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"Tesis ini disusun untuk mengetahui data profile MEP dan APB serta efek latihan penguatan otot ekspirasi dengan perangkat PEP terhadap MEP dan APB pada lansia sedentary. Penelitian menggunakan desain uji acak terkontrol (randomized control trial) dengan latihan PLB sebagai kontrol. Subjek penelitian adalah lansia berusia lebih dari 60 hingga 75 tahun, sedentary, MocaINA ≥ 26, tidak merokok dalam 5 tahun terakhir, memiliki care giver, dapat berbahasa Indonesia, nilai spirometri normal atau abnormal, dapat memahami dan mempraktekkan dengan benar penggunaan alat PEP dan latihan PLB, bersedia mengisi log book dengan benar dan teratur dan bersedia mengikuti penelitian secara sukarela serta menandatangani lembar persetujuan. Semua subjek penelitian (n=72) yaitu 35 orang dari kelompok PEP dan 37 orang dari kelompok PLB dilakukan penilaian MEP dan APB pada awal minggu pertama serta penentuan intensitas latihan yaitu 50% 1 RM pada kelompok PEP. Latihan dilanjutkan sebagai home program selama 4 minggu dengan kelompok PEP melakukan kunjungan setiap minggu untuk menentukan intensitas latihan yaitu 50% dari 1 RM yang baru sedangkan kelompok latihan PLB melakukan kunjungan pada minggu ketiga untuk evaluasi. Selama penelitian terdapat 6 subjek penelitian yang drop out, 2 dari kelompok PEP dan 4 dari kelompok PLB. Pada awal minggu kelima dilakukan kembali penilaian MEP dan APB pada kedua kelompok didapatkan kenaikan MEP dan APB yang secara klinis dan statistik signifikan ( p < 0,001) dengan kenaikan yang lebih besar pada kelompok PEP dan secara statistik kenaikan pada kelompok PEP jika dibandingkan dengan kenaikan yang terjadi pada kelompok PLB adalah signifikan (p < 0,001). Kesimpulan penelitian ini adalah data profile MEP lansia sedentary adalah rata-rata 48,73 ± 19,14 cmH2O pada kelompok PEP dan 40,61 ± 14,49 cmH2O pada kelompok PLB sedangkan data profile APB pada kelompok PEP rata-rata 268,64 ± 97,28 l/m dan 274,15 ± 79,25 l/m pada kelompok PLB. Latihan pernafasan dengan menggunakan perangkat PEP dapat meningkatkan nilai MEP dan APB pada lansia sedentary dimana didapatkan nilai median ∆ MEP adalah 23 (10 – 38) cmH2O dan nilai median ∆ APB adalah 40 (15 – 135) l/m dan secara statistik bermakna dengan nilai p < 0,001.

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This Thesis was aimed to determine the profile data of MEP and PCF as well as the effect of expiratory muscle strength training with PEP to MEP and PCF in sedentary elderly. The design was randomized control trial with PLB exercise as control. The subjects were eldery, ages more than 60 to 75 years old who were sedentary with MocaINA ≥ 26, no active history of cigarette smoking in the last 5 years, had assistance of care giver, actively speaking in Bahasa Indonesia, had normal or abnormal spirometry value, understood and were able to practice PEP or PLB exercise correctly, filling out log book regularly and correctly and voluntarily willing to join the research and signed signed inform consent form. All subjects (n=72) consisted of 35 subjects in PEP group and 37 subjects in control group (assigned to do PLB exercise). In the beginning of the first week the subject’MEP and PCF values were obtained and the intensity of exercise using PEP was determined at 50% of 1 RM. Exercise was continued as a home program for 4 weeks with the PEP group asked to come weekly to cardiorespiratory outpatient clinic in rehabilitation department to determine a new exercise intensity of 50% of the new 1 RM. While subjects in the PLB group came to cardiorespiratory outpatient clinic at the beginning of the third week to be evaluated. During this research 6 subjects dropped out, 2 subjects from PEP group and 4 subjects from PLB group. At the beginning of fifth week, MEP and PCF values were reassessed and the result demonstrated an increase in both MEP and PCF values (clinically and statistically) in both groups with a greater increase in PEP group. The increase in MEP and PCF values in PEP group was significant in comparison to the PLB group (p < 0,001. The study concluded that average profile data of MEP in sedentary elderly were 48,73 ± 19,14 cmH2O in PEP group and 40,61 ± 14,49 cmH2O in PLB group whereas average profile data of PCF in sedentary elderly were 268,64 ± 97,28 l/m and 274,15 ± 79,25 l/m in PLB group. Expiratory muscle strength training with PEP could increase MEP and PCF values in sedentary elderly with median ∆ MEP was 23 (10 – 38) cmH2O and median ∆ PCF was 40 (15 – 135) l/m and the increase was statistically significant with p < 0,001."

