ESSAY

1. Definition and Philosophy of Rehabilitation

- Definition
o Re means return; habilitation means ability
o A process that involves the disabled person in making plans and setting goals that are
important and relevant to their own circumstances
o According to WHO 1981
Aim at reducing the impact of disabling/ handicapped condition and art enabling the
disabled and handicapped to achieve social Integration.
o According to WHO 1969
The combine and coordinate of medical, social, educational, and Vocational Measure for
training and retaining the individual to the highest possible level of functional ability
- Philosophy
o To enhance someone functional ability according to his potention to maintain or increase
quality of life by decreasing or prevent impairment, disability, and handicap
o Maintain the functional state from ability and environment they have, based on their
recidual ability
o To add life to years, not years to live.

2. Rehabilitation Team
- Physiatrist
o As a leader of team approach
o Doing health care, organize MR program include promotive, preventive, curative, and
rehabilitative
o Doing solid coordination with whole of the team
- Psychologist
o Assesses and evaluates mental, emotional, intellectual state and perceptual function
o Councils and provides psychotherapy and giving motivation to patient and family
o Provides the team with recommendations for care
- Physioterapist
o Doing physiotherapy : a therapy uses physical characteristic from object or with action
o Physiotherapist have a responsible of physical capacity and functional ability which
performed directed and organized using biophysical and biomedical technology
- Speech therapist
o Evaluates and treats problems with communication (verbal, signal, writing and reading)
and chewing-swallowing, and assists with cognitive retaining
- Occupational Therapist
o Evaluates and trans patient in activities of daily living (ADL) skills
o Provides range of motion (ROM), strengthening, endurance, and coordination exercises
for the upper extremity and cervical area
 o Assesses driving skills
o Recommends orthoses (brace) for the upper extremity, adaptive equipment, and home
modifications as needed
- Prosthesis/Orthotics
o Designs, fabricates, and fits prosthesis (artificial limbs) and orthotics (braces and splints)
- Social Worker
o Evaluates the patient’s living situation
o Discusses financial and living arrangement options
o Provides emotional support to patient, family, and the team
- Rehabilitation nurse
o Manages the nursing care team, serves as an educational resource to other (non
rehabilitation) nursing personal, instructors, and family in functional skills and reinforces
skills in therapy.

3. Why do the Physiatrist must know Pain Management

Because a physiatrist’s treatment focuses on helping the patient become as functional
and pain-free as possible in order to participate in and enjoy life as fully as possible and to
increase the quality of life without pain.

4. Complication of Immobilization and bedrest?

- Cardiovascular : Hypotension Orthostatic, Heart decondition disturbance when resting and physical
activity, deep Vein Thrombosis
- Respiration : Cough, sputum retention, lung infections
- Central nervous system : mood changes, sensory disturbance, delirium, decrease of
intellectual capacity
- Musculoskeletal : diffuse atrophy, joint contracture, disuse osteoporosis.
- Gastrointestinal : Anorexia, constipation, Dehydration low intake
- Integument : Ulcus Decubitus
- Endocrine and metabolic : insulin response disturbance, Hyperglycemia, Osteoporosis
- Genitourinary : decrease of urination, incontinence uri, dieresis, Vesicolithiasis, urinary tract
infection.

5. Definition of Agonist, Antagonist, Synergist Muscle

- Primer mover or Agonist is the muscle that is responsible to finish the movement
- Synergist is the muscle that is contracted with Primer Mover
- Antagonist is the muscle that is relaxed and on the opposite side of the joint from the
agonist
- Cocontractors is the antagonist muscle that is contracted together with the agonist muscle.

6. The Relation between Cardiac Output, Threshold, dll

- Blood volume that is Pumped by Ventricle every minute  CO = SV x HR
- Ejection fraction is blood volume (in the Ventricle) that is pumped out from the Heart.
  EF = SV/EDV

7. The Relation between Neurophysiology and Medical Rehabilitation

Neurophysiology is a branch of physiology and neuroscience that is concerned with the study of
the functioning of the Nervous system
Neurophysiology and medical rehabilitation work together to maximize the physiological
functions of the nervous system.

