DAFTAR ISI
DAFTAR DAFTAR ISI........................................... ISI.................................................................. .............................................. ....................................... ...................1 ...1 BAB I.......................................... I................................................................. .............................................. ...................................................... ............................... 2 PENDAHULUAN...................................................................................................2 BAB II........................................... II.................................................................. .............................................. ....................................................3 .............................3 PEMBAHASAN............................. PEMBAHASAN.................................................... .............................................. .................................................. ........................... 3 2.1.
Cerebral Cerebral Palsy..... Palsy.......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ........3 ...3
2.1.1. 2.1.1.
Definisi.... Definisi......... .......... .......... .......... .......... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .......... ........... ............3 ......3
2.1.2. 2.1.2.
Ei!e"i#l#$ Ei!e"i#l#$i.... i......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .............. ............% ...%
2.1.3. 2.1.3.
E&i#l#$i... E&i#l#$i........ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ........... ............' ......'
2.1.%. 2.1.%.
Pa&#fisi#l#$ Pa&#fisi#l#$i..... i.......... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... ........... ............... ................... ...........1( .1(
2.1.'. 2.1.'.
)lasif*asi )lasif*asi *linis. *linis...... .......... .......... .......... .......... .......... .......... .......... .......... .......... ......... ......... .......... .......... .......... ..........1 .....13 3
2.1.+. 2.1.+.
Manifes&asi Manifes&asi )lini*..... )lini*.......... .......... .......... .......... .......... .......... .......... .......... ......... ......... .......... .......... ........... ............1+ ......1+
2.1.,. 2.1.,.
Dia$n#sis.. Dia$n#sis....... .......... .......... .......... .......... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .......... .......... .........1....1-
2.1.. 2.1..
Dia$n#sis Dia$n#sis ban!in$... ban!in$........ .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .............2 ........2-
2.1.-. 2.1.-.
Pena&ala*san Pena&ala*sanaan... aan........ .......... .......... .......... .......... .......... .......... ......... ......... .......... .......... .............. .................. .............3( ....3(
2.1.1( 2.1.1(..
)#"li )#"li*asi *asi... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ....... ........ ........ ........ ........ ........ ......3 ..3
2.1.1 2.1.11. 1.
Pr#$n# Pr#$n#sis. sis.... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ....... ........ ........ ........ ........ ......%( ..%(
)ESIMPULAN................................ )ESIMPULAN....................................................... .............................................. ...............................................%2 ........................%2 Daf&ar P/s&a*a.......................................... P/s&a*a................................................................. .............................................. ....................................... ................ %3
BAB I PENDAHULUAN
Cerebral alsy a!ala0 s/a&/ $an$$/an a&a/ *elainan yan$ &era!i a!a s/a&/ */r/n a*&/ !ala" er*e"ban$an ana* !i !ala" s/s/nan saraf /sa& bersifa& *r#ni* !an &i!a* r#$resif a*iba& *elainan a&a/ 4a4a& a!a arin$an #&a* yan$ bel/" selesai er&/"b/0annya.5ala//n lesi serebral bersifa& s&a&is !an &i!a* r#$resif &e&ai er*e"ban$an &an!a6&an!a ne/r#n erifer a*an ber/ba0 a*iba& "a&/rasi serebral. 718 728 738 9an$ an$ er&a"a er&a"a *ali "e"er*enal "e"er*enal*an *an enya*i& enya*i& ini a!ala0 5illia" 5illia" :#0n Li&≤1%3< yan$ "enyeb/&nya !en$an is&ila0 4erebral !ile$ia seba$ai a*iba& re"a&/ri&as a&a/ afi*sia ne#na&#r/". Sir 5illia" =lser a!ala0 yan$ er&a"a *ali "e"er*enal*an is&ila0 4erebral alsy se!an$*an Si$"/n! Fre/! "enyeb/&nya !en$an is&ila0 Infan&ile Cerebral Paralysis. 738 7%8 5ala// 5a la//n n s/li& e&i#l#$i 4erebral alsy erl/ !i*e&a0/i !i*e&a0/i /n&/* /n&/* &in!a*an &in!a*an en4e$a0an. Fisi#&erai !ini "e"beri 0asil bai* na"/n a!anya $an$$/an er*e"ban$an "en&al !aa& "en$0alan$i &er4aainya &//an en$#ba&an. 5in&0 5in&0r# r# P0els P0els "ene*a "ene*an*a n*an n en&in en&in$ny $nyaa en!e* en!e*a&an a&an "/l&i! "/l&i!isi isili lin n !ala" !ala" enan$anan en!eri&a 4erebral alsy seer&i !isilin ana* saraf "a&a THT THT be!a0 &/lan$ be!a0 saraf si*#l#$i a0li i4ara fisi#&erai e*era s#sial $/r/ se*#la0 I/ar biasa. Disa"in$ i&/ /$a 0ar/s !iser&a*an eranan #ran$ &/a !an "asyara*a&. 7%8
BAB II
1
PEMBAHASAN
2.1.Cerebral Palsy 2.1. 2.1.1. 1. Defi Defini nissi
Is&ila0 4erebral alsy ;CP< a!a aalnya !i4i&a*an lebi0 !ari sa&/ aba! lal/ !an !i&ere"a0*an seba$ai >*el/"/0an #&a*.> Na"/n !efinisi yan$ &ea& &e&a s/li& !ia0a"i *arena 4erebral alsy b/*anla0 b/*anla0 s/a&/ !ia$n#sis !ia$n#sis &/n$ &/n$$a $all
&e&a &e&ai i
>ay >ay/n /n$> $>
is&i is&ila la0 0
yan$ an$
"en$ "en$$a $a"b "bar ar*a *an n
lesi lesi
#&a* #&a*
n#nr#$res n#nr#$resif if yan$ "eliba&*an "eliba&*an *elainan *elainan "#&#ri* "#&#ri* a&a/ #s&/ral yan$ a!a sela"a er*e"ban$an aal. 728 Cerebral alsy a!ala0 se*el#"#* $an$$/an er*e"ban$an $era*an !an !an #s& #s&/r /r yan$ yan$ "eny "enyeba ebab* b*an an *e&e *e&erb rba&a a&asan san a*&i a*&i?i& ?i&as as yan$ yan$ &era! &era!ii n#nr# n#nr#$re $resif sif yan$ yan$ &era!i &era!i a!a a!a er*e" er*e"ban ban$an $an #&a* #&a* anin anin a&a/ bayi. bayi. @an$$/an @an$$/an M#&#r 4erebral alsy serin$ !iser&ai !iser&ai !en$an !en$an $an$$/an $an$$/an sensasi *#"/ni*asi *#$nisi ersesi !ana&a/ erila*/ !ana&a/$an$$/an *ean$. 728 7'8 Cerebral alsy !iba&asi /n&/* lesi #&a* saa enya*i& &er&en&/ a!a saraf erifer !ari s/"s/" &/lan$ bela*an$ ;"isalnya a&r#fi #&#& &/lan$ bela*an$"yel#"enin$#4ele< a&a/ *e #&#&6#&#& ;"isalnya !is&r#fi #&#&< "es*i/n "enyebab*an *elainan "#&#ri* aal &i!a* !ian$$a 4erebral alsy. 728 Cere Cerebr bral al als alsy y a!al a!ala0 a0 eny enyeb ebab ab /&a" /&a"aa *e4a *e4a4a 4a&a &an n ana* ana* yan$ an$ "e"en$ar/ "e"en$ar/0i 0i f/n$si f/n$si !an e"ban$/nan. e"ban$/nan. Lesi #&a* 4erebral alsy &era!i !ari !ari "asa "asa ani anin n a&a/ a&a/ ne#n ne#na& a&/s /s /n&/ /n&/* * sa" sa"ai ai /sia /sia 3 &a0/ &a0/n. n. Na"/ Na"/n n "es*i "es*i/n /n *er/sa* *er/sa*an an #&a* #&a* se&ela0 se&ela0 /sia /sia 3 &a0/n &a0/n sa"ai sa"ai !easa !easa !aa& !aa& ber"anifes&asi *linis seba$ai "iri a&a/ i!en&i* !en$an 4erebral alsy "en/r/& !efinisi lesi ini b/*anla0 4erebral alsy. Selain i&/ "es*i/n fa*&a fa*&a ba0a ba0a lesi a!a #&a* #&a* ber*e" ber*e"ban ban$ $ &era!i &era!i sebel/" sebel/" /sia /sia 3 &a0/n &a0/n !ia$n#sis !ari 4erebral alsy &i!a* !aa& !ila*/*an sa"ai se&ela0 a*&/ i&/. i&/. Bebera Beberaaa i0a* i0a* "en$an "en$an/r /r*an *an &i!a* &i!a* "e"b/a "e"b/a&& !ia$n# !ia$n#sis sis !efini& !efini&if if !ala" !ala" *as/s *as/s &erili &erili0 0 sa"ai sa"ai /sia /sia '&a0/n '&a0/n a&a/ la"ba& la"ba&.. Pen!e* Pen!e*a&an a&an ini
2
"e"/n$*in*an $a"baran *linis 0ar/s elas !an ber#&ensi "e"/n$*in*an en$e4/alian enya*i& r#$resif. Selain i&/ beberaa ana* yan$ &ela0 !i!ia$n#sa !en$an 4erebral alsy a!a /sia !ini 0anya "e"ili*i $eala yan$ ber/ba0 *e"/!ian. 728 Se*i&ar &ar
3(6'( 6'(
*e&e *e&erb rbel ela* a*an an$a $an n
asie sien
!en$ en$an
"en& "en&al al& &er er$a $an& n&/n /n$ $
4er 4erebral ral
a!a a!a enis enisny nya. a.
alsy
"e"il e"ilii*i
Na"/ Na"/n n )aren )arenaa
*es/li&an *es/li&an #r#"#&#r #r#"#&#r "#&#ri* 0al/s 0al/s !an"#&#ri* !an"#&#ri* *asar *asar *#"/ni*asi *#"/ni*asi a!a asien ini "/n$*in &er$an$$/ !an *aasi&as e*sresiin&ele*&/al &erba&as. Na"/n i*a 4erebral alsy !i!e*a&i se4ara "/l&i!isilin !en$an &erai fisi* e*eraan !an $ii /n&/* "e"a*si"al*an /aya re0abili&a&if asien !aa& lebi0 &erin&e$rasi se4ara a*a!e"is !an s#sial. Se*i&ar 1'6+( ana* !en$an 4erebral alsy "e"ili*i eilesi !an eilesi lebi0 serin$ a!a asien !en$an /a!rile$ia sas&i* a&a/ re&ar!asi "en&al. 728
2.1. 2.1.2. 2. Ep Epi iee!i"l !i"l"# "#ii
)ea!i )ea!ian an 4erebral 4erebral alsy alsy &i!a* &i!a* ber/ba ber/ba0 0 !ala" !ala" lebi0 lebi0 !ari !ari % !e*a!e !e*a!e "es*i/n *e"a/an si$nifi*an !ala" eraa&an "e!is !ari ne#na&/s. Di ne$ara "a/ re?alensi !ier*ira*an *esel/r/0an 4erebral alsy a!ala0 26 2' *as/s er 1((( *ela0iran 0i!/. Pre?alensi $an$$/an ini an&ara bayi re"a&/r !an san$a& re"a&/re a!ala0 a/0 lebi0 &in$$i. Di ne$ara ber*e"ban$ re?alensi 4erebral alsy &i!a* &er4a&a& &ai er*iraan er*ira an 1'6'+ *as/s er 1((( *ela0iran 0i!/. An$*a6an$*a ini "/n$*in !ian$$a re"e0 *arena */ran$nya !a&a */ran$nya a*ses *ese0a&an /"la0 *as/s yan$ &erlal/ banya* yan$ ara0 !an *ri&eria !ia$n#s&i* yan$ &i!a* *#nsis&en. 728 7+8 Se"/a ras yan$ &eren$ar/0 #le0 $an$$/an ini. S&a&/s s#sial e*#n#"i lebi0 ren!a0 !an se*s ria !aa& "enin$*a&*an fa*&#r risi*# 4erebral alsy. 728 Den$an Den$an *ai&annya *ai&annya !en$an !en$an /sia *ea!ian yan$ "eni"b/l*a "eni"b/l*an n 4erebral 4erebral alsy &era!i sela"a er*e"ban$an #&a* bel/" "a&/r. Men/r/& seba$ian besar referensi *ea!ian aal ini !aa& &era!i *aan saa an&ara
3
er*e"ban$an anin !an /sia 3 &a0/n. Na"/n ana*6ana* biasanya &i!a* &er!ia$n#sa sa"ai se&ela0 /sia 1 &a0/n !en$an *#n!isi &erseb/& "ena!i !ii!en&ifi*asi seba$ai ana*6ana* $a$al "e"en/0i &a0a er*e"ban$an. Serin$*ali ana*6ana* yan$ lebi0 &/a !an !i!ia$n#sis "en$ala"i 4erebral alsy seba$ai 0asil !ari "e"ili*i $eala yan$ a!a a&a/ "asala0 yan$ "iri !en$an #&a* 4erebral b/*an 0ar/s !iberi label !en$an e&i#l#$i 4e!era #&a* "ere*a ;yai&/ 4e!era #&a* &ra/"a&is se*/n!er /n&/* *e4ela*aan *en!araan ber"#&#rs&r#*e *#n!isi "e&ab#li* !ll<. 728
