Komunikasi Verbal pada Stroke Non Hemoragik di UPT Pelayanan Sosial Lanjut Usia Binjai

Introduction:Non hemorrhagic stroke is an attack on brain tissues that occurs suddenly and could cause paralysis or permanent disability in any part of the body. Health issues that arise due to the stroke are vary widely. If the stroke occurs in the left side of the brain it will affect the speech, the patient will experience speech disorders. One way to restore speech ability could be implemented by using verbal communication therapy by mentioning vowels. Objective:The study aimed to determine the application of nursing care to the patients with non-hemorrhagic stroke who experienced speech disorders and which can be done by implementing speech therapy vowels on communication ability of patients with non-hemorrhagic stroke.The method used descriptive case study. The subject of the study was conducted on 2 patients with the same case who experienced speech disorders. Results:The results showed that non hemorrhagic stroke was associated with impaired verbal communication. The intervention and implementation were performed by analyzing the general condition of the patients, distinguishing between aphasia and dysarthria, speakingdirectly to the patient slowly and calmly, communicating in normal tone and avoiding fast conversation, asking to follow simple command, and pronounce the vowels such. Conclusion:The evaluation carried out for 3 days and found that the patient could pronounce the vowels but its still unclear.

Inclination, hip abduction, orientation, and tone affect weight-bearing in standing devices

PURPOSE: With children who are unable to stand or walk independently in the community, therapists commonly use standing devices to assist lower-extremity weight-bearing which is important for bone and muscle health. In addition, positioning in hip abduction may improve hip stability and range of motion. This is the first study to explore the effect of angle of inclination, hip abduction, body orientation, and tone on weight-bearing in pediatric standing devices. METHODS: This descriptive exploratory study used a convenience sample of 15 participants (2 with normal tone, 5 with generalized hypotonia, and 8 with hypertonia) (mean age of 5 years and 10 months, range of 3 years 4 months to 9 years 7 months); 13 of whom used standing devices at home, as well as 2 typically developing siblings (normal tone). Each child stood in 36 positions to measure the amount of weight-bearing through footplates. RESULTS: Weight-bearing was highest with 60 degrees of abduction and no inclination (upright) in supine positioning for children with low and normal tone. Children with high muscle tone bore most weight through their feet with no abduction (feet together) and no inclination (upright) in prone positioning. Overall, supine positioning resulted in more weight-bearing in all positions for children with low and normal tone. Prone positioning resulted in slightly more weight-bearing in all positions for children with high tone. CONCLUSIONS: Weight-bearing was affected by all three of the variables (inclination, abduction, and orientation) for participants with high, normal, and low tone. To determine optimal positioning, all standers should include a system to measure where and how much weight-bearing is occurring in the device.

Design and Analysis Of Underwater Imaging Application susing High Frequency Array

Underwater picture preparing has a few applications in the field of maritime exploration work and logical applications, for example, archaeology, geography, underwater ecological appraisal, laying of significant distance gas pipelines and correspondence joins across the mainlands which request geo-referential looking over of the maritime bed and prospection of complex task. The lowering of a camera underwater requires satisfactory lodging utilizing high frequency. The moving of the camera with the assistance from distant spot or face to face at the site is similarly a perplexing undertaking. In any case, the significant test is forced by underwater medium properties. Underwater dimness picture upgrade has acquired far and wide significance with the quick advancement of present day imaging gear. Notwithstanding, the difference upgrade of single underwater dim picture is a difficult errand for logical investigation and computational applications. Versatile differentiation upgrade calculations to determine the picture fluffiness was proposed to suit underwater pictures with shifting difference. Fuzzy edge held intensification strategy had the option to furnish better upgrade with very much protected edge data and improved differentiation in examination with the fuzzy enhancement technique. Acoustic imaging systems are likewise valuable for reviewing or inspecting objects when water turbidity blocks the utilization of closed circuit television or other optical methods for survey. Likewise, light is weakened with a horizontal distance of proliferation, decreasing the light energy arriving at the camera, accordingly bringing about a deficiency of the normal tone.

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

Purpose: The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma.Methods: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year.Results: Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%).Conclusion: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.