8. Definition of Impairment, Disability, and Handicap

- Impairment – Organ Level – based on WHO 1997
Any loss or abnormality of body structure or a physiological or psychological function.
- Disability – Person Level
Any restriction or lack resulting from impairment of the ability to perform an activity in the
manner or within the range considered normal for a human being
- Handicap – Society Level
A disadvantage for a given individual, resulting from an impairment or a disability that limits
or prevents the fulfillment of a role that is normal (depending on the age, sex, and social
cultural factors for that individual).
- Activity : the nature and extent of functioning at the level of the person
- Participation : the nature and extent of a person’s involvement in life situation in
relationship to impairment, activities, health conditions and contextual factors.
9. The Role of Rehabilitation in Stroke
Return the independence of the patient to the maximize functional state to do their activity like
before.
- In acute phase : prevent and minimize the neurologic deficit, prevent complication of bed
rest
- Recovery phase : return the ADL skill to the maximize functional state.

10. Why do the Physiatrist must know the role of Nutrition

Nutrition can be a program that increase nutritional state of patient to maximize
recovery, to maximize growth and development in children, to support muscle strength, to
make short in time of treatment for patients in hospitalize, and to increase the quality of life.

11. Goal of Rehabilitation Program

To help people become independent and to prevent them from losing the ability to function.
- Based on WHO
o Prevent loss of function
o Slower the loss of function
o Repair of restore function
o Compensate for lost Function
o Maintain the residual function that the patient still have.

12. What is The benefit of exercise for human system

- Controls weight
- Combats health condition and disease
- Improves mood
- Boosts energy
- Promotes better sleep
- Puts the spark back into your sex life

13. The role of Medical Rehabilitation in Spinal Cord Injury?

Rehabilitation program in patient with spinal cord injury :
- Bladder Management for urination disturbance
- Bowel Management for defecation disturbance
- Skin Management  to prevent decubitus ulcer
- Contracture Prevention  because of spasticity
- Deep Vein thrombosis (DVT) prevention  because of immobilization
- Spasticity management  reduce pain and clonus because of spasticity
- Otonom Management  to prevent hypostatic orthostatic

14. Mention the Factor that can be Barrier for Functioning in Amputee case
 - Mental functions  Psychomotor, psychosocial, Emotional
- Functions of the cardiovascular, haematological, immunological and respiratory systems
 can increase the burden of cardiovascular and Respiratory system
- Genitourinary and reproductive functions  disturbance of urination function and sexual
function
- Neuromusculoskeletal and movement-related functions
o Disturbance of Mobility of joint functions and Stability of joint functions
o Disturbance of Muscle power functions, Muscle tone functions, and Muscle
endurance functions
o Disturbance of Gait pattern functions and Movement functions

15. Respiratory Mechanical and its function

16. The Risk Factor of OA genu and Explain
- Unmodified Factors
o Age  the older the patient, the Higher risk level of OA genu
o Gender
 Before 50, the men are Higher risk level of OA genu than the women
 After 50, the Women are Higher risk level of OA genu than the Men
o Race
 African and American are Higher risk level of OA genu than Kaukasia
 Asian is Higher risk level of OA Genu than Kaukasia
o Genetic Factor There is a relation between OA genu with Abnormality Genetic code
- Modified Factors
o Smoking  The poison of smoke in the blood flow can destruct the cartilage of joint
because of oxygen decreased. So it can increase the risk of OA genu
o Vitamin D Consumtion  Lack consumtion of Vitamin D, can increase the risk of OA genu
o Obesity  Increase of Body Weigh can increase the risk of OA genu
 o Osteoporosis  Osteoporosis can accelerate the breakdown of joint Cartilage. So, it can
increase the risk of OA Genu.
o Hysterectomy  Decreased of Estrogen after Hysterectomy can lead to OA genu.
o Meniscectomy  Patient with Meniscectomy, can increase the burden of joints. So, it can
increase the risk of OA Genu.
o Knee injury  Patient with knee injury, can increase the burden of joints. So, it can
increase the risk of OA Genu.
o Abnormality of Anatomy  Abnormality of Anatomy, can increase the burden of joints. So,
it can increase the risk of OA Genu.
o Occupation  The Work that much rests on the knee, can increase the burden of joints. So,
it can increase the risk of OA Genu.
o Physical Activity  Heavy physical activity, can increase the burden of joints. So, it can
increase the risk of OA Genu.
o Sport  Exercise weight, can increase the burden of joints. So, it can increase the risk of
OA Genu.
 Not Exercising, can decrease the food supply for joint. So it increase the risk.
17. Central Nervous System for Motor Control and Somatosensory system
18. Component of functioning activity