"Tesis ini disusun untuk mengetahui data profile MEP dan APB serta efek latihan penguatan otot ekspirasi dengan perangkat PEP terhadap MEP dan APB pada lansia sedentary. Penelitian menggunakan desain uji acak terkontrol (randomized control trial) dengan latihan PLB sebagai kontrol. Subjek penelitian adalah lansia berusia lebih dari 60 hingga 75 tahun, sedentary, MocaINA ≥ 26, tidak merokok dalam 5 tahun terakhir, memiliki care giver, dapat berbahasa Indonesia, nilai spirometri normal atau abnormal, dapat memahami dan mempraktekkan dengan benar penggunaan alat PEP dan latihan PLB, bersedia mengisi log book dengan benar dan teratur dan bersedia mengikuti penelitian secara sukarela serta menandatangani lembar persetujuan. Semua subjek penelitian (n=72) yaitu 35 orang dari kelompok PEP dan 37 orang dari kelompok PLB dilakukan penilaian MEP dan APB pada awal minggu pertama serta penentuan intensitas latihan yaitu 50% 1 RM pada kelompok PEP. Latihan dilanjutkan sebagai home program selama 4 minggu dengan kelompok PEP melakukan kunjungan setiap minggu untuk menentukan intensitas latihan yaitu 50% dari 1 RM yang baru sedangkan kelompok latihan PLB melakukan kunjungan pada minggu ketiga untuk evaluasi. Selama penelitian terdapat 6 subjek penelitian yang drop out, 2 dari kelompok PEP dan 4 dari kelompok PLB. Pada awal minggu kelima dilakukan kembali penilaian MEP dan APB pada kedua kelompok didapatkan kenaikan MEP dan APB yang secara klinis dan statistik signifikan ( p < 0,001) dengan kenaikan yang lebih besar pada kelompok PEP dan secara statistik kenaikan pada kelompok PEP jika dibandingkan dengan kenaikan yang terjadi pada kelompok PLB adalah signifikan (p < 0,001). Kesimpulan penelitian ini adalah data profile MEP lansia sedentary adalah rata-rata 48,73 ± 19,14 cmH2O pada kelompok PEP dan 40,61 ± 14,49 cmH2O pada kelompok PLB sedangkan data profile APB pada kelompok PEP rata-rata 268,64 ± 97,28 l/m dan 274,15 ± 79,25 l/m pada kelompok PLB. Latihan pernafasan dengan menggunakan perangkat PEP dapat meningkatkan nilai MEP dan APB pada lansia sedentary dimana didapatkan nilai median Δ MEP adalah 23 (10 – 38) cmH2O dan nilai median Δ APB adalah 40 (15 – 135) l/m dan secara statistik bermakna dengan nilai p < 0,001.

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This Thesis was aimed to determine the profile data of MEP and PCF as well as the effect of expiratory muscle strength training with PEP to MEP and PCF in sedentary elderly. The design was randomized control trial with PLB exercise as control. The subjects were eldery, ages more than 60 to 75 years old who were sedentary with MocaINA ≥ 26, no active history of cigarette smoking in the last 5 years, had assistance of care giver, actively speaking in Bahasa Indonesia, had normal or abnormal spirometry value, understood and were able to practice PEP or PLB exercise correctly, filling out log book regularly and correctly and voluntarily willing to join the research and signed signed inform consent form. All subjects (n=72) consisted of 35 subjects in PEP group and 37 subjects in control group (assigned to do PLB exercise). In the beginning of the first week the subject’MEP and PCF values were obtained and the intensity of exercise using PEP was determined at 50% of 1 RM. Exercise was continued as a home program for 4 weeks with the PEP group asked to come weekly to cardiorespiratory outpatient clinic in rehabilitation department to determine a new exercise intensity of 50% of the new 1 RM. While subjects in the PLB group came to cardiorespiratory outpatient clinic at the beginning of the third week to be evaluated. During this research 6 subjects dropped out, 2 subjects from PEP group and 4 subjects from PLB group. At the beginning of fifth week, MEP and PCF values were reassessed and the result demonstrated an increase in both MEP and PCF values (clinically and statistically) in both groups with a greater increase in PEP group. The increase in MEP and PCF values in PEP group was significant in comparison to the PLB group (p < 0,001. The study concluded that average profile data of MEP in sedentary elderly were 48,73 ± 19,14 cmH2O in PEP group and 40,61 ± 14,49 cmH2O in PLB group whereas average profile data of PCF in sedentary elderly were 268,64 ± 97,28 l/m and 274,15 ± 79,25 l/m in PLB group. Expiratory muscle strength training with PEP could increase MEP and PCF values in sedentary elderly with median Δ MEP was 23 (10 – 38) cmH2O and median Δ PCF was 40 (15 – 135) l/m and the increase was statistically significant with p < 0,001."

