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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