ENGLISH PAPER

NEUROLOGY, STROKE, MEDULA SPINALIS

NAMA : NESI PINARI

NIM : PO7220118 1465

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN TANJUNGPINANG

PROGRAM STUDI D-III KEPERAWATAN

2021
 BAB I

PENDAHULUAN

1.1 Stroke

Stroke is a sudden neurological disorder that occurs due to restriction or

stopping of blood flow through the arterial supply system of the brain (Price &
Wilson, 2006). Stroke is also defined as an abnormality in brain function that
occurs suddenly, caused by disturbances in the blood circulation of the brain and
can happen to anyone at any time (Musttaqin, 2008). Stroke is the leading cause
of disability and is the third leading cause of death in the world after heart disease
and cancer. In the world, 15 million people suffer a stroke every year, in the
United States there are about 780,000 new strokes or 3.4 per 100 thousand
population, while in Singapore 55 per 100 thousand population and in Thailand 11
per 100 thousand population (Elkind, 2010) in the Shah. (2011).

National data in Indonesia shows stroke is the leading cause of death, namely
15.4% (Soertidewi, 2011) in Shah (2011). The prevalence of stroke in Indonesia
based on basic health research (Riskesdas) in 2007 was eight per thousand
population or 0.8%. Of the total number of stroke sufferers in Indonesia, around
2.5% or 250 thousand people died and the rest were mild or severely disabled so
that in 2020 it is estimated that 7.6 million people will die from a stroke.
The increase in the stroke rate in Indonesia is estimated to be related to an
increase in the incidence of stroke risk factors. Factors found to be at risk for
stroke are diabetes mellitus, mental health disorders, hypertension, smoking and
abnormal obesity. Stroke is divided into two categories, namely hemorrhagic
stroke and ischemic stroke or non hemorrhagic stroke. Hemorrhagic stroke is a
stroke due to a rupture of a blood vessel, which prevents normal blood flow and
blood seeps into an area of the brain and damages it (Pudiastuti, 2011). Non-
hemorrhagic stroke is a cerebral blood circulation disorder due to blockage of
blood vessels without bleeding occurring, most of the patients or 83% had non-
hemorrhagic strokes (Wiwit, 2010).
From the data taken at BRSU Tabanan, there were 275 people suffering from
strokes in 2010, consisting of 225 cases (82%) non-hemorrhagic strokes and 50
cases (18%) hemorrhagic strokes. Stroke patients treated in 2011 were 308 people
consisting of 218 non-hemorrhagic strokes (71%) and 90 hemorrhagic strokes
(29%). In the HCU room, 344 patients were treated in 2012, consisting of 188
people with non-hemorrhagic strokes and 156 people with hemorrhagic strokes. In
2013 until the end of August, there were 239 stroke patients consisting of 86
people (36%) hemorrhagic stroke and 153 people (64%) non hemorrhagic stroke.
The recovery of stroke patients depends on several elements, namely the number
and location of the damaged brain, the patient's general health, personality and
emotional condition of the patient. Likewise, support from family and friends and
the most important thing is the treatment they receive (Pudiastuti, 2011). What is
most feared by stroke sufferers is that almost always sufferers who have a stroke
will experience disabilities, so that it can change someone who was strong and
looks fearless to become weak and always depends on the help of others.
According to Sharley (2003) in Sembiring (2010) states that in terms of
psychology, stroke can make sufferers feel inferior and useless due to disabilities.
The results of the observations that have been made, found that patients who are
hospitalized often experience stress and psychological problems related to their
illnesses which can cause patients to experience anxiety. Anxiety is the first
reaction that appears or is felt by the patient and his family when the patient has to
be suddenly hospitalized. Researchers estimate that between 50 and 80 percent of
all disease cases that occur are directly related to anxiety (Prasetyo, 2011).
Anxiety is a subjective experience of the individual and cannot be directly
observed and is an emotional state without a specific subject (Suliswati, 2005).
The social and emotional consequences of brain injury require extra attention in
the rehabilitation process, one of which is by reducing anxiety levels and
changing feelings of distress due to traumatic changes in the quality of life.
Directorate of Nursing Services Directorate General of the Ministry of Health RI
in 2008, listed anxiety as an indicator of the quality of clinical nursing services.
The incident of anxiety can affect the patient's health status because it can cause
discomfort, increase the number of hospitalization days and the patient can injure
himself, others and the environment. The impact of anxiety on the nervous system
as a neurotransmitter, there is an increase in the secretion of norepinephrine,
serotonin 4 and gamma aminobutyric acid, resulting in disturbances; a) physical
(physiology), among others; heart rate, body temperature, nausea, vomiting,
diarrhea, headaches and loss of appetite, b) symptoms of behavioral disorders,
among others; increased or decreased psychomotor activity, refusal, harsh speech,
difficulty sleeping and strange movements, c) mental symptoms, among others;