"Rehabilitasi pasien penyakit paru obstruktif kronik (PPOK) yang stabil bertujuan untuk mengurangi sesak, meningkatkan toleransi latihan, dan meningkatkan status kesehatan. Pada dekade terakhir banyak dikembangkan teknik terapi mandiri salah satunya adalah menggunakan perangkat positive expiratory pressure (PEP). Penelitan ini bertujuan untuk menilai efektivitas latihan pernapasan menggunakan perangkat PEP pada volume ekspirasi paksa detik pertama (VEP1), kapasitas fungsional, dan kualitas hidup pada pasien PPOK. Desain penelitian yang digunakan yaitu studi intervensional prospektif yang membandingkan efek sebelum dan sesudah latihan pernapasan menggunakan PEP selama 8 minggu. Subjek yang menyelesaikan penelitian sebanyak 20 orang. Latihan pernapasan dilakukan dua kali sehari dengan durasi 15 menit pada masing-masing sesi latihan. Tekanan yang digunakan disesuaikan dengan kemampuan pasien yaitu inspirasi berbanding ekspirasi 1:3. Tekanan ditentukan sebelum memulai latihan dan dievaluasi setiap dua minggu. Hasil keluaran yang dinilai adalah nilai VEP1, kapasitas fungsional yang diukur dengan kecepatan berjalan dalam uji jalan 4 meter dan kualitas hidup yang diukur dengan kuesioner St. George s Respiratory Questionnaire (SGRQ). Nilai VEP1 sebelum intervensi adalah 1369,5±569,63 ml dan sesudah sebesar 1390±615,01 ml (p=0.585). Kecepatan berjalan sebelum intervensi 1,43±0.31 m/s dan sesudah 1,56±0,40 m/s (p=0.248). Skor kuesioner SGRQ domain gejala terdapat penurunan dari rerata 44,00±17,88% menjadi 25,31±14,06% (p=0.000), domain aktivitas dari rerata 54,22±28,18% menjadi 40,38±24,25% (p=0.006), domain dampak dari 32,83% (0,00-67,46) menjadi 16,32% (0,00-61,33) (p=0.002), dan skor total dari 39,46% (6,30-75,42) menjadi 25,96% (5,24-61,34) (p=0.001). Peningkatan kecepatan berjalan dan perbaikan skor SGRQ memenuhi nilai minimum clinically important difference (MCID). Latihan pernapasan menggunakan perangkat PEP selama 8 minggu dapat meningkatkan nilai VEP1, kapasitas fungsional dan kualitas hidup pasien PPOK.

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Rehabilitation of stable chronic obstructive pulmonary disease (COPD) aims to reduce dyspnoe, increase exercise tolerance, and improve health status. In the last decade, many independent therapy techniques have been developed, one of them is positive expiratory pressure (PEP). The aim of this study was to assess the effectiveness of breathing exercises using a PEP device on Forced Expiratory Volume in 1 second (FEV1), functional capacity, and quality of life in COPD patients. The study design was a prospective interventional studies that compared the effects before and after breathing exercises using PEP for 8 weeks. Twenty subjects completed the study. Breathing exercises were carried out twice a day, 15 minutes duration at each session. The pressure used is adjusted to the patient's ability, reaching inspiration to expiration ratio of 1:3. Pressure was determined before starting the exercise and evaluated every two weeks. The outcome were FEV1, functional capacity measured by walking speed in the 4 meter gait speed assesment and quality of life as measured by the St. George s Respiratory Questionnaire (SGRQ). FEV1 ​​before intervention were 1369,5±569,63 ml and after 1390±615,01 ml (p=0.585). Walking speed before intervention was 1,43±0,31 m/s and after 1,56±0,40 m/s (p=0,248). The symptom domain SGRQ questionnaire score has a decrease from 44,00±17,88% to 25,31±14,06% (p=0,000), the activity domain from 54,22±28,18% to 40,38±24,25% (p=0.006), the impact domain of 32,83% (0,00-67,46) to 16,32% (0,00-61,33) (p=0,002), and the total score of 39,46% (6,30-75,42) to 25,96% (5,24-61,34) (p=0.001). Increase in walking speed and SGRQ score exceed the minimum clinically important difference (MCID). Breathing exercises using a PEP device for 8 weeks can increase FEV1, functional capacity and quality of life of COPD patients."

"Pendahuluan: Kejadian fraktur menjadi urutan ketiga di dunia dan ekstremitas bawah sebagai angka tertinggi di Indonesia. Open Reduction Internal Fixation (ORIF) merupakan tindakan fraktur ekstremitas bawah yang sering digunakan. Salah satu latihan yang dapat mencegah komplikasi imobilisasi yaitu isometrik quadricep dengan pressure biofeedback. Dalam penelitian ini pressure biofeedback diberikan pada pasien post ORIF ekstremitas bawah hari I sampai III. Tujuan: Tujuan penelitian ini untuk mengidentifikasi efektivitas pressure biofeedback terhadap kekuatan otot quadricep dan nyeri post ORIF ekstremitas bawah.Metode: Penelitian ini merupakan Randomized Controlled Trial dengan pre and posttest pada pengukuran skala nyeri dan posttest only pada skor kekuatan otot quadricep. Teknik pengambilan sampel menggunakan teknik simple random sampling dengan kriteria inklusi diantaranya post ORIF ekstremitas bawah hari pertama sampai ketiga dan berusia 18-64 tahun. Responden dengan multipel fraktur, fraktur bilateral, neglected, riwayat DM, kelainan neuromuskular, cacat fisik dan penurunan kesadaran dieksklusikan. Perhitungan sampel dengan menggunakan standar deviasi dan derajat kemaknaan diperoleh 30 responden di RSD Idaman Banjarbaru dan Ratu Zalecha Martapura yang terbagi menjadi 2 kelompok perlakuan. Double blind diterapkan pada responden dan pengambil data. Instrumen yang digunakan untuk mengukur kecemasan (APAIS), nyeri (VAS), dan kekuatan otot quadricep (MMT).Hasil: Penelitian ini melaporkan bahwa pressure biofeedback secara signifikan meningkatkan kekuatan otot quadricep (p value 0,01; α < 0,05). Namun, berdasarkan hasil uji statistik Paired T-test baik pada responden dengan latihan pressure biofeedback maupun tanpa pressure biofeedback, didapatkan hasil yang signifikan dalam penurunan nyeri (p value 0,00; α < 0,05). Meskipun demikian, dapat dikatakan bahwa pressure biofeedback tidak efektif dalam menurunkan nyeri pasien post ORIF ekstremitas bawah. Begitu pula hasil uji Mann Whitney pada selisih rerata skala nyeri yang menunjukkan bahwa penurunan nyeri yang terjadi tidak dipengaruhi oleh pressure biofeedback.Kesimpulan: Penelitian ini menunjukkan bahwa latihan isometrik kombinasi pressure biofeedback secara signifikan dapat meningkatkan skor kekuatan otot quadricep pada pasien post ORIF ekstrimtas bawah.

