Structural and Functional Neuroimaging in the Investigation of the Brain Neuroplasticity in Post-Stroke Patients (Literature Review)

2018 ◽  
Vol 3 (5) ◽  
pp. 247-253
Author(s):  
D. A. Potii ◽  
◽  
S. V. Tatarko ◽  
A. H. Snegir ◽  
G. A. Prokopenko ◽  
...  
Keyword(s):  
Literature Review ◽  
Functional Neuroimaging ◽  
Stroke Patients ◽  
Post Stroke ◽  
The Brain

scholarly journals Gambaran Activity Daily Living Pada Pasien Pasca Stroke Non Hemoragic Setelah Pemberian Propioceptive Neuromuscular Facilitation : Literature Review

2021 ◽  
Vol 1 ◽  
pp. 1959-1967
Author(s):  
Rizqika Indah Yuli Yanti ◽  
Nurul Aktifah
Keyword(s):  
Literature Review ◽  
Barthel Index ◽  
Daily Living ◽  
Google Scholar ◽  
Stroke Patients ◽  
Daily Living Activities ◽  
Post Stroke ◽  
Before And After ◽  
Physical Limitations ◽  
The Brain

AbstractStroke occurs when a blood vessel that carries oxygen and nutrients to the brain bursts or is blocked by a clot so that the brain does not get the blood it needs. Stroke affects physical limitations and disabilities in carrying out daily living activities. One of the rehabilitation interventions to increase daily living activities among them is propioceptive neuromuscular facilitation. Thisstudy aimed to describe the activity daily living in non-hemorrhagic post-stroke patients after propioceptive neuromuscular facilitation intervention. The selection of articles in the study usesthe PICO mnemonic. Searcharticles through the Indonesian Scientific Respirator Research, PubMed, GARUDA, and Google scholar with predetermined inclusion and exlusion criteria. The results show that propioceptive neuromuscular facilitation was proven in increase activity daily living in non-hemorrhagic post-stroke patients. The activity daily living was assessed using Barthel Index checklist. The average of Barthel Index before and after intervention were 42,493 and 75,372 respectively. The propioceptive neuromuscular facilitation has been shown to improve activity daily living in non-hemorrhagic post-stroke patients. Propioceptive neuromuscular facilitation can be a modality treatment to increase activity daily living in non-hemorrhagic post-stroke patients.Keywords: Activity Daily Living, Non-Hemorrhagic Post-Stroke, Propioceptive Neuromuscular Facilitation AbstrakStroke terjadi ketika pembuluh darah yang mengangkut oksigen dan nutrisi menuju otak pecah atau terblokir oleh bekuan sehingga otak tidak mendapat darah yang dibutuhkan. Kejadian stroke memunculkan gangguan keterbatasan fisik dan kecacatan dalam melakukan activity daily living. Peran fisioterapi pada penderita stroke yaitu tindakan rehabilitasi yang dapat meningkatkan ADL salah satuya adalah propioceptive neuromuscular facilitation. Penelitian ini bertujuan untuk mengetahui gambaran activity daily living pada pasien pasca stroke non hemoragic dengan pemberian propioceptive neuromuscular facilitation. Pemilihan artikel pada penelitian ini menggunakan mnemonic PICO. Penelusuran artikel melalui Neliti Respiratori Ilmiah Indonesia, PubMed, Garuda-Garba rujukan digital dan Google scholar dengan kriteria inklusi dan ekslusi yang telah ditentukan. Hasil literature review kelima artikel menunjukkan bahwa PNF terbukti meningkatkan ADL pada pasien pasca stroke non hemoragic dengan hasil rata-rata peningkatan sebesar 32.879 dengan menggunakan alat ukur indeks barthel sebelum intervensi 42.493 dan sesudah intervensi 75.372. Hasil literature review kelima artikel ini menunjukkan bahwa propioceptive neuromuscular facilitation terbukti dapat meningkatkan activity daily living pada pasien pasca stroke non hemoragic. Penetitian ini dapat digunakan sebagai dasar pengembangan praktisi fisioterapi pada masalah peningkatan activity daily living pada pasien pasca stroke non hemoragic dengan menggunakan latihan propioceptive neuromuscular facilitation.Kata Kunci: Activity Daily Living, Propioceptive Neuromuscular Facilitation, Pasca Stroke

