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BROSTROM REPAIR FOR CHRONIC ANKLE INSTABILITY

Posted by Konsultasi Online Fisioterapi Gratis on May 12, 2009 at 12:57 PM Comments comments (0)

GENERAL CONSIDERATIONS:

 

- Time frames mentioned in this article should be considered approximate with actual progression based upon clinical presentation. Careful observation and ongoing assessments will dictate progress. - No passive inversion or forceful eversion for 6 weeks.

- Avoid plantar flexion greater than resting position for 4 weeks.

- Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis.

- No running, jumping, or ballistic activities for 3 months.

- Aerobic and general conditioning throughout rehabilitation process.

- M.D. appointments at day 1, day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-operatively.

 

0 - 3 WEEKS:

 

- 90° immobilizer for 3 weeks. - Nonweightbearing for 3 weeks--no push off or toe-touch walking.

- Progress from posterior splint to pneumatic walker once most of swelling is gone.

- Pain and edema control / modalities as needed (i.e. cryotherapy, electrical stim, soft tissue treatments).

- Toe curls, toe spreads / extension, gentle foot movements in boot, hip and knee strengthening exercises.

- Well-leg cycling (bilateral once in walker with light resistance), weight training, and swimming in posterior splint after 10-12 days post-op.

 

3 - 6 WEEKS:

 

- Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6 weeks post-op. Aircast splint for day-to-day activities for 6-12 weeks post-op. - Immobilizer for sleeping for 4weeks, then Aircast splint for

4-6 weeks.

- Isometrics in multiple planes and progress to active exercises in protected ranges.

- Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.

- Soft tissue treatments daily and regular mobilization of intermetatarsal and midtarsal joints. Cautious with talocrural and subtalar mobilization.

- Cycling, aerobic machines in splint as tolerated, and pool workouts in splint.

 

6 - 12 WEEKS:

 

- Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception. - Passive and active range of motion exercises into inversion and eversion cautiously.

3 - 6 MONTHS:

 

- Progress back into athletics based upon functional status. - Wear a lace-up ankle support for athletics.

Neurobehaviour

Posted by Konsultasi Online Fisioterapi Gratis on May 12, 2009 at 12:53 PM Comments comments (7)

NEUROBEHAVIOUR

 

Neurobehavior adalah hubungan antara fungsi otak dengan perilaku dan proses berpikir manusia. Neurobehavior terkait dengan pola perilaku hidup seseorang yang berhubungan dengan sistem neural (sistem saraf) seperti pola tidur, mood atau suasana hati, stress, nafsu makan dan kesadaran diri. Fungsi luhur ini sangat vital bagi kehidupan manusia dewasa akhir,dewasa tengah,dewasa muda dan teristimewa bagi anak-anak. neurobehavior sangat berperan terhadap pertumbuhan dan perkembangan fisik dan mental pada manusia.

Keterkaitan antara neurobehavior dengan pertumbuhan dan perkembangan fisik dan mental dapat digambarkan sebagai berikut:

- Pola tidur dan kualitas tidur yang baik akan mempengaruhi pertumbuhan dan perkembangan otak anak (kecerdasan) dan pertumbuhan fisik yang baik.

Suasana hati akan berpengaruh terhadap kesiapan anak untuk menerima stimulus dari lingkungan dan memberikan respon yang tepat terhadap stimulus tersebut (proses belajar).

- Stress pada anak akan berpengaruh terhadap perkembangan mental anak. Jika anak mengalami stress, maka kemampuan kognitif (kemampuan yang berhubungan dengan kecerdasan), kemampuan afektif (kemampuan berhubungan dengan sesama manusia dan lingkungan) dan kemampuan psikomotorik (kemampuan gerak) akan terganggu. Anak akan kesulitan untuk menerima stimulus dan memberikan respon terhadap stimulus tersebut.

- Nafsu makan tentunya akan mempengaruhi konsumsi makanan dan total asupan gizi anak. Jika asupan gizi baik, maka pertumbuhan fisik dan mental akan baik pula.

