PMR MEDICAL STATUS FOR CASE PRESENTATION

TOPIC CASE PRESENTATION

IDENTITY

Name :
Date of Birth :
Age :
Gender :
Marital Status :
Education :
Occupation :

Referral Doctor :
Referral Diagnosis :
Date of referral :

ANAMNESIS (date of examination)

CHIEF COMPLAINT
HISTORY OF PRESENT ILLNESS
HISTORY OF PAST ILLNESS
CO-MORBITIES
MEDICATIONS
HISTORY OF FUNCTIONAL AND VOCATIONAL ACTIVITY
PSYCHO-SOCIO-ECONOMIC STATUS
• Psychological Condition
• Social Condition
• Economic Condition
REVIEW OF SYSTEM

PHYSICAL EXAMINATION
General appearance
Consciousness
Nutritional status
• Body Weight
• Body Height
• Body Mass Index

Vital signs
• Blood Pressure
• Heart Rate
 • Respiratory Rate
• Temperature

GENERAL STATUS
Head :
Neck :
Thorax :
Lung :
Heart :
Abdomen :
Extremities :
Integument/skin :

Posture
• Static posture is examined while standing.
• Instruksikan pada pasien untuk berdiri tegak sebaik mungkin
• Hasil Pemeriksaan:
 Normal Posture
 Poor posture (faulty posture)
is the posture that results from certain muscles tightening up or shortening while others lengthen and
become weak, which often occurs as a result of one's daily activities. It may lead to pain, injury, or other
health problems
5 tipe faulty posture
o Kifotik
o Lordotik
o Scoliosis
o Flat back
o Forward head
Evaluasi lebih lanjut apakah kelainan ini akibat masalah struktur atau fungsional.
•
• Abnormal posturing
is an involuntary flexion or extension of the arms and legs, indicating severe brain injury (lying position)
.
BODY FUNCTION

CRANIAL NERVE
Pemeriksaan saraf cranial I-XII

MENTAL FUNCTION

Consciousness State of consciousness

functions Mental functions that when altered produce states such as clouding of consciousness,
stupor or coma.
Compos mentis, somnolence, stupor or coma
Continuity of consciousness
Mental functions that produce sustained wakefulness, alertness and awareness and,
when disrupted, may produce fugue, trance or other similar states.
Quality of consciousness
Mental functions that when altered effect changes in the character of wakeful, alert
and aware sentience, such as drug-induced altered states or delirium
Orientation functions Orientation to time
Mental functions that produce awareness of day date, month and year.
Apakah pasien tahu sekarang tanggal berapa?
Orientation to place
Mental functions that produce awareness of one's location, such as one's immediate
surroundings, one's town or country.
 Apakah pasien tahu sekarang ada dimana?
Orientation to person
Mental functions that produce awareness of one's own identity and of individuals in
the immediate environment
Apakah pasien tahu siapa saya (dokter)?
Orientation to self
Mental functions that produce awareness of one's own identity.
Minta pasien menceritakan siapa saja keluarganya di rumah?
Orientation to others
Mental functions that produce awareness of the identity of other individuals in one's
immediate environment
Apakah pasien mengenal siapa yang berada di samping saya? (disamping dokter ada
perawat)
Attention functions Sustaining attention
Mental functions that produce concentration for the period of time required.
• Menepuk tangan setiap mendengarkan huruf A
(FBACMNAAJKLBAFADEAAAJAMOFAAB)
• Menghitung 100-7
Shifting attention
Mental functions that permit refocusing concentration from one stimulus to another
 Menyebutkan angka terbalik: 2-4-7
 Trail Making Test: Task switching (visual attention)
(1-A-2-B-3-C-4-D-5-E)
Dividing attention
Mental functions that permit focusing on two or more stimuli at the same time.
 Berikan kertas berisi kalimat yang harus dibaca dan tanyakan sesuatu yang tidak
berhubungan dengan kalimat yang sedang dibaca.
 Minta menyalin sebuah kalimat dan diantaranya panggil namanya (apakah pasien
bisa mendengar dan memberikan respons)
Memory functions Short-term memory
Mental functions that produce a temporary, disruptable memory store of around 30
seconds duration from which information is lost if not consolidated into long-term
memory
 Menyebutkan kembali kata2
(Wajah-sutera-masjid-anggrek-merah)
 Mengulang kalimat panjang
o Wati membantu saya menyapu lantai hari ini
o Tikus sembunyi di bawah dipan ketika kucing datang
Long-term memory
Mental functions that produce a memory system permitting the long-term storage of
information from short-term memory and both autobiographical memory for past
events and semantic memory for language and facts.
 Menanyakan mengenai pertemuan pertama kali dengan pasangannya
 Meminta menceritakan masa kecilnya atau masa sekolah yang memberikan kesan
yang sangat mendalam
Retrieval of memory
Specific mental functions of recalling information stored in long-term memory and
bringing it into awareness
Menyebutkan kata yang dimulai dengan huruf S
(sebanyak minimal 11 kata)
Emotional functions Appropriateness of emotion
Mental functions that produce congruence of feeling or affect with the situation, such
as happiness at receiving good news.
Regulation of emotion
Mental functions that control the experience and display of affect.
Range of emotion
Mental functions that produce the spectrum of experience of arousal of affect or
feelings such as love, hate, anxiousness, sorrow, joy, fear and anger.
Disini yang diperiksa kecemasan (anxiety), stress atau depresi (sadness)
 Alat ukur yang digunakan HADS atau DASS atau GDS
Perceptual functions Auditory perception
Mental functions involved in discriminating sounds, tones, pitches and other acoustic
stimuli.
Kedua mata pasien ditutup
 Memperdengarkan suara anjing menggonggong
 Memperdengarkan suara bayi tertawa
 Memperdengarkan suara gerincingan rangkaian kunci
Visual perception
Mental functions involved in discriminating shape, size, color and other ocular stimuli
 Memperlihatkan gelas minum yang besar dan kecil
 Memperlihatkan persegi-4 warna kuning dan biru
 Memperlihatkan bola tenis dan bola basket
Olfactory perception
Mental functions involved in distinguishing differences in smells.
Kedua mata pasien ditutup
 Memberikan penciuman kopi dan teh
 Memberikan penciuman wangi bunga melati dan mawar
Gustatory perception
Mental functions involved in distinguishing differences in tastes, such as sweet, sour,
salty and bitter stimuli, detected by the tongue.
Kedua mata pasien ditutup
 Memberikan rasa asam dan manis pada jeruk
 Memberikan rasa sirup dan madu
Tactile perception
Mental functions involved in distinguishing differences in texture, such as rough or
smooth stimuli, detected by touch.
Kedua mata pasien ditutup
 Tanyakan pada pasien mana yang lebih kasar meraba kain sutera dan kain katun
 Tanyakan pada pasien bahan apa saat meraba kunci metal dan sendok plastik
Visuospatial perception
Mental function involved in distinguishing by sight the relative position of objects in the
environment or in relation to oneself
• Membuat jam dinding lengkap dengan jarum menunjukkan pukul 11.10
• Menanyakan pada pasien kedua tangan pemeriksa yang mana terletak lebih diatas
(tangan pemeriksa pada posisi pronasi); lebih di depan (tangan pemeriksa pada posisi
memperlihatkan palmar)
• Mencontoh membuat kubus
• Bisection line test
Mental functions of Reception of language
language Specific mental functions of decoding messages in spoken, written or other forms, such
as sign language, to obtain their meaning.
Memberikan 3 steps instruction:
Kalau tidak ada buku warna biru ambil spidol warna merah yang ada didalam tempat
pensil
Expression of language
Specific mental functions necessary to produce meaningful messages in spoken,
written, signed or other forms of language
• Dimanakah alamat lengkap rumah Ibu/Bapak?
• Tolong ceritakan dari awal peristiwa penyakit Ibu/Bapak
Repetition:
• Wati membantu saya menyapu lantai hari ini
• Tikus sembunyi di bawah dipan ketika kucing datang
Catatan:
Bila Pasien tidak menjawab, berikan kertas dan pen dan minta menuliskan jawabannya.
Integrative language functions
Mental functions that organize semantic and symbolic meaning, grammatical structure
and ideas for the production of messages in spoken, written or other forms of language
Ditanyakan dimana pasien tinggal? (sebutkan lengkap dengan RT/RW dan Kode Pos)
 dan minta dituliskan alamat lengkap tersebut.
(Bila pasien tidak ingat boleh dibantu mengingatkan oleh keluarga)
Tanyakan sudah lamakah pasien tinggal disana? Apakah pasien menyukai lingkungan
rumah yang sekarang? Kalau ya atau tidak tolong dijelaskan kenapa?
Calculation functions Simple calculation
Mental functions of computing with numbers, such as addition, subtraction,
multiplication and division
Berapakah 12+5-1:4x2?
Boleh disampaikan secara bertahap misalnya berapakah 12+5; kemudian -1;
kemudian :4; kemudian x2
Complex calculation
Mental functions of translating word problems into arithmetic procedures, translating
mathematical formulas into arithmetic procedures, and other complex manipulations
involving numbers
Ibu/Bapak membeli 3 kg beras dengan harga Rp15.000,-/kg dan 2 kg gula pasir dengan
harganya Rp.12.500,-/kg. Uang yang Ibu/Bapak bawa sebesar Rp. 100.000,-.
Berapakah sisa uangnya?

SENSORY FUNCTIONS AND PAIN

Seeing function Visual acuity functions
Seeing functions of sensing form and contour, both binocular and monocular, for both
distant and near vision
Dari jarak satu (dan 6) meter, minta pasien melihat dengan satu mata bergantian, dan
menyebutkan nama jari apa yang diperlihatkan. (bisa digantikan dengan benda)
Bila pasien tidak bisa menyebutkan boleh diganti dengan berapa jumlah jari yang
pasien lihat.
Visual field functions
Seeing functions related to the entire area that can be seen with fixation of gaze.
Pemeriksa duduk berhadapan di depan pasien yang juga dalam posisi duduk. Pasien
diminta untuk menatap mata pemeriksa. Pemeriksa yang memperlihatkan angka satu
dengan jari telunjuk kanan dan kiri. Kemudian merentangkan lengannya ke kiri dan ke
kanan sejauh pemeriksa masih bisa melihat jari telunjuknya sendiri.
Kemudian menanyakan apakah pasien masih bisa melihat jari telunjuk pemeriksa.
Untuk memastikan bahwa pasien memang bisa melihat tanyakan apakah ada jari
telunjuk pemeriksa yang bergerak; sisi yang mana yang bergerak.
Quality of vision
Seeing functions involving light sensitivity, color vision, contrast sensitivity and the
overall quality of the picture.
Menggunakan Test Ishihara
Hearing function Hearing functions
Sensory functions relating to sensing the presence of sounds and discriminating the
location, pitch, loudness and quality of sounds.
Pemeriksa duduk di depan pasien tidak harus berhadapan, kemudian membisikkan:
• Test Audiometry
 Tes sederhana adalah dengan komunikasi namun menggunakan rendah dan tinggi
suara yang berbeda: Saya sudah lapar, bagaimana dengan Ibu/Bapak?
Vestibular function Vestibular functions
Sensory functions of the inner ear related to position, balance and movement
Although the vestibular system is a very fast sense used to generate reflexes, including
the righting reflex, to maintain perceptual and postural stability, compared to the other
senses of vision, touch and audition, vestibular input is perceived with delay.

