PROPOSAL OF FINAL PROGRAM EXAMINATION ORTHOTIC PROSTHETIC STUDY PROGRAM

SUB FACULTY PHYSIOTHERAPY POLITEKNIK KESEHATAN SURAKARTA YEAR 2005-2006

According to Guidelines for Health Staff Education Implementation, to accomplish educational program in Orthotic Prosthetic Study Program, a student must go through Final Program Test (UAP). I. Participant

Students of Semester VI/2005-2006 as many as 38 students, 2 were not in attendance because: 1. One person named Mr. Muhammad Ghandi applied for academic leave of

semester V-VI year 2005-2006 due to economic problems. 2. One person named Mr. Sigit Darmawan applied for academic leave of semester

VI year 2005-2006 and semester VII 2006-2007 due to health problems.

Requirements for participants: 1. Have written final assignment (KTI) on the subject of making a blue print of OP

equipment. 2. Have gone through final assignment test. 3. Have finished practice Administration. 4. Have finished financial administration up to semester VI/2005-2006. 5. Have finished all theory and practice classes.

II. Final Program Examination 1. Practice Test

a. Practice the process of ”Fitting – Finishing – Evaluation – Education/Home Care” on patient with OP equipment prepared along the final paper writing process.

b. Student prepares the patient. 2. Seminar for Practice result (a week after the practice), for 1 week students:

- Fix and do finishing to the OP tool tested. - Write a report for Final Program Test.

III. Final Program Examiner 1. 1 (one) examiner from OP experts 2. 1 (one) examiner from Physiotherapy experts. 3. 1 (one) examiner from Poltek/Medical team for basic technique

IV. Final Program Test Procedure 1. Registration by filling Final Program Test form. 2. 6 recent photos size 3x4 for certificate

- Black and white - Face front, both ears come into view - Apparel:

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a. Dark suit and tie for male b. For female : hair neatly combed, both ears come into view

: For those wearing jilbab, must wear white jilbab, Institution doesn’t take responsible for unexpected outcome due to the certificate photo (student filling a statement form to show agreement).

V. Time 1. Practice

Final Program Examination is planned from 10th July – 26th September 2006 Time needed: ± 1 jam Scoring form is enclosed

2. Seminar takes place a week after the practice - Presentation 15 minutes - inquiry with 3 examiners, each examiner is given 15 minutes time

VI. Final Program Examination Scoring 1. Score for Final Program Test is an average of the 3 examiners scores 2. Passing grade is minimal 2,75 / B 3. Result of Final Program Test is established in Final Program Test Judicial

Meeting attended by: - The examiners - Study Program Board - Head of Sub Faculty Physiotherapy - Directorate

On condition a student doesn’t pass the minimum required grade on the Final Program Examination, he/she is compulsory to take Final Program Re-Test I on: Re-Test I: Practice 31 July – 5 August 2006 Seminar 7 – 12 August 2006

VII. Coordination See appendix.

VIII. At the end Final Program Test session, there will be signature and ceremony to grant the OP tool to the patient as a form of public service. The ceremony is acknowledged by the Advisor and the Directorate. This Proposal is approved in OP Lecturer Team – OP Board Meeting on: 1. Hearing with the OP team in RSO on 23rd January 2006. 2. Meeting on 10th February 2006.

IX. Closing

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That is all about Final Program Examination Proposal, Orthotic Prosthetic Study Program year 2005/2006. In the future, we expect suggestion and criticism from the Director for the sake of success of the First Final Program Examination of Orthotic Prosthetic Study Program.

Acknowledged by, Head of Sub Faculty Physiotherapy Ig. Sujatno, SMPh., SPd. NIP. 140 057 848

Head of Orthotic Prosthetic Study Program (ad interim) Sub Faculty Physiotherapy Drs. Alfan Zubaidi, AMF NIP. 140 228 979

Appendices 1. Proposal of Final Program Examination Board Decree 2. Plan for Time Table of Final Program ExaminationAppendix 1. Proposal of Final Program Examination Board Decree

