REHABILITASI

PASIEN STROKE

DEPARTEMEN/BAGIAN KEDOKTERAN FISIK DAN REHABILITASI

FK UNLAM - RUMAH SAKIT UMUM DAERAH ULIN BANJARMASIN
STROKE :
THIS IS NOT JUST A DISEASE,

THIS IS A DISASTER !

KULIAH NEURO-REHABILITATION 2/19/2020 3

AS A KILLER :

1.CARDIOVASCULAR
DISEASE
2.CANCER

3.STROKE

4
AS A DISABLING DISEASE :

STROKE IS THE
CHAMPION
…it is the single most expensive disease, costing some $ 1.2
billion a year, even before the costs of physicians services and
nursing home and other nonhospitalized care are figure in..
( Stroke Foundation, Inc. N.Y. )

5
FACTS ABOUT STROKE :

1. A stroke does not have to be fatal

2. Strokes can be prevented
3. Most strokes have good prognosis
functionally

6
FAKTOR RESIKO UTAMA

Hipertensi
Diabetes Mellitus
Dislipidemia
Penyakit Jantung
Perokok Berat
Life Style
Stress Disease
Tujuan Rehabilitasi Pasien
Stroke
1. Mencegah kecacatan
2. Meminimalkan kecacatan
3. Mempertahankan fungsi dan kemandirian
hidup.
4. Mencegah serangan stroke berulang.
SAAT SERANGAN STROKE
 Serangan Stroke  IGD  dr.
SpS dan atau Sp.BS (Golden
Period = A.S.A.P)
 Edukasi pasien & keluarga 
cegah komplikasi fatal akibat
kesalahan manajemen akut
 R. HEMIPLEGIA vs L. HEMIPLEGIA

LEFT HEMISPHERE RIGHT HEMISPHERE

STROKE STROKE
Language problems Visio-motor perceptual deficits
( APHASIA ) Visual memory deficits
Left sided neglect
Reduced insight
Uncoordinated ADL
Superficial and Deep sensory
deficits
PASIEN STROKE TIA
RIND

Sembuh
total
Hidup
Stroke
Attack Cacat
Meninggal
DISABILITAS / KECACATAN PADA STROKE
1.PRIMER: akibat langsung dari stroke,
tergantung area otak yang terkena,
sangat bervariasi. Manajemen
adekuat pada golden period 
kerusakan minimal 
meminimalkan kecacatan.
2.SEKUNDER : akibat imobilisasi lama
dan kesalahan penanganan.
12
Complications of Prolonged
Immobilization
 There are 15 (4.7%) who develop complications
due to prolonged immobilization ( from 322 Stroke
patients ):
Decubitus ulcer 40.0%
Stiffness & Contracture 26.7%
Pneumonia 13.3%
Postural hypotension 6.7%
DVT 6.7%
Psychic problems 6.7%

Bayu Santoso, et al (2005)

 ACUTE STAGE
FOOT BOARD

TROCHANTER ROLL

14
 HAND ROLL

RESTING SPLINT

KULIAH NEURO-REHABILITATION 2/19/2020 15

KULIAH NEURO-REHABILITATION 2/19/2020 16
 COMPREHENSIVE
REHABILITATION
MEDICINE ASSESSMENT
17
PHYSICAL THERAPY

KULIAH NEURO-REHABILITATION 2/19/2020 18

 LYING

SITTING

KULIAH NEURO-REHABILITATION 2/19/2020 19

STEPS OF AMBULATION TRAINING
KULIAH NEURO-REHABILITATION 2/19/2020 20
AMBULATION TRAINING &
GAIT EXERCISES

PARALEL BARS

START LOW, GO SLOW

KULIAH NEURO-REHABILITATION 2/19/2020 21
KULIAH NEURO-REHABILITATION 2/19/2020 22
KULIAH NEURO-REHABILITATION 2/19/2020 23
WALKERS
KULIAH NEURO-REHABILITATION 2/19/2020 24
AXILLARY CRUTCHES

ENERGY EXPENDITURE >>

25
26
STAIRCASE
KULIAH NEURO-REHABILITATION 2/19/2020 27
 Mother tongue

SPEECH THERAPY
KULIAH NEURO-REHABILITATION 2/19/2020 28
OCCUPATIONAL
THERAPY

29
 OCCUPATIONAL
THERAPY

KULIAH NEURO-REHABILITATION 2/19/2020 30

 SHOULDER
SUBLUXATION

BE CAREFUL
for

SHOULDER-HAND
SYNDROME
WASPADA KONDISI PASKA STROKE

 Depresi paska stroke

 Gangguan Kognisi
 Manajemen faktor resiko
 FUNCTIONAL PROGNOSIS OF STROKE :
1. 75% of patients will reach independent level of
self-care or with minimal help
2. 75% will reach independent level of ambulation
with canes / ambulation device
3. Almost all patients will be able to control
bladder and bowel
4. Only 10% of patients fall into severe disabilities
and will be bedriddened
 Yalta Conference
4-11 Feb 1945

Winston Churchill F.D.R. Joseph Stalin

24 Jan 1965 12 Apr 1945 05 Mar 1953

STROKE ATTACK