- Learning and applying knowledge - Domestic life

- General tasks and demands - Interpersonal interactions and relationships
- Communication - Major life areas
- Mobility - Community, social and civic life
- Self-care

19. how to detect delay growth and development and physical problem of children

- Detection of Development disturbance - Detection of hearing and speech disturbance

 WHO method, DENVER method, - Detection of vision disturbance
MUNCHEN method - Detection of Behavior disturbance
- Detection of motor disturbance - Detection of studying disturbance
- Detection of convulsion - Detection of sensory disturbance
20. What are type of pain? Explain!
- Considering the durations of symptoms, pain can be divided into groups:
o Acute pain: duration < 3 months, acts as a warning defensive (post-operative pain,
traumatic, associated with medical procedures).
o Chronic pain: duration > 3 months, does not fulfill the role of warning and defensive, due
to the nature and symptoms of the disease is considered in itself, and requires a
multitherapeutic activities.
o Survived pain: most often occurs as a result of improper treatment of acute pain,persists
despite the healed tissue, the damage to which resulted in acute pain.
- Division of pain
o Anatomic pain – may be physiological receptor-functional (protective) or pathological, as
a result of local changes.
o Physiological pain – superficial pain, caused by irritation of the skin receptors, mucous
membranes and cornea by a damaging factor.
o Pathological pain – caused by chronic irritation of pain receptors by pain mediators
released from damaged tissues.
o Deep pain – is pathological, can be caused by blood vessels, bone and joint system,
muscles or organ structure.
o Vascular pain – caused by stimulation of mechano- and chemo- pain receptors, located in
the outer membrane of large arteries and veins. Stretching of the vascular vessels causes
pulsating, tension headaches.
o Bone and joint pain – the source of pain is stimulation of the pain receptors of the joint
capsule and periosteum.
o Myalgia – caused by irritation of the receptors in muscles and fascias by accumulated
metabolites, when they are over-load and tired.
o Organ pain – include biliary and renal colic.
o Wired pain – arises as a result of direct stimulation of the nerve fibers or pathways.
Includes neuralgia, causalgia, radicalgia and phantom pain.
o Neuralgia – applies to the trigeminal nerve, sciatic, femoral and lateral femoral
cutaneous nerve.
o Radicalgia – exacerbated by coughing and radiating movements to the appropriate areas
of the skin.
o Causalgia – neuralgia with an autonomic component, results from large nerve injuries,
with many of the sympathetic nerves. Pains are burning with dystrophic changes –
cyanosis, oedema, muscle atrophy
o Convolutional pain – the result of compression on the nerve plexus, caused by cancer or
inflammatory changes in the neck, top of the lungs, lower pelvis.
o Phantom pain – occurs in patients after amputation and relates to pain in the amputated
limb. Incidence of this pain explains the existence of chronic pain of embedded memory .
o Somatic Pain : Fracture, Incisional injury, Thermal injury, Traumatic injury
o Visceral Pain : Bowel obstruction, Constipation, Endometriosis, Metastatic organ
involvement
o Deafferentation : Alcoholic and nutritional neuropathy, Diabetic mononeuropathy and
polyneuropathy, Pancoast’s tumor (producing brachial plexopathy), Postherpetic
neuralgia
21. Role of Medical Rehabilitation in Stroke
- Acute phase (the first 2 weeks post stroke)  in hospital care
Prevent and minimize the neurologic deficit, prevent complication of bed rest
- Subacute phase (2nd week – 6th month post stroke)
 Exercise strengthening, endurance, and muscle contraction to increase the functional
state with assisted
 Maintain the others system during exercise
 Increase the cognition, perception, and sensory skill
 Prevent the complication of bed rest
- Chronic phase (over 6 months post stroke)
return the ADL skill to the maximize functional state.

22. Factor related to bone healing process

- Age
o The smaller aging, the sooner healing
- Location and Configuration
o The deeper bone location, the sooner healing
o Epiphyseal sooner than cancellous bone (sooner than Cortical Bone).
o Oblique and Spiral Fracture, sooner than Transversal Fracture
- Shift initials
o Undisplaced Fracture sooner than displaced fracture
- Blood flow to the Fracture Fragment
o Fragment with blood flow sooner than fragment without blood flow.