PROPOSAL FOR COMMITTEE BOARD FINAL PROGRAM EXAMINATION D-III

ORTHOTIC PROSTHETIC SUB FACULTY PHYSIOTHERAPY POLITEKNIK KESEHATAN SURAKARTA

YEAR 2006

Director : Head of PPSDM Board

Supervision : 1. Head of Pusdiknakes

2. Director of Poltekkes Surakarta 3. Head of Sub Official of HR of Health Official Prov. Central Java

Responsible : 1. Vice Director I 2. Ig. Sujatno, SMPh., SPd. (Head of Sub Faculty Physiotherapy) Chairman of the Board : Drs. Alfan Zubaidi, AMF. (Head of Orthotic Prosthetic Study Program)

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Secretary : Sri Surini Pudjiastuti, SMPh., SPd. (Coordinator I)

Treasurer : 1. 2. Anna Endang Winarni Technical members : 1. Lisa Triyanthi, SKM

2. Suhardi, SKM 3. S.Th. Susilowati, SMPh, SIP. Administrative members : 1. Yos Sutrisno, Amd.OP 2. Wiyono, Amd.OP., SMPh., SPd.

3. Sumarni 4. Sri Utami 5. Sadimin 6. Rohmad General Affair : D. Muh. Sasongko Practice and Seminar Examiner :

1. Ig. Sujatno, SMPh, SPd. 14. Nawangsasi, M. Physio. 2. Maskun Pudjianto, SPd, M Kes. 15. Setiawan, M. Physio. 3. M. Mudatsir Syatibi, M.Kes. 16. Budi Utomo, SKM. 4. Sri Surini Pudjiastuti, SPd. 17. Suhardi, SKM. 5. Heru Purbo Kuntono, M Kes. 18. dr. Prasetya Hudaya 6. S. Th. Susilowati, SIP. 19. Yos Sutrisno, Amd.OP 7. Kayunsari, SMPh, SPd . 20.. Wiyono, SMPh., Amd.OP., SPd. 8. Yulianto Wahyono, M.Kes. 21. Suhir, Amd.OP 9. Nur Basuki, M. Physio 22. Suharyanto, BSc 10. Drs. Alfan Zubaidi 23.. Suparjiman, Amd.OP 11. Marti Rustanti, SKM. 24. Ramelan, S.S 12. Sukadarwanto, SKM. 25. HS. Widodo, ST., SPd. 13. Bambang Tw, SPd, SKM.

Appendix 2. Plan of Final Program Examination Time Table

Plan for Practice Time Table (Fitting) Orthotic Prosthetic Year 2005 – 2006

I. Time table of Final Program Practice Examination NO Day,

Date Name of student

Registration Number (NIM)

Examiner Venue

1. Monday, 10th July 2006

1. 2. 3. 4. 5. 6.

1. Wiyono, SMPh., Amd.OP., SPd. 2. S. Th. Susilowati, SMPh., SIP. 3. Ig. Sujatno, SMPh., SPd. 1. Yos Sutrisno, Amd.OP 2. Yulianto W., Dipl.PT., M.Kes. 3. Mudatsir Syatibi, M.Kes.

OP Study Program Sub Faculty Physiotherapy Kapt. Adi Sumarmo Street, Tohudan, Colomadu.

2. Tuesday, 11th July 2006

1. 2. 3. 4. 5. 6. 7.

1. Ramelan, S.S. 2. Budi Utomo, SKM 3. Kayunsari, SMPh. 1. Suhir, Amd.OP 2. Bambang TW., SKM 3. Drs. Alfan Zubaidi, AMF

Lab Bahasa Class OP II

3. Wednesday, 12 July 2006

1. 2. 3. 4.

1. Suharyanto, BSc. 2. Sri Surini P., SMPh., SPd. 3. Maskun Pudjianto, M.Kes.

Lab Bahasa

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5. 6. 7.

1. Ramelan, S.S. 2. S. Th. Susilowati, SMPh., SIP. 3. Setiawan, M. Physio.

Class OP II

4. Thursday, 13th July 2006

1. 2. 3. 4. 5. 6. 7.

1. Suparjiman, Amd.OP 2. Suhardi, SKM., SIP. 3. Marti Rustanti, SKM 1. Suhir, Amd.OP 2. Drs. Alfan Zubaidi, AMF 3. Sukadarwanto, SKM

Lab Bahasa Class OP II

5. Friday, 14th July 2006

1. 2. 3. 4. 5. 6. 7.

