Neurorestorasi dan Fisioterapi

Geriatri
dr. Adre Mayza, Sp.S(K)
Subdivisi Neurobehavior dan Neurorestorasi
Departemen Neurologi RSCM-FKUI
 SIAPA GERIATRI???
• Lansia (WHO):
– usia > 60 tahun
– Tahap akhir fase kehidupan → aging process
• Lansia (Depkes RI):
– Kelompok usia lanjut 45 – 54 tahun → vibrilitas
– Kelompok usia lanjut 55-64 tahun → presenium
– Kelompok usia lanjut < 65 tahun → senium
 POTENSI DAN MASALAH PADA GERIATRI
AMOUNT OF OLDER LIFE
UNCONTROLLED RISK
PEOPLE
FACTOR NON- EXPECTATION
COMUNICABLE DISEASE Year 2014, 20,24 million RATE INCREASE
(Hipertention 25,8% 2024 , 41 million (68,6 (2004), 70,8
Cardiovasculer 1,5%, 2050, > 80 million in (2015), 72,2
DM 2,1%) indonesia (2030-2035)

A. Community base
Public awareness
COGNITIVE DECLINE /
NON- Screening
DEMENTIA
PHARMACOLOGY
?
PHARMACOL Brain exercise
Year 2030, 2,1 OGY
TREATMENT million life in COGNITIVE
indonesia. STIMULATIO B. Hospital base
N
74,7 million Cognitive stimulation
worldwide Functional diagnostic
DRUGS

Badan Pusat Statistik (BPS) 2015. Statistik Penduduk Lanjut Usia 2014. Available from: http://www.bappenas.go.id/ [9 November 2017]
Kementerian Kesehatan Republik Indonesia (RI) 2015. Pelayanan dan
Peningkatan Kesehatan Usia Lanjut. Available from: http://www.depkes.go.id/ [9 November 2017]
 Burden of Dementia (WHO)

• COMMUNITY HEALTH PROBLEMS • ECONOMIC PROBLEMS

Umur harapan hidup demensia yang Biaya kesehatan tinggi
meningkat → Usia lanjut Progresivitas meningka
Operasional perawatan jangka panjang

– Deteksi dini → cognitive decline → tatalaksana terlambat

1. WHO. Dementia: a public health priority.. 2012

2. Hampel H, Lista S. The rising global tide of cognitive impairment. NATURE REVIEWS | NEUROLOGY. 2016
ISTILAH YANG DIGUNAKAN UNTUK ORANG TUA DI INDONESIA

• KAKEK-NENEK
• ENGKONG-NYAI
• OPA-OMA
• AKUNG-APO

• MBAH KAKUNG-MBAH UTI

• AKI-NIN
• OMPU-OPUNG
Problematika Lansia di Asia
dan Barat

- Masalah sosial-ekonomi
- Masalah kesehatan
Orangtua Berantem
 PROBLEM OF AGING
– Kondisi fisik turun
– Daya tahan tubuh turun(rentan terhadap berbagai
macam penyakit)
– Penurunan fungsi otak → gangguan kognitif, afektif,
dan psikomotor → NEED NEURORESTORATION
BRAIN WORK & ANATOMY
BRAIN WORKS

14
 Schicoprenia,
GAD, PTSD
Stroke

Dementi
Brain a
Parkinso
Neuroinfectio n
disfunction n
(high
cortical
dysfunction
) (Sporns,
Chialvo.
2004)
 MECHANISME OF MEDICAL AND COGNITIVE INTERFERUM APPROACH
ACQUIRED BRAIN ▪ Technology Transportation 
INJURY ▪ Technology of information
▪ Changing lifestyle
▪ Environmental changing
TBI
200/100.000
50.000/Nu/yc
CEREBRAL
NOW + CBI
Tumor BRAIN
FUTURE 
INJURY
Infection
•Good Medical service Mortality 
Cognitive impairment : •Good Surgery service
a. Focal injury (CVA, tumor, ABI) •Good Pharmacotherapy
b. Multifocal injury (cerebrovascular, TBI bilateral)
c. Diffuse axonal injury (accelerated, decelerated Disability 
TBI, infectious, hypoxia)

Cognitive impairment:
-Aphasia
-Apraxia Needs cognitive
-Unilateral neglect rehabilitation
GERIATRIC PROBLEM INTEGRTED APPROACH ?

