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"Brain plasticity is the focus of a growing body of research with significant implications for neurorehabilitation. This state-of-the-art volume explores ways in which brain-injured individuals may be helped not only to compensate for their loss of cognitive abilities, but also possibly to restore those abilities. Expert contributors examine the extent to which damaged cortical regions can actually recover and resume previous functions, as well as how intact regions are recruited to take on tasks once mediated by the damaged region. Evidence-based rehabilitation approaches are reviewed for a range of impairments and clinical populations, including both children and adults."

"This book teaches psychologists with a neuropsychology background about cognitive remediation. It identifies the most commonly used neuropsychological test instruments for evaluating cognitive deficits, with emphasis on their input and output characteristics.;"

"Norman Doidge shows how the amazing process of neuroplastic healing really works. He describes natural, non-invasive avenues into the brain provided by the forms of energy around us - light, sound, vibration, movement - which pass through our senses and our bodies to awaken the brain's own healing capacities without producing unpleasant side effects."

"ABSTRAKPENDAHULUAN: 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.

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ABSTRACTINTRODUCTION: 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."

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Latar Belakang: Biaya kesehatan pasien delirium 2.5 kali lebih besar dibanding pasien tanpa delirium. Kuesioner Indeks Cadangan Kognitif(KICK) dapat menguantifikasi cadangan kognitif (CK) individu ke dalam indeks tunggal. Penelitian ini bertujuan melakukan uji validitas dan reliabilitas KICK serta mencari perbedaan rerata cadangan kognitif pasien delirium lansia dibanding kontrol di RSCM.

Metode: Penelitian dilakukan di RSCM pada Juni sampai September 2019. Tahap pertama merupakan uji validitas KICK, dengan 33 subyek di Poli Geriatri. Tahap kedua merupakan penelitian case controluntuk mengetahui peran cadangan kognitif yang diukur dengan KICK pada kasus delirium geriatri, dengan subyek 33 orangpasien delirium yang dirawat di Ruang Rawat Akut Geriatri Gedung A RSCMdan 33 pasien lain sebagai kontrol. 

Hasil: Uji validitas konstruksi dari ketiga subskala menunjukkan korelasi yang kuat dengan p<0,001. Uji reliabilitas konsistensi internal menunjukkan hasil Cronbach’s Alphasebesar 0,688. Ditemukan adanya perbedaan bermakna (p <0.01) hasil skor KICK pada kelompok delirium dibanding kelompok kontrol dengan OR sebesar 9 (95% CI 2.86 - 28.22). 

Simpulan: KICK valid dan reliabel mengukur CK pasien lansia di Indonesia.Pasien dengan cadangan kognitif rendah berpeluang mengalami delirium 9 kali lebih tinggi dibanding pasien dengan cadangan kognitif tinggi.

 

 

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Background:Health costs for delirium patients are 2.5 times greater than non-delirium patients. Cognitive Reserve Index questionnaire (CRIQ) is aimed to quantify cognitive reserve (CR) into one single index. We conducted this study to test the validity and reliability of the Indonesian version of CRIQ and define mean differences of CR in geriatric delirium cases compared to controls in RSCM. 

Method:The study was conducted in Cipto Mangunkusumo Hospital (CMH) on June to September 2019. The first stage was validity testing of the CRIQ to 33 subjects in Outpatient Clinic. The second stage is a case control study to determine the role of cognitive reserve (CR) by CRIQ in geriatric delirium cases to 33 subjects with delirium treated in the Acute Geriatric Inpatient ward and 33 non-delirium patients as controls.

Result:The construct validity of 3 subscales showed significant correlation (p <0,001). Reliability test showedCronbach’s Alphaof 0,688. There’s a significant difference in CRI score of delirium versus non-delirium patients (p<0,01) with OR 9 (95% CI 2.86 to 28.22) of developing delirium.

