Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKMotivasi adalah komponen penting dalam kepatuhan untuk mengikuti program rehabilitasi paska stroke. Penelitian ini bertujuan untuk menggali perspektif klien paska stroke terhadap motivasinya dalam mengikuti program rehabilitasi setelah keluar dari rumah sakit. Metode penelitian ini adalah studi fenomenologi melalui wawancara mendalam semi berstruktur terhadap enam partisipan yang didapat dengan teknik purpossive sampling. Lima tema yang dihasilkan adalah terbentuknya komponen dasar motivasi rehabilitasi, konsistensi motivasi rehabilitasi, faktor-faktor yang menguatkan dan melemahkan motivasi rehabilitasi, serta upaya untuk mempertahankannya. Klien paska stroke yang sedang mengikuti program rehabilitasi memiliki motivasi walaupun konsistensinya dapat berubah karena dipengaruhi faktor-faktor internal dan eksternal, dan dibutuhkan upaya untuk mempertahankan kualitasnya. Motivasi rehabilitasi hendaknya selalu dievaluasi karena faktor spiritual, fisik, psikologi, sosial, dan lingkungan dapat mempengaruhi kualitasnya. Penambahan partisipan yang lebih variatif dan penggunaan studi kuantitatif atau mixed method perlu dilakukan pada penelitian selanjutnya untuk menguatkan hasil penelitian ini serta mengembangkanya menjadi model motivasi efektif terhadap kepatuhan rehabilitasi.

---

ABSTRACTMotivation is an essential component in adherence to post stroke rehabilitation program. This study aimed to explore the client 39 s perspective on motivation in a post stroke rehabilitation program after discharge from hospital. This qualitative study used phenomenological method with 6 participants participated in individual in depth semi structured interview. Purposive sampling method was carried out in this study. Five themes were formed the formation of the basic components of rehabilitation motivation, the consistency of rehabilitation motivation, strengthening and weakening factors of rehabilitation motivation, and the attempt to preserve it. Although motivation was found in the post stroke client during rehabilitation program, it is possible to change due to both internal and external factors and attempt of preserving quality. Rehabilitation motivation should always be evaluated since some factors such as spiritual, physical, psychological, social, and environment factors could affect its quality. In order to support this result, further study is recommended with more varied participants and alternative method such as quantitative or mix method. Additionally, this future work would be beneficial to develop an effective motivation model to rehabilitation adherence."

"ABSTRAKStroke merupakan penyebab kematian tertinggi di wilayah perkotaan, salah satu daerah di Indonesia dengan angka stroke melebihi angka nasioanal adalah kota Pontianak. Penelitian ini bertujuan mengetahui hubungan strategi koing keluarga dengan kualitas hidup lansia pasca stroke di kota Pontianak. Desain penelitian analitik korelasi dengan pendekatan cross sectional . pengambilan sampel secara total sampling dengan responden berjumlah 58. Sampel penelitian ini adalah lansia pasca stroke dan anggota keluarga sebagai caregiver atau pelaku rawat utama yang merawat lansia dengan pasca stroke. Hasil analisa regresi linier berganda atau uji anova (uji f) dengan p value=0,001 (<0,05) yang menunjukkan bahwa ada hubungan yang signifikan antara dukungan sosial, reframing, usaha mencari dan menerima pertolongan, penerimaan pasif dan pendapatan dengan kualitas hidup lansia pasca stroke. Dukungan sosial merupakan elemen strategi koping yang paling dominan

---

ABSTRACTStroke was the highest cause of death in urban areas, one area in Indonesia with stroke rate exceeded nasional the city of Pontianak. This study aims to determine the association between family coping stategy and post stroke quality of life of the elderly in city of Pontianak. Design descriptive corelation reasearch with cross sectional approach was used in this study. Total sampling technique was held in the study with the sample size of the study was 58. Samples of this study are post-stroke and elderly family members as caregivers or primary caregiver caring for the elderly with post-stroke. The results of multiple linear regression analysis or ANOVA test (F test) with p value = 0.001 (<0.05) which indicates that there is a significant association between social support, reframing, the search for and accept help, and passive receipt of income by the quality of life of elderly post-stroke. Social support is an element of the most dominant coping strategy."

