Rehabilitasi Kusta

dr. Dewi Nur Fiana.,Sp.KFR

FK Unila/RSAM
 Kusta

Penyakit indeksi kronis yang disebabkan o/

mycobacterium Leprae

Merusak saraf perifer, utama superfisial

Number of bacillary:

less: pancibasillar (PB) -> deformitas >>

More: multibacilar (MB) -> medullar

 Cara penularan

Air borne

Skin contact for long period

Inkubasi 2-5thn
 Klasifikasi WHO

PB MB

Makula 1-5 >5

N.Perifer 1 nerve >>

BTA - +

Lepromin + -

Prognosis Baik Buruk

Th/ 6bln 12bln

 Manifestasi Klinik

Pancibacillar: imunitas tinggi, bakteri

dilokalisir di saraf perifer yg dingin
(superfisial), -> deformitas tinggi

Multibacillar: imunitas rendah, bakteri >>

di darah>> menular
Teori Ridley Joplin
Diagnosa Kusta, bila ditemukan
lebih dari 1 cardinal sign

1. Makula + anesthesia

2. Penebalan saraf perifer + disfungsi

motorik +sensori + otonom

3. Pada pemeriksaan kerokan Kulit: M.

Leprae (+)
 Saraf perifer yang
sering terkena
N. Facialis -> m. Orbicular oculi : menutup mata

N. Ulnaris

N. Medianus

N. Radialis, Tu/ cab. Cuteness radialis di daar radial dan longan atas

N. Perineus tu/ di posterior caput fibula

N. Tibialis posterior

N. Auricularis magnus

N. Suralis
 Diagnose Kusta

Anamnesis

Cari makula,

BTA (ziehl nielsen)

Periksa saraf perifer

 Pemeriksaan saraf
perifer di 3 tempot
Kepala : n. Facialis, n. Opthalmicus, greater
auricular nerve (pure sensory)

UE: n. Ulnaris, n. Medianus, N. Cuteness

radialis.

LE: common perineal nerve, posterior tibial

nerve, mural nerve
 Therapy
medikamentosa
Triple drugs: Dapson, Rifampisin, Lamprene

Adverse Effect:

Rifampicin : red urin, feses , perspiration

Lamprene: hiperpigmented skin

Dapson: pruritus, redness, kulit lepas-> rujuk

RS
 Detection of peripheral
nerve breakdown

1. Sensibility

2. Muscle weakness

Often: eyelid, hand, feet

Examine 5 pairs muscle (1 eyelid muscle, 3 hand

muscle-n.medianus, n.radialis, n. ulnaris, 1 foot
muscle-n.peroneus communes :m.tibialis anterior)

3. Imparment grading (WHO)

Impairment Grading
(WHO)
Eye Hand/ palm/ foot

0 Impairment (-)

Tdk tampak kelainan, Anethesi (+)

1
Penurunan Visus : mild Weakness

Lagopthalmus (+) Ulcus (+), knitting finger,

2 Severe disfunction in absorb/shorthening finger,
visus mutilation, drop foot
 Indikasi Op. Kusta
Sudah release from treatment

BTA (-)

Bebas Rx kusta minimal 6 bulan

Cacat mental 12 bulan

Ada motor tendon yg baik

Tidal ada kelainan kulit pada lokasi operasi

Pasien kooperatif
 Tujuan Rehabilitasi
Kusta

Meningkatkan kemampuan fungsional

Meningkatkan kualitas hides

Menurunkan impairment, disability,

handicap
 Edukasi

Protect, clean, wet, exercise

ROM exercise

Strengthening exercise
 Alat Bantu

Sun glasses/ googles

Eye protector when sleeping

Pipa panjang u/ tiup api saat masak

 OT

Grip the great objective/ cone

Strengthening with activity

Sensory reeducation

ADL exercise

Vocational training
 OP

Shoe , splint, crutch, kain pembungkus

ankle saat duduk di lantai
Eye impairment

Facial nerve

Lagopthalmus, insensitive cornea

Exposure keratitis

Ulcus cornea

Blindness
Claw hand: inability to extend fingers at
interphalanges joints,joints, result in
permanent flexion

Wrist drop: inability to extend the hand,

inability to fully extend the forearm

Ape Hand: thenar eminence wasting,

inability to pose or flex the thumb
Weakness of the hand’s intrinsic muscles

Claw hand Ape hand

Disfunction

Precision of grip power of grip

Contracture

Lesion

Infection

Mutilation
 Disfungtion of peripheral nerve

Motorik sensorik otonom

Paralisis insensitive dry skin

Contracture wound skin break

Disfunction infection

Mutilation
“One today is worth two tomorrows”

–Benjamin Franklin