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ORTOSIS PROSTETIC PADA EKSTREMITAS SUPERIOR
Kelompok III
Riska Nur Amalia
Mustika
Nur Melia Rante
Ummu Laila Malik
Riska Pakombong
PENGERTIAN
Ortotik Prostetik
ilmu yang mempelajari tentang pengukuran,
pembuatan, pengepasan alat bantu dan alat ganti
anggota gerak tubuh manusia yang hilang atau
disabilitas.
• Pada dasarnya ortosis di bagi menjadi:
-Ortosis anggota gerak atas
-Ortosis anggota gerak bawah
-Ortosis spinal
• Sedangkan Prostesis dibagi menjadi:
-Prostesis anggota gerak atas
-Prostesis anggota gerak bawah
• Contoh Ortotis: brace, splint, dan alat support (knee
support, ankle support…dll).
• Contoh Prostetis: alat pengganti anggota gerak tubuh
yang hilang /amputasi seperti kaki & tangan palsu,
jari palsu.
PENGGUNAAN OP
• Conginental (bawaan sejak lahir)
• Penyakit
• Insidential
http://jani-orthoprost.com/pengertian-ortotik-prostetik.html
TUJUAN PENGGUNAAN ORTOTIK PROSTETIK
1.mengganti fungsi yang hilang
2.mencegah kecacatan
3.memperbaiki kecacatan
4.Kosmetik
http://poltekkesjakarta1.ac.id/file/dokumen/77jurnal1.pdf
ORTHOSIS CLINIC TEAM
• Orthotist
• Social worker
• Psychologist
• Patient
• Physical Therapist
• Occupational Therapist
SCOPE OF PRACTICE
Occupational Therapy (OT)
• Rehabilitasi Extremitas Atas
– Memaksimalkan fungsi yang masih dimiliki (sisa) dari
pasien pasca bedah, cedera, atau penyakit di ext. atas
Physical Therapy (FT)
• RA 5680 Section 16
– Mengassessment alat bantu apa yg dibutuhkan dan
melatih pasien tersebut
– Melatih pasien menuju kemandirian fungsional
STANDAR PELAYANAN OP
a. Asesmen
b. Diagnosis
c. Perencanaan
d. Pengukuran
e. Pembuatan ortosa-protesa
f. Fitting
g. Finishing
h. Pemasangan dan penyerahan
i. Evaluasi
j. Dokumentasi
http://osteosupport.blogspot.com/2008/09/rscm.html
Akibat jika OP tidak sesuai
• buruknya pola jalan normal (normal gait analysis)
• pola jalan yang melebar ke arah luar (abduction gait)
• langkah jalan yang memutar (circumduction gait pattern)
• kecenderungan untuk menumpu hanya pada kaki yang
sehat (vaulting gait)
• kondisi tulang belakang seperti posisi badan penderita yang
condong ke samping pada saat menumpukan berat tubuh
(lateral bending) dan lumbal lordosis.