2.1.$. E%i"l"#i
Cerebral alsy !aa& &era!i a*iba& *elainan s&r/*&/ral yan$ "en!asari #&a* a!a aal *e0a"ilan 4e!era erina&al a&a/ se&ela0 "ela0ir*an *arena ins/fisiensi ?as*/ler &#in a&a/ infe*si a&a/ risi*# re"a&/ri&as. Ini "/n$*in &er"as/* *ela0iran re"a&/r *e0a"ilan $an!a e"ba&asan er&/"b/0an in&ra/&erin enis *ela"in la*i6la*i s*#r A$ar ren!a0 infe*si in&ra/&erin *elainan &ir#i! ib/ s&r#*e rena&alasfi*sia la0ir aaran "e&il "er*/ri ib/ !an !efisiensi y#!i/" ib/. 728 7,8 B/*&i "en/n/**an ba0a fa*&#r rena&al "e"en$ar/0i ,(6( *as/s 4erebral alsy. Dala" *ebanya*an *as/s enyebab as&inya &i!a* !i*e&a0/i &e&ai *e"/n$*inan besar "/l&ifa*&#rial. 728 Seb/a0 s&/!i N#re$ia yan$ "eliba&*an ana*6ana* !en$an 4erebral alsy !i!ia$n#sis sebel/" /sia ' &a0/n "en/n/**an ba0a s*#r A$ar ren!a0 a!a ' "eni& !i*ai&*an !en$an *ea!ian ini !i se"/a bera& la0ir. Pre?alensi &er&in$$i 4erebral alsy a!a ana*6ana* !en$an bera& la0ir ren!a0 na"/n #!! ra&i# *ea!ian ini !i*ai&*an !en$an s*#r A$ar ren!a0 ;G%< &er&in$$i a!a ana*6ana* bera& ba!an n#r"al. Mes*i/n !e"i*ian *ebanya*an ana* !en$an 4erebral alsy "e"ili*i s*#r A$ar lebi0 &in$$i !ari % a!a ' "eni&. 7,8 Mes*i/n *ela0iran re"a&/r a!ala0 fa*&#r risi*# 4erebral alsy yan$ !i&e$a**an s&/!i &erbar/ "en/n/**an ba0a *e0a"ilan #s&&er" a!a %2
%
"in$$/ a&a/ la"ba& &ela0 !i*ai&*an !en$an enin$*a&an risi*# *#n!isi ini. 728
@a"bar 1. E&i#l#$i Cerebral Palsy [8]
A. Ib&' (e)a!ilan an fa(%"r risi(" (e)a!ilan Fa*&#r6fa*&#r risi*# ib/ !an rena&al se4ara s&a&is&i* ber0/b/n$an
!en$an 4erebral alsy 728 7-8 a< Si*l/s "ens&r/asi Panan$ b< Sebel/"nya *e0ilan$an *e0a"ilan 4< Sebel/"nya *e0ilan$an bayi yan$ la0ir !< Ib/ *e&erbela*an$an "en&al e< @an$$/an &ir#i! ib/ &er/&a"a !efisiensi y#!i/" f< Ib/ $an$$/an *ean$ $< Riaya& "ela0ir*an se#ran$ ana* !en$an bera& */ran$ !ari 2((( $ 0< Riaya&
"ela0ir*an
ana*
!en$an
!efisi&
"#&#ri*
*e&erbela*an$an "en&al a&a/ !efisi& sens#ri*
Fa*&#r6fa*&#r beri*/& sela"a *e0a"ilan /$a ber0/b/n$an se4ara s&a&is&i* !en$an 4erebral alsy 728 a< b< 4< !< e< f< $<
P#li0i!ra"ni#n Pen$#ba&an ib/ !en$an 0#r"#n &ir#i! es&r#$en a&a/ r#$es&er#n Ib/ $an$$/an *ean$ Pr#&ein/ria bera& "a&ernal a&a/ &e*anan !ara0 &in$$i Ib/ &eraar "e&il "er*/ri Ca4a& *#n$eni&al a!a anin :enis *ela"in anin la*i6la*i '
0< Per!ara0an a!a &ri"es&er *e&i$a i< Re&ar!asi er&/"b/0an in&ra/&erine < )e0a"ilan "/l&ile )ea!ian 4erebral alsy a!a *e0a"ilan "/l&iel lebi0 "/n$*in ber0/b/n$an !en$an *ebera!aan re"a&/ri&as a&a/ 0a"ba&an er&/"b/0an !ala" *an!/n$an. )e0a"ilan "/l&iel "/n$*in &i!a* risi*# &a"ba0 /n&/* $an$$/an ini. Pen$e4/alian a!ala0 *e&i*a sala0 sa&/ *e"bar "a&i *e"bar yan$ "asi0 0i!/ "e"ili*i *ese"a&anlebi0 &in$$i !aria!a yan$ &/n$$al !ala" en$e"ban$an 4erebral alsy. B. Fa(%"r risi(" Perina%al Fa*&#r6fa*&#r erina&al beri*/& ini ber0/b/n$an !en$an enin$*a&an
risi*#4erebral alsy 728 71(8 7118 a< Pre"a&/ri&as b< )#ri#a"ni#ni&is 4< Presen&asi n#n?er&e !an aa0 anin !< La0ir asfi*sia Dala" 1( a&a/ */ran$ !ari *as/s 4erebral alsy *ela0iran asfi*sia !aa& !i&en&/*an seba$ai enyebab !efini&if. Ba0*an *e&i*a asfi*sia la0ir !ian$$a ber0/b/n$an elas !en$an 4erebral alsy
fa*&#r
*e0a"ilan
&i!a*
n#r"al
;"isalnyare&ar!asi
er&/"b/0an in&ra/&erin *elainan baaan #&a*< "/n$*in &ela0 ber*#n&rib/si
&er0a!a $aa& anin erina&al. )as/s 4erebral
alsy !isebab*an #le0 asfi*sia la0ir0ar/s "en!#*/"en&asi*an b/*&i nya&a asi!#sis ensefal#a&i ne#na&al se!an$ sa"aiara0 /a!rile$ia sas&i* enis !ys*ine&i4 a&a/ 4a"/ran !ari 4erebral alsy !an en$/4/alian e&i#l#$i lainnya. Selain i&/ *ea!ian in&raar&/" 0ar/s !isaran*an #le0 eris&ia sen&inel er/ba0an &in$*a& an&/n$ anin s*#r A$ar */ran$ !ari % a!a ' "eni& *er/sa*an #r$an sis&e" yan$ &er*ai& !en$an 0i#*sia arin$an !an *elainan en4i&raan aal. 728 Mes*i s*#r A$ar "enye!ia*an
"e&#!e
/n&/*
"en!#*/"en&asi*an S&a&/s 4ar!i#/l"#nary !an ne/r#"#&#r !i "eni&6"eni& se&ela0 la0ir s*#r ren!a0 saa &i!a* !aa& !i$/na*an
+
seba$ai
in!i*a&#r
asfi*sia
la0ir.
Nilai
&erseb/&
!aa&
"en4er"in*an *ea!aan yan$ &i!a* ber0/b/n$an !en$an asfi*sia la0ir seer&i infe*si !an *#n!isirena&al yan$ s/!a0 a!a sebel/"nya. 728
Table 1. S*#r AP@AR C. Fa(%"r risi(" P"s%na%al Fa*&#r6fa*&#r #s&na&al beri*/& !aa& "enyebab*an 4erebral alsy 728 a< Infe*si ;"isalnya "enin$i&is ensefali&is< b< Per!ara0an in&ra*ranial ;"isalnya *arena re"a&/ri&as *elainan
e"b/l/0 !ara0a&a/ &ra/"a< 4< Peri?en&ri4/lar le/*#"ala4ia ;a!a bayi re"a&/r< !< Hi#*sia6is*e"ia ;"isalnya !ari asirasi "e*#ni/"< e< Sir*/lasi anin ersis&en a&a/ 0ier&ensi ar/ ersis&en a!a bayi bar/ la0ir f< )ern i*&er/s )e"/n$*inan enyebab 4erebral alsy "en/r/& enisnya !iba0as !i baa0 ini 728 1< Sas&i* 0e"ile$ia Dari se"/a *as/s 4erebral alsy ,(6-( a!ala0 baaan !an 1(63( !ier#le0 ;"isalnya e"b/l/0 !ara0 infla"asi &ra/"a<. Pa!a lesi /nila&eral #&a* ilaya0 e"b/l/0 !ara0 yan$ alin$ serin$ &er*ena a!ala0 ar&eri serebral &en$a0 sisi *iri &erliba& !/a *ali lebi0 serin$ !iban!in$ *anan. )elainan #&a* s&r/*&/ral lainnya &er"as/* a&r#fi 0e"ibrain !an porencephaly posthemorrhagic. Pa!a bayi re"a&/rini "/n$*in a*iba& !ari le/*#"ala4ia eri?en&ri4/lar asi"e&ris.
,
2< Sas&i* !ile$ia Pa!a bayi re"a&/r *ean$ !ile$ia "/n$*in 0asil !ari er!ara0an aren*i"6in&ra?en&ri4/lar a&a/ le/*#"ala4ia eri?en&ri4/lar. Pa!a bayi anan$ &i!a* a!a fa4&#r risi*# "/n$*in !aa& !ii!en&ifi*asi a&a/ e&i#l#$i "/n$*in "/l&ifa*&#rial. 3< Sas&i* /a!rile$ia Se*i&ar '( !ari *ean$ *as/s 4erebral alsy a!ala0 /a!rile$ia rena&alerina&al a!ala0 3( !an 2( a!ala0 #s& na&al. Tie ini !i*ai&*an !en$an 4a?i&as yan$ ber*#"/ni*asi !en$an ?en&ri*el la&eral lesi *is&i* beberaa !i 0i&e "a&&er a&r#fi *#r&i*al !if/s !an 0i!r#sefal/s. Pasien serin$ "e"ili*i riaya& *ela0iran yan$ s/li& !en$an b/*&i asfi*sia erina&al. Bayi re"a&/r "/n$*in "e"ili*i le/*#"ala4ia eri?en&ri4/lar. Bayi "a&/r en/0 "/n$*in "e"ili*i *elainan #&a* s&r/*&/ral a&a/ 0i#erf/si serebral !ala" !is&rib/si ;yai&/ /&a"a !aera0 a*0ir ar&eri serebral<. %< Dys*ine&i4 ;e*s&raira"i!al< Dys*ine&i4 ;e*s&raira"i!al< serebral ber0/b/n$an !en$an e&i#l#$i yan$ /ni*.Se4ara 0is&#ris *erni*&er/s a&a/ ensefal#a&i bilir/bin a*/& ne#na&al a!ala0enyebab /&a"a. Den$an enin$*a&an "anae"en aal 0ierbilir/bine"ia seba$ian besar *as/s 4erebral alsy !ys*ine&i4 yan$ saa& ini &er*ai& !en$an 4e!era is*e"i* !i!/$a 0i#*sia b/*an !en$an 0ierbilir/bine"ia. Den$an &i!a* a!anya 0i#*sia 0ierbilir/bine"ia a&a/ re"a&/r *e"/n$*inan "e&ab#li* a&a/ ne/r#!e$enera&i?e. $an$$/an seba$ai !asar /n&/* resen&asi ini 0ar/s !ier&i"ban$*an. 2 Den$an !e"i*ian 4erebral alsy !ys*ine&i4 "/n$*in ber0/b/n$an !en$an0ierbilir/bine"ia a!a bayi re"a&/r a&a/ !en$an is&ila0 &ana 0ierbilir/bine"ia"en#n#l. Hi#*sia "e"en$ar/0i $an$lia basal !an &ala"/s !aa& "e"en$ar/0ibayi "a&/r lebi0 !ari bayi re"a&/r. @a"bar 2. Cerebral alsy &ie Sas&i4
2.1.*. Pa%"fisi"l"#i
Per*e"ban$an #&a* "an/sia !an a*&/ /n4a* &era!inya "eli/&i beri*/& 7128 a< b< 4< !< e<
Pri"er ne/r/la&i#n 6 Min$$/ 36% *e0a"ilan Per*e"ban$an Pr#sen4e0ali4 6 B/lan 263 *e0a"ilan Ne/r#nal r#liferasi 6 B/lan 36% *e0a"ilan Ne/r#nal "i$rasi 6 B/lan 36' *e0a"ilan =r$anisasi 6 B/lan ' !ari *e0a"ilan sa"ai ber&a0/n6&a0/n
as4a*ela0iran f< Mielinasi 6 La0ir sa"ai ber&a0/n6&a0/n as4a *ela0iran $< Peneli&ian *#0#r& &ela0 "en/n/**an enin$*a&an risi*# a!a ana* yan$ la0ir se!i*i& re"a&/r ;3,63 "in$$/< a&a/ #s&&er" ;%2 "in$$/< !iban!in$*an !en$an ana* yan$ la0ir a!a %( "in$$/. A. Ceera "%a( a%a& per(e!ban#an "%a( yan# abn"r!al Men$in$a& *#"le*si&as er*e"ban$an #&a* rena&al !an bayi 4e!era a&a/ er*e"ban$an abn#r"al !aa& &era!i se&ia saa& se0in$$a resen&asi *linis 4erebral alsy ber?ariasi ;aa*a0 *arena *elainan $ene&i* e&i#l#$i &#in a&a/ infe*si a&a/ins/fisiensi ?as*/lar<. Misalnya 4e!era #&a* sebel/" 2( "in$$/ *e0a"ilan !aa& "en$a*iba&*an !efisi& "i$rasi ne/r#nal 4e!era an&ara "in$$/ 2+ !an 3% !aa& "en$a*iba&*an le/*#"ala4ia eri?en&ri4/lar ;f#4i ne*r#sis 4#a$/la&i?e a!a 0i&e"a&&er ber!e*a&an !en$an ?en&ri*el la&eral< 4e!era an&ara "in$$/ *e63% !an *e6 %( !aa& "en$a*iba&*an 4e!era #&a* f#*al a&a/ "/l&if#*al. 728 Ce!era #&a* a*iba& ins/fisiensi ?as*/lar &er$an&/n$ a!a berba$ai fa*&#r a!asaa& 4e!era &er"as/* !is&rib/si e"b/l/0 !ara0 *e #&a* efisiensi
-
aliran !ara0 #&a* !an re$/lasi aliran !ara0 !an res#n bi#*i"ia arin$an #&a* /n&/* #*si$enasi "en/r/n. 728 B. Pre!a%&ri%as an pe!b&l&) ara) serebral S&res fisi* a!a bayi re"a&/r !an *e&i!a*"a&an$an e"b/l/0 !ara0 #&a* !an #&a* "/n$*in "enelas*an "en$aa re"a&/ri&as "er/a*an fa*&#r risi*# yan$ si$nifi*an /n&/* 4erebral alsy. Sebel/" "a&/r !is&rib/si sir*/lasi anin !en$an 0asil #&a* a!a *e4en!er/n$an 0i#erf/si *e 0i&e "a&&er
eri?en&ri4/lar. Hi#erf/si!aa& "en$a*iba&*an er!ara0an
"a&ri*s $er"inal a&a/ le/*#"ala4ia eri?en&ri4/lar. An&ara "in$$/ 2+ !an 3% /sia *e0a"ilan !aera0 0i&e "a&&er eri?en&ri4/lar !e*a& ?en&ri*el la&eral yan$ alin$ ren&an &er0a!a 4e!era. )arena !aera06!aera0 "e"baa sera& ber&an$$/n$ aab a&as *#n&r#l "#&#r !an &#n/s #&#& *a*i 4e!era !aa& &era!i !ala" !ile$ia sas&i* ;yai&/ *elen&/ran !#"inan !an *ele"a0an *a*i !en$an a&a/&ana *e&erliba&an len$an &in$*a& yan$ lebi0 ren!a0<. 728 C. Peri+en%ri,&lar le&("!ala,ia )e&i*a lesi lebi0 besar "enan$*a/ !aera0 saraf !es4en!en !ari *#r&e*s
"#&#r /n&/* "eliba&*an 4en&r/" se"i#?ale !an *#r#na ra!ia&a bai* e*s&re"i&as baa0 !ana&as "/n$*in &erliba&. Le/*#"ala4ia eri?en&ri4/lar /"/"nya si"e&ris !an !ian$$a*arena 4e!era is*e"i* 0i&e "a&&er a!a bayi re"a&/r. Ce!era asi"e&ris /n&/* 0i&e"a&&er eri?en&ri4/lar !aa& "en$0asil*an sa&/ sisi &/b/0 yan$ lebi0 &eren$ar/0 !ari yan$ lain. Hasilnya "enir/ 0e"ile$ia sas&i* &e&ai lebi0 bai* !i4iri*an seba$ai *ean$
!ile$ia
asi"e&ris.
