Background

Decreased sensory function is a complication that often occurs in non-hemorrhagic stroke patients, as a result of decreased cerebral circulation. Acupressure is useful in improving sensory function by launching the movement of the flow of qi (vital energy) in the body. But not many studies have examined the effectiveness of acupressure in the function and timing of sensory repair in non-hemorrhagic stroke patients.

Method

The type of research used is the study True Experiment Design with aapproach randomized control trial. This study compiled two groups, namely the intervention group and the control group. Technique Probability sampling with a method simple random sampling was used to get 42 respondents divided into 2 groups.

Results

Test results Independentt test shows value p value 0.000 which indicates that there is a significant difference in the value of sensory function between the intervention and control groups.

Conclusion

The results of the study after being given an intervention that an increase in sensory function is better and faster in patients who get acupressure, so this action is effectively implemented for non-hemorrhagic stroke patients with sensory disorders.

Keywords: Acupressure, Function and time, Sensoric, Non Hemorrhagic Stroke.

Stroke is a clinical sign that develops rapidly due to focal or global brain function disorders with symptoms lasting 24 hours or more that cause death without any other obvious cause other than vascular [1]. Stroke consists of hemorrhagic and non hemorrhagic. Hemorrhagic stroke is an acute focal neurological dysfunction and is caused by primary bleeding in the brain substance that occurs spontaneously due to rupture of arteries, veins and capillaries which are not caused by head injury [1]. Ischemic stroke is a stroke that occurs due to blockage of blood flow to certain parts of the brain resulting in a series of pathological processes in that area. Ischemic stroke covers about 70% of the total incidence of stroke with 50% of the disability rate after the attack. [1, 2] Disability in stroke patients can occur due to impaired sensory and motor functions. This disruption of function has an impact on decreasing activities that can affect the economy and even cause death [3].

An increase in the number of stroke patients has occurred in the last 5 years. In 2013 stroke patients in Indonesia were 7.0 per 1000 inhabitants, while in 2018 the incidence of stroke was 10.9 per 1000 population or an increase of 35.8% [4, 5].

Help in stroke patients prioritizes increasing blood flow to the brain, preventing death and minimizing disability. Someone who suffers a stroke needs to get fast and appropriate treatment to avoid preventing disability, both physically and mentally. As many as 30% - 40% of patients with this disease can recover completely if handled appropriately in the first 3-6 hours (golden period), at this time brain tissue that is experiencing ischemia can still be saved. Retnaningsih said that the most effective treatment for non-hemorrhagic strokes was thrombolytic administration at the latest 4.5 hours after the attack. This statement is in accordance with the stroke guidelines presented by the Stroke Foundation [6]. Examination of CT scans in patients with non-hemorrhagic strokes in the range of 12-24 hours after the onset of symptoms does not indicate abnormalities. So that giving action at this time will likely give results even though the possibility will not be optimal [7, 8].

Handling a stroke can be done with medical or non-medical treatment. In cases of acute stroke, treatment is generally carried out with the administration of drugs. American Hearth Associations (AHA) makes a guide to handling patients with acute ischemic stroke. This guideline details the handling of pre-hospital patients, conducts emergency evaluations, intravenous and intra-arterial treatment, management of hospital care designed for the first 2 weeks [9].

Non-medical or complementary therapy for post-acute stroke patients can be done by taking acupressure. This action aims to open up and stimulate a blockage / unblocking circulation chi by activating the points very specific on the meridian, which is called a pressure point(accupoint) passing near the skin so that it can pass freely [10]. Acupressure is a complementary action and is an alternative therapy in nursing listed in the Nursing Intervention Classification (NIC) [11, 12].

Adam's study showed that acupressure in the scapular area performed for 10 minutes in 7 days could improve upper limb motor skills in stroke patients who had hemiparesis with an effect size of 1.85. That is, according to this study acupressure has a very strong influence on increasing muscle strength in stroke patients [13]. Another study conducted by Asmawariza stated that acupressure at 14 meridian points within 15 minutes for 7 days was able to increase the strength of upper and lower extremity muscles in stroke patients with an effect size of 3.00, which means that acupressure measures of 14 meridian points have a very strong against increasing muscle strength in post-hemorrhagic post-stroke patients [14].

Kang's research stated that the acupressure of 14 meridian points in 56 respondents 10 minutes every day for 2 weeks showed the results of an increase in the range of motion both flexion and extension in the upper extremity. The effect size of shoulder flexion is 1.44 and shoulder extension is 1.88. From the results of the calculation shows a very strong influence between acupressure actions at 14 meridian points on the ability of range of motion both flexion and extension. Another study also stated that acupressure at 12 points performed on 27 stroke patients was able to improve walking ability (p = 0.00), hand movements (p = 0.026) and continued hand activities (p = 0.038) [15, 16].

Stroke in addition to causing motor disorders also causes sensory disorders such as impaired vision, touch / touch [17]. Disorders of sensory function are caused by damage to the cranial nerves (Central Nerves) which affect several sensory functions in the body such as changes in sensory sharpness, smell, vision and taste [18]. Patients with stroke can experience inability to interpret sensations. Sensory damage to a stroke can be mild touch damage or even more severe. By losing proprioception (the ability to feel the position and movement of body parts) as well as difficulties in interpreting visual, tactile and auditory stimuli [19].

