Hasil Penelitian

EFEKTIVITAS MIRROR THERAPY DENGAN KOMBINASI MIRROR

THERAPY - REPETITIVE TRANSCRANIAL MAGNETIC
STIMULATION TERHADAP FUNGSI MOTORIK EKSTREMITAS
ATAS PADA PASIEN STROKE ISKEMIK

THE EFFECTIVITY OF MIRROR THERAPY WITH COMBINATION

MIRROR THERAPY-REPETITIVE TRANSCRANIAL MAGNETIC
STIMULATION FOR UPPER EXTREMITY MOTORIC FUNCTION IN
ISCHEMIC STROKE PATIENTS

Disusun Oleh:

dr. Ferdy Halim

Pembimbing:

Dr. dr. Andi Kurnia Bintang, Sp.S(K), MARS

dr. Muhammad Akbar, Ph. D, Sp.S(K), DFM
Dr.dr.Jumraini Tammasse, Sp.S(K)
Prof. Dr.dr.Amiruddin Aliah, Sp.S (K),MM
Dr. dr. Burhanuddin Bahar, MS

PROGRAM PENDIDIKAN DOKTER SPESIALIS NEUROLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
MAKASSAR
2021

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 DAFTAR ISI

Halaman Sampul .................................................................................................................. ..... i

Daftar Isi ................................................................................................................................... ii

Daftar Gambar ................................................................................. ....................................... iv

Daftar Tabel .............................................................................................................................v

Bab I PENDAHULUAN ........................................................................................................ 1

1.1 Latar Belakang ............................................................................................................ 1

1.2 Rumusan Masalah ....................................................................................................... 5

1.3 Tujuan Penelitian ........................................................................................................ 5

1.4 Manfaat Penelitian....................................................................................................... 6

1.5 Hipotesis Penelitian...................................................................................................... 7

Bab II TINJAUAN PUSTAKA................................................................................................. 8

2.1.Stroke Iskemik ........................................................................................................... 8

2.1.1 Definisi..................................................................................................................8

2.1.2 Kematian sel pada stroke iskemik.........................................................................8

2.1.3 Mekanisme Pemulihan Stroke Iskemik ............................................................. 12

2.2 Plastisitas .................................................................................................................. .13

2.2.1. Reorganisasi dan Plastisitas Neuron pada stroke iskemik ............................... .13

2.2.2 Faktor-Faktor yang Mempengaruhi Plastisitas dan Reorganisasi Neuron pada

Stroke Iskemik................................................................................................... 19

2.3 Peran rTMS dan Mirror Theraphy terhadap plastisitas neuron pasca stroke............. 25

2.3.1 Hubungan rTMS terhadap reorganisasi dan plastisitas neuron pada pasien stroke
iskemik ........................................................................................................................25

2.3.2 Hubungan Mirror Theraphy Terhadap Reorganisasi dan Plastisitas Neuron pada
pasien stroke iskemik.................................................................................................. 26

2.4 Kerangka Teori ...........................................................................................................30

2.5 Kerangka Konsep .......................................................................................................31

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Bab III METODE PENELITIAN............................................................................................ 32

3.1 Desain Penelitian .................................................................................................... 32

3.1.1 Subjek Penelitian ................................................................................................ 32

3.1.2 Sampel Penelitian ............................................................................................... 32

3.1.3 Kriteria Inklusi ................................................................................................... 32

3.1.4 Kriteria Eksklusi ................................................................................................. 33

3.1.5 Kriteria Drop Out ............................................................................................... 33

3.1.6 Perkiraan Besar Sampel ...................................................................................... 33

3.2 Tempat dan Waktu Penelitian .......................................................................................... 34

3.3 Cara Pengumpulan Data .................................................................................................. 34

3.4 Identifikasi Variabel ........................................................................................................ 39

3.5 Definisi Operasional dan Kriteria Objektif ...................................................................... 39

3.6 Analisis Data dan Uji Statistik .......................................................................................... 44

3.7 Izin Penelitian dan Kelaikan Etik ..................................................................................... 44

3.8 Alur Penelitian .................................................................................................................. 45

Bab IV Hasil Penelitian .......................................................................................................... 46

Bab V Pembahasan ................................................................................................................ 52

Bab VI Kesimpulan dan Saran ............................................................................................... 61

DAFTAR PUSTAKA ............................................................................................................ 62

Lampiran-lampiran ................................................................................................................. 68

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DAFTAR GAMBAR

Gambar 1. Patofosiologi Stroke ......... .................................................................................. 13

Gambar 2. Lokasi sel progenitor neuronal pada susunan saraf pusat .................................. 14

Gambar 3. Peta Konsep Neuroplastisitas .............................................................................. 24

Gambar 4. Gambaran Cara Kerja rTMS di Otak .................................................................. 25

Gambar 5. Mirror Therapy ..................................................................................................... 27

Gambar 6. Model mekanisme MT, ilustrasi MT pada hemiparese kiri, subyek menggerakan
lengan kanan dan mempersepsikan sebagai lengan kiri ..................................................... 28

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DAFTAR TABEL

Tabel 1 Karakteristik Subjek Penelitian ............................................................................. 47

Tabel 2 Uji normalitas pada ketiga kelompok..................................................................... 47

Tabel 3 Skor ARAT sebelum dan setelah terapi pada ketiga kelompok ............................. 48

Tabel 4 Perbandingan rata-rata selisih skor ARAT antara kelompok perlakuan dan kelompok
kontrol ............................................................................................................................... 49

Tabel 5 Perbandingan nilai kemaknaan antara kelompok perlakuan yang mendapat rTMS +
mirror therapy + terapi standar dan kelompok kontrol....................................................... 49

Tabel 6 Perbandingan nilai kemaknaan antara kelompok perlakuan yang mendapat terapi
standar + mirror theraphy dan kontrol .............................................................................. 50

Tabel 7 Perbandingan nilai kemaknaan antara kedua kelompok

perlakuan............................................................................................................................ 50

Tabel 8 Perbandingan rata-rata selisih skor sub item ARAT antara kelompok perlakuan dan
kelompok kontrol .............................................................................................................. 51