How to cite:
Gunawan, Kliwon. (2022). The Effectiveness of Articulation Therapy
through Telepractice for Children with Cerebral Palsy Inclusive
Schools. Journal Eduvest. Vol 2(2): 716-723
E-ISSN:
2775-3727
Published by:
https://greenpublisher.id/
Eduvest – Journal of Universal Studies
Volume 2 Number 4, April, 2022
p- ISSN 2775-3735- e-ISSN 2775-3727
THE EFFECTIVENESS OF ARTICULATION THERAPY
THROUGH TELEPRACTICE FOR CHILDREN WITH
CEREBRAL PALSY INCLUSIVE SCHOOLS
Gunawan, Kliwon
Health Polytechnic of Surakarta, Department of Speech Therapy, Republic of
Indonesia’s Ministry of Health, Indonesia
Email: gunawantwgun@gmail.com, [email protected]
ARTICLE INFO ABSTRACT
Received:
March, 26
th
2022
Revised:
April, 16
th
2022
Approved:
April, 18
th
2022
The purpose of this study is providing information on the
effectiveness of articulation therapy through telepractice for
children with cerebral palsy at inclusive schools in Surakarta.
This study uses the survey method, aiming to find information
that will be used to solve problems and not to test hypotheses.
The subjects of this study were all children with cerebral palsy
in inclusive schools in Surakarta. The instrument in this study is
in the form of Articulation Test Guidelines on the consonant /r/
followed by vowel sounds [ /a/, /i/, /u/e/, /e/ and /o] initial,
middle and final positions in the form of words with the help of
pictures. Therapeutic tools used in intervening with children
are computers, cellphones with video calls. This research is
required to be one of the models of Intervention/Management
of Articulation Therapy through Telepractice for Children with
Cerebral Palsy in Inclusive Schools. Based on the results of the
analysis using the marginal homogeneity test, a p value of
0.031 (p < 0.05) statistically showed that there was a
difference between before and after telepractice articulation
therapy for cerebral palsy students in inclusive schools in
Surakarta.
KEYWORDS
Effectiveness, Articulation Therapy, Telepractice, Cerebral
Palsy
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
Gunawan, Kliwon
The Effectiveness of Articulation Therapy through Telepractice for Children with
Cerebral Palsy Inclusive Schools 717
INTRODUCTION
To respond to the health crisis related to access, distance and human resources of
speech therapists in Indonesia, we need a way that can overcome these problems effectively
and efficiently. In the 21st century, the world is faced with the emergence of new
technology in the health sector that allows speech therapists to practice in a virtual space,
without compromising the essence of health care itself, namely through Speech Therapy
Telemedicine. The strategy adopted is an unusual model of health care, in which between
speech therapists and patients, and speech therapists and the speech therapist profession
can not meet directly but are connected with information and communication technology
called Speech Therapy Telemedicine.
The Telemedicine program has been planned in the Strategic Plan of the Ministry of
Health of the Republic of Indonesia related to the legal basis as stipulated in the Law of the
Republic of Indonesia No. 8 of 2016 concerning Persons with Disabilities Article 63
Paragraph 4. Referral as referred to in paragraph (3) can be made in the form of sending
patients and specimens, and via telemedicine. Regulation of the Minister of Health of the
Republic of Indonesia No. 20 of 2019 concerning Telemedicine Services in Health Service
Facilities. Telepractice is defined as a management, coordination and delivery of care and
services provided through information technology and telecommunications (Mang‐Benza
& Hunsberger, 2020). The media used in telepractice therapy are: cell phone, WA, internet,
video and audio conferencing and computer information systems.
In accordance with the Ministry of Health's plan to implement e-Health which
includes Telemedicine, Nursing telepractice is a form of management, coordination and
delivery in providing care and services through information technology and
telecommunications as well as helping clients and families to actively participate in speech
therapy, especially for mild and moderate conditions. accelerate the success of therapy.
This system allows therapists to provide accurate information and support online (Stoll,
Kubendran, & Cohen, 2018). One of the steps in supporting the smooth implementation in
Indonesia with the characteristics of the archipelago and to be able to facilitate and improve
the quality of speech therapy services.
In this study, researchers will provide information on one of the management
services in emergency conditions and human resources. The number of cases of
communication disorders whose competence must be from a graduate of higher education,
namely diploma 4 or a bachelor of speech therapy, as well as disaster emergencies and
minimal human resources, approximately 1400 people throughout Indonesia, not all
provinces has speech therapists. Researchers are interested in taking the title "Effectiveness
of Articulation Therapy through Telepractice for Children with Cerebral Palsy Inclusive
Schools in Surakarta".
