The Effect Of Combination Spherical Grip And Kinesio Taping Exercise To Enhance Of Muscle Strength In Ischemic Stroke Patients In Jemursari Islamic Hospital Surabaya

Ischemic stroke patients are the main problem that occurs when disruption of cerebral blood fl ow. Data Global Burden Disease shows that all populations obtained 80% ischemic stroke and 20% hemorrhagic stroke with physical mobility barriers namely muscle weakness obtained 58%. Nursing actions that can be done, one of which is by giving activity to stroke patients who are useful to increase cerebral blood fl ow. This study aiming to analyze the effect of combination of spherical grip exerciseand Kinesio taping to the muscle strength of ischemic stroke patients inJemursari Islamic Hospital Surabaya. 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

This design of the study is Quasi Experiment with approach pre post test control group design.All populations are ischemic stroke patients in the azzahra room 1 as many as 41 people, a sample of 38 respondents divided into 19 treatment and control groups.In the intervention group was given a combination of Spherical Grip and Kinesio taping Exercise for 20 minutes twice a day for 3 weeks.Whereas in the control group was given training accordance with Hospital procedures.Statistical analysis usedWilcoxon signed rank test andMann-Whitneyα test< 0,05.The results of this research show that the mean increase in muscle constriction in the intervention group 2.83, and a big control group is 1.10.Analysis withMann Whitneyshowedp= 0.000.So that H0rejected this means that there is an effect of a combination of Spherical Grip and Kinesio taping exercises on increasing muscle strength in ischemic stroke patients in Jemursari Islamic hospitals.The combination of Spherical Grip and Kinesio taping routinely performed can increase muscle strength, resulting in increased muscle strength in ischemic stroke patients.Nurses need to apply Spherical Grips and Kinesio taping to ischemic stroke patients in the rehabilitation phase.

INTRODUCTION
Stroke is an occurrence of problems that occurred in society in this era, stroke is becoming an increasingly serious problem to be addressed in the whole world.This is because the incidence of a very sudden stroke can lead to a death in a person, physical and mental disability both in the productive age and the elderly (1).Ischemic stroke is caused by thrombus or embolism in blood fl ow to the brain and whereas hemorrhagic stroke is caused by bleeding in the brain tissue or in the subarachnoid space (2).Stroke is also a defi cit (disturbance) function of the nervous system that occurred suddenly, caused by circulatory disorders in the brain (3).
The problem caused by stroke for human life is very complex.Disorders of vital brain functions such as coordination disorders, balance disorders, posture control disorders, sensation disturbances, and motion reflex disorders will reduce the ability of individual functional activities every day.Stroke patients will experience paralysis for a while so that there is muscle weakness in the patient because this will give a disruption to the head nerves which will make the vein to drain blood to all parts of the muscle not well fl owed (4).
Muscle strength is the ability of the muscle to withstand the burden of both external and internal loads.Muscle strength is closely related to the neuromuscular system, namely how much the ability of the nervous system to activate the muscles to contract so that the more muscle fi bers are activated, the greater the strength produced by these muscles, so that ischemic stroke patients use a combination of spherical grip and kinesio taping is not done yet to help increase muscle strength (4).In ischemic stroke patients 90% of infarcts often occur in the area of 4-6 brodman which is the motor center which will cause no impulses to be sent to the fi ngers and no movement so that the muscle strength of the fi ngers will decrease.

A c c o r d i n g t o W H O ( W o r l d H e a l t h
As many as 55% of patients who experience an ischemic stroke experience more weakness in the hand, especially in the fi ngers (8).
Stroke patients with muscle weakness will experience limited mobilization.Patients who got limitations in mobilization will experience limitations of a few or all to perform a range of motion independently.Physical and mental weakness will prevent someone from doing their daily activities.In general, there are two types of disability: primary disability and secondary disability, primary disability caused by illness or trauma (eg paralysis of disorders or injury to the spinal cord) while primary disability (eg muscle weakness and bed rest) (9).Muscle weakness is a clue to the disruption of the motor system at a point or several places from the control circuit from the motor neuron cell to the muscle fi bers nerve directly through the limbic system, in which the existing excitatory processing causes a very rapid response in the nerve to act on the stimulus (13).
Kinesio taping is an application that is able to increase the sensomotor ability of stroke patients.Kinesio taping can increase propieptive feedback so as to produce the correct body position, this becomes a very basic thing that is needed when exercising to restore the function of the performed limb.stimulation of the neuromuscular system in activating the performance of nerves and muscles when performing a functional motion.Kinesio taping  Muscle weakness is a clue to the disruption of the motor system at a point or several places from the control circuit from the motor neuron cell to the muscle fi bers (5).
Stroke patients will experience paralysis for a while so that there is muscle weakness in the patient because this will give a disruption to the head nerves which will make the vein to drain blood to all parts of the muscle arenot well fl owed The results of the data analysis showed that p = 0,000, which means that there are signifi cant differences between the mean muscle strength scores before and after being carried out according to Jemursari Islamic hospital standard in the control group.In the intervention group the researchers followed each day of exercise, a combination of spherical grip and kinesio taping exercises which were carried out for 20 minutes every day for 3 weeks, then the study assessed MMT scores (0-5).Whereas in the control group the researchers did not follow the exercises carried out by the patients.The constraints of exercise in the control group included delay for re-control due to constraints in transportation and accompanying families, besides that there were also patients who did not continue the exercises carried out with physiotherapy.
In the control group the increase in muscle strength is more influential because the combination of Spherical grip and Kinesio taping exercises can stimulate motor function through ball grip exercises.(Spherical grip) is a soft sensory modality and pressure on receptors of encapsulated end organ in the upper extremity.Then the response will be conveyed to the sensory cortex in the sensory pathway through the cell body on the C7-T1 nerve directly through the limbic system, in which the existing excitatory processing causes a very rapid response to the nerve to act on the stimulus (13).Where as Kinesio taping through receptors in cutaneus can provide stimulation to the neuromuscular system in activating the performance of nerves and muscles when performing a functional motion.Kinosio taping will also facilitate mechanoreceptors to direct suitable movements and provide comfort in the paired area (12).
Muscle strength is the ability of the muscle to withstand the burden of both external and internal loads.Muscle strength is closely related to the neuromuscular system, namely how much the ability of the nervous system to activate the muscles to contract so that the more muscle fi bers are activated, the greater the strength produced by these muscles, so that ischemic stroke patients use a combination of spherical grip and kinesio taping is neverdone to help increase muscle strength (4).

