REHABILITASI

MEDIK PADA
GANGGUAN
KESADARAN/
IMOBILISASI
Dr. Joudy Gessal, SpKFR

 The adverse effects of prolonged bed rest

and immobility have become well
recognized over the past five decades.
Bed rest and immobilization were widely
used before 1950 in the management of
trauma and acute illness, before their
physiologic effects were well understood

 It was generally assumed that rest

fostered healing of the affected part of
the body.
What was not appreciated was that
physical inactivity could be harmful to the
unaffected parts of the body

Example
The immobilization of long bones with a
rigid cast has a beneficial effect on bone
healing after fractures.
may also result in undesirable effects,
such as joint contracture and atrophy of
the healthy muscles and bones

System(s)

Effect(s)

Musculoskeletal

Contractures
Muscle weakness and atrophy
Immobilization osteoporosis
Immobilization hypercalcemia

Cardiovascular and
pulmonary

- Redistribution of body fluids

- Orthostatic hypotension
- Reduction of cardiopulmonary
functional capacity
- Thromboembolism
- Mechanical resistance to breathing
- Hypostatic pneumonia

System(s)

Effect(s)

Genitourinary and
gastrointestinal

Urinary stasis, stones, and urinary infections

Loss of appetite
Constipation

Metabolic and
endocrine

Electrolyte alterations
Glucose intolerance
Increased parathyroid hormone production
Other hormone alterations

Cognitive and
behavioral

Sensory deprivation
Confusion and disorientation
Anxiety and depression
Decrease in intellectual capacity
Impaired balance and coordination

DISUSE ATROPHY
Decrease in the size of muscle fibers and
reduction of muscle mass is the hallmark of
muscle atrophy
The atrophy of disuse is generalized or
localized to the immobilized limb(s) and
more prominent in the antigravity muscles

 It is a consequence of the limited physical

activity and musculoskeletal loading that occurs
during immobilization, immobility, bed rest, or
exposure to microgravity during space flight.
As a general rule, increased muscular activity
leads to hypertrophy, whereas limited physical
activity leads to disuse atrophy and weakness
During and after bed rest, disuse atrophy is
more prominent in the lower limbs than in the
upper limbs

Dekubitus
Kerusakan / kematian kulit sampai
jaringan dibawah kulit, bahkan
menembus otot sampai mengenai
tulang akibat adanya penekanan pada
suatu area secara terus menerus
sehingga mengakibatkan gangguan
sirkulasi darah setempat

 Area yg biasa terjadi dekubitus adalah

tempat diatas tonjolan tulang & tidak
dilindungi cukup dengan lemak
subkutan : daerah sakrum, trokanter
mayor, tumit, siku

 Usia lanjut mempunyai potensi besar

untuk mengalami dekubitus karena
perubahan kulit berkaitan dengan
bertambahnya usia a.l :
jaringan lemak subkutan
jaringan kolagen & elastik
efisiensi kolateral kapiler pd kulit shg
kulit menjadi lebih tipis & rapuh
kecenderungan mengalami immobilisasi
memperbesar potensi terjadinya
dekubitus

 Patofisiologi
Tekanan darah kapiler berkisar 16 33
mmHg.
Kulit tetap utuh bila tekanan berkisar pd batas
tsb

Bila diberikan tekanan lebih dari batas tsb

dlm waktu < 2 jam
reversibel
> 2 jam
ireversibel
iskemik & bila berlanjut terjadi nekrosis
jaringan kulit

 Selain akibat faktor tekanan, ada faktor

mekanik tambahan yg dpt memudahkan
terjadinya dekubitus:
Teregangnya kulit
Terlipatnya kulit
Faktor tubuh sendiri (intrinsik) :
Status gizi
Anemia
Hipoalbuminemia
Penyakit neurologis;penyakit yg merusak
pembuluh darah
Keadaan hidrasi tubuh

 Perhatikan : (faktor ekstrinsik)

Kebersihan tempat tidur
Alas tempat tidur yg kusut & kotor
Peralatan medik
Yg menyebabkan penderita terfiksir
disuatu tempat

 Pengelolaan
Jaga kebersihan penderita khususnya
kulit
Setelah dibesihkan, kulit dikeringkan
Masase utk melancarkan sirkulasi darah
Tingkatkan status kesehatan penderita
Mengurangi/menyamaratakan faktor
tekanan yg mengganggu aliran darah

ISOMETRIC QUADRICEPS

knee in full
extension
contract quadriceps
without joint motion
pad under knee
minimal joint motion
add gradual resistance