EFEK LATIHAN PERMAINAN UNTUK MENINGKATKAN FUNGSI KOGNITIF PADA STROKE KRONIS DENGAN GANGGUAN KOGNITIF RINGAN
Abstract
Abstract
Background : Cognitive impairment is one of long term complication of stroke. Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. We assessed the effect of a 6 weeks intensive cognitive skills training through game on cognitive functions in adults with chronic stroke. Material and Methods: This was an experimental study with pre-test and post-test group design performed at the outpatient clinic in Department of Physical Medicine and Rehabilitation Kandou Hospital Manado. Twenty-two chronic stroke survivors (ie, 6 months since an index stroke) were participated in this study. Participants received a 6-weeks intensive cognitive skills training with sudoku game and memory card game where the training was held 3 times per week with total 18 meetings. The primary outcome measure was the MoCA-Ina score, angka span forwards test a cognitive test of memory, stroop test a cognitive test of selective attention , trail making test A and B a test for executive function. Results: Compared MoCA-Ina score before and after intervention were significantly improved (p<0,001) so does the angka span forwards test for memory, the stroop test for selective attention , trail making test A and B for executive function were significantly improved at the end of the 6-weeks intervention period (p<0,001). Conclusions: Cognitive skills training through game can significantly benefit cognitive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired, a population at high-risk for dementia. Thus, clinicians should consider prescribing cognitive training through game in the cognitive rehabilitation of chronic stroke survivors.
Key Words: Chronic stroke, Cognitive functions, Game, MCI.
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Abstrak
Latar Belakang : Gangguan kognitif merupakan salah satu komplikasi jangka panjang dari stroke. Penderita stroke yang mampu bertahan hidup merupakan populasi target yang membutuhkan strategi intervensi untuk meningkatkan fungsi kognitif dan mencegah demensia. Kami menilai efek dari pelatihan keterampilan kognitif intensif selama 6 minggu melalui permainan terhadap fungsi kognitif pada orang dewasa dengan stroke kronik. Bahan dan Metode : Penelitian ini merupakan penelitian eksperimental dengan rancangan pre-test dan post-test group design yang dilakukan di Instalasi Rawat Jalan Departemen Rehabilitasi Medik Rumah Sakit Kandou Manado. Dua puluh dua penderita stroke kronik (yaitu, 6 bulan sejak stroke indeks) berpartisipasi dalam penelitian ini. Peserta mendapatkan pelatihan keterampilan kognitif intensif selama 6 minggu dengan permainan sudoku dan permainan kartu memori dimana pelatihan tersebut dilaksanakan sebanyak 3 kali dalam seminggu dengan total 18 kali pertemuan. Hasil pengukuran yang utama adalah skor MoCA-Ina, tes rentang angka maju untuk mengevaluasi kognitif memori, tes stroop untuk mengevaluasi kognitif perhatian selektif, trail making test A dan B untuk mengevaluasi fungsi eksekutif. Hasil : Dibandingkan skor MoCA-Ina sebelum dan sesudah intervensi meningkat secara signifikan (p <0,001) begitu juga dengan tes rentang angka maju untuk memori, tes stroop untuk perhatian selektif, trail making test A dan B untuk fungsi eksekutif meningkat secara signifikan pada akhir periode intervensi 6 minggu (p <0,001). Kesimpulan : Pelatihan keterampilan kognitif melalui permainan dapat secara signifikan memberi manfaat pada fungsi kognitif pada penderita stroke kronik yang tinggal di komunitas yang memiliki gangguan kognitif ringan yang merupakan populasi yang berisiko tinggi untuk demensia. Dengan demikian, klinisi harus mempertimbangkan untuk meresepkan pelatihan kognitif melalui permainan dalam rehabilitasi kognitif penderita stroke kronik.
Kata Kunci : Fungsi Kognitif , Gangguan Kognitif Ringan , Permainan, Stroke Kronik.References
De Freitas GR, Bezerra DC, Maulaz AB, et al. Stroke: background, epidemiology, etiology and avoiding recurrence. In: Barnes M, Dobkin B and Bogousslavsky J. (ed.) Recovery after Stroke. Cambridge, Cambridge University Press, 2005:1-46.
Walsh ME, Galvin R, Loughnane C, et al. Community re-integration and long-term need in the first five years after stroke: results from a national survey. Disabil Rehabil 2015;37:1834-8.
Milinaviciene E, Rastenyte D, Krisciunas A. Effective¬ness of the second-stage rehabilitation in stroke pa¬tients with cognitive impairment. Medicina (Kaunas). 2011;47:486-93.
Cioncoloni D, Piu P, Tassi R, Acampa M, Guideri F, Taddei S, et al. Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke. NeuroRehabilitation. 2012;30:315-22.
Douiri A, Rudd AG, Wolfe CD. Prevalence of poststroke cognitive impairment: South London Stroke Register 1995–2010. Stroke. 2013;44:138–45.
Tham W, Auchus AP, Thong M, Goh ML, Chang HM, Wong MC, et al. Progression of cognitive impairment after stroke: one year results from a longitudinal study of Singaporean stroke patients. J Neurol Sci. 2002;203–204:49–52.
Nys GM, van Zandvoort MJ, de Kort PL, et al. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cere¬brovasc Dis. 2007;23:408-16.
Rasquin SM, Lodder J, Ponds RW, et al. Cognitive functioning after stroke: a one-year follow-up study. Dement Geriatr Cogn Disord. 2004;18:138-44.
Sachdev PS, Brodaty H, Valenzuela MJ, et al. Progression of cognitive impairment in stroke patients. Neurology. 2004;63:1618-23.
Galski T, Bruno RL, Zorowitz R, Walker J. Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients: the dominant role of higher-order cognition. Stroke. 1993;24:1794- 800.
Larson EB, Kirschner K, Bode RK, et al. Brief cognitive assessment and prediction of functional outcome in stroke. Top Stroke Rehabil. 2003;9:10-21.
Ballard C, Rowan E, Stephens S, Kalaria R, Kenny RA. Prospective follow-up study between 3 and 15 months after stroke: improvements and decline in cognitive function among dementia-free stroke survivors >75 years of age. Stroke 2003; 34: 2440–2444.
Popovi_c IM, Seri_c V, Demarin V. Mild cognitive impairment in symptomatic and asymptomatic cerebrovascular disease. J Neurol Sci 2007; 257: 185–193.
Gottesman RF, Hillis AE. Predictors and assessment of cognitive dysfunction resulting from ischaemic stroke. Lancet Neurol 2010; 9: 895–905.
Ozdemir F, Birtane M, Tabatabaei R, et al. Cognitive evaluation and functional outcome after stroke. Am J Phys Med Rehabil 2001;80:410-5.
Tombaugh TN, MCIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992;40:922-35.
Dong Y, Sharma VK, Chan BP, et al. The Montreal Cognitive As¬sessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci 2010;299:15-8.
Rui N, Yasuyuki T, Hikaru T, et al. Brain Training Games Improves Executive Functions and Processing Speed In Elderly : A Randomized Control Trial. PLoS ONE 2012;7:1-9.
Miura N, Iwata K, Watanabe J, et al. Cortical activation during reading aloud of long sentences: fMRI study. Neuroreport. 2003;14:1563–1566.
Kawashima R, Taira M, Okita K, et al. A functional MRI study of simple arithmetic—a comparison between children and adults. Cognitive Brain Research. 2004;18: 227–233.
Ambrose Teresa Liu, Eng J Janice. Exercise Training and Recreational Activities to Promote Executive Functions in Chronic Stroke : A Proof-of-Concept Study. Journal of Stroke and Cerebrovascular Diseases. 2015; 24:130-137.
Kusuma Y, Venketasubramanian N, Kiemas L, et al. Burden of stroke in Indonesia. Int J Stroke. 2009;4(5):379-80.
Handayani F. Angka Kejadian Serangan Stroke Pada Wanita Lebih Rendah Daripada Laki-Laki. Jurnal Keperawatan Medikal Bedah. 2013;1(1):75-9.
Bushnell DC. Stroke and the Female Brain. Nat Clin Pract Neurol. 2008;4(1):22-33.