"Pemberian ASI eksklusif memberikan banyak manfaat bagi ibu dan anaknya. Pentingnya pemberian ASI eksklusif juga telah diperhatikan oleh pemerintah, sehingga pemerintah membuat suatu peraturan yang mengatur tentang pemberian ASI eksklusif kepada bayi yang baru lahir. Meskipun persentase nasional dan persentase di Jakarta tentang ASI eksklusif dapat dibilang tinggi, akan tetapi persentase itu masih belum mencapai 100%, terlepas dari semua upaya yang dilakukan oleh pemerintah. Inisiasi menyusui dini dianggap menjadi salah satu faktor menuju keberhasilan pemberian ASI eksklusif. Penelitian ini bertujuan untuk mengetahui hubungan antara inisiasi menyusui dini dan menyusui eksklusif di salah satu rumah sakit di Jakarta Pusat Ini adalah studi cross sectional yang menggunakan data primer di sebuah rumah sakit di Jakarta Pusat. Para ibu diwawancarai oleh penulis yang pertanyaannya terdiri dari pertanyaan karakteristik demografis dan pertanyaan mengenai informasi detail mengenai menyusui inisiasi dini dan status menyusui mereka saat ini. Kami menggunakan subjek yang melahirkan di rumah sakit MH Thamrin antara Maret 2018 hingga Desember 2018 dan mengadakan wawancara pada bulan April 2019 hingga Juni 2019.Tidak ada perbedaan statistik yang signifikan antara inisiasi menyusui dini dalam pemberian ASI eksklusif ketika dipulangkan (p = 0,301) dan setelah 2 bulan (0.251). Data yang diperoleh dari penelitian ini menggunakan 90 sampel yang tidak menunjukkan peningkatan yang signifikan secara statistik pemberian ASI eksklusif pada mereka yang melakukan pemberian ASI dini.

---

Exclusive breastfeeding is very beneficial for both mother and their offspring’s. The importance of exclusive breastfeeding has been noticed by the government, hence it is included in government’s policy. Although the national percentage and Jakarta’s percentage on exclusive breastfeeding are considered high, it still had not reach 100% despite all the effort that was made by the government. Early initiation breastfeeding is said to be one of the factor towards the success of exclusive breastfeeding. This study aims to find the relationship between early initiation breastfeeding and exclusive breastfeeding in one of the hospitals in Central Jakarta. This is a cross sectional study that used a primary data in a hospital in Central Jakarta. Mothers were questioned by the author which comprise of demographic characteristics questions and questions regarding detail information of early initiation breastfeeding and their current status on breastfeeding. We used subject who gave birth in MH Thamrin hospital between March 2018- December 2018 and held the interview in between April 2019 to June 2019. There was no significant statistical difference between early breastfeeding initiation and exclusive breastfeeding when discharged (p=0.301) and after 2 months (p=0.251). The data obtained from this study using 90 samples in which it did not show statistically significant increase of exclusive breastfeeding administration in those who performed early breastfeeding administration. "

"Klien pasca stroke yang tidak melakukan perawatan yang optimal dapat menyebabkan terjadinya stroke berulang. Penelitian ini bertujuan untuk mengetahui hubungan dukungan keluarga, program pemulangan dan karakteristik klien dengan perawatan di rumah pada aggregate dewasa pasca stroke di Bukittinggi. Penelitian ini mengggunakan desain cross sectional dengan sampel penelitian 144 klien dewasa pasca stroke. Hasil penelitian didapatkan ada hubungan dukungan keluarga, program pemulangan, usia, jenis kelamin dan pendidikan dengan perawatan pasca stroke di rumah. Dukungan keluarga diperlukan dalam perawatan pasca stroke di rumah serta program pemulangan dari rumah sakit perlu terencana dan sistematis.