23. Muscle activity in stance

a. M. Temporalis : Maintance the dental position
b. M. Supraspinatus : prevent the subluxation of shoulder girdle
c. Mm. Cervical Extensor : Prevent over flexion of the neck
d. M. Erector Spinae : Stabilization of trunk
e. M. Obliquus Abdominus Internus : prevent forward of canalis inguinalis Structure
f. M. Iliopsoas : prevent the subluxation of the hip

24. The role of Rehabilitation in Hospital

- To run MR services as a reference hospital for medical rehabilitation’s cases
- To run education and training of MR
- To run research and develop MR science
- Working together with another sectorals and programs to give a good quality of MR services
with a large includes
- To make short in time of treatment for patients in hospitalize
25. Clinical manifestation of post stroke and the intervention

- Communication Disorders, dysphagia  Speech therapy (communication skill)

- Motor Impairment  Physiotherapy (strengthen, range of motion, endurance exercise)
- Mobility Disturbance, ADL disturbance  Occupation therapy (ADL skill and exercise of
using orthotic if needed)
- Sensory Impairment and Central Pain, musculoskeletal pain  physiotherapy (with physical
modality – TENS (Transcutaneus Electric Neural Stimulation))
- Depression  Psychotherapy (consultation and motivation

26. Divisions at MR

- Neuromuscular rehabilitation - Pediatric rehabilitation

- Musculoskeletal rehabilitation - Geriatric rehabilitation
- Cardiovascular rehabilitation - Sport injury rehabilitation
- Respiratory rehabilitation

27. Bone Healing Process

I. Initial / Hematoma  because of Internal Hemorrhagic
II. Inflamation and cell proliferation  proliferation of Osteogenic
III. Callus Formation  clinical union with immature bone
IV. Consolidation  Radiographic Union with lamellar bone
V. Remodeling  being softer callus, the diameter of the bone back to normal, formed back of
canalis Medularis

28. Disability prevention

- 1st level  reducing the occurrence of impairment
- 2nd level  limiting or reversing disability
- 3rd level  preventing the transition of disability into handicap

29. Muscle activity in Gait

30. The role of Rehabilitation in Country or village
Using CBR (Community Based Rehabilitation)
- Development regional program that prevent handicap, detection and rehabilitation of
people wit disability, which cover medical rehabilitation, education, skills, and social.
- In means of rehabilitation and prevention of disability is performed in the family and public
by changing the handicap, the family and public behavior to increase their awareness to
 have an active role to create a handicap to be a autonomous by using the resources and
available fund.
- The aims :
o Increasing the quality, term of service, facilitated the handicap to get their right
particularly in medical rehabilitation service and health service generally also to create
coordination with another sectorals and reference system of MR.
o To train the health care at Community Health Center to improve healthy condition,
detect and prevent disability and base MR, also can reference the cases which need a
special treatment.

31. Clinical Manifestation of Rheumatic

- Anamnesa : morning Stiffness, edema, deformity, rash/ulcer, tenderness, effusion, Pain,
Stiffness, Limited ROM, decrease in Strength, ADL disturbance
- Region
o Hand
 Swelling in Proximal Inter Phalange (PIP)
 Subluxation at Meta Carpo Phalangeal (MCP) with ulnar deviation
 Boutounniere (Flexion of PIP and Hyperextension of DIP)
 Swan Neck (Hyperextension of PIP and Flexion DIP)
 Tenosynovitis
 Crepitate
 Nodule
o Elbow
 Decrease of Extension because of Inflamation and effusion
 Effusion at para-olecranon groove
 Decrease of extension and flexion because of Chronic inflammation and cartilage
erosion between radius and ulna
 Rheumatoid Nodule at extensor part of Proximal Ulna
o Shoulder
 Effusion at antero-inferior part of Acromion
 Decrease in strength in Rotator cuff muscle
o Cervical : Limited ROM, pain, Parestesia, and Lhermitte sign (+)
o Back : Synovitis, effusion, and Tenderness
o Genu : Bulge sign, or ballotable patella, or baker’s cyst
o Ankle : Synovitis, effusion, limited ROM, Hindfoot

