Global Health Observatory(GHO) Data

• Insufficient Physical Activity  Risk

Factor for global Mortality.
• Insufficient Physical Activity 20% -
30% increase Risk of All cause
mortality.
• Regular Physical activity reduce the
Risk of All cause mortality.
 Low Physical Activity
• Low Physical Activity = Smoking (Number of
Deaths)
• 1/3 of adults are not doing enough physical
activity
How about in Indonesia?
 INDONESIA IS A BLUE OCEAN
for PT
10 thousand PT’s for
255 million People’s
Ratio = 1 : 25.500
2016
Rp. 109 Trillion
 Clinical Excellence: Dimensions
Multidimensional
Knowledge Patient centered

Clinical Philosophy
of PT Virtues Caring
Commitment
Reasoning Practice
Collaborative process
Reflection

Central focus
Movement Centered on function

Jensen GM et al (2000) Phys Ther 80(1):28–43

MULTIDICIPLINE APPROACH

MD
PT OT

NURSE ST
PATIENT
 Physiotherapist
NO ONE CAN DO LIKE YOU DO
 Old New
• Top down • Multi- input
• Tracts • Systems
• Reflex activity • Modulation
• Electrical activity • Neurotransmitters
• All or nothing • Multi - level processing
• Hard wired • Plastic
• Irreparable • Re - organisation
 In the Systems Theory

• Control is distributed throughout many interacting

systems working co-operatively
• Central command is equated with the interplay
between external forces and variations in the initial
conditions
• Different commands result in the same movement
• The body is a mechanical system with many degrees
of freedom which must be controlled in order to
work together as a functional unit
Neuroplasticity
Damaged Brain plasticity
• Diaschisis (neural shock)
• Unmasking
• Denervation supersensitivity
• Silent synapses recruitment
• Sprouting
• Axonal regeneration
• Collateral sprouting
Damaged Brain plasticity

Ipsilateral motor pathway

Neuroplasticity in Normal Brain
 CNS Lesions

Abnormal postural tone

Abnormal quality of movement Effort

Abnormal sensory feedback and feedforward

Abnormal quality of movement Compensation

Abnormal postural tone

 Anticipatory Mechanisms

Hodges & Richardson 1997

EMG Activity of each of the trunk muscles relative to that of the prime mover
 STABILITY vs MOBILITY

"the direction of movement depends on the

location of stability"
 Treatment

Thinking Out of The Box Test and Re-Test Practice

APPROPRIATE POSTURAL TONE
 POSTURAL STABILITY

Deep Core Muscle attached to each spinal

segment provide segmental stability
 FEELING

Tone
Response to contact and handling
Reaction to being moved
CoP and BoS
CENTRAL PATTERN GENERATORs
Automatic Mechanism
Thank You