Method of virtual reality for early comprehensive rehabilitation of patients with acute stroke

2020 ◽  
pp. 39-45
Author(s):  
N. Nozdryukhina ◽  
E. Kabayeva ◽  
E. Kirilyuk ◽  
K. Tushova ◽  
A. Karimov
Keyword(s):  
Virtual Reality ◽  
Literature Review ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Recovery Process ◽  
Stroke Patients ◽  
Post Stroke ◽  
Stroke Disability ◽  
Comprehensive Rehabilitation ◽  
High Level

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

Abstract TP274: Orosomucoid-1 Protein Increases Following Ischemic Stroke in the Brain and Periphery

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hetal Mistry ◽  
Madeline Levy ◽  
Meaghan Roy-O'Reilly ◽  
Louise McCullough
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Rna Sequencing ◽  
Multiple Testing ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mrna Levels ◽  
Stroke Patients ◽  
Post Stroke ◽  
Protein Levels ◽  
The Brain

Background and Purpose: Orosomucoid-1 (ORM-1) is an abundant protein with important roles in inflammation and immunosuppression. We utilized RNA sequencing to measure mRNA levels in human ischemic stroke patients, with confirmation by serum ORM-1 protein measurements. A mouse model of ischemic stroke was then used to examine post-stroke changes in ORM-1 within the brain itself. Hypothesis: We tested the hypothesis that ORM-1 levels increase following ischemic stroke, with sex differences in protein dynamics over time. Methods: RNA sequencing was performed on whole blood from ischemic stroke patients (n=23) and controls (n=12), with Benjamini-Hochberg correction for multiple testing. Enzyme-linked immunosorbent assay was performed on serum from ischemic stroke patients (n=28) and controls (n=8), with analysis by T-test. For brain analysis, mice (n=14) were subjected to a 90-minute middle cerebral artery occlusion (MCAO) surgery and sacrificed 6 or 24 hours after stroke. Control mice underwent parallel “sham” surgery without occlusion. Western blotting was used to detect ORM-1 protein levels in whole brain, with analysis by two-way ANOVA. Results: RNA sequencing showed a 2.8-fold increase in human ORM-1 at 24 hours post-stroke (q=.0029), an increase also seen in serum ORM-1 protein levels (p=.011). Western blot analysis of mouse brain revealed that glycosylated (p=0.0003) and naive (p=0.0333) forms of ORM-1 were higher in female mice compared to males 6 hours post-stroke. Interestingly, ORM-1 levels were higher in the brains of stroke mice at 6 hours (p=.0483), while at 24 hours ORM-1 levels in stroke mice were lower than their sham counterparts (p=.0212). In both human and mouse data, no sex differences were seen in ORM-1 levels in the brain or periphery at 24 hours post-stroke. Conclusion: In conclusion, ORM-1 is a sexually dimorphic protein involved in the early (<24 hour) response to ischemic stroke. This research serves as an initial step in determining the mechanism of ORM-1 in the ischemic stroke response and its potential as a future therapeutic target for both sexes.

scholarly journals POST-STROKE PSYCHIATRIC DISORDERS: AN OVERVIEW ON ITS SCREENING AND MANAGEMENT

2019 ◽  
Vol 12 (1) ◽  
pp. 11
Author(s):  
Keerthana Chandrasekar ◽  
Nakka Gautam Sai ◽  
Princy Sabu John ◽  
Sruthi Ninan ◽  
Raja D ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Bipolar Disorders ◽  
Depression And Anxiety ◽  
Stroke Patients ◽  
Post Stroke ◽  
The Third ◽  
Insufficient Amount ◽  
Psychiatric Complications ◽  
The Brain