Experience from the vestibular system is called equilibrioception. It is mainly used for
the sense of balance and for spatial orientation. When the vestibular system is
stimulated without any other inputs, one experiences a sense of self-motion. For
example, a person in complete darkness and sitting in a chair will sense that he or she
has turned to the left if the chair is turned to the left. A person in an elevator, with
essentially constant visual input, will sense she is descending as the elevator starts to
 descend. There are a variety of direct and indirect vestibular stimuli which can make
people sense they are moving when they are not, not moving when they are, tilted
when they are not, or not tilted when they are.
Sensations associated with hearing and vestibular function
Sensations of dizziness, falling, tinnitus and vertigo.
Taste function Taste function
Sensory functions of sensing qualities of bitterness, sweetness, sourness and saltiness.
Kedua mata pasien ditutup
Memberikan rasa manis gula dan rasa asin garam
Smell function Smell function
Sensory functions of sensing odors and smells.
Kedua mata pasien ditutup
Menciumkan bau teh dan kopi
Proprioceptive Proprioceptive function
function Sensory functions of sensing the relative position of body parts
Propriosepsi lengkap menilai:
• posisi sendi
• arah gerak (kinesthesia)
• force /power (tenaga)
Kedua mata pasien ditutup
• Tanyakan posisi bagian tubunhnya
• Tanyakan arah gerak bagian tubuhnya
• Berikan benda ringan dan berat, minta untuk memegang di tangan. Tenaga yang
dikerahkan harus sesuai dengan berat benda.
Light Touch function Touch function
Sensory functions of sensing surfaces and their texture or quality
Kedua mata pasien ditutup
Memberikan pasien untuk meraba kertas tissue untuk lap tangan. Tanyakan kualitas
dan texture kertas
Temperature function Sensitivity to temperature
Sensory functions of sensing cold and heat.
Kedua mata pasien ditutup
Minta mencelupkan tangan ke air yang bervariasi temperaturnya (air es, air biasa, air
hangat)
Musculoskeletal Pain Generalized pain
Kwalitas Nyeri Sensation of unpleasant feeling indicating potential or actual damage to some body
• Burning: nyeri seperti structure felt all over, or throughout the body.
panas Anamnesis* NRS
• Sharp: nyeri tajam Pain dengan NRS pada pasien yang terminal-ill atau palliative-care
• Aching: sakit Pain in body part
• Dull: nyeri tumpul Sensation of unpleasant feeling indicating potential or actual damage to some body
• Stabbing: nyeri seperti structure felt in a specific part, or parts, of the body
ditusuk-tusuk Anamnesis and PF* NRS
• Radiating: nyeri yang Pain in multiple body parts
menjalar Unpleasant sensation indicating potential or actual damage to some body structure
• Throbbing: nyeri located in several body parts.
mendenyut Anamnesis dan PF* NRS
• Cramping: kram
• Shooting: linu

Neurogenic Pain Radiating pain in a dermatome

Unpleasant sensation indicating potential or actual damage to some body structure
located in areas of skin served by the same nerve root.
Anamnesis dan PF. Jelaskan nyeri dari mana kemana. NRS
Radiating pain in a segment or region
Unpleasant sensation indicating potential or actual damage to some body structure
located in areas of skin in different body parts not served by the same nerve root
Anamnesis dan PF. Jelaskan luas nyeri. NRS
VOICE AND SPEECH FUNCTIONS
Voice functions Production of voice
Functions of the production of sound made through coordination of the larynx and
surrounding muscles with the respiratory system
Quality of voice
Functions of the production of characteristics of voice including pitch, resonance and
other features.
Articulation functions Articulation functions
Functions of the production of speech sounds.
Fluency and rhythm of Fluency of speech
speech functions Functions of the production of smooth, uninterrupted flow of speech.
Rhythm of speech
Functions of the modulated, tempo and stress patterns in speech.
Speed of speech
Functions of the rate of speech production.
Melody of speech
Functions of modulation of pitch patterns in speech.
Alternative vocalization Production of notes
functions Functions of production of musical vocal sounds
Making a range of sounds
Functions of production of a variety of vocalizations, such as babbling in children

FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND

RESPIRATORY SYSTEM
Functions of the cardiovascular system
Heart functions Heart functions
Functions of pumping the blood in adequate or required amounts and pressure
throughout the body.
PF gallops, mur-mur
PP EF pada pemeriksaan echocardiography
 A normal ejection
Heart rate
fraction is about 50%
Functions related to the number of times the heart contracts every minute.
to 75%, according to
PF HR
the American Heart
Heart rhythm
Association.
Functions related to the regularity of the beating of the heart.
 A borderline ejection
PF BJ regular, ritmis,
fraction can range
Contraction force of ventricular muscles
between 41% and 50%
Functions related to the amount of blood pumped by the ventricular muscles during
every beat
PF BJ kuat, lemah
Blood supply to the heart
Functions related to the volume of blood available to the heart muscle.
PP Cor Angiography, Echocardiography
Blood vessel Functions of arteries
functions functions related to blood flow in the arteries
PF pemeriksaan denyut nadi arteri (misalnya di a. dorsalis pedis)
Ankle Brachial Index (ABI)
Functions of capillaries
Functions related to blood flow in the capillaries.
CRT <2 sec
Functions of veins
Functions related to blood flow in the veins, and the functions of valves of veins.
JVP 5 H2O
PP Doppler Ultrasonography
Blood pressure Blood pressure functions
functions Functions of maintaining the pressure of blood within the arteries.
 Tekanan darah mmHg (dengan obat atau tanpa obat)
Functions of the hematological and immunological systems
Haematological Production of blood
system functions Functions related to the production of blood and all its constituents
Hasil Lab: (Eritrosit, leukosit dan thrombosit termasuk darah muda)
Oxygen-carrying functions of the blood
Functions related to the blood's capacity to carry oxygen throughout the body
• Hasil Lab: (Hb, anemnia atau polisitemia vera)
• Saturasi Oksigen
Immunological Functions of the body related to protection against foreign substances, including
system functions infections, by specific and non-specific immune responses.
Lab: (AIDS, Leukopenia, Immunoglobulin, Interleukin)
Functions of the respiratory system
Respiration functions Respiration rate
Functions related to the number of breaths taken per minute.
PF Pernafasan per menit
Respiratory rhythm
Functions related to the periodicity and regularity of breathing
PF irama pernafasan: ritmik atau arithmic
Dibedakan dalam Pola Pernafasan
 Eupnea (normal)
 Pendek dangkal (restriksi),
 Expirasi memanjang (obstruksi),
 Kussmaul (sentral),
 Dalam dan cepat (metabolic)
 Paradoxical breathing (chest wall disorder, kelemahan otot pernafasan)
Depth of respiration
Functions related to the volume of expansion of the lungs during breathing
Diukur melalui:
Spirometri
Bila tidak ada bisa digunakan:
Single Breath Counting Test atau
Chest expansion (pastikan tidak ada thorax cage deformity or rigidity)
Respiratory muscle Respiratory muscle functions
functions Functions of the muscles involved in breathing.
The static respiratory pressures, Maximal Inspiratory Pressure (MIP or PIMAX) and
Maximal Expiratory Pressure (MEP or PEMAX) are a way to non-invasively assess
respiratory muscle strength.
Diukur menggunakan Respiratory Muscle Strength
Additional respiratory functions
Additional functions related to breathing, such as coughing, sneezing and yawning
Diukur melalui:
Peak Cough Flow
Peak Flow Meter
Additional functions and sensations of the cardiovascular and respiratory systems
Exercise tolerance General physical endurance
functions Functions related to the general level of tolerance of physical exercise or stamina.
Diukur melalui Exercise Testing
Salah satunya menggunakan: 6 MWT (Mets)
Aerobic capacity
Functions related to the extent to which a person can exercise without getting out of
breath.
Diukur melalui:
 Sub-maximum test
 Maxium test: CPET dengan atau tanpa helium gas
Fatigability
Functions related to susceptibility to fatigue, at any level of exertion.
Diukur menggunakan:
  Borg Scale
 RPE
Sensations associated Sensations such as missing a heartbeat, palpitation and shortness of breath, sensations
with cardiovascular and of tightness of chest, feelings of irregular beat, dyspnea, air hunger, choking, gagging
respiratory functions and wheezing.

FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS

Functions related to the digestive system
Ingestion functions Sucking
Functions of drawing into the mouth by a suction force produced by movements of the
cheeks, lips and tongue.
Biting
Functions of cutting into, piercing or tearing off food with the front teeth
Chewing
Functions of crushing, grinding and masticating food with the back teeth (e.g. molars).
Manipulation of food in the mouth
Functions of moving food around the mouth with the teeth and tongue.
Salivation
Function of the production of saliva within the mouth.
Swallowing Oral swallowing
Function of clearing the food and drink through the oral cavity at an appropriate rate
and speed
Dievaluasi
• Arah, kecepatan dan ketepatan gerak lidah ke seluruh arah
• Kemampuan gerak, kekuatan dan koordinasi bibir
• Palatum mole menutup penuh
It involves the contraction of the tongue to push the bolus up against the soft palate and
then posteriorly into the oropharynx by both the tongue and the soft palate.
Pharyngeal swallowing
Function of clearing the food and drink through the pharynx at an appropriate rate and
speed
Dievaluasi awal melalui screening test:
• Dry Swallow Test
• Toronto Bed-Side Swallowing Screening Test (TOR-BSST)
• Gugging Swallowing Screen (GUSS)
Asesmen fungsi menelan menggunakan
• Video Fluoroscopy (Golden Standard)
• FEES
Regurgitation and vomiting
Functions of moving food or liquid in the reverse direction to ingestion, from stomach
to esophagus to mouth and out.
Defecation functions Elimination of feces
Functions of the elimination of waste from the rectum, including the functions of
Bristol Stool Chart contraction of the abdominal muscles in doing so.
• Tipe 1-2 menunjukan Kemampuan untuk defekasi secara spontan atau menggunakan obat atau maneuver
konstipasi Menanyakan apakah setelah defekasi merasa tuntas
• Tipe 3-4 feses ideal Fecal consistency
• Tipe 5-7 menunjukkan Consistency of feces such as hard, firm, soft or watery
diare atau urgensi Menggunakan Bristol Stool Chart
Nomal feses tipe 3-4
Frequency of defecation
Functions involved in the frequency of defecation.
Menanyakan fekuensi defekasi
Normal: 3 kali/hari sampai dengan 3 kali/minggu
Fecal continence
Functions involved in voluntary control over the elimination function
Menanyakan mampu mengkontrol sphincter ani; tidak terjadi inkontinensia alvi
Weight maintenance Weight maintenance functions
functions Functions of maintaining appropriate body weight, including weight gain during the
developmental period.
Penambahan atau penurunan Berat Badan selama masa pertumbuhan
Sensations associated Sensation of nausea
with the digestive Sensation of needing to vomit.
system Anamnesis
Feeling bloated
Sensation of distension of the stomach or abdomen.
Anamnesis dan PF
Sensation of abdominal cramp
Sensation of spasmodic or painful muscular contractions of the smooth muscles of the
gastrointestinal tract.
Anamnesis dan PF BU meningkat, bunyi metalik, absen
Functions related to metabolism and the endocrine system
General metabolic Basal metabolic rate
functions Functions involved in oxygen consumption of the body at specified conditions of rest
and temperature
BMR
Carbohydrate metabolism
Functions involved in the process by which carbohydrates in the diet are stored and
broken down into glucose and subsequently into carbon dioxide and water.
Pasien penderita Diabetes Mellitus (tipe apa, sejak kapan dan dalam terapi apa)
Lab darah: Gula darah puasa dan post-prandial
Lab urine : glucose dalam urin
Protein metabolism
Functions involved in the process by which proteins in the diet are converted to amino
acids and broken down further in the body.
Lab darah: protein lengkap (terutama albumin dan globulin)
Lab urine : protein dalam urin
Fat metabolism
Functions involved in the process by which fat in the diet is stored and broken down in
the body.
Lab darah: Cholesterol (total, LDL, HDL) dan Triglyceride
Water, mineral and Water balance
electrolyte balance Functions involved in maintaining the level or amount of water in the body
functions Monitor menggunakan Balans Input-Output Chart
Mineral balance
Functions involved in maintaining equilibrium between intake, storage, utilization and
excretion of minerals in the body.
Electrolyte balance
Functions involved in maintaining equilibrium between intake, storage, utilization and
excretion of electrolytes in the body.
Lab darah: Na, K, Cl, Ca
Thermoregulatory Body temperature
functions Functions involved in regulating the core temperature of the body.
PF temperatur tubuh
Maintenance of body temperature
Functions involved in maintaining optimal body temperature as environmental
temperature changes.
Anamnesis and PF korelasi perubahan temperature ruangan dengan temperature
tubuh (terutama pada SCI T6 ke atas)
Endocrine gland Functions of production and regulation of hormonal levels in the body, including
functions cyclical changes.

GENITOURINARY AND REPRODUCTIVE FUNCTIONS

Urinary functions
Urinary filtration Filtration of urine
function Functions of filtration of urine by the kidneys; anuria or oliguria or polyuria
 PF menggunakan Input-Output Chart 24 jam
Laboratorium: GFR
Urinary collection Collection of urine
functions Functions of collection and storage of urine by the ureters and bladder
Fungsi Penyimpanan Urine (voiding diary pada pasien yang ada keluhan)
• Tidak ada Overactive bladder
• Tidak ada inkontinensia urine karena inkompeten sfinter externa
• Kapasitas bladder normal (350-500 ml)
Urination functions Urination
Functions of voiding the urinary bladder.
PF spontaneous voiding-tuntas, tanpa maneuver
Bila diperlukan: uroflowmetry
Frequency of urination
Functions involved in the number of times urination occurs.
Anamnesis frekuensi miksi; nomal 5-7 kali/24 jam termasuk miksi pada malam hari
(nokturia) 1 kali. (voiding diary)
Urinary continence
Functions of control over urination; such as in stress, urge, reflex, continuous and
mixed incontinence
Anamnesis dan PF adanya
• Stress incontinence
• Urgency with/without incontinence,
• Mixed incontinence
• Reflex voiding
• Incompetence sphincter
• Functional incontinence
Sensations associated Sensations arising from voiding and related urinary functions; sensations of incomplete
with urinary functions voiding of urine, feeling of fullness of bladder
Anamnesis
• Sensasi penuh (100-200ml)
• Sensasi ingin miksi (250-300ml)
• Sensasi kuat ingin miksi (350-400ml)
• Sensasi urgensi (>500ml)
• Sensasi miksi tuntas
Genital and reproductive functions
Sexual functions Mental and physical functions related to the sexual act, including the arousal,
preparatory, orgasmic and resolution stages.
Menstruation functions Functions associated with the menstrual cycle, including regularity of menstruation and
discharge of menstrual fluids.
Sensations associated Sensations arising from sexual arousal, intercourse, menstruation, and related genital
with genital and or reproductive functions.
reproductive functions

NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS

Functions of the joints and bones
Mobility of joint Mobility of joint functions
functions Functions of the range and ease of movement of a joint.
PF ROM
Stability of joint Stability of joint functions
functions Functions of the maintenance of structural integrity of the joints.
PF tes untuk mengevaluasi adanya laxity ligaments
Mobility of bone Mobility of bone functions
functions Functions of the range and ease of movement of the scapula, pelvis, carpal and tarsal
bones; such as frozen scapula and frozen pelvis
Mobilitas dari pelvic girdle, shoulder girdle
Muscle functions
Muscle power functions Muscle power functions
 Functions related to the force generated by the contraction of a muscle or muscle
groups.
PF MMT/MRC otot atau grup otot untuk semua arah gerakan
Muscle tone functions Tone of isolated muscles and muscle groups
Functions related to the tension present in the resting isolated muscles and muscle
groups and the resistance offered when trying to move those muscles passively; such
as in focal dystonia, e.g. torticollis
PF tonus otot
Tone of muscles of one limb
Functions related to the tension present in the resting muscles and muscle groups in
one arm or leg and the resistance offered when trying to move those muscles
passively.
PF Tonus extremitas pada saat otot istirahat atau bila digerakkan secara pasif
• Normal tone
• Hypertone
• Hypotone
Muscle endurance Muscle endurance functions
functions Functions related to sustaining muscle contraction for the required period of time.
Kemampuan otot atau group otot untuk melakukan kontraksi melawan tahanan dalam
waktu tertentu, misalnya:
• membawa barang belanjaan yang berat (muscle endurance di lengan)
• berdiri lama untuk jangka waktu lama (muscle endurance di tungkai).
Movement functions
Motor reflex functions Stretch motor reflex
Functions of involuntary contractions of muscles automatically induced by stretching
PF physiological reflexes
Reflexes generated by noxious stimuli
Functions of involuntary contractions of muscles automatically induced by painful or
other noxious stimuli.
PF withdrawal reflex or facial grimacing in baby
Reflexes generated by other exteroceptive stimuli
Functions of involuntary contractions of muscles automatically induced by external
stimuli other than noxious stimuli.
PF Ice Water Test (untuk melihat lengkung reflex S2-4 intak atau tidak pada SCI)
Involuntary movement Involuntary movement reaction functions
reaction functions Functions of involuntary contractions of large muscles or the whole body induced by
body position, balance and threatening stimuli; functions of postural reactions, righting
reactions, body adjustment reactions, balance reactions, supporting reactions,
defensive reactions
Postural reflex; Postural control is function of posture reaction to maintain balance
Balance test menggunakan Berg Balance Test Scale (BBS)
Control of voluntary Control of simple voluntary movements
movement functions Functions associated with control over and coordination of simple or isolated voluntary
movements.
PF kemampuan melakukan gerakan dasar terkontrol pada UE dan LE
(misalnya gerak fleksi, ekstensi, abduksi, adduksi, internal dan eksternal rotasi bahu)
Control of complex voluntary movements
Functions associated with control over and coordination of complex voluntary
movements.
PF kemampuan melakukan aktivitas tertentu seperti menyisir (shoulder
mempertahankan posisi, elbow memanjang dan memendek sesuai jarak yang
diperlukan, pergelangan tangan mengarahkan serta jari mampu memegang sisi sambil
melakukan aktivitas menyisir).
Pada pasien Stroke yang masih didominasi oleh pola sinergis gunakan pemeriksaan
Fughl Meyer test.
Coordination of voluntary movements
Functions associated with coordination of simple and complex voluntary movements,
performing movements in an orderly combination; right left coordination, coordination
 of visually directed movements, such as eye hand coordination and eye foot
coordination, diadochokinesia
PF tes koordinasi
Tes Eye-Hand –Coordination
pada pasien lesi di otak bisa dilakukan tes melalui virtual reality (VR)
Involuntary movement Involuntary contractions of muscles
functions Functions of unintentional, non- or semi-purposive involuntary contractions of a
muscle or group of muscles, such as those involved as part of a psychological
dysfunction, such as choreatic and athetotic movements.
PF Involuntary movement assessment
Tremor
Functions of alternating contraction and relaxation of a group of muscles around a
joint, resulting in shakiness.
PF Tremor (resting atau intentional tremor)
Gait pattern functions Gait pattern functions
Functions of movement patterns associated with walking, running or other whole body
movements.
Macam-macam Pola jalan:
• Normal gait
• Hemiplegic gait (serta pola kompensasinya berupa sircumduction, hip hiking, back-
ward movement atau excessive lateral pelvic sifting)
• Diplegic gait (spastic)
• Ataxic gait (cerebellar)
• Parkinsonian gait (festinating and propulsive gait)
• Choreiform gait (hyperkinetic gait)
• Waddling gait (Trendelenburg gait - myopathic)
• Steppage gait (neuropathic)
• Antalgic gait
Bila ada kelainan dalam pola jalan perlu dideskripsikan kinetic dan kinematic serta
spatiotemporal characteristic gait dalam tiap phase dari gait cycle:
1. Initial contact
2. Loading response
3. Mid-stance
4. Terminal stance
5. Pre-swing
6. Initial swing
7. Mid-swing
8. Late swing
Sensations related to Sensation of muscle stiffness
muscles and movement Sensation of tightness or stiffness of muscles.
functions PF kekakuan dan atau pemendekkan otot
Sensation of muscle spasm
Sensation of involuntary contraction of a muscle or a group of muscles
PF spasme otot
Sensations related to muscles and movement functions, other specified such as
sensation of muscles heaviness
Pasien merasa berat saat bergerak namun kekuatan ototnya baik
FUNCTIONS OF THE SKIN AND RELATED STRUCTURES
Functions of the skin
Protective functions of Protective functions of the skin
the skin Functions of the skin for protecting the body from physical, chemical and biological
threats.
PF keutuhan serta tidak adanya kelainan pada kulit yang menyebabkan ketidak
mampuan kulit untuk memproteksi jaringan di bawahnya.
Repair functions of the skin
Functions of the skin for repairing breaks and other damage to the skin.
PF adanya gangguan kulit untuk menutup luka
Sensation related to the skin
 Sensations related to the skin such as itching, burning sensation and tingling.

BODY STRUCTURE
YANG DIMAKSUD PADA GANGGUAN BODY STRUCTURE ADALAH KELAINAN ANATOMIS
Structures of the nervous system
Structure of brain Indicate the location
Spinal cord and related structures • more than one region
Structure of meninges • right
Structure of sympathetic nervous system • left
• both sides
Structure of parasympathetic nervous system
• front
The eye, ear and related structures • back
Structure of the eye • proximal
Structure of the ear • distal
Structures involved in voice and speech
Structure of nose
Structure of mouth
Structure of pharynx
Structure of larynx
Structures of the cardiovascular, immunological and respiratory systems
Structure of cardiovascular system
Structure of respiratory system
Structures related to the digestive, metabolic and endocrine systems
Structure of esophagus
Structures related to the genitourinary and reproductive systems
Structure of urinary system
Structure of pelvic floor
Structure of reproductive system
Structures related to movement
Structure of head and neck region
Structure of shoulder region
Structure of upper extremity
Structure of pelvic region
Structure of lower extremity
Structure of trunk
Skin and related structures
Structure of areas of skin

ACTIVITIES AND PARTICIPATION

PEMERIKSAAN ACTIVITIES AND PARTICIPATION DILAKUKAN MELALUI
• OBSERVASI (PENGAMATAN)
• ANAMNESIS MELALUI WAWANCARA (Bila pasien tidak bisa melakukan ditanyakan apa yang menjadi masalah
utama yang dirasakan oleh pasien sehingga aktivitas atau partisipasi tersebut tidak bisa dilakukan)
• PEMERIKSAAN FISIK (untuk mengkonfirmasi body function yang menghambat aktivitas atau partisipasi)
LEARNING AND APPLYING KNOWLEDGE
Purposeful sensory experiences
Watching
Using the sense of seeing intentionally to experience visual stimuli, such as watching a sporting
event or children playing.
Kemampuan memperhatikan sesuatu (misalnya film di TV) dengan seksama secara fokus
Listening
Using the sense of hearing intentionally to experience auditory stimuli, such as listening to a
radio, music or a lecture.
Kemampuan mendengarkan sesuatu (misalnya lagu, cerita) dengan seksama secara fokus
Basic learning
Copying
Imitating or mimicking as a basic component of learning, such as copying a gesture, a sound or
the letters of an alphabet.
Pasien diminta untuk meniru gerakan tubuh tertentu misalkan gerakan melambaikan tangan,
Pasien menirukan suara dan meniru membunyikan huruf a/i/u/e/o/m/r
Rehearsing
Repeating a sequence of events or symbols as a basic component of learning, such as counting
by tens or practicing the recitation of a poem
Pasien diperlihatkan huruf atau angka; diminta untuk menuliskan kembali
Pasien diminta menirukan kalimat (misalnya rajin pangkal pandai) atau deretan angka yang
lebih panjang (misalnya 1-10)
Learning to read
Developing the competence to read written material (including Braille) with fluency and
accuracy, such as recognizing characters and alphabets, sounding out words with correct
pronunciation, and understanding words and phrases
Kemampuan pasien mencapai kompetensi membaca apa yang tertulis.
Pasien diberikan bahan untuk dibaca (sesuaikan dengan umur dan pendidikan) perhatikan
pengucapan yang benar serta intonasinya, memahami kata atau kalimat yang dibaca.
Learning to write
Developing the competence to produce symbols that represent sounds, words or phrases in
order to convey meaning (including Braille writing), such as spelling effectively and using correct
grammar.
Kemampuan pasien mencapai kompetensi merangkai simbol atau huruf menjadi suatu kata
yang mempunyai arti
Pasien diminta untuk menulis huruf, kata, dan kalimat dengan penggunaan gramer yang tepat.
Learning to calculate
Developing the competence to manipulate numbers and perform simple and complex
mathematical operations, such as using mathematical signs for addition and subtraction and
applying the correct mathematical operation to a problem.
Kemampuan pasien mencapai kompetensi memanipulasi angka dalam format matematika
Pasien diberikan soal +/-/:/x diperhatikan kemampuan menghitungnya baik ketepatan maupun
kecepatan menyelesaikan hitungan
Acquiring skills Acquiring basic skills
Learning elementary, purposeful actions, such as learning to manipulate eating utensils, a pencil
or a simple tool.
Pasien diminta untuk mengambil dan memegang alat tulis; perhatian cara memegang dan saat
menggunakannya untuk menulis atau menggambar
Pasien diminta untuk mengambil dan memegang sendok (dan garpu); perhatikan cara
memegang dan saat menggunakan peralatan tersebut untuk menyendok makanan.
Acquiring complex skills
Learning integrated sets of actions so as to follow rules, and to sequence and coordinate one's
movements, such as learning to play games like football or to use a building tool.
Pasien mampu bermain misalnya kartu, ular tangga, halma, monopoli, congklak dsb.
Perhatikan tingkat usia dan kesulitan prehension dan manipulasi tangannya. (disini tidak untuk
menilai ketrampilan dan manipulasi tangannya)
Applying knowledge
Focusing attention
Intentionally focusing on specific stimuli, such as by filtering out distracting noises.
Pasien diminta mencari kartu padanan dari sekian banyak kartu lainnya.
(banyaknya kartu perancu disesuaikan)
Bisa digunakan mencari kacang kedelai merah diantara kacang-kacang tanah lainnya.
Thinking
Formulating and manipulating ideas, concepts, and images, whether goal-oriented or not, either
alone or with others, such as creating fiction, proving a theorem, playing with ideas,
brainstorming, meditating, pondering, speculating, or reflecting.
Pasien dapat diajak bermain monopoli atau scramble untuk melihat kemampuan fokus atensi,
mempunyai ide, konsep dan image dan juga membuat strategi kemenangan
Reading
Performing activities involved in the comprehension and interpretation of written language (e.g.
books, instructions or newspapers in text or Braille), for the purpose of obtaining general
knowledge or specific information.
Pasien diberikan bahan bacaan yang disesuaikan dengan tingkat kemampuan dan usia. Diminta
untuk menceritakan kembali apa yang dibaca untuk mengetahui pemahaman pasien.

Untuk pasien dewasa dapat diberikan contoh sbb:

Dievaluasi kemampuan memahami yang dibaca secara rinci apa yang tertulis; misalnya ini obat
Amlodipin 5 mg yang diminum setiap pagi pada waktu yang sama boleh sebelum atau sesudah
makan selama 10 hari.
 Writing
Using or producing symbols or language to convey information, such as producing a written
record of events or ideas or drafting a letter.
Pasien diberikan sebuah gambar yang harus dituliskan apa cerita pada gambar tersebut.

Untuk pasien dewasa bisa diberikan gambar dibawah ini untuk dituliskan apa yang pasien lihat
(bergabung dengan kemampuan fungsi kognitif)

Calculating
Performing computations by applying mathematical principles to solve problems that are
described in words and producing or displaying the results, such as computing the sum of three
numbers or finding the result of dividing one number by another.
Pasien diberikan simulasi berbelanja ke supermarket
Barang yang dibeli 2 botol minyak goreng 2L dengan harga Rp.40.000/2L; 2 kg telur ayam
dengan harga 30.000/kg dan 3 kg beras dengan harga Rp 15.000/kg.
Uang yang dimiliki Rp. 200.000,-
Adakah sisa uangnya?
Solving Solving simple problems
problems Finding solutions to a simple problem involving a single issue or question, by identifying and
analyzing the issue, developing solutions, evaluating the potential effects of the solutions and
executing a chosen solution.
Ditanyakan solusi mengenai beberapa hal dibawah ini:
Saat membeli obat di apotek, resep dokternya lupa dibawa. Bagaimanakah solusinya?
Saat berbelanja di mini market, ternyata uang yang dibawa kurang. Bagaimanakah solusinya?
Solving complex problems
Finding solutions to a complex problem involving multiple and interrelated issues, or several
related problems, by identifying and analyzing the issue, developing solutions, evaluating the
potential effects of the solutions and executing a chosen solution.
Di pertengahan bulan sisa uang untuk makan sehari-hari tinggal Rp. 500.000,- ; ternyata motor
rusak harus di perbaiki dengan biaya Rp. 150.000,- dan dari sekolah anak ada kegiatan
 extrakulikuler dengan biaya Rp. 100.000,-.
Bagaimana cara mengatasinya?
Making decisions
Making a choice among options, implementing the choice, and evaluating the effects of the
choice, such as selecting and purchasing a specific item, or deciding to undertake and
undertaking one task from among several tasks that need to be done.
Pasien ada pertemuan penting di suatu tempat, namun di tengah jalan motor yang pasien
gunakan mogok. Sementara pasien hanya mempunyai 30 menit lagi dari waktu pertemuan. Apa
yang akan pasien lakukan? (Pasien boleh memberikan jawaban secara bebas, namun bila tidak
bisa menjawab dapat diberikan pilihan sebagai berkut:
• Pasien akan pergi ke bengkel untuk memperbaiki motor terlebih dahulu?
• Pasien akan menelpon ke tempat pertemuan untuk memberitahukan kondisinya saat ini?
• Pasien akan menitipkan motor di tempat parkir dan menggunakan transportasi umum untuk
mencapai tempat pertemuan.

Pasien sedang memasak untuk makan siang anak-anak, namun gas elpiji habis dan di rumah
uang sisa tinggal Rp 20.000,- Apa yang akan pasien lakukan? (Pasien boleh memberikan jawaban
secara bebas, namun bila tidak bisa menjawab dapat diberikan pilihan sebagai berkut:
Pasien akan meminjam uang tetangga untuk membeli Gas Elpiji.
Pasien akan membeli makanan siap saji dengan uang yang ada
Pasien menelpon anak-anak agar membeli makanan di perjalanan pulang.

GENERAL TASKS AND DEMANDS

Undertaking a Undertaking a simple task
single task Preparing, initiating and arranging the time and space required for a simple task; executing a
simple task with a single major component, such as reading a book, writing a letter, or making
one’s bed.
Pasien diminta untuk cuci tangan hingga mengeringkannya.
(monitoring tahapan prosedural kegiatan mencuci tangan sampai mengeringkan)
Undertaking a complex task
Preparing, initiating and arranging the time and space for a single complex task; executing a
complex task with more than one component, which may be carried out in sequence or
simultaneously, such as arranging the furniture in one's home or completing an assignment for
school.
Pasien menelpon restoran cepat saji untuk memesan makanan siang bagi anak2nya
(Monitoring tahapan ingin memesan makanan apa, jenis dan jumlah makanan sesuaikah dengan
jumlah anak2nya, mencari nomor telpon atau menggunakan jasa online sampai selesai
bagaimana cara bayarnya)
Undertaking Undertaking multiple tasks independently
multiple tasks Preparing, initiating and arranging the time and space for multiple tasks, and managing and
executing several tasks together or sequentially, on one’s own and without the assistance of
others.
Pasien diberikan tugas untuk merencanakan kegiatan pertemuan.
(Monitoring kemampuan untuk merencanakan tempatnya, jumlah orang yang diundang,
menyusun menu dan banyaknya makanan dan minuman yang harus disediakan berdasarkan
jumlah undangan dan lamanya pertemuan dan bagaimana mengatur semua pelaksanaannya
termasuk merinci budget yang diperlukan).
Undertaking multiple tasks in a group
Preparing, initiating and arranging the time and space for multiple tasks, and managing and
executing several tasks together or sequentially with others who are involved in some or all
steps of the multiple tasks.
Pasien diberikan tugas untuk merencanakan piknik bersama.
(Monitoring kemampuan untuk memulai dari jumlah orang yang ikut serta, tempat tujuan,
transportasi kesana, apa saja yang diperlukan, membagikan tugas pada setiap orang yang ikut
serta, mana yang harus dipersiapkan terlebih dahulu dan mana yang pada saat hari pikniknya
dan mana yang harus diselesaikan saat sudah kembali)
Carrying out Managing daily routine
daily routine Carrying out simple or complex and coordinated actions in order to plan and manage the
requirements of day-to-day procedures or duties.
 Ditanyakan kegiatan hariannya apa dan bagaimana mempersiapkannya.
Contohnya:
Memasak sarapan untuk anak2 dan suaminya. Kapan makanan harus sudah selesai?
Perencanaan masak makanan apa hari itu, bahan2 apa saja yang diperlukan, apakah bahan
makanan sudah dibeli sehari sebelumnya, , berapa lama diperlukan untuk menyelesaikannya?
Oleh karena itu ia harus bangun pagi itu pukul berapa?

Pergi bekerja atau sekolah/kuliah. Masuk pukul berapa?

Berapa lama waktu yang diperlukan untuk membersihkan diri, berpakaian, menyiapkan tas dan
barang yang diperlukan, sarapan pagi, transportasi yang digunakan, lama perjalanan menuju
kantor / sekolah dengan memperhitungkan juga kemacetan di jalan.
Oleh karena itu ia harus bangun pagi itu pukul berapa?
Completing the daily routine
Carrying out simple or complex and coordinated actions in order to complete the requirements
of day-to-day procedures or duties.
Diberikan tugas:
Hari ini anak pulang dengan baju seragam kotor. Saat dicuci hari hujan sepanjang hari sehingga
sampai malam baju belum juga kering, sedangkan anaknya masuk sekolah pagi pk. 07.00
dengan lama perjalanan sekitar 25 menit dengan angkutan kota dari rumah.
Apa dan bagaimana solusi?

Pasien selalu pergi mengantar anak yang berusia 8 tahun ke sekolah setiap pagi dengan motor
sebelum pergi ke kantor. Namun besok ada acara kantor yang mendapat kunjungan tamu
penting sehingga pukul 07.00 sudah harus bersiap di kantor.
Apa dan bagaimana solusinya?

Communicating - receiving
Receiving - spoken messages
Comprehending literal and implied meanings of messages in spoken language, such as
understanding that a statement asserts a fact or is an idiomatic expression
Membacakan suatu berita. Pasien diminta untuk menyampaikan kembali yang didengar melalui
kalimatnya sendiri:
Susi Susanti berhasil memenangkan medali emas untuk Bulu Tangkis Tunggal Putri di Olimpiade
Musim Panas 1992 di Barcelona, Spanyol. Susi merupakan peraih medali emas pertama di
pertandingan Olimpiade untuk Indonesia.
Receiving - nonverbal messages
Comprehending the literal and implied meanings of messages conveyed by gestures, symbols
and drawings, such as realizing that a child is tired when she rubs her eyes or that a warning bell
means that there is a fire
Pasien diminta mengartikan simbol-simbol ini :
Dilarang merokok

Toilet untuk pria dan wanita

 Receiving - written messages
Comprehending the literal and implied meanings of messages that are conveyed through
written language (including Braille), such as following political events in the daily newspaper or
understanding the intent of religious scripture.

Gletser yang merupakan bongkahan es raksasa yang terbentuk selama ratusan atau ribuan
tahun diperkirakan akan mencair dengan kecepatan yang mengkhawatirkan seiring dengan
kondisi Bumi yang kian memanas. Selain menyebabkan permukaan laut naik, Tim dari
Universitas Aberystwyth memperkirakan situasi tersebut dapat mengakibatkan lebih dari
100.000 ton mikroba, termasuk bakteri, terlepas ke sungai dan danau dalam 80 tahun ke depan.
Ahli mikrobiologi, Arwyn Edwards, mengatakan dalam hasil penelitiannya mikroorganisme
dalam skala sangat besar hidup di permukaan atau terkunci di dalam gletser Bumi.

Q.S. An-Najm ayat 45: Dan bahwasanya Dialah yang menciptakan berpasang-pasangan pria dan
wanita.
Communicating - producing
Speaking
Producing words, phrases and longer passages in spoken messages with literal and implied
meaning, such as expressing a fact or telling a story in oral language.
Pasien diminta menceritakan aktivitas dari pagi hari sampai sore hari
(Perhatikan terhadap tahapan kejadian, penggunaan kalimat dengan gramatik yang benar).
Producing nonverbal messages
Using gestures, symbols and drawings to convey messages, such as shaking one's head to
indicate disagreement or drawing a picture or diagram to convey a fact or complex idea;
including producing body gestures, signs, symbols, drawings and photographs
Bagaimana memberikan tanda: “Jangan Berisik”

Writing messages
Producing the literal and implied meanings of messages that are conveyed through written
language, such as writing a letter to a friend.
Pasien diminta untuk menulis pesan tertulis kepada Guru Sekolah untuk memintakan izin
anaknya untuk tidak masuk hari ini karena tidak ada yang mengantar.
atau
Menuliskan pesan singkat kepada teman bahwa ia datang sedikit terlambat ke pertemuan
karena jalanan macet.
Conversation and use of communication devices and techniques
Conversation
Starting, sustaining and ending an interchange of thoughts and ideas, carried out by means of
spoken, written, sign or other forms of language, with one or more people one knows or who
are strangers, in formal or casual settings.
Bercakap-cakap dengan dokter tentang suatu topik. Misalkan soal pekerjannya, kuliah, hobi.
 (pewawancara harus memiliki pengetahuan soal topik tersebut)
Using communication devices and techniques
Using devices, techniques and other means for the purposes of communicating, such as calling a
friend on the telephone.
Pasien diminta untuk menelpon temannya menggunakan Hand-phone
Pasien diminta untuk membuka pesan singkat yang masuk di telepon seluler
Pasien diminta untuk menjawab telepon yang masuk

MOBILITY
Pemeriksaan disini memerlukan
• Observasi
• Wawancara; pada aktivitas yang tidak dapat dilakukan tanyakan kesulitan pasien apa?
Changing and maintaining body position
Changing basic Lying down
body position Getting into and out of a lying down position or changing body position from horizontal to any
other position, such as standing up or sitting down.
Pasien diminta untuk mengubah posisi dari supine bangun ke arah duduk dan sebaliknya, posisi
supine miring ke sisi kanan atau kiri.
Squatting
Getting into and out of the seated or crouched posture on one's haunches with knees closely
drawn up or sitting on one's heels, such as may be necessary in toilets that are at floor level, or
changing body position from squatting to any other position, such as standing up.
Pasien diminta untuk jongkok dari posisi berdiri atau duduk dan sebaliknya.
Kneeling
Getting into and out of a position where the body is supported by the knees with legs bent, such
as during prayers or changing body position from kneeling to any other position, such as
standing up.
Pasien diminta untuk berlutut dan berdiri kembali seperti saat shalat atau berdoa
Sitting
Getting into and out of a seated position and changing body position from sitting down to any
other position, such as standing up or lying down.
Pasien diminta duduk dari posisi berdiri dan sebaliknya
Standing
Getting into and out of a standing position or changing body position from standing to any other
position, such as lying down or sitting down.
Pasien diminta untuk berdiri dari posisi duduk atau berbaring dan sebaliknya.
Bending
Tilting the back downwards or to the side, at the torso, such as in bowing or reaching down for
an object.
Pasien diminta untuk membungkuk mengambil barang di bawah atau ruku’
Shifting the body's center of gravity
Adjusting or moving the weight of the body from one position to another while sitting, standing
or lying, such as moving from one foot to another while standing.
Pasien diminta untuk mempertahankan posisi dengan mengubah CoG, dalam posisi duduk atau
berdiri sway ke kiri-kanan-depan-belakang.
Maintaining a Maintaining a lying position
body position Staying in a lying position for some time as required, such as remaining in a prone position in a
bed.
Pasien diminta untuk mempertahankan posisi berbaring supine atau prone selama 1-5 menit
Maintaining a squatting position
Staying in a squatting position for some time as required, such as when sitting on the floor
without a seat.
Pasien diminta untuk berjongkok selama1-5 menit
Maintaining a kneeling position
Staying in a kneeling position where the body is supported by the knees with legs bent for some
time as required, such as during prayers in church.
Pasien diminta untuk mempertahankan posisi berlutut selama 1-5 menit
Maintaining a sitting position
 Staying in a seated position, on a seat or the floor, for some time as required, such as when
sitting at a desk or table.
Pasien diminta mempertahankan posisi duduk di lantai selama 1-5 menit
Maintaining a standing position
Staying in a standing position for some time as required, such as when standing in a queue.
Pasien diminta untuk mempertahankan posisi berdiri selama 1-5 menit
Transferring Transferring oneself while sitting
oneself Moving from a sitting position on one seat to another seat on the same or a different level, such
as moving from a chair to a bed; moving from a chair to another seat, such as a toilet seat;
moving from a wheelchair to a car seat
Pasien diminta untuk bergeser dalam posisi duduk, misalnya dari tempat tidur ke kursi, dari
kursi ke kursi yang lain atau toilet seat atau car seat
Transferring oneself while lying
Moving from one lying position to another on the same or a different level, such as moving from
one bed to another.
Pasien diminta untuk bergeser tempat dalam posisi berbaring
Carrying, moving and handling objects
Lifting and Lifting
carrying objects Rising up an object in order to move it from a lower to a higher level, such as when lifting a glass
from the table.
Pasien diminta untuk mengangkat objek seperti gelas dari meja ke atas dan sebaliknya
Carrying in the hands
Taking or transporting an object from one place to another using the hands, such as when
carries a drinking glass or a suitcase.
Pasien diminta untuk membawa gelas atau cangkir ke tempat lain
Carrying in the arms
Taking or transporting an object from one place to another using the arms and hands, such as
when carries a child.
Pasien diminta untuk memindahkan barang dengan menggunakan lengan bawah dan tangan
seperti menggendong anak
Carrying on shoulders, hip and back
Taking or transporting an object from one place to another uses the shoulders, hip or back, or
some combination of these, such as when carries a large parcel.
Pasien diminta untuk memanggul barang yang besar, seperti membawa tas ransel
Putting down objects
Using hands, arms or other parts of the body to place an object down on a surface or place,
such as when lower a container of water to the ground.
Pasien diminta untuk menurunkan barang menggunakan tangan, lengan dan bagian tubuh lain
seperti menurunkan gallon air ke lantai
Moving objects Pushing with lower extremities
with lower Using the legs and feet to exert a force on an object to move it away, such as pushing a chair
extremities away with a foot.
Pasien diminta untuk mendorong/menggeser kursi atau objek lain dengan kaki
Kicking
Using the legs and feet to propel something away, such as kicking a ball.
Pasien diminta untuk menendang bola atau barang dengan kaki
Fine hand use Picking up
Lifting or taking up a small object with hands and fingers, such as when picking up a pencil.
Pasien diminta mengambil pulpen/pensil dengan jari tangan
Grasping
Using one or both hands to seize and hold something, such as when grasping a tool or a door
knob.
Pasien diminta untuk menggenggam obeng atau gagang pintu
Manipulating
Using fingers and hands to exert control over, direct or guide something, such as when handling
coins or other small objects.
Pasien diminta untuk meraih dan memanipulasi koin/kancing masuk pada tempatnya
Releasing
 Using fingers and hands to let go or set free something so that it falls or changes position, such
as when dropping an item of clothing.
Pasien diminta untuk melepaskan/menjatuhkan baju ke tempat cucian atau ke lantai.
Hand and arm Pulling
use Using fingers, hands and arms to bring an object towards oneself, or to move it from place to
place, such as when pulling a door closed.
Pasien diminta untuk menutup pintu.
Pushing
Using fingers, hands and arms to move something from oneself, or to move it from place to
place, such as when push an animal away.
Pasien diminta untuk mendorong barang menjauh dengan menggunakan tangan dan lengan
Reaching
Using the hands and arms to extend outwards and touch and grasp something, such as when
reaching across a table or desk for a book.
Pasien diminta untuk meraih barang di atas meja mendekat
Turning or twisting the hands or arms
Using fingers, hands and arms to rotate, turn or bend an object, such as is required to use tools
or utensils.
Pasien diminta untuk memutar kunci
Throwing
Using fingers, hands and arms to lift something and propel it with some force through the air,
such as when tossing a ball.
Pasien diminta untuk melempar bola tenis atau bola volley
Catching
Using fingers, hands and arms to grasp a moving object in order to bring it to a stop and hold it,
such as when catching a ball.
Pasien diminta untuk menangkap bola
Carrying, Pasien diminta untuk mengambil barang, mengangkat dan membawa ke tempat lain.
moving and Misalnya pasien diminta untuk mengambil minuman untuk tamu di rumah. Berarti pasien harus
handling mampu menuangkan air ke dalam gelas dan membawanya diatas baki ke ruang tamu.
objects
Walking and moving
Pemeriksaan disini didapatkan melalui:
• Wawancara (bila pasien tidak bisa melakukan tanyakan apa yang pasien rasakan menjadi penyebab)
• PF konfirmasi apakah yang pasien rasakan sebagai hambatan memang terganggu atau ada hal lain yang
menyebabkannya.
Walking short distances
Walking for less than a kilometer, such as walking around rooms or hallways, within a building
or for short distances outside.
Kemampuan jalan < 1 km
Walking long distances
Walking for more than a kilometer, such as across a village or town, between villages or across
open areas.
Kemampuan jalan di area terbuka > 1 km
Walking on different surfaces
Walking on sloping, uneven, or moving surfaces, such as on grass, gravel or ice and snow, or
walking aboard a ship, train or other vehicle.
Kemampuan jalan di permukaan tidak rata, dipermukaan yang sedang berjalan (seperti
berpindah tempat di lift yang sedang berjalan, di atas kereta api yang sedang berjalan). di
rumput, bebatuan dsb.
Walking around obstacles
Walking in ways required to avoid moving and immobile objects, people, animals, and vehicles,
such as walking around a marketplace or shop, around or through traffic or other crowded
areas.
Kemampuan berjalan di keramaian seperti pasar/supermarket/mal atau kerumunan orang
Moving around Crawling
Moving the whole body in a prone position from one place to another on hands, or hands and
arms, and knees.
 Kemampuan merangkak
Climbing
Moving the whole body upwards or downwards, over surfaces or objects, such as climbing
steps, rocks, ladders or stairs, curbs or other objects.
Kemampuan naik turun tangga
Running
Moving with quick steps so that both feet may be simultaneously off the ground.
Kemampuan berlari
Jumping
Moving up off the ground by bending and extending the legs, such as jumping on one foot,
hopping, skipping and jumping or diving into water.
Kemampuan loncat dengan satu atau dua kaki
Swimming
Propelling the whole body through water by means of limb and body movements without
taking support from the ground underneath.
Kemampuan berenang
Moving around Moving around within the home
in different Walking and moving around in one's home, within a room, between rooms, and around the
locations whole residence or living area.
Kemampuan berjalan berkeliling di dalam rumah
Moving around within buildings other than home
Walking and moving around within buildings other than one's residence, such as moving around
other people's homes, other private buildings, community and private or public buildings and
enclosed areas.
Kemampuan berjalan berkeliling di dalam mal
Moving around outside the home and other buildings
Walking and moving around close to or far from one's home and other buildings, without the
use of transportation, public or private, such as walking for short or long distances around a
town or village.
Kemampuan berjalan ke rumah tetangga atau ke mesjid (yang ditempuh dengan jalan kaki)
Moving around Moving around using equipment
using Moving the whole body from place to place, on any surface or space, by using specific devices
equipment designed to facilitate moving or create other ways of moving around, such as with skates, skis,
or scuba equipment, or moving down the street in a wheelchair or a walker
Kemampuan berkeliling dari satu tempat ke tempat lain dengan bantuan alat jalan (seperti
walker atau kursi roda)
Moving around using transportation
Using Using private motorized transportation
transportation Being transported as a passenger by private motorized vehicle over land, sea or air, such as by a
taxi or privately owned aircraft or boat.
Kemampuan menggunakan kendaraan bermotor sebagai penumpang
Using public motorized transportation
Being transported as a passenger by a motorized vehicle over land, sea or air designed for public
transportation, such as being a passenger on a bus, train, subway or aircraft.
Kemampuan menggunakan transportasi umum
Driving Driving human-powered transportation
Driving a human-powered vehicle, such as a bicycle, tricycle, or rowboat.
Kemampuan mengendarai sepeda
Driving motorized vehicles
Driving a vehicle with a motor, such as an automobile, motorcycle, motorboat or aircraft
Kemampuan menyetir mobil atau sepeda motor

SELF-CARE
Pada pemeriksaan self-care dipastikan pasien tidak ada masalah di executive function
Pemeriksaan disini melalui
• Wawancara
• Observasi
• PF untuk mengkonfirmasi adanya gangguan body function yang menyebabkannya
Washing Washing body parts
oneself Applying water, soap and other substances to body parts, such as hands, face, feet, hair or nails,
in order to clean them.
(contoh wawancara untuk self-care)
Apakah pasien mengalami kesulitan saat berwudhu,
Apakah pasien mengalami kesulitan mencuci muka/kaki/ tangan dengan sabun?
Apa yang pasien rasakan sebagai penyebab?
Washing whole body
Applying water, soap and other substances to the whole body in order to clean oneself, such as
taking a bath or shower.
Apakah pasien mengalami kesulitan saat mandi?
Bagaimana cara pasien mandi? Mengunakan gayung, timba atau shower?
Bila tidak bisa mandi sendiri apa yang pasien rasakaan sebagai penyebab?
Drying oneself
Using a towel or other means for drying some part or parts of one's body, or the whole body,
such as after washing.
Apakah pasien mengalami kesulitan saat mengeringkan sebagian atau seluruh badan?
Caring for body Caring for skin
parts Looking after the texture and hydration of one's skin, such as by removing calluses or corns and
using moisturizing lotions or cosmetics.
Apakah pasien mengalami kesulitan saat memelihara kelembaban kulit menggunakan body
lotion atau pelembab kulit atau sunblock?
Caring for teeth
Looking after dental hygiene, such as by brushing teeth, flossing, and taking care of a dental
prosthesis or orthotics.
Apakah pasien mengalami kesulitan menggosok gigi, membersihkan gigi dengan benang gigi,
atau memasang/melepaskan gigi palsu.
Caring for hair
Looking after the hair on the head and face, such as by combing, styling, shaving, or trimming.
Apakah pasien mengalami kesulitan saat menyisir, menggunakan krim rambut, mencukur
kumis/jenggot?
Caring for fingernails
Cleaning, trimming or polishing the nails of the fingers.
Apakah pasien mengalami kesulitan saat membersihkan kuku, menggunting atau mencat kuku
tangan?
Caring for toenails
Cleaning, trimming or polishing the nails of the toes.
Apakah pasien mengalmi kesulitan saat membersihkan, menggunting atau mencat kuku kaki?
Toileting Regulating urination
Coordinating and managing urination, such as by indicating need, getting into the proper
position, choosing and getting to an appropriate place for urination, manipulating clothing
before and after urination, and cleaning oneself after urination.
Apakah pasien memiliki kesulitan dalam merasakan keinginan kencing, pergi ke toilet,
menurunkan celana dan memposisikan diri (berdiri, duduk atau jongkok), kencing,
membersihkan diri, mencuci tangan, memakai kembali celana dan merapihkan baju? Bagian
manakah yang sulit? Apa yang pasien rasakan menjadi penyebab?
Regulating defecation
Coordinating and managing defecation such as by indicating need, getting into the proper
position, choosing and getting to an appropriate place for defecation, manipulating clothing
before and after defecation, and cleaning oneself after defecation.
Apakah pasien memiliki kesulitan dalam merasakan keinginan defekasi (Buang Air Besar), pergi
ke toilet, menurunkan celana dan memposisikan diri (duduk atau jongkok), BAB, membersihkan
diri, mencuci tangan, memakai kembali celana dan merapihkan baju? Bagian manakah yang
sulit? Apa yang pasien rasakan menjadi penyebab?
Menstrual care
Coordinating, planning and caring for menstruation, such as by anticipating menstruation and
using sanitary towels and napkins.
Apakah pasien memiliki kesulitan jika sedang menstruasi, baik dalam mengantisipasi datangnya
menstruasi atau dalam menggunakan pembalut?
Dressing Putting on clothes
Carrying out the coordinated tasks of putting clothes on various parts of the body, such as
putting clothes on over the head, over the arms and shoulders, and on the lower and upper
halves of the body; putting on gloves and headgear.
Pasien diminta untuk berpakaian (kaos, kemeja/blus, celana, termasuk memakai hijab dan
topi/penutup kepala).
Taking off clothes
Carrying out the coordinated tasks of taking clothes off various parts of the body, such as pulling
clothes off and over the head, off the arms and shoulders, and off the lower and upper halves of
the body; taking off gloves and headgear.
Pasien diminta untuk menanggalkan pakaian (kaos, kemeja/blus, celana, termasuk memakai
hijab dan topi/penutup kepala)
Putting on footwear
Carrying out the coordinated tasks of putting on socks, stockings and footwear.
Pasien diminta memakai kaus kaki, stocking dan sepatu atau sandal.
Taking off footwear
Carrying out the coordinated tasks of taking off socks, stockings and footwear.
Pasien diminta membuka kaus kaki, stocking dan sepatu atau sandal
Choosing appropriate clothing
Following implicit or explicit dress codes and conventions of one's society or culture and
dressing in keeping with climatic conditions.
Apakah pasien mengalami kesulitan dalam memilih pakaian yang sesuai (keserasian serta sesuai
dengan acara yang dihadiri serta kondisi iklim)
Eating Eating
Carrying out the coordinated tasks and actions of eating food that has been served, bringing it
to the mouth and consuming it in culturally acceptable ways, cutting or breaking food into
pieces, opening bottles and cans, using eating implements, having meals, feasting or dining.
Pasien diminta untuk makan makanan yang sudah disediakan diatas meja; mulai dari
menyendok dan memasukkan makanan ke mulut, menggunakan alat makan yang sesuai,
memotong-motong makanan menjadi lebih kecil, membuka botol atau kaleng bila diperlukan.
Drinking Drinking
Taking hold of a drink, bringing it to the mouth, and consuming the drink in culturally acceptable
ways, mixing, stirring and pouring liquids for drinking, opening bottles and cans, drinking
through a straw or drinking running water such as from a tap or a spring; feeding from the
breast.
Pasien diminta untuk minum dengan cara yang sesuai dengan kebudayaan setempat, mengaduk
dan mencampurkan minuman membuka botol atau kaleng dan menuangkan ke gelas, minum
melalui sedotan. Untuk bayi kemampuan menetek/menyusu.
Looking after Ensuring one’s physical comfort
one’s health Caring for oneself by being aware that one needs to ensure, and ensuring, that one's body is in a
comfortable position, that one is not feeling too hot or cold, and that one has adequate lighting.
Kemampuan pasien untuk memperhatikan kenyaman diri misalnya saat duduk posisi yang
relaks, saat cuaca dingin atau panas menggunakan pakaian yang sesuai, menyesuaikan
pencahayaan saat hari menjelang malam dengan menyalakan lampu dsb.
Managing diet and fitness
Caring for oneself by being aware of the need and by selecting and consuming nutritious foods
and maintaining physical fitness.
Kemampuan pasien memperhatikan kebutuhan diri akan makanan yang bergizi dan kebugaran.