ORTOTIS EXTREMITAS ATAS
UPPER EXTREMITY ORTHOSIS
CLASSIFICATION
Type
• Static
• Dynamic
Function
• Flexion
• Extension
• Abduction
• Adduction
• Rotation
Region
• Volar or Dorsal
• Joints crossed* Finger / thumb splint * Wrist Splint * Wrist Hand Orthosis
(WHO ) * Elbow (WHO) * Shoulder (Elbow- WHO)
SPLINT STATIS
TUJUAN PENGGUNAAN
Immobilisi atau
support/penyangga
Cegah deformitas
Cegah kontaktur jaringan
lunak
Memblok bagian tertentu/
mengontrol pergerakan sendi
tertentu
Name the components
Lumbrical BarMetacarpal bar
Deviation
Bar
Forearm trough Metacarpal bar
Orthosis Statis Berdasarkan regio :
• Finger and thumb Orthosis
– DIP
– PIP
• Hand Orthosis
– Volar or dorsal hand orthosis
– Universal Cuff
• WHO
– Cock - up splint
– Resting hand splint
– Thumb spica
– Antispasticity splints
Indikasi Diagnosis
• Fractures
• Tendon injuries
• Crush injuries
• Amputation
• Arthritis
• Carpal tunnel release
• Arthroplasty
• Tendon transfer
• Tumor excision
• Reconstruction of
congenital defects
• Overuse syndromes
• Cumulative trauma
disorders
Tujuan penggunaan
• Mencegah atau mengurangi edema
• Membantu proses penyembuhan jaringan
• Penurunkan nyeri
• relaksasi
• untuk otot yang tidak digunakan, salah gerak, dan
penggunaan berlebihan (misuse, disuse, overuse)
• Menghindari cedera
• Mengembalikan fungsi motorik dan sensorik
Finger Orthosis ( DIP )
• Tipe
– Static or dynamic
• Region
– Volar or dorsal
– Joint crossed
• Function
Static Volar
DIP Extension Splint
Finger Orthosis ( PIP )
Static Three point orthosis untuk deformitas boutonniere
Hand Orthosis
• Type
• Region
• Function
Static Dorsal
Hand Orthosis
With an MP
Block
Hand Orthosis
• Universal Cuff
Wrist Cock-Up Splint (WHO)
• Menjaga wrist berada pada posisi netral atau mildly
extended position
• Immmobilisasi wrist saat MCP dan ibu jari masih dapat
bergerak
Wrist Cock-Up Splint (WHO)
Contraindikasi:
• MCP synovitis aktif
• Peradangan sendi yang menghasilkan subluksasi volar dan
deviasi ulnar
Kekurangan:
• Mengganggu sensibilitas taktil pada permukaan tangan dan
palmar.
• Strap dorsal dapat menghalangi aliran limfa
Dorsal Wrist Cock-Up Splint
• Penyokong mekanik wrist
yg paling kuat dan memberi
ruang sensorik yang lebih
luas pada telapak dan
punggung tangan
• Penyebaran yg lebih luas
diarea permukan dorsal
wrist
• dapat mentoleransi udem
Hand Condition/ Suggested Wearing Schedule Position
NERVE COMPRESSION
Carpal Tunnel Syndrome
(median nerve compression)
Carpal Tunnel Release
Surgery
Radial Nerve Palsy
Wrist extensor tendinitis
Acute flare up stage: 4 to 6 weeks
continuously worn except for
cleaning/hygiene and ROM exercises
Gradually decreases in duration with
some doctors recommending
nighttime wear only
1 week post-surgery, fitting may
commence
Wearing schedule that applies
during sleep. Strenuous activities,
and for support throughout the
healing phase
Wrist kept in functional position and
the splint should substitute for the
loss of the radial nerve by placing
the wrist in extension
Continuous wearing followed by
gradual weaning of the splint
Volar, dorsal, or ulnar gutter splint
with the wrist in a neutral position
Volar splint with the wrist in a
neutral or slightly extended position
Volar or dorsal with wrist in 0 to 30
degrees in extension
Volar with 20-30 degrees of wrist
extension
Hand Condition Suggested Wearing Schedule Position
FRACTURES
Colle’s fracture
(closed reduction)
Indicated following removal of the
cast and healing of fracture
Discontinue use as soon as possible
to allow functional hand movement
Volar with maximum passive
extension that the patient can
tolerate- usually up to 30 degrees
RHEUMATOID ARTHRITIS
Periods of swelling and joint
inflammation
Worn continuously with established
periods for ROM exercises between
splint wearing schedule
Volar, in extension up to 30 degrees
based on patient tolerance
OTHER
Reflex Sympathetic
Dystrophy