Wilcoxon and Mann Whitney test results
The effect of a combination of Spherical grip and In stroke patients in decreasing functional activity experiencing caused by a lack of blood flow to the brain causing death of tissue in the brain and tissues that are damaged will experience a decrease in work in accordance with their respective functions, especially in the tissues that regulate the motor area.Functional ability occurs due to the improvement of lesions that continue on the vascularization system.Furthermore, there is an improvement in the function of actional / sinasi activation that is not effective through Neural plasticity, namely the ability of the brain to modify and organize functions that have been damaged through sprouting, namely the part that has not been damaged will go to the part that experienced lesions, usmaking that is in normal circumstances not all synapses are active , because of the lesion in the main pathway the inactive part will replace the position that has the lesion (16).Repeated activities will become controlled and controlled movements so that giving exercise to stroke patients can accelerate the patient's recovery rate.
Exercise therapy is a method to overcome the problem of physical mobility after brain damage.Kinesio taping therapy can increase propeptive feedback so as to produce the correct

(
10).This is supported by the research conducted by (11) about effectiveness Range Of Motion active-asistif (Spherical Grip) to increase muscle strength extremelyus done by stroke patientsin Tugurejo Regional General Hospital Semarang The results obtained from the Spherical Stroke ROM with a duration of 5 days and performed twice a day.Research conducted by (12) about kinesio taping aplication and Motor Relearning Program Method (MRP) n improving the road pattern of post-stroke patients showed the results in the group given kinesio taping had an average age of 65.1 years with the number of 6 men and 4 women the duration of exercise 3 times a week with 60 minutes for 4 weeks.This shows that of exercise to presence can increase muscle strength in stroke patients.Nursing action that aimed to be carried out are one of the active motion therapies that can be done by spherical grip.Spherical grip is an exercise to stimulate motion in the hand with the form of grasping function training.This exercise is carried out through three stages, namely opening the hand, closing the fi ngers to grasp the object and to adjust the grip strength.This exercise aims to have the functional hand to hold a round object like a ball on the palm of the hand (4).Helping recovery of the arm or part of the upper extremity requires a technique to stimulate the hand like a Spherical grip exercise which is a functional hand by holding a spherical object like a ball on the patient's palm.Spherical grip is a smooth sensory modality and pressure on the receptors of encapsulated end organs in the upper extremities.The response will be conveyed to the sensory cortex in the sensory pathway through the cell body on the C7-T1

( 4 )
.Muscle weakness is a clue to the disruption of the motor system at a point or several places from the control circuit from the motor neuron cell to the muscle fi bers (10).In addition there are several risk factors that can be prevented in stroke patients to avoid a stroke.Risk factors that can be prevented include spherical grip is an exercise to stimulate motion in the hand with the form of grip function training.This exercise is carried out through three steps, namely opening the hands, closing the fi ngers to grasp the object and to regulate the grip strength.This exercise aims to make the hand function can hold a round object like a ball on the palm of the hand, Kinesio taping can increase propioseptive feedback so as to produce a position the right body, this is a very basic thing that is needed when training to restore the function of the extremities performed (12).
Kinesio taping exercises on increasing muscle strength in ischemic stroke patients In Jemursari Islamic hospital Surabaya.Based on Table 3 the difference in the mean value of the delta muscle strength before and after administration after Spherical grip combination and Kinesio taping exercises in the treatment group was 2.83.The mean delta of muscle strength before and after administration after administering standard hospital exercises in the control group was 1.10.This means that the Wilcoxon Signed ranks test = 0,000 there is a significant difference between the delta difference in muscle strength before and after the combination of Spherical grip and Kinesio taping exercises in the intervention group and control.I n a d d i t i o n t o d e c r e a s i n g m u s c l e strength, stroke patients experience decreased coordination, decreased coordination of motion in stroke patients due to damage to the cerebellum caused by a lack of supply of blood fl ow to the brain (15).The combination of Spherical grip and Kinesio taping exercises used the voluntary movement and works with antagonistic groups in forming a movement.