Ma&ri*s
$er"inal
*ailer
!i
!aera0
eri?en&ri4/lar san$a& ren&an &er0a!a 4e!era 0i#*sia6is*e"i* *arena l#*asi "ere*a !i seb/a0 #naerba&asan ?as*/lar an&ara #na a*0ir ar&eri s&ria&e !an &0ala"i4. Selain i&/ *arena"ere*a a!ala0 #&a* *ailer "ere*a "e"ili*i *eb/&/0an &in$$i /n&/* "e&ab#lis" #*si!a&if. 728 D. Perara)an peri+en%ri,&lar -perara)an in%ra+en%ri,&lar Banya* i0a* berenan$ &ela0 "enen&/*an &in$*a&an bera&nya er!ara0an eri?en&ri4/lar
er!ara0an
in&ra?en&ri4/lar
"en$$/na*an
sis&e"
1(
*lasifi*asi aalnya !ielas*an #le0 Paile !** a!a 1-, seba$ai beri*/& 728 a< @ra!e I 6 Per!ara0an s/been!y"al !ana&a/ "a&ri*s $er"inal b< @ra!e II 6 er!ara0an S/been!y"al !en$an e*s&ensi *e !ala" ?en&ri*el la&eral&ana e"besaran ?en&ri*el 4< @ra!e III 6 er!ara0an S/been!y"al !en$an e*s&ensi *e !ala" ?en&ri*ella&eral !en$an e"besaran ?en&ri*el !< @ra!e I 6 Seb/a0 er!ara0an "a&ri*s $er"inal yan$ "e"be!a0 !an "el/as *earen*i" #&a* yan$ ber!e*a&an &erleas !ari a!a a&a/ &i!a* a!anya er!ara0anin&ra?en&ri4/lar /$a !iseb/& seba$ai er!ara0an in&raaren40y"al saa& !i&e"/i !i &e"a& lain !i aren*i" &erseb/&. Per!ara0an "el/as *e 0i&e "a&&er eri?en&ri4/lar ber*ai&an !en$an er!ara0an $er"inal isila&eral er!ara0anin&ra?en&ri4/lar "a&ri*s yan$ !iseb/& infar* ?ena eri?en&ri4/lar0e"#ra$i*.
E. Ceera serebral +as(&ler an )ip"perf&si Saa& "a&/r *e&i*a sir*/lasi *e #&a* alin$ "enyer/ai sir*/lasi serebral
!easa 4e!era e"b/l/0 !ara0 a!a saa& ini 4en!er/n$ &era!i alin$ serin$ a!a !is&rib/si ar&eri serebral &en$a0 "en$a*iba&*an 4erebral alsy sas&i* 0e"ile$ia. Na"/n #&a* "a&/r /$a ren&an &er0a!a 0i#erf/si yan$ seba$ian besar "enar$e&*an !aera0 aliran !ari *#r&e*s ;"isalnya a*0ir #na ar&eri serebral /&a"a<"en$a*iba&*an 4erebral alsy sas&i* /a!rile$i*. @an$lia basal /$a !aa&!ien$ar/0i se0in$$a 4erebral alsy e*s&raira"i!al a&a/ !ys*ine&i4. 728
2.1.. /lasif(asi (linis
Cerebral alsy !aa& !i*lasifi*asi*an ber!asar*an $eala !an &an!a *linis ne/r#l#$is. Sas&i4 !ile$ia /n&/* er&a"a *ali !i!es*risi*an #le0 !r.Li&&le ;1+(< "er/a*an sala0 sa&/ ben&/* enya*i& yan$ !i*enal selan/&nya seba$ai 4erebral alsy. Hin$$a saa& ini 4erebral alsy !i*lasifi*asi*an ber!asar*an *er/sa*an $era*an yan$ &era!i !an !iba$i !ala" e"a& *a&e$#ri yai&/ 718 11
1<
CP Sas&i* Mer/a*an ben&/*an CP yan$ &erbanya* ;,(6(< #&#& "en$ala"i *e*a*/an !an se4ara er"anen a*an "ena!i *#n&ra*&/r. :i*a *e!/a &/n$*ai "en$ala"i sas&isi&as a!a saa& sese#ran$ beralan *e!/a &/n$*ai &a"a* ber$era* *a*/ !an l/r/s. @a"baran *linis ini "e"ben&/* *ara*&erisi&i* ber/a ri&"e beralan yan$ !i*enal !en$an $ai& $/n&in$ ;s4iss#r $ai&< Ana* !en$an sas&i4 0e"ile$ia !aa& !ise&ai &re"#r 0e"iaresis !i"ana sese#ran$ &i!a* !aa& "en$en!ali*an $era*an a!a &/n$*ai a!a sa&/ sisi &/b/0. :i*a &re"#r "e"bera& a*an &era!i $an$$/an $era*an bera&. a. M#n#le$i len$an b. Dile$ia
bila 0anya "en$enai 1 e*s&re"i&as saa biasanya
*ee"a& e*s&re"i&as &er*ena &e&ai *e!/a *a*i lebi0
bera& !aria!a *e!/a len$an 4. Trile$ia bila "en$enai 3 e*s&re"i&as yan$ alin$ banya*
a!ala0 "en$enai *e!/a len$an !an *a*i !. J/a!rile$ia *ee"a& e*s&re"i&as &er*ena !en$an !eraa&
yan$ sa"a e. He"ile$ia
Men$enai sala0 sa&/ sisi !ari &/b/0 !an len$an
&er*ena lebi0 bera&. 2< CP A&e&#i! !is*ine&i* Ben&/* CP ini "e"/nyai *ara*&eris&i* $era*an "en/lis yan$ &i!a* &er*#n&r#l !an erla0an. @era*an abn#r"al ini "en$enai &an$an *a*i len$an a&a/ &/n$*ai !an a!a seba$ian besar *as/s #&#& "/*a !an li!a0 "enyebab*an ana* &a"a* selal/ "enyerin$ai !an selal/ "en$el/ar*an air li/r. @era*an serin$ "enin$*a& sela"a eri#!e enin$*a&an s&ress !an 0ilan$ a!a saa& &i!/r. Pen!eri&a /$a "en$ala"i "asala0 *##r!inasi $era*an #&#& bi4ara ;!isar&ria<. CP a&e&#i! &era!i a!a 1(62( en!eri&a CP. 3< CP A&a*si! :aran$ !i/"ai "en$enai *esei"ban$an !an ersesi !ala". Pen!eri&a yan$ &er*ena serin$ "en/n/**an *##r!inasi yan$ b/r/* beralan &i!a* s&abil !en$an $aya beralan *a*i &erb/*a lebar "ele&a**an *e!/a *a*i !en$an #sisi yan$ salin$ bera/0an *es/li&an 12
!ala" "ela*/*an $er*an 4ea& !an &ea& "isalnya "en/lis a&a/ "en$an4in$*an ba/. Mere*a /$a serin$ "en$ala"i &re"#r !i"/lai !en$an $era*an ?#l/n&er "isalnya "en$a"bil b/*/ "enyebab*an $era*an seer&i "en$$i$il a!a ba$ian &/b/0 yan$ bar/ a*an !i$/na*an !an &a"a* "e"b/r/* sa"a !en$an saa& en!er&ia a*an "en// #bye* yan$ !i*e0en!a*i. Ben&/* a&a*si! ini "en$enai '61( en!eri&a CP. %< CP Ca"/ran Serin$ !i&e"/*an a!a se#ran$ en!eri&a "e"/nyai lebi0 !ari sa&/ ben&/* CP yan$ a*an !iabar*an !i a&as. Ben&/* 4a"/ran yan$ serin$ !i/"ai a!ala0 sas&i4 !an $era*an a&e&#i! &e&ai *#"binasi lain /$a "/n$*in !i/"ai.
@a"bar 3. Se?eri&y Se4&r/" Cerebral Palsy [8]
Ber!asar*an !ari !efisi& ne/r#l#$is 4erebral alsy &er!iri !ari 1< Tie sas&is a&a/ yra"i!al Pa!a &ie ini $eala yan$ 0a"ir selal/ a!a a!ala0 a. Hier&#ni ;fen#"ena isa/ lia&< b. Hierfle*si yan$ !iser&ai *l#n/s 4. )e4en!er/n$an &i"b/l *#n&ra*&/r !. Refle*s a&#l#$is 2< Tie e*s&raira"i!al A*an beren$ar/0 a!a ben&/* &/b/0 $era*an in?#l/n&er seer&i a&e&#sis !is&#nia a&a*sia. Tie ini serin$ !iser&ai $an$$/an e"#si#nal 13
!an re&ra!asi "en&al. Disa"in$ i&/ /$a !i/"ai $eala 0ier&#ni 0ierfle*si rin$an aran$ sa"ai &i"b/l *l#n/s. Pa!a &ie ini *#n&ra*&/r aran$ !i&e"/*an aabila "en$enai saraf #&a* bisa &erli0a& aa0 yan$ asi"e&ris !an !isar&ri 3< Tie 4a"/ran @eala6$eala "er/a*an 4a"/ran *e!/a $eala !i a&as "isalnya 0ierrefle*si !an 0ier&#ni !iser&ai $era*an *0#rea. Cerebral alsy /$a !aa& !i*lasifi*an ber!asar*an es&i"asi !eraa& bera&nya enya*i& !an *e"a"/an en!eri&a /n&/* "ela*/*an a*&i?i&as n#r"al ;Tabel 1.< Tabel 2. )lasifi*asi CP ber!asar*an Deraa& Penya*i& 2 )lasifi*asi Mini"al
Rin$an
Se!an$
Bera&
Per*e"ban$an "#&#ri* @eala N#r"al 0anya 1< )elainan &#n/s &er$an$$/ se4ara se"en&ara */ali&a&if 2< Refle*s ri"i&if "ene&a &erlal/ la"a 3< )elainan #s&/r rin$an %< @an$$/an $era* "#&#ri* *asar !an 0al/s "isalnya 4l/"sy Beralan /"/r 2% 1< Per*e"ban$an b/lan refle*s ri"i&if abn#r"al 2< Res#n #s&/lar &er$an$$/ 3< @an$$/an "#&#ri* seer&i &re"#r %< @an$$/an *##r!inasi Beralan /"/r 3 &a0/n 1< Berba$ai *elainan *a!an$ "e"erl/*an ne/r#l#$is bra4in$. Ti!a* erl/ 2< Refle*s ri"i&if ala& *0/s/s "ene&a 3< Res#n #s&/ral &erla"ba& Ti!a* bisa beralan 1< $eala ne/r#l#$is a&a/ beralan !en$an !#"inan ala& ban&/ *a!an$ 2< refle*s ri"i&if b/&/0 #erasi "ene&a 3< res#n #s&/ral &i!a* "/n4/l
Penya*i& enyer&a @an$$/an *#"/ni*asi @an$$/an belaar sesifi*
Re&ar!asi "en&al @an$$/an belaar !an *#"/ni*asi )ean$
1%
2.1.0. Manifes%asi /lini(
@eala CP &a"a* seba$ai se*&r/" yan$ "en$$a"bar*an ?ariasi bera&nya enya*i&. Sese#ran$ !en$an CP !aa& "ena"a**an $eala *es/li&an !ala" 0al "#&#ri* 0al/s "isalnya "en/lis a&a/ "en$$/na*an $/n&in$ "asala0 *esei"ban$an !ala" beralan a&a/ "en$enai $era*an in?#l/n&er "isalnya &i!a* !aa& "en$#n&r#l $era*an "en/lis. @eala !aa& berbe!a a!a se&ia en!eri&a !an !aa& ber/ba0 a!a se#ran$ en!eri&a. Pen!eri&a CP !eraa& bera& a*an "en$a*iba&*an &i!a* !aa& beralan a&a/ "e"b/&/0*an eraa&an yan$ e*s&ensif !an an$*a anan$ se!an$*an CP !eraa& rin$an "/n$*in 0anya se!i*i& 4an$$/n$ !ala" $era*an !an "e"b/&/0*an ban&/an yan$ &i!a* *0/s/s. CP b/*an enya*i& "en/lar a&a/ bersifa& 0ere!i&er. @a"baran aal a!a en!eri&a 4erebral alsy biasanya &a"a* a!a /sia G3 &a0/n !an #ran$ &/a serin$ "en4/ri$ai *e&i*a *e"a"/an er*e"ban$an "#&#ri* &i!a* n#r"al. Bayi !en$an 4erebral alsy serin$ "en$ala"i *ela"ba&an er*e"ban$an "isalnya &en$*/ra !/!/* "eran$*a* &erseny/" a&a/ beralan. 718
@a"bar %. Manifes&asi )lini* Cerebral Pallsy 1< Sas&isi&as Ter!aa& enin$$ian &#n/s #&#& !an refle*s yan$ !iser&ai !en$an *l#n/s !an refle* Babins*i yan$ #si&if. T#n/s #&#& yan$ "enin$$i i&/ "ene&a !an &i!a* 0ilan$ "es*i/n en!eri&a !ala" *ea!aan &i!/r.