1. Wiyono, SMPh., Amd.OP., SPd. 2. Nur Basuki, M. Physio. 3. dr. Prasetya Hudaya 1. Yos Sutrisno, Amd.OP. 2. Heru Purbo K., M. Kes 3. Suhardi, SKM., SIP.

Lab Bahasa Class OP II

6. Saturday, 15th July 2006

1. 2. 3. 4. 5. 6. 7.

1. Ramelan, S.S. 2. Suhardi, SKM., SIP 3. ATW 1. Suhir, Amd.OP. 2. Sri Surini P., SMPh., SPd. 3. Nawangsasi T., M. Physio.

Lab Bahasa Class OP II

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II. Time Table of Seminar Plan for Seminar Time Table

Prodi Ortotik Prostetik Tahun 2005 – 2006 NO Day,

Date Name of Student

Registration Number

Examiner Venue

1. Monday, 17th July 2006

1. 2. 3. 4. 5. 6.

1. Wiyono, SMPh., Amd.OP., SPd. 2. S. Th. Susilowati, SMPh., SIP. 3. Ig. Sujatno, SMPh., SPd. 1. Yos Sutrisno, Amd.OP 2. Yulianto W., Dipl.PT., M.Kes. 3. Mudatsir Syatibi, M.Kes.

OP Study Program Sub Faculty Physiotherapy Kapt. Adi Sumarmo Street, Tohudan, Colomadu.

2. Tuesday, 18 July 2006

1. 2. 3. 4. 5. 6. 7.

1. Ramelan, S.S. 2. Budi Utomo, SKM 3. Kayunsari, SMPh. 1. Suhir, Amd.OP 2. Bambang TW., SKM 3. Drs. Alfan Zubaidi, AMF

Lab Bahasa Class OP II

3. Wednesday, 19 July 2006

1. 2. 3. 4. 5. 6. 7.

1. Suharyanto, BSc. 2. Sri Surini P., SMPh., SPd. 3. Maskun Pudjianto, M.Kes. 1. Ramelan, S.S. 2. S. Th. Susilowati, SMPh., SIP. 3. Setiawan, M. Physio.

Lab Bahasa Class OP II

4. Thursday, 20 July 2006

1. 2.

1. Suparjiman, Amd.OP 2. Suhardi, SKM., SIP.

Lab Bahasa

7

3. 4. 5. 6. 7.

3. Marti Rustanti, SKM 1. Suhir, Amd.OP 2. Drs. Alfan Zubaidi, AMF 3. Sukadarwanto, SKM

Class OP II

5. Friday, 21st July 2006

1. 2. 3. 4. 5. 6. 7.

1. Wiyono, SMPh., Amd.OP., SPd. 2. Nur Basuki, M. Physio. 3. dr. Prasetya Hudaya 1. Yos Sutrisno, Amd.OP. 2. Heru Purbo K., M. Kes 3. Suhardi, SKM., SIP.

Lab Bahasa Class OP II

6. Saturday, 22 July 2006

1. 2. 3. 4. 5. 6. 7.

1. Ramelan, S.S. 2. Suhardi, SKM., SIP 3. ATW 1. Suhir, Amd.OP. 2. Sri Surini P., SMPh., SPd. 3. Nawangsasi T., M. Physio.

Lab Bahasa Class OP II

Head of Orthotic Prosthetic Study Program (Ad interim)

Drs. Alfan Zubaidi, AMF

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NIP. 140 228 979

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BLUE PRINT AND MAKING PROCESS OF

TRAUMATIC KNEE PROTHESES

Written by:

Agnes Monica

P 27227003001

ORTHOTIC PROSTHETIC STUDY PROGRAM DIPLOMA III

SUB FACULTY PHYSIOTHERAPY

POLITEKNIK KESEHATAN SURAKARTA

2006

xi

LEGALIZATION

It is approved by Final Assignment Advisor to be examined by Final Assignment

Examiner Board of Politeknik Kesehatan Surakarta Sub Faculty Physiotherapy

Orthotic Prosthetic Study Program

Approved

On :

Advisor I : Advisor II :

Wiyono, SMPh., Amd. OP., SPd. Yulianto Wahyono, Dip.PT, M.Kes

NIP 1400218359 NIP 140285550

xii

EXAMINER SHEET

Examined by the Final Assignment Board Politeknik Kesehatan Surakarta

Sub Faculty Physiotherapy Orthotic Prosthetic Study Program and approved to

complete Assignments and Meet the Requirements to accomplish Diploma III

Orthotic Prosthetic Program.