- Functional Classification of RA

I No ADL limited
II Good in self-care and Vocational, but with avocational limited
III Good in self-care, but with Vocational and Avocational Limited
 IV ADL limited
- Radiology Examination
o Laboratorium : increase of rheumatoid Factor & anti-cyclic citrullinated Peptide
o X-RAY : Periarticular Osteopeni and marginal erosion
 Cervical : Odontoid erosion and Atlanto-axial subluxation
 Thorax : Pulmonary nodules or interstitial fibrosis
o ECG : abnormal Conduction, because of Nodul Rheumatoid

32. Basic Handling of fracture

- Recognition sign of fracture
- Reposition for displaced Fracture
- Retaining with Fixation
- Rehabilitation  Isometric Exercise
o Restore limb function
o Prevent Diffuse atrophy and distal Joint Stiffness

33. Factors that must be taken to avoid disability  Prevent Impairment that include :

Body Function Body Structure

1. Mental functions
2. Sensory functions and pain
3. Voice and speech functions
4. Functions of the cardiovascular,
haematological, immunological and
respiratory systems
5. Functions of the digestive, metabolic and
endocrine systems\
6. Genitourinary and reproductive functions
7. Neuromusculoskeletal and movement-
related functions
8. Functions of the skin and related structures
1. Structures of the nervous system
2. The eye, ear and related structures
3. Structures involved in voice and speech
4. Structures of the cardiovascular,
immunological and respiratory systems
5. Structures related to the digestive,
metabolic and endocrine systems
6. Structures related to the genitourinary and
reproductive systems
7. Structures related to movement
8. Skin and related structures

34. Rehabilitation role in cerebral palsy

- Education for parents about the condition, complication, program rehabilitation.
- Make a good team work with the parents, the teacher, and the environment factor
- Prevent progressive handicap
- Intervention in mental, physiological, communication, etc to maximize the functional state.

35. Please explain some system organ that we must be considered in patient with Spinal cord
injury
- Sensory functions and pain
o Disturbance of sensory (pain, temperature, pressure)
o Sensibility disosiatiom
o Disestia, hyperestesia
 - Genitourinary and reproductive function
o Disfunction spincter
o Urination, defecation, and sexual disturbance
- Neuromusculoskeletal and movement-related functions
o Paresis UMN and LMN
o Disturbance of contraction, strengthening, tonus, physiologic reflex
o With or without Pathologic reflex and clonus.

36. Rehabilitation of lower extremity amputee

- Pre operation phase  Preparation of mental and general state, Explanation about the
operation, Strengthen of lower extremity muscle
- Post operation / acute phase  Skin care and stump hygiene, Exercise on healthy upper and
lower extremity for strengthening, remove the stitching
operation in 7th – 10th day.
- Pre prosthetics phase  stump hygiene and bandage (figure of 8), exercise in pain region,
education of phantom pain
- Prosthetic phase  making prosthetic prescription, fitting, and prosthetic training
- Follow up  evaluation in 1 until 3 month during the 1st year. Then every 6 month per year.
Evaluation of comfortable in activity (sitting, standing, walking), skin irritation,
shape of stump, atrophy muscle.

37. Pathophysiology of Fracture

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38. Medical rehabilitation role in Osteoarthritis

- Purpose  return function and range of motion capacity, reduce pain and muscle spasm,
strengthen muscle, increase the quality of life.
- Manner  rest, exercise, physical modality therapy, reduce the body weight, using orthotic,
joint protection, psychotherapy.
- Evaluation symptom and function
- Prevent the complication
39. Type of contraction muscle
- Isotonic and isometric
Isotonic (Same tonus) : making shorten of muscle and changes in joint angel
Isometric (same size) : contraction muscle without changes in joint angel.
 - Eccentric and Concentric
Eccentric : muscle contraction which getting weakness and with lengthening
Concentric : muscle contraction with shortening.

40. Orthopedics Examination

- Anamnesis : autoanamnesis and alloanamnesis
- Physical examination : General state and Localize state (Look, Feel, Move)
- Additional examination : Radiology, laboratory, EMG, USG musculoskeletal, dll
- Purpose in rehabilitation :
 to diagnose congenital abnormality, new born injury, development deviation, etc
 to make the rehabilitation program

41. The aim of medical rehabilitation

- Improve and maintain the quality of life

- Minimize sequel or deformity
- Explore the residual function of patient
- To practice ADL skill for environment adapted
- Return the functional ability and prevent complication
- Intervening in their personal and environment factor.