Wrist joint synovitis or
tenosynovitis
Nighttime wearing
Worn during acute flare ups
Volar, in extension as tolerated by
patient
Volar, o to 15 degrees in extension
Resting Hand Splint (WHO)
• Immobilisasi untuk mengurangi gejala
• Posisi lumbrical (functional alignment)
• Memperlambat deformitas yg lebih lanjut
Resting Hand Splints (WHO)
Forearm through
Thumb through
Pan
C-bar
Hand Condition Suggested Wearing Schedule Position
RHEUMATOID ARTHRITIS
Acute Exacerbation
Fitted to maintain as close to a
functional (midpoint) position as
possible until exacerbation is over
Removed for hygiene and exercise
purposes
Worn during the day and at
nighttime as needed
WRIST: neutral or 20-30 degrees
extension depending on patient
tolerance
MCP: 15-20 degrees flexion and 5-
10 degrees ulnar deviation
THUMB: position of comfort in
between radial and palmar
abduction
TRAUMA
Crush injuries of the hand
Fitted after the injury to reduce
pain, edema, and swelling and to
provide rest to injured tissues
Worn at nighttime and worn as
needed
WRIST: extension of 0 to 30
degrees
MCP: 60-80 degrees of flexion
PIPs and DIPs: full extension
THUMB: palmar abduction and
extension
BURNS
Dorsal or Volar hand burns
Worn after the burn injury until
healing begins and removed for
dressing changes, hygiene, and
exercise
WRIST: Volar or circumferential
burn 30-40 degrees of extension;
Dorsal burn neutral position
MCP: 70-90 degrees of flexion
DIPs: full extension
THUMB: palmar abduction and
extension
Pertimbangan Khusus
• Mencegah infeksi : ketika luka terbuka mengandung
eksudat, bersihkan splint dengan air besabun, hydrogen
peroxide, atau alkohol.
• Untuk pasien ICU : gunakan bahan yg steril, dan ikuti
petunjuk pemakaian fasilitas
• Untuk pasien RA lebih baik menggunakan
thermoplast/plastik yg lebih tipis (< 1/8 inci)
Thumb Spica Splint (WHO)
• Menstabilkan sendi CMC, MCP dan IP
Thumb
Post•Volar
•Dorsal
•Radial
Gutter Opponens
Bar
Hand ConditionSuggested Wearing
SchedulePosition
SOFT TISSUE
INFLAMMATION
de Quervain’s
tenosynovitis
Acute flare-up: worn
continuously with removal for
hygiene and exercise
IP joint included only if pain is
present with IP flexion and
resisted IP extension
Long Forearm-based or Radial ulnar gutter
splint:
WRIST: 15 degrees of extension
THUMB CMC: palmar abduction 40-45degrees
THUMB MCP: 5 to 10 degrees of flexion
If with inflamed tendons, the the thumb CMC
joint is sometimes positioned in radial abduction
and extension instead of palmar abduction
RHEUMATOID
ARTHRITIS
Periods of pain and
inflammation in the
thumb joint
Worn continuously with
removal for hygiene and
exercise
Wearing schedule is adjusted
according to the patient’s pain
and inflammation levels
Long Forearm-based thumb spica splint
WRIST: 20-30 degrees of extension
THUMB CMC: palmar abduction 45 degrees; or
midway between radial and palmar abduction
depending on patient’s tolerance
THUMB MCP: if included, 5 degrees of flexion
TRAUMATIC
INJURIES OF THE
THUMB
Gamekeeper’s
thumb
Worn continuously for 3 to 4
weeks with removal for hygiene
Short opponens splint
MCP: joint immobilized and the thumb CMC
joint palmarly abducted 25 to 30 degrees
Upper Extremity Orthosis
Static
Dorsal
Elbow
Orthosis
Upper Extremity Orthosis
Balanced
Forearm
OrthosisForearm trough
Elbow dial
Rocker Assembly
Distal arm
Distal bearing
Proximal
bearing
Bracket
Upper Extremity Orthosis
Shoulder slings Humeral Fracture Brace
Upper Extremity Orthosis
Airplane Splints
SPLINT DIMANIS
TUJUAN PENGGUNAAN
Cocok untuk pasien yg kehilangan
fungsi motorik
Mengoriksi exiting deformity
Mengontol pergerakan
Dapat digunakan pada fracture
alignment dan penyembuhan luka
Pertimbangan Fisiologis
• Penguluran berlebih– lelah
– cedera
– kerusakan
• Penguluran kurang– Artrofi atau memperlemah
– kulit, tendon, ligament, dan
kapsul sendi akan semakin
memendek akibat tidak ada
pemberian tegangan yg
seperti biasanya.