---

Post-stroke clients who do not do the optimal treatment can lead to recurrent stroke.. This study aims to determine the relationship of family support, repatriation programs and the characteristics of clients with home care in the aggregate post-stroke adult in Bukittinggi. These studies use traditional cross-sectional design of the study sample with clients poststroke.

The study found a significant associations of family support, repatriation program, age, gender and education with post-stroke care at home. Family support is needed in post-stroke care at home as well as the repatriation program of the hospital need to be planned and systematic."

"[ABSTRAKTujuan penelitian ini yaitu mengembangkan intervensi model adaptasi paska stroke serta mengidentifikasi efektifitasnya terhadap perilaku adaptasi dan kualitas hidup pasien paska stroke. Penelitian ini secara keseluruhan dilakukan dalam dua tahap. Tahap satu yaitu pengembangan model intervensi yang diawali dengan penelitian kualitatif menggunakan pendekatan fenomenologi deskriptif tentang pengalaman pasien beradaptasi paska stroke. Model intervensi kemudian dikembangkan dengan cara mengintegrasikan tema hasil penelitian kualitatif, studi literatur, dan konsultasi pakar. Tahap kedua yaitu uji coba intervensi model untuk menentukan efektifitasnya terhadap respon adaptasi dan kualitas hidup pasien paska stroke. Penelitian tahap dua merupakan penelitian kuasi eksperimen menggunakan desain post test control group. Metode sampling yang digunakan dalam penelitian tahap dua yaitu consecutive sampling dengan jumlah sampel 65 orang (32 orang kelompok intervensi dan 33 orang kelompok kontrol). Pembagian sampel ke dalam kelompok intervensi dan kontrol dilakukan dengan matching rumah sakit. Hasil penelitian tahap satu teridentifikasi 9 tema yang dinyatakan partisipan dan dihasilkan intervensi model adaptasi paska stroke (IMAPS) beserta perangkatnya meliputi buku panduan intervensi model, modul untuk perawat pelaksana, dan booklet untuk pasien dan keluarga. Hasil penelitian tahap dua membuktikan adanya perbedaan respon adaptasi fisiologis, adaptasi psikososial, dan kualitas hidup yang bermakna antara pengukuran 3 bulan dengan 4 bulan sesudah intervensi diantara kelompok intervensi dan kontrol. Kesimpulan hasil penelitian yaitu intervensi model adaptasi paska stroke efektif meningkatkan respon adaptasi fisiologis, adaptasi psikososial dan kualitas hidup paska stroke.;

---

ABSTRACTThe purpose of this research was to develop intervention adaptation model for post-stroke (IMAPS) and identify its effectiveness on adaptation response and quality of life after stroke. This study conducted in two stages. The first stage was the development of intervention model that begins with a qualitative research using a descriptive phenomenological approach. Intervention model was then developed by integrating the results of qualitative research, literature review, and expert review. The second stage was examination the intervention model to identified its effectiveness on adaptation response and quality of life after stroke. This study was quasi-experimental research using post test control group design. The sampling method used in this study was consecutive sampling with a sample of 65 stroke patient (32 samples in intervention group and 33 samples in control group). Samples were allocated to intervention and control group by matching the hospital. The qualitative study identified nine theme stated by the participants. Qualitative themes serve as guidelines for developing intervention model. The first stage resulted in intervention model and its devices include intervention manual, module for nurses, and booklet for patients and their families. The second stage of research proves the significant difference in physiological and psychosocial adaptation response, and quality of life between measurements 3 months to 4 months after the intervention between groups. We conclude that IMAPS effectively improve the response of physiological and psychosocial adaptation, and quality of life after stroke;The purpose of this research was to develop intervention adaptation model for post-stroke (IMAPS) and identify its effectiveness on adaptation response and quality of life after stroke. This study conducted in two stages. The first stage was the development of intervention model that begins with a qualitative research using a descriptive phenomenological approach. Intervention model was then developed by integrating the results of qualitative research, literature review, and expert review. The second stage was examination the intervention model to identified its effectiveness on adaptation response and quality of life after stroke. This study was quasi-experimental research using post test control group design. The sampling method used in this study was consecutive sampling with a sample of 65 stroke patient (32 samples in intervention group and 33 samples in control group). Samples were allocated to intervention and control group by matching the hospital. The qualitative study identified nine theme stated by the participants. Qualitative themes serve as guidelines for developing intervention model. The first stage resulted in intervention model and its devices include intervention manual, module for nurses, and booklet for patients and their families. The second stage of research proves the significant difference in physiological and psychosocial adaptation response, and quality of life between measurements 3 months to 4 months after the intervention between groups. We conclude that IMAPS effectively improve the response of physiological and psychosocial adaptation, and quality of life after stroke, The purpose of this research was to develop intervention adaptation model for post-stroke (IMAPS) and identify its effectiveness on adaptation response and quality of life after stroke. This study conducted in two stages. The first stage was the development of intervention model that begins with a qualitative research using a descriptive phenomenological approach. Intervention model was then developed by integrating the results of qualitative research, literature review, and expert review. The second stage was examination the intervention model to identified its effectiveness on adaptation response and quality of life after stroke. This study was quasi-experimental research using post test control group design. The sampling method used in this study was consecutive sampling with a sample of 65 stroke patient (32 samples in intervention group and 33 samples in control group). Samples were allocated to intervention and control group by matching the hospital. The qualitative study identified nine theme stated by the participants. Qualitative themes serve as guidelines for developing intervention model. The first stage resulted in intervention model and its devices include intervention manual, module for nurses, and booklet for patients and their families. The second stage of research proves the significant difference in physiological and psychosocial adaptation response, and quality of life between measurements 3 months to 4 months after the intervention between groups. We conclude that IMAPS effectively improve the response of physiological and psychosocial adaptation, and quality of life after stroke]"

"Nafas Dalam, Rentang Gerak Sendi, dan Peregangan merupakan bentuk intervensi keperawatan komunitas untuk meningkatkan kemampuan rehabilitasi pada lansia paska stroke. Penulisan bertujuan memberikan gambaran pelaksanaan bentuk intervensi dalam pelayanan dan asuhan keperawatan komunitas melalui integrasi CAP, FCN, konsekuensi fungsional, dan manajemen pada lansia dengan paska stroke di Kelurahan Curug. Hasil terjadi peningkatan skor perilaku anggota kelompok pendukung yaitu pengetahuan 14,6%, sikap 10,6%, dan tindakan 8,75%. Peningkatan perilaku kelompok lansia paska stroke yang meliputi pengetahuan 16,67%, sikap 5,2%, dan tindakan 8,1%. Terjadi peningkatan skor kekuatan otot lengan sebesar 0,87% dan otot kaki 0,7%. Terjadi penurunan skor kecemasan sebesar 6,4%. Terjadi peningkatan perilaku keluarga meliputi pengetahuan 16,7%, sikap 13,5%, dan tindakan 18,36%. Terjadi peningkatan tingkat kemandirian keluarga sebesar 100%. Kesimpulan dari penulisan ini yaitu terdapat pengaruh pelaksanaan intervensi "NAfas DAlam, Range Of Motion dan Stretching (Nada ROMS) terhadap peningkatan kemampuan rehabilitasi pada kelompok lansia paska stroke. Diharapkan keluarga dapat memberikan dan mendampingi lansia dalam melakukan latihan NADA ROMS di rumah.