Day :

Date :

Final Examiner Board :

Name Signature

Examiner I : Wiyono, SMPh., AMd.OP., SPd. ....................................

Examiner II : Nur Basuki, M. Physio. ………………………

Examiner III :YuliantoWahyono,Dipl.PT.,M.Kes. ………………………

Legalized by :

Head of Sub Faculty Head of O/P Study Program Ad. Interim

Politeknik Kesehatan Surakarta

Ig. Sujatno, SMPh., SPd. Drs. Alfan Zubaidi, AMF

NIP. 140057848 NIP. 140228979

xiii

MOTTO

You will not be able to guide people you love, yet ALLAH will guide

people HE wishes to guide.

(Al-Qoshosh :56 )

xiv

DEDICATION

• For my sisters and my best friends, who’re always with me in happy

and sad

• Alumnae, Teachers, my country and my nation

xv

PREFACE

Praise and gratitude only for ALLAH SWT who has showered His Mercy,

Grant and Guidance so that I can accomplish this assignment well.

A Final Paper entitled

BLUE PRINT AND MAKING PROCESS OF

TRAUMATIC KNEE PROSTHESES

is submitted to meet the requirements to complete Diploma IV Physiotherapy

Study Program, Sub Faculty Physiotherapy, Politeknik Kesehatan Surakarta.

I realized that it’s far away from perfect, hence I expect inputs, criticism as

well as suggestion to make a betterment of this paper.

Next, I want to thank to :

1. Mrs. Rita Benya Adriani, SKp.M.Kes., as the Director of Politeknik

Kesehatan Surakarta

2. Mr. Ig. Sujatno. SMPh, SPd., as the Head of Sub Faculty Physiotherapy

of Polteknik Kesehatan Surakarta.

3. Mr. Drs. Alfan Zubaidi, AMF., as the Head of D III Orthotic Prosthetic

Study Program (ad interim) of Sub Faculty Physiotherapy Politeknik

Kesehatan Surakarta.

4. Mr. Wiyono and Mr. Yulianto Wahyono, Dipl, PT., as the Advisor for this

paper, thank you for the time, opportunity, knowledge and advise given

5. To my friends in D III Orthotic Prosthetic Study Program Sub Faculty

Physiotherapy Politeknik Kesehatan Surakarta who motivate me and

guide through all this.

xvi

6. To everybody I can’t mention one by one here who has helped and

encouraged me to finish this paper.

I realize that this paper I’ve written is still far away from early possi of

femora quadriceps muscle strength measurement perfect, hence I really expect

that there will be inputs, criticism as well as advises for the bettement of this

paper.

Surakarta,

Writter

Agnes Monica

xvii

CONTENT

COVER …………………………………………………… i

LEGALIZATION ………………………………………..

EXAMINER SHEET……………………………………………………

MOTTO………………………………………………………………….

DEDICATION…………………………………….......

ii

iii

iv

v

PREFACE…………………………………………………… vi

CONTENT …………………………………………………………….. viii

PICTURE APPENDICES ……………………………………………….

TABLE APPENDICES………………………………………………….

GRAPHIC APPENDICES ……………………………………………

ix

x

xi

CHAPTER I INTRODUCTION………………..………………… 1

A. ………………………….. …………….………………. 1 B. ………………………….. …………….………………. 3 C. ………………………….. …………….………………. 3 D. ………………………….. …………….………………. 4

CHAPTER II THEORY ……………………………… 5

A. ………………………….. …………….………………. 5 B. ………………………….. …………….………………. 12 C. ………………………….. …………….………………. 13 D. ………………………….. …………….………………. 16

CHAPTER III OP PROGRAM IMPLEMENTATION………….. 17

A. ………………………….. …………….………………. 17 B. ………………………….. …………….………………. 18 C. ………………………….. …………….………………. 19 D. ………………………….. …………….………………. 20 E. ………………………….. …………….………………. 22 F. ………………………….. …………….………………. 27

CHAPTER IV CONCLUSION AND SUGGESTION ………………. 28

xviii

BIBLIOGRAPHY …………………………………………………….