• Penguluran yang cukup
– Peningkatan ROM dalam seminggu, dengan rentang 1-10
derajat dapat diterima (Cummings et al 1992 )
– Penguluran intensitas tinggi durasi rendah meningkatkan
stiffness.
– Klien/pasien seharusnya merasakan adanya tension/tegangan
pada jaringan, tapi tidak ada nyeri yang timbul.
Dynamic Splints
• Dynamic finger extension splint
• Dynamic wrist extension splint
• Tenodesis training
• Dynamic ulnar nerve splint
• Capener
• Anti-microstomial splint
Dynamic Finger Extension Splint
• Dynamic radial nerve splint
• tujuan:
– Immobilisi wrist pada posisi
fungsional
– Secara pasif mengekstensikan
MCP sampai 0 derajat
– Memperbolehkan full aktif fleksi
MCP dan pergerakan IP tidak
terhalangi
• Indikasi:
– Paralysis of wrist, MCP, Finger
extensors
Finger Cuff
Dorsal Forearm Trough
Dynamic Springwire Assist
Dynamic Wrist Extension Splint
• Tujuan :
– Ekstensi pasif wrist
sementara tangan fleksi
– Mencegah kontraktur
– Menginervasi fleksor
wrist
• Indicasi:
– Kelemahan atau paralisis
wrist extensors
Metatarsal Bar
Dynamic Springwire Knucklebender Assist
Volar Forearm Trough
Tenodesis Training Splint
• tujuan:
– Untuk melatih genggaman
tenodesis
– Untuk melatih OS agar
dapat melakukan gerakan
menjepit (tripod pinch)
dengan wrist extension
– melatih finger membuka
dengan wrist flexion
• Indikasi:
– C6 quadriplegia with grade
3 strength of wrist
extensors
Finger Cuff
Thumb Spica
Forearm Cuff
Dynamic Elastic Band Assist
Dynamic Ulnar Nerve Splint
Dynamic anti-claw deformity
splint, Wynn Perry Splint
Tujuan :
Untuk mempasif flexikan MCP
ke 4 dan ke 5
Mencegah pemendekan
ligamen Collateral MCP
Melatih active IP flexion
Indikasi
Ulnar nerve lesion
Metacarpal Bar
Dynamic Springwire Knucklebender Assist
Lumbrical Bar
Capener Splint
Dynamic spring wire splint
untuk PIP extension
tujuan:
Untuk mempasif
ekstensikan PIP
Aktif IP fleksi
Menstabilkan PIP
restabilisasi lateral
bands and mencegah
ruptur central slip
Indikasi :
– kontraktur PIP fleksi
– dislokasi PIP dorsal
– Volar plate injury
– perbaikan tendon Flexor
akibat kontraktur
– Partial or complete tear of
the collateral ligament
– Boutonniere deformity
ThermoplastDynamic Springwire Finger Coil Assist
Anti-microstomial Splint
Tujuan :
Memungkinkan penguluran
jaringan sekitar oral cavity
Mencegah kontraktur bibir
jaringan buccal yg
menyebabkan limitasi saat
membuka mulut
Indikasi:
Facial and perioral burns
Aturan penggunaan :
Penggunaan continue
Diangkat hanya untuk
dibersihkan
Pencegahan :
Ujung bibir cenderung
mengalami kerusakan kulit jika
pemasangan dan tegangan
splint yang tidak tepat.