---

Deep Breathing, Range of motion, and Stretching are the forms of community nursing interventions that can be conducted by families and communities to improve post-stroke rehabilitation in the elderly. This report aimed to provide an overview of the implementation of nursing intervention and services project through the integration of the CAP, FCN, functional consequences, and management in older adults with post-stroke in Curug sub district, Depok. The result showed that the score of support groups behaviour increased by 14.6%, 10.6% and 8.75% (knowledge, attitude, and skill respectively). The result showed that the score of knowledge level, attitude, and action of elderly with post stroke in Curug increased by 16.67%, 5,2% and 8.1% respectively. There was an increase in arm muscle and leg muscles strength score by 0.87% and 0.7%. The anxiety scores decreased by 6.4%. The family behavior included knowledge 16.7%, 13.5% attitude and skill by18.36%. There was an increase in the level of family independence of 100%. The study concludes that there are significan implementation of the intervention "Deep breathing, Range Of Motion and Stretching (NADA ROMS) to increase the rehabilitation capacity of post-stroke elderlies. Caregiver or family member should assist elderly with post stroke to do NADA ROMS exercises."

"Tujuan: Penelitian ini bertujuan untuk mengetahui besarnya risiko stroke berulang pada pasien paska stroke pertama di RS Pusat Otak Nasional dan faktor risikonya. Metode: Desain penelitian ini adalah cohort retrospektif. Sampel dalam penelitian ini adalah semua pasien stroke serangan pertama yang menjalani pelayanan rawat inap pada tahun 2014 dan memiliki catatan rekam medik yang lengkap. Analisis data mengunakan regresi cox multivariat. Hasil: Hasil penelitian menunjukkan bahwa pada bulan ≤ 15,umur ≥ 60 tahun memiliki risiko lebih besar untuk terjadinya stroke berulang ; pada bulan < 15, overweight memiliki risiko lebih tinggi untuk terjadinya stroke berulang; pada bulan ≤ 15, obesitas memiliki risiko lebih tinggi untuk terjadinya stroke berulang; pada bulan ≤ 30, pre hipertensi memiliki risiko lebih tinggi untuk terjadinya stroke berulang ; pada bulan ≤ 15, hipertensi grade 1 dan 2 memiliki risiko yang lebih tinggi untuk terjadinya stroke berulang, ; kontrol yang tidak teratur memiliki risiko 8,71 kali lebih tinggi untuk terjadinya stroke berulang.

---

Objective: This study aims to determine the risk of recurrent strokein patients with post-stroke first in the brain center of the national hospitaland the risk factors that influence.

Methods: This study was a retrospective cohort. The sample in this study is the first to attack all stroke patients who underwent inpatient services in 2014 and had a complete medical record. Analysis of data using multivariate cox regression.

Results: The results showed that in ≤ 15, ≥ 60 years of age have a greater risk for recurrent stroke; in <15 overweight have a higher risk for recurrent stroke; in ≤ 15, obesity have a higher risk for recurrent stroke; in ≤ 30, pre-hypertension are at higher risk forrecurrent stroke; in ≤ 15, hypertension grade 1 and 2 have a higher risk for the recurrent stroke; control irregular had 8.71 times higher risk for recurrent stroke."