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Introduction: The incidence of fractures is third in the world and lower extremities are the highest in Indonesia. Open Reduction Internal Fixation (ORIF) is a frequently used procedure for lower extremity fractures. One exercise that can prevent immobilization complications is quadriceps isometrics with pressure biofeedback. In this study, pressure biofeedback was given to post ORIF lower extremity patients on days I to III.

Objective: The aim of this study was to identify the effectiveness of pressure biofeedback on quadricep muscle strength and post-ORIF lower extremity pain. Methods: This study was a Randomized Controlled Trial with pre and posttest on pain scale measurements and posttest only on quadricep muscle strength scores. The sampling technique used simple random sampling technique with inclusion criteria including post ORIF lower extremities first to third day and aged 18-64 years. Respondents with multiple fractures, bilateral fractures, neglected, history of DM, neuromuscular disorders, physical disabilities and decreased consciousness were excluded. Sample calculations using standard deviation and degree of significance obtained 30 respondents at RSD Idaman Banjarbaru and Ratu Zalecha Martapura who were divided into 2 treatment groups. Double blind is applied to respondents and data takers. Instruments used to measure anxiety (APAIS), pain (VAS), and quadricep muscle strength (MMT).

Results: This study reported that pressure biofeedback significantly increased quadricep muscle strength (p value 0.01; α < 0.05). However, based on the results of the Paired T-test statistical test for both respondents with pressure biofeedback training and without pressure biofeedback training, significant results were obtained in reducing pain (p value 0.00; α < 0.05). However, it can be said that pressure biofeedback is not effective in reducing pain in post-ORIF lower extremity patients. Likewise, the results of the Mann Whitney test on the mean difference on the pain scale showed that the reduction in pain that occurred was not influenced by pressure biofeedback.

Conclusion: This study shows that isometric training combined with pressure biofeedback can significantly increase quadricep muscle strength scores in lower extremity post ORIF patients."

"Tesis ini disusun untuk mengetahui korelasi antara derajat kebiasaan merokok dengan Arus Puncak Batuk, Arus Puncak Ekpirasi dan kekuatan otot kuadriceps pada laki-laki dewasa muda perokok aktif. Penelitian menggunakan desain uji potong lintang (crosssectional). Subjek penelitian merupakan pasien laki-laki keturunan asli Indonesia, perokok tembakau aktif minimal 6 bulan, usia 18-40 tahun, tidak obesitas dan memiliki kekuatan otot ekstremitas bawah dengan penilaian MRC 5 tanpa ada riwayat kelemahan sebelumnya. Semua subjek (n=41) dilakukan penilaian derajat kebiasaan merokok berdasarkan Indeks Brinkman, pengukuran Arus Puncak Batuk (APB) dan Arus Puncak Ekspirasi (APE) dengan Peak Flow Meter serta pengukuran kekuatan otot kuadriceps dengan Hand-held dynamometer sesuai dengan prosedur di Poliklinik Departemen Rehabilitasi Medik RSCM Jakarta. Selain itu, dilakukan pengukuran fungsi respirasi menggunakan Spirometri. Hasil keluaran penelitian ini berupa derajat kebiasaan merokok subjek, yaitu 27 perokok ringan dan 14 perokok sedang, serta didapatkan nilai APE, APB, dan kekuatan otot kuadriceps. Selain itu berdasarkan hasil spirometri didapatkan 3 subjek dengan gangguan obstruksi, 1 subjek gangguan restriktif dan sisanya dalam batas normal. Pada karakteristik pekerjaan, didapatkan terbanyak pada kategori manual (58,5%), diikuti non-manual (24,4%) dan bidang jasa (17,1%). Analisa statistik uji korelasi Spearman dilakukan untuk menilai korelasi antara derajat kebiasaan merokok dengan nilai APB, APE dan kekuatan otot kuadriceps. Kesimpulan penelitian menyatakan bahwa terdapat korelasi bermakna secara statistik antara Indeks Brinkman dengan nilai APE, tapi tidak demikian pada nilai APB dan kekuatan otot kuadriceps. Rerata nilai APE pada subjek dewasa muda perokok ringan dan perokok sedang sebesar 429,76±76,89 L/menit dengan nilai p = 0,026. Sedangkan rerata nilai APB dan kekuatan kuadriceps masing-masing sebesar 445,61±73,38 L/menit dan 19,36±4,28 kg pada kaki kanan, serta 18,92±4,03 kg pada kaki kiri, tanpa ada korelasi yang signifikan. Penelitian lebih lanjut mencakup subjek perokok berat dan faktor level aktivitas fisik serta marker biomolekuler diperlukan untuk menilai dampak merokok terhadap fungsi respirasi dan kekuatan otot.

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This thesis was aimed to determine correlation between the degree of cigarrette smokers to peak cough flow, peak expiratory flow and quadriceps muscle strength in young adults male active smokers. The design was cross-sectional. The subjects were Indonesian male, actively cigarette smoking for at least 6 months, aged 18-40 years, not obesity and had lower limb muscle strength with MRC value 5 and no history of weakness. All subjects (n=41) were assessed the degree of smoking habits based on the Brinkman Index, measurements of Peak Cough Flow and Peak Expiratory Flow with Peak Flow Meters and measurements of quadriceps muscle strength with a Hand-held dynamometer according to procedures at Polyclinic of the Medical Rehabilitation Department at the RSCM Hospital Jakarta. In addition, the respiratory function measurements were taken using Spirometry. The study results include the degree of smoking habits, 27 subject mild smokers and 14 subject moderate smokers, the value of peak cough flow, peak expiratory flow, and quadriceps muscle strength on both legs. Based on spirometry examination, there are 3 subjects with obstructive, 1 subject restrictive and the others within normal limits. Based on working type, the highest on manual category (58,5%), followed by nonmanual (24,4%) and services (17,1%). Statistical analysis was performed to assess the correlation between Brinkman Index with the three variables. The study concludes that the higher Brinkman Index value, the lower peak expiratory flow value, but not on the peak cough flow and quadriceps muscle strength results. The average peak expiratory flow value in young adult subjects with mild and moderate smokers was 429.76 ± 76.89 L/min with significant difference was obtained with p value = 0.026. While the average peak cough flow and quadriceps muscle strength were 445.61 ± 73.38 L / min and 19.36 ± 4.28 kg in the right leg, and 18.92 ± 4.03 kg in the left leg, with no significant correlation. Further research including heavy smoker subjects, evaluation of physical activity level and biomolecular markers is needed to assess the impact of smoking on respiration function and muscle strength"

"ABSTRAKLatar Belakang. Atelektasis merupakan komplikasi pernapasan perioperatif yang sering terjadi hingga 24 jam pascaoperatif, namun dapat bertahan hingga beberapa hari. Penggunaan PEEP dapat membuka alveolus yang kolaps pascaoperatif. Penelitian ini berusaha membandingkan efek PEEP 5 cmH20 dan 10 cmH2O terhadap distribusi ventilasi pada pasien pascaoperatif menggunakan EIT.Metoda. Uji klinis acak ini dilakukan di RS Cipto Mangunkusumo terhadap 35 pasien operasi kranioktomi dan laparotomi elektif (usia 18-60 tahun, durasi bedah > 3 jam, paru normal). Subjek dirandomisasi ke dalam 2 kelompok intervensi: ventilasi mekanik pascaoperatif PEEP 5 cmH20 (PEEP-5) dan PEEP 10 cmH2O (PEEP-10). Hipotesis penelitian adalah distribusi ventilasi PEEP-10 lebih baik dibandingkan PEEP-5. Parameter ∆TIV, ∆EELI (global dan regional) dan CR diambil dari monitor EIT PulmoVista 500®.Hasil. Nilai ∆TIV antara bagian paru anterior dan posterior berbeda bermakna secara statistik pada menit ke-20 (p=0,012), namun masih ada subjek kelompok PEEP-5 dengan distribusi ventilasi tidak homogen hingga 1 jam pengukuran. Nilai ∆EELI global dan regional dalam 1 jam secara statistik bermakna dengan nilai p<0,05. Nilai ∆CR (anterior dan posterior) bermakna secara statistik (p=0,000) dalam 1 jam. Tidak ditemukan perbedaan ratio PF, lama intubasi dan lama rawat di UPI. Tidak ditemukan komplikasi paru/ekstraparu lain dan mortalitas.Simpulan. Distribusi ventilasi berdasarkan gambaran EIT antara penggunaan PEEP 10 cmH2O dan PEEP 5 cmH2O tidak berbeda secara statistik dalam 1 jam penggunaan ventilasi mekanik pascaoperatif. Distribusi ventilasi hanya bermakna secara statistik pada menit ke-20. pernapasan perioperatif