1'
Penin$$ian &#n/s ini &i!a* sa"a !eraa&nya a!a s/a&/ $ab/n$an #&#& *arena i&/ &a"a* sifa& yan$ *0as !en$an *e4en!er/n$an &era!i *#n&ra*&/r "isalnya len$an !ala" a!/*si fle*si a!a sen!i si*/ !an er$elan$an &an$an !ala" r#nasi ser&a ari6ari !ala" fle*si se0in$$a #sisi ib/ ari "elin&an$ !i &elaa* &an$an. T/n$*ai !ala" si*a a!/*si fle*si a!a sen!i a0a !an l/&/& *a*i !ala" flesi lan&ar !an &elaa* *a*i ber/&ar *e !ala". T#ni4 ne4* refle !an refle*s ne#na&al "en$0ilan$ a!a a*&/nya. )er/sa*an biasanya &erle&a* !i &ra*&/s *#r&i*#sinalis. Ben&/* *el/"/0an sas&isi&as &er$an&/n$ *ea!a le&a* !an besarnya *er/sa*an yai&/ "#n#le$ia "#n#aresis. )el/"/0an *ee"a& an$$#&a $era* &e&ai sala0 sa&/ an$$#&a $era* lebi0 0eba& !ari yan$ lainnya 0e"ile$ia 0e"iaresis a!ala0 *el/"/0an len$an !an &/n$*ai !ii0a* yan$ sa"a !ile$ia !iaresis a!ala0 *el/"/0an *ee"a& an$$#&a $era* &e&ai &/n$*ai lebi0 0eba& !aria!a len$an &e&rale$ia &e&raaresis a!ala0 *eli"/0an *ee"a& an$$#&a $era* len$an lebi0 a&a/ sa"a 0eba&nya !iban!in$*an !en$an &/n$*ai. 2< T#n/s #&#& yan$ ber/ba0 Bayi a!a $#l#n$an ini a!a /sia b/lan er&a"a &a"a* fla*si! ;le"as< !an berbarin$ seer&i *#!#* &erlen&an$ se0in$$a &a"a* seer&i *elainan a!a l#er "#&#r ne/r#n. Menelan$ /"/r 1 &a0/n bar/la0 &era!i er/ba0an &#n/s #&#& !ari ren!a0 0in$$a &in$$i. Bila !ibiar*an berbarin$ &a"a* fle*si! !an si*anya seer&i *#!#* &erlen&an$ &e&ai bila !iran$san$ a&a/ "/lai !ieri*sa #&#& &#n/snya ber/ba0 "ena!i sas&is Refle*s #&#& yan$ n#r"al !an refle*s babins*i ne$a&if &e&ai yan$ *0as iala0 refele* ne#na&al !an &#ni4 ne4* refle "ene&a. )er/sa*an biasanya &erle&a* !i ba&an$ #&a* !an !isebab*an #le0 afi*sia erina&al a&a/ i*&er/s. 3< )#re#6a&e&#sis )elainan yan$ *0as yai&/ si*a yan$ abn#r"al !en$an er$era*an yan$ &era!i !en$an sen!irinya ;in?#l/n&ary "#?e"en&<. Pa!a + b/lan er&a"a &a"a* fla*si! &e&aa ses/!a0 i&/ bar/la0 "/n4/l *elainan &erseb/&. Refle*s ne#na&al "ene&a !an &a"a* a!anya er/ba0an
1+
&#n/s #&#&. Daa& &i"b/l /$a $eala sas&isi&as !an a&a*sia *er/sa*an &erle&a* !i$an$lia basal !isebab*an #le0 asfi*sia bera& a&a/ i*&er/s *ern a!a "asa ne#na&/s. %< A&a*sia A&a*sia a!ala0 $an$$/an *##r!inasi. Bayi !ala" $#l#n$an ini biasanya fla*si! !an "en/n/*an er*e"ban$an "#&#ri* yan$ la"ba&. )e0ilan$an *esei"ban$an &a"aa* bila "/lai belaar !/!/*. M/lai beralan san$a& la"ba& !an se"/a er$era*an 4an$$/n$ !an *a*/. )er/sa*an &erle&a* !iserebel/". '< @an$$/an en!en$aran Ter!aa& '61( ana* !en$an serebral alsi. @an$$/an ber/a *elainan ne/r#$en &er/&a"a ersesi na!i &in$$i se0in$$a s/li& "enan$*a *a&a6*a&a. Ter!aa& a!a $#l#n$an *#re#6a&e&#sis +< @an$$/an bi4ara Disebab*an #le0 $an$$/an en!en$aran a&a/ re&ra!asi "en&al. @era*an yan$ &era!i !en$an sen!irinya !ibibir !an li!a0 "enyebab*an s/*ar "en$#n&r#l #&#&6#&#& &erseb/& se0in$$a ana* s/li& "e"ben&/* *a&a6*a&a !an serin$ &a"a* ana* berli/r ,< @an$$/an "a&a @an$$/an "a&a biasanya ber/a s&rabis"/s *#n?er$en !an *elainan refra*si a!a *ea!aan asfi*sia yan$ bera& !aa& &era!i *a&ara*.
2.1.. Dia#n"sis Ana!nesis
Ana* !en$an 4erebral alsy !aa& 0a!ir se&ela0 $a$al "e"en/0i &a0a er*e"ban$an yan$ !i0ara*an a&a/ $a$al /n&/* "ene*an refle*s ri"i&if aib.
Ta0/n
2((3
A"eri4an
A4a!e"y
#f
Ne/r#l#$y
;AAN<
"enyaran*an ara"e&erra*&e* s*rinin$ /n&/* #&ensi serebral alsi beri*/& &er*ai& !efisi& a!a enilaian aal 728 1< 2< 3< %<
Men&al re&ar!asi =0&0al"#l#$i4 !an $an$$/an en!en$aran @an$$/an Bi4ara !an ba0asa Disf/n$si =r#"#&#r
1,
Dia$n#sis !i"/lai !en$an riaya& *e&erla"ba&an er*e"ban$an "#&#ri* *asar a!a &a0/n er&a"a *e0i!/an. Cerebral alsy serin$ ber"anifes&asi seba$ai 0i#&#nia aal /n&/* + b/lan er&a"a sa"ai 1 &a0/n *e0i!/an !ii*/&i !en$an sas&i*. 718 728 =&#& yan$ abn#r"al a!ala0 $eala yan$ alin$ serin$ !ia"a&i. Ana* "/n$*in 0a!ir seba$ai bai*
0i#&#ni*
a&a/
lebi0
/"/"
0ier&#ni*
!en$an
resis&ensi
bai* "en/r/n a&a/ "enin$*a& "ena!i $era*an asif "asin$6"asin$. Ana*6ana* !en$an 4erebral alsy "/n$*in "e"ili*i eri#!e aal 0i#&#nia !ii*/&i #le0 0yer&#nia. Se"a*in la"a eri#!e 0i#&#nia sebel/" 0yer&#nia se"a*in besar *e"/n$*inan ba0a 0yer&#nia a*an lebi0 ara0. 728 Tan$an referensi &er&en&/ sebel/" /sia 1 &a0/n a!ala0 ben!era "era0 /n&/* *e"/n$*inan 0e"ile$ia. Meran$*a* asi"e&ris a&a/ *e$a$alan "eran$*a* /$a "/n$*in "enyaran*an 4erebral alsy. @an$$/an er&/"b/0an serin$ !i4a&a& a!aana* !en$an 4erebral alsy &er/&a"a $a$al &/"b/0. Riaya& "e!is /"/" 0ar/s "en4a*/ *aian sis&e" /n&/* "en$e?al/asi /n&/* *#"li*asi beberaa yan$ !aa& &era!i !en$an 4erebral alsy. 728 1< Riaya& Prena&al Riaya& rena&al 0ar/s "e"as/**an inf#r"asi &en&an$ *e0a"ilan ib/ seer&i aaran rala0ir /n&/* #ba&6#ba&an &erlaran$ ra4/n a&a/ infe*si !iabe&es ib/ enya*i& ib/ a*/& &ra/"a aaran ra!iasi eraa&an ra6na&al !an $era*an anin. Riaya& aal ab#rsi s#n&an serin$ *e*eraba&an #ran$&/a !an riaya&*el/ar$a
enya*i&
ne/r#l#$is
;"isalnya
enya*i&
ne/r#!e$enera&i?e *e&/r/nan< /$a en&in$. 2< Riaya& Perina&al Riaya& erina&al 0ar/s "en4a*/ /sia *e0a"ilan ana* ;yai&/ !eraa&re"a&/ri&as< saa& la0ir resen&asi ana* !an enis ersalinan bera& la0ir s*#r A$ar!an *#"li*asi a!a eri#!e ne#na&al ;"isalnya a*&/ in&/basi a!anya er!ara0anin&ra*ranial *es/li&an "a*an anea bra!i*ar!ia infe*si !an 0ierbilir/bine"ia<. 3< Riaya& Per*e"ban$an 1
Riaya& er*e"ban$an ana* 0ar/s "enina/nya !ari se$i "#&#ri* *asar"#&#ri* 0al/s ba0asa !an s#sial !ari la0ir sa"ai saa& e?al/asi. Per0a&ian "#&#ri* *asar !en$an 4erebral alsy &er"as/* *#n&r#l *eala a!a/sia 2 b/lan ber$/lin$ a!a /sia % b/lan !/!/* !i /sia + b/lan !an beralan a!a/sia 1 &a0/n. Bayi !en$an 4erebral alsy "/n$*in si$nifi*an &er&/n!a "#&#ri* *asar a&a/ "en/n/**an referensi &an$an !ini a!a /sia */ran$ !ari 1' &a0/n "en/n/**an *ele"a0an rela&if !ari sa&/ sisi. Ha!irnya re$resi !ielas*an a*an lebi0 s/$es&if !ari enya*i& *e&/r/nan ne/r#!e$enera&i?e !ari 4erebral alsy. )e&era"ilan s#sial saa& ini res&asi a*a!e"is !an ar&isiasi !ala" r#$ra"in&er?ensi aal ;i*a G3 &a0/n< a&a/ !/*/n$an se*#la0 ;i*aK 3 &a0/n< 0ar/s !i&ina/ /lan$ &er"as/* ban&/an s/"ber !aya r/an$ fisi* e*eraan !an &erai bi4ara !anba0asa !an a!a&if fisi* en!i!i*an. Pen$/ian *#$ni&if !an en!i!i*an s&an!ar !an ren4ana en!i!i*an in!i?i!/alsaa& ini !aa& !i$/na*an /n&/* "enen&/*an aa*a0 &erai i4ara &erai #*/asi !an&erai fisi* bera!a !i &e"a& a&a/ aa*a0 ara0an /n&/* ini !ierl/*an. 728 Pe!eri(saan Fisi(
In!i*a&#r fisi* 4erebral alsy &er"as/* *#n&ra*&/r sen!i se*/n!er /n&/* #&#& sas&i* 0i#&#ni* /n&/* &#n/s #&#& sas&i* *e&erla"ba&an er&/"b/0an !an refle ri"i&if ersis&en. 718 728. Presen&asi aal 4erebral alsy &er"as/* 0i#&#nia aal !ii*/&i !en$an *e*ean$an. U"/"nya *elen&/ran &i!a* &er//! sa"ai se&i!a*nya + b/lan sa"ai1 &a0/n *e0i!/an. E?al/asi ne/r#l#$is "eli/&i en$a"a&an !e*a& !an e"eri*saan ne/r#l#$is f#r"al. Sebel/" e"eri*saan fisi* f#r"al #bser?asi !aa& "en$/n$*a*an le0er abn#r"al a&a/ &#n/s #&#& &r/n*al ;"en/r/n a&a/ "enin$*a& &er$an&/n$
a!a
/sia
!an enis 4erebral alsy<
#s&/r asi"e&ris *e*/a&an a&a/ $aya beralan a&a/ *##r!inasi abn#r"al. Pasien
!en$an
4erebral
alsy
!aa&
"en/n/**an
refle*s
1-
"enin$*a&"en/n/**an a!anya lesi /er "#&#r ne/r#n. )#n!isi ini /$a !aa& 0a!ir seba$ai ersis&ensi refle*s ri"i&if seer&i M#r# ;refle*s *e/&< !an refle*s le0er asi"e&ris&#ni* ;yai&/ #s&/r !en$an le0er ber/ba0 !ala" ara0 yan$ sa"a *e&i*a sa&/ len$an !ieranan$ !an yan$ lain &er&e*/*<. T#ni* le0er si"e&ris $en$$a"an al"arlabirin &#ni* !an refle*s ene"a&an *a*i /$a !i4a&a&. Refle*s M#r# !an labirin &#ni* se0ar/snya 0ilan$ a!a saa& bayi s/!a0 ber/sia %6+ b/lan refle*s e$an$al"aris a!a '6+ b/lan refle*s &#ni* le0er asi"e&ris !an si"e&ris a!a +6, b/lan!an ene"a&an refle*s *a*i sebel/" 12 b/lan. Cerebral alsy /$a &er"as/* *e&erbela*an$an a&a/ &i!a* a!anya refle*s #s&/ral a&a/ r#&e*&if ;"e"eranan$len$an *e&i*a !/!/*<. 728 P#la *ira0 *esel/r/0an 0ar/s !ia"a&i !an "asin$6"asin$ bersa"a !ie*s&re"i&as baa0 !an e*s&re"i&as a&as 0ar/s !inilai seba$ai beri*/& 728 a< Pan$$/l 6 fle*si berlebi0an a!!/*si !an an&e?ersi#n fe"#ralis "e"ben&/* #la"#&#ri* !#"inan. S4iss#rin$ *a*i a!ala0 /"/" a!a 4erebral alsy sas&i*. b< L/&/& 6 Fle*si !an e*s&ensi !en$an ?al$/s a&a/ ?ar/s &era!i. 4< F##& 6 E/in/s a&a/ beralan !en$an ari *a*i !an ?ar/s a&a/ ?al$/s !ari !< Hin!f##& a!ala0 /"/" !i 4erebral alsy. )elainan $aya beralan "/n$*in &er"as/* #sisiber#n$*#* !en$an fle*s#r in$$/l *e&a& !an a0a bela*an$ a0a !ean le"a0!an a&a/ !#rs#fle*si berlebi0an. A. Cerebral palsy spas%i, pira!ial3 Pasien !en$an sas&i* serebral ;ira"i!a< b/*&i 4erebral alsy
;yai&/enin$*a&an *e4ea&an yan$ &er$an&/n$ !ala" &#n/s #&#&< !an "er/a*an ,' !ariasien !en$an 4erebral alsy. Pasien "e"ili*i &an!a6&an!a *e&erliba&an /er "#&#r ne/r#n &er"as/* 0yerrefleia 4l#n/s res#n e*s&ens#r Babins*i refle*s ri"i&if ersis&en !an refle*s #?erfl# ;"elin&asi a!!/*&#r<. Hal ini !aa& !ia"a&i #le0*e4en!er/n$an ana* /n&/* "ena$a si*/ !ala" #sisi &er&e*/* a&a/ in$$/l &er&e*/* !an a!!/*si !en$an l/&/& &er&e*/* !an !i ?al$/s !an er$elan$an *a*i !i e/in/sse0in$$a beralan ari *a*i. 2(
B. Dys(ine%i, e(s%rapira!ial3 ,erebral palsy Dys*ine&i4 ;e*s&raira"i!al< 4erebral alsy !i&an!ai !en$an #la
er$era*ane*s&raira"i!al re$/lasi abn#r"al &#n/s #&#& *#n&r#l #s&/ral n#r"al !an !efisi&*##r!inasi. P#la $era*an abn#r"al !aa& "enin$*a&*an s&res a&a/ *e$ia&an yan$ ber&//an. =&#& biasanya n#r"al sela"a &i!/r. In&elien a!ala0 n#r"al a!a , asien !en$an 4erebral alsy a&0e&#i!. Tin$$inya insi!en $an$$/an en!en$aran sens#rine/ral
!ila#r*an.
