MOTORIK BARU sekali

8/13/2019 MOTORIK BARU sekali

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PEMERIKSAANMOTORIK

Dr. Moch. Bahrudin, SpS

NEUROLOGICAL SKILL



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Pemeriksaan Motorik Penting

Gerakan Piramidalis

Ekstra Piramidalis

Cerebellum



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Lesi UMN



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This classical pictureof the homunculi,based on the work ofWilder Penfield in the1930s and 1940s



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1. Cornu ant (poliomielitis akut & atrofi muskular spinalis progresif kronik) : selcornu mati shg paralisis flacid, atrofi otot yg disarafi

2. The peripheral nerve, (ventral and dorsal nerve roots i.e., radiculopathy ornerve i.e., neuropathy) : iritasi radikuler (parastesia dan nyeri dalam poladistribusi tertentu, bila berat gangguan sensorik dan motorik), yg diperiksakonduksi saraf.

3. Neuromuscular junction (miastenia gravis)

4. The muscle (i.e congenital myopathy, metabolic myopathy, inflammatorymyopathy)

Lesi LMN



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UMN LMN

Spasticity Flaccid

Increased tone Decreased tone

Increased muscle

stretch reflexes

Decreased muscle

stretch reflexes

Minimal muscle

atrophy (disuse

atrofi)

muscle atrophy

Fasciculations (-) Fasciculations (+)

Refleks patologis (+) Refleks patologis (-)



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1. INSPEKSI Jalan , Sikap , Atropi dll

2. TONUS

3. KEKUATA

4. KOORDINASI/ cerebellum

Alat & Persiapan :

@ Informasi pemeriksaan@ Perhatikan Dermatome otot

Pemeriksaan MOTORIS



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1. INSPEKSI : Jalan , Sikap , Atropi , Involuntary1.a. Jalan : - Hemiplegi gait - Ataxic gait

- Scissor gait - Walding gait

- Parkinson gait

1.b. Sikap : - Drop hand - Claw hand- Drop foot - Ape hand

- Dystonik - Wajah topeng

1.c. Involuntary : - Tremor - Chorea

- Athetose - Ballismus

- Kejang tonik / klonik / mioklonik

- Tics - Automatis

1.d. Atropi / Hipertrophy / Pseudohipertrophy

Pemeriksaan MOTORIS



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Pemeriksaan Inspeksi

http://medicine.tamu.edu/neuro/87.gif





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Atropi THENAR , “ Ape hand “

Hipestesia jari 123 ½ Volar

Parese Flexor Jari 123

Lesi n.Medianus



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Hipestesia Jari 45 Volar

Parese Flexor jari 45

Inter Ossei

Atropi Hipothenar

Lesi n.Ulnaris



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Lesi n.Radialis Hipestesia Dorsum tangan

jari 123

Parese Extensor tangan

Extensor jari 123Sikap Drop hand



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Lesi n.Peroneus

Hipestesia betis lateral

dorsum kaki

Parese Extensor kaki

Sikap Drop Foot





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Gower’s sign

DMP DUCHENE



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Palpasi : kelompok otot(biseps, triceps, deltoid,

quadriceps, hamstring)

TONUS : PENDERITA PASIF

Hipertonus (Spastis) : akibat

kontraksi otot, Lesi UMN

Rigiditas : ggn EPS

(Parkinson)

Flaksid (hilangnya tonus otot)

: Lesi LMN



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TONUS OTOT • Gerakan pasif semua sendi

• Px relax tidak melawan

• Yang dicari tahanan gerakan

KELAINAN TONUS :

SPASTIS :

Fenomena PISAU LIPAT :

=Ada tahanan awal

RIGIDITAS : Tahanan sepanjang gerakan yang hilang timbulDECORTICATE Rigidity

DCEREBRATE Rigidity

Fenomena PIPA TIMAH :

- Tahanan sepanjang gerakan



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Pemeriksaan TONUS OTOT

Decorticate

Rigidity

Decerebrate

Rigidity

Video Skill Motor Inspeksi Tonus



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Video Skill Motor Inspeksi Tonus