APPENDICES

29

xix

PICTURE APPENDICES

Picture Page

2.1. .............................................................................…………. 6

2.2. ................................................................................... ……. 9

2.3. .......................................................………………………... 12

2.4. .............................................................……………………. 13

3.1. …………………………….. ……………………………… 18

3.2. …………………………………………….………………… 21

xx

TABLE APPENDICES

TABLE PAGE

4.1. ……………………………………… ………………………… 32

4.2. ………………………………………………………………… 33

4.3. …………………………………….…………………………... 35

4.4. ……………………………… ……………………………….. 37

4.5. ………………………………………………………. ………. 39

4.6. ……………………………………………………….. ……… 41

xxi

GRAPHIC APPENDICES

GRAPHIC PAGE

5.1. ………………………………….. ………………………… 32

5.2. …………………………………… ……………………….. 36

5.3. ………………………………............................................... 38

5.4. ……………………………………………………….......... 40

5.5. ……………………………………………………….……. 42

xxii

STATEMENT

Herewith, I :

Name : Agnes Monica

Registration Number : P27227003001

state truthfully that the Final Assignment entitled:

BLUE PRINT AND MAKING PROCESS OF

TRAUMATIC KNEE PROSTHESES

is my own idea and work. Things which are not my own work in this paper is

given a quote sign and written in bibliography.

In condition that this statement is untrue, I will accept all the

consequences of academic sanction in a form of cancellation of this Final

Assignment and Title I may obtain of this paper.

Surakarta, ……………………..

Stated sincerely by

Agnes Monica

xxiii

EXAMPLE

BLUE PRINT AND MAKING PROCESS OF

TRAUMATIC KNEE PROSTHESIS

FINAL ASSIGNMENT

To meet the requirements of

Accomplishing Diploma III Orthotic Prosthetic Study Program

Submitted by :

Agnes Monica

P 27227003001

DIPLOMA III ORTHOTIC PROSTHETIC STUDY PROGRAM

SUB FACULTY PHYSIOTHERAPY

POLITEKNIK KESEHATAN SURAKARTA

2006

xxiv

25

TITLE OF FINAL EXAMS PAPERS POLITEKES KESEHATAN SURAKARTA PHYSICALTHERAPY FACULTY

ON STUDY PROGRAM ORTHOTIC PROSTHETIC

NO NAME REG.NO TITLE 1 Achmad Mubin P27227003 001 Blue print and Making Process of PTB Prostheses

with Corset on amputee Bellow Knee Post Trauma 2 Adhi Dwi Hananto P27227003 002 Blue print and Making Process of PTB-SL

Supracondylair on amputee Bellow Knee Post Mechanic Trauma

3 Adi Sanjaya Suryaningtyas P27227003 003 Blue print and Making Process of Supracondylair Left Prostheses on amputee Bellow Knee Post Trauma

4 Agus Setyo Nugroho P27227003 004 Blue print and Making Process of Above knee Prostheses on Amputee Left Leg Post Trauma

5 Agus Tri Rohmadi Blue print and Making Process of Ankle Foot Orthoses (AFO) on CTEV Left foot

6 Dalimin P27227003 Blue print and Making Process of PTB Supracondylair Right on Amputee Bellow Knee Post Trauma

7 Danny Trias Jatmiko P27227003 008 Blue print and Making Process of Above Knee Double Socket Prostheses on Amputee Post Trauma

8 Daryono P27227003 009 Blue print and Technical Making Process of Knee Ankle Foot Orthoses (KAFO) on Post Poliomyelitis

9 Didit Permono P27227003 010 Blue print and Making Process of Patellar Tendon Bearing (PTB) Prostheses on Post Amputee Bellow Knee Right Because Diabetic