Pasien
serin$
"e"ili*i
*e&erliba&an
se/!#b/lbar !en$an !isar&ria *es/li&an "enelan air li/r *es/li&an #r#"#&#r !an #la bi4ara n#r"al. Den$an !e"i*ian resen&asi fisi* *lasi* 4erebral alsy !ys*ine&i4 "eli/&i a< Hi#&#nia aal !en$an $an$$/an $era*an yan$ "/n4/l a!a b< 4< !< e< f< $< 0<
/sia 163 &a0/n Len$an lebi0 &eren$ar/0 !aria!a *a*i Refle*s &en!#n !ala" biasanya n#r"al se!i*i& "enin$*a& Beberaa sas&i* =r#"#&#r !isf/n$si @ai& )e&i!a*s&abilan ba!an Risi*# *e&/lian a!a "ere*a yan$ &er*ena !a"a* *erni4&er/s Pasien6asien !en$an 4erebral alsy !ys*ine&i4
"/n$*in
en/r/nan &#n/s*eala !an &r/n*al !an 4a4a& a!a *#n&r#l #s&/ral !an !isf/n$si "#&#ri* seer&ia&0e&#sis ;yai&/ $era*an la"ba& "en$$elia& &a* &er*en!ali &er/&a"a !i e*s&re"i&as!is&al< 40#rea ;yai&/ $era*an
&iba6&iba
&i!a*
&era&/r<
a&a/
40#re#a&0e&#sis
;yai&/*#"binasi a&0e&#sis !an $era*an 40#reif#r"< !an !is&#nia ;yai&/ $era*an la"ba&berira"a &er*a!an$ !en$an &#n/s #&#& "enin$*a& !an #s&/r abn#r"al "isalnya !ie*s&re"i&as !an ra0an$ a&as<.
C. Spas%i, )e!iple#i, ,erebral palsy
21
He"ile$ia !i&an!ai !en$an fle*si 0i le"a0 !an !#rs#fle*si er$elan$an *a*i seb/a0 #&#& &ibialis #s&eri#r yan$ &erlal/ a*&if *a*i s/inasi !ala" si*a si*a e*s&re"i&as a&as ;yai&/ serin$ !ia!a*an !en$an ba0/ a!!/*si si*/ &er&e*/* len$anbaa0 &err#nasi er$elan$an &an$an &er&e*/* &an$an "en$eal !ala" &in/ !en$anib/ ari !i &elaa* &an$an< sensasi &er$an$$/ 26&i&i* !is*ri"inasi &er$an$$/ !ana&a/rasa
#sisi &er$an$$/. Beberaa $an$$/an
*#$ni&if !i&e"/*an a!a se*i&ar 2 !ariasien &erseb/&. Den$an !e"i*ian 4erebral alsy sas&i* 0e"ile$ia "eli/&iresen&asi fisi* *lasi* beri*/& a< Defisi& sa&/ sisi /er "#&#r ne/r#n b< Len$an /"/"nya !ien$ar/0i lebi0 !ari *a*i "/n$*in &an$an referensi aala&a/ *ele"a0an rela&if a!a sa&/ sisi $aya beralan 4< !< e< f<
"/n$*in
!i&an!ai
!en$an4ir4/"!/4&i#n
e*s&re"i&as baa0 a!a sisi yan$ &er*ena )e&i!a*"a"/an belaar sesifi* =r#"#&#r !isf/n$si )e"/n$*inan !efisi& sens#ri* sei0a* Defisi& "e!an en$li0a&an ;"isalnya
!ari
0e"ian#sie
0#"#ny"#/s< !an s&rabis"/s $< )ean$
D. Spas%i, iple#i, ,erebral palsy Pasien !en$an *ean$ !ile$ia serin$ "e"ili*i eri#!e 0i#&#nia
!ii*/&i !en$an*elen&/ran e*s&ens#r !i e*s&re"i&as baa0 !en$an *e&erba&asan f/n$si#nal se!i*i&a&a/ &i!a* a!a e*s&re"i&as a&as. Pasien "en$ala"i *e&erla"ba&an !ala" "en$e"ban$*an *e&era"ilan "#&#ri* *asar. )e&i!a*sei"ban$an #&#& *ean$ serin$ "enyebab*an ersis&en @an$$/an *#$ni&if 0a!ir !ala" se*i&ar 3( asien !ile$i4 sas&i*. Cerebral alsy sas&i* !ile$i4 "eli/&i resen&asi fisi* *lasi* beri*/& a< Te"/an /er "#&#r ne/r#n !i *a*i lebi0 !ari len$an
22
b< P#la s4iss#rin$ $ai& !en$an in$$/l &er&e*/* !an a!!/*si l/&/& &er&e*/* !en$an?al$/s !an er$elan$an *a*i !i e/in/s "en$a*iba&*an beralan !en$an ari *a*i 4< Defe* belaar !an *ean$ */ran$ /"/" !aria!a !i 0e"ile$ia sas&i*
E. Spas%i, 4&ariple#i ,erebral palsy )ebanya*an asien !en$an 4erebral alsy sas&i* /a!rile$i
"e"ili*ibeberaa $an$$/an *#$ni&if !an "en/n/**an resen&asi fisi* *lasi* beri*/& a< Se"/a an$$#&a ba!an yan$ &er*ena !a"a* bai* sel/r/0 &/b/0 b< 4< !< e< f<
0yer&#nia a&a/ &r/n*al 0i#&#nia !en$an e*s&re"i&as 0yer&#nia =r#"#&#r !isf/n$si Menin$*a&nya risi*# *es/li&an *#$ni&if )ean$ )a*i /"/"nya !ien$ar/0i sa"a a&a/ lebi0 !ari len$an Pre!i*a& 0e"ile$ia $an!a i*a len$an lebi0 &erliba& !aria!a *a*i
Pe!eri(saan pen&n5an#
Dia$n#sis 4erebral alsy /"/"nya !ib/a& ber!asar*an $a"baran *linis na"/nbeberaa en/lis "en$e"/*a*an ba0a !ia$n#sis 0ar/s !i&/n!a sa"ai ana* /sia 2 &a0/n a&a/ lebi0. )arena #&a* &er/s ber*e"ban$ se&ela0 la0ir *elainan &#n/s "#&#r a&a/ $era*an !i beberaa "in$$/ er&a"a a&a/ b/lan se&ela0 *ela0iran se4araber&a0a !aa& "e"bai*
sela"a &a0/n
er&a"a
*e0i!/an
;a&a/
ba0*an nan&i<.
C#llab#ra&i?e Perina&al Pr#e4& "ene"/*an ba0a 0a"ir '( #ran$ yan$ !i!ia$n#sis !en$an 4erebral alsy !an ++ ana* !i!ia$n#sis !en$an !ile$ia sas&i* !i&e"/*an se4ara s/$es&if 4erebral alsy a!a /sia , &a0/n. 9an$ lain &i!a* "ens/$es&i*an &an!a6&an!a nya&a "#&#ri* !ari $an$$/an ini 0in$$a /sia 162 &a0/n. 728 )#n!isi lain yan$ 0ar/s !ier&i"ban$*an *e&i*a "en$e?al/asi asien !en$an4erebral alsy yan$ !i4/ri$ai &er"as/* enya*i& "e&ab#li* !an $ene&i* arale$ias*ean$ 0ere!i&er sin!r#" Re&& !an *elainan s/"s/" &/lan$ bela*an$. 728 23
Pa!a Ta0/n 2((3 A"eri4an A4a!e"y #f Ne/r#l#$y ;AAN< "en$e"/*a*an ra*&e* ara"e&er a!a 4erebral alsy "enyaran*an e"eri*saan lab#ra&#ri/" i*a 7138 1< Riaya& *linis a&a/ &e"/an !ari ne/r#i"a$in$ &i!a* "en/n/**an *elainan s&r/*&/ral &er&en&/ 2< Fi&/r &a"ba0an !an a&ii*al yan$ 0a!ir !ala" riaya& a&a/ e"eri*saan *linis a&a/ 3< S/a&/ *elainan #&a* yan$ &er!e&e*si a!a ana* !en$an 4erebral alsy. Selain i&/ &es !ia$n#s&i* /n&/* $an$$/an *#a$/lasi !ian/r*an i*a infar* serebral &erli0a& na"/n !a&a yan$ &erse!ia &i!a* 4/*/ /n&/* "e"bi"bin$ aas&/!i &ea& 0ar/s !iesan. 728 :i*a &ersan$*a !ia$n#sis $an$$/an 0ere!i&er a&a/ ne/r#!e$enera&i?e enyarin$an /n&/* *elainan "e&ab#li* a&a/ $ene&i* yan$ "en!asari 0ar/s !ila*/*an. Na"/n eneli&ian &er&en&/ &i!a* !ire*#"en!asi*an #le0 ara"e&er ra*&e* AAN seba$ai s&/!i &erseb/& 0ar/s bere!#"an a!a $a"baran *linis. 728 Para"e&er
ra*&e*
AAN
&i!a*
"ere*#"en!asi*an
seb/a0
ele4&r#en4e0al#$ra";EE@< *e4/ali *e4/ri$aan /n&/* eilesi a&a/ sin!r#" eilesi 0a!ir &ai i&/"ere*#"en!asi*an ne/r#i"a$in$ >/n&/* "ene&a*an ba0a *elainan #&a* a!a a!aana* !en$an 4erebral alsy yan$ "/n$*in a!a $ilirannya "enyaran*an e&i#l#$i!an r#$n#sis>. Per0a&i*an ba0a s&/!i en4i&raan #&a* n#r"al &i!a* berar&i ba0aana* &i!a* "e"ili*i 4erebral alsy *arena !ia$n#sis selal/ 0anya ber!asar*an &e"/an e"eri*saan fisi*. 728 1< Tes Lab#ra&#ri/" yan$ Ber#&ensi Ber"anfaa& Ti!a* a!a eneli&ian lab#ra&#ri/" !efini&if /n&/* "en!ia$n#sa 4erebral alsys&/!i 0anya /n&/* "enyin$*ir*an enyebab $eala lain seer&i *elainan "e&ab#li* a&a/ $ene&i* yan$ !ian$$a erl/ ber!asar*an e"eri*saan *linis. S&/!i &erseb/& !aa& "eli/&i 728 a< S&/!i f/n$si &ir#i! 6 f/n$si &ir#i! abn#r"al "/n$*in ber0/b/n$an !en$an*elainan a!a #&#& a&a/ refle*s &en!#n !ala" a&a/ $an$$/an $era*. 2%
b< )a!ar la*&a& !an ir/?a& 6 )elainan !aa& "en/n/**an *elainan "e&ab#lis"eener$i ;yai&/ 4y&#a&0y "i&#*#n!ria<. 4< )a!ar A"#nia 6 Penin$*a&an *a!ar a"#nia !aa& "en/n/**an !isf/n$si 0a&ia&a/ 4a4a& si*l/s /rea. !< Asa" =r$ani* !an a"in# 6 ser/" asa" a"in# */an&i&a&if !an */an&i&a&if /rinnilai asa" #r$ani* !aa& !i/n$*a*an !ala" "earisi $an$$/an "e&ab#lis"e. e< Analisis *r#"#s#" 6 analisis *r#"#s#" &er"as/* analisis *ari#&i !anen$/ian DNA sesifi* !aa& !iin!i*asi*an /n&/* "enyin$*ir*an sin!r#" $ene&i* i*a fi&/r !is"#rfi* a&a/ *elainan berba$ai sis&e" #r$an yan$ 0a!ir. f< Pr#&ein serebr#sinal 6 *a!ar !aa& "e"ban&/ !ala" "enen&/*an asfi*sia a!aeri#!e ne#na&al. Tin$*a& r#&ein !aa& "enin$*a& !e"i*ian /$a rasi# la*&a&*e ir/?a&.