lack of concentration, jumping thoughts, loss of perceptual abilities, memory loss,
phobias, illusions and hallucinations. Anxiety about disability and death in stroke
patients can result in disruption of the treatment and rehabilitation process.
Based on the results of a preliminary study in August 2013 in the HCU Room
BRSU Tabanan, 34% of the treated patients experienced anxiety, both mild and
moderate anxiety. Symptoms of anxiety shown by the patient include the patient
complaining of anxiety and fear, sleep disturbances, loss of appetite, the patient
feels tight, increased heart rate and blood pressure, the patient looks restless, the
face is tense, sweats easily, refuses, speaks harshly and lacks concentration. .
So far, the provision of standard therapy for stroke and rehabilitation is more
aimed at improving the functional ability of stroke sufferers who experience
neurological deficits and can reduce losses due to prolonged treatment. Giving
sedatives to anxious patients, such as antidepressants, antihistamines,
benzodiazepines have side effects, namely dependence and neurological disorders
when given for a long time. Other treatments carried out in overcoming anxiety
disorders include 5 giving psychotherapy such as Cognitive Behavioral Therapy
(CBT) is a psychotherapy approach with talk that aims to solve problems about
dysfunctional emotions, behavior and cognition through oriented and systematic
procedures in these days, helping patients identify thoughts that contribute to
anxiety but this method usually takes months or even years. Music therapy is a
therapeutic modality in dealing with anxiety which is currently being used by
health professionals. Music therapy is the use of music and / or musical elements
(sound, rhythm, melody and harmony) by a music therapist who has met the
qualifications, with clients or groups in the process of building communication,
improving interpersonal relationships, learning, increasing mobility, expressing
expressions, organizing themselves and to achieve other therapeutic goals
(Djohan, 2006).
Music therapy is a universal therapeutic tool, easily accepted by the hearing
organs and then through the auditory nerve channeled to the limbic system, the
part of the brain that processes emotions. So music therapy itself is the use of
music as a therapeutic tool to help patients recover physically and psychologically
from various medical conditions, including strokes.
Music is a form of complementary therapy (Syah, 2011). Recent research shows
that music-based therapy in stroke patients in addition to improving motor
function associated with improved cortical connections, can also provide positive
emotional effects, improve mood / mood and cognitive function and reduce
stress / anxiety (Esi RS, 2012) . Research conducted by Forsblom A, et al, (2009)
shows that listening to music can be done during the acute phase of stroke
recovery, where using music with standard therapy in acute stroke patients can
have a positive emotional effect and appear to be more cooperative in running a
rehabilitation program than control group. During the acute phase, improvements
in mood, emotions, social interactions and faster recovery were found (Tamaino
CM, 2009) in Esi RS (2012).
According to Mucci (2004), the choice of music is very important in providing a
relaxing effect on patients experiencing stress and anxiety. The music chosen
should be simple, soothing and have a regular tempo. The types of music that are
not recommended are pop, disco, rock and roll and loud music (anapestic beat,
which is two short beats, one long beat and then pause), which are rhythms that
are opposite to the rhythm of the heart. Soft and regular music such as
instrumental and classical music is music that is often used for music therapy
(Potter, 2005) as quoted by Antonie (2013).
Relaxation music is music that is simple, calming and has a regular tempo that can
be used as a way to deal with stress, anxiety and can cause a relaxed state in a
person. The best relaxation music is instrumental music, natural music around or
mediative music (Mucci, 2004). Listening to instrumental music can help
someone relax and concentrate, where this music is universal because there are no
lyrics, so we don't need to interpret something (Anthonie, 2013). Research
conducted by Windari (2012) at Sanglah General Hospital states that instrumental
relaxation music therapy can reduce anxiety levels in patients undergoing
hemodialysis therapy. From the results of a preliminary study conducted in the
HCU room of BRSU Tabanan in August 2013, of the nine people who
experienced anxiety after listening to several types of music, six people chose the
type of instrumental relaxation music, the rest chose the gayatri mantras and
classical music. The type of instrumental music most patients liked was rindik
music. Music that suits the patient's taste affects the limbic system and autonomic
nerves, creates a relaxed, safe and pleasant atmosphere so as to stimulate the
reward center and release of chemical substrates gamma amino butyric acid
(GABA), enkephalin and beta endorphins which will eliminate neurotransmitters
of pain and anxiety so that create calm and improve the patient's mood (Prasetyo,
2005).