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ABSTRACTBackground. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute.;Background. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute.;Background. Atelectasis is the most common perioperative respiratory complications up to 24 hours postoperatively, but can last up to several days. PEEP can open postoperative alveolar collapse. We determined to compare the effect of PEEP 5 cmH20 and 10 cmH2O on distribution of ventilation in patients postoperatively using EIT.Method. This randomized clinical trial conducted in Cipto Mangunkusumo Hospital to 35 patients underwent elective craniotomy and laparotomy (18-60 years of age, surgery> 3 hours, normal lung). Subjects were randomized into two intervention groups: postoperative mechanical ventilation PEEP 5 cmH20 (PEEP-5) and 10 cmH2O PEEP (PEEP-10). The hypothesis is distribution of ventilation PEEP-10 is better than PEEP-5. Parameter ΔTIV, ΔEELI (global and regional) and ΔCR were taken from a monitor EIT PulmoVista 500®.Results. ΔTIV values ​​between anterior and posterior parts of lung statistically significant difference in the 20th minute (p=0.012), but there is still a subject of the PEEP group-5 which has a non-homogeneous distribution of ventilation up to 1 hour of measurement. The value of ΔEELI (global and regional ) in 1 hour statistically significant with p <0.05. ΔCR value (anterior and posterior) was statistically significant (p = 0.000) in 1 hour. No differences found for PF ratio, length of intubation and duration of hospitalization in ICU. No pulmonary/extrapulmonaary complications and mortality were found.Conclusion. Distribution of ventilation based EIT imaging between the use of PEEP 10 cmH2O and PEEP 5 cmH2O do not differ statistically within 1st hour of the postoperative mechanical ventilation. Distribution of ventilation is statistically significant only in the 20th minute."

"Cedera medula spinalis (CMS) adalah kondisi cedera pada medula spinalis yang ditandai dengan gangguan pada komponen motorik, sensorik, serta otonom. Severitas gangguan yang terjadi sesuai dengan klasifikasi ASIA Impairment Scale (AIS) dan level neurologis. Salah satu gangguan yang biasa ditemui adalah kelemahan otot pernapasan. Kekuatan otot inspirasi digambarkan dengan nilai Maximal Inspiratory Pressure (MIP), diukur dengan manometer otot pernapasan (MicroRPM®), dan  ditingkatkan dengan latihan kekuatan otot inspirasi. Tesis ini disusun untuk mengetahui rerata MIP sebelum dan setelah latihan otot inspirasi menggunakan Threshold Inspiratory Muscle Trainer (threshold IMT®) pada pasien CMS fase kronis. Desain menggunakan studi intervensi one group pre and post-test. Sebelas orang penderita CMS AIS A-D dan level neurologis C5-T6 diberikan latihan otot inspirasi dengan beban sebesar 30% MIP yang disesuaikan berdasarkan pengukuran MIP setiap minggu. Latihan dengan durasi 30 menit/hari dan frekuensi 5 hari/minggu selama 6 minggu. Uji Wilcoxon digunakan untuk membandingkan data MIP sebelum dan setelah latihan selama 6 minggu. Nilai tengah MIP sebelum dan setelah latihan didapatkan sebesar 38 (30-85) cmH₂O dan 85 (56-126) cmH₂O dengan nilai p<0,05. Simpulan: terjadi peningkatan kekuatan otot inspirasi setelah latihan menggunakan threshold IMT pada pasien CMS fase kronis.

 

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Spinal cord injury (SCI) is injury of the spinal cord characterized by disorders of the motor, sensory, and autonomic components. The severity depends on the ASIA Impairment Scale (AIS) classification and neurological level. The common problems is respiratory muscle weakness so sufferers tend to experience respiratory complications. Inspiratory muscle strength is illustrated by Maximal Inspiratory Pressure (MIP) value, measured using respiratory muscle manometer (MicroRPM®), and enhanced by inspiratory muscle strength training. This thesis is structured to determine the average MIP before and after inspiratory muscle training using Threshold Inspiratory Muscle Trainer (threshold IMT®) in chronic phase SCI patients. The study design used one group pre and post-test intervention study. Eleven people with SCI AIS A-D and neurological level C5-T6 were given inspiratory muscle training with load 30% MIP adjusted according to weekly MIP measurements. The duration is 30 minutes / day and  frequency is 5 days / week for 6 weeks. The Wilcoxon test was used to compare MIP data before and after exercise for 6 weeks. The median MIP before and after exercise was 38 (30-85) cmH₂O and 85 (56-126) cmH₂O with p <0.05. Conclusion: increase in inspiratory muscle strength after exercise using threshold IMT in chronic phase SCI.

 

