1.Orientation Exercises

*Connectivity and Functional Specialization in the Brain*

orientation to the reality of the patient [42].

**3.2 Physical-cognitive therapy screening**

function if therapy is carried out continuously.

**3.3 Intervention procedures cognitive therapy**

cognitive function in ICU patients.

on the results of the study showed that cognitive therapy was effective in improving

Physical-cognitive therapy-pharmacological is a nonprevention and management to improve cognitive quality and physical function (Miller and Ely, 2007) intervention physical-cognitive therapy can improve the cognitive and physical function of Critically ill patients in the ICU and after the patient leaves the ICU. Therapy is given for no more than 20 minutes due to the response fatigue patients during ICU treatment and the response to hemodynamic changes during fatigue. Physical and cognitive exercise interventions are appropriate and recommended by the Nursing Interventions Classification (NIC). Physical exercise can be done by teaching exercise prescribing (5612), positioning (0840), neurological positioning (0844), increasing strength training (0201), stretching exercises (0202), improving body mechanics (0140), and rehabilitative cardiac care (4046). Cognitive exercise can be done with delusional management (6440) which supports the comfort and

Interventions Physical-cognitive therapy (PCT) is implemented to the patient once a day at ±10.00 a.m. because at that time it is the body's metabolic response in the best conditions. Intervention is carried out for a maximum of 20 minutes for 3 days according to the patient's condition or adjusted to the Richmond Agitation Sedation Scale (RASS) so that patients get intervention according to their needs and abilities because muscle and neurotransmitter metabolism can achieve maximum

Physical-cognitive therapy can be performed in Critically ill patients with respiratory failure, patients on noninvasive ventilators pressure ventilation, high flow nasal cannula, shock (Dopamine ≥7.5 mcg/kg/min, Norepinephrine ≥5 mcg/kg/ min, Dobutamine ≥5 mcg / kg / min, Phenylephrine ≥75 mcg/kg/min, Epinephrine, Vasopressin >0.03 mcg/min). This intervention should be avoided in patients >72 hours after the development of respiratory failure or shock, cardiac surgery, and post-cardiac arrest. This intervention is only given a maximum of 20 minutes [24]. The first intervention procedure physical-cognitive therapy, namely Critically ill patients in the ICU, is first assessed by RASS. Patients with RASS score of -5 to −4 and − 3 to −2, started to physical therapy intervention using passive Range of Motion (ROM). Patients with RASS score of −3 to −2 patients started to learn cognitive training in the form of space, place, time, and people orientation. The patients with RASS score of −1, 0, +1, would start for physical exercise in the form of active exercise, including sitting beside the bed, standing or moving, Activity Daily Living (ADL) training such as eating, drinking, eliminating, changing positions and finally walking. Meanwhile, for the patient's cognitive training, orientation training Interventions were carried out, digit span forward, matrix puzzle, digit span reverse, noun list recall, paragraph or story recall, letter-number sequences, pattern recognition. Patients with RASS score of −3 to −2 started to learn cognitive training in the form of space, place, time, and people orientation. The patients with RASS score of −1, 0, +1 would start physical exercise in the form of active exercise, including sitting beside the bed, standing or moving, training of Activity Daily Living (ADL) such as eating, drinking, eliminating, changing positions, and finally walking.

Intervention therapy Cognitive is a cognitive exercise given to patients for a maximum of 20 minutes for 1 time a day for at least 3 days of implementation.

**54**

Patients are asked to answer 10 orientation questions and are assessed. Five questions are questions related to time orientation (current year, season, month, date, and day). The next five questions assessed the orientation of the place including city, state, province, where the patient is (ICU hospital), and what floor the patient is currently hospitalized for. The orientation of time and place is instantaneous. Correctly answered questions were repeated starting over for all or 10 orientation questions.
