Indonesian Journal of Physical Medicine and Rehabilitation

Pearls Beyond The Elderly

Ellyana Sungkar

The term elderly refers to those who are 65 years old or older. The number of older people will increase in every country. As people get older, some changes will happen including mind, body, and their view of the world. The brain will become less efficient at creating memories, decreasing physical activities and posture. However, aging is not a lost youth, but a new stage of opportunity and strength. Therefore, some compensation are needed, such as increasing awareness about physical exercise and prevention of the negative impacts of aging.

Association of Physical Activity and Physical Performance with Sarcopenia in Elderly Obese Patient in Community

Annisa Budi Prayuni — 2022-12-28

Introduction: Sarcopenic obesity (SO) is a condition in which sarcopenia and obesity occur simultaneously. This condition will lead to risk of higher morbidity, mortality, and reduced quality of life. This study aimed to examine the proportion of SO patients in community and investigate the association between physical activity level and physical performance with sarcopenia in elderly obese patient in community

Methods: An analytic observation cross-sectional study with consecutive sampling. Inclusion criteria included subjects with age ≥ 60 years old, body mass index ≥ 25 Kg / m², able to walk at least 10 meters, and has a good cognitive function. Subjects with pacemaker, have metal implants, history of cancer, acute cardiovascular and respiratory disorders, deformities, or pain in extremities and receive regular therapeutic exercise were excluded from this research. Measurement of physical activity level using Physical Activity Scale for Elderly (PASE) questionnaire and physical performance using 6meter walking speed test and timed up and go test (TUG). Sarcopenia is based on criteria from Asian Working Group of Sarcopenia 2019 with body composition assessment using Bioelectric Impedance Analysis (BIA)

Results: There were 119 subjects in this study. Proportion of sarcopenia obesity in all subjects was 23,5% with 71,4% was female. The results showed that there was no significant association on physical activity level (p > 0,05) and a significant association on walking speed and TUG test (p < 0,05).

Conclusion: This research concluded that there was a significant association between physical performance with sarcopenia in elderly obese patient in the community.

Correlation Between Body Mass Index and Frailty on Activities of Daily Living among Elderly in The Nursing Home

Zuhal Darwis — 2022-12-28

Introduction: High Body Mass Index (BMI) is associated with mortality and morbidity in the elderly. High BMI is also associated with limited physical function. Another issue faced by the elderly is frailty, frailty is associated with decreased exercise capacity, reduced muscle strength, and decreased bone mass leading to adverse health outcomes such as disability, falls, hospitalization and death. Physical frailty is highly prevalent for the elderly who is living in nursing homes. The aim of this study is to determine the association between body mass index and frailty to Activities of Daily Living (ADL) among the elderly in the nursing home.

Methods: This study was conducted in 3 nursing homes in South Sulawesi. BMI and frailty were measured. Frailty was assessed by Edmonton Frail Scale (EFS), while activities of daily living was examined by Barthel Index (BI)

Results: There were 30 participants, consisting of males 10 (33.3%), and females 20 (66.7%) with a median age of 72 years old, included in this study. The median BMI result was 20.4 (13.3-29.2). The median result of EFS was 5.5 (2-12). The median BI result was 92.5 (45-100). BMI have insignificant correlation with ADL (r = 0.196; p = 0.298), frailty have negative strong correlation with ADL (r = -0.738; p=0.000).

Conclusion: There was no significant correlation between BMI and ADL. Otherwise, frailty and ADL have a strong correlation among the elderly in the nursing home.

Fatigue, Sleepiness, Anxiety-Depression Score, Calories And BDNF Serum Level, Quality Of Life Alteration During Holy Ramadhan Month

Irma Ruslina Defi — 2022-12-28

Introduction: Ramadhan fasting increases mental and physical health. The study aims to evaluate the effect of Ramadhan fasting on fatigue, sleepiness, depression and anxiety mood, quality of life (QoL), and Brain-derived neurotrophic factor (BDNF) serum level.

Methods: Twenty participants are included in the fasting group (FG), and nineteen participants are included in the non-fasting group (NFG). Fatigue severity scales (FSS), fatigue VAS, Epworth sleepiness scale (ESS), hospital depression and anxiety score (HADS), Beck depression inventory (BDI)-II, Short form 12 (SF-12), and BDNF in both groups were assessed at five-time points: one week before Ramadhan (T1), in the middle of Ramadhan (T2), the last days of Ramadhan (T3), one week after Ramadhan fasting (T4) two weeks after Ramadhan (T5).

Results: We found no significant differences across the time points between FG and NFG groups in all variables (p>0.05). There is a significant correlation between fatigue VAS with BDNF serum levels (r > r table), SF-12 PCS (r>r table) with BDNF, SF-12 MCS (r>r table). There is no correlation between fatigue, depression and anxiety intensity, sleepiness, QoL, BDI-II, and BDNF serum levels with calories, BDI-II, and BDNF of fasting group in Ramadhan (r < r table).

Conclusions: Ramadhan fasting has positive effects on fatigue and mood. Ramadhan fasting does not have a significant effect on sleepiness, physical exercise, and calories consumed. Fatigue VAS and SF-12 PCS can replace the serum BDNF.

Open Versus Closed Kinetic Chain Exercise: a Comparison of Walking Capacity in Chronic Post-Stroke Phase

Kukuh Wibisono — 2022-12-28

Introduction: The chronic post-stroke phase is often accompanied by various sensory, cognitive, motoric, coordination, and balance impairments. Decreased strength and motoric control contribute to walking capacity in patients with stroke. This study aims to evaluate the effect of Open Kinetic Chain (OKC) vs Closed Kinetic Chain (CKC) exercise on walking capacity in the chronic post-stroke phase. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) were reported to improve functional mobility and balance in the chronic post-stroke phase. However, there is a lack of studies emphasizing the effect of OKC and CKC on walking capacity.

Methods: This study is a quasi-experimental pre- and post-controlled trial group design. Twenty subjects were randomized into two groups of equal size: the CKC group (n=10) and the OKC group (n=10). There was one subject from each group who dropped out at the end of the study. CKC and OKC groups were trained for 6 weeks. The walking capacity was measured with 2 Minutes Walking Test (2WMT).

Results: 2WMT results showed improvement in both groups after 6 weeks of intervention, 56,17 ± 10,95 ± to 57,43 ± 11,29 in CKC group (p<0.001) and 57,04 ± 8,58 to 58,19 ± 8,77 in OKC group (p<0.002).

Conclusion: CKC and OKC exercise significantly improve the 2WMT results after 6 weeks of intervention.

Keywords: Chronic post-stroke phase, walking capacity, open kinetic chain exercise, closed kinetic chain exercise

Stigma and Prosthetic Rehabillitation Chalange for Leprosy Survivor in Pandemic Situation

Melinda Harini — 2022-12-28

Indonesia ranks third in terms of countries with the highest number of leprosy in the world. This fact hasn't changed since 20 years ago. This shows the magnitude of leprosy management problems, both at the world level and national level. These problems range from the problem of finding new cases, continuity of the provision of various drug regimens, and control of the spread. In addition to problems related to the detection and handling of new cases, there are also problems in leprosy survivors. Survivors generally have disabilities due to the disease. The disability can continue to be aggravated over time, even though leprosy itself has healed long since. These disabilities vary from numbness, paralysis, shortened and claw-like fingers on the hands and feet, wounds resulting in amputations of the nose, ears, fingers and limbs. Such problems require a complete and continues management. Meanwhile, the management of leprosy, both in patients and survivors, has challenges both in terms of medical, policy, financing, and culture. Not to mention the challenges related to low socialistism, not many Indonesians know the problem of leprosy, especially knowing the magnitude of the problem. Pandemic conditions make things worse. This case report will explain the journey of leprosy survivor who has been amputated and has rehabilitation related to the maintenance and replacement of leg prosthetic in pandemic situation. It will describe the stigma, medical, and socioeconomic challenges that he has to go through. This case report is expected to be an inspiration in improving public, academics, policy makers, and stakeholder awareness, related to leprosy handling problems in Indonesia, both problems for patient and survivors. Thus, it is ultimately expected to reduce the level of disability, promote equal rights for people with disabilities, and support the realization of leprosy elimination nationally and internationally.

Dysphagia in Frail Elderly

Vina Megitasari — 2022-12-28

Effective and safe swallowing is one of the basic needs for human survival. Dysphagia or swallowing disorders often occur in the elderly and increase with age. Patients often do not complain of dysphagia and compensate by modifying the texture of the food. Frailty is associated with an increased prevalence of dysphagia. Difficulty of chewing, formation and positioning bolus are associated with dysphagia. In addition, dysphagia can cause weakness because there is a disturbance due to decrease nutritional status, muscle function, and can cause recurrent aspiration pneumonia. Frailty and dysphagia can be described as a cycle and affect each other. Several interventions were carried out to overcome dysphagia, either compensatory, rehabilitative, or a combination of both.