TESIS
PELATIHAN VISUAL CUE TRAINING TIDAK BERBEDA DALAM MENINGKATKAN KESEIMBANGAN BERDIRI DAN FUNGSIONAL BERJALAN DARIPADA PELATIHAN RHYTMIC AUDITORY STIMULATION PADA PASIEN PASCASTROKE
JERRY MARATIS NIM 1390361006
PROGRAM MAGISTER PROGRAM STUDI FISIOLOGI OLAHRAGA PROGRAM PASCASARJANA UNIVERSITAS UDAYANA DENPASAR 2015
PELATIHAN VISUAL CUE TRAINING TIDAK BERBEDA DALAM MENINGKATKAN KESEIMBANGAN BERDIRI DAN FUNGSIONAL BERJALAN DARIPADA PELATIHAN RHYTMIC AUDITORY STIMULATION PADA PASIEN PASCASTROKE
Tesis untuk Memperoleh Gelar Magister pada Program Magister, Program Studi Fisiologi Olahraga, Program Pascasarjana Universitas Udayana
JERRY MARATIS NIM 1390361006
PROGRAM MAGISTER PROGRAM STUDI FISIOLOGI OLAHRAGA PROGRAM PASCASARJANA UNIVERSITAS UDAYANA DENPASAR 2015
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Tesis Ini Telah Diuji pada Tanggal 2 Juli 2015
Panitia Penguji Tesis Ini Berdasarkan SK Rektor Universitas Udayana, No.: 1911/ UN. 14.4/ HK/ 2015, Tanggal 1 Juli 2015
Ketua
: Prof. dr. N. T. Suryadhi, MPH, Ph.D
Sekretaris
: Muhammad Irfan, SKM, S.Ft, M.Fis
Anggota
:
1. Dr. dr. Bagus Komang Satriyasa, M.Repro 2. Prof. Dr. dr. N. Adiputra, M.OH, AIFO 3. S. Indra Lesmana, SKM, SSt.Ft, M.Or
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ABSTRAK PELATIHAN VISUAL CUE TRAINING TIDAK BERBEDA DALAM MENINGKATKAN KESEIMBANGAN BERDIRI DAN FUNGSIONAL BERJALAN DARIPADA PELATIHAN RHYTMIC AUDITORY STIMULATION PADA PASIEN PASCASTROKE Stroke merupakan gangguan fungsional otak lokal maupun global akut, lebih dari 24 jam, berasal dari gangguan aliran darah otak dan bukan disebabkan oleh gangguan perdarahan darah otak sepintas, tumor otak, stroke sekunder karena trauma maupun infeksi. Penelitian ini bertujuan untuk membuktikan perbandingan keseimbangan berdiri dan kemampuan fungsional berjalan pada pelatihan Visual Cue Training (VCT) dan Rhythmic Auditory Stimulation (RAS). Penelitian ini menggunakan metode penelitian eksperimental dengan rancangan penelitian pre-test and post-test control group design. Jumlah sampel kelompok pertama sebesar 11 pasien diberikan pelatihan Visual Cue Training (VCT) selama 20 menit, sedangkan pada kelompok kedua sejumlah 11 pasien diberikan pelatihan Rhythmic Auditory Stimulation (RAS) selama 20 menit. Penelitian dilakukan dalam periode waktu selama 2 bulan. Setiap pasien diajarkan berbagai kemampuan keseimbangan berdiri dan fungsional berjalan sesuai dengan konsep panduan operasionalnya. Tes pengukuran keseimbangan berdiri menggunakan Single Limb Stance Test (SLST) dan tes kemampuan fungsional berjalan menggunakan Gait Cycle Measurement . Hasil penelitian diketahui setelah melakukan uji normalitas sebelum perlakuan pada keseimbangan berdiri perlakuan VCT = 0,172, perlakuan RAS = 0,498, pada fungsional berjalan perlakuan VCT = 0,148, perlakuan RAS = 0,555, menyatakan distribusi datanya normal (p>0,05). Untuk uji homogenitas sebelum perlakuan pada keseimbangan berdiri = 0,882, pada fungsional berjalan = 0,359, menyatakan distribusi homogen (p>0,05). Untuk uji komparasi dengan Independent t-test yang menunjukkan pada rerata±SB post-test keseimbangan berdiri pada perlakuan VCT (3,36±0,647) dan pada perlakuan RAS (2,82±0,603) dengan nilai p = 0,829. Pada rerata±SB post-test kemampuan fungsional berjalan pada perlakuan VCT (46,64±9,77) dan pada perlakuan RAS (41,18±6,306) dengan nilai p = 0,308, menyatakan tidak adanya perbedaan yang signifikan (p>0,05) antara pelatihan Visual Cue Training dan pelatihan Rhythmic Auditory Stimulation pada pasien pascastroke. Disimpulkan bahwa pelatihan Visual Cue Training (VCT) tidak ada perbedaan yang signifikan dalam meningkatkan keseimbangan berdiri dan fungsional berjalan daripada pelatihan Rhythmic Auditory Stimulation (RAS) pada pasien stroke. Kata kunci: Stroke, keseimbangan berdiri, kemampuan fungsional berjalan, Visual Cue Training (VCT), Rhythmic Auditory Stimulation (RAS), Single Limb Stance Test (SLST), Gait Cycle Measurement.
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ABSTRACT VISUAL CUE TRAINING EXERCISE WAS NOT DIFFERENT WITH RHYTHMIC AUDITORY STIMULATION EXERCISE IN INCREASING STANDING BALANCE AND FUNCTIONAL GAIT AMONG STROKE PATIENTS Stroke is a functional disorder of the brain, local or global acute, more than 24 hours, came from disorders of brain flow and not caused by transient ischemic attack, brain tumor, secondary stroke, trauma or infection. The purpose of this study is to know the comparison of both exercise. This study uses an experimental research with pre-test and post-test control group design. Number of samples of the first group is 11 patients given Visual Cue Training (VCT) exercise for 20 minutes , while the second group 11 patients were given Rhythmic Auditory Stimulation (RAS) exercise for 20 minutes. The research was conducted in 2 month period time. Each patient is taught a variety of standing balance and functional gait ability in accordance with the operational concept guidance. Measuring test standing balance is using Single Limb Stance Test (SLST) and functional gait is using Gait Cycle Measurement (GCM). The result revealed after normality test pre-test exercise on standing balance exercise VCT = 0.172, exercise RAS = 0.498, in the exercises of functional walking bility exercise VCT = 0.148, exercise RAS = 0.555, indicating normal data distribution (p> 0.05). For homogeneity test before exercise on standing balance =0.882, the functional ability to walk = 0.359, indicating homogeneous distribution (p> 0.05). For a comparison test with Independent t-test that shows the mean ± SB standing balance post-test exercise of VCT (3.36 ± 0.647) and in the exercise of RAS (2.82 ± 0.603), with p = 0.829. In the mean ± SB post-test of fuctional walking ability VCT exercise (46.64 ± 9.77) and the exercise of RAS (41.18 ± 6.306) with p = 0.308, indicating the absence of a significant difference (p>0.05) between VCT and RAS in improving the standing balance and functional walking ability in poststroke patients. All of these showed no significant difference (p>0,05) between Visual Cue Tarining and Rhythmic Auditory Stimulation exercise in improving the standing balance and functional ability in poststroke patients. It was concluded that the Visual Cue Training exercise was no different with Rhythmic Auditory Stimulation exercise in increasing standing balance and functional gait among stroke patients. Keywords : Stroke, standing balance, functional gait, Visual Cue Training (VCT) , Rhythmic Auditory Stimulation (RAS), Single Limb Stance Test (SLST), Gait Cycle Measurement (GCM).
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DAFTAR ISI SAMPUL DEPAN ............................................................................................... i PRASYARAT GELAR ....................................................................................... ii LEMBAR PENGESAHAN ...............................................................................iii LEMBAR PENETAPAN PANITIA PENGUJI ................................................ iv SURAT PERNYATAAN BEBAS PLAGIAT.................................................... v UCAPAN TERIMA KASIH .............................................................................. vi ABSTRAK .......................................................................................................viii ABSTRACT ....................................................................................................... ix RINGKASAN…………………………………………………………………x DAFTAR ISI ..................................................................................................... xii DAFTAR GAMBAR ........................................................................................ xv DAFTAR TABEL ............................................................................................ xvi DAFTAR SINGKATAN ............................................................................... xvii DAFTAR LAMPIRAN ..................................................................................xviii BAB I PENDAHULUAN .................................................................................. 1 1.1 Latar Belakang Masalah ............................................................. 1 1.2 Rumusan Masalah ...................................................................... 6 1.3 Tujuan Penelitian........................................................................ 6 1.4 Manfaat Penelitian...................................................................... 7 BAB II KAJIAN PUSTAKA ............................................................................ 9 2.1 Keseimbangan Berdiri ................................................................ 9 2.1.1 Pengertian ..................................................................... 9 2.1.2 Single Limb Stance Test .............................................. 10 2.2Fungsional Berjalan................................................................... 10 2.2.1 Pengertian ................................................................... 10 2.2.2 Siklus Berjalan ............................................................ 11 2.3Gait Cycle Measurement ........................................................... 16 2.3.1 Pengertian .................................................................... 16 2.3.2 Evaluasi Data ............................................................... 17 2.4Stroke ........................................................................................ 19 2.4.1 Pengertian .................................................................... 