GANGGUAN
PSIKOMOTOR

GANGGUAN GANGGUAN
KOGNITIF AFECTIVE

GERIATRIC

GANGGUA GANGGUAN
FISIK ORGAN
NEURORESTORASI
• Suatu pendekatan layanan medis yang bertujuan
untuk mendendalikan fungsi dari suatu sistem
yang mengalami suatu gangguan pada fase awal
mulai dari pada saat terjadinya penyakit sampai
dengan suatu proses pemulihan fungsi (recovery).

• Pendekatan dasar neurorestorasi adalah

neuroanatomi, neuropsikologi, dan neuroscience.

• Pendekatan neuroscience lebih menjelaskan

proses pemulihan fungsi yang berpengaruh
terhadap perilaku (neuropsikologi).
 Definition of Neurorestoratology
• Neurorestoratologi adalah suatu disiplin ilmu baru dan
berkembang, cabang dari neuroscience dan kedokteran,
berbasis teori restorasi neuron bahwa kerusakan pada SSP
dapat mengalami perbaikan (restorasi sel).
• Tujuan: untuk merestorasi atau memicu perbaikan dari sel
saraf yang telah rusak atau kehilangan fungsinya.

Huang H, Sharma HS. Neurorestoratology: one of the most promising new disciplines at the forefront of neuroscience and medicine.
Huang H, Sharma HS. Neurorestoratology: one of the most promising new disciplines at the forefront of neuroscience and medicine.
Huang H, Sharma HS. Neurorestoratology: one of the most promising new disciplines at the forefront of neuroscience and medicine.
 Integrated Brain Based Human Development and Neurobehavioral
Program PIK KemKes 2012
• NEURODEGENERATIF (USIA LANJUT)
A. PREVENTION
1. Public Awareness (Brain Health Lifestyle) 5. Penyusunan Buku PAPAIA
2. Screening ( ABCDE Screening and Grouping) 6. Penyusunan buku dongeng
3. Grouping (Beler) 7. Raport Pasien
4. Aktivitas Kelas (Stimulasi Kognitif) 8. Aplikasi Ceria
B. Treatment (Tatalaksana Pharmacology dan Nonpharmacology)
a. Pharmacological therapy
b. Nonpharmacology (Functional Therapy):
a. Neurorestoration and Neurorehabilitation (physical, cognition, and
emotional)
b. Neuromodulation therapy (physical, cognition, and emotional):
a. TMS (Transmagnetic stimulation)
b. Neurofeedback aktif dan pasif
c. Conventional and Modified neurofeedback
PREVENTIVE
1. PUBLIC AWARENESS
• TUA BER JA GA

• TUNGGU USIA AKHIR (WAITING FOR

OLDER DAYS)

• BERSOSIALISASI (SOCIALIZED)

• JAGA KESEHATAN (MAINTAIN

HEALTH)

• GAYA JUGA PENTING (STYLE IS ALSO

IMPORTANT)
 3. Grouping
Group of risk factor management & Cognitive stimulation
in community (Puskesmas “center of public health
service”)
Group of Risk Factor (BELER Class)
TEST
CLASS ACTIVITY CATEGORY
A B C D E

Brain learning — — — — — Normal

Brain exercise — + — + + Disorder

Brain restoration + — — — — Disorder

 4. Class Activity

• Note:
• Brain learning class do : to prevent cognitive decline
- brain gym vitalization, complete physical exercise, emotional exercise
- Carving, membatik, dancing, and STORY TELLING (PAUD & PAUL)
• Brain exercise class do:
- Special exercise for elderly disorder
- Limited brain gym vitalization and limited physical exercise

