The Influence and Feasibility of Therapeutic Exercise Videos at Home on the Functional Status of Post-COVID-19 Hospitalization

The COVID-19 pandemic pushed physicians to modify conventional practices to reduce the exposure and risk of infection among patients and health workers. Telemedicine is one of the safest methods, and telerehabilitation could prevent the sequelae of COVID-19. A quasi-experimental study with randomized sampling without masking/blinding was conducted. The study was conducted from August 2021 to March 2022 at Hospital A in Pekanbaru, Hospital B in Jayapura, and Hospital C in Jakarta, Indonesia. A total of 27 patients were recruited and divided into control and intervention groups. The control group was given conventional education on therapeutic exercise at home, while the intervention group was shown educational videos about therapeutic exercise at home. The comparison of all functional outcomes between the two groups after the intervention showed a significant difference. The intervention group improved more than the control group, except for the fatigue severity scale. Most of the responses showed that this video was feasible and useful and did not need to be supervised by health workers. Therapeutic exercise educational videos can be an option to deliver rehabilitation programs for post-COVID-19 hospitalized patients

Prevalens dan Faktor Prediktor dari Kemampuan Berjalan Pasien Palsi Serebral pada Masa Anak di Rumah Sakit Cipto Mangunkusumo dan Yayasan Pembinaan Anak Cacat

Latar belakang. Permasalahan palsi serebral (PS) yang menjadi perhatian bagi orangtua adalah kemampuan berjalan. Tujuan. Mengetahui prevalens kemampuan berjalan pasien PS dan faktor prediktor yang berhubungan terhadap kemampuan berjalan pasien PS pada masa anak. Metode. Dilakukan penelitian terhadap 102 pasien PS berusia 6 tahun ke atas dengan pengisian kuesioner melalui wawancara orang tua dan melihat rekam medis di RSCM dan YPAC. Hasil. Duapuluh tujuh (26,5%) pasien berjalan tanpa alat bantu, 13 (12,7%) pasien berjalan dengan alat bantu, dan 62 (60,8%) pasien tidak berjalan walau dengan alat bantu. Faktor prediktor yang bermakna secara statistik adalah mampu duduk tanpa topangan sebelum usia 2 tahun (p<0,001; OR=6,89; IK 95%=2,42-19,71) dan tipe PS spastik unilateral (OR=7,36; IK 95%=1,86-29,18). Kesimpulan. Prevalens kemampuan berjalan pasien PS di RSCM dan YPAC adalah 26,5% berjalan tanpa alat bantu, 12,7% berjalan dengan alat bantu, dan 60,8% tidak berjalan walaupun dengan alat bantu. Faktor prediktor yang berhubungan dengan kemampuan berjalan pada masa anak adalah mampu duduk tanpa topangan sebelum usia 2 tahun dan tipe spastik unilateral

Feeding difficulties in children with cerebral palsy

Background Children with cerebral palsy (CP) often have feeding difficulties due to their disability. This results in inadequate calorie intake which finally leads to malnutrition. Several studies found that 30-90% of children with CP have feeding difficulties associ- ated with malnutrition. There has been no sufficient published data about this problem in Indonesia. Objective To determine the prevalence of feeding difficulties and malnutrition in children with CP. Methods A cross-sectional study was done from January to September 2005 in the pediatric outpatient clinic of Dr. Cipto Mangunkusumo Hospital (CMH). Children with CP underwent nutritional and feeding difficulties assessment. Nutritional sta- tus was determined by the ratio of body weight to body height standardized to CDC-NCHS 2000 growth curve and were classified based on Waterlow. Calorie intake was evaluated by dietary analysis and defined as adequate if it reached 13.9 kcal/ em BH ± 10%. Feeding difficulties assessment included history taking, physical examination and observation of feeding skill in the outpatient clinic. Results Fifty-five children with CP were included in this study, most of them were spastic type, mainly spastic diplegic and spastic quadriplegic cerebral palsy (SQCP). Malnutrition was found in 76% subjects, most were SQCP. Feeding difficulties were found in 76% subjects, half of them were SQCP, 38% with spastic diplegic. Thirty- eight percents of the parents whose children had feeding difficulties was not aware of these problems in their children. Parallel with data above, 78% subjects received inadequate calorie intake. Conclusions The prevalence of undernourished and severe malnutrition in children with CP is 66% and 11% respectively. Malnutrition in CP patients tends to be related with inad- equate calorie intake due to feeding difficulties that is found in 78% subjects especially those with SQC

COVID-19 pandemic in Indonesia: Situation and challenges of rehabilitation medicine in Indonesia