Stroke is the third leading cause of death. Stroke occurs when an insufficient amount of blood is supplied to the brain due to a thrombus or an emboli leading to permanent tissue damage. Lesions in the brain can lead to psychiatric complications. The prevalence of psychiatric complications after stroke is very common. Psychiatric complications such as depression, anxiety, apathy, pseudobulbar effects (laughing and crying), mania, psychosis, and bipolar disorders are seen after stroke. In this review, various psychiatric disorders are reported among post-stroke survivors in which depression and anxiety are common. Consequently, apathy, pseudobulbar effects, catastrophic reactions, psychosis, bipolar disorder, and mania are also observed after stroke. Therefore, early detection and management of psychiatric disorders prevent further complications and improve the quality of life in post-stroke patients.

scholarly journals Gambaran Fungsi Kognitif Pasien Pasca Stroke

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Reinaldi O. Boletimi ◽  
Mieke A. H. N. Kembuan ◽  
Junita M. Pertiwi
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Literature Review ◽  
Stroke Patients ◽  
Post Stroke ◽  
Low Education ◽  
History Of ◽  
Male Patients ◽  
Abstract Domains ◽  
And Gender

Abstract: Stroke or brain attack occurs directly and its incidence is still very high until now. It is reported that two-thirds of stroke patients suffered from cognitive impairment leading to dementia within three months after stroke that can interfere with one’s daily activities if left untreated. This study was aimed to obtain the description of cognitive function in post-stroke patients. This was a literature review study using three databases, as follows: Goggle Scholar, Pubmed, and Clinical Key, and the keywords were cognitive impairment, cognitive decline, post-stroke, and MoCA. There were 10 literatures that met the inclusion and exclusion criteria. The results showed that many post-stroke patients showed cognitive function decline in the visuospatial/executive, memory, language, attention, and abstract domains. Cognitive impairment occured mostly in male patients, age 60 years and over, low education, ischemic stroke, left hemisphere lesion, with a history of hypertension. In conclusion, there is a relationship between post-stroke cognitive impairment and the location of lesion, age, and education level, albeit, there was no relationship between the cognitive impairment and gender as well as diabetes mellitus.Keywords: cognitive impairment, post-stroke, MoCA Abstrak: Stroke menyerang otak secara langsung dengan angka kejadian yang masih sangat tinggi sampai saat ini. Dua pertiga pasien stroke dilaporkan mengalami gangguan fungsi kognitif yang berujung pada demensia dalam tiga bulan pasca stroke serta dapat mengganggu aktivitas sehari-hari bila dibiarkan. Penelitian ini bertujuan untuk mendapatkan gambaran fungsi kognitif pasien pasca stroke. Jenis penelitian ialah literature review, dengan pencarian literatur pada tiga database yaitu Goggle Scholar, Pubmed, dan Clinical Key. Kata kunci yang digunakan ialah penurunan fungsi kognitif, pasca stroke, dan MoCA. Hasil seleksi mendapatkan 10 literatur yang memenuhi kriteria inklusi dan eksklusi. Hasil penelitian menunjukkan bahwa pada pasien pasca stroke sering terjadi penurunan fungsi kognitif dengan domain visuospasial/eksekutif, memori, bahasa, atensi, dan abstrak yang paling sering terganggu. Penurunan fungsi kognitif banyak ditemukan pada pasien laki-laki, usia 60 tahun ke atas, jenjang pendidikan rendah, stroke iskemik, lesi hemisfer kiri, dengan riwayat hipertensi. Simpulan penelitian ini ialah adanya hubungan antara penurunan fungsi kognitif dengan lokasi lesi, usia, dan jenjang pendidikan namun tidak terdapat hubungan dengan jenis kelamin dan diabetes melitus.Kata kunci: gangguan kognitif, pasca stroke, MoCA

scholarly journals Gambaran Peningkatan Kemampuan Motorik Ekstremitas Atas Setelah Pemberian Mirror Therapy Pada Pasien Pasca Stroke : Literature Review

2021 ◽  
Vol 1 ◽  
pp. 1536-1541
Author(s):  
Infa Dirah Pangestika Oktafiani ◽  
Wahyu Ersila
Keyword(s):  
Literature Review ◽  
Upper Extremity ◽  
Motor Skills ◽  
Functional Limitations ◽  
Upper Extremities ◽  
Google Scholar ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Post Stroke ◽  
Incidence And Mortality