Kesadaran diri terkait dengan kemampuan anak untuk memahami konsep diri, lingkungan dan hubungannya. Kesadaran diri lebih terkait dengan perkembangan mental anak.

Fungsi neurobehavior ini diatur oleh hormon yang diproduksi dalam otak, yaitu hormon Serotonin (5-Hydroxy-Typtamine). Hormon Serotonin diproduksi dari prekursornya, yaitu asam amino Triptofan. Asam amino Triptofan merupakan asam amino esensial yang tidak dapat disintesis dalam tubuh dan harus diperoleh dari makanan. Sumber Triptofan terutama adalah makanan berprotein tinggi, terutama protein hewani seperti daging, unggas, ikan, susu dan telur.

Rasio Triptofan tertinggi terdapat di protein Alfa-Laktalbumin dibandingkan dengan jenis protein lainnya (kasein, protein kedelai dan Beta-Laktoglobulin). Alfa-Laktalbumin merupakan senyawa protein yang secara alami terdapat dalam ASI. Penelitian yang dilakukan oleh Markus et.al (2002) dan Bork (2004) menunjukkan bahwa Alfa-Laktalbumin dapat membantu produksi hormon Serotonin dan membantu memperbaiki neurobehavior seperti pola tidur (kualitas tidur yang lebih baik), mood, stress, nafsu makan dan kesadaran diri.

Selain Triptofan, suasana hati juga dipengaruhi oleh vitamin B Kompleks. Kekurangan Vitamin B Kompleks sering dicirikan dengan suasana hati yang kurang baik dan tidak bersemangat. Vitamin B Kompleks sangat penting untuk kesehatan otak karena Vitamin B Kompleks bertugas mengatur homosistein, asam amino yang secara alami diproduksi oleh tubuh. Tingginya kadar homosistein dalam darah akan menyebabkan peradangan, kerusakan pembuluh darah dan merusak sel otak. Selain itu, tingginya kadar homosistein dalam darah juga akan mempengaruhi kecepatan psikomotorik atau kemampuan tubuh untuk melakukan gerak, baik psikomotorik kasar (berjalan, berlari, dsb) atau psikomotorik halus (menulis, membaca, dsb) (Perlmutter 2004).

Alfa-Laktalbumin, Triptofan dan Vitamin B Kompleks akan membantu membentuk neurobehavior yang baik. Dengan neurobehavior yang baik serta pola pengasuhan dan pembelajaran yang baik pula diharapkan akan membantu membentuk anak yang sehat, cerdas dan memiliki mental yang baik.

Jika seseorang mengalami gangguan Neurobehaviour maka akan mengganggu ”Performance Skill” yang berhubungan dengan aktifitas kehidupan sehari-hari (AKS), Produktifitas dan aktifitas ” Leisure”. Untuk mengatasi hal tersebut maka harus dibutuhkan penanganan team medis yang terpadu. Team medis yang terlibat disini ada dokter saraf, dokter anak, dokter spesialis rehabilitasi medis yang di bantu oleh fisioterapi, okupasi terapi, terapi wicara dan ortotik protestik dan psikolog.Jika penangannya dilakukan secara team maka hasil yang dicapai akan maksimal sesuai kondisi seseorang yang mengalami gangguan neurobehaviour seperti Gangguan hiperaktifitas,gangguan kosentrasi, autis, gangguan belajar dan kondisi-kondisi lainnya.

 

 

DAFTAR PUSTAKA

- Bork R. 2004. Alpha-Lactalbumin as Functional Ingredient. IUFost Symposium. Shanghai.

- Markus CR, Olivier B & de Haan EHF. 2002. Whey Protein Rich in Alpha-lactalbumin Increases The Ration of Plasma Tryptophan to The Sum of The Other Large Neutral Amino Acid and Improves Cognitive Performance in Stress Vulnerable Subjects.

- Am. J. Clin. Nutr., Vol. 75, No. 6, 1051 – 1056.

- Perlmutter D, Colman C. 2004. The Better Brain Book. New York: Riverhead Books.