RESEARCH METHOD
This study uses the survey method, aiming to find information that will be used to
solve problems and not to test hypotheses. The study was conducted from March to
September 2021 at the Surakarta Inclusion School (Al Majid Surakarta Foundation) as
follows: Cerebral Palsy Children aged 6-12 years boys and girls
Meanwhile, the research process carried out by researchers can be completed in 9
months, starting from February to October 2021. Research conducted using samples to
represent the existing population. Population refers to the whole group of Cerebral Palsy
aged 6 to 12 years, events/things of interest to the researcher.
Eduvest – Journal of Universal Studies
Volume 2 Number 4, April 2022
718 http://eduvest.greenvest.co.id
The population is the entire research subject or object under study (Notoatmodjo,
2012). The population of this study was all children with cerebral palsy in inclusive schools
in Surakarta (Al Majid Foundation Surakarta). The sample is part of the overall object
under study and is considered to represent the entire population (Damayanti, 2022). In this
study, the determination of the sample used a purposive sampling technique, which means
it was determined by considering the research objectives based on predetermined criteria.
The criteria applied to the sample of this study include:
1. Cerebral Palsy Boys and Girls
2. 6-12 years old because normal children aged 4-8 years are able to pronounce the
consonant /r/: Templin 1978, and Gunawan, HS. 2021.
In this study, the researcher determined the research sample as many as 4 students.
male 3 students and female 1 student, because the items for therapy are 18
items/instruments
The variables of this study consisted of variables consisting of independent variables
and dependent variables.
A. Independent variable: Articulation Therapy
B. Dependent variable: Telepractice Children with Cerebral Palsy Age 6-12 Years
To test young children, a picture has been prepared to elicit spontaneous speech if
possible from the desired stimulus word. In testing a young child, tell him that you have
several pictures and you want him to name each one. Show and point to each picture in its
order. Most children will continue to name the pictures with some encouragement.
Sometimes there are children who need to be asked about each picture. In addition to using
the question “What is this?”, for some pictures use the questions printed below the picture.
For the most part, test materials consist of simple pictures of common words so that
they can elicit spontaneous responses. However, it must be acknowledged that sometimes
it is necessary for the tester to say a word and ask the child to repeat it if all the sounds of
the speech being tested are to be obtained. If the tester has limited time or if he wants all
the utterances tested from preschoolers, it may be better for him to ask the child to repeat
the word. -word test and use the object pictures as motivation. If all pictures are used, this
procedure may use both spontaneous and artificial responses because many children will
quickly spontaneously name pictures.
RESULT AND DISCUSSION
1. Univariate Analysis
The univariate analysis aims to describe the character of each research variable. The
univariate analysis in this study was for the research variable of the articulation ability of
children with cerebral palsy at the Inclusive School in Surakarta. The data of this study
were analyzed using analytic statistics to report research results in the form of frequency
distribution or percentage (%) in each item or variable, both pre-test and post-test. The
results of the univariate analysis of each variable are as follows:
a. Pretest
The pretest was held on September 6, 2021, which aims to determine the articulation
ability of cerebral palsy students at inclusive schools in Surakarta City. The test is done by
asking children with cerebral palsy to articulate the letter /r/ which is at the beginning,
middle, and end of the letter. The results of the pretest are presented in the following table:
Gunawan, Kliwon
The Effectiveness of Articulation Therapy through Telepractice for Children with
Cerebral Palsy Inclusive Schools 719
Table 1 Articulation Ability Level of Cerebral Palsy Students before the experiment
No
Total
Persentase
1
1
25,00%
2
3
75,00%
3
0
0,00%
4
100,00%
Table 1 above shows that the articulation ability of cerebral palsy students in
inclusive schools in Surakarta City shows that the articulation ability is less than 1 student
(25.00%), the articulation ability is sufficient for 3 students (75.00%) and there are no
cerebral palsy students who have good articulation skills (0.00%). The average articulation
ability of cerebral palsy students before the experiment was 6.25 which was included in the
less category. So, in general it can be stated that the articulation ability of cerebral palsy
students before the experiment was still low.
b. Posttest
The posttest value was obtained from the total score during the implementation of 6
(six) experiments on cerebral palsy students at inclusive schools in Surakarta City.
Articulation therapy experiments with telepractice were carried out from September 6,
2021 to September 17, 2021. Telepractice articulation therapy was carried out remotely by
asking children with cerebral palsy to articulate the letter /r/ at the beginning, middle, and
end of the letter. The results of the posttest are presented in the following table:
Table 2 Articulation Ability Level of Cerebral Palsy Students before the
experiment
No
Articulation Ability
Total
Percentage
1
Not enough
1
25,00%
2
Enough
2
50,00%
3
Well
1
25,00%
Amount
4
100,00%
Table 2 above shows that the articulation ability of cerebral palsy students in
inclusive schools in Surakarta City after the experiment showed that the articulation ability
was less than 1 student (25.00%), the articulation ability was sufficient as much as 2
students (50.00%) and cerebral palsy students 1 student (25.00%). The average articulation
ability of cerebral palsy students before the experiment was 6.25 which was included in the
sufficient category. So, in general it can be stated that the articulation ability of cerebral
palsy students after getting the experiment was 7.63 in the sufficient category. When
compared to before the experiment, the post-test value has increased even though the
category has not changed much.
2. Bivariate Analysis
Bivariate analysis is used to determine the effect on two variables (Notoatmojo,
2014). In this study, a bivariate analysis was carried out to determine whether or not
telepractice articulation therapy was effective in improving the articulation ability of
cerebral palsy students at inclusive schools in Surakarta City. To determine the
significance, bivariate analysis was performed using the marginal homogeneity test with a
significance limit of 5% (0.05). Rejection of the hypothesis if p < 0.05 which means there
Eduvest – Journal of Universal Studies
Volume 2 Number 4, April 2022
720 http://eduvest.greenvest.co.id
is a difference, failure to reject the hypothesis if p > 0.05 which means there is no
difference. Analysis of the data using a computer program SPSS. In addition, when viewed
from the significance of the p value, it can be interpreted as follows:
a) Ho is rejected if p < 0.05, which means there is a difference between before and after
telepractice articulation therapy for cerebral palsy students in inclusive schools in
Surakarta City.
b) Ho is accepted if p > 0.05, which means there is no difference between before and after
telepractice articulation therapy for cerebral palsy students in inclusive schools in
Surakarta.
The results of the bivariate analysis using the marginal homogeneity test obtained
the following data:
Table 3 Bivariate Test Results
post
Total
Asymp. Sig
Not enough
Enough
Good
pre
Not enough
1
0
0
1
0,031
Enough
0
2
1
3
Total
1
2
1
4
Based on the results of the analysis using the marginal homogeneity test, a p value
of 0.031 (p < 0.05) statistically showed that there was a difference between before and after
telepractice articulation therapy for cerebral palsy students in inclusive schools in
Surakarta. So, it can be stated that telepractice articulation therapy is effective for
improving the articulation ability of cerebral palsy students at inclusive schools in
Surakarta City during the pandemic.
Discussion
1. Articulation Ability of Students with Cerebral Palsy Inclusive Schools in Surakarta
Based on the analysis, it was found that the articulation ability of cerebral palsy
students in inclusive schools in the city of Surakarta before the experiment showed that the
articulation ability was less than 1 student (25.00%), the articulation ability was sufficient
for 3 students (75.00%) and there were no cerebral palsy students. have good articulation
skills (0.00%). The average articulation ability of cerebral palsy students before the
experiment was 6.25 which was included in the less category. the articulation ability of
cerebral palsy students in inclusive schools in Surakarta City after the experiment showed
that the articulation ability was less than 1 student (25.00%), the articulation ability was
sufficient for 2 students (50.00%) and cerebral palsy students who had good articulation
ability were as many as 1 student (25.00%). The average articulation ability of cerebral
palsy students after the experiment was 7.63 which was included in the sufficient category.
So, in general it can be stated that the articulation ability of cerebral palsy students after
getting an experiment is in the sufficient category. When compared to before the
experiment, the post-test value has increased even though there is not much change in the
category.
The limited articulation ability of children with cerebral palsy is caused by anal
cerebral palsy, which is someone who experiences difficulties in motor aspects, but
sometimes accompanied by accompanying disorders such as emotional, speech,
intelligence, and sensory disorders. Meanwhile, (Cahyanto, Yuni, & Efendi, 2021) states
that Cerebral Palsy is a form of brain injury, which is a condition that affects the control of
Gunawan, Kliwon
The Effectiveness of Articulation Therapy through Telepractice for Children with
Cerebral Palsy Inclusive Schools 721
the motor system due to a lesion in the brain or a neuromuscular disease caused by
developmental disorders or damage to parts of the brain connected to the control of motor
function.
