMN.

• Lower motor neurons (LMN) directly innervate the skeletal muscle

Berasal kortek serebri dan menjulur kebawah :Traktus kostiko bulbaris berakhir pada batang otak sampai nuklei N. carnialis.Traktus kortikospinalis menyilang bagian bawah medulla oblongata turun kedalam medulla spinalis sampai cornu anterior medulla spinalis.

Upper Motor Neuron

Mencakup sel – sel motorik nuklei nervus kranialis dan akson-aksonnya serta sel – sel kornu anterior medulla spinalis dan akson – aksonyaSerabut motorik keluar melalui radik anterior.

Lower Motor Neuron

SYARAF SPINAL

AdaTidak ada

Tidak adaSeringkali ada

FasikulasiKlonus

Fisiologis menurun/tidak adaPatologis -

Fisiologis meninggiPatologis +

Reflek

Atropi jelasDisuse atropiMassa otot

FlasidSpastisitasTonus

Bergantung LMN yang terkena yaitu segmen radik, syaraf yang mana

Lesi diotak : distribusi piramidalisLesi di medulla spinalis

Jenis dan distribusi kelemahan

LMNUMNKARAKTERISTIK

PERBEDAAN GANGGUAN UMN DAN LMN

SISTEM SYARAF OTONOM

StrokeHead injurySpinal cord traumaGuillan Barre SyndromaMultiple sclerosis

NEUROLOGY DESEASE

A problem in any of principle part of the brain or spinal cord involved with skeletal muscle control can affect mobility.

Cerebral motor cortek assume the major role of controlling precise, discrete movement.

Stroke or head trauma may damage motor cortex and produce temporary or permanent voluntary control impairment

PROBLEM AFFECTING THE CENTRAL NERVOUS SYSTEM

Basal ganglia integrate semivoluntary movement such as walking swimmming and laughing

Degenerative basal ganglia: parkinson’s desease : tremors and muscle rigidity which interfere with voluntary movement.

The cerebellum assist the motor cortex and basal ganglia by making body movement smooth and coordinated.

In multiple sclerosis , the myelin sheaths of neuron in the CNS deteriote to hardened scars or plaques. Plague formation in cerebellum may produce lack of coordination of one hand.

Terjadi akibat tersumbat atau pecahnya pembuluh darah serebral

Gejala tergantung pada area otak yang diperdarahi vaskuler tersebut

Penurunan perfusi pada daerah cortek motorik menyebabkan hemiparesis

STROKE

A forceful blow to the head can result in brain injuryMajor or minor, depending on extent of damageIntracranial hemorrhage– Hard blow to head results in blood vessel damage– Leading cause of deathClinical syndrome characterized by impairment ofneural functions : Loss of consciousness, disturbed vision, loss of equilibrium

Head Injuries

Dapat disebabkan oleh traumaGejala tergantung pada syaraf spinal mana yang cederaCedera pada radik anterior menyebabkan gangguan motorik

pada sisi yang sama

CEDERA MEDULA SPINALIS

Neurological disease that destroys myelin sheathsof axons

Has genetic componentDue to immune attack on myelinResults in progressive loss of nervous system

functionFatigue, muscle weakness, poor motor control, loss of balance, mental depression

Exercise can improve functional capacity and Leads to improved quality of life

Multiple Sclerosis

Disorder of basal gangliaResults in decreased production of neurotransmitter dopamineInhibiting amount of muscular movementControl of various muscular activitiesSymptoms– Involuntary movement or tremor– Difficulty carrying out slow movementsTreatment– Drugs that stimulate production of dopamine

Parkinson’s Disease

Guillain-Barré Syndrome

is an acute inflammatory demyelinating polyneuropathy a disorder affecting the peripheral nervous system. It is usually triggered by an acute infectious process.

The etiology of Guillain-Barré syndrome is unclear, but an autoimmune response is strongly suspected.

There is a preceding event or trigger that is often an infection. Occasionally, vaccinations have been known to trigger Guillain-

Barré syndrome. Approximately half of the people who develop Guillain- Barré

syndrome have a mild febrile illness 2 to 3 weeks before the onset of symptoms.

The febrile infection is usually respiratory or gastrointestinal. Approximately 25% of patients with this disease have antibodies

to either cytomegalovirus or Epstein-Barr virus

PATHOPHYSIOLOGY

• In Guillain-Barré syndrome, the myelin sheath surrounding the axon is lost.

• Demyelination is a common response of neural tissue to many agents and conditions, including physical trauma, hypoxemia, toxic chemicals, vascular insufficiency, and immunological reactions.

• Loss of the myelin sheath in Guillain-Barré syndrome makes nerve impulse transmission is aborted.

CLINICAL MANIFESTATIONS

• The syndrome may develop rapidly over the course of hours or days, or may take up to 3 to 4 weeks to develop.

• Most patients demonstrate the greatest weakness in the first weeks of the disorder.

• Patients are at their weakest point by the third week of the illness.

• In the beginning, a flaccid, ascending paralysis develops quickly.

• The patient is most commonly affected in a symmetrical pattern.

The patient may first notice weakness in the lower extremities that may quickly extend to include weakness and abnormal sensations in the arms.

Deep tendon reflexes are usually lost, even in the earliest stages.

The trunk and cranial nerves may become involved. Respiratory muscles can become affected, resulting in

respiratory compromise.Autonomic disturbances such as urinary retention and

orthostatic hypotension may also occur. Superficial and deep tendon reflexes may be lost. Some patients experience tenderness and pain on deep

pressure or movement of some muscles.

Sensory symptoms of paresthesias, including numbness and tingling, may occur.

Pain is a complaint in a large number of patients. It is aching in nature and often compared with the feeling of

muscles that have been overexerted. If there is cranial nerve involvement, cranial nerve VII, the

facial nerve, is most often affected. Guillain-Barré syndrome does not affect level of

consciousness, pupillary function, or cerebral function.Symptoms may progress for several weeks. The level of

paralysis may stop at any point. Motor function returns in a descending fashion. Demyelination occurs rapidly, but the rate of remyelination is

approximately 1 to 2 mm per day.

DIAGNOSIS

The history of the onset of symptoms can be revealing because symptoms of Guillain-Barré syndrome usually begin with weakness or paresthesias of the lower extremities and ascend in a symmetrical pattern.

A lumbar puncture may be performed and reveal increased protein.

Also, nerve conduction studies record impulse transmission along the nerve fiber.

Pulmonary function tests are done when Guillain-Barré syndrome is suspected to establish a baseline for comparison as the disease progresses.

Declining pulmonary function capacity may indicate the need for mechanical ventilation and management in an ICU.

04/22/23

Penurunan kesadaran, stroke, trauma medulla spinalislis, trauma syaraf spinalis, GBS gangguan syaraf motorik.

Penurunan fungsi motorik

Kerusakan mobilitas fisik