1.2 HEAD TRAUMA

Head trauma is predicted to become the third largest killer in developing

countries by 2020. The number of head injury cases in the United States reaches
1.7 million cases annually. Of these, 52,000 people died, of which 10% died
before arriving at the hospital. Of the total head injury patients who arrived at the
hospital, 80% were classified as mild head injury (CKR), 10% moderate head
injury (CKS), and 10% severe head injury (CKB) (CDC, 2010). The head has not
been recorded properly, but the data obtained from the Cipto Mangunkusumo
Hospital Jakarta, of the total inpatients, there are 60% -70% with CKR, 15% -20%
CKS, and about 10% with CKB, while the highest mortality rate reached 35%
-50% due to CKB, 5% -10% CKS, while for CKR no one died (PERDOSI, 2009).
In Sanglah General Hospital, Denpasar, the annual incidence of head injury is
over 2000 cases, of which 30% are moderate and severe head injury patients (IRD
Sanglah Register, 2011).
Moderate head injury is a head injury with a Glasgow coma scale of 9-
12 (Turner, 1996; Choi, et al, 1991). Pathophysiologically, head injury occurs as a
direct result of external mechanical effects on the brain (2 primary brain injuries)
and due to metabolic processes, brain cell ion hemostasis, intracranial
hemodynamics, compartment of CSF that occurs after trauma (secondary brain
injury). Symptoms in moderate head injury patients may be confused or
somnolent but still be able to follow simple commands. Patients with head trauma
need to make the diagnosis as little as possible (early detection) of worsening
factors, so that appropriate, accurate and systematic action and therapy can be
carried out immediately in order to avoid complications that will occur and
produce a good prognosis (Arifin, 2002 ; Golden, et al, 2013; Teuntje, et al,
2011).
In general, the prognosis for moderate head injury is good, with about
90% of sufferers experiencing improvement. Although primary head injury cannot
be intervened further, it has a better prognosis than secondary head injury.
Therefore secondary head injury requires assessment of the factors that affect
deterioration and treatment as early as possible to prevent further damage from the
primary injury (Thurman, et al, 2003).
Several factors that influence the outcome of head injury patients can be measured
using the Glasgow Outcome Scale Extended (GOSE) which is divided into eight
categories, namely death, vegetative state, lower severe disability, upper severe
disability, lower moderate disability, upper moderate disability, lower good
recovery. , and upper good recovery. The outcome of this outcome is influenced
by many indicators including demographic indicators (age, sex), clinical
indicators (initial GCS, pupillary reflex, extracranial factors such as hypotension,
hypoxia, physiostatic physiological disorders, operating time, length of treatment),
and other indicators based on Computerized Tomography Scan characteristics
(epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage,
brain swelling, mid line shift deviation) (Chantal, et al, 2005).
This combination of prognostic factors will provide a solid basis for estimating
the probability of the GOSE (Glascow Outcome Scale Extended) category being
unfavorable and favorable in moderate head injury patients within 3 months of
follow-up (Gordon, et al, 2007).
To date, a scoring system to determine the prognostic assessment of head injury
patients is not in place, so we are interested in investigating risk factors that affect
prognostic and outcome in moderate head injury patients.

