Skripsi

Peran pemeriksaan neurologis kepala dalam mendeteksi keterlambatan motorik kasar anak usia 6—18 bulan = Role of paediatric head neurological assessment in detecting gross motor developmental delay in children 6 to 18 months of age.

Latar Belakang Data dari Ikatan Dokter Anak Indonesia (2013) menyebutkan bahwa sekitar 5—10% anak mengalami kelainan dalam perkembangannya, serta sekitar 1—3% anak usia di bawah 5 tahun mengalami kelainan pada lebih dari 1 aspek perkembangan (global developmental delay). Perkembangan motorik yang mengalami keterlambatan memiliki dampak negatif, bukan hanya terkait kompetensi motorik yang buruk, melainkan juga pada risiko keterlambatan di domain perkembangan lainnya beserta gangguan kesehatan yang berpotensi dialami anak di usia mendatang. Penelitian ini berfokus untuk mencari tahu peran pemeriksaan neurologis kepala dalam mendeteksi keterlambatan motorik kasar pada anak usia 6—18 bulan. Metode Penelitian ini dilakukan dengan desain cross-sectional di Poliklinik Neurologi Departemen Ilmu Kesehatan Anak, Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Kiara pada bulan September—Oktober 2023. Sebanyak 80 subjek direkrut secara consecutive sampling. Analisis dilakukan untuk mengetahui indikator diagnostik sensitivitas, spesifisitas, PPV, NPV, dan OR secara bivariat dan multivariat. Analisis dilakukan pada seluruh sampel dengan inklusi maupun eksklusi faktor risiko. Hasil Kemampuan menunjuk menunjukkan analisis hubungan paling signifikan melalui analisis bivariat dan multivariat dengan baseline covariate exclusion dengan OR 6,968 (CI 95% 1,009-48,141; p < 0,05). Rentang indikator diagnostik seluruh pemeriksaan kepala yakni sensitivitas 34—68% (tertinggi pada kemampuan menunjuk); spesifisitas 66,67—96,67% (tertinggi pada kontak visual); PPV 66,67—96,15% (tertinggi pada kontak visual); dan NPV 39,62%—61,90% (tertinggi pada kemampuan menunjuk). Indikator diagnostik pemeriksaan neurologis kepala cukup sebanding dengan alat asesmen keterlambatan motorik kasar lain. Kesimpulan Pemeriksaan neurologis kepala, khususnya lingkar kepala, kontak visual, bentuk kepala, dan kemampuan menunjuk, memiliki potensi pemanfaatan sebagai alat deteksi keterlambatan motorik kasar pada anak usia 6—18 bulan.
Kata Kunci: bentuk kepala, kemampuan menunjuk, keterlambatan perkembangan, lingkar kepala, motorik kasar, pemeriksaan neurologis


Introduction According to data sourced from Indonesian Pediatric Society (2013), approximately 5— 10% of children experience abnormalities in their development and maturation process, and around 1—3% of children under 5 experience delay in more than 1 domain of child development (global developmental delay). Delay in motoric development not only affect said children’s motor skills, but could potentially risk delay in other developmental domains and make them more susceptible to other health issues in the future. This study focuses on the role of head neurological assessment in detecting gross motor developmental delay in children 6 to 18 months of age. Method This cross-sectional study was held at the Neurology Clinic of Cipto Mangunkusumo Kiara Hospital for the period of September to October 2023. Exactly 80 samples were recruited using consecutive sampling according to patient visit. Bivariate and multivariate analysis were done to acquire diagnostic indicators such as sensitivity, specificity, PPV, NPV, dan DOR. Samples were analyzed both including and excluding significant risk factors. Results Pointing produced the most significant discriminative correlation using bivariate and multivariate analysis excluding significant risk factors with OR 6,968 (OR 6,968; CI 95% 1.009-48.141; p < 0,05). Diagnostic indicators including all head neurological assessments showed good result intervals, with sensitivity of 34—68% (highest in pointing test), specificity of 66.67—96.67% (highest in eye contact test), PPV of 66.67—96.15% (highest in eyes contact test), and NPV of 39,62—61,90% (highest in pointing test). Such results can be closely compared to other commonly used gross motor assessment tools. Conclusion Head neurological assessment in paediatric patients, especially evaluations of head circumference, eye contact, head shape, dan pointing have the potential to be effectively implemented as a tool for detecting gross motor development delay in children 6 to 18 months of age.
Keywords: developmental delay, gross motor, head circumference, head shape, neurologic examination, pointing