Conclusion:CRIQ is valid and reliable to measure CR of elderly Indonesian patients. Patients with low CR score have 9 times higher chance of developing delirium compared to those with high CR.

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"Tatalaksana nutrisi pada pasien cedera kepala sedang dan berat mencakup pemberian makronutrien mikronutrien nutrien spesifik pengelolaan cairan dan elektrolit serta pemantauan dan evaluasi Dukungan nutrisi yang adekuat perlu diberikan pada pasien cedera kepala agar meningkatkan perbaikan kondisi optimal pasien Sebagian besar pasien cedera kepala memiliki status gizi yang baik sebelum terjadinya trauma Pemenuhan nutrisi yang optimal dapat turut menunjang perbaikan inflamasi metabolisme dan menjaga tidak terjadi penurunan status gizi Pasien pada serial kasus ini seluruh pasien laki laki mempunyai rentang usia 19 sampai 49 tahun Adanya penyakit penyerta mempengaruhi luaran akhir pasien cedera kepala Terapi nutrisi diberikan sesuai dengan kebutuhan setiap pasien Kebutuhan energi total dihitung berdasarkan perkiraan kebutuhan energi basal menggunakan persamaan Harris Benedict dikalikan faktor stres 1 4 1 6 dan pemberiannya disesuaikan dengan kondisi klinis pasien Kebutuhan protein 1 5 2 g kg BB hari dan lemak 20 30 Pemantauan mencakup tanda klinis toleransi asupan makanan kapasitas fungsional keseimbangan cairan parameter laboratorium dan antropometri Pemberian nutrisi pada pasien cedera kepala berat dengan sakit kritis bersifat individual dan mencakup semua aspek Tatalaksana nutrisi yang baik dan dilanjutkan dengan edukasi pada pasien dan keluarga diharapkan dapat meningkatkan kualitas hidup pasien cedera kepala dengan meminimalkan komplikasi yang dapat terjadi

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Nutrition therapy in patients with moderate and severe traumatic brain injury includes the provision of macronutrient micronutrient specific nutrition fluid and electrolyte management with monitoring and evaluation Adequate nutrition support should be given in traumatic brain injury to optmalyze outcome patient Three from four this case series have a normoweight before trauma Nutritional support can improve metabolism decrease inflammation and manage nutritional status Patients in this case series all male have an age range from 19 to 49 kg years Their comorbid condition influence outcome of traumatic brain injury patient Nutritional support is given according to each patient rsquo s requirement which is calculated with basal energy requirement using Harris Benedict equation with stress factor 1 4 1 6 and the administration starts with individual condition which gradually increased to reach the total energy expenditure Protein requirement 1 5 2 g kg day and lipid requirement is calculated 20 30 total energy requirement Patient rsquo s monitoring include clinical signs food intake tolerance functional capacity fluid balance laboratory and anthropometric parameter were taken With the management of good nutrition expected quality of life of patients with moderate and severe traumatic brain injury various comorbidities would be better "

"Cedera kepala pada anak akibat dari kecelakaan merupakan salah satu masalah pada masyarakat perkotaan. Salah satu penanganan pada cedera kepala yaitu dengan pembedahan yang dapat mengakibatkan gangguan rasa nyaman berupa nyeri. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran asuhan keperawatan cedera kepala pada anak dengan menerapkan terapi musik audio visual untuk mengatasi nyeri paska pembedahan. Penerapan terapi musik audio visual ini diterapkan selama lima hari diperoleh hasil penurunan skala nyeri dari 6 menjadi 1. Selain itu, terapi musik audio visual juga efektif menurunkan nyeri pada prosedur lainnya seperti perawatan luka, pelesasan drainase dan jahitan operasi. Terapi musik audio visual ini sangat direkomendasikan untuk mengurangi nyeri pada anak paska pembedahan. Oleh karena itu, diharapkan ruang rawat dapat menerapkan terapi musik audio visual dengan menyediakan DVD musik anak-anak.

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Head injury among children caused by accident is one of the urban problems. One of the treatments for this injury is by performing surgery which can cause discomfort, specifically pain. This paper aims to show how to care children experiencing head injury by playing audio visual music therapy to reduce the pain after the surgery. After giving this audio visual music therapy for 5 days, the scale of the pain decreases from 6 to 1. Moreover, the children do not feel pain or worry when the surgical dressing is changed or when the drainage and suture are taken off if the music is played."

"Olahraga aerobik terbukti mampu meningkatkan struktur dan fungsi kognitif. Data tentang jenis olahraga aerobik yang terbaik untuk menjaga keseimbangan oksidatif, serta memicu angiogenesis dan neuroplastisitas di berbagai regio otak masih terbatas. Penelitian ini menganalisis pengaruh olahraga aerobik halang rintang terhadap kadar neuroglobin otak, protein pemicu angiogenesis, neuroplastisitas di hipokampus dan korteks prefrontal, serta fungsi memori relasional. Mencit Mus musculus CBS-Swiss strain jantan berusia 10 bulan dilatih berlari di roda berjalan yang diberi halang rintang, berlari dengan kecepatan 10 m/menit, 30 menit/hari, 5 hari/minggu sambil melewati halang rintang untuk setiap 78 cm. Tiga jenis halang rintang diganti setiap 3 hari. Kelompok pembanding adalah mencit yang berlari dengan kecepatan dan waktu yang sama, namun tanpa halang rintang, serta kelompok kontrol yang tidak berolahraga. Kadar neuroglobin otak tidak berbeda bermakna pada tiga kelompok mencit. Latihan lari halang rintang memberikan efek lebih baik dibanding lari tanpa halang rintang pada kadar developmentally regulated brain protein-A (drebrin-A) di hipokampus. Kedua kelompok olahraga memiliki efek yang lebih baik dibanding kontrol pada ekspresi vascular endothelial growth factors (VEGF), kadar drebrin-A, dan paired associative cognitive test. Olahraga aerobik kompleks memicu neuroplastisitas yang lebih baik dibanding aerobik sederhana di hipokampus. Kedua tipe olahraga aerobik mampu meningkatkan angiogenesis dan neuroplastisitas di otak, dan meningkatkan kemampuan memori relasional. Olahraga aerobik tidak meningkatkan kadar neuroglobin secara bermakna. Hal ini menunjukkan bahwa intensitas olahraga aerobik memberikan efek hipoksia yang dapat ditoleransi oleh jaringan otak.

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Aerobic exercise has been proven to improve of cognitive structure and function. Study about the type of aerobic exercise affects on angiogenesis, neuroplasticity and oxidative homeostasis in brain?s specific regions is still limited. The present study was conducted to investigate the effects of hurdle aerobic exercise on brain neuroglobin level, angiogenesis and neuroplasticity proteins in hippocampus and prefrontal cortex, and relational memory among middle aged CBS-Swiss strain mice. Mice, age 10 months were subjected to hurdle running wheel for 8 weeks. They ran at speed of 10 m/min, 30 min/day, and 5 days/week with hurdles for every 78 cm. Three types of hurdles were changed for every 3 days. Another group of same age mice ran at same speed, time, and period, without hurdle as comparison, while other control group never exercises. The hurdle group exercise has significant higher level of developmentally regulated brain protein-A (drebrin- A) in hippocampus compared to non-hurdle group. Both of exercise groups have significant higher ability on paired associative cognitive test, and they have significant higher expression of vascular endothelial growth factor (VEGF) and higher level of drebrin-A compared to control. Neuroglobin level was not significant different among of all groups. More complex aerobic exercise has better effect on hippocampus neuroplasticity. Both of aerobic exercise has better effect on angiogenesis and neuroplasticity in the brain, and also on cognitive function. Aerobic exercise does not resulting high hypoxic stress and could be tolerated by brain."