• Brain restoration class do :

•accompanied by caregiver for elderly that cannot do daily activity
•We offered to geriatric hospital
 5. Penyusunan Buku
PAPAIA
Panduan Pencegahan Demensia

Pedoman dan modul untuk

keberlanjutan kegiatan

Konten :

• Penjelasan mengenai demensia

• Metode penilaian fungsi otak
• Rangkaian kegiatan GEMPITA
6. Penyusunan Buku Dongeng & Puzzle Kupu-Kupu
 7. Penyusunan Rapor Pasien

No. Week-1 Week-2 Week-3

V
1 Nutrition

2 Spirituaity
V
3 Socialization

4 Phsyical Activity V
5 Mental Stimulation
8. Aplikasi Ceria (Skrining ABCDE)
Created by GEMPITA Group
 II. Treatment of Cognitive Decline and Dementia
A. PHARMACOLOGICAL THERAPY
➢Penggunaan obat untuk terapi demensia dimulai
sejak tahun 1996. Pembiayaan penelitian obat-
obatan demensia mencapai 604 triliyun dollar US
pada tahun 2010.

1. Knapton S. Alzheimer's: New drug that halts mental decline is 'best news for dementia in 25 years‘ Archived from
http://www.telegraph.co.uk/science/2016/09/01/alzheimers-new-drug-that-halts-mental-decline-is-best-news-for-d/
2. WHO. Dementia: a public health piority. 2012
FIRST WHO MINISTERIAL CONFERENCE ON
GLOBAL ACTION AGAINST DEMENTIA
 B. Treatment nonpharmacological Therapy
1. TMS (Transcranial Magnetic Stimulation)

Otal B, OlmaMC ,FlöelA and WellwoodI. Inhibitory non-invasive brain stimulation to homologous language region sasan adjunct to
speech and language therapy inpost-stroke aphasia:a meta-analysis. Front. Hum. Neurosci. 2015; 9:236.
 Treatment nonpharmacological Therapy
2. Neurofeedback (Self Regulation)
MONITOR OF EEG WAVE
MONITOR
APPROPIATE TO STIMULUS
STIMULUS

EEG CHANNEL Visual

4,8,16,32 Stimulation

Auditory
Stimulation • Alpha
• Betha
• Delta
• Tetha
• Gamm
a
RESULT
RECORDING Brainwave • Alpha
• Betha
• Delta
• Tetha
• Gamm
a
 MODEL DIAGNOSTIK TOPIS DAN PENDEKATA
NEURORESTORASI
KORTIKAL SUB KORTIKAL BATANG OTAK MEDULLA SPINALIS

GANGGUAN KOGNITIF PERSEPSI PERSEPSI RESEPTOR

ATENSI, VISIOSPASIAL, TAKTIL, VESTIBULER, TAKTIL, VESTIBULER,
BAHASA, MEMORI, FUNGSI INDERA, INDERA, PROPIOSEPTIK
EKSEKUTIF PROPIOSEPTIK GGN PERILAKU
GGN BELAJAR & PERILAKU GGN PERILAKU

TEMPAT NEUROTRANSMITER BASAL GGL MESENSEPALON

KERUSAKAN
HEMISPHERES NUKLEUS CAUBATUS PONS

LOBUS SINGULATE MEDULLO OBLONGATA

THALAMUS
PENDEKATAN BOTTOM UP INTER CONNECTION TOP DOWN TOP DOWN
KESIMPULAN
• Permasalahan geriatri dapat diatasi dengan layanan
neurorestorasi yang sejalan dengan fisioterapi
• Neurorestorasi dan fisioterapi saling bersinergi dalam
kapasitas layanan masing-masing (prosedur
pelayanan, rujukan dan evaluasi bersama)
• Neurorestorasi dapat sejalan dengan fisioterapi
dalam rangka mengoptimalkan kualitas hidup geriatri
(geriatri yang berdaya karya)