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Video Skill Motor Jalan



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Video Skill Motor Loncat



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Tehnik : 1. Perintahkan mengangkat sekuat2nya

melawan Gravitasi2. Mengukur KEKUATAN maksimal

Derajat Kekuatan :

5 Normal

4 Melawan Gravitasi , tahanan cukup

3 Melawan Gravitasi + , tahanan kecil

2 Gerak sendi + Tidak bisa melawan gravitas

1 otot kontraksi tetapi gerak Sendi -

0 Plegi

KEKUATAN MOTORIS



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0No muscle contraction is detected

1 A trace contraction is noted in the muscle by palpating the

muscle while the patient attempts to contract it.

2The patient is able to actively move the muscle when gravity is

eliminated.

3The patient may move the muscle against gravity but not

against resistance from the examiner.

4The patient may move the muscle group against some

resistance from the examiner.

5The patient moves the muscle group and overcomes the

resistance of the examiner. This is normal muscle strength.

Since this rating scale is skewed towards weakness, many clinicians

further subclassify their finding by adding a + or -, e.g., 5- or 3+.

Vid Skill M t K k t



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Video Skill Motor Kekuatan

Vid Skill M t KEKUATAN



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Video Skill Motor KEKUATAN



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C 537

C 45



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Shoulder Adduction (C 5 - T1):The main muscle of adduction isthe Pectoralis Major, though theLatissiumus and otherscontribute as well

Shoulder Abduction (C 5, 6):The deltoid muscle, innervatedby the axillary nerve,



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M. deltoids,

The deltoid

muscle is

innervated bythe C5 nerve

root via the

axillary nerve.



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C 5 6

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Shoulder Adduction (C 5 - T1):The main muscle of adduction isthe Pectoralis Major, though theLatissiumus and otherscontribute as well

Shoulder Abduction (C 5, 6):The deltoid muscle, innervatedby the axillary nerve,







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C 5 6



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Elbow Flexion (C 5, 6): the

Brachialis Muscle (along

with the Biceps Muscle).These muscles are

innervated by the

Musculocutaneous Nerve.

Elbow Extension (C 7, 8):

the triceps muscle. TheTriceps is innervated by

the Radial Nerve



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C 5 6



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C 6

C 6 7



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C 6

C 7 8





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C 8

C 8



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C 8

T 1



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C 5 6 7

Sk



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C45

C56

C7C6

C7

C8

C67

C71

T1

Skema

Myotome

Cervical



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L 123



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L5 S12



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L45 S1



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L 234



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L5 S12



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L5 S12



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L 45

S 12



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L5 S1

Skema



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L123

L45

L234

L5

L45S1 L5S1

S1

Skema

Myotome

Lumbo Sacral



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Fungsi CEREBELLUM :Fungsi Gangguan

Gerakan halus Ataxia

Keseimbangan Ataxia , Romberg ( )

Tepat jarak Dysmetri

Gerak ritmik Dysdiadokokinesia

Rem gerak Rebound fenomena

KOORDINASI MOTORIS



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KOORDINASI MOTORIK

Mata Terbuka diikuti

Tertutup



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KOORDINASI MOTORIK

Mata Terbuka diikutiTertutup

Dismetri



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•Finger to finger test

Dismetri

•Heel to knee test

KOORDINASI MOTORIK



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KOORDINASI MOTORIK

KOORDINASI MOTORIK



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KOORDINASI MOTORIK

KOORDINASI MOTORIK



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KOORDINASI MOTORIK

Video Skill Motor Romberg



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g

Video Skill Motor DYS DIADOKOKINESIA



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Video Skill Motor DYSMETRIA



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Video Skill Motor DYSMETRIA



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Video Skill Motor Pronation Sign



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Pemeriksaan Koordinasi



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Tandem walking test

Pemeriksaan Koordinasi

R b t t



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Romberg test



SELAMAT BELAJAR

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MOTORIK BARU sekali