- Perlmutter D, Colman C. 2004. The Better Brain Book. New York: Riverhead Books.

- Steinberg LA, O’Connel NC, Hatch TF, Picciano MF & Birch LL. 1992.

- Tryptophan Intake Influences Infant’s Sleep Latency. J. Nutr. 122:1781 – 1791.

Physiotherapy Career Planning

Posted by Konsultasi Online Fisioterapi Gratis on May 12, 2009 at 12:27 PM Comments comments (0)

25 Hot Tips for Managing Your Career

________________________________________

by William S. Frank

Since the late 1970s, I've spent more than 20,000 hours as a career consultant listening to people talk about their work. My clients have included CEOs, law firm partners, professional athletes, engineers, factory workers, you name it. They've shared their highs and lows, and their innermost secrets. They've taught me the do’s and don’t’s of corporate politics and given me the keys to success. My sixteen years of career counseling can be boiled down to a few short lessons:

• Achieving success usually involves sacrifice. If it were always easy, everyone would drive a Porsche.

• Even if you work for a big company, you're essentially on your own. Businesses offer career paths, training, and team building, and they want to be fair, but they're subject to impersonal market conditions like mergers, acquisitions, takeovers, and international competition; so anything can happen. That's why your employer can't be responsible for your career. You have to take charge of it yourself. Those who expect companies to take care of them, or to "do the right thing" are often disappointed. Chances are, no one will ever care more about your career than you do.

• The workplace can be fun and challenging. It can also be difficult. It rewards effort, planning, and training, but it punishes indifference and lack of preparation. Those who don't take charge of their own careers—who just let things happen—often end up in painful, dead-end jobs, feeling trapped in unhappy lifestyles.

• People are very different. Certain people belong in certain kinds of careers. You have special gifts that fit you for some jobs and disqualify you from others. If you're in the right place, you'll skyrocket. If not, you'll struggle. In order to learn where you'll be happiest, get to know yourself.

• Take time to assess your skills, temperament, aptitudes, likes, dislikes, and natural gifts. Design your ideal work life on paper, then risk to create your dream. There's no reason you can't enjoy your work. If you need help designing or implementing your plan, seek the advice of a professional career counselor. (But never pay large counseling fees in advance. Pay only by the hour.)

• Your career may be your biggest financial resource more valuable than any stock you could own. For example, let's assume you're earning $20,000 per year today. The average annual pay raise is about 5%. If you earn 8% instead, you'll earn an extra $264,000 in 20 years. You may be paid what you're worth right now, but investigate the market. Don't over- or under-price yourself.

• Jumping from job to job from salesman to customer service representative, then to teacher, staff accountant, and technical writer isn't a career. Beginning as an accounts payable clerk, then progressing to junior accountant, accountant, controller, chief financial officer, and vice president of finance is a career. A career builds on itself over time.

• In a growing and expanding industry like environmental science, job changing isn’t necessarily a problem, because there are always too few experienced workers. But in a declining industry like oil & gas, where established companies are systematically downsizing and keeping only their top performers, moving from employer to employer makes a candidate an unattractive hire. That's more true the older you get and the higher your pay.

• Changing fields, industries, or functional specialties is difficult, and the bigger the change, the more difficult it is. Hardwood manufacturers may not want you if you've been in softwood. And vice versa. Therefore, choose your direction carefully. Once you leave a career path to try something new, it may be difficult to re-enter. You'll look like a "traitor" to insiders, and you'll be competing with those who've stayed.

• Today's engineering graduate is obsolete in less than five years. You may be, too. If you aren't learning something new today, you may be out-of-date and unmarketable tomorrow. That's especially true for those over 40. (If you're over 40, do you know Microsoft Word? How about Excel?)

• Think of your career as a public relations campaign, much like running for political office. Your goal is to get as many people to like you as quickly as possible and keep liking you. Therefore, every person male, female, minority, old, young is important. Treat all others with kindness and respect. Make life a little easier for those around you, and your career will benefit.