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"Latihan kekuatan otot non mesin merupakan latihan yang dapat meningkatkan kemampuan fungsional dalam hal ini otot tungkai. Tujuan: Penelitian ini bertujuan mengetahui efek latihan kekuatan otot non mesin selama 10 minggu terhadap kekuatan otot tungkai, daya tahan otot tungkai, kecepatan berjalan dan keseimbangan berjalan sebagai variabel kemampuan fungsional otot. Penelitian ini juga untuk mengetahui apakah latihan kekuatan otot jenis kombinasi weight bearing dan elastic resistance memberikan peningkatan yang lebih besar dibandingkan dengan latihan jenis weight bearing yang dilanjutkan dengan elastic resistance. Metode: Subyek terdiri dari 36 orang karyawan pra usia lanjut (45-56 tahun) sehat tidak terlatih yang dibagi menjadi 2 kelompok. Kelompok A melakukan latihan jenis kombinasi weight bearing dan elastic resistance sedangkan kelompok B melakukan latihan jenis weight bearing saja dan kemudian dilanjutkan dengan latihan elastic resistance saja. Kedua kelompok tersebut melakukan latihan dengan frekuensi 2-3 xlminggu selama 1 jam dengan intensitas 1-3 setlgerakan dan tiap set terdiri dari 8-12 ulangan/repetisi. Hasil: Hasil menunjukan kedua jenis latihan memberikan peningkatan terhadap kemampuan fungsional otot tungkai (Uji Anova p=0,00), namun jenis kombinasi weight bearing dan elastic resistance memberikan peningkatan yang lebih besar (Uji t p=0,01-0,04). Latihan kekuatan otot tungkai jenis kombinasi weight bearing dan elastic resistance memberikan peningkatan kekuatan otot (59,93%), daya tahan otot (58,42%), kecepatan berjalan (36,88%) dan keseimbangan berjalan (47,12%) sedangkan jenis weight bearing dilanjutkan elastic resistance memberikan peningkatan kekuatan otot (39,66%), daya tahan otot (31,69%), kecepatan bedalan (23,33%) dan keseimbangan berjalan (25,90%). Seluruh variabel kemampuan fungsional tersebut mempunyai korelasi yang kuat satu dengan lainnya (Uji korelasi Pearson p=0,000-0,001). Selain itu melalui kuesioner didapatkan bahwa subyek merasa nyaman dengan latihan jenis kombinasi dan menambah minat mereka terhadap latihan jasmani. Kesimpulan: Dari hasil penelitian dapat disimpulkan bahwa latihan kekuatan otot jenis kombinasi weight bearing dan elastic resistance memberikan peningkatan yang lebih besar terhadap variabel kemampuan fungsional otot pada kelompok karyawan pra usila sehat tidak terlatih.

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Non machine muscle strength exercises can be used to increase functional ability, especially the lower limb muscle. Purpose: The purpose of this research was to evaluate the effects of 10 weeks of non machine muscle strength exercises on muscle functional ability. The variables for functional ability will be muscle strength, muscle endurance, speed of walk and balance of walk. And to determine if simultaneously combined weight bearing and elastic resistance exercises will be better than weight bearing followed by elastic resistance exercises on increasing muscle strength. Methods: The subjects were 36 healthy untrained employees aged between 45-56 years. They were divided randomly into 2 groups, groups A and B. Group A was trained with a simultaneous combination of weight bearing and elastic resistance exercises while group B was first trained with weight bearing exercises and then with elastic resistance exercises. Both groups exercised 2-3 times a week for 1 hour with an intensity of 1-3 sets/motion and 8-12 repetitions/set. Results: Results showed both types of exercises increased muscle functional ability (ANOVA test p-0.00), but the simultaneous combination of weight bearing and elastic resistance exercises was better (t test p=O.01-0.04). The simultaneous combination of weight bearing and elastic resistance exercises increased muscle strength (59.93%), muscle endurance (58.42%), speed of walk (36.88%), and balance of walk (47.12%), while the succeeding weight bearing and elastic resistance exercises increased muscle strength (39.66%), muscle endurance (31.69%), speed of walk (23.33%), and balance of walk (25.90%). All muscle functional ability variables were strongly correlated to one other (Pearson correlation test p=0.000-0.001). From the questionnaires given, it was found that the subjects enjoyed the simultaneous combination exercises which increased their motive for physical exercise. Conclusion: It was concluded that muscle strength exercises which simultaneously combined weight bearing with elastic resistance exercises were better in increasing muscle functional ability in healthy untrained young older employees."

"Stimulus sensorik merupakan salah satu dari intervensi keperawatan komplementer yang membantu mengatasi masalah gangguan kelemahan (hemiparesis). Hipnoterapi merupakan terapi potensial yang menggunakan sugesti positif sebagai input sensoris dalam merangsang pusat somatosensoris untuk perencanaan dan pemrograman gerakan. Penelitian ini bertujuan untuk mengindentifikasi pengaruh hipnoterapi terhadap peningkatan kekuatan otot dan rentang pergerakan sendi pada ekstermitas. Desain penelitian kuasi-eksperimen dengan pendekatan nonequivalent control group pre?posttest design dengan purposive sampling sebanyak 44 responden. Kelompok kontrol diberikan perlakuan latihan range of motion (ROM) sedangkan kelompok intervensi diberikan latihan ROM dan hipnoterapi. Terdapat peningkatan kekuatan otot dan rentang pergerakan sendi pada kelompok kontrol dan kelompok intervensi sesudah 10 kali intervensi. Namun analisa lebih lanjut juga terdapat perbedaan yang signifikan diantara kelompok intervensi dan kelompok kontrol (p value < 0,05). Diperlukan penelitian lanjutan dengan homogenitas sampel yang lebih baik dan situasi yang lebih terkontrol.

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Sensory stimulus exercise is one of activity in the complementary nursing interventions to overcome weakness (hemiparesis). Hypnotherapy is a potential therapy utilizes art of persuasive communication as the sensory input to provoke the somatosensory center in planning and programming movement.

