Tesis

Perbandingan Efektivitas Modified Constraint Induced Movement Therapy dengan Mirror Therapy Terhadap Fungsi Motorik Anggota Gerak Atas Penderita Stroke Kronik = Comparison the effectiveness of modified Constraint Induced Movement Therapy and Mirror Therapy on Motor Functions Of Upper Extremity in chronic stroke patients.

Objektif: Untuk menilai perbandingan efektivitas antara latihan modified Constraint Movement Therapy (mCIMT) dengan Mirror Therapy terhadap fungsi motorik anggota gerak atas pada penderita stroke iskemik fase kronik dengan hemiparesis. Metode: Penelitian ini merupakan uji eksperimental studi acak terkontrol tersamar tunggal terhadap dua kelompok dimana dilakukan pemberian latihan modified Constraint Induce Movement Therapy atau Mirror Therapy selama 4 minggu di rumah pada pasien stroke fase kronik dengan hemiparesis. Penelitian dilakukan di Poliklinik Rehabilitasi Medik RSUPN Cipto Mangunkusumo Jakarta. Penilaian fungsi motorik anggota gerak atas dengan Fugl-Meyer Assessment Upper Extremity (FMA-UE) dan Chedoke Arm and Hand Activity Inventory (CAHAI) dilakukan sebelum dan sesudah intervensi. Hasil: Jumlah subjek penelitian sebesar 24 subjek, dengan masing-masing 12 subjek pada tiap kelompok yang dapat dianalisis. Rerata usia 58.83 ± 11.76 tahun pada kelompok mCIMT dan 57.08 ± 11.14 tahun pada kelompok mirror therapy. Onset stroke pada penelitian ini memiliki nilai rerata 10.92 ± 3.6 bulan pada kelompok mCIMT dan 12.5 ± 4.62 bulan pada kelompok mirror therapy. Saat dibandingkan antara 2 kelompok, tidak terdapat perbedaan signifikan antara 2 kelompok pada nilai akhir pasca intervensi, dengan nilai rerata FMA-UE motorik pada kelompok mCIMT sebesar 53.92 ± 10.3 dan nilai rerata pada mirror therapy sebesar 45.17 ± 12.98. Hasil analisis dari nilai CAHAI pasca intervensi didapatkan nilai rerata CAHAI 43.92 ± 6.97 pada kelompok mCIMT dan nilai rerata pada mirror therapy sebesar 37.67 ± 10.56 dengan nilai p > 0,05. Kesimpulan: Latihan mCIMT dan mirror therapy di rumah selama 4 minggu terbukti secara signifikan dan sama baiknya dalam meningkatkan fungsi motorik anggota gerak atas pada pasien stroke iskemik fase kronik dengan hemiparesis. Kelompok mCIMT juga terbukti efektif meningkatkan aspek fungsi sensorik dan lingkup gerak sendi pasif, dan pada kelompok mirror therapy terbukti efektif meningkatkan aspek lingkup gerak sendi pasid dan nyeri sendi pada pasien stroke iskemik fase kronis dengan hemiparesis.
Kata kunci: Stroke iskemik fase kronik, modified constraint induced movement therapy, mirror therapy, FMA-UE, CAHAI


Objective: To determine comparison the effectiveness of modified Constraint Induced Movement Therapy and Mirror Therapy on motor functions of upper extremity in chronic stroke patients with hemiparesis. Methods: This is a single blind randomized controlled trial with 2 groups in chronic stroke patient with hemiparesis that given by two different intervention which are modified Constraint Induce Movement Therapy and Mirror Therapy for 4 weeks at home. This study is in Rehabilitation Polyclinic at RSUPN Cipto Mangunkusumo Jakarta. FuglMeyer Assessment Upper Extremity (FMA-UE) and Chedoke Arm and Hand Activity Inventory (CAHAI) as outcome measurement was examined before and after intervention. Results: Total subjects were 24 subjects, with 12 subjects in each group that could be analyzed. The mean of subject’s age was 58.83 ± 11.76 years in mCIMT group and 57.08 ± 11.14 years in mirror therapy group. Stroke onset in this study was 10.92 ± 3.6 months in mCIMT group and 12.5 ± 4.62 months in mirror therapy group. Comparison between two groups, there is no significant different between two groups in the end of interventions, the mean of motoric FMA-UE in mCIMT group was 53.92 ± 10.3 and in mirror therapy group was 45.17 ± 12.98. Also, the mean of CAHAI in mCIMT group was 43.92 ± 6.97 and in mirror therapy group was 37.67 ± 10.56 with p value > 0.05. Conclusion: Home based mCIMT and mirror therapy for 4 weeks significantly increased motor functions of upper extremity in chronic stroke patients with hemiparesis. In mCIMT group also significantly increased in sensory function and passive range of motion. In mirror therapy also significantly increase passive range of motion and joint pain in chronic stroke patients with hemiparesis.
Keywords: Chronic ischemic stroke, modified constraint induced movement therapy, mirror therapy, FMA-UE, CAHAI