ROM And CIMT Treatment Effects To Stroke Patients’s Upper Extremity Functional Ability

Stroke is a brain functionality disorder caused by disruption of blood supply into the brain. Stroke is one of the leading causes of weakness or hemiparesis on ekstremities. A stroke patient who encounter hemiparesis may suffer joints contracture which then can become permanently disabled if it is not trained. In hospitals, Range of Motion Exercise is often performed, but the results are less optimal. This research aims to discover the combination effects of Range of Motion Exercise (ROM) and Constraint Induced Movement Therapy (CIMT) to the changes of upper extremity functional ability by using a measuring tool Chedoke Arm and Hand Activity Inventory form (CAHAI) to stroke patients with hemiparesis at Interna 1 of dr. R. Soedarsono Regional Public Hospital, Pasuruan. This research uses Quasi Experimental with non-Equivalent Control Group design. The respondents were chosen by using Consecutive Sampling technique with a total of 34 respondents divided into two groups. 17 respondents as the treatment group were given combination therapy ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Stroke is the second biggest cause of death in the world and is also the top cause of longterm disability that occurs in the age of adulthood (1). Irfan (2010) mentions that the manifestation of the stroke depends on the magnitude of the lesions that may lead to hemiparese, hemiplegia, hemiparestesia, afasia/motor disfasia or sensory, hemianopsia, dysarthria, non-symmetrical face, and agile movement disorders or non-coordinated movements (2). This condition, in addition to the functional limitations and dependence of stroke patients, also has an impact on socioeconomic and may induce the risk of depression among the patients and their families who take care of them (3).
Around the world there are 15 million people suffering from strokes each year, including deaths occurring in 5 million people and 5 million others experiencing permanent disability (4). Basic health Research (Riskesdas) (7). Depkes RI (2014) further identifies that based on some research 65% of stroke patients are experiencing defects (8). Stroke is also the main cause of functional disorders whereby 20% of the patients are in need of advanced care in health institutions after 3 months and 15%-30% of patients with stroke are permanently disabled (3 Stroke is a brain disease occured due to the stopping of blood supply to the brain caused by obstruction (non-hemorrhagic stroke) or bleeding (hemorrhagic stroke) (9). Stroke can result in motor disorders from no oxygen supply to the brain (10). Motor disorders caused by stroke as a result of muscular weakness will inflict paralysis or loss of ability to move the upper or lower limbs or known as hemiparesis (11). Patients with hemiparesis, if not trained, will suffer from joints contracture and in longer term will be permanent disabled. Patients with impaired stroke will be followed by aging process in the brain and nerve tissue that, if not treated early on, will trigger some problems such as motion disorder, balance disorder, etc (12).
The treatment of post-stroke rehabilitation is an absolute necessity for stroke patients to improve their mobility and motor function.
The earlier the rehabilitation is carried out, the greater the expectation mobility and function will increase (13). Rehabilitation is expected to restore the old ability of the body of hemiparesis, Functional improvements can bring neurological improvements (13).
Previous studies mentioned that the modified showed that it was more effective in influencing the motor capability of non-hemorrhagic stroke patients (19).

MATERIALS AND METHODS
Based on its type, this research is categorized as Quasy experimental Research.

The design used was Non Equivalent Control
Group, allowing the researcher to compare intervention results in a similar control. The samples on the treatment group and the control group were not grouped randomly. This method can also be called as Non random control group pre test post test (14).
Respondents were divided into two groups, the control group and the treatment group. Meanwhile, Independent T test was used to test the two samples of data that are not interconnected or in pair with the functional ability of upper extremity between the control group and the treatment group.

RESULTS AND DISCUSSION
The characteristic data of respondents includes: gender, age and the stroke type suffered by the respondents. Table 1 shows that the percentage of males in the treatment group is 47.1%, which is smaller than the control group (58.8%). The percentage of females in the treatment group is 52.9%, which is larger than the control group (41.2%). Table 2 indicates that the average age of the treatment groups is 55 years (middle age).

Age
The range of the age starts from 45 years (middle age) to 75 years (old). Meanwhile, the average age of the control group is 58 years (middle age). The range of the age starts from 47 years (middle) to 67 years (elderly).      Overview of upper extremity function of ROM control group  The differences of upper extremity function

CIMT treatment group by using Paired T-Test
Based on the results of the normality test, the results of the data were normally distributed so that the bivariate analysis in this study used the Paired T test statistical test.

Discussion
The results indicated that there was a noticeable improvement of upper extremity  functional ability of the treatment group after intervention, while in the control group the scores increased but the improvement was not too significant compared to the treatment group because the intervention given to the control group was less routine, less scheduled and was given with less intensity than the intervention given to the treatment group. This Researchers argue that this is because the control group is only given ROM therapy without combined it with CIMT with the intensity and duration in accordance with the hospital program which is carried out once a day.

CONCLUSIONS AND SUGGESTIONS
There is a significant improvement of upper