2< Pen4i&raan S&/!i )ranial Peneli&ian ne/r#i"a$in$ !aa&
"e"ban&/ /n&/* "en$e?al/asi
*er/sa*an #&a* !an /n&/* "en$i!en&ifi*asi #ran$ yan$ berisi*# /n&/* 4erebral alsy. Da&a /n&/* "en!/*/n$ !ia$n#sis !efini&if 4erebral alsy "asi0 */ran$. Ul&ras#n#$rafi *ranial !ila*/*an a!a eri#!e ne#na&al !ini !aa& "e"ban&/ a!a bayi se4ara "e!is s&abil sa"ai "ere*a "a"/ "en&#lerir
&rans#r&asi
/n&/* ne/r#i"a$in$
yan$
lebi0
rin4i.
Ul&ras#n#$rafi !aa& "en$$a"bar*an elas *elainans&r/*&/ral !an "en/n/**an b/*&i er!ara0an a&a/ 4e!era 0i#*sia6is*e"i*. Seba$ai 4#n� /l&ras#n#$rafi *ranial ne#na&al "e"beri*an inf#r"asi &en&an$ sis&e"?en&ri*el $an$lia basal !an 4#r/s 4all#s/" ser&a inf#r"asi !ia$n#s&i* a!aer!ara0an in&ra?en&ri4/lar !an 0i#*sia6is*e"i* 4e!era a!a "a&eri /&i0eri?en&ri4/lar. Le/*#"ala4ia eri?en&ri4/lar aalnya "/n4/l seba$ai !aera0e40#!ense yan$ "en$*#n?ersi *e area e40#l/4en& *e&i*a asien a!ala0 se*i&ar /sia 2"in$$/. Le/*#"ala4ia eri?en&ri4/lar san$a& &er*ai& !en$an 4erebral alsy.
2'
Pa!a bayi 4#"/&e! &#"#$ra0y ;CT< s4annin$ #&a* "e"ban&/ /n&/* "en$i!en&ifi*asi 4a4a& baaan er!ara0an in&ra*ranial !an le/*#"ala4iaeri?en&ri4/lar lebi0 elas !aria!a US@. Ma$ne&i4 Res#nan4e I"a$in$ ;MRI< #&a* a!ala0 yan$ alin$ ber$/na se&ela0 263 "in$$/ *e0i!/an !an a!ala0 s&/!i ne/r#i"a$in$ !ia$n#s&i* ili0an /n&/* ana*6ana* yan$ lebi0 &/a *arena "#!ali&as ini "en!efinisi*an s&r/*&/r *#r&i*al !an 0i&e"a&&er !an *elainan lebi0 elas !aria!a "e&#!e lainnya. MRI /$a "e"/n$*in*an/n&/* enen&/an "ielinasi yan$ &ea& /n&/* /sia &er&en&/. Pa!a ana* !en$an *a*iyan$ sas&i* !an "e"b/r/*nya f/n$si /s/s !an *an!/n$ *e"i0 seb/a0 MRI &/lan$bela*an$ !aa& "e"ban&/ "en$i!en&ifi*asi *er/sa*an &/lan$ bela*an$. 728 Mes*i/n eran yan$ &ea& /n&/* MRI !ala" !ia$n#sis !an e"eri*saan ana*6ana* !en$an 4erebral alsy a&a/ *el/"/0an #&a* !i!/$a bel/" seen/0nya!ielas*an li&era&/r "en/n/**an ba0a MRI 0ar/s !ier&i"ban$*an !ala" se"/a*as/s !ala" seb/a0 eneli&ian - ana* !en$an 4erebral alsy !i&e"/*an "e"ili*iMRI abn#r"al.
Selain i&/
"e"re!i*si
MRI
"/n$*in
0asiler*e"ban$an
saraf
"e"ili*i a!a
eran
bayi
!ala"
re"a&/r.
Ul&ras#n#$rafi CT s4an !an MRI *eala!aa& "e"ban&/ /n&/* "en!ia$n#sis !an e"an&a/an &e"/an 0i!r#sefal/s. 71%8 71'8 Pasien yan$ 0a!ir se4ara *linis !en$an 4erebral alsy "/n$*in "e"ili*i 0asilyan$ n#r"al !ari s&/!i en4i&raan #&a*. Hasil n#r"al !ari
s&/!i
ne/r#i"a$in$
&i!a* "en$e4/ali*an
!ia$n#sis
*linis
$an$$/an ini. Na"/n !ala" *as/s ini e&i#l#$i"e&ab#li* !an $ene&i* lain yan$ "en!asari 0ar/s !ier&i"ban$*an !an !i*el/ar*an sebel/" "en!ia$n#sis ana* !en$an 4erebral alsy 728 3< Ele4&r#en4e0al#$ra0y Ele4&r#en4e0al#$ra0y ;EE@< ber$/na !ala" "en$e?al/asi 4e!era ara00i#*sia6is*e"i*. S&/!i ini en&in$ !ala" !ia$n#sis $an$$/an *ean$ &e"/anaalnya "en/n/**an ene*anan !i&an!ai a"li&/!# !an erla"ba&an !ii*/&i !en$an#la &er/&/s enin!asan &e$an$an !en$an se"b/ran &e$an$an &in$$i $el#"ban$&aa" !an la"ba& 2%6% 2+
a". Na"/n EE@ &i!a* !iin!i*asi*an i*a *ean$ &i!a* !i4/ri$ai bersa"a !en$an 4erebral alsy. 728 %< EM@ !an S&/!i *#n!/*si saraf Ele*&r#"i#$rafi ;EM@< !an s&/!i *#n!/*si saraf san$a& "e"ban&/ *e&i*a$an$$/an #&#& a&a/ saraf !i4/ri$ai ;"isalnya ne/r#a&i "#&#r a&a/ sens#ri* 0ere!i&erseba$ai !asar /n&/* !ef#r"i&as *a*i e/in/s !an beralan ari *a*i<. 728 2.1.6. Dia#n"sis banin#
1< Ne/r#"/s*/ler a. Sinal "/s4le ar&r#0y b. Dis&r#fia "/s*/ler )elainan #&#& 0ere!i&er yan$ r#$resif &i"b/l sebel/" /sia ' &a0/n biasanya a!a ana* la*i6la*i. )ele"a0an #&#& &a"a* !i r#*si"al. 2< De$enera&if a. Frie!rie40s a&aia b. Penya*i& C0#rea H/n&in$&#n "asa ana* @an$$/an $era*an yan$ !isebab*an *arena !isf/n$si basal $an$lia. @era*an "enyen&a* 4ea& ire$/ler &i!a* !aa& !ire!i*si*an !aa& &era!i a!a sa&/ ba$ian &/b/0 yan$ *e"/!ian !aa& "en$enai ba$ian &/b/0 yan$ lain !aa& !iser&ai !en$an *es/li&an /n&/* "a*an $an$$/an $ai& 4l/"siness. 3< Me&ab#li* a. Penya*i& 5ils#n %< )elainan T/lan$ Sen!i a. Ar&0er# $ry0#sis "/l&ile *#n$eni&al '< Penya*i& $an$$/an $era* in?#l/n&er a. Sin!r#" T#/re&&e b. C0#rea Sy!en0a" 4. Sas"/s n/&ans +< Penya*i& "e&ab#li* ,< T/"#r a&a/ AM "e!/lla sinalis < Sinal !ys&r#0ia 71+8
2.1.7. Pena%ala(sanaan
Pen$el#laan asien !en$an 4erebral alsy 0ar/s in!i?i!/al ber!asar*an resen&asi
*linis
ana*
!an
"e"erl/*an
en!e*a&an
"/l&i!isilin.
2,
Re0abili&asi a!ala0 >in&er?ensi s&ra&e$i *#"re0ensif yan$ !iran4an$ /n&/* "e"fasili&asi a!a&asi !anar&isiasi !ala" enin$*a&an /"la0 !an berba$ai en$a&/ran !ala" "asyara*a& !anb/!aya. 728 Ne/r#l#$is !an sesialis re0abili&asi #ba& ;0ysia&ris&s< "e"ain*an eranen&in$ !ala" en$el#laan #ba& an&isas&i4i&y. Tan$$/n$ aab !#*&er a!ala0 /n&/* "ens/er?isi !an "en$el#la *#"li*asi "e!is yan$ &ela0 !i*ai&*an !en$an 4erebralals y. 728 Pen!eri&a
CP
"e"erl/*an
&a&ala*sana
&era!/"/l&i
!isiliner
"en$in$a&"asala0 yan$ !i0a!ai san$a& *#"le*s yai&/ 71,8 a< b< 4< !< e< f< $< 0< i< < *<
@an$$/an "#&#ri4 Re&ar!asi "en&al )ean$ @an$$/an en!en$aran @an$$/an rasa raba @an$$/an ba0asa !an bi4ara Ma*an$ii @an$$/an "en$#n&r#l "i*si ;n$#"#l< @an$$/an *#nsen&rasi @an$$/an e"#si @an$$/an belaar
Ti" !ia$n#s&i* !an ena&ala*sanaan CP ini "eli/&i 1< Ti" In&i a< Ne/r#e!ia&ri b< D#*&er @i$i 4< Psi*#l#$ !< Peraa& e< Fisi#&erai ;&erai *era &erai bi4ara< f< Pe*era S#sial ;en$/n/n$ r/"a0< 2< Ti" )#ns/l&asi a< Ti" T/"b/0 )e"ban$ Ana* !an Re"aa b< D#*&er Be!a0 ;=r&#e!i< 4< D#*&er Ma&a !< D#*&er THT e< Psi*ia&er Ana* f< @/r/ SLB ;4a4a& &/b/0 &/nane&ra &/nar/n$/< Pena&ala*sanaan CP "eli/&i
2
A. Me!i*a"en&#sa /n&/* "en$a&asi sas&isi&as 1< Ben#!iaein a. Usia G + b/lan &i!a* !ire*#"en!asi b. Usia K + b/lan (126( "$)$BB0ari
P=
!iba$i +6
a" ;&i!a* lebi01( "$!#sis< 2< Ba4l#fen ; Li#resal < 3 1( "$ P= ;!aa& !inai**an sa"ai %(6 ( "$0ari< 3< Dan&r#lene ; Dan&ri/" < !i"/lai !ari 2' "$0ari !aa& !inai**an sa"ai%( "$0ari %< Oal#eri!#l ((3 "$)$BB0ari P= !#sis &/n$$al ;/n&/* "en$/ran$i$era*an in?#l/si< '< B#&# a. Usia G 12 &a0/n bel/" !ire*#"en!asi*an b. Usia K 12 &a0/n 12'62' "l ;(('6(1 "l &ia 36% b/lan< 4. Aabila bel/" ber0asil !#sis beri*/&nya !inai**an 2&i!a* lebi0 2' "ler*ali a&a/ 2(( "l erb/lan B. Terai Per*e"ban$an Fisi* ;Re0abili&asi Me!i*< C. Lain6lain 1< Pen!i!i*an *0/s/s 2< Peny/l/0an si*#l#$is 3< Re*reasi Mana5e!en 8era(an Abn"r!al
Ini "enar$e&*an #ba& *elen&/ran !is&#nia "i#*l#n/s 40#rea !an a&0e&#sis.Seba$ai 4#n� ba4l#fen ;anal#$ $a""a6a"in#b/&yri4 a4i! ;@ABA<< !iberi*an bai* se4ara #ral a&a/ in&ra&0e4al serin$ !i$/na*an /n&/* "en$#ba&i sas&isi&as a!a asienini. 728 1< B#&/lin/" &#*sin !en$an a&a/ &ana 4as&in$ B#&/lin/" &#*sin ;b#&#< &ie A !aa& "en$/ran$i *e*ean$an sela"a 36+ b/lan !an 0ar/s !ier&i"ban$*an /n&/* ana*6ana* !en$an 4erebral
alsy
!en$an
*elen&/ran
a!a
e*s&re"i&as
baa0
;$as&r#4ne"i/s *0/s/snya<. Terai ini !aa &"e"/n$*in*an /n&/* "enin$*a&*an
ren&an$
$era*
!ef#r"i&as
!i*/ran$i
res#n
!i&in$*a&*an /n&/* &erai #*/asi !an fisi* !an *e&erla"ba&an !ala" *eb/&/0an /n&/* "anae"en #erasi *elen&/ran. Cas&in$ !en$an a&a/ &ana &#*sin b#&/lin/"&ie A bisa "ena!i ili0an &a"ba0an /n&/*
2-
ana*6ana* !en$an 4a4a& e/in/s"es*i/n b/*&i i&/ "asi0 a$a* ber&en&an$an. 728 7138 D#sis ba!an yan$ !iben&/* &#&al &#*sin b#&/lin/" !iba&asi sa"ai 12 U*$"a*si"al %(( U er */n/n$an. ;Banya* ra*&e* ba$ai"ana/n &ela0 a"a n"en$$/na*an 2( U*$ "a*si"al +(( U<. Se&ia #&#& *e4il "eneri"a 162 U*$ !an#&#&6#&#& besar %6+ U*$. In&er?al an&ara !#sis 0ar/s "ini"al % b/lan /n&/* "e"ban&/ "en4e$a0 e"ben&/*an an&ib#!i yan$ bisa "e"b/a& r#se!/r b#&/lin/"&#*sin selan/&nya */ran$ efe*&if. Per0a&i*an ba0a #&#&6 #&#& besar "/n$*in &i!a* "eres#n 0al ini "e"ba&asi !#sis a&a/ 4/*/ serin$ asien erl/ beberaa #&#&!ila*/*an a!a se&ia */n/n$an. 728 2< Fen#l in&ra"/s*/lar ne/r#lysis Se4ara 0is&#ris ne/r#lysis in&ra"/s*/lar fen#l &ela0 !ian$$a ili0an lain en$#ba&an. A$en ini !aa& !i$/na*an /n&/* beberaa #&#&6#&#& besar a&a/ *e&i*a #&#& beberaa !ierla*/*an &ai &erai fen#l lebi0 s/li& /n&/* "en$el#la !ari a$en lain. )arena fen#l !iberi*an "en$$/na*an eran$san$ saraf en$#ba&an ini lebi0 "enya*i&*an !an anes&esi serin$ !i$/na*an *e&i*a &erai ini !ila*/*an. Selain i&/fen#l bisa !ala" saraf &er&en&/ "enyebab*an !yses&0esias sens#ri* "enyenan$*an#le0 *arena i&/ en$$/naannya serin$ &erba&as 0anya a!a saraf !en$an ersarafan "#&#r seer&i "/s*/l# */&ane/s ;/n&/* "en$/ran$i fle*si len$an< !an #b&/ra&#ri/s;/n&/* "en$/ran$i a!!/*si an$$/l<. Pen$#ba&an Fen#l ini /$a !i$/na*an /n&/* &i&i* 0a"s&rin$ bl#* "#&#r ;/n&/* fle*si l/&/&<. 728 3< An&iar*ins#n an&i*#n?/lsan an&i!#a"iner$i4 !an
a$en
an&i!eresan Mes*i/n #ba& an&iar*ins#n ;"isalnya #ba&6#ba&an an&i*#liner$i* !an !#a"iner$i*< !an a$en an&isas&i4i&y ;"isalnya ba4l#fen< &ela0 &er/&a"a !i$/na*an !ala" en$el#laan !is&#nia an&i*#n?/lsan #ba& an&i!#a"iner$i4 !an an&i!eresan /$a &ela0 !i4#ba. 728 An&i*#n?/lsan ;&er"as/* ben#!iaein seer&i !iaea" asa" ?alr#a& !anbarbi&/ra&< &ela0 ber$/na !ala" en$el#laan "i#*l#n/s.
