Konsep Metode Ndt

7/31/2019 Konsep Metode Ndt

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KONSEP METODENDT / BOBATH

NAWANG SASI TAKARINI


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KONSEP AWAL

KAREL DAN BERTA BOBATH UNTUK

KONDISI KELAINAN SUSUNAN SYARAF

PUSAT

KONSEP AWAL

REFLEX INHITING PATTERN (RIP)

key point of control (KPoC)


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KONSEP BARU

NORMAL NEURO DEVELOPMENT

NORMAL POSTURAL DEVELOPMENT

REFLEX INHIBITING POSTURE (RIP) NORMAL POSTURAL REFLEX MECHANISM

(NPRM)


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NPRM

3 VARIABLE:

TONUS POSTURAL NORMAL

RECIPROCAL INERVATION

CO-CONTRACTION

COORDINATION

MOVEMENT VARIATION DAN AKTIVITAS


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3 ELEMEN YG PENTING PADA

NPRM

RIGHTING REACTION (RR)

EQUILIBRIUM RECTION (ER)

PROTECTIVE REACTION (ER)


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BASIC MOVEMENT

HEAD TO BODY RR

BODY TO BODY RR

NECK TO BODY RR OPTICAL REACTION

LABIRINTHINE RR

ALIGNMENT GARIS TUBUH PADATRUNK


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TEHNIC

RIP

KPoC

TAPPING SENSO-MOTOR INTEGRATION


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Postural Reflex

Dasar -> sensory motor anatomy yang

berhubungan dengan posture-relate

behaviours

1. Attitudinal reflexes

2. Automatic right reflexes

3. Balance and Protective reflexes


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Attitudinal Reflexes

Reflex attitudinal mempengaruhi postur ->

otot2 pada multiple level dari spinal cord

(Sumway-Cook & Woolocott, 2002).

Akan timbul akibat -> posisi kepala

1. ATNR

2. STNR3. Tonic Labyrinthine Reflex (TLR)


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Automatic Reflexes

Automatic reflexes akan membantu kepala yangberhubungan dengan gravity serta tubuh dengankepala.

Dimunculan oleh vestibular, visual dan proprioseptifspinal.

1. Labyrinthine head righting (vestibulocollic reflex,vestibular trigger)

2. Optical head righting (visual trigger)

3. Neck on body righting (cervicocollic)

4. Body on head righting (Vestibulocollic andcervicocollic reflexes)

5. Body on Body righting (spinal)

6. Landau reflex (vestibular, visual & spinal trigger)


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Balance and Protective Reflexes

Reflex balance dan protective -> center of

mass -> sebagai based support. Balance & protective reflexes -> complex

(rumit) -> adaptive behaviours.

1. Tilting reactionmovement that recoveryof COG over based of support

2. Postural fixation -> movement to counter /stabilize in the presence of en external appliedforce

3. Protective extension reaction -> movementthat protect the heard from injury during fall.


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Kontradiksi teori

(Hierarchical VS systems) Hierarchical -> presume motor control

progressively moves up the neuroaxis as

higher brain centers mature, and the mature

system posture is cortical controlled.

Higher brain center mature -> inhibit lower

reflex centers

Ini akan mempengaruhi pematangan ->

execute postural strategy


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Kontradiksi teori

(Hierarchical VS systems)System theories :

Pengalaman sensori diperlukan untuk motorstrategy

Sensory system adalah fungsional tetapipada infant dan toddler memerlukanpengalaman yang normal, baik dan cukup yang

berhubungan dengan perception with actionuntuk pematangan sensoris.


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Hukum arah perkembangan

Pada perkembangan postural control-> teorihierarchypematanganpengalaman sensoris

acquisition mastery postural controlrostro/cephalo-caudal

Sensori motor -> pemetaankepalaleharprogres berlanjut ke trunk musculatureekstrimitas.

Higher-order association are formed, childrenfirst selectively depend on vision to controltheir posture, then learn to rety to an increasingextent on somatosensory.


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5 first signs of voluntary postural control.

S1. Sensory system (vestibular, visual, somatosensory) forpostural control are present in the neonate on soonthereafter

S2. Motor responses can be elicited for each postural contextconcurrent with acquisition on control for that posture.

S3. Motor responses tend to be more consistent in infantsand young children if vision is blocked

S4. Posture of infants and young children is greatlychallenged by looming visual stimuli.

S5. Variability in motor responses my be attribute tovariability in biomechanics during loos of balance dueto postural instability at the onset of the perturbation(adults are very stable at the onset of a test trial)


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Stabilitas pada posture dan

kontrol posture yang baik

akan meningkatkan

stabilitas pada head, neck,

jaw, tounge, lips baikdrooling menurun


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LOCOMOTOR (GAIT)

Perkembangan Gait

1. Faktor Neurologikal:

Basic neural organization -> berfungsi untuk

execute locomotion dokontrol oleh Central Pattern

Generator (CPG) di spinal cord atau otak2. Factor Mechanical

- ROM

- Strength- appropriate bone structure & composition

- body composition


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ONSET OF WALKINGTime and Distance Parameter 1 yrs 1.5 yrs 3 yrs 7 yrs

Opposite toe of (% cycle)

Opposite foot-strike (% cycle)

Single stance (% cycle)

Toe-off (% cycle)

Step-length (cm)Stride length (cm)

Cycle time (sec)

Cadence (step/min)

Walking velocity- cm / sec

- m / min

17

49

32

67

2243

0.68

176

64

38.4

18

50

32

68

2550

0.70

171

71

42.6

16

50

35

66

3367

0.77

154

86

71.6

12

50

38

62

4897

0.87

144

114

68.4


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One complete gait cycle pada anak

Double

support

(10%)

Loading

response

10%

Stance (60%)

30%

Double

support(10%)

Midstance Terminal

stance

Preswing

50% Toe off

Initial

swing

70%

Midswing Terminal

swing

85%

Swing (40%


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Gait Lab

Konsep Metode Ndt

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