General Paresis in a Child with Unusual Presentation

Introduction: Acute onset quadriparesis can be a manifestation of a variety of neurological, metabolic or autoimmune conditions. Rarely, it could be one of many clinical presentations of juvenile dermatomyositis which belongs to the group of idiopathic inflammatory myopathies of childhood. We report the case of a 9-year old girl who presented with global myopathy over a two-month period. Case report: A 9-year-old girl referred with a 2 months history of generalised muscular pain and weakness. There were no significant history of preceded illness, trauma or excessive strenuous exercises. She had no other systemic complaints such as fever or skin rash. Past medical history was unremarkable except for recurrent tonsillitis. Physical examination revealed a child with normal alertness and behaviour. She has notable generalised swelling of all four limbs. Her neurological examination revealed normal tone however her power was definitely reduced in all four limbs (Graded 3/5). She demonstrated signs of proximal myopathy. Subsequent investigations revealed high Creatinine Kinase (CK) levels of 6470U/L, ESR 84mm/hr with deranged transaminases and positive serum mycoplasma and CMV IgM. Her MRI brain and spine along with lumbar puncture results were normal. She was referred to tertiary centre for further evaluation as her weakness progressed. An MRI muscle demonstrated marked inflammation in all four limbs including paravertebral muscles. Her muscle biopsy showed inflammatory myopathy leading to a diagnosis of juvenile dermatomyositis (JDM). She is now showing sustained clinical improvements following a course of immunoglobulin and corticosteroids therapy. Discussion: The diagnosis of JDM is generally considered in patients with rash-associated muscle weakness. Essentially, it involves assessment of muscle, skin, lung and cardiac involvement on top of baseline list of investigations that has been outline by Single Hub and Access point for pediatric Rheumatology in Europe (SHARE). This case reflects that JDM is possible despite non-existent of skin involvement.

Language Strategies to Reduce Anxiety of At-risk Children Deprived of Parental Care

The present study examines language impact on anxiety in at-risk children deprived of parental care. Bulgarianchildren without parents (n=40) divided into 3 age groups (aged 7-10; aged 11-14; and aged 15-17) embedintervention accomplished by four volunteers using four interaction strategies: normal voice and positive language;high tone and positive language; normal tone and negative language, and high tone and negative language.Surveillance has been conducted subjecting anxiety reactions of children measured in 10 indicators: diffidence,dependence, dissatisfaction, reliance, insecurity (for self-assessment anxiety); inadequacy, inactivity,non-communication, inability to seek help, and lack of empathy (for interpersonal anxiety). The present study resultsdemonstrate that linguistic signs have higher influence than paralinguistic cues on children’s behaviour and the useof negative language would increase anxiety in children to a greater extent when the tone is normal while raising thetone would enhance self-assessment and interpersonal anxiety of children with emotional disorders. Balanced use ofnegative and positive language combination with a different tone in different situations would increase socialfunctioning of the child. The use of different strategies for interaction by specialists – with normal and high tone,encouragement or reprimand should be tailored to the specifics of the child as well as to the relevant skills to bedeveloped.

Pain Level in Critical Patients With Sleep Hygiene Care In Intensive Care Unit

Bacground: Complaints in critical patients are an unpleasant experience as long as patients are admitted to the ICU. Critical patients with pain are still common and need collaboration to reduce patients in the ICU.Purpose: The purpose of this study was to determine the Pain Level Description of Critical Patients with Sleep Hygiene Care in the Intensive Care Unit.Method: Research design is descriptive-analytic. The study population was all critical patients in the ICU. The study sample was a portion of critical patients who received 170 sleep hygiene care patients. The sampling technique is purposive sampling. The research variable is a description of the patient's pain level. The research instrument used a questionnaire. Data were collected and analyzed using the frequency distribution method.Result: The results of the pain indicator on the Facial Expression study found that the majority of respondents showed grimacings (46.6%), Body movements study found that most showed restlessness (39.4%), Vocalization found that almost all respondents showed Tolerating ventilator or movement / Talking in normal tone / no sound (72.9%), Muscle tension assessment found that most respondents showed Relaxed as much (51.8%). The results of the study showed that the pain scale based on CPOT of the majority of respondents had mild pain as many as 64 respondents (37.6%).Conclusion: Pain description in critical patients with sleep hygiene care shows that there are still many patients who feel pain and need identification and further intervention to reduce it.