DOMESTIC LIFE
Acquisition of necessities
Acquisition of Shopping
goods and Obtaining, in exchange for money, goods and services required for daily living (including
services instructing and supervising an intermediary to do the shopping), such as selecting food, drink,
cleaning materials, household items or clothing in a shop or market; comparing quality and
price of the items required, negotiating and paying for selected goods or services, and
transporting goods.
• Apakah pasien biasa berbelanja untuk kebutuhan sehari-hari, misalnya makanan, pakaian,
 atau perlengkapan rumah tangga?
• Bila ya, apakah mendapat kesulitan untuk memilih barang yang akan dibeli? Bagaimana cara
pembayarannya? Bagaimana cara membawa barang atau mengirimkan barang tersebut?
• Mengapa pasien merasakan kesulitan untuk berbelanja sendiri?
Gathering daily necessities
Obtaining, without exchange of money, goods and services required for daily living (including
instructing and supervising an intermediate to gather daily necessities), such as by harvesting
vegetables and fruits and getting water and fuel.
• Apakah pasien mudah memperoleh kebutuhan sehari-hari?
• Bila ya, bagaimana cara mendapatkannya?
• Bila tidak, apakah kesulitannya?
Household tasks
Preparing Preparing simple meals
meals Organizing, cooking and serving meals with a small number of ingredients that require easy
methods of preparation and serving, such as making a snack or small meal, and transforming
food ingredients by cutting and stirring, boiling and heating food such as rice or potatoes.
• Apakah pasien mampu menyiapkan makanan sendiri?
• Bila ya, makanan apa yang disiapkan? Bagaimana menyiapkan dan memasaknya? Untuk siapa
sajakah makanan tersebut?
• Mengapa pasien mendapat kesulitan untuk menyiapkan makanan?
Preparing complex meals
Planning, organizing, cooking and serving meals with a large number of ingredients that require
complex methods of preparation and serving, such as planning a meal with several dishes, and
transforming food ingredients by combined actions of peeling, slicing, mixing, kneading, stirring,
presenting and serving food in a manner appropriate to the occasion and culture.
• Apakah pasien mempunyai tugas menyusun menu makanan harian keluarga?
• Bila ya, menu makanan apa yang disiapkan? Bagaimana memasak makanan (sebut jenis
makanan sesuai jawaban pasien) disiapkan, dimasak, dan disajikan?
• Mengapa pasien mendapat kesulitan untuk menyusun menu makanan harian keluarga?
Doing Washing and drying clothes and garments
housework Washing clothes and garments by hand and hanging them out to dry in the air.
• Apakah pasien mencuci dan menjemur pakaian sendiri?
• Bila ya, apakah mencuci dengan tangan atau menggunakan mesin cuci? Apakah mendapat
kesulitan saat mencuci dengan tangan dan menjemurnya?
• Mengapa pasien mendapat kesulitan untuk mencuci dan menjemur pakaian sendiri?
Cleaning cooking area and utensils
Cleaning up after cooking, such as by washing dishes, pans, pots and cooking utensils, and
cleaning tables and floors around cooking and eating area.
• Apakah pasien mencuci peralatan makan (piring, sendok, garpu) dan peralatan masak sendiri?
• Bila ya, apakah membersihkan meja makan dan lantai ruang makan juga?
• Bila tidak, siapa yang membersihkannya?
• Mengapa pasien mendapat kesulitan untuk mencuci peralatan makan dan masak sendiri?
Cleaning living area
Cleaning the living areas of the household, such as by tidying and dusting, sweeping, swabbing,
mopping floors, cleaning windows and walls, cleaning bathrooms and toilets, cleaning
household furnishings.
• Apakah pasien membersihkan rumah sendiri?
• Bila ya, apa saja yang dilakukan saat membersihkan rumah?
• Mengapa pasien mendapat kesulitan untuk membersihkan rumah?
Using household appliances
Using all kinds of household appliances, such as washing machines, driers, irons, vacuum
cleaners and dishwashers.
• Apakah pasien memiliki peralatan rumah tangga seperti mesin cuci atau setrika,
• Bila ya, apakah sering menggunakannya?
• Mengapa pasien mendapat kesulitan untuk menggunakan peralatan tersebut?
Storing daily necessities
Storing food, drinks, clothes and other household goods required for daily living; preparing food
for conservation by canning, salting or refrigerating, keeping food fresh and out of the reach of
animals.
 • Apakah pasien merapihkan dan menyimpan dan makanan atau bahan makanan, pakaian, atau
peralatan rumah tangga?
• Bila ya, bagaimana cara menyimpannya? Dimana menyimpannya (makanan, pakaian dan
peralatan rumah tangga)
• Mengapa pasien mendapat kesulitan untuk menyimpannya?
Disposing of garbage
Disposing of household garbage such as by collecting trash and rubbish around the house,
preparing garbage for disposal, using garbage disposal appliances; burning garbage.
• Bagaimana pasien menangani sampah rumah tangga?
• Apakah pasien yang membuang sampah? Bila sampah dibakar (sebut sesuai jawaban pasien),
apakah pasien yang membakar sampah?
• Bila tidak, siapa yang membuang/membakar (sebut sesuai jawaban pasien) sampah?
• Mengapa pasien mendapat kesulitan untuk membuang/membakar sampah?
Caring for household objects and assisting others
Item dibawah ini hanya diperiksa apabila pasien biasa melakukannya sebelum sakit
Caring for Making and repairing clothes
household Making and repairing clothes, such as by sewing, producing or mending clothes; reattaching
objects buttons and fasteners; ironing clothes, fixing and polishing footwear.
• Apakah pasien dapat membuat pakaian dan memperbaiki pakaian yang rusak/robek/kancing
yang lepas? Apakah dapat menyemir sepatu?
• Bila tidak, siapa yang memperbaikinya?
• Mengapa pasien mendapat kesulitan untuk melakukannya?
Maintaining dwelling and furnishings
Repairing and taking care of dwelling, its exterior, interior and contents, such as by painting,
repairing fixtures and furniture, and using required tools for repair work.
• Bila ada kerusakan rumah seperti genteng bocor, cat dinding luntur, kursi rusak, lampu mati,
apakah pasien yang biasa memperbaiki sendiri?
• Bila tidak, siapa yang memperbaikinya?
• Mengapa pasien mendapat kesulitan untuk memperbaikinya?
Maintaining domestic appliances
Repairing and taking care of all domestic appliances for cooking, cleaning and repairing, such as
by oiling and repairing tools and maintaining the washing machine.
• Bila ada kerusakan peralatan rumah tangga, apakah pasien mampu memperbaikinya?
• Bila tidak, siapa yang memperbaikinya?
• Bila orang lain yang melakukan apa yang pasien lakukan saat ada kerusakan?
Maintaining vehicles
Repairing and taking care of motorized and non-motorized vehicles for personal use, including
bicycles, carts, automobiles and boats.
• Apakah pasien memiliki kendaraaan pribadi (misal mobil, sepeda)?
• Apakah pasien yang merawat kendaraan atau memperbaikinya bila ada kerusakan?
• Bila tidak, siapakah yang melakukannya?
• Mengapa pasien mendapat kesulitan untuk merawat dan memperbaiki kendaraan?
Maintaining assistive devices
Repairing and taking care of assistive devices, such as prostheses, orthotics and specialized tools
and aids for housekeeping and personal care; maintaining and repairing aids for personal
mobility such as canes, walkers, wheelchairs and scooters; and maintaining communication and
recreational aids.
• Apakah pasien menggunakan ortosis/prostesis/alat bantu untuk berjalan dan beraktivitas?
• Bila ya, apakah yang digunakan?
• Apakah pasien mampu merawat dan memperbaiki alat bantu/ganti tersebut?
• Bila tidak, mengapa pasien mendapat kesulitan dalam merawat dan memperbaikinya?
Taking care of plants, indoors and outdoors
Taking care of plants inside and outside the house, such as by planting, watering and fertilizing
plants; gardening and growing foods for personal use.
• Apakah pasien memelihara tanaman?
• Bila ya, apakah pasien yang memelihara tanaman sendiri?
• Bila tidak, mengapa pasien mendapat kesulitan untuk memelihara tanaman?
Taking care of animals
 Taking care of domestic animals and pets, such as by feeding, cleaning, grooming and exercising
pets; watching over the health of animals or pets; planning for the care of animals or pets in
one's absence.
• Apakah pasien mempunyai binatang peliharaan?
• Bila ya, apakah binatang peliharaan yang dimiliki?
• Apakah pasien dapat merawat binatang peliharaan itu sendiri?
• Mengapa pasien mendapat kesulitan untuk merawat dan memelihara binatang tersebut?
Assisting others Assisting household members and others with their learning, communicating, self-care,
movement, within the house or outside; is being concerned about the well-being of household
members and others.
• Apakah pasien tinggal bersama orang lain di rumah?
• Bila ya, apakah pasien yang bertanggung jawab atas kenyamanan anggota keluarga yang lain?
• Apakah pasien mempunyai salah satu peran dalam kehidupan di dalam rumah tangga tsb?
• Apa peran/bantuan pasien dalam keluarga tsb?
• Mengapa pasien sekarang mendapat kesulitan dalam memberikan bantuan?

INTERPERSONAL INTERACTIONS AND RELATIONSHIPS

General interpersonal interactions
Basic interpersonal interactions
Interacting with people in a contextually and socially appropriate manner, such as by showing
consideration and esteem when appropriate, or responding to the feelings of others.
Kemampuan mempunyai empati, memperhatikan kebutuhan orang disekitarnya dan
memberikan respons yang adekuat
Complex interpersonal interactions
Maintaining and managing interactions with other people, in a contextually and socially
appropriate manner, such as by regulating emotions and impulses, controlling verbal and
physical aggression, acting independently in social interactions, and acting in accordance with
social rules and conventions
Kemampuan mencegah terjadinya atau menyelesaikan apabila terdapat konflik dalam
berinteraksi dengan orang disekitarnya.
Particular interpersonal relationships
Membangun relasi dengan orang lain
Bila mendapat kesulitan dalam membangun relasi, perlu ditanyakan kenapa. Apa yang dirasakan pasien menjadi
penyebab hambatan ia membangun relasi dengan orang lain.
Formal relationships
Creating and maintaining specific relationships in formal settings, such as with employers,
professionals or service providers.
Dengan teman sekerja
Informal social relationships
Entering into relationships with others, such as casual relationships with people living in the
same community or residence, or with co-workers, students, playmates or people with similar
backgrounds or professions; such as informal relationships with friends, neighbors,
acquaintances, co-inhabitants and peers
Dengan tetangga, teman seasrama, teman bermain, bekas teman sekelas dsb.
Family relationships
Creating and maintaining kinship relationships, such as with members of the nuclear family,
extended family, foster and adopted family and step-relationships, more distant relationships
such as second cousins, or legal guardians; parent-child and child-parent relationships, sibling
and extended family relationships
Dengan keluarga inti, keluarga jauh, keluarga karena perkawinan
Intimate relationships
Creating and maintaining close or romantic relationships between individuals, such as husband
and wife, lovers or sexual partners.
Dengan pasangan

MAJOR LIFE AREAS

Education
 Informal education
Learning at home or in some other non-institutional setting, such as learning crafts and other
skills from parents or family members, or home schooling
Kemampuan melakukan pembelajaran informal
School education
Gaining admission to school, Education, engaging in all school-related responsibilities and
privileges, and learning the course material, subjects and other curriculum requirements in a
primary or secondary education program, including attending school regularly, working
cooperatively with other students, taking direction from teachers, organizing, studying and
completing assigned tasks and projects, and advancing to other stages of education.
Kemampuan melakukan tugas dan kewajiban sebagai seorang pelajar
Vocational training
Engaging in all activities of a vocational program and learning the curriculum material in
preparation for employment in a trade, job or profession.
Kemampuan untuk mengikuti pelatihan/training pembelajaran khusus
Higher education
Engaging in the activities of advanced educational program in universities, colleges and
professional schools and learning all aspects of the curriculum required for degrees, diplomas,
certificates and other accreditations, such as completing a university bachelor's or master's
course of study, medical school or other professional school.
Kemampuan untuk melakukan tugas dan kewajiban dalam pendidikan di perguruan tinggi atau
pendidikan profesi
Work and employment
Remunerative Self-employment
employment Engaging in remunerative work sought or generated by the individual, or contracted from
others without a formal employment relationship, such as migratory agricultural work, working
as a free-lance writer or consultant, short-term contract work, working as an artist or crafts
person, owning and running a shop or other business.
Kemampuan untuk membuka dan mengelola usaha/perusahaan sendiri
Part-time employment
Engaging in all aspects of work for payment on a part-time basis, as an employee, such as
seeking employment and getting a job, doing the tasks required of the job, attending work on
time as required, supervising other workers or being supervised, and performing required tasks
alone or in groups.
Kemampuan melakukan tugas dan tanggung jawab bekerja sebagai pegawai paruh waktu.
Full-time employment
Engaging in all aspects of work for payment on a full-time basis, as an employee, such as seeking
employment and getting a job, doing the required tasks of the job, attending work on time as
required, supervising other workers or being supervised, and performing required tasks alone or
in groups.
Kemampuan melakukan tugas dan tanggung jawab sebagai pegawai tetap/penuh waktu sesuai
dengan dekripsi kerja yang diharapkan perusahaan kepada pasien.
Non- Engaging in all aspects of work in which pay is not provided, full-time or part-time, including
remunerative organized work activities, doing the required tasks of the job, attending work on time as
employment required, supervising other workers or being supervised, and performing required tasks alone or
in groups, such as volunteer work, charity work, working for a community or religious group
without remuneration, working around the home without remuneration.
Kemampuan melakukan tugas dan tanggung jawab pekerjaan tidak berbayar seperti misalnya
aktif diperkumpulan keagamaan, yayasan amal dsb.
Economic life
Basic economic transactions
Engaging in any form of simple economic transaction, such as using money to purchase food or
bartering, exchanging goods or services; or saving money
Kemampuan pasien untuk melakukan transaksi jual-beli
Complex economic transactions
Engaging in any form of complex economic transaction that involves the exchange of capital or
property, and the creation of profit or economic value, such as buying a business, factory, or
equipment, maintaining a bank account, or trading in commodities
 Kemampuan pasien untuk mengatur keuangan pribadi ataupun keuangan keluarga