"PENDAHULUAN: Teknik motor imagery diketahui berpengaruh terhadap fungsi motorik anggota gerak atas pasien stroke iskemik kronik. Meskipun demikian, belum diketahui pengaruh teknik motor imagery terhadap neuroplastisitas secara molekular pada pasien stroke iskemik kronik. Penelitian ini bertujuan mengetahui pengaruh teknik motor imagery terhadap fungsi anggota gerak atas dan neuroplastisitas pasien stroke iskemik kronik.METODE: Kami melaporkan 3 kasus stroke iskemik kronik. Kasus pertama wanita usia 40 tahun dengan stroke pertama awitan 5 tahun dan komorbid systemic lupus erythematosus (SLE). Kasus kedua wanita usia 53 tahun dengan stroke pertama awitan 3 tahun, komorbid hipertensi dan diabetes mellitus tipe 2. Kasus ketiga pria usia 51 tahun dengan stroke berulang ketiga awitan 1 tahun, komorbid hipertensi dan hiperlipidemia. Kami melakukan intervensi teknik motor imagery 1 sesi per minggu selama 12 minggu, dengan durasi 20 menit per sesi, menggunakan panduan elektroensefalografi (EEG) elektroda tunggal portabel. Luaran fungsional dinilai dengan Chedoke Arm and Hand Activity Inventory-13 (CAHAI-13) sebelum dan sesudah intervensi. Parameter neuroplastisitas diukur dari kadar Brain Derived Neurotrophic Factor (BDNF) serum yang dinilai pada pra-intervensi, minggu ke-6, dan pasca-intervensi minggu ke-12HASIL: Pemulihan fungsi anggota gerak atas yang bermakna secara klinis didapatkan pada kasus kedua dengan peningkatan skor CAHAI-13 sebesar 21 poin disertai peningkatan kadar BDNF serum pada minggu ke-6 yang relatif menetap pada pengukuran minggu ke-12. Pada kasus ketiga didapatkan peningkatan skor CAHAI-13 yang tidak bermakna secara klinis, sementara pada kasus pertama tidak didapatkan perubahan. Kadar BDNF pada kasus pertama dan ketiga memiliki kecenderungan yang sama, yaitu meningkat pada minggu ke-6, dan turun kembali pada minggu ke-12 dengan kadar yang masih lebih tinggi dibandingkan kadar pra-intervensi.KESIMPULAN: Teknik motor imagery 1 sesi per minggu selama 12 minggu, durasi 20 menit per sesi, terbukti berpengaruh terhadap neuroplastisitas pasien stroke iskemik kronik, dan terhadap pemulihan motorik anggota gerak atas pasien stroke iskemik kronik serangan pertama awitan 3 tahun.

---

INTRODUCTION: Motor imagery is known to affect motor function of upper limbs in chronic ischemic stroke patients. However, the effect of motor imagery on molecular neuroplasticity in chronic ischemic stroke patients is not yet established. This study aims to determine the efect of motor imagery on upper limb function and neuroplasticity of chronic ischemic stroke patients.

METHODS: We reported 3 cases of chronic ischemic stroke. The first case was a 40-year-old woman with stroke onset 5 years and comorbid systemic lupus erythematosus (SLE). The second case was a 53-year-old woman with a first strokte of 3 years onset, comorbid hypertension and diabetes mellitus type 2. The third case was a 51-year-old with third recurrent stroke of 1 year onset, comorbid hypertension and hyperlipidemia. We performed motor imagery 1 session per week for 12 weeks, with a duration of 20 minutes per session, using single electrode portable electroencephalograph (EEG) guidance. Functional outcomes were assessed using the Chedoke Arm and Hand Activity Inventory-13 (CAHAI-13) before and after intervention. Neuroplasticity parameters were measured from serum Brain Derived Neurotrophic Factor (BDNF) levels which were assessed at pre-intervention, week 6, and week 12 post-intervention.

RESULTS: Clinically significant recovery of upper limb function was found in the second case with an increase in the CAHAI-13 score of 21 points, accompanied by an increase in serum BDNF levels at week 6 which was relatively stable at week 12. In the third case, there was an increase in the CAHAI-13 score which was not clinically significant, while in the first case there was no change. Serum BDNF levels in the first and third cases had the same tendency, which increased at week 6 and decreased at week 12, with the levels still higher than pre-intervention levels.

CONCLUSION: Motor imagery 1 session per week for 12 weeks, with the duration of 20 minutes per session, has been shown to have an effect on neuroplasticity of chronic ischemic stroke patients, and on motor recovery of limbs in patient with first chronic ischemic stroke of 3 years onset."

