UPPER EXTREMITAS

Sholuder

Fleksi (0-180*)

- Deltoid anterior ( axillary nerve , c5c6)

- Pectoralis mayor ( pectoral nerve , c5c6c7c8t1)
- Biceps brachii ( musculocutaneus nerve, c5c6)
- Coracobrachialis ( musculocutaneus nerve, c5c6)

Extensi (0-60*)

- Posterior deltoid (axillary nerve, c5c6)

- LAtisimus dorsi ( thoracodorsal nerve, c6c7c8)
- Teres major ( lower subscapular nerve, c5c6)
- Tricep long head ( radial nerve, c6c7c8)
- Pectoralis major ( pectoral nerve , c5c6c7c8T1)

Abduction (0-180*)

- Middle deltoid ( axillary nerve , c5c6)

- Supraspinatus ( suprascapular nerve, c5c6)

Adduction (0-60*)

- Pectoralis major ( pectoral nerve , c5c6c7c8T1)

- Latissimus dorsi ( thoracodorsal nerve c6c7c8T1)
- Teres major (subscapular nerve , c5c6)
- Coracobracialis ( musculocutaneus nerve, c5c6c7)
- Infraspinatus ( suprascapular nerve, c5c6)
- Long head of triseps ( radial nerve, c6c7c8)
- Anterior and posterior deltoid ( axillary nerve , c65c6)

Internal rotation

- Subscapularis ( subscapular nerve c5c6)

- Pectoralis major ( pectoral nerve c5c6c7c8T1)
- Latissimus dorsi ( thoracodorsal nerve , c5c6)
- Anterior deltoid ( axillary nerve, c5c6)
- Teres major ( subscapular nerve , c5c6)

External rotation

- Infraspinatus ( suprascapular nerve , c5c6)

- Teres minor ( axillary nerve c5c6)
- Posterior deltoid ( axillary nerve c5c6)
- Supraspinatus (suprascapular nerve c5c6)

Elbow
 Flexion (0-135*)

- Brachialis ( musculocutaneus nerve , c5c6c7)

- Biceps brachii ( musculocutaneus nerve, c5c6c7)
- Brachioradialis ( radial nerve, c5c6c7)
- Pronator teres ( median nerve , c6c7)

Elbow (0-5*)

- Triceps ( radial nerve c6c7c8)

- Anconeus ( radial nerve , c7c8T1)

Forearm supination ( 0-90*)

- Supinator ( radial nerve , c5c6)

- Biceps brachii ( musculocutaneus nerve , c5c6)

Forearm pronation (0-90*)

- Pronator teres ( median nerve, c6c7)

- Pronator quadrates ( median nerve,c7c8T1)
- Flexor carpi radialis (median nerve , c6c7)

Wrist

Flexion (0-80*)

- Flexor carpi radialis ( median nerve, c6c7)

- Flexor carpi ulnaris ( ulnar nerve, c8T1)
- Palmaris longus ( median nerve , c7c8)
- Flexor digitorum superfisialis ( median nerve ,c7c8T1)
- Flexor digitorum profundus ( median nerve, c7c8T1)
- Flexor policis longus ( median nerve , c8T1)

Extention ( 0-70*)

- Extersor carpi radialis longus ( radial nerve , c6c7)

- Extensor carpi radialis brevis ( radial nerve, c6c7)
- Extensor carpi ulnaris ( radial nerve, c7c8)
- Extensor digitorum comunis ( radial nerve, c7c8)
- Extensor digiti minimi ( ulnar nerve , c8T1)
- Extensor indicis ( radial nerve , c6c7c8)
- Extensor pollicis longus ( radial nerve , c6c7c8)

Ulnar deviation / adduction ( 0-30*)

- Flexor carpi ulnaris ( ulnar nerve , c8T1)

- Extensor carpi ulnaris ( radial nerve , c7c8)

Radial deviation/ abduction (0-20*)

- Flexor carpi radilalis ( median nerve , c6c7)

- Extensor carpi radialis ( radial nerve , c6c7)

LOWER EXTREMITAS

Hip
 Flexor

- Ilipsoas ( femoral nerve L1L2L3)

- Sartorius ( femoral nerve L2L3L4)
- Rectus femoris ( femoral nerve L2L3L4)
- Pectineus ( femoral nerve ( L2L3L4)
- Tensor fasciae latae ( superior gluteal nerve , L4L5s1)
- Adductor brevis ( obturator nerve , L2L3L4)
- Adductor longus ( obturator nerve , L2L3L4)
- Adductor magnus ( obturator dan sciatic nerve,L2L3L4L5s1)
- Gracilis ( obturator nerve , L2L3L4)

Extensor

- Gluteus maximus ( gluteal nerve ,L5s1s2)

- Glutes medius ( gluteal nerve , L4L5,s1)
- Gluteal minimus ( gluteal nerve , L4L5s1)
- Piriformis ( piriformis nerve, s1s2)
- Hamstring muscle ( sciatic nerve)
o Bicep femoris
o Semi membranosus
o Semitendinosus

