KONSEP METODE NDT / BOBATH

NAWANG SASI TAKARINI

KONSEP AWAL

KAREL DAN BERTA BOBATH UNTUK KONDISI KELAINAN SUSUNAN SYARAF PUSAT KONSEP AWAL

REFLEX INHITING PATTERN (RIP) key point of control (KPoC)

KONSEP BARU

NORMAL NEURO DEVELOPMENT NORMAL POSTURAL DEVELOPMENT

REFLEX INHIBITING POSTURE (RIP) NORMAL POSTURAL REFLEX MECHANISM (NPRM)

NPRM
3 VARIABLE:

TONUS POSTURAL NORMAL RECIPROCAL INERVATION

CO-CONTRACTION COORDINATION

MOVEMENT VARIATION DAN AKTIVITAS

3 ELEMEN YG PENTING PADA NPRM

RIGHTING REACTION (RR) EQUILIBRIUM RECTION (ER) PROTECTIVE REACTION (ER)

BASIC MOVEMENT

HEAD TO BODY RR BODY TO BODY RR NECK TO BODY RR OPTICAL REACTION LABIRINTHINE RR ALIGNMENT GARIS TUBUH PADA TRUNK

TEHNIC

RIP KPoC TAPPING SENSO-MOTOR INTEGRATION

Postural Reflex
Dasar -> sensory motor anatomy yang berhubungan dengan posture-relate behaviours 1. Attitudinal reflexes 2. Automatic right reflexes 3. Balance and Protective reflexes

Attitudinal Reflexes

Reflex attitudinal mempengaruhi postur -> otot2 pada multiple level dari spinal cord (Sumway-Cook & Woolocott, 2002). Akan timbul akibat -> posisi kepala 1. ATNR 2. STNR 3. Tonic Labyrinthine Reflex (TLR)

Automatic Reflexes

Automatic reflexes akan membantu kepala yang berhubungan dengan gravity serta tubuh dengan kepala. Dimunculan oleh vestibular, visual dan proprioseptif spinal. 1. Labyrinthine head righting (vestibulocollic reflex, vestibular trigger) 2. Optical head righting (visual trigger) 3. Neck on body righting (cervicocollic) 4. Body on head righting (Vestibulocollic and cervicocollic reflexes) 5. Body on Body righting (spinal) 6. Landau reflex (vestibular, visual & spinal trigger)

Balance and Protective Reflexes

Reflex balance dan protective -> center of mass -> sebagai based support. Balance & protective reflexes -> complex (rumit) -> adaptive behaviours. 1. Tilting reaction movement that recovery of COG over based of support 2. Postural fixation -> movement to counter / stabilize in the presence of en external applied force 3. Protective extension reaction -> movement that protect the heard from injury during fall.

Kontradiksi teori (Hierarchical VS systems)

Hierarchical -> presume motor control progressively moves up the neuroaxis as higher brain centers mature, and the mature system posture is cortical controlled. Higher brain center mature -> inhibit lower reflex centers Ini akan mempengaruhi pematangan -> execute postural strategy

Kontradiksi teori (Hierarchical VS systems)

System theories : Pengalaman sensori diperlukan untuk motor strategy Sensory system adalah fungsional tetapi pada infant dan toddler memerlukan pengalaman yang normal, baik dan cukup yang berhubungan dengan perception with action untuk pematangan sensoris.

Hukum arah perkembangan

Pada perkembangan postural control-> teori hierarchy pematangan pengalaman sensoris acquisition mastery postural control rostro/cephalo-caudal Sensori motor -> pemetaan kepala lehar progres berlanjut ke trunk musculature ekstrimitas. Higher-order association are formed, children first selectively depend on vision to control their posture, then learn to rety to an increasing extent on somatosensory.

5 first signs of voluntary postural control.

S1. Sensory system (vestibular, visual, somatosensory) for postural control are present in the neonate on soon thereafter S2. Motor responses can be elicited for each postural context concurrent with acquisition on control for that posture. S3. Motor responses tend to be more consistent in infants and young children if vision is blocked S4. Posture of infants and young children is greatly challenged by looming visual stimuli. S5. Variability in motor responses my be attribute to variability in biomechanics during loos of balance due to postural instability at the onset of the perturbation (adults are very stable at the onset of a test trial)

Stabilitas pada posture dan kontrol posture yang baik akan meningkatkan stabilitas pada head, neck, jaw, tounge, lips baik drooling menurun

LOCOMOTOR (GAIT)
Perkembangan Gait 1. Faktor Neurologikal: Basic neural organization -> berfungsi untuk execute locomotion dokontrol oleh Central Pattern Generator (CPG) di spinal cord atau otak 2. Factor Mechanical - ROM - Strength - appropriate bone structure & composition - body composition

ONSET OF WALKING
Time and Distance Parameter 1 yrs 1.5 yrs 3 yrs 7 yrs

Opposite toe of (% cycle) Opposite foot-strike (% cycle) Single stance (% cycle) Toe-off (% cycle) Step-length (cm) Stride length (cm) Cycle time (sec) Cadence (step/min) Walking velocity - cm / sec - m / min

17 49 32 67 22 43 0.68 176 64 38.4

18 50 32 68 25 50 0.70 171 71 42.6

16 50 35 66 33 67 0.77 154 86 71.6

12 50 38 62 48 97 0.87 144 114 68.4

One complete gait cycle pada anak

Double support

Double support

(10%)
Loading response

Stance (60%)
Midstance Terminal stance

(10%) Preswing Initial swing

Swing (40%
Midswing Terminal swing

10%

30%

50%

Toe off

70%

85%

One complete gait cycle pada dewasa

Gait Lab