19 2.4.2 Klasifikasi Stroke......................................................... 21 2.4.3 Faktor Resiko ............................................................... 22 2.4.4 Gejala Klinis ................................................................ 23 2.4.5 Neuroplasticity ............................................................. 24 2.4.6 Pola Berjalan Pasien Stroke ......................................... 26 2.5Visual Cue Training .................................................................. 27 2.6Rhytmyc Auditory Stimulation ................................................. 29 2.7Perbandingan VCT dan RAS dalam Penatalaksanaan Pasien Pascastroke.......................................................................... 31 BAB III KERANGKA BERPIKIR, KONSEP DAN HIPOTESIS PENELITIAN .................................................... 33 3.1 Kerangka Berpikir .................................................................... 33 vi
3.2 Konsep Penelitian ..................................................................... 36 3.3Hipotesis Penelitian ................................................................... 37 BAB IV METODE PENELITIAN ................................................................. 38 4.1 Rancangan Penelitian ............................................................... 38 4.2 Lokasi dan waktu Penelitian .................................................... 39 4.3. Ruang Lingkup Penelitian Penelitian ...................................... 39 4.4 Penentuan Sumber Data Penelitian .......................................... 40 4.4.1 Variabilitas Populasi .................................................... 40 4.4.2 Kriteria Subjek ............................................................. 40 4.4.3 Besaran Sampel ........................................................... 42 4.4.4 Teknik Penentuan Sampel ........................................... 44 4.5 Variabel Penelitian ................................................................................. 44 4.5.1 Identifikasi dan KlasifikasiVariabel ............................ 44 4.5.2 Definisi Operasional Variabel .................................... 45 4.6 Bahan dan Instrumen Penelitian ............................................... 47 4.7 Prosedur Penelitian ................................................................... 48 4.7.1 Tahap Persiapan dan Administrasi ............................. 48 4.7.2 Tahap Penentuan Populasi dan Pemilihan Sampel ...... 49 4.7.3 Tahap Pengukuran Pertama atau Tes Awal ................. 50 4.7.4 Tahap Pelatihan ................................................................................. 51 4.7.5 Tahap Pengukuran Kedua atau Tes Akhir ................... 55 4.8 Metode Pengukuran Parameter Jalan dengan Inked-Footprint .......................................................... 55 4.8.1 Alat-Alat yang Diperlukan ........................................... 56 4.8.2 Langkah Pengukuran ................................................... 56 4.8.3 Menghitung dan Mencatat Hasil Pengukuran .............. 57 4.9 Metode Penetapan Dosis VCT dan RAS................................ 60 4.9.1 Pada Pelatihan dengan VCT ........................................ 60 4.9.2 Pada Pelatihan dengan RAS ........................................ 60 4.10 Analisis Data Peneltian ......................................................... 61 4.11 Alur Penelitian........................................................................ 64 BAB V HASIL PENELITIAN DAN ANALISIS ........................................... 65 5.1 Deskripsi Karakteristik Subjek Penelitian ............................... 65 5.2 Hasil pengukuran Mingguan SLST & GCM........................... 69 5.3 Uji Normalitas ......................................................................... 73 5.4 Uji Homogenitas ....................................................................... 74 5.5Uji Hipotesis Keseimbangan Berdiri dan Kemampuan Berjalan ............................................................. 75 5.5.1 Peningkatan Keseimbangan Berdiri ............................ 75 5.5.2 Peningkatan Kemampuan Fungsional Berjalan ........... 76 BAB VI PEMBAHASAN ................................................................................ 76 6.1 Karakteristik Sampel ................................................................ 77 6.2 Pelatihan VCT dan Pelatihan RAS Meningkatkan Keseimbangan Berdiri Pasien Pascastroke .............................. 78 6.3 Pelatihan VCT dan Pelatihan RAS Meningkatkan Kemampuan Fungsional Berjalan pada Pasien Pascastroke ... 79 vii
6.4 Pelatihan VCT Tidak Berbeda Signifikan dengan Pelatihan RASdalam Meningkatkan Keseimbangan Berdiri dan Kemampuan Fungsional Berjalan pada Pasien Pascastroke ........................................... 82 6.5 Pelatihan VCT Tidak Berbeda Signifikan dalam Meningkatkan Kemampuan Fungsional Berjalan daripada Pelatihan RAS pada Pasien Pascastroke ................................. 84 6.6 Kelemahan Penelitian .............................................................. 85 BAB VII SIMPULAN DAN SARAN ............................................................ 86 3.1 Simpulan................................................................................... 86 3.2 Saran ......................................................................................... 86 DAFTAR PUSTAKA ....................................................................................... 87 LAMPIRAN-LAMPIRAN
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