External rotator

- Piriformis 9 piriformis nerve s1s2)

- Obturator internus ( obturatore nerve L5s1)
- Superior gemellus ( gemellus nerve L5s1s2)
- Inferior gemellus ( gemellus nerve L5s1s2)
- Obturator externus
- Quadratus femoris
- Gluteus maximus ( gluteal nerve L5s1s2)

Internal rotator

- Tensior fasciae latae ( gluteal nerve, L4L5s1)

- Adductor brevis ( obturator nerve , L2L3L4)
- Adductor longus ( obturator nerve , L2L3L4)
- Adductor magnus ( obturator dan sciatic nerve,L2L3L4L5s1)
- Gracilis ( obturator nerve , L2L3L4)
- Gluteus medius ( gluteal nerve , L4L5,s1)
- Gluteal minimus ( gluteal nerve , L4L5s1)
- Semi membranosus
- Semitendinosus

Knee

Flexi (0-135)

- Hamstring muscle ( bicep femoris, semimembranosus, semitendinosus)

- Sartorius ( femoral nerve , L2L3)
 - Gracilis ( obturator nerve , L2L3L4)
- Gastrocnemius ( tibial nerve , s1s2)

Extensi ( 0*)

- Quadriceps ( rectus femoris, vastus lateral, vastus medial, vastus intermedius)

- Patellar tendon

Medial rotator (0-10*)

- Semitendinosus ( sciatic nerve, L4L5s1s2)

- Semimembranosus ( sciatic nerve , L4L5s1s2)
- Sartorius ( femoral nerve , L2L3)
- Gacilis (obturator nerve , L2l3L4)

Lateral rotator

- Biceps femoris long and short head

Ankle

Dorsoflexion (0-20*)

- Inversion
o Tibialis anterior ( deep peroneal nerve , L4L5)
o Extensor halucis longus ( deep peroneal nerve, L5s1)
- Eversion
o Extensor digitorum longus ( deep peroneal nerve, L5s1)
o Peroneus tertius ( deep peroneal nerve , L5s1)

Plantar flexion

- Inversion
o Tibialis posterior ( tibial nerve, L4L5)
o Flexor digitorum longus ( tibial nerve, s1s2)
o Flexor halucis longus ( tibial nerve, s2s3)
o Plantaris ( tibial nerve,s1s2)
o Gastrocnemius (tibial nerve, s1s2)
o Soleus ( tibial nerve , s1s2)
- Eversion
o Peroneus longus ( peroneal nerve, L5s1s2)
o Peroneus brevis ( peroneal nerve, L5s1s2)

*Terapi fisiatrik

a. fisioterapi , antara lain:

terapi dingin ( ice packs, cold gel packs, vapocoolant spray)

terapi panas (radiative, konduktif,konversi)

 traksi, tens, laser

b. ortotik-prostetik

c. terapi okupasi

d. terapi wicara

* otot2 trunk

Fleksi

- M. rectus abdominis
- M. obliques externus abdominis
- M. obliques internus abdominis

Extensi :

- Iliocostalis thoracis
- Longissimus thoracis
- Spinalis thoracis
- Iliocostalis lumborum
- Semispinalis thoracis
- Multividus
- Rotator thoracis and lumborum
- Interspinalis thoracis and lumborum
- Quadratus lumborum

Erector spinae

- Iliocostalis
- Spinalis
- Longissimus

Deep extensor

- Rotator
- Semispinalis
- Multividus

Rotation

- M. obliques externus abdominis

- M. obliques internus abdominis

*beda physiatrist dan physiotherapist

Physiatrist bisa meresepkan obat/terapi, melakukan planning dan monitoring terhadap pasien,
sedangkan physiotherapist tidak bias meresepkan obat/terapi

*Tim di PMR

1. PMR specialist
2. Fisioterapi
3. Ortosis prostetik
4. Occupation terapi
5. Speech terapi
 6. Psikologi
7. Nurse
8. Social worker

*Divisi di PMR

Pediatric, Geriatric, Neuromuscular, Musculoskeletal, Cardiiorespirasi, Spinal cord injury

*Gait descripsition

Terdiri dari 2 fase :

1. Stance phase yaitu : heel strike( initial contact), loading response ( foot flat), midstance,
terminal stance, heel off)
2. Swing phase yaitu : preswing ( toe off) , initial and midwsing, terminal swing

*Kepanjangan MMT (Manual Muscle Testing )

0. No visible or palpable contraction

1. visible or palpable contraction

2. Active full ROM if gravity eliminated

3. Active full ROM agains gravity

4. Active full ROM agains gravity with moderate resistance

5. Active full ROM agains gravity with maximum resistance

*Gangguan fungsional pada pasien stroke

- Gangguan gerak
- Gangguan keseimbangan
- Gangguan sensibilitas
- Gangguan menelan
- Gangguan kognitif (memori, perhatian, persepsi ruangan)
- Gangguan komunikasi
- Gangguan fungsi seksual
- Gangguan berkemih
- Gangguan defekasi
- Gangguan psikis
- Gangguan fungsional dan perawatan diri