AbstractStroke is a serious health problem with high incidence and mortality, and causes disability in patients. It causes complex problems, one of which is motor disorders, especially the upper extremities. Impaired motor function causes functional limitations and disabilities in stroke patients. Mirror Therapy is a new technique that is simple and able to improve upper extremity function with the concept of visual illusion. This study aimed to describe of the motoric improvement of the upper extremities after the implementation of Mirror Therapy in post-stroke patients. This study was a literature review by searching for articles from databases such as PubMed, Science Direct, and Google Scholar. The articles were chosen based on several inclusion and exclusion criteria as well as a feasibility test. The number of articles that was appropriate and reviewed was five. The results of review of the five articles showed that Mirror Therapy was proven to be able to improve the motoric skills of post-stroke patients with an average difference of 13.68 using the Fugl Meyer Assessment of Upper Extremity (FMA-UE) measuring instrument. The most common type of stroke was ischemic stroke (64.6%), and it was more common in males (72.3%) with an average age of 52.84 years. Mirror Therapy could improve the upper extremity motor skills in post-stroke patients. This study is expected to be the basis of action in performing physiotherapy management, especially in improving upper extremity motor skills in post-stroke patients with Mirror Therapy interventions.Keywords : Mirror skills; Motor Therapy; Post stroke AbstrakStroke merupakan masalah kesehatan yang penting dengan kejadian dan kematian tinggi dan menyebabkan kecacatan pada penderita. Permasalahan yang ditimbulkan kompleks, salah satunya gangguan motorik khususnya ekstremitas atas. Fungsi motorik yang terganggu menyebabkan keterbatasan fungsional dan disabilitas pada pasien stroke sehari-hari. Mirror therapy merupakan teknik baru yang sederhana dan mampu memperbaiki fungsi ekstremitas atas dengan konsep ilusi visual. Penelitian ini bertujuan untuk mengetahui gambaran peningkatan motorik ekstremitas atas setelah pemberian mirror therapy pada pasien pasca stroke. Penelitian menggunakan literature review dengan pencarian artikel melalui database seperti PubMed, Science Direct, dan Google Scholar. Artikel diambil berdasarkan kriteria inklusi dan eksklusi, serta dilakukan uji kelayakan. Jumlah artikel yang sesuai dan dilakukan review (n=5). Hasil literature review lima artikel menunjukkan bahwa pemberian mirror therapy terbukti dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke dengan rata-rata selisih peningkatan sebesar 13,68 menggunakan alat ukur Fugl Meyer Assessment of Upper Extremity (FMA-UE). Jenis stroke terbanyak yaitu stroke iskemik 64,6% dan jenis kelamin laki-laki lebih banyak 72,3% dengan karakteristik rata-rata usia 52,84 tahun. Mirror Therapy dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke. Diharapkan menjadi dasar tindakan dalam melakukan manajemen fisioterapi, mengenai masalah peningkatan kemampuan motorik ekstremitas atas pada pasien pasca stroke dengan intervensi mirror therapy.Kata kunci: Kemampuan motorik; Mirror therapy; Pasca stroke

scholarly journals Rancang bangun alat monitoring fisioterapi pasien pasca stroke menggunakan sensor MPU6050 melalui media transmisi bluetooth

JURNAL ELTEK ◽  
2021 ◽  
Vol 19 (2) ◽  
pp. 39
Author(s):  
Lis Diana Mustafa ◽  
Azam Muzakhim Imamuddin ◽  
Yoyok Heru Prasetio
Keyword(s):  
Transient Ischemic Attack ◽  
Knee Flexion ◽  
The Body ◽  
Stroke Patients ◽  
Post Stroke ◽  
Elbow Movement ◽  
Mild Stroke ◽  
Ischemic Attack ◽  
The Brain ◽  
Average Angle