3(
C0#rea !an a&0e&#sisserin$*ali s/li& /n&/* !i*el#la "es*i/n ben#!iaein
ne/r#le&i*
!an
#ba&an&iar*ins#n
;"isalnya
le?#!#a< &ela0 !i4#ba. Ben#!iaein !an ba4l#fen biasanya !i$/na*an /n&/* "en$el#la *elen&/ran. D. Be!a0 saraf !an Be!a0 #r&#e!i Ba$ian ini a*an "e"ba0as se4ara sin$*a& seba$ai beri*/& enyisian #"aba4l#fen in&ra&e*al r0i#&#"y sele*&if !#rsal $an$lia basal s&ere#&a4&i4 !an in&er?ensi be!a0 #r&#e!i. 728 a. Penyisian #"a ba4l#fen in&ra&e*al Penyisian in&ra&e*al !ari #"a ba4l#fen /n&/* "en$#ba&i sas&isi&as !an a&a/ !is&#nia ber$/na a!a asien !en$an *elen&/ran !if/s a&a/ !is&#nia #"a ba4l#fen yan$ alin$ ber$/na
!ala"
"e"ban&/
/n&/*
"en$/ran$i
*elen&/ran
a!ae*s&re"i&as baa0 !an ba&an$ &e&ai /$a !aa& "en$/ran$i *elen&/ran a!ae*s&re"i&as a&as !an "enin$*a&*an bi4ara. P#"a !i&e"a&*an !i !in!in$ er/& an&eri#r !an &er0/b/n$ *e seb/a0 *a&e&er !i"as/**an *e !ala" r/an$ s/bara40n#i! yan$ "elaisi *#n/s !ari s/"s/" &/lan$ bela*an$. In&ra&e*al ba4l#fen !aa& "e"/n$*in*an en$0a"ba&an resina&i* lebi0 l#*al !ari aferen sens#ri* Ia !an"e"ili*i efe* sa"in$ lebi0 se!i*i& !aria!a ba4l#fen #ral. b. R0i#&#"y sele*&if !#rsal Pen$#ba&an lain be!a0 saraf a!ala0 ba0a !ari r0i#&#"y /n$$/n$ sele*&ifyan$ "/n$*in ber"anfaa& bai* !ala" an$*a en!e* !an an$*a la"a /n&/* "en$#ba&i *e4ea&an &er$an&/n$ a!a
*elen&/ran.
Pr#se!/r
ini
"en4a*/La"ine*&#"i
!an
*e"/!ian ablasi be!a0 !ari ,(6-( !ari a*ar saraf !#rsal a&a/ sens#ri*.
Den$an "e"#&#n$
sera&
sens#ri* Ia
r0i#&#"y
/n$$/n$ sele*&if "en$/ran$i *elen&/ran !en$an "en$/ran$i a*&i?asi refle*sif "#&#ne/r#n yan$!ier*ira*an seba$ai a*iba& !ari */ran$nya &/r/n "as/*an sera&. =erasi ini &ela0 !a&an$ yan$ a*an !ila*/*an lebi0 aran$ sea* "/n4/lnya #"a ba4l#fen. )arena la"ine4&#"ies beberaa 31
#erasi sebel/"nya "en$ala"i*#"li*asi lebi0 l#r!#sis l/"balis ara0 beberaa &a0/n se&ela0 #erasi. )ebanya*an a0li be!a0 se!an$ "ela*/*an la"ine4&#"ies *e4il 0anya 162 &in$*a&. 4. S&ere#&a4&i4 basal $an$lia Mes*i/n !a&a &erba&as a!a #/lasi ini #erasi $an$lia basal s&ere#&a4&i4 !aa& "enin$*a&*an *e*a*/an 40#re#a&0e&#sis !an &re"#r !. Be!a0 #r&#e!i in&er?ensi S4#li#sis !an !isl#*asi in$$/l a!ala0 *#n!isi yan$ alin$ /"/" yan$"e"b/&/0*an e"be!a0an. Ten!#n "e"eranan$ a&a/ &ransfer !aa& "en$/ran$i*e&i!a*sei"ban$an #&#& sas&i* !an as/*an !ef#r"asi !an #s&e#&#"i !aa&"enye&el *e"bali an$$#&a &/b/0 &er"as/* le0er fe"/r &ibia !an 4al4ane/s e. Pen$$/naan $ab/n$an eran$*a& *#n&in/ inf/s !an anal$esi* #ral &ela0 &erb/*&i lebi0 efe*&if !aria!a #ba& #ral saa !ala" "en$/ran$i in&ensi&as nyeri a!a ana* !en$an 4erebral alsy yan$ "enalani r#se!/r #r&#e!i e*s&re"i&as baa0.
/"ns&l%asi
Seer&i
!iseb/&*an
sebel/"nya
en!e*a&an
&i"
"/l&i!isilin
!ierl/*an !ala" en$el#laan asien !en$an 4erebral alsy. Di an&ara sesialis yan$ 0ar/s !i*#ns/l&asi*an a!ala0 0ysia&ris&s a0li be!a0 #r&#e!i a0li saraf !an a0li be!a0saraf a0li $ene&i*a en4ernaan a0li $ii !an &i" "e"beri "a*an !an "enelan/l"#n#l#$is&s &i" *e&i!a*"a"/an belaar !an sesialis lain. 728 1< P0ysia&ris&. Se#ran$ A0 0ar/s !i*#ns/l&asi*an /n&/* e?al/asi !an "anae"en !ari r#$ra" re0abili&asi. Sesialis ini !aa& "e"ban&/ !en$an banya* ase* eraa&an na"/n &i!a* &erba&as a!a yan$ ber*ai&an !en$an "anae"en *elen&/ran &erai "#!ali&asbra4in$ sial#rr0ea !an ins#"nia. P0ysia&ris&s /$a !aa& "en$el#la &#*sinb#&/lin/" &ie A in&ra"/s*/lar.
32
2< A0li be!a0 #r&#e!i. A0li be!a0 #r&#e!i "/n$*in !ierl/*an /n&/* "e"ban&/ "e"erbai*i !ef#r"i&as s&r/*&/ral !an 0ar/s !i*#ns/l&asi*an /n&/* en$el#laan #erasi !isl#*asi in$$/l s4#li#sis
!an
*elen&/ran
;"isalnya&en#&#"y
r#se!/r
e"anan$an6&en!#n<. D#*&er be!a0 #r&#e!i /$a !aa& "en$el#la &#*sin b#&/lin/" &ie A in&ra"/s*/lar. 3< A0li saraf !an a0li be!a0 saraf. Se#ran$ a0li syaraf !aa& "e"ban&/
!en$an
"en$esa"in$*an
!ia$n#sis
$an$$/an
!iferensial
ne/r#l#$is
!an
lainnya.
!en$an )#ns/l&asi
!en$an a0li saraf /$a !aa& "e"ban&/ !ala" en$#ba&anasien !en$an
*ean$.
A0li
be!a0
saraf
0ar/s
!i*#ns/l&asi*an
/n&/* "en$i!en&ifi*asi !an "en$#ba&i 0i!r#sefal/s *elainan &/lan$ bela*an$ a&a/*ean$. A0li be!a0 saraf "ela*/*an r#se!/r r0i#&#"y !#rsal. %< A0li $ene&i*a. Se#ran$ sesialis !ala" $ene&i*a !aa& "e"ban&/ !en$an!ia$n#sis
!iferensial
!an
!en$an
"en$esa"in$*an
$an$$/an lain. Seba$ai4#n� a0li $ene&i*a 0ar/s !i*#ns/l&asi*an /n&/* "en$e?al/asi seb/a0sin!r#" $ene&i* yan$ "en!asari *0/s/snya !ala" en$a&/ran fi&/r !is"#rfi**elainan #r$an "/l&ile a&a/ riaya& *el/ar$a sin!r#" ne/r#l#$is yan$ sa"a '< A0li @as&r#en&er#l#$i a0li $ii !an &i" "e"beri "a*an"enelan. A0l i@as&r#en&er#l#$i a0li $ii !an &i" "e"beri "a*an !an "enelan "enye!ia*an "anae"en *es/li&an e"berian a*an !an "enelan
!an
refl/*s
$as&r#es#0a$eal !a"
"enilai
s&a&/s
$ii. A0li @as&r#en&er#l#$i !aa& "e"ban&/ !en$an refl/*s !an se"beli& e"berian
!an
!aa&
"a*an
"e"ban&/ /n&/*
!ala"
"en$a&/r
"en$*##r!inasi*an bera&
ba!an
a&a/
r/$i i*a !ierl/*an. Seb/a0 $as&ri4 &/be a&a/ e/n/" &/be "/n$*in /$a !ierl/*an /n&/* "e"ban&/ e"berian $ii. +< )#ns/l&asi $ii eri#!i* a!ala0 en&in$ /n&/* "e"as&i*an ba0a ana* &i!a* "en!eri&a !ari *e$a$alan er&/"b/0an a&a/ *e*/ran$an $ii.
33
,< P/l"#n#l#$is&. en$el#laan
P/l"#n#l#$is enya*i&
0ar/s
ar/
!i*#ns/l&asi*an
*r#nis
a*iba&
/n&/* !islasia
br#n*#/l"#nalis !an asirasi serin$ a&a/ber/lan$. < Ti" )e&i!a*"a"/an Belaar. Seb/a0 &i" "/l&i!isilin yan$ "en$*0/s/s*an!iri !ala" ana* ber*eb/&/0an *0/s/s belaar 0ar/s !i*#ns/l&asi*an /n&/* "en$i!en&ifi*asi *e&i!a*"a"/an belaar sesifi* "#ni&#r er*e"ban$an*#$ni&if !an asa e"an!/ "elal/i in&er?ensi !ini !an se*#la0. Ana* 0ar/s!ie?al/asi #le0 /sa& enin$*a&an *#"/ni*asi /n&/* "e"an!/ &erai bi4araba0asa !an en$$/naan eran$*a& *#"/ni*a&if. -< Sesialis Lain. )#ns/l&asi !en$an !#*&er "a&a !aa& !iin!i*asi*an /n&/* &in!a* lan/& !ari se&ia asien "en$ala"i !efisi& ?is/al !an !#*&er
THT
!aa&
"e"ban&/
/n&/*
"ens*rinin$
!efisi&
en!en$aran. Selain i&/ */n/n$an *e!#*&er $i$i yan$ &era&/r san$a& en&in$. En!#4rin#l#$is& *a!an$6*a!an$!ierl/*an /n&/* /ber&as re*#*s a&a/ en$#ba&an #s&e##r#sis. Pe"an&a/an :an$*a Panan$. )lini* "/l&i!isilin 4erebral alsy !aa& "e"/n$*in*an /n&/* &in!a* lan/& yan$ serin$ *#"re0ensif !ari ana*6ana* !en$an $an$$/an ini se*ali$/s "en$/ran$i *eb/&/0an /n&/*
eralanan
asien.Tin!a*
lan/&
ne/r#l#$is
yan$
!e*a&
!ierl/*an /n&/* asien !en$an 4erebralals y. 2.1.19. /"!pli(asi
)#"li*asi 4erebral alsy !aa&
"e"en$ar/0i beberaa
sis&e".
Misalnya*#"li*asi */li& "eli/&i /l*/s !e*/bi&/s !an l/*a *#"li*asi #r&#e!i "/n$*in &er"as/* *#n&ra*&/r !isl#*asi in$$/l !ana&a/ s4#li#sis. 728 Me"er&a0an*an bera& ba!an "en!e*a&i bera& ba!an i!e en&in$ ba$i asienber*/rsi r#!a a&a/ "ere*a yan$ "e"ili*i !isf/n$si beralan. )#ns/l&asi $ii 0ar/s!ila*/*an sea* !ini !an se4ara ber*ala /n&/* "e"as&i*an er&/"b/0an yan$ &ea&.=ran$ &/a !an ara r#fesi#nal "e!is 0ar/s &e&a "en$a&asi *es/li&an $ii #&ensiala!a ana* !en$an 4erebral 3%
alsy. Pasien6asien ini san$a& berisi*# &er*ena #s&e##r#sis *arena ban&alan bera& "en/r/n se0in$$a beri*/& as/an *alsi/" "ere*a a!ala0 en&in$ 728 )#"li*asi $as&r#in&es&inal !an $ii "eli/&i a< @a$al &/"b/0 *arena *es/li&an "a*an !an "enelan se*/n!er /n&/* *#n&r#l#r#"#&#r yan$ b/r/* asien "/n$*in "e"erl/*an &ab/n$ $as&r#s&#"y ;@6&ab/n$< a&a/ &ab/n$ e/n#s&#"y ;:6&ab/n$< /n&/* "ena"ba0 $ii. b< @as&r#es#0a$eal refl/ !an &er*ai& ne/"#nia asirasi 4< Se"beli& !< @i$i *aries. Masala0 $i$i /$a &er"as/* !is$enesis ena"el "al#*l/si !an 0ierlasia $in$i?a. Mal#*l/si !/a *ali lebi0 /"/" seer&i !ala" #/lasi n#r"al.Insi!en enin$*a&an "asala0 $i$i serin$ se*/n!er /n&/* en$$/naan #ba&*0/s/snya #ba& !iberi*an a!a bayi re"a&/r !an a$en an&ieilesi. )#"li*asi ernaasan "eli/&i a< Menin$*a&nya risi*# ne/"#nia asirasi *arena !isf/n$si #r#"#&#r b< Penya*i& ar/ *r#nis!islasia br#n*#/l"#nalis 4< Br#n40i#li&isas"a )#"li*asi ne/r#l#$is "eli/&i a< Eilesi. b< @an$$/an en!en$aran ;&er/&a"a a!a asien yan$ "en$ala"i ensefal#a&i bilir/bin a*/& 7*erni*&er/s8 /$a &erli0a& a!a asien yan$ la0ir re"a&/r a&a/yan$ &er*ena #ba& #&#&#i4< 4< Pen$li0a&an )elainan "e!an en$li0a&an *arena 4e!era *#r&i*al !< S&rabis"/s Eilesi &era!i a!a 1'6+( ana* !en$an 4erebral alsy !an lebi0 serin$&era!i a!a asien !en$an /a!rile$ia sas&i* a&a/ re&ar!asi "en&al. Bila !iban!in$*an !en$an *#n&r#l ana* !en$an 4erebral alsy "e"ili*i insi!en yan$lebi0 &in$$i !en$an #nse& eilesi !ala" &a0/n er&a"a *e0i!/an !an lebi0 "/n$*in/n&/* "e"ili*i riaya& *ean$ ne#na&al s&a&/s eile&i*/s #ly&0eray !anen$#ba&an !en$an lini *e!/a
3'
an&i*#n?/lsan. Fa*&#r yan$ &er*ai& !en$an "asa bebas*ean$ "ini"al 1 &a0/n &er"as/* *e4er!asan n#r"al enis *ean$ &/n$$al "#n#&erai !an *ean$ !ile$ia. )e&aa"an ?is/al ber*/ran$ a!a bayi re"a&/r*arena re&in#a&i
re"a&/ri&as
!en$an
0yer?as4/laria&i#n
!an
"/n$*in
ablasire&ina. )#"li*asi *#$ni&ifsi*#l#$iserila*/ "eli/&i beri*/& ini a< )e&erbela*an$an "en&al ;3(6'(< alin$ serin$ !i*ai&*an !en$an b< 4< !< e< f< $<
/a!rile$ia*ean$ Defisi& er0a&ian$an$$/an 0iera*&i?i&as Disabili&as belaar Da"a* a!a *inera a*a!e"i* !an 0ar$a !iri Penin$*a&an re?alensi !eresi )es/li&an in&e$rasi sens#ri* Penin$*a&an re?alensi $an$$/an er*e"ban$an r#$resif a&a/ a/&is"e yan$ ber0/b/n$an !en$an !ia$n#sis bersa"aan 4erebral alsy
2.1.11. Pr"#n"sis
Den$an layanan &erai yan$ &ea& asien "/n$*in !aa& seen/0nya bereran ser&a se4ara a*a!e"is !an s#sial. M#rbi!i&as !an "#r&ali&as 4erebral alsy ber0/b/n$an !en$an &in$*a& *eara0an *#n!isi ini !an seirin$ *#"li*asi "e!is seer&i *es/li&an ernaasan !an en4ernaan. Pa!a asien !en$an /a!rile$ia *e"/n$*inan eilesi *elainan e*s&raira"i!al !an $an$$/an *#$ni&if ara0 lebi0 besar !ari a!a "ere*a !en$an !ile$ia a&a/ 0e"ile$ia. @an$$/an *#$ni&if &era!i lebi0 serin$ a!a #ran$ !en$an #&a* !ari a!a #/lasi /"/". Tin$*a& *esel/r/0an *e&erbela*an$an "en&al a!a #ran$ yan$ &er*ena !a"a* !ian$$a 3(6'(. Beberaa ben&/* *e&i!a*"a"/an
belaar
;&er"as/*
*e&erbela*an$an
"en&al<
&ela0
!ier*ira*an &era!i a!a "/n$*in ,' asien. Na"/n s&an!ar en$/ian *#$ni&if
&er/&a"a
"en$e?al/asi
*e"a"/an
?erbal
!an
!aa&
"en$a*iba&*an "ere"e0*an *e"a"/an *#$ni&if a!a beberaa in!i?i!/. Dala" beberaa eneli&ian 2' asien !en$an 4erebral alsy &i!a* !aa&beralan. Na"/n banya* asien !en$an $an$$/an ini ;&er/&a"a
3+
"ere*a yan$ !ile$iasas&i* !an enis 0e"ile$ia sas&i*< !aa& "an!iri a&a/ !en$an erala&an ban&/.Den$an !e"i*ian se*i&ar 2' ana* !en$an 4erebral alsy "e"ili*i *e&erliba&anrin$an !en$an *e&erba&asan f/n$si#nal "ini"al a&a/ &i!a* a!a !ala" beralaneraa&an !iri !an *e$ia&an lainnya.
Se*i&ar
se&en$a0
yan$
4/*/
&er$an$$/
sa"ai6sa"ai
*e"er!e*aan en/0 &i!a* "/n$*in &e&ai f/n$si "e"/as*an. Hanya 2'be$i&/ san$a& 4a4a& ba0a "ere*a "e"erl/*an eraa&an yan$ l/as !an &a* bisaberalan. Pa!a asien !en$an /a!rile$ia sas&i* r#$n#sis yan$ */ran$ "en$/n&/n$*an ber*#relasi !en$an en/n!aan la$i !ala" enyelesaian na!a e*s&ens#r. )a!an$6*a!an$ 0ier&#nisi&as !an *elen&/ran !aa& "e"erbai*i a&a/"enyelesai*an !ari a*&/ *e a*&/ a!a asien !en$an 4erebral alsy. )elen&/ran a!a asien !en$an /a!rile$ia sas&i* !aa& lebi0
&a0an
ba0*an
!en$an
layanan!an
#r&#e!i
!an
in&er?ensi
re0abili&a&if. Pasien !en$an ben&/* ara0 4erebral alsy !aa& "e"ili*i an$*a 0i!/ yan$ ber*/ran$ se4ara si$nifi*an "es*i/n 0al ini &er/s "e"bai* !en$an "enin$*a&nya elayanan *ese0a&an !an &ab/n$ $as&r#s&#"y. Pasien !en$an ben&/* rin$an !ari $an$$/an ini "e"ili*i 0araan 0i!/ !e*a& !en$an "asyara*a& /"/" "es*i/n "asi0 a$a* ber*/ran$. Pasien !en$an &ie &e&rale$i r#$n#sa a! ?i&a" !an f/n$si#na" a! "ala" se!an$*an Tie 0e"iaresis a&a/ !iaresis rin$an /# a! ?i&a"nya a! b#na". Bila a!a re&ar!asi "en&al eilesi $an$$/an li0a& !en$ar r#$n#sis */ran$ bai* 71+8
3,
/ESIMPULAN
Cerebral alsy a!ala0 se*el#"#* $an$$/an er*e"ban$an $era*an !an #s&/r yan$ "enyebab*an *e&erba&asan a*&i?i&as yan$ &era!i n#nr#$resif yan$ &era!ia!a er*e"ban$an #&a* anin a&a/ bayi. @an$$/an M#&#r 4erebral alsy serin$!iser&ai !en$an $an$$/an sensasi *#"/ni*asi *#$nisi ersesi !ana&a/ erila*/ !ana&a/ $an$$/an *ean$. Cerebral alsy !i*lasifi*asi*an "en/r/& &#n/s #&#& saa& is&ira0a& !an aa an$$#&a&/b/0 yan$ &erliba& ;!iseb/& !#"inasi &##$rafi<. Cerebral alsy !aa& &era!i a*iba& *elainan s&r/*&/ral yan$ "en!asari #&a* a!aaal *e0a"ilan 4e!era erina&al a&a/ se&ela0 "ela0ir*an *arena ins/fisiensi ?as*/ler &#in a&a/ infe*si a&a/ risi*# re"a&/ri&as. Riaya&
rena&al
erina&al
#s&
na&al
!an
er*e"ban$an
bayi
beren$ar/0&er0a!a &era!inya 4erebral alsy. In!i*a&#r e"eri*saan fisi* "eli/&i *#n&ra*&/r sen!i sa"ai #&#& yan$ sas&i* &#n/s yan$ 0i#&#ni* sa"ai sas&i* 0a"ba&an er&/"b/0an !an refle ri"i&if yan$ "ene&a. Dia$n#sis 4erebral alsy /"/"nya !ib/a& ber!asar*an $a"baran *linis.Pe"eri*saan en/nan$ !aa& "e"ban&/ "enyin$*ir*an !ia$n#sa ban!in$.
3
Pen$el#laan asien !en$an 4erebral alsy 0ar/s in!i?i!/al ber!asar*an resen&asi *linis ana* !an "e"erl/*an en!e*a&an "/l&i!isilin. Den$an layanan &erai
yan$
&ea&
asien
"/n$*in
!aa&
seen/0nya
bereran
ser&a
se4araa*a!e"is !an s#sial. Pr#$n#sis 4erebral alsy &er$an&/n$ a!a &ie 4erebral alsy &erseb/&.
Daf%ar P&s%a(a
718 M. :#0ns&#n >En4e0ali&ies Cerebral Palsy !an )lie$"an> in eBook Nelson Textbook of Pediatrics, 18th 2((,. 728 H. H. Ab!el A. )a# an! A. el!in >Cerebral Palsy> 7=nline8. A?ailable 0&&e"e!i4ine."e!s4ae.4#". 7A44esse! 1- N#?e"ber 2(1'8. 738 D. Sa0ars# >Dia$n#sis !an Ta&ala*sana !ala" Nas*a0 Len$*a C=n&/inin$ E!/4a&i#n Il"/ )ese0a&an Ana* OOOI> in Kapita elekta !lm" Kesehatan #nak $! S/rabaya RS DR. S#e&#"# 2((+. 7%8 I. A!nyana >Cerebral Palsy !i&ina/ !ari Ase* Ne/r#l#$i> in %ermin &"nia Kedokteran 1--' . 3,6%(. 7'8 M. Ba M. @#l!s&ein P. R#senba/" A. Le?i&#n N. Pane&0 an! B >Pr##se! !efini&i#n an! Classifi4a&i#n #f Cerebral PAlsy> &e' (ed %hild Ne"rol, ?#l. %, n#. . ',16',+ 2(('. 7+8 P. An4el F. Li?ine4 B. Larr#/e S. Marre& C. Arna/! an! . Pierra& >Cerebral Palsy A"#n$ ?ery Pre&er" C0il!ren in Rela&i#n &# @es&a&i#nal A$e an! Ne#na&al Ul&ras#/n! Abn#r"ali&ies &0e EPIPA@E 4#0#r& s&/!y>
3-
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