The obstacles experienced by children with cerebral palsy are not only in their motor
skills but also in their language development. According to its function, language is a
communication tool used by a person in his association or relationship with other people.
Language is a social tool. Therefore, the use of language becomes effective since one
person needs to communicate with other people. Since a baby begins to communicate with
other people, since then language is needed. In line with the development of one's language
(infants) it begins with touching (sounds or sounds without meaning) and is followed by
one-syllable, two-syllable language, composes simple sentences and so on to socialize
using complex language according to the level of social behavior.
Children's problems in moving the muscles that process sound can be formed, one
of which has an impact on articulation disorders. Articulation is how individuals are able
to produce speech with sound or do breathing without sound through movements of the
lips, tongue, velum, and base of the esophagus. Articulation disorders in children with
cerebral palsy are a significant aspect of their interpersonal communication problems
(Satria, 2019).
2. Effectiveness of Articulation Therapy through Telepractice for Cerebral Palsy
Students in Inclusive Schools in Surakarta
Based on the results of the analysis using the marginal homogeneity test, a p value
of 0.031 (p < 0.05) statistically showed that there was a difference between before and after
telepractice articulation therapy for cerebral palsy students in inclusive schools in
Surakarta. So, it can be stated that telepractice articulation therapy is effective to improve
the articulation ability of cerebral palsy students in inclusive schools in Surakarta City. The
results of this study are in accordance with the research
Ministry of Health to implement e-Health which includes Telemedicine, and
Nursing. Telepractice is a form of management, coordination and delivery in providing
care and services through information technology and telecommunications also helps
clients and families to actively participate in speech therapy, especially for mild conditions
and accelerate the success of therapy. This system allows therapists to provide accurate
information and support online. One of the steps in supporting the smooth implementation
in Indonesia with the characteristics of the archipelago and to be able to facilitate and
improve the quality of speech therapy services.
Telepractice includes all types of speech therapy and services provided over long
distances. can be performed in various settings such as outpatient speech therapy, call
centers, hospital units, emergency departments, HR. The examples of telepractice speech
therapy are as follows: answering questions about consultation, providing information,
facilitating audio or video for consultation, providing evaluation and counseling about early
detection and early stimulation. Speech therapy uses video equipment, computers and data
to monitor the health status of clients in home, sending pictures of lesions on the camera to
get remote speech therapy (Indriati et al., 2011).
Based on the research that has been conducted on the four subjects with cerebral
palsy, the general result is that telepractice articulation therapy can improve the articulation
ability of cerebral palsy students. These results can be seen from the increasing score on
Eduvest – Journal of Universal Studies
Volume 2 Number 4, April 2022
722 http://eduvest.greenvest.co.id
each component in the articulation ability test tool. This is in accordance with the purpose
of articulation therapy expressed by Tiel (2007:327) in his book that articulation therapy is
to improve language and speech skills, especially language production by means of how
children can issue ideas that exist in the form of words, as well as expansion of language
mastery. Even though the approach is for children to be able to express various ideas in the
form of language, the imitation form will also be positively rewarded.
From the results of the research above, it can be said that telepractice articulation
therapy can improve the articulatory abilities of cerebral palsy students and reduce the
symptoms of language weakness (barriers) in children with cerebral palsy with verbal
abilities. It is possible that some people with cerebral palsy respond positively to
researchers as a motivator. In accordance with the behaviorism view that language
development is seen as a progress from random verbal expression to the actual ability to
communicate through the principle of S-R (stimulus-response) relationships. In other
words, telepractice articulation therapy is effective in optimizing the articulation ability of
children with cerebral palsy at the Inclusive School in Surakarta City.
In telepractice therapy, the role of parents is not only to look at the child's physical
health, but also to pay attention to the progress and development of physical motor (motion)
and language skills that occur in children, and to give attention and motivation to children.
Parents take a very central role in the education of their children, because parents are
the main formation of the family. The main shapers of the family are parents, so the
responsibility for education for children lies with the parents. According to (Ceka & Murati,
2016) the family is an informal education that functions as a provider or user. That is,
education in the family, will educate their children intentionally based on the ideals and
hopes for them (Morrow, 2013). The implication of this opinion is that education in the
family carried out by parents is a consequence of forming a family with lofty ideals (Sun,
2018). All parents have aspirations and hopes for the existence of their children as the next
generation who are able to be independent and live in society.
Parents with children with cerebral palsy are the main educators who are very crucial
for the development of their children. Parents, when they get their children with cerebral
palsy, there are certainly many who experience loss or hopelessness. It was also stated by
(Cleary, Taylor, Dodd, & Shields, 2019), parents who experience parenting stress are prone
to have a perceptual bias in assessing child's behavior, reactive in responding to children,
and showing a tendency to aggressive behavior. The return to the condition to accept the
condition of their child and gradually have the hope to be able to optimize their child from
a condition that is considered unable to develop is a struggle that must be carried out
gradually. For this reason, this condition is a challenge when they are motivated to act as
primary educators.
Referring to (Sumarno, 2011) that education in the family by parents as informal
education which has flexibility, wider reach, and continuity. Children with cerebral palsy
have language disorders that can be found in almost every child. Research conducted by
(Voorman, Dallmeijer, van Eck, Schuengel, & Becher, 2010) which shows that 74% of
children with cerebral palsy have difficulty in communication.
CONCLUSION
Based on the results of data analysis, this study can be concluded that articulatory
Gunawan, Kliwon
The Effectiveness of Articulation Therapy through Telepractice for Children with
Cerebral Palsy Inclusive Schools 723
therapy through the telepractice model is effective for improving articulation skills in
cerebral palsy children at inclusive schools in Surakarta City during the Covid-19
pandemic.
REFERENCES
Cahyanto, Tri, Yuni, Billy Nabil, & Efendi, Muhammad. (2021). Zonation Drives The
Abundance of Understory Exotic Plant Species in Ir. Djuanda Forest Park, West
Java. Elkawnie: Journal of Islamic Science and Technology, 7(1), 156–171.
Ceka, Ardita, & Murati, Rabije. (2016). The Role of Parents in the Education of Children.
Journal of Education and Practice, 7(5), 61–64.
Cleary, Stacey L., Taylor, Nicholas F., Dodd, Karen J., & Shields, Nora. (2019). Barriers to
and facilitators of physical activity for children with cerebral palsy in special
education. Developmental Medicine & Child Neurology, 61(12), 1408–1415.
Damayanti, Fitriani Nur. (2022). Hubungan tingkat pengetahuan dan sikap lansia dengan
keikutsertaan lansia dalam posyandu lansia di kelurahan Sembungharjo kota
Semarang.
Indriati, Etty, Swisher III, Carl C., Lepre, Christopher, Quinn, Rhonda L., Suriyanto, Rusyad
A., Hascaryo, Agus T., Grün, Rainer, Feibel, Craig S., Pobiner, Briana L., & Aubert,
Maxime. (2011). The age of the 20 meter Solo River terrace, Java, Indonesia and
the survival of Homo erectus in Asia. PloS One, 6(6), e21562.
Mang‐Benza, Carelle, & Hunsberger, Carol. (2020). Wandering identities in energy
transition discourses: Political leaders’ use of the “we” pronoun in Ontario, 2009–
2019. The Canadian Geographer/Le Géographe Canadien, 64(3), 516–529.
Morrow, Virginia. (2013). Whose values? Young people’s aspirations and experiences of
schooling in Andhra Pradesh, India. Children & Society, 27(4), 258–269.
Notoatmodjo, Soekidjo. (2012). Metodologi penelitian kesehatan.
Satria, Nova Tri. (2019). KEBERTAHANAN RITUAL LARUNG SESAJI DI TELAGA SARANGAN,
KECAMATAN PLAOSAN, KABUPATEN MAGETAN. Institut Seni Indonesia (ISI)
Surakarta.
Stoll, Katie, Kubendran, Shobana, & Cohen, Stephanie A. (2018). The past, present and
future of service delivery in genetic counseling: Keeping up in the era of precision
medicine. American Journal of Medical Genetics Part C: Seminars in Medical
Genetics, 178(1), 24–37. Wiley Online Library.
Sun, Shuyang. (2018). Analysis on the Effect of Psychological Guidance for Problem
College Student. Proceedings of the International Conference on Contemporary
Education, Social Sciences and Ecological Studies (CESSES 2018).
Voorman, Jeanine M., Dallmeijer, Annet J., van Eck, Mirjam, Schuengel, Carlo, & Becher,
Jules G. (2010). Social functioning and communication in children with cerebral
palsy: association with disease characteristics and personal and environmental
factors. Developmental Medicine & Child Neurology, 52(5), 441–447.