1.3 MEDULA SPINALIS

The spinal cord or spinal cord is a thin nerve that is an extension of the
central nervous system of the brain and encloses and is protected by the spine. or
nerve tissue shaped like white wires that extend from the medulla oblongata down
through the spine and branch to various parts of the body.
The spinal cord is the main part of the central nervous system that conducts
sensory and motor nerve impulses to and from the brain. Also called the spinal
cord or spinal cord. The location of the spinal cord, extends inside the spinal
cavity, starting from the vertebrae of the neck to the second vertebrae of the
lumbar.
Meninges membrane is useful for wrapping the spinal cord. When viewed
crosswise, the spinal cord on the outside will appear white (substance alba) and on
the inside which has a butterfly-like shape, gray (grissea substance).
Many of the axon content (neurites) in the white part which covers it is myelin.
This section functions as a conductor of impulses to the brain and from the brain
to the effectors. Then, the gray part contains nerve fibers without myelin. To
distinguish in this section there are 2 roots, namely dorsal or posterior roots and
ventral or anterior roots. Dorsal roots contain sensory neurons, while the ventral
roots contain motor neurons.
 BAB II

PEMBAHASAN

2.1 Currently in the HCU BRSU Tabanan Room in handling anxiety in patients,
it is only limited to standard procedures such as giving anti-anxiety drugs and
terapeuric communication, and has not implemented instrumental relaxation
music therapy, so the authors are interested in conducting research on the effect of
instrumental relaxation music therapy on levels anxiety in stroke patients in the
HCU BRSU Tabanan room.
a. Causes of Stroke
Based on the cause, there are two types of stroke, namely:
. Ischemic stroke
An ischemic stroke occurs when the arteries that carry blood and oxygen to the
brain become narrowed, causing a marked reduction in blood flow to the brain.
This condition is also known as ischemia. Ischemic strokes can be further divided
into 2 types, thrombotic strokes and embolic strokes.
2. Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel in the brain bursts causing
bleeding. Bleeding in the brain can be triggered by several conditions that affect
the blood vessels. These conditions include uncontrolled hypertension, weakening
of blood vessel walls, and treatment with blood thinners. There are two types of
hemorrhagic strokes, namely intracerebral and subarachnoid hemorrhages.

b. Stroke Symptoms
Each part of the brain controls different parts of the body, so the symptoms of a
stroke depend on which part of the brain is affected and the degree of damage.
That is why the symptoms or signs of stroke can vary from person to person.
However, most strokes appear suddenly. There are three main symptoms of a
stroke that are easy to recognize, namely:
1. One side of the face will appear drooping and unable to smile due to drooping
mouth or eyes.
2. Inability to lift one arm because it feels weak or numb. Not only the arm, the
leg that is on one side of the arm also experiences weakness.
3. Speech is unclear, chaotic, or even unable to speak at all even though the
patient looks conscious.
2.2 Causes of Moderate Head Trauma
Minor head trauma is generally caused by a blow to the head, which can occur
from a fall, blow, or accident. In addition, shaking as well as a violent pounding
of the head or body can trigger trauma, known as a concussion.
b. Symptoms of Moderate Head Trauma
Generally, moderate head trauma has mild symptoms with a short duration, the
following symptoms are referred to:
1. Nausea or vomiting;
2. Dizziness or lightheadedness;
3. Blurred vision;
4. Dazed;
5. Looks blank;
6. Irritable or irritable;
7. Changes in sleep patterns, such as insomnia or sleeping longer than usual;
8. Ringing in the ears;
9. Feel weak or tired; and
10. Experiencing disturbed body balance.
These symptoms can occur some time after the person has suffered an injury and
can occur after several hours or several days afterward. In children who have a
concussion, the symptoms tend to be the same as those of adults, but they are
more difficult to detect, the symptoms in children are usually added by:
1. More whiny than usual or even continues to cry;
2. Changes in attitude or way of playing, for example not being interested in his
favorite toy;
3. Urring;
4. Difficulty focusing;
5. Losing balance, making it difficult to walk; and
6. Easily tired.

