Modalitas Tatalaksana Rehab Medik

Tipe Subtipe Indikasi Note

Exercises Strengthening ● MMT≥3 ● Isometric=no joint

● Pasien bisa motion
diinstruksi ○ KI: PJK &
Hipertensi
● Isotonic
○ Concentric
○ Eccentric
● Isokinetic

ROM ● Prevent contracture ●

● Passive MMT<2
● Active assisted
MMT=2
● Active ≥3

Stretching ● Stiffness, ●
contracture

Endurance ● Low resistance, ● Conditioning &

high frequency, reconditioning
long duration

Physical Heat ● Subakut (3 hari abis ● Superficial

modalities akut) ● DEEP → diathermy

Cold ● Akut ●
● KI: kelainan
vaskular, alergi
dingin

Cervical & ● Cervical root ●

lumbal traction syndrome
● Spasme otot
● HNP
● KI: spondylitis,
osteomyelitis,
kanker leher,
osteoporosis, PJK

Electrical ● Spasme ● Transcutaneus

● KI: pacemaker, electrical nerve
regio thorax, uterus, stimulation (TENS)
open wound, sinus
karotis

Hydrotherapy ● ●
Prosthetic- ● Recovery & cegah ● Namanya
Orthotic deformitas tergantung
letaknya, cth: FO,
AFO, KAFO, CO,
CTO
● Orthotic=tambahan
(di luar)
● Prosthetic=substitu
si (di dalam)

Medicamen ● Skip ● Skip

touse

Non-Trauma

● General approach

Anamnesis ● Pain
● Activity related pain
● Morning stiffness berapa lama? >30 menit → inflammatory
● Crepitus → OA?
● Fever, malaise → inflammatory
● Genetic, history, sosial
Look ● Deformitas
○ Genu varus (OA?), valgus
○ Heberden DIP, Bouchard PIP (OA?)
○ Swan neck & ulnar deviasi (RA?)
● Swelling? → inflammatory → RA, GA, SA?
● Gait
Feel ● Pain/tenderness
● Efusi → patellar tap test
● Nodul
● Hangat
Move ● Crepitus
● Stiffness (pasif aman), kontraktur (aktif pasif nggak aman)
● ROM
● MMT
Special test 1. Patellar tap test (knee) → efusi
2. Schober → ankylosing spondylitis
3. Lasegue → HNP (L4-S1)
4. Apley scratch → frozen shoulder/adhesive capsulitis
Radiologi 1. OA
a. Joint space narrowing
b. Sclerosis subkondral
 c. Kista subkondral
d. Osteofit
2. RA
a. Juxtaarticular osteopenia
b. Ankylosis
c. Erosi
d. Deformitas
3. GA
a. Soft tissue swelling
4. SA
a. Opaque di sendi (?)
Lab ● RF → RA
● Asam urat → GA
● CRP → fase akut
● ESR
Tx ● Farmako
○ Kortikosteroid → tidak untuk OA; sebagai bridging untuk RA
○ DMARD → RA
○ NSAID
● Non-farmako
○ Exercise
■ Quadricep bench → melatih otot kuadrisep → OA?
○ Modalitas
■ Ortesa
■ TENS
■ Diathermy (deep)
■ Icing
■ Walking aids

● Some penyakit penting

Penyakit Klinis Rx Lab Rehab/Tx

OA ● Liat slide ● Suda ● NO ● Exercise → QUADRICEPS & HAMSTRING
(sudah rapi) h di RM
● QUADRICEPS atas AL ● Modalitas fisik → kompres hangat, infrared,
LEMAH diathermy, laser, tens
● ONSET LAMA ● Ortosis → knee brace
● Liat slide:)
RA ● Sistemik ● Erosi, ● RF ● Akut → imobilisasi & ROM ex.
(fatigue, destru ● ESR
malaise, fever) ksi, , ● Mild → isometric ex → jangan
● Simetris devia CRP isotonic/isokinetik
polyarthritis si, ● Cryotherapy → akut, superficial heat → jangan
● Morning fusi
stiffness >1 untuk akut
jam ● Orthosis
● Swelling, ● Farmako → NSAID, DMARD, steroid
 eritema ● Edukasi → kalo akut istirahatkan
GA ● Asimtomatik → ● Swelli ● Hipe ● Akut: kolkisin, NSAID, steroid
ng ruris ● Kronik: allopurinol, probenecid
akut → soft emia
interkritikal → tissue

intermittent
(lebih parah)
● PODAGRA
● Sistemik
● Tempat lain:
ankle, heel,
knee, midfoot
● Tophus
(kronik)
SA
Frozen ● ROM↓ ● Xray ● ● ROM ex
shoulder norm ● Stretch ex
● Inflamasi
al ● Pain therapy
● Stages:
● USG, ● Ultrasound & electrical stimulation
painful,
MRI
stiffening,
thawing
● Special test:
○ Appre
hensio
n test
○ Drop
arm
○ Yergas
on
○ Apley
scratc
h
LBP ● William flexion exercise → lihat slide
● Mackenzie program
● Traction
● Strict bed rest is not recommended
● Ergonomi
Osteopro ● Mineral:organi ● DEXA ● Bifosfonat
sis c rasio normal, ≤ -2.5 ● Kalsium & vit D
less bone ● Exercise = liat slide
tissue
● Fraktur
● Generalized &
localized
● Tipe
1=postmenopa
use
● Tipe 2=Senile
 Sport injury

● Sport injury ada yang traumatic (fracture, dislok, sprain, strain) dan ada yang overuse
(tendinitis, bursitis)

Look ● Laserasi
● Edema
● Hematom
● Lesi
● Deformitas

Feel ● Krepitus
● Pain/tenderness
● Efusi

Move ● ROM
● Pain → bandingkan dua limb

Special ● MMT
test ● Neurologis
● Special test spesifik

General ● Akut → PRICE/POLICE

Tx
○ Ice → 20 menit tiap jam, lalu 3-4x setiap 24 jam hingga 72 jam
○ Compression → elastic bandage

Ankle ● Paling sering sprain → Anterior Talofibular Lig. (ATFL)

● Mekanisme injury tersering → plantarflexion + inversi → cedera lateral
ligament
● Grading → berdasarkan ATFL dan CFL (calcaneofibular)
○ I → ATFL parsial, CFL PTFL intak, anterior drawer (-)
○ II → ATFL komplit, CFL parsial, anterior drawer (+)
○ III → talar tilt (+), anterior drawer (+), ATFL + CFL komplit
● Special test
○ Anterior Drawer → shift ke anterior
○ Lachman
○ Thompson → achilles tear
○ Talar tilt → inversi
● Tx
○ Grade 1 & 2 sprain → NSAID, PRICE, analgesic, imobilisasi →
 exercise & bracing, moist, diathermy
○ Grade 3 → surgery

Knee ● Special test

○ Patellar tap test → efusi
○ Drawer → anterior (ACL), posterior (PCL)
○ MCL & LCL → valgus & varus stress
○ Apley grinding → Meniscus
○ McMurray → Meniscus
● Tx=sama seperti ankle