This study aimed to identify the effect of hypnotherapy to increase muscle strength and range of motion the joints extremity. Quasi-experimental designs with purposive sampling 44 samples. Control group were given range of motion (ROM) exercise and experiment group were given ROM exercise and hypnotherapy.

There were significant effect in both experiment and control group to increase muscle strength and range of motion. Further analysis also getting significant differences between control and experiment group (p value < 0,05). Require further research with better homogeneity sample and more controlled situation."

"Latar belakang: Insidensi penyakit kardiovaskular meningkat signifikan diseluruh dunia dan menjadi penyebab utama kematian. Penyakit kardiovaskular pada tenaga kesehatan dapat meningkatkan angka ketidakhadiran kerja dan menjadi masalah bagi sistem layanan kesehatan. Karantina pada Pandemi COVID-19 secara umum dapat mengurangi aktivitas fisik dan latihan fisik harian, sehingga mengganggu kebugaran fisik dan kesehatan jantung. Perlunya pengembangan latihan fisik untuk mencegah risiko penyakit kardiovaskular pada nakes, salah satunya Senam Jantung Sehat dan latihan kekuatan otot. Tujuan: Mengetahui risiko penyakit kardiovaskular dan pengaruh intervensi latihan secara virtual terhadap faktor risiko penyakit kardiovaskular serta komponen kebugaran terkait kesehatan pada tenaga kesehatan. Metode: Studi intervensi dengan membandingkan 2 kelompok (uji dan kontrol). Randomized. Tiga puluh empat subjek tenaga kesehatan kedalam kelompok intervensi (Senam Jantung Sehat dan latihan kekuatan otot), diberikan secara virtual melalui aplikasi Zoom, Senam Jantung Sehat dilakukan 3x seminggu dan latihan kekuatan otot diberikan 2x seminggu setelah selesai Senam Jantung Sehat, dengan jeda 3 hari. Tiga puluh empat subjek tenaga kesehatan dalam kelompok kontrol hanya diberikan edukasi aktivitas fisik. Intervensi diberikan selama 3 bulan, dengan total 36 sesi. Analisa data dilakukan untuk menilai perbedaan rerata dan delta dengan uji T tidak berpasangan dan Mann Whitney. Hasil: Analisa data dilakukan pada 5 subjek sesuai dengan kriteria >60% kehadiran, dimana 29 subjek gagal menghadiri 60% kehadiran karena berbagai alasan. Risiko utama penyakit kardiovaskular adalah Indeks massa tubuh (IMT). Rata rata angka kepatuhan latihan fisik pada kelompok uji adalah 33,1 %. Ditemukan penurunan IMT dan persen lemak tubuh lebih baik pada kelompok uji dibandingkan kelompok kontrol (p=0,025 dan p= 0,031). Penurunan kekuatan otot punggung lebih baik pada kelompok kontrol dibandingkan kelpmpok uji (p=0,007). Penurunan nilai pada tekanan darah sistolik, total kolesterol, low density lipoprotein dan peningkatan kebugaran kardiorespirasi memiliki kecenderungan yang lebih baik meskipun tidak bermakna secara statistik. Kesimpulan: Pemberian intervensi pada kelompok uji secara umum tidak berbeda secara statistik jika dibandingkan dengan kelompok kontrol, namun intervensi pada kelompok uji memiliki kemungkinan dalam mencegah risiko penyakit kardiovaskular.

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Background: The incidence of cardiovascular disease has increased significantly worldwide and is a major cause of death. Cardiovascular disease in health workers can increase absenteeism and become a problem for the health care system. Quarantine in the COVID-19 Pandemic in general can reduce physical activity and daily physical exercise, thereby interfering with physical fitness and heart health. The need for the development of physical exercise to prevent the risk of cardiovascular disease, one of which is Senam Jantung Sehat and muscle strength training. 

Objectives: To determine the risk of cardiovascular disease and the effect of virtual exercise intervention on cardiovascular disease risk factors and health-related fitness components in health workers.

Methods: An intervention study by comparing 2 groups (test and control). Randomized. Thirthy four subjects of health workers into the intervention group (Senam Jantung Sehat and muscle strength training), administered virtually through the Zoom application, Senam Jantung Sehat was performed 3x a week and muscle strength training were given 2x a week after completion of Senam Jantung Sehat, with a 3-day break. Thirty-four subjects of health workers in the control group were only given physical activity education. The intervention was given for 3 months, for a total of 36 sessions. Data analysis was carried out to assess the mean and delta differences with the unpaired T test and Mann Whitney.

Results: Data analysis was carried out on 5 subjects according to the criteria of >60% attendance, where 29 subjects failed to attend 60% attendance for various reasons. The main risk of cardiovascular disease is body mass index (BMI). The average physical exercise adherence rate in the test group was 33.1%. It was found that the decrease in BMI and percent body fat was better in the test group than the control group (p=0.025 and p=0.031). The decrease in back muscle strength was better in the control group than the test group (p=0.007). The decrease in systolic blood pressure, total cholesterol, low density lipoprotein and increased cardiorespiratory fitness tended to be better, although not statistically significant. 

Conclusion: The intervention in the test group in general was not statistically different when compared to the control group, but the intervention in the test group had the possibility of preventing the risk of cardiovascular disease."