c. Prevention of Moderate Head Trauma

How to prevent minor head trauma, namely:
1. Using a helmet while riding a motorcycle; and
2. Wear head protection when doing sports that have a risk of accidents. Such as
when cycling, martial arts, or when doing extreme sports.

2.3 Spinal Marrow Functions

The main function of the spinal cord is the transmission of stimuli between the
periphery and the brain.
as for the functions of the spinal cord, including below:
1. Conducting impulses from receptors (senses) to the brain,
2. Conducting impulses from the brain to the receptors (senses),
3. Connecting the brain with the whole body,
4. The center of reflex motion and provides the shortest possible path of reflex
motion.
b. The Structure of the Spinal Marrow
The spinal cord is a collection of cylindrical nerves starting from the lower part of
the brain and then extending down the spinal canal. The spinal cord is divided into
several segments, each of which has a pair of nerve roots on the right and left. The
roots of the front (ventral) nerves or efferent nerves act as motor, while the roots
of the back (dorsal) nerves or afferent nerves act as sensory.

The segments of the spinal cord are grouped into several areas, in order from top
to bottom, namely:
1. Cervical (neck), consisting of 8 nerve roots.
2. Torak (chest), consisting of 12 nerve roots.
3. Lumbar (stomach), consisting of 5 nerve roots.
4. Sacrum (pelvis), consisting of 5 nerve roots.
5. Koksigeus (coccyx), consisting of 1 nerve root.
From each of these areas, nerve fibers will spread to certain parts of the body and
organs according to their level. For example, the thoracic nerve means innervating
the chest, skin, respiratory muscles, and the organs in it. And so on up to the feet.
 BAB III

PENUTUP

A. CONCLUSION

1. stroke
Stroke is a sudden neurological disorder that occurs due to restriction or stopping
of blood flow through the arterial supply system of the brain (Price & Wilson,
2006). Stroke is also defined as a sudden abnormality in brain function, caused by
a disturbance in the blood circulation of the brain.
2. Head Trauma
Head injury (head trauma) is a condition in which the structure of the head
experiences an external impact and has the potential to interfere with brain
function. Some conditions for head injuries include minor injuries, bruises to the
scalp, swelling, bleeding, dislocations, skull fractures and concussions, depending
on the mechanism of impact and the severity of the injury.
3. Spinal cord
The spinal cord or spinal cord is a thin nerve which is an extension of the central
nervous system of the brain and is enclosed and protected by bones.
back. or nerve tissue shaped like white wires that extend from the medulla
oblongata down through the spine and branch to various parts of the body.

B. Suggestions
1. for nursing services
Nurses can provide health education for families regarding the above diseases,
nurses are also expected to help patients and families in increasing patient
motivation to recover.
2. for families
 Families need to increase motivation for post-stroke patients to be more
independent with supervision and not give a negative effect of dependence on
self-care.
3. for the community
The community can increase their sense of care by providing support for
discussions and questions and answers with patients.
Kecemasan : anxiety

Komunikasi : communication

Penelitian : research

Oksigen : oxygen

Penurunan : decrease

Pengobatan : treatment

Pendarahan : bleeding

Otak : brain

Saraf : nerves

Trauma : trauma

Keseimbangan tubuh : body balance

Gegar otak : cocusions

Anak : childern

Insomnia : insomnia

Fungsi : function

Sumsum tulang : bone marrow

Saraf punggung : dorsal nervus

Tulang belakang : spin

Gerak reflek : reflex motion

Transmisi : transmision