COMMUNITY, SOCIAL AND CIVIC LIFE

Apakah pasien mendapat kesulitan dalam menjalankan rekreasi dan waktu senggangnya.
• Seberapa jauh kesulitannya dan
• Apa yang pasien rasakan menjadi penyebab tidak mampu berpartisipasi disini.
Play
Engaging in games with rules or unstructured or unorganized games and spontaneous
recreation, such as playing chess or cards or children's play
Sports
Engaging in competitive and informal or formally organized games or athletic events, performed
alone or in a group, such as bowling, gymnastics or soccer.
Arts and culture
Engaging in, or appreciating, fine arts or cultural events, such as going to the theatre, cinema,
Recreation and
museum or art gallery, or acting in a play, reading for enjoyment or playing a musical
leisure
instrument.
Crafts
Engaging in handicrafts, such as pottery or knitting.
Hobbies
Engaging in pastimes such as collecting stamps, coins or antiques.
Socializing
Engaging in informal or casual gatherings with others, such as visiting friends or relatives or
meeting informally in public places.
Religion and Engaging in religious or spiritual activities, organizations and practices for self-fulfillment,
spirituality finding meaning, religious or spiritual value and establishing connection with a divine power,
such as is involved in attending a church, temple, mosque or synagogue, praying or chanting for
a religious purpose, and spiritual contemplation.
Self-Satisfaction QoL
Dapat menggunakan measurement tool seperti EQ5D

ENVIRONMENTAL FACTORS

Assistive products and technology are defined as any product, instrument, equipment or technology adapted or
specially designed for improving the functioning of a disabled person.
• General product berarti mudah didapat diproduksi secara masal
• Assistive product berarti diproduksi secara khusus atau tailor-made
Products and technology
Products and General products and technology for personal use in daily living;
technology for not adapted or specially designed
personal use in Assistive products and technology for personal use in daily living
daily living Adapted or specially designed equipment, products and technologies that assist people in daily
living, such as prosthetic and orthotic devices, neural prostheses (e.g. functional stimulation
devices that control bowels, bladder, breathing and heart rate), and environmental control units
aimed at facilitating individuals' control over their indoor setting (scanners, remote control
systems, voice-controlled systems, timer switches).
Products and General products and technology for personal indoor and outdoor mobility and transportation;
technology for not adapted or specially designed.
personal indoor Assistive products and technology for personal indoor and outdoor mobility and transportation
and outdoor Adapted or specially designed equipment, products and technologies that assist people to move
mobility and inside and outside buildings, such as walking devices, special cars and vans, adaptations to
transportation vehicles, wheelchairs, scooters and transfer devices.
Products and General products and technology for communication equipment;
technology for not adapted or specially designed.
communication Assistive products and technology for communication
Adapted or specially designed equipment, products and technologies that assist people to send
and receive information, such as specialized vision devices, electro-optical devices, specialized
writing devices, drawing or handwriting devices, signaling systems and special computer
 software and hardware, cochlear implants, hearing aids, FM auditory trainers, voice prostheses,
communication boards, glasses and contact lenses.
Products and General products and technology for education;
technology for not adapted or specially designed.
education Assistive products and technology for education
Adapted and specially designed equipment, products, processes, methods and technology used
for acquisition of knowledge, expertise or skill, such as specialized computer technology.
Products and General products and technology for culture, recreation and sport;
technology for not adapted or specially designed.
culture, Assistive products and technology for culture, recreation and sport
recreation and Adapted or specially designed equipment, products and technology used for the conduct and
sport enhancement of cultural, recreational and sporting activities, such as modified mobility devices
for sports, adaptations for musical and other artistic performance.
Products and General products and technology for the practice of religion or spirituality;
technology for not adapted or specially designed.
the practice of Assistive products and technology for the practice of religion or spirituality
religion and Adapted or specially designed products and technology that are given, or take on a symbolic
spirituality meaning in the context of the practice of religion or spirituality, such as Braille religious books,
and special protection for wheelchair wheels when entering temples.
Design, Design, construction and building products and technology for entering and exiting buildings for
construction public use
and building Products and technology of entry and exit from the human-made environment that is planned,
products and designed and constructed for public use, such as design, building and construction of entries
technology of and exits to buildings for public use (e.g. workplaces, shops and theatres), public buildings,
buildings for portable and stationary ramps, power-assisted doors, lever door handles and level door
public use thresholds.
Desain untuk pintu keluar masuk gedung
Design, construction and building products and technology for gaining access to facilities inside
buildings for public use
Products and technology of indoor facilities in design, building and construction for public use,
such as washroom facilities, telephones, audio loops, lifts or elevators, escalators, thermostats
(for temperature regulation) and dispersed accessible seating in auditoriums or stadiums.
Desain itu fasilitas yang tersedia di dalam gedung
Design, construction and building products and technology for way finding, path routing and
designation of locations in buildings for public use
Indoor and outdoor products and technology in design, building and construction for public use
to assist people to find their way inside and immediately outside buildings and locate the places
they want to go to, such as signage, in Braille or writing, size of corridors, floor surfaces,
accessible kiosks and other forms of directories.
Desain dan ketersediaan petunjuk menuju ke gedung sesuai untuk berbagai disabillitas
Support and relationships
Suport yang dimaksud disini adalah sejauh mana keterlibatan bantuan secara fisik, materi dan non materi yang
diberikan kepada pasien dalam upayanya mendapatkan solusi untuk masalah disabilitasnya.
Immediate family
Individuals related by birth, marriage or other relationship recognized by the culture as
immediate family, such as spouses, partners, parents, siblings, children, foster parents, adoptive
parents and grandparents.
Extended family
Individuals related through family or marriage or other relationships recognized by the culture
as extended family, such as aunts, uncles, nephews and nieces
Friends
Individuals who are close and ongoing participants in relationships characterized by trust and
mutual support.
Personal care providers and personal assistants
Individuals who provide services as required to support individuals in their daily activities and
maintenance of performance at work, education or other life situation, provided either through
public or private funds, or else on a voluntary basis, such as providers of support for home-
making and maintenance, personal assistants, transport assistants, paid help, nannies and
 others who function as primary caregivers.
Services, systems and policies
Health services, Health services
systems and Services and program at a local, community, regional, state or national level, aimed at delivering
policies interventions to individuals for their physical, psychological and social well-being, such as health
promotion and disease prevention services, primary care services, acute care, rehabilitation and
long-term care services; services that are publicly or privately funded, delivered on a short-
term, long-term, periodic or one-time basis, in a variety of service settings such as community,
home-based, school and work settings, general hospitals, specialty hospitals, clinics, and
residential and non-residential care facilities, including those who provide these services.
Ketersediaan pelayanan kesehatan
Health systems
Administrative control and monitoring mechanisms that govern the range of services provided
to individuals for their physical, psychological and social well-being, in a variety of settings
including community, home-based, school and work settings, general hospitals, specialty
hospitals, clinics, and residential and non-residential care facilities, such as systems for
implementing regulations and standards that determine eligibility for services, provision of
devices, assistive technology or other adapted equipment, and legislation such as health acts
that govern features of a health system such as accessibility, universality, portability, public
funding and comprehensiveness.
Kemudahan mendapat pelayanan kesehatan
Health policies
Legislation, regulations and standards that govern the range of services provided to individuals
for their physical, psychological and social well-being, in a variety of settings including
community, home-based, school and work settings, general hospitals, specialty hospitals,
clinics, and residential and non-residential care facilities, such as policies and standards that
determine eligibility for services, provision of devices, assistive technology or other adapted
equipment, and legislation such as health acts that govern features of a health system such as
accessibility, universality, portability, public funding and comprehensiveness.
Apakah kebijakan yang ada menanggung seluruh kebutuhan layanan yang diperlukan
• Keseluruhan secara penuh
• Sebagian (sebutkan yang tidak menjadi tanggungan asuransi kesehatan)
• Sama sekali tidak ditanggung
Labor and Labor and employment services
employment Services and programs provided by local, regional or national governments, or private
services, organizations to find suitable work for persons who are unemployed or looking for different
systems and work, or to support individuals already employed, such as services of employment search and
policies preparation, reemployment, job placement, outplacement, vocational follow-up, occupational
health and safety services, and work environment services (e.g. ergonomics, human resources
and personnel management services, labor relations services, professional association services),
including those who provide these services.
Labor and employment systems
Administrative control and monitoring mechanisms that govern the distribution of occupations
and other forms of remunerative work in the economy, such as systems for implementing
policies and standards for employment creation, employment security, designated and
competitive employment, labor standards and law, and trade unions.
Labor and employment policies
Legislation, regulations and standards that govern the distribution of occupations and other
forms of remunerative work in the economy, such as standards and policies for employment
creation, employment security, designated and competitive employment, labor standards and
law, and trade unions.

SUPPORTING EXAMINATION

CASE RESUME
 Kesatuan dari kasus ini setelah dilakukan asesmen secara menyeluruh.

DIAGNOSIS
MEDICAL DIAGNOSIS
• Patologi atau Disease atau Kondisi sakit yang menyebabkan timbulnya Impairments
• Penyakit penyerta yang menjadi penyulit atau perhatian dalam tatalaksana rehabilitasi
REHABILITATION DIAGNOSIS
• Pada fase akut dituliskan IMPAIRMENT OF BODY FUNCTION yang mungkin akan menimbulkan
komplikasi disabilitas akibat penyakitnya atau tirah baring yang memerlukann tindakan
pencegahan atau impairment of BODY FUNCTION yang memerlukan tindakan rehabilitasi
• Pada fase subakut dan fase kronis dituliskan ACTIVITY LIMITATION AND PARTICIPATION
RESTRICTION disertai dengan body function yang menjadi penyebabnya, yang memerlukan
intervensi rehabilitasi (melalui pendekatan substitusi, remediasi, kompensasi ataupun
adaptasi) atau IMPAIRMENT OF BODY FUNCTION yang memerlukan intervensi rehabilitasi.

PROGNOSIS
AD VITAM Prediksi penyakitnya akan menyebabkan kematian atau tidak
AD Prediksi perjalanan penyakitnya
SANATIONAM • Statis (menetap)
• Memburuk (lambat atau progresif)
• Berulang
AD Prediksi kemampuan fungsional atau FUNCTIONING yang paling maksimal dapat dicapai oleh
FUNCTIONAM pasien dengan intervensi rehabilitasi medis yang paling optimal
(disesuaikan dengan kondisi setempat, factor lingkungan dan personalitas pasien)

REHABILITATION GOALS
Goal rehabilitasi adalah tujuan intervensi rehabilitasi yang akan diberikan untuk mencapai
prediksi FUNCTIONING pasien (prognosis functionam)

TARGET-ORIENTED REHABILITATION PROGRAM

Tahapan program untuk mencapai tujuan rehabilitasi
Karena tujuan rehabilitasi bervariasi dengan tingkat kesulitan berbeda maka dibuatlah target
oriented rehabilitation program yang lama tatalaksananya berbeda-beda.
Pada setiap program dituliskan berapa lama perkiraan intervensi akan diberikan dan kapan
perlu dilakukan evaluasi, serta apa tindak lanjutnya sampai mencapai tujuan.

EVALUATION/FOLLOW-UP
To evaluated the achievement of the program; proceed to the next program or to evaluate
cause of failure of the programs if they are not achieved as predicted
use SOAP
Subjective: Anamnesis from patients and family
Objective : Physical and Supporting Examination or Finding
evaluation of the program
Analysis : synthesis of “subjective” and “objective” evidence to arrive at a diagnosis or
conclusion
Plan :
• State which testing is needed and the rationale for choosing each test to resolve
diagnostic ambiguities; ideally what the next step would be if positive or negative
• Therapy needed rehabilitation intervention or medications
• Specialist referral(s) or consultations
• Patient education or counseling

CASE ANALYSIS
Not explaining about definition, classification or the cause of the disease; not to analyze why
the impairments are happened in general;
Do analyze this case in PMR View and the reason why we decided to set that level of
functioning of this patients and how to achieve it. If there is more than one solution, analyze
and explain why this solution what you have choose is for the patient the best.

End of Presentation