• "People skills" are just as important as "technical skills," because even in highly technical jobs, you have to work with others. Many outplacement candidates are technical superstars who've been fired. They knew their jobs, but couldn't collaborate or get along with others. Average performers with strong people skills often last longer. It's better to be a "people person" with average skills than to be an abrasive expert who wins at the expense of others.

• Be careful expressing strong emotions in business, especially anger and disappointment. Communicate your feelings quietly and tactfully. Understate your case. Anger is powerful, even when expressed softly. Don't explode, threaten, or attack others publicly. Don't tell opponents off, even if it would feel great.

• Burning bridges damages your reputation not only with the person you dislike but with the business community at large. Remember, if you make an enemy today, it may take them ten years to "get you." But chances are, they will.

• Spend time with people you admire. Success really does rub off. There's no substitute for "knowing the right people," and for "being in the right place at the right time." Take a risk to contact someone you'd like to meet.

• Whether you are an entry-level shipping clerk or a CEO, a warm, enthusiastic, caring, and positive attitude outwardly expressed to others is your single biggest career asset.

• On any given day, your present job may end, even if you own the company. Therefore, think short-term. Don't take your present opportunity for granted. I define a consultant as "someone who wakes up every morning unemployed." You should feel the same way. Get up every morning feeling unemployed, and constantly fight to prove yourself. Appreciate your job, but figure out what you're going to do next. It's always nice to have a "Plan B."

• Except in rare cases, don't sue your former employer if you're fired or laid off. Take a good, hard look at yourself. Ask yourself what, if anything, you could have done differently. Did you stay on the leading edge of technology? Were you too political? Not political enough? Were you giving it 110%? Did you get complacent?

• Honestly determine your part in causing the problem. Then work to create a better life for yourself, even if you think it was the employer's fault. Don't dwell on the past. It's non-productive and it prolongs your unhappiness.

• If you lose your job, 80% of your marketing for a new position will already have been done. That's right. Your reputation, results, accomplishments, people skills, contributions, and friendships are all a matter of record. If you've been a contributor, if you've been kind to others and easy-to-work-with, you'll be in demand. If not, you won't. No career consultant in the world can create close friendships and a good reputation for you if you haven't laid the groundwork yourself.

• Your friends--even distant friends--are your best allies in your life and in your career, especially in job hunting. No one will help you more than those who already know you. So make an extensive list of your business and personal contacts (essentially, everyone you've met), and stay in touch with them, even after you've found a new job.

• Employers hire their friends first. Only when they run out of familiar faces do they consider hiring strangers. When companies recruit from a group of outsiders, they interview, test, and screen heavily. Your best career strategy--besides keeping your skills up-to-date and achieving a lot--is to cultivate deep, long-lasting friendships.

• Your accomplishments are your calling card for the future. They will help to determine your marketability. In selling yourself, it's results that count. A baseball player who gets a hit every time at bat is easier to market than one who doesn't. It's that simple. Try to contribute something substantial and measurable every single day. And make sure you keep a written record of your results.

• Don't let yourself be unemployed, even for a day. Volunteer a few hours, work part-time for a temporary agency, help a friend in his or her company. Do something to get yourself out of the house. We live in a fast-changing world. Look carefully. There are people all around you who need your help.

• Love, happiness, friendship, and time for oneself are just as important as making it big in the world. If your career is your whole life, you're vulnerable to disappointment and burnout; and burned out people are often less marketable.

• Too much success can kill you. Learn when enough is enough. If you think you're burning out, you may be right. Highly successful people are the most subject to burnout. They demand too much from themselves--and from everyone around them. Seek balance. Remember The Golden Mean: "All things in moderation."

• Don't stay in a job you hate. Hating your daily routine can ruin your health; and it can make everyone around you, including your spouse and family, miserable. Take a risk! Take action! Change things!

• Don't make excuses when things go wrong. I have collected a list of "66 Excuses," and few of them are valid. When facing challenges, tell yourself this: "I'm in control of my own future. No one can deny me a happy life if I decide to plan it and work for it. Ultimately, no one can stop me from becoming successful but myself."

• Whatever your expertise, give some of it away.


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