NYERI PASIEN KRITIS PADA INTERVENSI SLEEP HYGIENE CARE DI INTENSIVE CARE UNIT

Pasien Kritis memiliki banyak keluhan saat dirawat di Icu salah satunya adalah keluhan nyeri. Pasien kritis mengeluh nyeri dan dapat mengganggu segala respon yang terjadi pada pasien. Tujuan penelitian ini adalah mengetahui Gambaran Nyeri Pasien Kritis dengan Sleep Hygiene Care di Ruang Perawatan Kritis. Desain penelitian adalah Deskriptif. Populasi penelitian adalah semua pasien kritis di ICU. Sampel penelitian adalah sebagian pasien kritis yang mendapatkan sleep hygiene care. Teknik sampling adalah Purposive sampling. Variabel penelitian adalah gambaran nyeri. Instrumen penelitian menggunakan kuesioner. Data dikumpulkan dan dianalisis menggunakan metode distribusi. Hasil penelitian didapatkan pasien grimacing (46,6%), restlessness (39,4%), Tolerating ventilator or movement /Talking in normal tone/no sound (72,9%), Relaxed (51,8%). Hasil penelitian menunjukkan bahwa skala nyeri sebagian besar responden memiliki mild pain (37,6%). Pasien memiliki gambaran nyeri pada pasien dengan sleep hygiene care yang menunjukkan bahwa masih banyak pasien merasakan nyeri dan perlu terus dilakukan pengkajian secara terus menerus.

36 Too Scared to Blink: Pseudoparkinsonism due to Nyctophobia

IntroductionA hallmark of Parkinson’s disease is facial akinesia with decrease in blink frequency (Karson, 1984). A markedly decreased blink frequency from nyctophobia, a fear of the dark, has not heretofore been reported.MethodCase Study: A 26-year-old right handed male presented with a 20-year history of phantasmagoria. Visual hallucinations of strangers appeared several to a hundred times a day, seconds to minutes in duration. These morbid images were horrific, of dead people or ghosts, suddenly appearing in his visual space, actively attacking real people. Examples included a little girl, decapitated, cradling her head in her arm or Freddy Krueger like apparitions, shooting, stabbing, strangling or maiming actual people who were within the patient’s visual field. He was able to differentiate between the hallucinations and real people, either from the context (a non hallucination would not be murdering someone else), or he would wait for the hallucinations to vanish, allowing him to then interact with the person who is actually there. The images were so disturbing to him that he fled his home state to run away from the hallucinations, but to his chagrin, they persisted. There were diurnal variations to his hallucinations, which were more frequent at night, or when he closed his eyes, and the fear of these has induced nyctophobia. In order to avoid these, he attempted to curtail closing his eyes or blinking. He had been treated with 9 different psychotropic medications, which had no effect on his hallucinations. Phenytoin was begun, and once therapeutic levels were achieved, all of his hallucinations resolved, as did his nyctophobia, with return to normal blink frequency.ResultsPhysical examination: Bilateral palmar erythema. Facial expression with decreased blink frequency, approximately 1/per minute, but not otherwise hypomimetic. Neurological examination: Cranial Nerve (CN) Examination: CN III, IV and VI: bilateral ptosis. Motor Examination: Normal tone without cogwheel rigidity. No bradykinesia. Drift Testing: Right upward-outward drift, right cerebellar spooning, and Abductor Digiti Minimi sign. Gait: Normal without instability or retropulsion. Reflexes: 1+ throughout. Hoffman Reflex: positive bilaterally. Other: Magnetic Resonance Imaging of brain with/without infusion: Normal. Five-day Electroencephalogram: Temporal Lobe Status Epilepticus with bilateral foci.DiscussionIn this individual, the sheer terror of phantasmagoria with his eyes closed, forced him to maintain them in the open position as long as possible, reducing his blink frequency to once a minute or less. The return to a normal rate of blink frequency with treatment using phenytoin, with resolution of his horrific hallucinations, further validates this as the origin for his infrequent blinking. In those with low nictation, without other manifestations of Parkinson’s disease, query as to volitional inhibition of blink frequency and nyctophobia is warranted.