Stroke Transient Ischemic Attack (TIA ) adalah kondisi stroke ringan. Stroke ringan diakibatkan oleh berkurangnya suplai darah menuju otak. Kelumpuhan disebabkan oleh kurangnya aliran darah ke otak, sehingga sisi tubuh akan mengalami kelumpuhan terutama pada siku dan lutut. Fisioterapi pada pasien pasca stroke ringan dilakukan dengan metode terapi gerakan antara lain seperti penggunaan alat bantu fisioterapi pasien pasca stroke menggunakan sensor MPU6050 melalui media transmisi Bluetooth. Sistem rancangan ini membantu latihan pada pasien berbentuk sensor MPU6050 yang digunakan untuk  mendeteksi sudut serta banyaknya gerakan rehabilitasi pasien pasca stroke. Sensor gyroscope menghasilkan deteksi sudut pada siku sebesar 150  dan sudut pada  lutut sebesar 135 . Data yang didapatkan diproses oleh arduino nano menggunakan metode I2C. Penelitian ini bertujuan untuk merancang alat bantu fisioterapi pasien pasca stroke berbasis mikrokontroler guna memperoleh hasil yang maksimal karena bentuk alat ini yang portable. Stroke Transient Ischemic Attack (TIA) is a mild stroke condition that can be caused by reduced blood supply to the brain due to blocked blood vessels. Lack of blood flow to the brain can cause paralysis, usually only on one side of the body such as the elbows and knees. Physiotherapy in post-stroke patients is carried out using movement therapy methods, including elbow and knee flexion. Currently, patients come to the therapist or vice versa to perform therapeutic movements, so a telemonitoring system for post-stroke patient physiotherapy tools is made using the MPU6050 sensor which is connected to ESP 232 and the internet network and can be monitored by therapists and clinic admins where the therapy is done. This system helps monitor elbow and knew flexion exercises using the MPU6050 sensor which is used to detect the angle and number of rehabilitation movements of post-stroke patients. . From the results of testing the accuracy of this sensor is able to detect the angle of elbow movement from 00-1500 and knee flexion angle of 00-1350 by 99%.The telemonitoring application for physiotherapy tools for post-stroke patients based on Android is equipped with a therapist menu so that the number of movements and the average angle of movement of the knees and elbows can be monitored by the therapist, this tool can also be used anywhere and anytime due to the portable form of this tool.

scholarly journals Identification of post-stroke EEG signal using wavelet and convolutional neural networks

2020 ◽  
Vol 9 (5) ◽  
pp. 1890-1898 ◽  
Author(s):  
Esmeralda C. Djamal ◽  
Rizkia I. Ramadhan ◽  
Miranti I. Mandasari ◽  
Deswara Djajasasmita
Keyword(s):  
Neural Networks ◽  
Convolutional Neural Networks ◽  
Stochastic Gradient Descent ◽  
Eeg Signal ◽  
Stroke Patients ◽  
Post Stroke ◽  
Moment Estimation ◽  
Testing Data ◽  
The Brain ◽  
Eeg Signal Processing

Post-stroke patients need ongoing rehabilitation to restore dysfunction caused by an attack so that a monitoring device is required. EEG signals reflect electrical activity in the brain, which also informs the condition of post-stroke patient recovery. However, the EEG signal processing model needs to provide information on the post-stroke state. The development of deep learning allows it to be applied to the identification of post-stroke patients. This study proposed a method for identifying post-stroke patients using convolutional neural networks (CNN). Wavelet is used for EEG signal information extraction as a feature of machine learning, which reflects the condition of post-stroke patients. This feature is Delta, Alpha, Beta, Theta, and Mu waves. Moreover, the five waves, amplitude features are also added according to the characteristics of the post-stroke EEG signal. The results showed that the feature configuration is essential as distinguish. The accuracy of the testing data was 90% with amplitude and Beta features compared to 70% without amplitude or Beta. The experimental results also showed that adaptive moment estimation (Adam) optimization model was more stable compared to Stochastic gradient descent (SGD). But SGD can provide higher accuracy than the Adam model. 

scholarly journals PRINCIPLES OF MOTOR RECOVERY IN POST-STROKE PATIENTS USING HAND EXOSKELETON CONTROLLED BY THE BRAIN-COMPUTER INTERFACE BASED ON MOTOR IMAGERY