"Penelitian ini bertujuan untuk mengetahui pengaruh rehabilitasi berbasis Realitas Virtual Imersi Penuh pada pemulihan motorik anggota gerak atas pasien stroke iskemik kronik dengan hemiparesis. Penelitian ini merupakan studi serial kasus pada pasien stroke yang datang berobat ke Poliklinik Rehabilitasi Medik RSUPN Cipto Mangunkusumo. Pasien dilakukan pemeriksaan dengan pengambilan data baseline berupa nilai Fugl-Meyer Upper Extremity (FM-UE) dan Chedoke Arm, Hand Activity Inventory (CAHAI), dan Brain Derived Neurotrophic Factor (BDNF). Pasien mendapat perlakuan reahabilitasi fisik selama 18 kali pertemuan, 3 kali seminggu, 30 menit per sesi selama 6 minggu. Pasca tindakan, dilakukan kembali pengambilan data FM-UE, CAHAI dan BDNF ulang untuk melihat fenomena pemulihan motorik atas. Subjek penelitian terdiri dari 2 pria dan 3 wanita dengan rentang usia 45 – 59 tahun, 4 hemiparesis kiri dan 1 hemiparesis kanan, rentang Brunnstrom IV – VI. Setelah diberikan intervensi, terdapat peningkatan pada ketiga parameter FM-UE (median difference: 2, min – max: 1 – 19 MCID: 5,25), CAHAI (median difference: 2, min – max : 1-18, MCID: 6,3), dan BDNF (median difference: 16.68, min – max : 9,76 - 46,8). Kesimpulan penelitian ini adalah rehabilitasi berbasis realitas virtual imersi penuh menunjukan fenomena peningkatan positif yang menjanjikan pada pemulihan motorik anggota gerak atas pasien stroke iskemik kronik setelah 6 minggu intervensi.

---

This study aims to determine the effect of Full Immersion Virtual Reality-based rehabilitation on upper limb motor recovery in chronic ischemic stroke patients with hemiparesis. This research is a case series study in stroke patients who come for treatment at the Medical Rehabilitation Polyclinic of Cipto Mangunkusumo General Hospital. Patients were examined by taking baseline data in the form of Fugl-Meyer Upper Extremity (FM-UE) and Chedoke Arm, Hand Activity Inventory (CAHAI), and Brain Derived Neurotrophic Factor (BDNF) values. Patients received physical rehabilitation treatment for 18 meetings, 3 times a week, 30 minutes per session for 6 weeks. After the action, FM-UE, CAHAI and BDNF data were collected again to see the phenomenon of upper motor recovery. The study subjects consisted of 2 men and 3 women with an age range of 45 – 59 years, 4 left hemiparesis and 1 right hemiparesis, Brunnstrom IV – VI range. After the intervention was given, there was an increase in all three parameters FM-UE (median difference: 2, min – max: 1 – 19, MCID: 5.25), CAHAI (median difference: 2, min – max: 1-18, MCID: 6 .3), and BDNF (median difference: 16.68, min – max: 9.76 - 46.8). The conclusion of this study is that full immersion virtual reality-based rehabilitation shows a promising positive improvement phenomenon in upper limb motor recovery in chronic ischemic stroke patients after 6 weeks of intervention."