AbstrakCOVID-19 telah menjadi pandemik di Indonesia sejak ditemukannya kasus pertama pada tanggal 2 Maret 2020 di Depok. Peningkatan kasus perhari semakin tinggi sejak akhir Agustus 2020 yang mencapai lebih dari 2000 kasus per hari. Sistem kesehatan di Indonesia perlu ditingkatkan dalam hal kapasitas, termasuk rehabilitasi medik yang harus dilibatkan dari fase akut hingga jangka panjang dalam penanganan pasien COVID-19. Rehabilitasi medik juga diperlukan untuk pasien lain yang bukan COVID-19. Pentingnya keterlibatan, pelayanan rehabilitasi medik dan implementasinya dimasa pandemic COVID-19 memerlukan strategi tersendiri yang harus dilakukan baik oleh pekerja kesehatannya, rumah sakit dan kebijakan pemerintah. Hal ini diperlukan untuk percepatan peningkatan kesehatan pasien, percepatan pemulangan dan menghindari readmisi pasien, dan juga pengoptimalan program kembali bekerja untuk pasien yang sembuh dari COVID-19.AbstractCOVID-19 has become a pandemic in Indonesia since the first cases have been positively diagnosed on 2 March 2020 in Depok. The cases have been increased gradually since the end of August 2020 that has reached 1000 cases per day. The health system in Indonesia needs to be improved in terms of capacity, including rehabilitation medicine that should be involved in all health phases (from acute to long-term) in managing patients with COVID-19. Rehabilitation is also still needed for other non-COVID-19 patients. The importance of involvement and implementation of rehabilitation services during the COVID-19 pandemic will need special strategies that should be done by rehabilitation professionals, hospitals, and government. These are necessary to accelerate the improvement of patients’ health, discharge, and avoid re-admission, as well as optimize return-to-work for patients who are recovered from COVID-19

Health care service for leprosy patients in Sitanala Tangerang (A proposed approach of comprehensive health care for Leprosy patient)

Based on WHO data, Indonesia has the third largest leprosy burden in the world, afterIndia and Brazil. Although leprosy was declared to be eliminated in severalprovinces, there are still several leprosy settlements spread in Indonesia. Oneof these settlements is Neglasari village in Tangerang City, West Java, whereleprosy patients have been living since 1981. There is a scarcity ofinformation regarding the features of leprosy in Indonesia, especially aboutthe description of the patients’ posttreatment condition in terms of bothclinical sequelae and health services provided. A collaboration betweenmultiple departments of Ophthalmology, Dermatovenereology, and MedicalRehabilitation from the Cipto Mangunkusumo Hospital/Universitas Indonesia,Jakarta, was established in the form of a health service program to determinethe number and features of disabilities of ex-leprosy patients. We providehealth services, including physical examinations, extend free medication andeye glasses, and impart knowledge about the chronic complications to patientsand local cadres. A nonroutine health service program for leprosy patients wasconducted in Neglasari village, which performed four primary activities ofpromotive, preventive, curative, and rehabilitative. The program included atotal of 260 patients, with a mean age of 50.45 ± 10.15 years and most of thembeing males (60.4%). A duration of >5 years of leprosy was found in 47% ofsubjects, and 96% of them have been released from treatment. Disabilitiescomprised 52.5% in the eye, 87.7% in the hand, and 92% in the foot. In total,65% of the patients had an uncorrected visual acuity of normal to mildimpairment, whereas 5.8% were blind. Eye abnormalities included madarosis(43.9%), entropion (41%), cataract (26%), corneal hypoesthesia (20.6%),trichiasis (17.8%), and lagophthalmos (15.1%), and examination of theextremities revealed that 16% of the subjects had an amputated foot. Spectacleswere successfully distributed to 100% of patients who were visually correctable.This proposed model for leprosy health care program involving multidisciplinaryexpertise is effective for screening numerous disabilities in leprosy patientsat one time. This enables caretakers to determine a holistic management that atthe end is intended to improve the quality of life of patients

Factors Affecting Oral Feeding Ability in Indonesian Preterm Infants

Most preterm infants exhibit atypical and immature feeding skills. Even though preterm infants have fulfilled the oral feeding readiness criteria, they still do not have optimal oral feeding ability. This study aimed to determine various factors affecting oral feeding ability in Indonesian preterm infants who have fulfilled oral feeding readiness criteria but still have not been able to feed orally. A cross-sectional study included 120 preterm infants admitted to five tertiary hospitals in Jakarta, Indonesia. Participants were preterm infants born at 28–34 weeks gestational age who had fulfilled the oral feeding readiness as the inclusion criteria: (1) stable cardiorespiratory status, (2) have achieved full enteral feeding via orogastric tube (OGT) 120 mL/kg/day without vomiting or bloating, and (3) strong and rhythmic non-nutritive sucking (NNS) through objective measurement. Infants’ oral feeding ability and various factors that were assumed to affect oral feeding ability, including physiological flexion postural tone, physiological stability, rooting reflex, self-regulation, behavioral state, and level of morbidity were evaluated. Chi-square and multivariate analysis with Poisson regression were performed. Results indicated that postural tone, rooting reflex, physiological stability, self-regulation, behavioral state, and level of morbidity were significantly related to oral feeding ability in preterm infants. The most influencing factors were self-regulation with a prevalence ratio (PR) of 1.96 (1.16–3.34; CI 95%) and p = 0.012, followed by postural tone, high morbidity, and behavioral state (PR 1.91; 1.59; 1.56; CI 95%, respectively). In conclusion, despite meeting the oral feeding readiness criteria, most preterm infants were still not able to feed orally. There are other factors affecting oral feeding ability in Indonesian preterm infants

Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU

Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability