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ABSTRACTS OF THE
SECOND CONFERENCE OF KUWAIT PHYSICAL MEDICINE AND REHABILITATION
SOCIETY & THE SECOND REGIONAL MEETING OF THE
INTERNATIONAL SOCIETY OF PHYSICAL & REHABILITATION MEDICINE
KUWAIT, APRIL 1-4, 2002
Motor Recovery After Stroke
Dr. Ali T. Ghouse
Assistant Clinical Professor of Medicine, McMaster
University, Hamilton, Canada
The Majority of Stroke Patients
Achieve Considerable Functional Recovery. This presentation explores
the neural mechanisms of recovery and management of motor dysfunction
to maximize motor recovery following a cerebrovascular accident. The
neural mechanisms discussed are the inhibition/facilitation reflexes
and synergies. Motor function may recover by intrinsic biologic and
plastic or adaptive pathophysiologic mechanisms. The management
techniques are conventional and facilitative, such as with use of
biofeedback, functional electrical stimulation or orthotics.
The Use of Motor Evoked
Potentials in Rehabilitation of Locomotor Disorders
Mark A. Lissens, M.D., Ph.D.
Department of Physical Medicine & Rehabilitation, KHK
University, Geel -Belgium
The technique of transcranial stimulation is a painless and easily
applicable technique to investigate the central motor conduction
properties of various muscle groups, both in healthy humans and in
patients with various neurological disorders. Since the MEP-latency
times and central motor conduction times (CMCT) show a good
reproducibility and a very small variability, these variables can be
used as parameters in the diagnosis and follow-up of these diseases.
For the MEP-amplitudes on the other hand, some caution needs to be
taken into account, since they show a much higher variability. Here,
left to right comparison is necessary, on condition that electrode
placement is correct and similar for both sides and that stimulus
parameters are the same bilaterally.
MEPs can be
useful in physical therapy and rehabilitation. After the acute phases
of several locomotor disorders, MEPs can be a useful tool to document
rehabilitation progress. It not only gives important information about
the prognosis and rehabilitation techniques to be used, but also can
be applied as a quantitative measurement during the rehabilitation
period. This allows the health professionals (such as the physical
therapists and rehabilitation staff), who are dealing with either
restoring the impaired spinal cord functions or compensating for the
losses by enhancing the residual functions, to direct and evaluate the
therapeutic procedures throughout the course of the rehabilitation. On
the other hand it provides a helpful tool to motivate the patients,
which may eventually lead to a better outcome result.
In stroke
patients for example MEPs are a quantitative and objective method to
document motor activity recovery, as they parallel improvement of
motor function. Therefore, MEPs can be used as a qualitative and
quantitative measurement of motor function and motor control at
follow-up during rehabilitation.
In chronic
spinal cord injury patients there are short and long latency MEPs.
Short and constant delay in MEP latency time can be explained by
impaired conduction of long descending axons. Long and variable MEP
latencies on the other hand probably result from the interposition of
a spinal interneuron system between upper and lower motor neurons. In
these patients transcranial motor cortex stimulation is a simple and
non-invasive method to not only provide insight into the status of
suprasegmental influence below the spinal cord lesion in subjects with
residual motor control and to describe the supraspinal innervation
pattern for locomotion, but also can be applied to document the
evolution of motor control control in follow-up studies, particularly
when different therapeutic or restorative procedures or interventions
are applied.
In high
cervical spinal cord injuries, as well as in several neuromuscular
disorders, such as amyotrophic lateral sclerosis, Guillain-Barre
syndrome, muscular dystrophies, myasthenia gravis, brachial neuritis,
critical illness neuropathy, leprosy, metabolic disorders etc., often
in the critical care unit, the respiratory muscles can be affected. To
measure central conduction in order to assess the integrity of the
corticospinal tracts and central respiratory drive magnetic
transcortical and nerve root stimulation of the respiratory muscles
now also can be performed.
Parkinson's Disease - Modified
Rehabilitation Management Under Indian Situation
Dr. Ajit K. Varma
Physiatrist, Head of Rehabilitation Medicine Department, Patna
Medical College, India
Freezing, loss of postural instability and stooping with kyphosis,
associated with bradykinesia, tremor and rigidity are the usual
outcome of Parkinson's Disease. Impaired manual dexterity, increasing
social isolation and depression are often frustrating and embarrassing
situations leading to disturbed harmony. The existing joint family
structure in India, illiteracy, poverty and strong God fearing beliefs
have a decisive overall effect in the outcome of rehabilitation
management of Parkinson's Disease. The purpose of this study is to
observe the efficacy of multifactorial issues that may affect and
influence the final outcome in rehabilitation management.
Since there is
variation in performances of the activities of daily living in such
patients, a realistic assessment of ability is required. The patient
is judged on his day of poor performances as well as on his best days.
Apart from hospital management, home care in respect to postural
re-education, postural adaptations while worshipping God, chanting
rhymes loudly & correctly, and use of adaptive equipments,
psychosocial interactions between the family members were taken into
consideration.
Altogether 44
cases of Parkinson's Disease, reporting to Rehabilitation Department,
were evaluated within a period of one and half years. The disability
components were evaluated. The supportive role of the family members
under the joint family systems, strong religious beliefs among the
patients, group therapy and workplace adaptations, postural retraining
in the temples, showed a distinct and positive role in the outcome of
total rehabi-litation management. A distinct improvement in overall
performances was also noted among 35 patients within two month.
Supporting
joint family system, strong religious beliefs and positive attitude
helps to regain lost confidence and improve activities of daily
living. Techniques to improve postural instabilities need constant
attention and practice. Hence these are to be considered as part of
total rehabilitation management.
Botulinum Toxin Therapy for
Upper Limb Flexor Spasticity in Stroke Patients
Dr. Musaed F. Khamees, Dr. Maria Kondeva
Physical Medicine & Rehab. Hospital, Kuwait
Hemiparetic patients with severe upper limb spasticity are severely
disabled by rigid flexion contractures and impaired self-care
abilities.
We studied the
effectiveness of BOTX-A in 40 chronic hemiparetic patients with
moderate to severe flexor spasticity in the upper limb refractory to
conventional physical and medical treatment.
Muscle
selection was based primarily on clinical assessment and aimed to
provide limb posture and range and ease of passive movements and limb
function. Treatment was an adjunct to ongoing physical therapy.
Effective parameters included Ashworth spasticity scale, Spasm
frequency scale, Global pain scale, MCR scale, Motoricity index,
Barthel index.
Evaluation of
patients after 2 weeks, 1 and 3 months showed significant reduction of
muscle tone and pain, increase of passive range of movement and motor
activity of the upper limb, but no change in the functional
independence. Our preliminary experience indicates that Botulinum
toxin is promising adjunctive treatment for selected patients with
chronic spasticity.
Traumatic Spinal Cord Injury
in Saudi Arabia:
A Retrospective Study
Maher Al Jadid, K.S.M. Ashraff Ali, Mohamed El Musharaf, Laith Al
Falahi
Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia
A retrospective study was conducted on spinal cord injured patients
who were admitted to Riyadh Armed Forces Hospital over the last twenty
years to investigate the characteristic features of traumatic spinal
cord injury in Saudi Arabia focusing on the leading causes of these
catastrophic injuries. Four hundred and sixty seven patients were
rehabilitated in the Rehabilitation Unit.
Eighty five
percent of those were male and sixty seven were between the ages of 17
and 40 years old. Only five percent were over the age of sixty years
old. The male to female ratio was 5:1. The mean age at that time of
injury was 30 years old. The mean age for male patients was 30 years
old and 28 years old for female patients. Half of them were married
and twenty five percent were students at the time of injury. Road
traffic accidents (80%) account for the highest percentage of
injuries, while falls (9.4%) and gunshot (6.4%) were second and third
respectively. Sports related account for 4.2%. Thirty three percent
were tetraplegic and sixty seven were paraplegic. Regarding the
tetraplegic patients, the commonest level was C5 and in paraplegics
the commonest level was L 1. When compared to similar studies from
other countries, our results show a disproportionately high incidence
of road traffic accidents and a greater male to female ratio. Hence,
the Saudi male appeared as an important risk factor for SCI and at
more risk of this injury than males living in other countries.
The average
duration of the inpatient rehabilitation program received was twelve
weeks ranging from one week to one hundred and twenty weeks of
hospitalization. The impact of spinal cord injury has many far
reaching implications not only on the individual and their family but
also on society as a whole. These patients are surviving and living
longer than before. The cost of these injuries to both individuals and
society are staggering. Moreover, with advancing medical technology,
the costs of SCI are increasing at a rapid pace.
Given the costs
and severe physical consequences of spinal cord injury, priority
should be given to additional research aimed at developing primary
national prevention programs for these injuries. Other types of
injuries could also be prevented as a result of that program.
Spinal Cord Injury in Syria
Dr. Ziad Al Dehneh
General Secretary of the Syrian Association of Osteoporosis
Prevention, Damas-Mazzeh-Jabal, Syria
34 Syrian S.C.I. patients been rehabilitated at Ebn-Nafees National
Physical Medicine & Rehabilitation Center in Ebn-Nafees General
Hospital in Damas. Age of patients ranges 13-34 mean 23 years. Average
stay period 6 months.
Layout:
All patients were admitted in our Inpatient Rehab. Unit which consists
of 8 beds. Everyone received two physiotherapy session each day except
Fridays. Plan of treatment include medication, physiotherapy,
orthotics devices, instruction to every patient caretaker to turn him
regularly, applying passive ROM exercises and other arrangements which
will be mentioned in detail.
Results:
- Psychosis 26.5%
- Reflex Sympathetic Dystreaty 3.2%
- Deep vein thromboses 8.8%
- Heterotropic ossification 14%
- Fulfill pre proposed target 88.2%
- No death occurred
- Urinary infection was 100%
- Pressure sores at discharge 35%
- Chest infection 20.5%
- Patients asked to leave 2.9%
Recommendations:
- Fractures vertebra should
be fixed.
- Urinary infection & pressure sores are the main problem.
- Spasticity comes next.
- Professional experts to tackle those obstacles are needed.
- Sympathetic medical staff at all levels are needed.
This experience must be
implemented in other Syrian provinces.
A Follow Up Study to Evaluate
Long Term Mobility in Persons with Paraplegia
Dr. Lata Prasad
Physical Medicine & Rehabilitation Hospital, Kuwait
In many countries allover the world, the wheelchair is the cornerstone
of mobility restoration in persons with paraplegia. In India, since
most of the patients return to environments which are not wheelchair
friendly, a lot of emphasis is laid on walking training with calipers
and crutches during their rehabilitation period. Often the only way
for a person to be mobile within the house and com-munity would be
through the use of calipers and crutches.
The gait
training program involves teaching patients to walk on level and rough
ground, walk over slopes, climb stairs and do floor transfers.
This study was
done to evaluate how our patients have sustained their mobility after
discharge from the hospital. 100 patients with neurological levels T2
to L3 were followed up for a period of 1 year to 22 years. Follow up
data was collected by home visits or when patients came to hospital
for their annual check up. Patients were classified into 3 groups
according to their functional ability into functional walkers,
therapeutic walkers or therapeutic standing only.
Conclusion:
Of the 100 patients, 55% were functional walkers at discharge and 71%
of these patients continued walking. Almost all the patients with
spinal lesion at L3 level were functional walkers.
Pain following Spinal Cord
Injury
Dr. Maher Saad Al Jadid, M.D.; DMR; JBPM&R; FAFRM
Consultant and Head of Rehabilitation Medicine Division, Dept. of
Neurosciences Riyadh Armed
Forces Hospital, K.S.A.
Spinal Cord Injuries (SCI) is a
traumatic insult spinal cord that can result in alteration of motor,
sensory and autonomic function. Pain represents frequent and major
sequel after SCI. Overall reported prevalence for chronic pain in
persons with SCI has ranged up to 94% and that which interferes with
activity and adversely affects quality of life from 5% to 45%.
Generally, pain
following SCI is classified as nociceptive (musculo-skeletal,
mechanical, visceral) and Neuropathic pain. This is further divided
according to level as above level, at level and below level.
Both types of
pain have different clinical charac-teristics as well as different
responses to treatment. Management requires a detailed history,
clinical examination, appropriate investigation and psychological
assessment. The primary goals of treatment are alleviating pain and
enhancing quality of life and functional capabilities.
Acute pain and
nociceptive pain management is based on pharmacological,
psychological, medical and surgical intervention; chronic pain has no
clearly identifiable pharmacological, physical or surgical cure. It is
multifaceted experience which requires multi-faceted team approach,
physical rehabilitation, modalities and exercises is a part of the
component of this approach.
Treatment of
the chronic pain following SCI is done through a usual medical
rehabilitation team members. Nociceptive type usually responds to
treatment but the neuropathic one has been historically known
difficult to treat. Tricyclic antidepressant and anticonvulsants have
been employed in its management. Opoid can be effective in treating
chronic neuropathic pain, and that is only when all other optional
management plan have failed.
Behavioural and
relaxation intervention has been found effective in SCI below level
central pain.
The role of
surgery is limited to the pain due to occasionally the unstable spine
and to Dorsal Root Entry Zone (DREZ) lesion in selected cases for
neuropathic pain at level, radicular and central pain. Its effect is
still varies.
Low Level Laser Therapy for Pain
Management: Preliminary Observation and Experience in JCRPO
Al- Turaiki, M., Ambalavanan, C., Khan, M.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO BOX 27240, Riyadh 11417, Kingdom of
Saudi Arabia.
LASER (Light Amplification by Stimulated Emission of Radiation) is presently
being used in various medical specialities. In Physical Medicine it is
primarily used for musculoskeletal pain, wound healing, sports injuries,
etc.
Recently JCRPO has
initiated this new modality as first of its kind in the Kingdom. It's usage
in the soft tissue injuries (sports injuries) and musculoskeletal pain
disorders are studied.
We have used class 3B
Infra Red Laser with the wave length of 830nm and the output power of
120-150 mw. The laser beams are exposed directly to tender areas and also to
traditional acupuncture points. The power varies between 10-16 J for tender
spots and 1-1.6 J for acupuncture points. The treatment session varied from
2-3 sessions per week for 2-3 weeks.
Among the various
musculoskeletal disorders treated with laser, majority of them obtained good
pain relief and the functional outcome measures also improved.
The details of
treatment methods and the results will be discussed.
Action Potential Simulation [APS]
Therapy in the Management of Pain: A Clinical Study
Al- Turaiki, M., Ambalavanan,C., Selvakumar, S., Farooqi, M.J.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO BOX 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
This paper focuses on the management of pain with a recent advanced method
of electrotherapy-the Action Potential Simulation [APS] therapy. APS therapy
involves the application of action potential current to the painful areas.
This current mimics the naturally occurring action potentials that are
normally found in a neuron. This current enhances the ability of neuron to
activate itself, thereby increasing the rate of action potentials produced
along the neuron, which in turn relieves the pain through gate control
theory mechanism and also by releasing the endorphins.
The APS device
consists of a main unit with two positive and two negative channels and with
4 self-adhesive electrodes. Patients with painful conditions like
degenerative joint diseases, low back pain, lumbar and cervical spondylosis
and soft tissue injuries were treated with APS therapy. The treatment
sessions varied between 8-16 minutes for 3 times a week extending up to 2-3
weeks duration.
Almost all patients
had very good pain relief and found APS to be more effective and more
acceptable than other electrical modalities. The biggest advantage of APS
therapy is that it can, not only be used in the clinical set up but also be
extended to the home environment.
Details of this study
will be discussed.
Disability Evaluation
Dr. Ali T. Ghouse
Asst. clinical professor, Mcmaster University, Hamilton, Canada.
Evaluation of disability is of vital importance in the determination
of severity of disability, monitoring patient gains and outcomes, team
conference management, rehabilitation program evaluation, normative
and variance data relating impairment and level of disability to
outcome of care and deter-mination of cost effectiveness. Disability
may be evaluated through global functional scales, ADL scales and
disease or task specific scales. This presentation explores the
concept of disability evaluation using several of the available
measurement tools. The functional independence measure (fim) will be
used as an example to evaluate the burden of illness in ADL across
varied diagnostic categories from neurological to musculoskeletal
disabilities. The usefulness of fim is discussed with regards to
validity, reliability, feasibility and its use as a screening and
predictive tool.
Functional Assessment in Outpatient
Settings
Dr. M.I. Feroz Khan
Physical Medicine and Rehabilitation Hospital, Kuwait.
The increase in health awareness and
the cost of medical care has made the patients and health care providers
very demanding. In a busy rehabilitation facility like us where average 500
new patients and 8500 patients are reviewed in outpatients. Even though the
local cultural environment stress on improvement of symptoms associated with
the disqbabilities a broad assessment system is evolved. It is at present
used in the disability /handicap survey conducted by the Higher Council of
Disabled Affairs in Kuwait.
The assessment items
are in two categories, one for children from 2 -12 years and others for
adults. We have used this for 100 children and same number of adults.
The results are
analyzed and the practical limitations of the well known assessment scales
are also discussed.
Treatment of Spinal Focal Spasticity
with Botulinum Toxin (Dysport)
Dr. C. A. Thiyagarajan
Staffgrade, Nsic, Stokemandeville Hospital, Aylesbury-U.K.
Introduction: Spasticity is one of the most common and potentially
disabling complications affecting spinal cord injured (scied). 67% of scied
are spastic one year after injury. Common clinical presentation of spinal
spasticity is generalised (global), focal or both, it may be beneficial or
problematic. The problematic focal spasticity is treated with botulinum
neurotoxin (bnt). Literature review revealed many studies with stroke,
cerebral palsy, multiple sclerosis and brain injury. Unfortunately, few case
reports and case studies were found on spinal skeletal muscle spasticity
treated with bnt. In order to construct a prospective study on this subject
and to organise a bnt multidisciplinary clinic, a retrospective analysis of
scied treated with botulinum neurotoxin type a (bta) in our spinal unit was
undertaken.
Objectives:
To evaluate the current practice on the management of spinal spasticity with
botulinum neurotoxin in a national spinal injuries centre.
Method:
Retrospective analysis of medical case notes of scied treated with bta
between August 1999 and August 2001. Variables analysed from the case notes
are age, sex, neurological level, asia classification, duration of
paralysis, primary indication for bta injection, frequency of injection
sessions, methods used to identify the targeted muscles, sero type and
product name of bnt used, patterns of targeted muscles, dosage and side
effects, non responders, anti spastic medications received, follow up
period, outcome measures and outcome.
Results:
24 case notes were analysed. Age ranged from 18 to 80. 16 males and 18
females. Cervical-19, thoracic-04 and lumbar-01. Asia distribution-a: 09; b:
02; c: 04; d: 09. Primary indication for bt injection-29% to improve
comfort, which includes pain relief and hygiene improvement, 25% to improve
function, 17% to improve mobility, 17% to improve positioning, 4% to improve
orthotic fit and 8% indication not documented. Outcome calculated from
narrative document found in the case notes, using global assessment of
spasticity showed 12.5% mild improve-ment, 17% moderate improvement and
58.5% marked improvement. Over all post injection improvement was 87%.
Conclusion: 1) bta is used as an adjunct therapy. 2) bta is used to manage
problematic focal spasticity. 3) muscles injected are patient goal
orientated. 4) too many (>4) injection sessions are not indicated. 5)
mean injection sessions per patient is about two sessions which indicate bta
used to create therapeutic window to apply physical therapy and occupational
therapy with ease. 6) incomplete cervical lesions are most indicated lesions
for bta injection. 7) all complete lesions (n=09) had only one injection
session with good response. Their follow up period ranges from 1 day to 658
days (mean-190, median-184, mode-215). 8) biceps is the targeted muscle in
acute phase of the spinal cord injury (duration of injury one year). 10) bta
has a successful role in managing the focal problematic spinal spasticity
(88% showed improvement). 11) narrative description is used as a consistent
outcome measure.
Our experience with Botulinum Toxin
for treatment of Spasticity in Adult Pateints with Chronic Neurological
Conditions
Dr. Maria Kondeva, Dr. Musaed F. Khamees
Physical Medicine & Rehab. Hospital, Kuwait.
Spasticity is an important factor in the management of chronic neurological
conditions. Problems, associated with spasticity include pain, restricted
motion, inter-mittent spasm, reduced function and cosmetic effects. These
symptoms can be treated with physiotherapy, oral medications and surgery,
but there are drawbacks associated with main therapeutic interventions.
The aim of the Botox
therapy in the clinical management of chronic spasticity is to reduce focal
and regional abnormal hyperactivity of the spastic muscles. Potential
application include reducing of muscle spasm to relieve the pain and
correcting abnormal posture.
Based on our
experience with 55 patients with chronic neurological conditions we can
conclude that Botox has definite anti spastic effect and has additional
useful analgesic effect, lasting for 3 to 4 months. The toxin is simple and
quick to administer. Side effects observed in 3 patients were minor and
transient.
Botox has significant
advantage over alternative therapies but must be supported by a complex
rehabilitation measures. It is the physiotherapy rather than the toxin that
will maintain long term benefit.
Cardiovascular Management - Experience
in Dubai
Dr. Mohamed Abdulla
Prof.of Rheumatology and Rehab. Head of Physical Medicine and Rehab.
Dept. Dubai Hospital, Dubai-U.A.E.
Physical inactivity and cardiovascular disease is the No.1 killer in almost
all communities, and its prevention remains the leading challenge to public
health workers today. Lack of physical activity is now clearly shown to be a
risk factor for heart disease. After the age of 30 there is a loss of 0.5%
of performance capability/year, can reach up to 2% in physically inactive
individuals. There is also a loss of 3-5% of muscle fiber mass/decade in
inactive persons. Physical activities for at least 30-60 minutes/day, 3-4
days/week, at 60-80% of maximal heart rate is recommended for most healthy
people and for health benefits to heart, lung and circulation.
Cardiac
rehabilitation exercise training consistently improves objective measures of
exercise tolerance, without significant cardiovascular complications or
other adverse outcomes. Appropriately prescribed and conducted exercise
training is recommended as an integral component of cardiac rehabilitation
services, particularly for patients with decreased exercise tolerance.
Cardiac rehabilitation is not only restricted to patients admission, but
includes three phases. Phase one refers to inpatient cardiac rehabilitation,
phase two begins immediately after discharge and finally phase three is a
maintenance program which may best be community-based. All phases of cardiac
rehabilitation aim to facilitate recovery and to prevent further cardiac
illness (secondary prevention) cardiovascular health and fitness is not only
just an exercise program, it is also a lifestyle program. The focus is on
building healthy life habits.
Worsening Seizure Control due to
Anticonvulsant-Induced Hypocalcemia
Dr. Fawzi Ali, Dr. Waleed Al-Bussairi, Dr. Fatema Al-Mulla
Medical Rehabilitation Center, Ministry of Social Affairs, Kuwait.
Long-term use of anticonvulsant drugs in the treatment of epilepsy is
associated with metabolic bone disease. Abnormalities included elevated
plasma alkaline phosphatase and reduced plasma calcium, and plasma
25-hydroxy-cholecalciferol, radiological and histological signs of
osteomalacia, and a lower bone mineral content than normal.
Institutionalized individuals are more vulnerable to these complications
because of the added factors of use of multiple drugs, poor diet, physical
inactivity, and lack of exposure to sunlight.
We report a case an
institutionalized, mentally retarded, epileptic male who had been treated
with phenytoin and penobarbitone for 15 years and was seizure free for the
last five years. He presented with unexplained loss of seizure control in
spite of adequate medication. Investigations revealed the cause to be
reactive seizures due to anticonvulsant induced hypocalcemia. Seizure
control was regained after treatment with calcium and vitamin D. We conclude
that a sufficient supplementation of vitamin D is necessary in patients
treated with anticonvulsant drugs.
Cholelithiasis with Down Syndrome
Dr. Ibrahim Al-Gendy, Dr. Waleed Al-Bussairi, Dr. Fatma Al-Mulla, Dr. Abdul
Salam Rashid
Medical Rehabilitation Center, Ministry of Social Affairs, Kuwait.
Down syndrome is a chromosomal disorder most often observed in the newborn
period. Various facial, limb and internal abnormalities are found in this
disorder.
Cholelithiasis with
Down syndrome is rare. But with increasing use of abdominal US, more cases
of cholelithiasis are being diagnosed even with healthy people. The etiology
may be unknown or may be related to risk factors such as sickle cell anemia
and thalassemia.
Screening study for
Down Syndrome was done in Medical Rehabilitation Center in Kuwait. We found
from total resident (1000) total Down cases (50) 5%. Abdomi-nal sonar for
all Down cases showed 4 cases with multiple stones Gall bladder (8%). The
first case discovered accidentally and other 3 cases discovered during
screening. All positive cases are male and their Karyotype 47,x7.+21.
Awareness of this association with Down Syndrome will enable appropriate
evaluation for early diagnosis of this surgically correctable malformation.
Assessment of the Quality of Life
of Cancer Patients: Experience of the HMJCSS Head & Neck Unit with the
EORTC QOL Questionnaires
K.A. Al Saleh, Z.S. Thotathil, B. Jamal, M.A. Nasser, H.S. Hooda
Dept. of Radiation Oncology, Hussain MakiAl Juma Center for Surgery,
Kuwait.
Introduction: Cancer rehabilitation can be defined as a process that
assists the cancer patient to obtain maximal physical, social,
psychological, and vocational func-tioning within the limits created by the
disease and resulting treatment. Cancer rehabilitation is an organized
approach to providing interdisciplinary services that include such varied
areas as social services, physical therapy, nutritional consultation, and
vocational counseling. Assessment of rehabilitation needs should be
integrated within the care provided in radiation, surgical, or medical
oncology settings.
Aims:
(1) Study the applicability of the EORTC QOL questionnaires to study the
quality of life of patients treated for Head & Neck cancer at the HMJCSS
(2) Assessment of the rehabilitation needs of our patient population based
on responses obtained to the questionnaire.
Materials &
Methods: We used a QOL questionnaire developed by the European
Organization for Research and Training in Cancer (EORTC) composed of 2
parts. The Core questionnaire (QLQ-C30) incorporates five functional scales
(physical, role, cognitive, emotional and social), three symptom scales
(fatigue, pain, and nausea, and vomiting), a global health status/QOL scale,
and a number of single items assessing additional symptoms commonly reported
by cancer patients (dyspnoea, loss of appetite, insomnia, constipation and
diarrhoea) and perceived financial impact of disease. There are a total of
30 questions. In addition we used the Supplementary module developed by the
EORTC specifically for Head and Neck Patients (QLQ-H&N35). This was
developed so that when used in conjunction with the Core module, provides
more detailed information relevant to evaluating QOL in our specific patient
population. This module comprises 35 questions assessing symptoms and side
effects of treatment, social function, and body image/sexuality. The
questionnaire is in English. We encouraged patients to answer the questions
themselves. Those who could not were assisted in the task by one of the
investigating team.
Results &
Conclusions: The questionnaire was introduced in our clinic in
January 2002. Patients were picked at random from among those seen in the
OPD. An interim analysis was performed on the responses obtained from the
first 40 patients. The results and our impressions will be presented.
An Introduction to the Blood Flow
Study and its Application in Disability and Rehabilitation
Al- Turaiki, M.; Khan, M.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO Box 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
Our life depends on flow of blood. As long as blood circulates, the natural
defence of our body can take care of a number of types of injuries. Any
disturbance in blood supply to any part of the body will be reflected on the
physiology of that part or tissue of the body. Study of blood flow in small
vessels and capillaries is more important than flow in larger vessels from
diagnostic point of view. Exchange of nutrients and gases and clearance of
waste products take place at the capillary level. Hence any change in the
capillary circulation will affect the health of the organ or tissue
concerned.
Study of
microcirculation has a wide application in Disability and Rehabilitation.
This paper will highlight the following application areas:
-
Designing of prosth/orthot
devices
-
Assessment of effect of
electrical stimulation on muscle blood circulation
-
Pressure sore management
-
Evaluation of various modalities
of physical therapy
-
Assessment of microangiopathies
in diabetic patients
-
Wound healing
The techniques used to study the flow
of blood such as Ultrasound Doppler and Laser Doppler techniques will also
be discussed.
Age Related Over Dose Treatment of
Diabetes Mellitus and Mobility in Diabetic Type 1 Patients in Home
Care Visits (Kuwait)
Dr. E. Esbaita, Dr. F. Al-Mulla; Dr. M. Al-Sayed; Dr. Waleed Al-Bussairi
Medical Rehabilitation Center, Ministry of Social Affairs, Kuwait.
Objective: To investigate the prevalence of over dose treatment in
home care and the patterns of difficulty in mobility of elderly patients
(quality of life).
Design:
Our study consisted of designing a special program to 40 elderly diabetic
patients, in our medical home care visits. This program consisted of:
decreasing the insulin daily dose, nutritional therapy, daily blood sugar
controls (tests).
Results:
- 8 patients did not respect the
program
- 32 patients respected the program
- 4 patients started to walk without the help of the P.T.
- 13 patients trying to walk with the help of the P.T.
- 15 patients have improved regarding the symptoms of hypoglycemia and the
difficulty in the mobility, improved, over all the quality of their
lifestyle has improved.
Conclusion: To improve
quality of life for diabetics elderly patients by decreasing the dose of
insulin and nutrition therapy.
Duchenne Muscular Dystrophy (DMD)
Profile in a Special School in Kuwait.
Dr. M. I. Feroz Khan
Physical Medicine and Rehabilitation Hospital, Kuwait.
Duchenne Muscular Dystrophy is the most disabling progressive handicap in
children and adolescent limiting rehabilitation outcome. The changing nature
of the disabilities and complications are a challenge to the rehab team and
the parents. In this study we have analyzed the clinical profile of 20 boys
in a special school in Kuwait are assessed. The data collected were
regarding motor weakness in key muscles, the onset of first weakness, to
time lapse from onset of illness and stopped walking, nature of contracture
and deformities and their functional level.
Age ranges from 4 -
19 years (mean 12.2) mean time of onset of weakness and stopped walking 2.9
years. The average age when thye stopped walking was 8.7 years Knee flexion
deformities were most common, followed by equines, elbow flexion
deformities. Nineteen are wheel chair dependent.
Orthotic Management of Spina Bifida
Patients: A Retrospective Study at JCRPO
Al- Turaiki, M., Saleh, G., Ambalavanan, C., Joseph, G., Khan, T.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO BOX 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
This paper describes the experience of JCRPO in orthotic management of Spina
Bifida patients.
Spina Bifida is a
defect that occurs about 24-26 days after the mother becomes pregnant,
affecting the development of the infant's spine. The incidence is reported
in the USA to be between 4-9/1000 births.
Among the various
etiologies genetic and nutritional factors play an important role. There are
many recent technologies available for early detection and proper management
including rehabilitation and the use of assistive devices.
At JCRPO out of 5713 patients, 55 were found to have spina bifida. After a
comprehensive evaluation by the rehab. team members, they were recommended
for suitable orthotic management. 56% of them were females, and more than
90% had spina bifida with meningomyelocele at lumbar region. Five patients
were using parapodium for standing and partial mobility, while 2 were
successful with ARGO for mobility. 15 of them were using conventional
orthoses for ambulation, and 33 using wheelchairs for mobility.
Detailed orthotic
management of spina bifida cases will be discussed in this paper.
Management of Spasticity in
Pediatrics
Dr. Vesna Zeljic
Physical Medicine & Rehab. Hospital, Kuwait.
Spasticity occurs in children with upper motor neuron lesion and is major
problem and important factor in pediatric rehabilitation management.
Most of the children
with cerebral palsy develop spasticity early, which cause chain of secondary
complications like weakness of antagonist muscles, restricted function, loss
of selective motor control, contracture in joints and pain.
Very many different
approaches are involved in pediatric rehabilitation management from physical
and occupational therapy procedures combined with casting, splinting,
electrical stimulation. Further more use of botulinum toxin A, phenol
blocks, selective dorsal rhisotomy, baclofen pump have role in certain
number of patients, sometimes combine with different surgical interventions
in order to decrease spasticity and improve function and quality of life.
The role of Botox (Botulinum
Toxin A) in treatment of children with cerebral palsy has grown in recent
years. The patient who will benefit the most from Botox is one who is
hypertonic and whose abnormal tone is interfering with function, or who is
expected to develop contracture because of abnormal tone.
Effect of Botox was
studied in group of 40 children with moderate to severe degree of spasticity,
with average age of 4 years and 4 months. Before injecting the Botox all
children were assessed by modified Ashworth scale of spasticity, adductor
rating scale, active and passive range of motion in joints and popliteal
angle.
Outcome was assessed
in certain time with the same scales and with doctors and parents rating
scale. All children were video recorded. Duration of effect was more than 5
months.
Botox is found to be
effective and safe in patients with spasticity in terms of mobility, muscle
tone and functional outcome and has significant role in pediatric
rehabilitation management.
Consanguinity Among Patients with
Mental Retardation - Antenatal Diagnosis of Mental Retardation
Dr. Waleed Al Bussairi, Dr. Fatema Al Mulla, Dr. Hossam Sabri, Dr. Abdel
Salam Rashid
Medical Rehabilitation Center, Ministry of Social Affairs & Labor,
Kuwait.
Society in general, patients individually are concerned about causes &
prevention of mental retardation. Fortunately the number of these conditions
that can be detected antenatally is growing at rapid pace. This is because
of the development of new techniques to obtain fetal tissue and especially
because of rapid advances in recombinant DNA technology. We will review the
causes of mental retardation in our institutions and the frequency of
consanguinity among the parents of mentally retarded patients and finally we
will discuss the high risk factors for patients at risk for mental
retardation in their offspring.
Aim: (1) To study
some risk factors which may contribute to mental retardation (2) To discuss
the antenatal dignosis of MR & preventive measures of MR as genetic
counselling, fetal diagnostic procedures, good obstetric care and diagnosis
of inborn errors of metabolism (3) To study the frequency of consanguinity
among the parents of mentally retarded patients (4) To represent a case
report of Treacer Collin's Syndrome which is a rare syndrome (This is the
only case in our institution).
Non Surgical Management of Urinary
Stress Incontinence
Dr. Musaed F. Khamees, Dr. Abdulla A. Eyadeh, Dr. Samira Al-Awadhi, Mrs. Ira
Tzankova
Kuwait.
Many people are suffering from
urinary stress incontinence in silence. Pelvic floor re-education play an
important role in the management of the problem. Treatment by pelvic floor
exercises, biofeedback and electrical stimulation will be reviewed.
Advantages of Using Portable
Bladder Scanner to Measure the Postvoid Residual Urine Volume (PRV)
in Spinal Cord Injury Patients with Neurogenic Bladder Disorders
Dr. Soad Fakhri, Dr. Mohieldin M.H., Dr. Safaa H. Allam, Dr. Moh'd Akbar,
and Dr. Abdulla A. Eyadeh.
Introduction: Estimation of postvoid residual urine volume (PRV) is
a useful tool in the diagnosis and management of lower urinary tract
dysfunction. It indicates the rehabilitation outcome of urinary bladder
retraining measures.
Objective:
To assess the accuracy and the advantages of using the portable bladder
scanner (BVI 3000) to measure the PRV in spinal cord injury patients with
neurogenic bladder disorders. Further, to determine whether ultrasound
scanning could be considered as an accurate gold of determining the PRV.
Setting:
Physical Medicine and Rehabilitation Hospital, Kuwait.
Methods:
The bladder scanner (BVI 3000) was used to display bladder shape and
residual urine volume. 39 patients with spinal cord injury (SCI) were
included in this study. They were divided into two groups including group I
(21 SCI patients with hyperreflexic bladder) and group II (18 SCI patients
with hyporeflexic bladder). Ultrasound PVR measurement was done immediately
before uretheral catheterization to measure the residual urine volume. The
residual urine volume by ultrasound and catheter were recorded in
millilitres. The mean difference between the residual volume by ultasound
and catheter were determined.
Results:
There is no significant difference of residual urine volume measured by
ultrasound and catheterization in both groups of SCI patients. The mean + SD
difference of residual urine volume measured by ultrasound and
catheterization in the first group of SCI patients was 29 + 7 ml, while it
was 47 + 11 ml in the second group.
Conclusion:
We considered that the bladder scan is non invasive technique and non
infective and as good as a catheter to measure residual volume. Also the
bladder scan results are reliable and have a good correlation with the
results of uretheral catheterization.
Management of Urine incontinence in
Women with Stroke and Spinal Lesions in a Rehab. Setting
Dr. S. Jai Shanthini, Dr. Abdulla A. Eyadeh, Dr. Musaed F. Khamees, Dr. Leon
JR
Physical Medicine and Rehabilitation Hospital, Kuwait.
Aim: To assess the type of urine incontinence in women with stroke
and spinal lesions and to evaluate the outcome of conservative management.
Design:
Thirty one female patients who attended Physical Medicine &
Rehabilitation Hospital suffering from urine incontinence following stroke
(n=17) and spinal lesions (n=14) were selected. The type of incontinence was
assessed by Urodynamic examination. 27 patients were selected for
conservative management and 4 were referred for surgery. Treatment
modalities included pharmacological agents, specific physical therapy
program and bladder training program. Measurement of daytime and nocturnal
frequency, and subjective improvement of incontinence were the main outcome
measures at initial presentation and at 3 months follow up.
Results:
In the stroke group 12 patients were found to have Detrusor hyperreflexia
(DH) one had Detrusor sphincter dyssnergia and in 4 the urodynamic study was
normal. In the spinal group, the anatomical level of lesion and the
corresponding findings were as follows A. Cervical (n=4): DH = 2 Atonic
bladder = 1 and sensory urgency = 1 B. Dorsal (n=2): DH = 1 Detrusor
hyporeflexia with Detrusor Sphincter Dyssnergia (DSD) = 1 C. Lumbar (n=6):
DH = 2, DH with DSD = 2, Sensory urgency = 1 and Stress incontinence = 1. D.
Lumbosacral myelomeningocele (n=2): Atonic bladder with sphincter paralysis
= 1 and DH = 1.
In the stroke group,
all the 12 patients with DH were given bladder training and specific pelvic
floor exercise program. 9 patients required anticholinergics in addition.
Intermittent catheterization (IC) was done for 1 patient with DSD. The 4
patients with a normal urodynamic study required bladder training program
only. In the Spine group 4 were referred for surgery and 1 was kept on
indwelling catheter. 5 patients with DSD were treated with IC and one was
prescribed alpha blocker as well.
2 patients with DH
and 2 with sensory urgency were treated with anticholinergics along with
pelvic floor exercise therapy. All patients were given a bladder training
program. 1 patient dropped out. Treatment was individualized. The rationale
for selection of treatment modality based on urodynamic parameters, and the
principles of rehabilitation program including pelvic floor training and
bladder training are discussed. Decrease in urinary frequency by 63.4% was
noticed in the patients who received conservative treatment for
incontinence. They also reported subjective improvement and decrease in
number of incontinent episodes.
Conclusion:
Urine incontinence is a significant problem to be managed in the
rehabilitation of patients with stroke and different types of spinal
problems. Conservative management based on urodynamic findings is successful
in majority of these patients.
Role of Alternative Medicine in Rehabilitation
Medicine
Sae-il Chun, M.D.
Pochon CHA University, Republic of Korea.
The ultimate goal of eliminating diseases and maintaining normal health is
same both in western medicine, oriental medicine and alternative medicine.
At present, the western medicine tends to take more scientific technological
approach in their practice while the oriental medicine still maintain more
humanistic approach. 5000 year old traditional medicine still challenges the
21 century scientific modern medicine in the field of clinical practices.
The "disease-oriented" western medicine classify the human
condition as "diseased and non-diseased" states. In the mean time
the "health-oriented" oriental medicine classify it into
"healthy and unhealthy" states.
For the maintenance
of normal health, five principles are emphasized. They are (1) eat right (2)
move right (3) sleep right (4) breathe right and (5) mind right. To reverse
an unhealthy condition back to normal healthy state, the methods of (1)
natural substance therapy (2) exercise therapy and (3) stimulation therapies
including acupuncture, moxibustion, finger pressure, and cupping techniques.
In order to eliminate the diseases, four distinct approaches namely (1)
chemical (2) physical (3) psychological and (4) surgical treatments are
utilized.
Recent international
trend of globalization has brought an information explosion and
transcultural exchange of science, technology, arts and medicine. There are
so many different kinds of traditional medicine, hidden popular folk
medicine, and various less recognized techniques and theories of healing
arts. Some are originated in oriental culture while others are originated in
western culture. Experts of western medicine claim that only those
informations clarified or proven by the objective and scientific methodology
can be recognized as a part of western (orthodox or conventional) medicine.
All kinds of traditional medicines, folk medicines, and many other fragments
of medical techniques and theories are collectively labelled as
"alternative medicine or complementary medicine".
There are clear
evidence that the western medicine, oriental medicine, and alternative
medicine are all complimentary to each other, and that alternative medicine
and rehabilitation medicine share much in common regarding "whole
person oriented" and "integrative approach". If and when all
the complimentary components existing in various healing arts are taken
together in one medicine, a new integrated comprehensive wholistic medicine
can be produced and useful in the field of rehabilitation medicine.
Medical Rehabilitation Research -
Overview with a Focus on its Status in the Rehabilitation Center in
Kuwait
Dr. Abdulla A. Eyadeh
Physical Medicine & Rehabilitation Hospital, Kuwait.
The author presents in international aspect the targets of the
rehabilitation research, the accomplishments of the past with the advances
that led to substantial improve-ments in the life of the individuals with
disabilities and their families, as well as the expectations for the future.
The main achievements
of the scientific research in Physical Medicine & Rehab. Hospital have
been reported and the perspective rehabilitation programs outlined.
The need of
determining the effectiveness and efficacy of rehabilitation interventions
has been emphasized.
Medical Research in Medical
Rehabilitation Center in Last 10 Years
Dr. Waleed A. Al Bussairi, Dr. Fatema Al Mulla, Dr. Shawkat Al Khattam, Dr.
Abdul Salam R, Dr. Fawzi Ali
Medical Rehabilitation Center, Ministry of Social Affairs and Labour,
Kuwait.
The Medical Rehabilitation Center is incharge of providing medical services
to handicapped and geriatric residents. Since it's establishment in 1992 the
medical rehabilitation center has not only provided medical services, but
also have conducted research work in the field of internal medicine,
geriatrics and genetic studies, for all, age groups.
The research work
done over 10 years time included 20 papers published in different journals
and presented in different conferences in and outside the state of Kuwait.
We present our work
in research for the past 10 years of medical services and rehabilitation,
such research helped understand and manage this special need and
disadvantaged population.
The Use of Modern Techniques in Clinical
Gait Analysis
Al- Turaiki, M., Al-Mawaldi, M.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO Box 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
The pattern of gait is the outcome of a complex interaction between the
neuromuscular and structural elements of the locomotor system. Abnormal gait
may result from a disorder in any part of this system, including the brain,
spinal cord, nerves, muscles, joints and skeleton. Restoration of an optimum
gait pattern is often a central part of the rehabilitation process. Visual
gait analysis is practiced everyday in orthopedic and rehabilitation centers
throughout the world for planning the treatment for disabled patients.
However, it was reported that such visual clinical methods were unreliable
and the resulted treatment was unsatisfactory for both the patients and the
clinical team. On the other hand modern techniques are more objective, and
efficient. Several medical and rehabilitation centers used the modern gait
analysis technique. It has been shown that gait analysis technique is useful
for planning the treatment and evaluating the results of such treatments.
The aim of the paper is to review some of the current techniques used for
gait analysis and to discuss their clinical suitability. It was concluded,
after having a few years experience of implementing such techniques at
JCRPO, that the use of modern gait analysis technique is an important
clinical tool for treatment and rehabilitation of various category of
persons with disability.
Modular Ortho Prosthesis for a
Congenital Lower Limb Deficiency: A Case Report
Al- Turaiki, M., Joseph, G., Khan, T., Ambalavanan, C.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO Box 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
A 29 years old male patient reported to our center with a diagnosis of left
congenital proximal focal femoral phocomelia. Clinically he was found to
have shortening of left lower limb (thigh segment), absent movements in left
hip, fixed flexion deformity of knee. The foot and ankle were normal. The
entire lower limb was externally rotated. The absent movement on the left
hip was due to surgical hip nailing done at earlier stage for better
stability. Functionally patient was independent with abnormal gait. He also
had tendency for scoliosis.
After a comprehensive
evaluation and team discussion he was prescribed with a Modular Ortho
Prosthesis with a Dynamic Foot. The ortho prosthesis consisted of the
following major components:
- Plastic AFO with laminated
reinforcement
- Socket attachment block
- Pylon tube adaptor
- Cosmetic foam
- Dynamic foot
After a course of physical therapy he
walked better and felt comfortable with the prosthesis. It is a light weight
strong and durable ortho prosthesis with better cosmetic appearance.
Orthotic Management for Charcot's
Foot
Mr. Julius Niven Immanuel
Prosthetic and Orthotic Dept., Physical Medicine & Rehab.
Hospital, Kuwait.
A study was performed to evaluate the effectiveness of the New Polypropylene
Orthosis (PPO) based on the title. With reference to American Orthopedic
Foot & Ankle Society (Seattle) information, the new PPO was designed.
Charcot's a common complication in diabetes with peripheral Neuropathy.
The study comprises a
thorough analysis of the complication supported by a statistical report,
based on which the study was performed to quantify how the PPO is effective
in the management on Charcot's foot. Based on a clear selection criterion a
random of 10 clients involved in the study and the follow up still in the
streamline.
Eventually a
comparative study was also done with Belgium Cast to evidently picturise the
outcome.
- Effectiveness in the treatment
- Clients better degree of acceptance
Biomechanical Evaluation of
Quadrilateral and Ischial Containment Socket
Al-Mawaldi., M.
Bioengineering Unit, Strathclyde Univ., Glasgow, U.K. [Presently at The
Joint Centre for Research in Prosthetics & Orthotics and Rehabilitation
Programmes (JCRPO), PO BOX 27240, Riyadh 11417, Kingdom of Saudi Arabia].
The quadrilateral socket (QS) is the most common prescription, worldwide,
for the above-knee amputee. However, this socket has been criticized for
being of a non-anatomical shape and for providing poor stump control in the
coronal plane. Therefore, the ischial containment socket (ICS) has been
designed in order to solve those problems. It has been reported that the ICS
proved its superiority in terms of function and comfort over the QS.
However, up till now no study has been done to investigate the differences
in the amputee's gait when fitted with a QS or ICS. The purpose of this
study was to compare the performance of the QS and the ICS in terms of gait
parameters.
The gait parameters
of three above-knee amputees wearing QS and three wearing ICS were
investigated using two Kistler force plates and Strathclyde TV-system. An
eight segment biomechanical model of the above-knee amputee was developed to
calculate and present temporal-distance parameters, kinematic, and kinetic
data. It was found that the ICS improved the gait and was more comfortable.
It can be tentatively concluded from the results that the ICS might be the
alternative to the QS in the future.
JCRPO Efforts on Custom Molded Special Seating for Patients with Severe
Disabilities in Saudi Arabia
Al- Turaiki, M., Joseph, G., Khan, T., Ambalavanan, C., Cherian, T.J.*
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO BOX 27240, Riyadh 11417, Kingdom of
Saudi Arabia, *MRCH, P.O.BOX 91409, Riyadh 11633, Kingdom of Saudi Arabia.
Provision of suitable seating is a difficult task for patients with severe
disabilities and deformities such as scoliosis, kyphosis, marked pelvic
obliquities, and limitations of joint movements at the hips, knees and feet.
A custom molded seating system is the best remedy for patients with such
disabilities.
JCRPO has provided
many custom molded seating systems (Bead Seating System) for these group of
patients. A properly fabricated bead seating system forms an intimate
interface with the patient, totally reflecting all body contours. It gives
more surface contact which will enable maximum comfort.
JCRPO has provided
bead seating system to 52 disabled (33 males and 19 females) so far with
different diagnosis as follows:
40 - Spastic Quadriplegia due to
Cerebral Palsy
6 - Spinal Muscular Atrophy
4 - Muscular Dystrophy
2 - Cerebellar Ataxia
Bead Seating System provides the patient with excellent control of balance,
mobility, firm support and a strong feeling of security. It has proven to be
very versatile and can easily be used with other seating components to make
the system truly unique in nature.
Dysarthria Assessment & Management
Msr. Sulaiman Abdullah
Master of Science Degree, Speech and Language Pathologist, Physical
Medicine & Rehab. Hospital, Kuwait.
Dysarthria is a neurogenic voice and speech impairment which may result from
damage to the central and/or peripheral motor speech nervous systems causing
weakness, lack of coordination or altered tone of the speech and voice
muscles. It is one of the common impairments among adult patients who come
to the speech pathologist at the Physical Medicine & Rehab. Hospital (PMRH).
In this paper I will
present the most common classification of dysarthrias and their
distinguishing factors in terms of:
a. Perceptual characteristics
b. Neuromuscular conditions
c. Localization and causes of lesions
Discussion of these
factors will mainly focus on the speech language pathologist's role in
assessing and treating dysarthric patients with varying severity of speech
and voice symptoms affecting respiration, phonation, resonance,
articulation, rate, and prosody.
Idiopathic Delayed Language
Development
Tahany Abdel Karim
Speech-Language Pathologist, Kuwait Montessori.
Language is the medium of speech, which may be expressed through verbal or
nonverbal ways, before acquiring the expressive skills.
The prerequisite for
language development is a stimulating environment to help trigger the
in-built capacity of the child to develop language.
The main factors,
which help beside complete physical and mental health to develop language
are: (1) Environmental stimulation (2) Emotional and psychological balance.
Absence of any of
these important factors may cause D.L.D. with inexplicable organic symptoms
(Idiopathic) we notice increase in number of such cases nowadays, due to
social progress. Observations by families of such children point to the
following important factors:
1. First child in family hasn't
good social communi-cations with others
2. Middle child, which doesn't take sufficient care
3. Smallest baby boy between many sisters
4. Last child in big family members with a difference in age between last
two children (about 7:10 years).
5. Child raised up by maid, foreigners or some nationality
6. Presence in bilingual families
These early discovering and treatment
of such cases gives us a great success to overcome this problem. This paper
will discuss the details of such cases and proper way to overcome the
problems with family guidance and speech therapy.
The Efficiency of Language and
Speech Rehabilitation of Down Syndrome
Esmat Lofty
Speech therapist, Physical Medicine & Rehab. Hospital, Kuwait.
The Down Syndrome is a common congenital syndrome coming to the Phoniatric
clinic with delayed language development. The Phoniatric unit in the
Physical Medicine & Rehab. Hospital is considered as one of the
teamworks of the early rehabilitation programme for the special needs of
children.
Our aim is to help
the patient (child) and his family to face his difficulties in
communication, education, and improve self-confidence during child's growth.
Our services started in PMR Hospital in 1996 to form complete rehabilitation
teamwork in the hospital (Physiatrist, Phoniatrist, P.T., O.T. & Speech
therapist). The Phoniatric unit introduces services to all cases with
communicative problems, including (language and speech disorders) for both
genders at any age.
This study will go
through:
1. The communicative problems of Down Syndrome children
2. The role of Language and Speech Stimulation programme
3. The effectiveness of the cooperation by family members in the programme
Swallowing Management Protocol in
PMR Hospital
Dr. Amal Salah Darwish
Phoniatrist, Physical Medicine & Rehab. Hospital, Kuwait.
The swallowing disorders is a life threatening medical problem it could
occur at any age group, it is mostly of neurological disorder and rarely
occur with the oral and pharyngeal deformity or abnormality, the problem
should have a proper scheduling of examination, investigations to reach the
proper diagnosis, to start the proper management programme.
This paper will
discuss about 50 dysphagic patients who attended Phoniatric clinic to reach
the proper diagnosis and to receive the proper active swallowing
rehabilitation programme, through the complete rehabilitation team sharing
in the diagnostic therapeutic procedures in order to wean the patients from
Nagastric tube feeding or Gastrostomy feeding.
With successful trail
of weaning of majority of cases to prove the proper diagnostic criteria,
manage-ment programme starting with the proper medical intervention, then
sharing with Speech therapist, Occupational therapist & Physiotherapist
in Physical Medicine & Rehab. Hospital, Kuwait with detail of our
management protocol.
Low Incidence of Foot Involvement in
Saudi Rheumatoid Arthritis: Personal Observation and Propose Explanation
Dr. Samer Abdullah (Paris) FACR
Consultant, Physical Medicine and Rheumatology, New Mowasat
Hospital, Kuwait. Ex-Head of Physical Medicine & Rheumatology Dept.-Dammam
Central Hospital, KSA.
A study of 75 cases of RA, diagnosed in Damman Central Hospital, showed that
there is infrequent involvement of small joints of foot i.e., 27% as
compared to 60-90% reported in international literature. There is so far, no
studies or any scientific explanation for this observation, but we think the
following may act as a contributing factors:
1. Wearing of open sandals
2. Wadhoo (Muslims pre-prayer wash)
3. Use of Henna on feet (Traditional cosmetic Herbal dye)
Possible
Explanations: It is known that RA causes Neuropathic segments i.e.,
there is regression of inflammatory, process in joints of paralyzed limbs.
This is due to the decrease of the substance P; a neuro-peptide secreted
usually by Nocioceptive receptors in response to a trauma. This capacity is
lost with loss of sensation, low S.P. also results from reduction of trauma.
Thus rest splints reduces the inflammatory reaction in RA; this hypothesis
is linked to the less traumatic effect of the open sandal.
Regular washing and
massage like effect of Wadhoo also has sedation and relaxing effect on the
toes. Cooling also reduces inflammatory signs; this is the possible
explanation of beneficial effect of Henna application which is a traditional
treatment for burning feet.
Well controlled large
studies are needed to confirm this hypothesis.
Comparative Therapeutic Trial of
Osteoarthritis of the Knee
Dr. Soad Fakhri, Dr. Salah Hawas, Dr.
Abdulla A. Eyadeh
Physical Medicine & Rehabilitation Hospital, Kuwait.
Osteoarthritis is the most common rheumatic disease and a major cause of
impairment of joint function and disability. The knee is the commonest site
of osteoarthritis. Ultrasound was used successfully in treatment of knee
osteoarthritis. However, the problem is not yet completely solved. There is
controversy about the role played by laser (light amplification by
stimulated emission of radiation) in treating rheumatic diseases.
Our aim is to assess
the value of mid laser in management of knee osteoarthritis and to compare
its effect with that of ultrasound.
Eighty osteoarthritic
knees of forty-seven patients were equally divided into 4 groups (each
comprised 20 osteoarthritic knees). All groups received the same static
quadriceps exercises program, in addition the first group treated by
ultrasound, the second group by infra laser, the third group by placebo (untuned)
ultrasound and the fourth group by placebo infra red laser.
Analysis of the
results revealed that improvement was marked with the group treated by
ultrasound followed by infra red laser. Cases treated with either placebo
ultrasound or placebo infra red laser failed to show significant
improvement.
Ligamental Insufficiency as a Cause
of Spondylogenic Disorders
Dr. Miloslav Kadlec
Assistant Professor, Post Graduate Medical Institute, Moravska 34, Prague
2-Czech Republic.
Functional spinal disorders are more frequently connected with movement
limitation. Another type shows no limitation, rather hypermobility is
present. This type starts from a genetic failure-s.c. mesodermal
insufficiency. Typically, it is present in women, range of joint motion is
greater as in other population. If the muscular support of trunk is not
strong enough, painful fatigue or pain at longer remaining in standing or
sitting occurs. Diagnosis is done by personal and case history; clinically
palpation of painful ligamental insertions, range of motion examination, by
x-rays. In x-rays, there is a typical sclerosis on bone surface at
overloaded places. Therapy after pain reduction / physical therapy,
infiltration with local anaesthetics / restoring of muscle support by
resistance exercises. Use of external supports / collars, braces, belts / is
sometimes useful, but long-term use of such orthoses may cause further
weakening of trunk muscles and so the braces bearing may be life-long
necessity.
Syndrome of Coccyx & Pelvic
Floor and Chaining of Functional Disorders
Dr. Soad Fakhri, Dr. Jan Slaninka, Dr.
Moh'd Akbar Ali
Physical Medicine & Rehab. Hospital, Kuwait.
The clinical diagnosis of syndrome of coccyx and pelvic floor is frequently
discussed in medical literature in past years.
The importance of
pelvic floor for breathing, abdominal press, excretion, delivery and static
and dynamic of the body is obvious. Any disturbance arising from this region
is negatively affecting the equilibrium of the whole body.
As many of the
patients diagnosed to have this syndrome are complaining of pain localized
in different parts of the body, detailed, assessment is essential.
Most frequent
complains of the patients, some clinical findings and chaining of functional
disorders are discussed in the paper.
Clinical and Radiological
Characters of Cervical Malalignment in Patients with Cervical Spondylosis
Dr. Soad Fakhri, Dr. Jv1ohieldin M.H.,
Dr. Abdulla A. Eyadeh
Physical Medicine & Rehab. Hospital, Kuwait.
Introduction: The degenerative diseases of the cervical spine are
the common disorders. They involve the joints including the intervertebral
disc, the apophyseal joints and the uncinate joints of Lushka. Complications
of the degenerative diseases of cervical spine include malalignment, disc
herniation and spinal stenosis.
Objective:
To evaluate of clinical and radiological features of mechanical malalignment
of the cervical spine in patients with cervical spondylosis.
Setting:
Physical Medicine & Rehabilitation Hospital, Kuwait.
Methods:
Fifty subjects were studied, thirty patients with cervical spondylosis
having cervical malalignment and twenty were normal to serve as control
subjects. Lateral view of plain x-ray of cervical spine has been used as non
invasive tool for measuring the degree of angle and its (site) level of
cervical malalignment.
Results:
The most common clinical findings in thirty patients with cervical
spondylosis having cervical malalignment were neck pain (24 cases),
occipital headache (18 cases), vertigo (17 cases), radiculopathy (15 cases),
and pyramidal signs or quadriplegia (3 cases). The most common levels of
cervical malalignment in the first group were at C5-C6 (15 cases), C4-C5 (5
cases) and C3-C2 (one case). The most common degree of cervical malalignment
was 11-15 degrees, while less common degree was 0-5 degrees.
Conclusion:
This study highlights the importance of the evaluation of cervical
malalignment associated with a complex of symptoms and signs. Neck collar
may be recommended to patients with cervical malalignment associated with a
complex of symptoms and signs.
Validity of Radiological Methods in
Early Detection of Shoulder Synovitis and Correlation with Rheumatoid
Activity
Dr. Musaed F. Khamees, Dr. Hala Eissa
Physical Medicine & Rehab. Hospital, Kuwait.
The study was carried out on 34 patients with active rheumatoid arthritis
(RA). All studied cases had been subjected to careful history, clinical and
joint examination, routine laboratory investigations, Interleukin-1 (
(IL-1() level was detected. Twenty seven patients with painful shoulder were
radiologically examined by PR, US, CT and MRI with quantitative evaluation
of bone erosions and joint space narrowing to assess disease activity.
Positive correlations were found between IL-1 (and Ritchie articular index (RAI).
ESR, disease activity score (DAS), RF in all patients (p=0.007, <0.05,
=0.007,<0.001 respectively). Radiologically glenohumeral erosion were
detected by PR in 15 patients (55.5%), by US in 21 patients (77.7%), by CT
in 15 patients (55.5%) and by MRI in 19 patients (70.3%). US was most
sensitive in detecting erosion of glenohumeral articulations (77.7%) while
MRI was more sensitive in erosions of acromioclavicular, major & minor
tuberosities (81.4% and 88.8% respectively), grading of these erosions was
done by the 4 modalities. Effusion and rotator cuff tear was detected by US
in 25.9% and by MRI in 33.3%. Pannus was only detected by MRI. Total scores
for bone erosions and joint space narrowing showed significantly positive
correlations with serum levels of IL-1 ( in our patients (P<0.001) and
0.005 respectively). All four radiological modalities are complementary in
diagnosis and monitoring patients with rheumatoid shoulder and there is a
positive correlation between these radiographic scoring methods and
clinical, laboratory parameters of disease activity.
Defective Fibrinolytic Activity in
Frozen Shoulder
Dr. Soad Fakhri, Dr. Salah Hawas, Dr.
Abdulla A. Eyadeh
Physical Medicine & Rehabilitation Hospital, Kuwait.
Fibrin is common in acute and chronic inflammatory conditions. It is
normally cleared from the tissue by a process of fibrinolysis in order to
restore normal tissue structure and function.
Recent studies have
demonstrated defective plasma fibrinolytic activity in many rheumatic
diseases as rheumatoid arthritis, SLE., ankylosing spondylitis and systemic
sclerosis. To date no studies of fibrinolytic system have been carried out
in frozen shoulder.
Fibrinolytic activity
in 50 patients with primary frozen shoulder and 20 apparently healthy
controls was asssessed using: Plasma fibrinogen, fibrinogen and fibrin
degredation products (FDPs) and Euglobulin clot lysis time (ECLT). Defective
fibrinolytic activity was found in patients with frozen shoulder. This is
demonstrated by a significant increase in the level of plasma fibrinogen
(p<0.01 ), FDPs (p<0.001 ) and a significant prolongation of ECL T
(p<0.01 ). This has led us to develop a new hypothesis about the
pathogenesis of frozen shoulder. A wide variety of forms of damage may
affect the shoulder with subsequent inflammation and fibrin deposition. In
some predisposed cases, there is persistance of fibrin because of a defect
in fibrinolytic activity, hence the chronicity of shoulder pain with
ultimate estabishment of the full picture of frozen shoulder. The use of
fibrinolytic enhancement therapy for frozen shoulder is worthy in future
study.
Bone Turnover in Female
Osteoarthritic Patients and the Inverse Relationship with Osteoporosis
Dr. Abdulla A. Eyadeh, Dr. Hala Eissa,
Dr. Moh'd M. Kamal
Physical Medicine & Rehab. Hospital, Kuwait.
Aim of the work: To explain a differential association between
osteoarthritis (OA) and osteoporosis (OP) and to understand this apparent
inverse relationship.
Patients &
Methods: 20 female patients with definite OA were included in the
study as well as control group of 20 normal subjects. All of them underwent
clinical assessment, laboratory assays (osteocalcin and deoxypyridinoline)
and radiological assessment (plain x-ray to knee and DXA).
Results:
The average bone turnover markers, osteocalcin and deoxypyridinolines tend
to be greater after one year of follow up in the control group and this
increase was highly statistically significant (P<0.01 ). On the other
hand, in OA group, OC levels showed a non significant drop after one year
(P>0.05), however the drop in DPd level was highly statistically
significant (P<0.01). After one year follow up of both groups, the BMD
tend to be the same or even increased in OA patients and tend to drop
significantly in control group associated with highly significant increase
in bone turnover markers (OC & DPd). The mean BMD, Z & T scores at
femur and spine were significantly lower in the control group than in OA
group (P<0.05), the total BMD at the two sites showed higher mean value
in OA patients, the difference was significant (P<0.05) at femur site,
highly significant at spine (P<0.01). A higher percentage of osteoporosis
among control group was observed when compared to that in OA group, however
this difference was not statistically significant.
Conclusion: Bone Mass is increased in persons with OA, but the
rate of bone loss is greater also.
Endoscopic Reconstruction of Rupture
Anterior Cruciate Ligament
Dr. Abdul Rahman AI Mesfer
Orthopaedic Surgeon, Sports Unit AI Razi Hospital, Kuwait.
Sixty five patients with anterior cruciate ligament (ACL) deficient knees
had all reconstruction in AI Razi Hospital, Kuwait. In thirty five patients
semiten-dinosus and gracilis used as autograft (group A), and in thirty
patients patellar tendon was the autograft (group B).
A comparison of the
results showed that the two groups are comparable with each other with a
trend of better stability toward group B.
Management of Traumatic Knee
Dislocation
Dr. Sameer Abdulrazak Ibrahim
AI Razi Orthopaedic Hospital, Kuwait.
The management of traumatic dislocation of the knee in 40 patients (41
knees) with a mean age of 26.3 years is described. They were treated by
primary repair and reconstruction with autologous grafting of the anterior (ACL)
and posterior cruciate ligaments (PCL) and repair injuries to the collateral
ligament and soft-tissue. The ACL and PCL were reconstructed using the
patellar tendon and the gracilis and semitendinosus tendons, respectively.
Early mobilization using a continuous-passive-movement machine and active
exercises was started on the second day after operation. At a mean follow up
of 39 months no patient reported 'giving way' and all except one had good
range of movement. Of the 41 knees, 21 were rated as excellent, 15 good,
four fair and one poor. Early reconstruction of the cruciate ligaments and
primary repair of the collateral ligaments followed by an aggressive
rehabilitation programme are recommended for these young, active patients.
Rehabilitation After Mensical
lnjury
Dr. Sherif Khairat
Sports Clinic, Physical Medicine & Rehabilitation Hospital,
Kuwait.
Traditionally, rehabilitation of patients after mensical injuries was
limited. The mensci, not thought to be a key functional component to the
human knee, were surgically removed when injured. After the wound had
healed, patients gradually returned to their functional activities with
minimal short-term disability. However, as time passed, many of these
patients developed advanced degenerative arthritis, and clinicians began to
report the disappointing long-term consequences of this treatment approach.
This realization, coupled with an increased understanding and appreciation
for the vital structure-function role of the menisci in load transmission,
joint stability, lubrication and articular cartilage nutrition. This led to
more conservative surgical approached to patients with mensical injuries.
Arthroscopy and arthroscopic surgical techniques have contributed
significantly to this trend, allowing for preservation of as much meniscal
tissued as possible and thus resulting in less short- and long- term
morbidity. The role of rehabilitation in restoring function to the mensical-injured
knee has became better recognized. Yet, the application of sound
biomechanical principles in rehabilitation protocol has been lacking. The
goal of treatment is to eliminate the symptoms associated with a meniscal
injury while preserving as much meniscal tissue as possible. This is
accompanied by first accurately defining the pathology and then deciding on
whether operative intervention is warranted, as not all meniscal injuries
require operative treatment. The rehabilitation program is divided into five
functional stages based on rehabilitation and biomechanical principles. The
length of the rehabilitation program varies from weeks to months, depending
on the initial extent of injury, surgical procedure performed and motivation
of the patient. Stages of Meniscal Rehabilitation: Stage I: Early Protected
Mobilization, Stage II: Kinetic Chain Strength Training, Stage III:
Neuromuscular Proprioceptive Training, Stage IV: Functional Activity
Training, Stage V: Return to activity
Factors Influencing the Incidence
Reccurrence and Rehabilitation of Athletic Sports Injuries in Kuwait
AI-Mousawi, Abdul Majeed M.
Department of Physical Education, Kuwait & Hillis, W.S., Department
of Medicine and Therapeutics Glasgow, U.K.
The incidence, reoccurrence rate and rehabilitation management of Kuwaiti
athletic sports injuries was assessed retrospectively and prospectively
identifying 179 injuries in seasons 1997-98 and 1999-00. The controlled
prospective study identified 103 injuries in 662 active athletes with an
incidence of 3.78 injuries per 1000 hours of athletic activity, similar to
that reported in previous international studies. Injuries occurred most
frequently in mature adult participants (43%) and there was a low incidence
in adolescents. More injuries (54%) occurred during training than in active
competition and therefore would be potentially avoidable. The average
duration of disability was 38 days (1 day to 8 months). 50% of the athletes
had injury reoccurrence on the same (28%) or other anatomical sites
suggesting that a role for prophylactic intervention is indicated. Doctors
diagnosed almost all reported injuries (65%) however rehabilitation was
directed mainly by coaches in many (38%) and by physiotherapists (36%).
Adequate medical support is required. Non completion of the rehabilitation
course was a factor in reinjury and extended disability. Of the 70 who
completed their course only 17 (24%) had a reoccurrence whereas there were
12 (36%) further injuries in the 33 who did not complete the course. Several
areas of care and rehabilitation can be improved in this client group to
reduce duration and reoccurrence of disability.
The Classification in Sports for
People with Special Challenges
Dr. Fadi Kobal
Physical Medicine and Rehab. Hospital, Kuwait.
The sport for people with special challenges began as a part of
rehabilitation program in 1948 in Stoke Mandeville Hospital-U.K., over the
time the concept has developed and now there are World and Olympic
Competitions, Sport Medicine and Sport Science for people with special
challenges.
The impetus for this
development was the real need and varied benefits of the sports for these
persons; physical benefits (health, fitness, improvement of the function of
the cardiovascular system...), psychological benefits (gaining confidence
and dignity...), social benefits (reintegration...), and patriotic benefits
(participation and winning in World Championships); subsequently improving
the quality of the life- the ultimate aim of the rehabilitation.
The classification is
a unique aspect of sports for people with special challenges, and it is
considered to be often the complex issue.
The classification as
an operation enables the athlete to be grouped with others whose performance
lies in a somewhat similar range, it has to contribute to fair competition
and should respect the athletes' rights.
It is critical issue
because it is the key determinant of competition results, except in archery
and shooting, and not in recreational, health or fitness sports.
The traditional
classification (medical) was based on the individual athlete profile; but
later on it became functional classification based on technical and skill
aspects of each sport, and the medical aspects were only of secondary
priority.
Finally sports for
people with special challenges (including the classification) need more
support and care from the specialists and society.
Why to Give More Support to the
Ankle Joint Ligaments and When?
Abdul Majeed AI-Bannai, Msc, R.P.T.
Physical Medicine & Rehabilitation Hospital, Kuwait.
Athletic taping and bandaging procedures provide the best and most lasting
support when applied correctly and directly to the skin. Many athletic are
readily and successfully treated by more or less standardized types of
adhesive strapping that have come to be widely accepted of their
effectiveness in physiologically correcting the specific traumatic pathology
and in restoring function to the injured part as soon as possible.
The methods of
applying taping and bandaging are highly useful on the playing field and in
the training room, but should be modified by the individual physiotherapist
or athletic trainer according to the injured part and ligaments.
The use of adhesive
tape and substance in the care of external lesions goes back to ancient
times. The Greek nearly used the same composition and material to support
and treat soft tissue injuries, but the adhesive tape has developed recently
into a vital therapeutic adjunct. Modern adhesive tape has great
adaptability to use in sport because of its uniform, adhering qualities, and
lightness as well as the relative strength of the backing materials. All of
the above are of value in holding and protecting injured areas.
Occupational Therapy Perspective in
Developing Skills in Wheelchairs Sports
Amit Kumar
Occupational therapist, Physical Medicine & Rehabilitation Hospital,
Kuwait.
A person with wheelchair is differently abled and by enhancing his existing
ability he can be an integral part of the society. He can participate in
different skillful sport events. To gain mastery over wheelchair mobility
and in order to participate in various competitive events; a wheelchair
bound person may be given analytical training, with biomechanical,
neuromuscular and wheelchair manipulation techniques. Presently Olympic
Committee for different abled people organize various sport events. It is an
attempt to practically demonstrate the analytical training approach to gain
mastery with wheelchair for enhancing competitive sport skills.
Thoraco Lumbo Sacral Orthosis for
Congenital Scoliosis: A Case Report
Al- Turaiki, M., Khan, T., Joseph, G.,
Ambalavanan, C.
The Joint Centre for Research in Prosthetics & Orthotics and
Rehabilitation Programmes (JCRPO), PO Box 27240, Riyadh 11417, Kingdom
of Saudi Arabia.
A 3 year-old male child reported to JCRPO, was diagnosed as a Congenital
thoraco lumbar scoliosis with multiple hemivertebrae and apical vertebrae on
D8 left and L3 on the right. The patient was also having mild dorsal
kyphosis. He was treated with custom-made TLSO having maximum intimate
interface with the body contours, derotation and correction forces to
achieve correction and give stability to the spine to avoid further
deformation of the spine. Free zones or windows were made in the corset
opposite to the corrective and derotative forces to make them more effective
on one hand and make the orthosis light-weight and well ventilated on the
other.
After treatment, the
patient's posture improved with reduced curve angles in both dorsal and
lumbar spine.
Simultaneous Effect of Neuromotor
Block and Occupational Therapy in a Spastic Child
Jitendra Singh*, Dr. P. K.
Dubey**
*Occupational therapist, Paediatric Neurologist, **Physical
Medicine & Rehab. Hospital, Kuwait.
In the field Occupational therapy, caring for cerebral palsy patient or
spastic child is the main area to work. For the management of cerebral
palsy, there are mainly two ways:
1. Surgical
2. Conservative
In India everybody is well aware of surgical process being costly and that
is why I have taken 20 cases of cerebral palsy whose age ranges from 3-12
years and that involves spasticity of adductor, popliteal (hamstring) and
plantar group of muscles.
One of our consultant
(Pediatric Neurologist) working with us has used this procedure of myoneural
blocks (by injecting 45% Ethyl Alcohol) as the means of conservative
treatment and the result shown after myoneural block along with splinting
and appropriate therapy were excellent.
Hence in my opinion
the case of cerebral palsy with mild contracture should first be tried on by
this method to avoid surgical intervention.
The method of
conservative treatment as compared to operative one is less costly, less
time consuming, safe and with excellent result, if a child has regularly
continued with this treatment.
The Use of Botulinum Toxin A in
Children with Cerebral Palsy -Kuwait Experience
Dr. Vesna Zeljic, Dr. Fadi Kobal
Physical Medicine & Rehab. Hospital, Kuwait.
Introduction: Spasticity is major problem in cerebral palsy and can
lead to significant physical problems. Several open studies have reported
the beneficial effect of Botulinum toxin A especially in gait pattern.
Aim &
Method: As a part of rehabilitation management, we injected Botox in
40 children. All had predominantly spastic form of moderate to severe
degree. Our goal was oriented toward improvement of function. Before
injecting, all children were assessed by modified Ashworth scale of
spasticity, adductor rating scale, active and passive range of motion in
joints and popliteal angle was measured. Dose used was 2-7 units per kg. per
injected muscle. The outcome was assessed two weeks, two, four and six
months after injecting using the above measured scales together with parents
and doctors rating scale. For proper monitoring simple form was designed
with necessary data. Children were on regular NDT programme 3 times per week
for 2-4 months. Some of them had gips immobilization, orthosis or FES. All
children were monitored on video. In 33 children, with average age 4.4
years, very good effect was recorded for 5.5 seconds.
Conclusion:
Results in our patients were very good and promissing in comparison with
reports from the literature.
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