"Stroke adalah penyebab kematian kedua serta penyebab kecacatan ketiga di dunia. Penatalaksanaan yang menjadi standar baku emas pada stroke iskemik akut adalah trombolisis. Angka tindakan trombolisis masih rendah, bawah standar yang diharapkan sebesar 12% (Hoffmeister et al., 2016). Kondisi ini terjadi secara global, baik negara maju maupun negara berkembang. Oleh karena itu, perlu dilakukan penelitian mengenai penyebab rendahnya cakupan tindakan trombolisis pada penderita stroke di berbagai negara di dunia. Penelitian ini merupakan systematic review dengan melakukan analisis faktor konfirmatori. Penelusuran dilakukan pada basis data dari PubMed, EMBASE, SpringerLink, dan ScienceDirect dari tahun 2012 sampai dengan 2022. Dilakukan juga penelusuran pada Google Schoolar dan Pusinfokesmas FKM UI serta Universitas Indonesia Library. Pelaporan systematic review ini menggunakan panduan PRISMA. Pada hasil penelusuran berdasarkan kata kunci dan kriteria yang sudah ditetapkan didapatkan total 4971 jurnal didapatkan dari berbagai negara di dunia. Setelah dilakukan skrining terdapat 101 jurnal, kemudian setelah diteliti, terdapat 26 studi terpilih yang diekstraksi dan disintesis. Analisis faktor yang diteliti mengikuti kerangka kerja Donabedian yang mengevaluasi pelayanan kesehatan. Pada hasilnya didapatkan bahwa pada komponen struktur pelayanan trombolisis terdapat beberapa hal yang menjadi penyebab rendahnya trombolisis pada pasien stroke iskemik di berbagai negara yaitu kurangnya penggunaan telemedisin pada lokasi yang jauh dari pusat stroke, belum optimalnya pelayanan EMS sehingga meningkatkan door to needle time, tim stroke belum berkompeten dan berpengalaman, faktor pembiayaan dari mahalnya biaya pelayanan dan kurang mendukungnya penjaminan dari asuransi, tipe rumah sakit yang belum mendukung, SOP rumah sakit yang belum sempurna, kurangnya pelatihan, kultur organisasi rumah sakit yang belum mendukung, serta faktor dari pasien sendiri. Proses trombolisis dilakukan di beberapa tempat, antara lain di pusat stroke di rumah sakit besar, maupun di rumah sakit kecil dengan telestroke. output dari pelayanan trombolisis yaitu cakupan pemberian trombolisis pada pasien stroke akut di rumah sakit dimana pada penelitian ini ditemukan memiliki angka yang masih relatif kecil. Disarankan kepada manajemen rumah sakit dan otoritas kesehatan setempat untuk meningkatkan kesadaran masyarakat mengenai stroke dan langkah yang harus dilakukan saat terjadi stroke. Rumah sakit juga perlu untuk meningkatkan kapabilitas tim stroke dengan pelatihan dan simulasi, menyempurnakan prosedur pelayanan melalui hospital by law, meningkatkan kemampuan EMS sehingga door to needle time berkurang, dan mencoba menerapkan berbagai metode trombolisis seperti telestroke untuk pasien yang lokasinya jauh, metode Helsinki dan drip and ship yang terbukti menurunkan penundaan pemberian trombolisis

---

Stroke is the second leading cause of death and the third cause of disability in the world. The gold standard treatment for acute ischemic stroke is thrombolysis. The rate of thrombolysis is still low, below the expected standard of 12% (Hoffmeister et al., 2016). This condition occurs globally, both developed and developing countries. Therefore, it is necessary to conduct research on the causes of the low coverage of thrombolysis in stroke patients in various countries in the world. This is a systematic review research by conducting confirmatory factor analysis. Searches were conducted on databases from PubMed, EMBASE, SpringerLink, and ScienceDirect from 2012 to 2022. A search was also carried out on Google Schoolar and the FKM UI's Pusinfokesmas and the University of Indonesia Library. This systematic review report uses PRISMA guidelines. In the search results based on keywords and predetermined criteria, a total of 4971 journals were obtained from various countries in the world. After screening there were 101 journals, then after being researched, there were 26 selected studies that were extracted and synthesized. The factor analysis studied followed the Donabedian framework that evaluates health services. In the results, it was found that in the structural component of the thrombolysis service there are several things that cause low thrombolysis in ischemic stroke patients in various countries, namely the lack use of telemedicine at locations remote from the stroke center, not optimal EMS services that increasing door to needle time, the stroke team has not competent and experienced, the financing factor is the high cost of service and the lack of support for insurance coverage, the type of hospital that does not supported, the hospital SOP is not perfect, the lack of training, the organizational culture of the hospital is not supportive, as well as factors from the patients themselves. The thrombolysis process is carried out in several places, including in stroke centers in large hospitals, as well as in small hospitals with telestroke. The output of thrombolysis services is the coverage of thrombolysis in acute stroke patients in hospitals, which in this study were found to have relatively small numbers. It is recommended to the hospital management and local health authorities to increase public awareness about stroke and the action that must be taken when a stroke occurs. Hospitals also need to improve stroke team capabilities with training and simulations, improve service procedures through hospital by law, improve EMS capabilities so that door-to-needle time is reduced, and try to apply various thrombolysis methods such as telestroke for patients who are placed remotely, the Helsinki method and drip and ship which has been shown to reduce delays in thrombolysis."