Task-Oriented Training dan Virtual Reality dalam meningkatkan Neuronal Plasticity Pasien Stroke dengan Diabetes Militus: Literatur Review
Task-Oriented Training and Virtual Reality in Improving Neuronal Plasticityin Stroke Patients with Diabetes Mellitus: A Literature Review
Abstract
Stroke pada pasien Diabetes Melitus (DM) sering menimbulkan gangguan fungsi motorik yang lebih berat akibat penurunan kapasitas neuronal plasticity. Hiperglikemia kronis menghambat proses neuroregenerasi dan memperlambat pemulihan neurologis. Pendekatan fisioterapi modern seperti Task-Oriented Training (TOT) dan Virtual Reality (VR) terbukti mampu meningkatkan reorganisasi neuronal melalui stimulasi sensorimotor berulang. Literatur review ini bertujuan menganalisis pengaruh fisioterapi Task-Oriented Training dan Virtual Reality terhadap neuronal plasticity pada pasien stroke dengan DM berdasarkan bukti ilmiah terkini periode tahun 2020–2025. Pencarian literatur dilakukan melalui PubMed, ScienceDirect, SpringerLink, dan Garuda (SINTA) menggunakan kata kunci Task-Oriented Training, Virtual Reality, Neuronal Plasticity, Stroke, dan Diabetes Mellitus. Artikel yang diinklusi adalah penelitian eksperimental, quasi-eksperimental, dan randomized controlled trial (RCT) yang menilai efek TOT dan VR terhadap fungsi motorik dan biomarker neuroplastisitas. Sepuluh artikel memenuhi kriteria inklusi. TOT meningkatkan aktivasi korteks motorik melalui latihan berbasis tugas yang berulang, sedangkan VR menstimulasi area premotor dan cerebellum melalui umpan balik visual-interaktif. Kombinasi keduanya meningkatkan kadar Brain-Derived Neurotrophic Factor (BDNF), aktivasi kortikal pada fMRI, serta skor Fugl-Meyer Assessment. Fisioterapi berbasis Task-Oriented Training dan Virtual Reality berpengaruh positif terhadap peningkatan neuronal plasticity pada pasien stroke dengan Diabetes Melitus, sehingga keduanya dapat dijadikan pendekatan rehabilitasi efektif dan berbasis bukti.
References
Ergul, A., Li, W., Elgebaly, M. M., Bruno, A., & Fagan, S. C. (2020). Diabetes-induced cerebrovascular remodeling and stroke: Implications for pharmacotherapy. Pharmacological Research, 159, 104934.
Hao, Y., Xie, H., Harp, K., & Zhao, Y. (2022). Effects of Virtual Reality Intervention on Neural Plasticity in Stroke Rehabilitation: A Systematic Review. Archives of Physical Medicine and Rehabilitation, 103(4), 739–749.
Lang, C. E., Lohse, K. R., & Birkenmeier, R. L. (2022). Dose and timing in neurorehabilitation: Optimizing motor recovery after stroke. Current Opinion in Neurology, 35(6), 1–9.
Laver, K. E., George, S., Thomas, S., Deutsch, J. E., & Crotty, M. (2020). Virtual reality for stroke rehabilitation. Cochrane Database of Systematic Reviews, (11), CD008349.
Lin, Y. J., Chang, Y. J., Chen, S. F., & Hsu, M. J. (2021). Combined task-oriented and virtual reality training improves cortical reorganization and motor recovery after stroke: A randomized controlled trial. Frontiers in Neurology, 12, 674–681.
Lin, Y. J., Wu, C. Y., Chen, C. L., & Hsu, M. J. (2023). The synergistic effects of task-oriented and virtual reality training on cortical activation and balance in stroke with diabetes mellitus: A pilot study. Neurorehabilitation and Neural Repair, 37(2), 95–105.
Mang, C. S., Campbell, K. L., Ross, C. J. D., & Boyd, L. A. (2020). Promoting neuroplasticity for motor rehabilitation after stroke: Considering the effects of aerobic exercise and genetic variation on brain-derived neurotrophic factor. Physical Therapy, 100(1), 81–90.
Nishimura, Y., Kobayashi, N., & Fujiwara, T. (2020). Neurophysiological mechanisms underlying task-oriented training in stroke rehabilitation. Frontiers in Human Neuroscience, 14, 125.
Nudo, R. J. (2019). Recovery after brain injury: Mechanisms and principles. Frontiers in Human Neuroscience, 13, 120.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., & Hoffmann, T. C. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71.
Pan, A., Zhang, C., Li, H., & Wang, X. (2012). Diabetes mellitus impairs cortical plasticity and functional recovery following ischemic stroke. Journal of Neuroscience, 32(22), 7826–7837.
Srikanth, V., Thrift, A. G., Saposnik, G., & Churilov, L. (2020). Type 2 diabetes mellitus impedes neuroplasticity and quality of life after stroke: A prospective cohort study. Journal of Family Medicine and Primary Care, 9(8), 3961–3968.
Sweetnam, D. A., Holmes, A., Tennant, K. A., & Brown, C. E. (2016). Illuminating the effects of stroke on the diabetic brain. Diabetes, 65(7), 1779–1792.
Winstein, C. J., Lewthwaite, R., Blanton, S. R., Wolf, S. L., & Schweighofer, N. (2019). Task-oriented rehabilitation to promote upper extremity recovery after stroke: A systematic review. Stroke, 50(3), e51–e59.
The use of the article will be governed by the Creative Commons Attribution license as currently displayed on Creative Commons Attribution 4.0 International License.
Author’s Warranties
The author warrants that the article is original, written by stated author(s), has not been published before, contains no unlawful statements, does not infringe the rights of others, is subject to copyright that is vested exclusively in the author and free of any third party rights, and that any necessary written permissions to quote from other sources have been obtained by the author(s).
User Rights
JFR's spirit is to disseminate articles published are as free as possible. Under the Creative Commons license, JFR permits users to copy, distribute, display, and perform the work. Users will also need to attribute authors and JFR on distributing works in the journal.
Rights of Authors
Authors retain all their rights to the published works, such as (but not limited to) the following rights;
- Copyright and other proprietary rights relating to the article, such as patent rights,
- The right to use the substance of the article in own future works, including lectures and books,
- The right to reproduce the article for own purposes,
- The right to self-archive the article
Co-Authorship
If the article was jointly prepared by other authors, any authors submitting the manuscript warrants that he/she has been authorized by all co-authors to be agreed on this copyright and license notice (agreement) on their behalf, and agrees to inform his/her co-authors of the terms of this policy. JFR will not be held liable for anything that may arise due to the author(s) internal dispute. JFR will only communicate with the corresponding author.
Miscellaneous
JFR will publish the article (or have it published) in the journal if the article’s editorial process is successfully completed. JFR's editors may modify the article to a style of punctuation, spelling, capitalization, referencing and usage that deems appropriate. The author acknowledges that the article may be published so that it will be publicly accessible and such access will be free of charge for the readers as mentioned in point 3.