2017 ◽  
Vol 27 (1) ◽  
pp. 107-137 ◽  
Author(s):  
A. A. Frolov ◽  
Dušan Húsek ◽  
E. V. Biryukova ◽  
P. D. Bobrov ◽  
O. A. Mokienko ◽  
...  
Keyword(s):  
Motor Imagery ◽  
Brain Computer Interface ◽  
Motor Recovery ◽  
Computer Interface ◽  
Stroke Patients ◽  
Post Stroke ◽  
Hand Exoskeleton ◽  
The Brain

scholarly journals Pengaruh Pelatihan Tentang Perawatan Pasien Pasca Stroke Terhadap Peningkatan Pengetahuan Kader

2021 ◽  
Vol 1 ◽  
pp. 2098-2104
Author(s):  
Wahyu Ersila ◽  
Lia Dwi Prafitri ◽  
Syavira Nooryana
Keyword(s):  
Physical Exercise ◽  
Patient Care ◽  
Community Service ◽  
Stroke Patient ◽  
Neurological Disease ◽  
Stroke Patients ◽  
Post Stroke ◽  
A Value ◽  
Before And After ◽  
The Brain

AbstractStroke is a neurological disease that can cause damage to the brain, the damage has an impact on the decline of the body's functional organs. Physical exercise carried out by post-stroke patients is also able to restore recovery, it is necessary to have a companion when doing these exercises from family members or closest neighbors, one of which can be done by Elderly Cadres. Cadre training can increase the knowledge of cadres which is expected to be able to improve the services provided to post-stroke patients. The purpose of this community service is to determine the effect of training on increasing the knowledge of cadres regarding post-stroke patient care. The method used is a question and answer lecture, discussion, and demonstration. The number of cadres who participated in this activity was 20 cadres. The instrument used to determine the increase in knowledge is a questionnaire. The results of this community service show that before the cadre training was carried out there were 15 cadres (75%), and after the cadre training the knowledge increased to Good as many as 17 cadres (85%). The effect of increasing the knowledge of cadres statistically is training with a value of 0.003 (<0.05), this means that training changes the knowledge of cadres before and after regarding post-stroke patient care. Suggestions for puskesmas in order to increase the knowledge of cadres can be through similar training with other themes.Keywords: Cadre; training; knowledge AbstrakStroke merupakan penyakit neurologi yang dapat menyebabkan kerusakan pada otak, kerusakan tersebut berdampak pada kemunduran organ fungsional tubuh. Latihan fisik yang dilakukan pasien pasca stroke juga mampu mempercepat pemulihan, perlunya ada pendamping ketika lansia melakukan latihan tersebut bisa dari anggota keluarga atau tetangga terdekat salah satunya dapat dilakukan oleh Kader Lansia. Pelatihan kader dapat meningkatkan pengetahuan kader yang diharapkan mampu untuk meningkatkan pula pelayanan yang diberikan kepada pasien pasca stroke. Tujuan dari pengabdian masyarakat ini adalah untuk mengetahui pengaruh pelatihan terhadap peningkatan pengetahuan kader mengenai perawatan pasien pasca stroke. Metode yang digunakan adalah ceramah tanya jawab, diskusi, dan demontrasi. Jumlah kader yang mengikuti kegiatan ini adalah 20 kader. Instrumen yang digunakan untuk mengetahui peningkatan pengetahuan adalah kuesioner. Hasil pengabdian masyarakat ini bahwa sebelum dilakukan pelatihan pengetahuan kader ada pada kategori cukup sebanyak 15 kader (75%), dan setelah dilakukan pelatihan pengetahuan kader meningkat menjadi Baik sebanyak 17 kader (85%). Pengaruh pelatihan dalam meningkatkan pengetahuan kader secara statistic dengan nilai p 0,003 (<0,05) hal ini berarti pelatihan berpengaruh mengubah pengetahuan kader sebelum dan setelah pelatihan mengenai perawatan pasien pasca stroke. Saran bagi puskesmas agar dapat meningkatkan pengetahuan kader dapat melalui pelatihan sejenis dengan tema yang lain. Keywords: Kader;pelatihan;pengetahuan

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