LAMPIRAN A
Usia 18 – 49 tahun = 1
Usia 50 tahun = 2
33 18 1
34 21 1
35 23 1
36 26 1
37 20 1
38 50 2
39 62 2
40 26 1
41 23 1
42 38 1
43 23 1
44 54 2
45 18 1
46 64 2
23 120 2
24 130 2
25 110 2
26 100 2
27 110 2
28 110 2
29 130 2
30 90 1
31 120 2
32 110 2
33 130 2
34 110 2
35 130 2
36 110 2
37 110 2
38 80 1
39 110 2
40 140 2
41 120 2
42 130 2
43 110 2
44 110 2
45 130 2
46 70 1
32 25 4
33 65 2
34 55 3
35 60 2
36 55 3
37 65 2
38 10 5
39 40 3
40 65 2
41 70 2
42 40 3
43 50 3
44 65 2
45 60 2
46 10 5
LAMPIRAN B
Descriptive Statistics
Std.
N Minimum Maximum Mean Deviation
Valid N (listwise) 46
Barthel Score
Valid Cumulative
Frequency Percent Percent Percent
Total 47 100.0
Jenis Kelamin
Cumulative
Frequency Percent Valid Percent Percent
Umur Penderita
Cumulative
Frequency Percent Valid Percent Percent
Total 47 100.0
GCS Awal
Valid Cumulative
Frequency Percent Percent Percent
Total 47 100.0
Reflek Cahaya
Total 47 100.0
Valid Cumulative
Frequency Percent Percent Percent
LAMPIRAN C
Cases
Count
Barthel Score
Umur 18 - 49 14 11 8 0 33
Penderita
> 50 2 4 2 5 13
Total 16 15 10 5 46
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
N of Valid Cases 46
Cases
Count
Barthel Score
Needs
minimal help Partially Very Totally
with ADL dependent dependent dependent
(60-79) (40-59) (20-39) (<20) Total
Total 16 15 10 5 46
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
a
Pearson Chi-Square 3.937 3 .268
N of Valid Cases 46
Cases
Count
Barthel Score
Reflek Positif 15 15 10 2 42
Cahaya
Negatif 1 0 0 3 4
Total 16 15 10 5 46
Chi-Square Tests
N of Valid Cases 46
Cases
Count
Barthel Score
Total 16 15 10 5 46
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
N of Valid Cases 46
Cases
Count
Barthel Score
Hasil CT Abnormal 11 15 9 5 40
Scan Kepala
Normal 5 0 1 0 6
Total 16 15 10 5 46
Chi-Square Tests
Asymp. Sig.
Value df (2-sided)
a
Pearson Chi- 7.758 3 .051
Square
N of Valid Cases 46
LAMPIRAN D
1. Susunan Peneliti
2. Naskah Penjelasan kepada Orangtua / Kerabat
Pasien Lainnya
3. Persetujuan Setelah Penjelasan (PSP)
4. Persetujuan dari Komisi Etika Penelitian
5. Formulir/Kuisioner
6. The Barthel Index
Susunan Peneliti
Peneliti
d. Fakultas : Kedokteran
Pembimbing
Bedah saraf
d. Fakultas : Kedokteran
Medan, ……………………………2011
Yang memberikan Yang membuat pernyataan persetujuan
penjelasan
Formulir/Kuisioner
Status Pasien
No. MR : Tanggal : Dilakukan Oleh :
Identitas Pribadi
Nama : ………………………………………………..L / P
Usia : ............ tahun
Tempat, Tanggal Lahir : ………………………………………………...
Alamat Rumah : …………………………………………………
ANAMNESIS
Penyakit yang sedang dialami (jika ada) : ……………………………
PEMERIKSAAN FISIK
SKG Awal 3 4 6 7 8 9 10 11 12 13
Pupil RC + / RC -
isokor / anisokor
Keluarga :
Nama :
Alamat :
No. HP/Rumah :
Hubungan dengan pasien :
Activity Score
FEEDING
0 = unable
5 = needs help cutting, spreading butter, etc., or requires modified diet
10 = independent ______
BATHING
0 = dependent
5 = independent (or in shower) ______
GROOMING
0 = needs to help with personal care
5 = independent face/hair/teeth/shaving (implements provided) ______
DRESSING
0 = dependent
5 = needs help but can do about half unaided
10 = independent (including buttons, zips, laces, etc.) ______
BOWELS
0 = incontinent (or needs to be given enemas)
5 = occasional accident
10 = continent ______
BLADDER
0 = incontinent, or catheterized and unable to manage alone
5 = occasional accident
10 = continent ______
TOILET USE
0 = dependent
5 = needs some help, but can do something alone
10 = independent (on and off, dressing, wiping) ______
TRANSFERS (BED TO CHAIR AND BACK)
0 = unable, no sitting balance
5 = major help (one or two people, physical), can sit
10 = minor help (verbal or physical)
15 = independent ______
MOBILITY (ON LEVEL SURFACES)
0 = immobile or < 50 yards
5 = wheelchair independent, including corners, > 50 yards
10 = walks with help of one person (verbal or physical) > 50 yards
15 = independent (but may use any aid; for example, stick) > 50 yards ______
STAIRS
0 = unable
5 = needs help (verbal, physical, carrying aid)
10 = independent ______