10 Ekky Yuliarto Nur Baskoro P27227003 011 Blue print and Making Process of Milwaukee Brace for Scoliotic case

11 Endra Rudiyanto P27227003 012 Blue print and Making Process of Above Knee Prostheses on Amputee Post Trauma

12 Eny Widyawati P27227003 013 Blue print and Making Process of Disarticulation Prostheses Conventional on Lower Limb left congenital

13 Giyanto P27227003 014 Blue print and Making Process of KAFO on Poliomyelitis Left Lower Limb

14 Hari Santoso P27227003 015 Blue print and Making Process of Above knee Prostheses Double Socket Right Post Trauma

15 Hariyadi P27227003 016 Blue print and Making Process of Patellar Tendon Bearing (PTB) Prostheses on Amputee Post Trauma

16 Hendi Gunanto P27227003 017 Blue print and Making Process of Patellar Tendon Bearing Prostheses (PTB) Post Trauma

17 Komang Arya Sedana Arta P27227003 018 Blue print and Making Process of Knee Ankle Foot Orthoses (KAFO) on weaknesses Right Leg Post Poliomyelitis

18 Kuncoro P27227003 019 Blue print and Making Process of PTB Supracondylair on Bellow Knee Post Trauma

19 Margono P27227003 020 Blue print and Making Process of Knee Ankle Foot Orthoses (KAFO) on Mono pareses Right Leg Post poliomyelitis

20 Moch. Baharuddin Yusuf P27227003 021 Blue print and Making Process of Patellar Tendon Bearing Supracondylair on Amputee Bellow Knee Because of Gangrene

26

21 Mokhamad Iswanto P27227003 022 Blue print and Making Process of Patellar Tendon Bearing Supracondylair (PTB-SL) Left Bellow knee Prostheses Post Trauma

22 Muizzah Ekowati P27227003 024 Blue print and Making Process of Knee Ankle Foot orthoses Conventional on Poliomyelitis

23 Muslimin P27227003 025 Blue print and Making Process of Above Knee Prostheses Post Amputee Because of Trauma

24 Ni'amah Fatmawati P27227003 026 Blue print and Making Process of Patellar Tendon Bearing Supracondylair (PTS) on Amputee Bellow knee Right Because of Trauma

25 Noventri Jayanti P27227003 027 Blue print and Technical Making Process of Bellow Knee Right Supracondylair Because of Congenital Deformity

26 Nuri Wahyuni P27227003 028 Blue print and Technical Making Process of Patellar

Tendon Bearing (PTB) with Tight Corset on Amputee Short Bellow Knee Left Post Trauma

27 Putut Seno Widodo P27227003 029 Blue print and Making Process of Hip Knee Ankle Foot orthoses (HKAFO) on Post poliomyelitis

28 Rohmad Setiyanto P27227003 030 Blue print and Making Process of Bilateral Short Leg

Brace with Built Up Shoes on Gait Problem Because of Weaknesses Peronel Nerve

29 Sri Lestari P27227003 032 Blue print and Making Process of Munster Scolioses Orthoses (MSO) on Scoliotic Case

30 Sugeng Dwi Wahyudi P27227003 033 Blue print and Making Process of Above knee Right Prostheses on Amputee Post Trauma

31 Suparjo P27227003 034 Blue print and Technical Making Process of Bellow Knee Prostheses Conventional

32 Triwanto P27227003 036 Blue print and Making Process of KAFO Conventional on Poliomyelitis Case Residual Stage

33 Vivid Perdananto P27227003 038 Blue print and Making Process of HIP Knee Ankle Foot Orthoses (HKAFO) on Post Poliomyelitis

34 Yusuf Haryadi P27227003 040 Blue print and Making Process of Munster Scolioses Orthoses on Idiopatic Scoliotic T7 – L4

35 Komang Arya S.A P27227003 018 Treatment on Polio Case Right Leg with Long Leg Brace (Hip Knee Ankle Foot Orthoses)

36 Aris Asidiki P27227003 006 Blue print and Use Long Leg Brace on Polio Case

37 Teguh iksan Ragutomo P27227003 035 Blue print and Making Process of Bellow Knee Prostheses (PTS) on Congenital case

38

Umi Fatmawati P27227003 037 Blue print and Making Process of PTB

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