The research conducted by Astutik about pressure ulcers stated that disturbances in sensory perception in stroke patients can cause pressure ulcers. Based on the statistical test, get p value = 0.007. This result means that sensory perception disorders significantly play a role in the occurrence of pressure ulcers in stroke patients. Thus need immediate treatment in stroke patients who experience sensory disorders [20].

Acupressure actions stimulate the formation of histamine, heparin and kinase prostase where all three will cause vascular vasodilation and cause perfusion to brain tissue will also be more smooth. With the smooth circulation will affect improving brain function (thalamus area) as a sensory center, so that sensory function will improve. The mechanism of action of acupressure when viewed from this function is to improve sensory function by improving circulation to the area of ​​the thalamus as a sensory center. Stroke non-hemorrhagic occurs due to blockage in the brain's blood vessels which results in decreased tissue perfusion resulting in brain damage. Pharmacologically, the first action of patients with non-hemorrhagic strokes is to give thrombolytic drugs to lyse blockages in blood vessels. The teraupeutic window for administration of drugs in this phase ranges from 12-24 hours. After the blood vessel drug administration process will begin to open, this is where the role of acupressure as a complementary (non-pharmacological) action to help facilitate circulation to the brain area, so that sensory functions will improve [8].

Research as described above has not discussed the effect of acupressure on increasing sensory ability in stroke patients. Thus this study will analyze the effect of acupressure on increasing sensory ability in stroke patients. Previous studies on acupressure for motor strength and range of motion in non-homoragic stroke patients performed by Asmawariza used 14 acupressure meridian points. The results obtained from the study state that the effect of acupressure is very strong on increasing motor strength in the upper and lower extremities of non-hemorrhagic stroke patients [14]. In this study we will use other points of acupressure namely GV-20 (Baihui), ST-36 (Zusanli), LI-4 (Hegu), LI-11 (Quchi), KI-1 (Yongkuan) which are acupressure points associated with improved cerebral perfusion and sensory function.

Medical record data of Tidar Magelang General Hospital in 2016, 2017 and 2018 the average visit of inpatients with stroke was 1,386 patients, with the distribution of hemorrhagic stroke as many as 428 patients per year, Non Hemorrhagic 858 patients per year and unknown causes of 100 patients per year. In Central Java, based on the 2013 Riskesdas, 40,972 stroke patients were divided into 12,542 hemorrhagic patients and 28,430 non-hemorrhagic patients.

This type of research used True Experiment Design with approach randomized control trial. The researchers compiled two groups, namely the intervention group and the control group. Measuring the respondent's sensory function and time using the NIHSS instrument carried out for 15 days, namely before the treatment (pretest) as much as 1 time assessment and after treatment (posttest) 14 times.

The population in this study were post-acute non-hemorrhagic stroke patients who were treated in the flashlight room of the Tidar Magelang General Hospital, Central Java Province. Determination of the minimum number of samples using atechnique sampling probability with a method simple random sampling and based on inclusion and exclusion criteria as many as 42 respondents divided into 2 groups with 21 respondents each in the intervention group and 21 respondents in the control group.

In this study researchers conducted data collection by observing, identifying, interviewing and filling out the questionnaire. The collected data was analyzed through the IBM SPSS version 21.0, and continued with a different test, namely parametric test (Paired T test, Independent T test and One Way ANOVA test). The processed data is used as the basis for discussing problem statements, which are then presented in table form so conclusions can be drawn.

Table 1 Frequency distribution of the inte rvention group and control based on demographic characteristics (n = 42)

Table 1 shows that the average intervention and control groups were in the age range of 45-65 years (elderly). The number of male respondents in the intervention group was 47.6% and women were 52.4%, while in the male sex control group it was 42.8% while women were 57.2%. Respondents experienced a first or second stroke both light and moderate. Where as seen from admission time shows that all respondents both intervention group and control group are on admission time more than 4.5 hours.

Table 2 Over view of overall sensory function in the intervention group and control

Based on table 2 shows that acupressure intervention can reduce sensory disorders in patients. The decrease in sensory disorders began on the 9th day in the intervention group and the 12th day in the control group. The decline occurred several times, namely on the 11th, 12th and 13th days. The average value of sensory impairment in the intervention group from 1.07 to 0.90 on day 15, while in the control group from 1.07 to 1.04 on day 15.

Graph 1 Decreased Overall Sensory Disorders in the Intervention group and Control

Graph above shows that sensory disorders in both groups decreased. However, the decline in the intervention group was faster and more sharp compared to the control group. In the intervention group it was seen that there was a decline on the 9th day to the 13th day. The control group only decrease sensory disturbance occurred on day 12.

Table 3 Analysis of differences in sensory function day - 1 (pre) and day - 15 (post) in the intervention group and control

*Paired T test statistic

From the table above, shows the differences in sensory function before and after treatment in the intervention group value p = 0.004. This shows that there is a significant difference between sensory function before and after treatment in the intervention group. Where as in the control group p = 0.162, which means that there is no significant difference between sensory functions before and after treatment.

Table 4 Analysis of differences in sensory function day 15 (post) and difference test (deviation) between the intervention group and control

*Independent T test statistic

Table above, can be seen the results of the difference test between the intervention and control groups p = 0.000. This shows that there is a significant difference between the difference in sensory function values ​​between the intervention groups and control.

Table 5 Analysis of the sensory repair time of the intervention group

*One Way ANOVA Statistic

The analysis of the time of sensory improvement stated that there was no effect of day on sensory function in the intervention group with p = 0.079.

Processing and analysis of data regarding the effectiveness of acupressure on the function and timing of sensory improvement can be concluded as follows: