The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

His Majesty King Abdullah II Ben Al-Hussein

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

WELCOME MESSAGE

Dear Colleagues, Dear Friends,

On

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

behalf of the executive committee, it gives me great honor and pleasure to welcome you to attend and participate in the 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis and Rehabilitation at Le Meridien Hotel, Amman between November 5-7, 2008. From Jordan, Arab Countries and around the world a renowned faculty of doctors and other rehabilitation team members will be presented in Amman to offer excellent and useful scientific knowledge. The scientific program includes different topics of rehabilitation like Rheumatology, Orthopedic, Neurology, Prosthetics-Orthotics, sport medicine, Physical Medicine Osteoporosis, pain Management …. etc. covers all aspects of Rehabilitation. During the congress, local and International researchers have the opportunity to exchange their experiences through plenary lectures, symposiums, short courses, frees papers and workshops. I would like to draw your attention that Jordan has a wide variety of unique natural, historical, recreational, ecological and sacred religious sites, well worth visiting. We are honored that you are able to take time from your busy schedules and join us in this congress. We hope that your stay in Jordan will be professionally rewarding and personally enjoyable. I have to thank the organizing committees who dedicated all their effort and time into making this congress successful. I also like to express my gratitude to the governmental organizations, private agencies, donors and all the companies for the most valuable aid, contribution and assistance to our congress. Welcome again to our congress and to our lovely country-Jordan, we hope you enjoy both. Sincerely, Dr. Abdel-Fattah Al-Worikat President of the Congress President of the Jordanian Society of PM & R.

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International Speakers (In alphapatical order) A. Samer AlKawadri

Syria

Alain Delarque

France

Abdulzahra Kzar

Iraq Italy

Ali Jawad

UK

Aly Mahmoud

Egypt

Amir Al-Din

UK

Aziz Al-Feeli

Kuwait

Calogero Foti

Italy

David Lawrence

USA

Dirk Dressler

Germany

Firas Sarhan

UK

Horst Aschoff

Germany

Kamil Yazicioglu

Turkey

John Schulte

USA

Joseph Khazaal

Lebanon

Mofid Saif

UK

Mufeed Al-Jeady

Saudi Arabia

Nat Padhiar

UK

Natasha Milenovic

Serbia

Nicolas Christodoulou

Cyprus

Raoul Saggini

Italy

Slavica Golubovic

Serbia

Sonya M. Rashad

Egypt

Xanthi Michail

Greece

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Alessandro Giustini

5

Society Administration Committee & Congress Chairman Committees

‫الهيئة االدارية للجمعية ورؤساء‬ ‫لجان المؤتمر‬

Dr. Abdel-Fattah Al-Worikat President of the Congress & Society

‫الدكتور عبدالفتاح الوريكات‬ ‫رئيس المؤتمر ورئيس الجمعية‬

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Dr. Wael Thunaibat Vice President Dr. Mohammad Omar Abu-Zaid Congress Secretary General & Chairman of Medical Exhibition Committee

‫الدكتور محمد عمر أبو زيد‬ ‫أمين عام المؤتمر ورئيس المعرض الطبي‬

Dr. Tamara Quandour Chairman of Scientific Committee

‫الدكتوره تمارا قندور‬ ‫رئيس اللجنة العلمية‬

Dr. Mohammad Kanaan Chairman of Financial Committee

Dr. Sameer Guboug Chairman of Social Committee Dr. Taha Al-Tawayah Chairman of International Relations Committee

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‫الدكتور وائل ذنيبات‬ ‫نائب الرئيس‬

‫الدكتور محمد كنعان‬ ‫رئيس اللجنة المالية‬

‫الدكتور سمير قابوق‬ ‫رئيس اللجنة االجتماعية‬ ‫الدكتور طه الطوايعة‬ ‫رئيس لجنة العالقات الدولية‬

‫أعضاء اللجنة التنفيذية‬ ‫الدكتور عبدالفتاح الوريكات‬ ‫الدكتورة عائدة دوغان‬ ‫الدكتور علي الغويري‬ ‫الدكتور علي الحديد‬ ‫الدكتور علي العتوم‬ ‫الدكتور عوني هناندة‬ ‫الدكتور بركات الزبن‬ ‫الدكتور الياس حتر‬ ‫الدكتور هاني ذخرالدين شوقه‬ ‫‪The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation‬‬

‫الدكتور هشام الصايغ‬ ‫الدكتورة جين قعوار‬ ‫الدكتور خلدون العدوان‬ ‫الدكتور منصور باك‬ ‫الدكتور خليل نمر حامد‬ ‫الدكتور محمد عمر أبو زيد‬ ‫الدكتور محمد كنعان‬ ‫الدكتور محمود نزال‬ ‫الدكتور نزار سبيناتي‬ ‫الدكتور سائد البرغوتي‬ ‫الدكتور سالم المجالي‬ ‫الدكتور سمير قابوق‬ ‫الدكتور سمير مصطفى‬ ‫الدكتور طه الطوايعة‬ ‫الدكتورة تمارا قندور‬ ‫الدكتور وائل الذنيبات‬ ‫الدكتور يوسف سرحان‬ ‫الدكتور زهير الصباغ‬ ‫الدكتور زياد حوامدة‬ ‫الدكتور زياد صبيح‬

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‫‪Members of Executive Committee‬‬ ‫‪Dr. Abdel-Fattah Al-Worikat‬‬ ‫‪Dr. Aida Doughan‬‬ ‫‪Dr. Ali Al-Ghuweri‬‬ ‫‪Dr. Ali Al-Hadid‬‬ ‫‪Dr. Ali Al-Otom‬‬ ‫‪Dr. Awni Hanandeh‬‬ ‫‪Dr. Barakat Al-Zaben‬‬ ‫‪Dr. Elias Hattar‬‬ ‫‪Dr. Hani Shoqah‬‬ ‫‪Dr. Hisham Al-Sayegh‬‬ ‫‪Dr. Jane Kawar‬‬ ‫‪Dr. Khaldoun Al-Adwan‬‬ ‫‪Dr. Mansour Bac‬‬ ‫‪Dr. Khalil N. Hamid‬‬ ‫‪Dr. Mohammad Omar Abu-Zaid‬‬ ‫‪Dr. Mohammad Kanaan‬‬ ‫‪Dr. Mahmoud Nazal‬‬ ‫‪Dr. Nizar Sbeinati‬‬ ‫‪Dr. Saed A. Barghothy‬‬ ‫‪Dr. Salem Al-Majali‬‬ ‫‪Dr. Sameer Guboug‬‬ ‫‪Dr. Sameer Mustafa‬‬ ‫‪Dr. Taha Al-Tawayah‬‬ ‫‪Dr. Tamara Quandour‬‬ ‫‪Dr. Wael Thunaibat‬‬ ‫‪Dr. Yusef Sarhan‬‬ ‫‪Dr. Zuhair El-Sabbagh‬‬ ‫‪Dr. Ziad Hawamdah‬‬ ‫‪Dr. Ziad Sbeih‬‬

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Congress Committees

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Scientific Committee

Financial Committee

Social Committee

Dr. Tamara Quandour, Chairman

Dr. Mohammad Kanaan, Chairman

Dr. Sameer Guboug, Chairman

Dr. Abdel-Fattah Al-Worikat Dr. Sameer Mustafa Dr. Yusef Sarhan Dr. Aida Doughan Dr. Ali Al-Otom Dr. Ali Al-Hadid Dr. Khaldoun Al-Adwan Dr. Ziad Sbeih Dr. Ziad Hawamdeh Dr. Mohammad Omar Abu-Zaid Dr. Sameer Guboug Dr. Nizar Sbeinati Dr. Awni Hanandeh Dr. Jane Kawar Dr. Hisham Al-Sayegh

Dr. Nizar Sbeinati Dr. Salem Al-Majali Dr. Mahmoud Al-Riyati Dr. Na’el Al-Kurdi Dr. Defallah Magablah

Dr. Lilia Al-Taleb Dr. Tamara Quandour Dr. Marwan Al-Taher Dr. Thabit Madi Dr. Jafar Al-Momani Dr. Zaied Al-Dahamsha Dr. Haitham Abu-Humedan Dr. Awni Al-Hadid Dr. Karem Al-Rashdan Dr. Yahia Al Quwasmi Dr. Waleed Hawatmeh

Medical Exhibition Committee

International Relations Committee

Dr. Mohammad Omar Abu-Zaid, Chairman Dr. Ali Al-Rjoub Dr. Natalya Mohammad Dr. Lama Abu-Sharar Dr. Rabi Rowhi Dr. Aziz Afram Dr. Najeeb Al-Nabulsi Dr. Naheyah Al-Muhtaseb

Dr. Taha Al-Tawayah, Chairman Dr. Ibrahim Al-Amayreh Dr. Mubarak Al-Twal Dr. AbdelKarim Mutawea Dr. Tariq Marabha Dr. Rajab Suleiman Dr. Mohammed Khdair Dr. Walid Al-Momani Dr. Munther Al-Momani Dr. Ali Qandel Dr. Samer Qamouh Dr. Khaleh Al-Sheikh

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Scientific Program

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Wednesday November 05th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session I: 11:00-13:00 Rheumatology Rehabilitation (1) Chairpersons: Zuhair El-Sabbagh / Jane Kawar / Barakat Al-Zaben

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

11:00-11:15: TNF alpha INHIBITION IN RA: EFFORTS AT PREDICTING RESPONSE AND USING ALTERNATIVE THERAPY Ali S. Jawad, United Kingdom

11:15-11:45: Uveitis and arthritis in childhood rheumatic diseases Aly A Fathy Mahmoud, Egypt

11:45-12:00: CORTICOSTEROIDS THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS Natasa Milenovic, Serbia

12:00-12:20: PREVALENCE OF OSTEOARTHRITIS IN

RHEUMATOLOGICAL OUTPATIENT CLINICS Jane Kawar, Jordan

12:20-12:35: Do we need to do temporal artery biopsy? Manal Al-Mashaleh, Jordan

12:35-12:45: A study on 28 patients with TMJ dysfunction Barakat Moh’d AL-Zaben, Jordan

12:45-12:55: Hereditary Thrombophilia, Frequency and Clinical Outcome in a

Jordanian Cohort Abdelrazzaq Wraikat, Jordan

12:55-13:00: Discussion

13:00-14:30: Lunch at Le Meridien Hotel, Sponsored by Jordanian Society PM & R

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Wednesday November 05th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session II: 14:30-16:00 Neuro-Rehabilitation (1) Chairpersons: Samer Mustafa / Mahmoud Nazal / Ali Al-Hadid 14:30-14:55: Neurological Challenges in Neuro-Rehabilitation The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Amir S N Al-Din, United Kingdom

14:55-15:20: MANAGEMENT OF POSTSTROKE SPASTICITY Dirk Dressler, Germany 15:20-15:30: Aphasia in Hemiplegic Patients Zaidan Alkhamiaseh, Jordan

15:30-15:40: Vital Stim Therapy for Treating Dysphagia (Swallowing Disorders) In Stroke & TBI Patients Mufeed Al Jeady, KSA

15:40-15:50: DIAGNOSIS OF ULNAR NEUROPAYHY AT THE ELBOW USING MIXED LATENCY DIFFERENCE SAMEER GUBOUG, Jordan

15:50-16:00:

Discussion

16:00-16:30:

Coffee Break

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Wednesday November 05th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session III: 16:30-18:30 Orthopedic Rehabilitation

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Yusef Sarhan / Mansour Bac / Khaldoun Al-Adwan 16:30-16:55:

Past and present of the UEMS Section and Board of Physical and Rehabilitation Medicine Alain Delarque, France

16:55-17:20:

MAXIMIZING OUTCOMES FOLLOWING JOINT REPLACEMENT David Lawrence, USA

17:20-17:45:

Perspectives for Rehabilitation in Europe: a particular role for ESPRM Alessandro GIUSTINI, Italy

17:45-18:00

BRACING IN TREATMENT OF CONGENITAL CLUBFOOT Mahmoud M Odat, Jordan

18:00-18:15:

The Treatment of Fractures and Orthopedics Deformities by Llizarov Hamdi Negresh, Jordan

18:15-18:25:

ELECTRICAL BURN AND LIMB LOSS; A FOUR-YEAR EXPERIENCE Samer Haddad, Jordan

18:25-18:30:

Discussion

20:00:

Dinner Sponsored by Royal Medical Services

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Thursday November 06th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

07:30-08:30: Registration, (Dana Hall)

Session IV: 08:30-10:35 Spinal Rehabilitation

08:30-08:55:

Aggressive Orthotic treatment of the Spinal Cord involvement patient John F. Schulte, USA

08:55-09:15:

Thrombembolic Disorder in Spinal Cord Injury Ali Otom, Jordan

09:15-09:35:

Pressure Ulcers Following Spinal Cord Injury Mofid Saif, United Kingdom

09:35-09:50

Complications following SCI during the Acute Phase Firas Sarhan, United Kingdom

09:50-10:05

Assessment of bladder and bladder program in SCI patients in Syria Ahmad Samer Alkawadri, Syria

10:05-10:20:

Transferring Patients to Spinal Cord Injury (SCI) Centres Firas Sarhan, United Kingdom

10:20-10:30:

POST OPERATIVE PYOGENIC INTERVERTEBRAL DISKITIS Abdulzahra Kzar, Iraq

10:30-10:35:

Discussion

10:30-11:00:

Coffee Break

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Elias Hattar / Ali Al-Otom / Ali Al-Ghuweri

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Thursday November 06th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session V: 11:00-13:00 Sport Medicine

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Ziad Sbeih / Hisham Al-Sayegh / Ali Al-Rjoub

11:00-11:25:

Evidence based tragedies for patient handling in Rehabilitation settings. Prof Xanthi MICHAIL, Greece

11:25-11:50:

NON-SURGICAL MANAGEMENT OF RESISTENT ACHILLES TENDINOPATHY USING HIGH VOLUME IMAGE GUIDED INJECTION. Nat Padhiar, United Kingdom

11:50-12:15

REHABILITATION OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SONYA M. RASHAD, EGYPT

12:15-12:35:

Physical Medicine and Rehabilitation in Sports Injuries. Nicolas Christodoulou, Cyprus

12:35-12:45

Complications and Treatment during Rehabilitation after Anterior Cruciate Ligament Reconstruction Sudqi A. Sarrawi, Jordan

12:45-12:55:

Management of grade 11 acute lateral ankle sprain in a basketball Player Hashem Yasin, Jordan

12:55-13:00:

Discussion

13:00-14:30: Lunch at Le Meridien Hotel, Sponsored by Jordanian Society of PM & R

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Thursday November 06th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session VI: 14:30-16:00 Prosthetics & Orthotics Rehabilitation + Free Papers

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Abdel-Fattah Al-Worikat / Mohammad Omar Abu-Zaid Ziad Hawamdah

14:30-15:00: The Endo - Exo – Femurprosthesis

A new concept of prosthetic rehabilitation following above-knee Amputation Horst-Heinrich Aschoff, Germany

15:00-15:20: THE OUTCOME MEASUREMENTS FOR LOWER LİMB PROSTHEfTIC REHABILITATION Kamil YAZICIOGLU, Turkey

15:20-15:50:

The newest developments in trends utilizing Dynamic, joint Controlling Lower Extremity Orthotics resulting in changing Prescription orderingCriteria John F. Schulte, USA

15:50-16:00:

Discussion

16:00-16:30:

Coffee Break

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Thursday November 06th, 2008 Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session VII: 16:30-18:30 Physical Medicine + Pain Management

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Khalil Hamid / Mohammad Kanaan / Khaled Al-Adwan

16:30-16:50:

VIBRATION ENERGY IN REHABILITATION MEDICINE FOTI Calogero, ITALY

16:50-17:10:

Effects of rehabilitative muscles approach using local acoustic Vibrations on skeletal muscle trophism in elderly and young People Saggini Raoul, Italy

17:10-17:30:

Mesotherapy and Cryotherapy Joseph Khazaal, Lebanon

17:30-17:45

Chronic Pain Program – The Holistic Approach Aziz Alfeeli, Kuwait

17:45-18:00

Stress and musculoskeletal injury: potential path physiological Pathways and their links to pain management. Aziz Alfeeli, Kuwait

18:00-18:10:

Complex regional pain syndrome Ayman Askari, Jordan

18:10-18:20:

The role of the occupational therapist in Jordan: A survey of the Members Of the healthcare team exploring their knowledge about Occupational therapy in rehabilitation hospitals. Rawan Ala’ Al-Heresh, Jordan

18:20-18:30:

Discussion

20:00:

Gala Dinner at Tourist Palm Village

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Friday November 07th, 2008

Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A 07:30-08:30 Registration (Dana Hall)

Session VIII: 08:30-09:35 Osteoporosis

08:30-08:45:

Validation of Ten – year fracture risk prediction (FRAX) Aida Doughan, Jordan

08:45-08:55:

The Effects of Magnet Therapy verses Exercise Intervention on the Management of Low Bone Mineral Density at the lumber spine in Postmenopausal WOMEN: a Comparative Study. Fuad A. Abdulla, Jordan

08:55-09:05:

Osteoporosis: Gynecological risk factors among Jordanian Postmenopausal women Ahmad Al-Zubi, Jordan

09:05-09:15:

The Role of Dual Energy X-ray Absorbtometry (DEXA scan) in Transient Osteoporosis of femur Khaled Alkhawaldeh, Jordan

09:15-09:25:

The Use of Sonography for Screening Carpal Tunnel Syndrome Moh’d S. Khassawneh, Jordan

09:25-09:35:

Discussion

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Aida Doughan / Nizar Sbeinati / Saed Barghothy

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Friday November 07th, 2008

Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session IX: 09:35-10:45 Rheumatology Rehabilitation (2) Chairpersons: Hani Shoqah / Tamara Quandour / Ibrahim Al-Amayeh

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

09:35-09:50: APPLICATION PHYSICAL THERAPY IN TREATMENT PATIENTS WITH RHEUMATOID ARTHRITIS N Milenovic, Serbia

09:50-10:05: Management of Shoulder Pain Tamara Quandour, Jordan

10:05-10:15: Percutaneous Needle Aponeurotomy in Dupuytren’s contracture Issam A. Dahabra, Jordan

10:15-10:25: Occlusal appliance therapy in patients with temporomandibular Joint disorders Yousef Al-Shumailan, Jordan

10:25-10:35

Comparison between Hot packs therapy and diclofenac sodium in acute low back pain Essa A Mayyas, Jordan

10:35-10:45:

Discussion

10:45-11:00:

Coffee Break

11:00-13:00:

Friday Pray

13:00-14:30: Lunch sponsored by Islamic Hospital

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Friday November 07th, 2008

Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A

Session X: 14:30-16:00 Prosthetics & Orthotics Rehabilitation

14:30-14:55:

COMPREHENSIVE REHABILITATION FOLLOWING LOWER EXTREMITY AMPUTATION David Lawrence, USA

14:55-15:10

Assessment of anxiety and depression after lower limb amputation In Jordanian patients Ziad M Hawamdeh, Jordan

15:10-15:20:

How to Choose Prosthetics Components According to the Amputee Mobility Grade Imad. J. Aldibee, Jordan

15:20-15:30:

The effectiveness of early intervention of physical therapy with Individuals who had amputation of the lower limbs in preProsthetic stage Nezar M. Khaddam, Jordan

15:30-15:40:

The Trans Femoral Anatomical Medial Ramus Containment Socket Design Ghazi Alamrat, Jordan

15:40-15:50:

The Use of Patient Satisfaction for Evaluation the Quality of Healthcare Mohammad Obeidat, Jordan

15:50-16:00:

Discussion

16:00-16:30:

Coffee Break

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Chairpersons: Salem Al-Majali / Wael Thunaibat / Taha Al-Tawayah

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Friday November 07th, 2008

Venue: “Le Meridien Hotel” Amman Royal Convention Center, Hall A Session XI: 16:30-18:30 Neuro-Rehabilitation (2) + Free Papers Chairpersons: Awni Hanandeh / Sameer Guboug / Bassam Zyadat

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

16:30-16:40:

Functional Outcome of Intrathecal Baclofen in Spastic patient Bassam Zaidat, KSA

16:40-16:50:

Treatment of Spasticity in Children with Cerebral Palsy by Botulinium Toxins (Dysport) Ali AL-Ghuweri, Jordan

16:50-17:00:

Critical Illness Polyneruropathy & Myopathy Abdullah Al-Sarhan, Jordan

17:00-17:10:

C-REACTIVE PROTEIN (CRP) AS A PREDICTOR FOR LONG-TERM OUTCOME IN ISCHEMIC STROKE PATIENTS Amjad Banihani, Jordan

17:10-17:20:

Weight Bearing Reduces Spasticity in Children with Spastic Cerebral Palsy Fuad A. Abdulla, Jordan

17:20-17:30:

Frequency and family study of the congenital deformity of The chest Hasan A.Qader, Jordan

17:30-17:40:

Role of Interferential Therapy in the Treatment of Trigeminal Neuralgia SAMEER GUBOUG, Jordan

17:40-17:50:

Gallstones in Spinal Cord Injury (SCI): A Late Medical Complication? Ali Al-Hadid, Jordan

17:50-18:00:

Multiple Congenital Contractures (MCC’s) MOHAMMAD ABU-ZAID, Jordan

18:00-18:05: Discussion 18:05-18:30: Closing Ceremony 20:00: Dinner Sponsored by Jordan Hospital 20

Workshops Program The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Venue: “Le Meridien Hotel” Amman Royal Convention Center

(Kahraman & Aqiq Hall)

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Wednesday November 05th, 2008

Agenda for the Comprehensive Prosthetics Workshop Fillauer Companies, USA 14:30 – 14:35 14:35 – 14:50

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

14:50 – 15:50

15:50 – 16:30

Introduction of Speakers Program Goals and Expectations At the conclusion of this program, the attendee will, through the multimedia, didactic, support materials and end of program tests to quantify the attendees understanding of presented materials. Lower Extremity Prosthetic Socket designs The length of the residuum many times limits the style and design of the prosthetic socket. The ability of the practitioner and prescriber to maximize function for the patient. The various designs, materials, function and energy expenditure results in a more cosmetic and functional gait. Current and Historical designs will be discussed in this interactive presentation. Prosthetic Feet Comparisons This interactive program will show through multi-media materials, the various prosthetic Feet and the drawbacks and Benefits of each. The attendee will be able to better recommend prosthetic feet recommendations for the optimum patient outcomes at the conclusion of this presentation.

16:30 - 16:45

Break

16:45 – 17:45

Prosthetic componentry options to maximize function of the Lower Extremity amputee Various prosthetic componentry available today from Pediatric through the 200 kg. patient will be presented to maximize the function and energy expenditure through prescription considerations for the Lower Extremity patient.

17:45 - 18:30 Program review and Questions allowing the participants the opportunity for direct discussion amongst the participants and hands-on examination of the various componentry and devices.

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Thursday November 06th, 2008

Agenda for the Comprehensive Orthotic Workshop 09:00 – 09:05 09:05 – 09:15

09:15 – 09:35

09:35 – 10:00

10:00 - 10:35

10:35 - 11:05

11:05 – 11:20 11:20 – 12:00

12:00 – 12:50

12:50 - 13:00

Introduction of Speakers Program Goals and Expectations At the conclusion of this program, the attendee will, through the multi-media, didactic, support materials and end of program tests to quantify the attendees understanding of presented materials. Rigid vs. Dynamic Orthoses The new, lightweight materials, joint control componentry have brought about a change in prescription ordering criteria for the prescribing physician. This change, combined with more cosmetic, energy returning devices have brought about unprecedented acceptance from the Orthotic end user. Below the Knee Orthotic Solutions Utilizing the various Orthotic prescription options available today, we will discuss current and new componentry choices to control the foot / ankle complex of the Lower Extremity and their applications that will provide optimum treatment outcomes. Introduction to the Dynamic Walk Orthosis and patient selection The attendee, at the end of this presentation will understand the concepts relating to the materials, adjustment and patient selection criteria for the Dynamic Walk LE Orthosis including case studies and patient applications. Orthotic Knee Control componentry This presentation will discuss the numerous component options available to provide the patient in need of knee control including the newest line of modular joints that enable the Orthotic practitioner the option to change the joint instead of the entire Orthosis as the patient activity level changes. Break Swing Phase Lock Knee Joint This presentation will cover the history and development of the Swing Phase Lock Knee Joint, which gives the background of the current design. Lecturer will also provide a broad overview of usage and optimization including case studies and patient applications. Introduction to the Reciprocal Gait Orthosis The Reciprocal Gait Orthosis is indicated for a number of Spinal disorders. The lecturer will present the history, clinical indications, case presentations and troubleshooting of this Lower Extremity Orthosis. Program review and Questions allowing the participants the opportunity for direct discussion amongst the participants and handson examination of the various componentry and devices.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Fillauer Companies, USA

Friday November 07th, 2008

09:00-11:00: CAD – CAM System Canfit – Vorum, Canada Mahmmod Al-Khaldi Trading EST. JORDAN The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

With the cooperation of Centre Harika sarl Lebanon (sole agent Vorum for the Middle East) Session by Antoine Harika

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Poster Program

•

TREATMENT OF WILSON’S DISEASE -CASE STUDY Slavica Golubovic, Serbia

•

HABILITATION AND SPECIAL EDUCATION IN CHILDREN WITH AUTISM Slavica Golubovic, Serbia

•

PHYSICIANS FOR PEACE - WALKING FREE David Lawrence, USA

•

Health Promotion for Spinal Cord Injury (SCI) people Firas Sarhan, UK

•

The Potential for Domiciliary Visit by Telenursing in Spinal Injuries Firas Sarhan, UK

•

Ageing Process and Spinal cord Injury Firas Sarhan, UK

•

Scope of Isolated Urinary Pathogens and Their Antibiotic Susceptibility Abdallah Mohammad Da`meh, Jordan

•

Rheumatology Nurse Specialists – Do we need them? Afaf .A.Al Sarahneh, Jordan

•

The Roll of AFO in the Treatment of CP patients Azza Nofan, Jordan

•

Sixth and Tenth Nerve Palsy Secondary to Pseudomonas Infection of the Skull Base Ali Mah’d Al-Amouri, Jordan

•

RENAL OSTEODYSTROPHY Elias Turk, Jordan

•

Evaluation of occulomotor nerve palsy Ali AL-Ammouri, Jordan

•

Transtibial amputation Lama Al-Junaidi, Jordan

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Venue: “Le Meridien Hotel” Amman

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

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Should military doctors be the only burden bearers in treating War Injuries? Mahmoud M Odat, Jrodan

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Effectiveness of using silicone heel pads for planter fasciitis Mohammad D.S.Al-Omari, Jordan

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Food Acceptability among Hospitalized Patients IN KHMC Mohammad M. Aqel, Jordan

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Community based rehabilitation in Palestinian refugee camps in Jordan: Challenges to achieving Occupational Justice Rawan Ala’ Al-Heresh, Jordan

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Neurogenic thoracic outlet syndrome SAMEER GUBOUG, Jordan

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Cervical Myelopathy MOHAMMAD ABU ZAIED, Jordan

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LPB with An abnormality on the thoracolumbar spine X-Ry JALAL AL-BATAIENA, Jordan

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Post-poliomyelitis syndrome (PPS) SAMEER GUBOUG, Jordan

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The Effectiveness of Intermittent Cervical Traction on Pain Relief in Cervical Spondylosis. Fayrouz H. Al-Rawahneh, Jordan

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Psoriatic Arthritis Bassam Nsoor, Jordan

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Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of Osteoarthritis Zaid Dahamsheh, Jordan

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The New Curve Wooden Modified To The Straight Wooden Finger Ladder Abdulhadi Elkhatib, Jordan

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The importance of lasers in dermatology setting Issa Al-Ziyoud, Jordan

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UVEITIS IN CHILDREN; Mohammed Ammouri, Jordan

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INTRAVITREAL TRIAMCINOLONE FOR DIABETIC MACULAR EDEMA Mohammed Ammouri, Jordan

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Plenary Lectures & Free Papers

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TNF alpha INHIBITION IN RA: EFFORTS AT PREDICTING RESPONSE AND USING ALTERNATIVE THERAPY

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Ali S. Jawad, The Royal London Hospital, London, UNITED KINGDOM; R.A. Mageed, The Bone and Joint Research Unit, The William Harvey Research Institute, Barts and the London Queen Mary School of Medicine and Dentistry, London, UNITED KINGDOM; Background: RA is a chronic autoimmune disease of uncertain cause associated with symmetric polyarthritis and, in some patients, with extraarticular manifestations. Patients with rheumatoid arthritis experience a chronic, fluctuating course that may result in joint damage, disability, deformities, and even a shortened life span. TNFα is is a pro-inflammatory mediator that has been identified as a key molecule in the pathogenesis of RA.Three TNFα antagonists have been approved for the treatment of RA: 1. Etanercept, a soluble p75 TNFα receptor fusion protein 2. Infliximab, a chimeric (mouse/human) anti-TNFα antibody 3. Adalimumab, a fully human monoclonal anti-TNFα antibody B cells are also thought to play a role in the pathogenesis of RA. Rituximab, a monoclonal antibody to CD20 that induces depletion of B cells, has been approved for the treatment of RA. Tocilizumab is a humanized anti-human IL-6 receptor antibody of the IgG1 subclass. Tocilizumab competes for both the membrane-bound and soluble forms of human IL-6 receptor, thereby inhibiting the binding of the native cytokine to its receptor and interfering with the cytokine’s effects. We have started a study into mechanism of action of TNF inhibitors in responder and non-responder patients. Methods: Fifteen RA patients with active disease (DAS 28>5.1 on 2 occasions 1 month apart) who had failed to respond to, or tolerate 2 standard disease modifying anti rheumatic drugs (DMARD) one of which been methotrexate were enrolled in the first phase of the investigation. Changes in disease were quantified using DAS and HAQ measurements. Blood (25ml) was drawn from patients prior to and at 3 months after initiation of anti-TNFα treatment. T- and B-lymphocyte and monocytes were individually isolated by negative selection (>95% purity). Cytokines produced spontaneously (18hr culture), 28

Results: Six of 15 patients (40%) did not respond to anti-TNFα (etanercept, adalimumab) while 9 responded to the treatments. Measurement of cytokines produced by T-lymphocytes (IL-5, IL-6, IL-10, TNFα and IFNgamma) before treatment was not predictive of responsiveness to anti-TNFα. There was a wide spread in the level of cytokines produced by the T-lymphocytes in responders and non-responders alike. After treatment, there was a general trend towards increased IL-5 and 10 production (TH2 cytokines) and reduced IFNgamma (TH1) in the responder patients. However, there was no clear-cut polarization towards TH2 cells, or regulatory T-lymphocytes. Overall, responder patients had reduced ratios of cytokines produced following immunological stimulation through the CD3/CD28 to PMA/ionomycin-induced. Conclusions: There was a wide spread in the level of cytokines produced by the T-lymphocytes in responders and non-responder patients before and after treatment with TNF alpha inhibitors. Based on these results in this relatively small cohort of patients it may be that it would be difficult to predict the outcome of treatment with TNF alpha inhibitors based solely on measuring the level of the T-cell cytokines studied. We are in the process of studying more patients. After treatment, there was a general trend towards increased IL-5 (TH2 cytokine) and reduced IFN alpha (TH1) in the responder patients. However, there was no clear-cut polarization towards TH2 cells, or regulatory T-lymphocytes. The level of IL-10 decreased significantly in most of the responder patients, while there was no significant decrease in the non responders. A range of immune cells contribute to the immuno-pathology and inflammation of RA and future studies should involve investigation of the biology and responses of other immune cells.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

or induced, by anti-CD3 and anti-CD28 for T-cells, or by PMA/ionomycin were measured by FACS using cytometric bead array.

Uveitis and arthritis in childhood rheumatic diseases Aly A Fathy Mahmoud, Ophthalmology Department, Al-Azhar University, Assiut, Egypt

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Abstract: In childhood and adolescence, uveitis is a potentially vision-threatening and part of the clinical spectrum of many inflammatory-rheumatic diseases. According to the national ophthalmological and paediatric rheumatological database, one out of four children with juvenile chronic arthritis develops ocular complications such as synechiae, band keratopathy, cataract, glaucoma and macular oedema. Complications are seen especially in uveitis patients with late diagnosis and insufficient anti-inflammatory therapy. Regular ophthalmologic examinations should allow early diagnosis and effective therapy. The pediatric rheumatologist can collaborate effectively with ophthalmologists in assessing indications for introducing and monitoring the safety and efficacy of immunomodulatory agents, including new biologic agents. Better therapeutic regimens have led to a better overall prognosis in recent years. Faculty of Medicine, Al-Azhar University, Assiut, Egypt Prof. Dr Aly A Fathy Mahmoud, Dean of faculty of medicine. Email:[email protected]

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CORTICOSTEROIDS THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS N Milenovic, B Popovic Institute for Rheumatology, Faculty of Medicine, University of Novi Sad, Serbia

Aim- The aim of study was to evaluate effect of GC therapy in patients with RA. Material and methods- We examined 250 patients 57.26 years old (± 9.34 years), 77.67% was female patient, who suffered from RA 8.39 years (1-39 years), in 89.32% was RF positive RA. Results- Patients used in 95.15% non-fluorides GC. Predominate form was oral application 57.29% (prednisone 41.75% and metilptrednisolon 15.54%), but in 33.98 was intramuscular application of metilprednisolon-acetat. Only 3.88% patients took combination. Stage or RA changes was classified with Stein-Brocker`s criteria and we found that 45.63% of our patients were in Grade 3 anatomical classification but 58.25% were in Grade 2 functional classification, but bettering functional capacity statistically significant correlated (r=0.2227, p=0.024) was GC application. Morning stiffness longer than 60 minutes had 54.37%. Serious adverse effect was not evidenced. Conclusion- We can conclude that application of corticosteroids in treatment RA can be safe and beneficial for patient.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Introduction- Rheumatoid arthritis (RA) as autoimmune, inflammatory arthropathy required specific treatment which includes usage of glikocorticoides (GC).

PREVALENCE OF OSTEOARTHRITIS IN RHEUMATOLOGICAL OUTPATIENT CLINICS Jane Kawar (M.D), Mbarak Twal (M.D), Oseilah Burgan (M.D) Objective: To assess the prevalence and joint distribution of osteoarthritis (O.A) in a community based rheumatological outpatient clinics in KHMC.

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Methods: 1860 of new and returning patients with osteoarthritis were recorded using a standard diagnosis form. Results: 1860 patients were studied, 1116 (60%) were females and 744 (40%) were males. The most common joint affected by OA is the Knee 930 (50%), followed by OA of the spine 558 (30%), OA of the upper limbs 372 (20%), OA hip 112 (6%) sand the least affected is the ankle joint 75 (4%). The commonest age group for both male and female patients is between 5160 years (46%). Conclusion: OA of the knee joint is the most common effected joint in females & males, and the most common effected age group is between 51-60 years. These results confirmed other international and global studies.

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Do we need to do temporal artery biopsy? Manal Al-Mashaleh Rheumatology.KHMC

Patients and Methods: Thirty three patients with the clinical diagnosis of TA were held in Westmead hospital/Sydney Australia in the period 2001-2006. TAB was taken from every patient for histopathological examination. Results: Out of 33 patients who were diagnosed to have TA on clinical bases, 20 patients (64%) showed typical histological findings of TA. Conclusion: Although starting the vision saving therapy for patients of TR based on clinical bases is a justifiable policy, the histopathological diagnosis should be relied on to consider continuing the therapy or stopping it.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Objective: To determine the percentage of positive Temporal Artery Biopsy (TAB) in patients clinically diagnosed to have Temporal Arteritis (TA).

A study on 28 patients with TMJ dysfunction Barakat Moh’d AL-Zaben , MD, JMC, Physical medicine And rehabilitation, Head of rehabilitation department, Prince Faisal Bin AL-Hussein hospital (MOH

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Objectives: To evaluate the outcome of physiotherapy in The management of TMJ dysfunction, regarding the Number and percentage of improved patients. Setting: Physical Medicine, Rehabilitation Department in Prince Faisal bin Al-Hussein Hospital (MOH). Participants: 28 patients: 18 (64.2%) female, mean age 24 years, and 10 (35.8%) male, mean age 36 years. Interventions: Physical therapy modalities, (Ultrasound Contrast Baths) and an exercise program. Results: 10 patients (35.7%) improved completely 13 patients (46.4%) partial improvement. 5 patients (17.9%) no change. 0 patients worsened by physiotherapy.

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Hereditary Thrombophilia, Frequency and Clinical Outcome in a Jordanian Cohort Dr.Abdelrazzaq Wraikat MD JBHP Dr.Shaher Mahafza MD JBIM Dr.Suzan Alshdefat MD JBOG Objective: To determine the frequency of various causes, the clinical outcome, the age, family history and gender distribution of hereditary thrombophilia seen at the Internal Medicine Department of Prince Rashed Military Hospital and King Hussein Medical Centre.

Results: All patients who presented to our clinic with thromboembolic events or were hospitalized because of thromboembolic phenomena were screened for thrombophilia, of 120 patients; 64 males and 56 females, pure heterozygous form of the hyperhomocystienemia Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation was present in 28.34%, pure activated protein C resistance heterozygous for factor V Leiden mutation was present in 26.67%, double heterozygosity for both activated protein C resistance factor V Leiden mutation and the hyperhomocystienemia Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation was found in 15%, normal thrombophilia screen was found in 6.67% of those presenting with serious thromboembolic phenomena. Protein S deficiency was found in 4.17%, pure Activated Protein C Resistance homozygous for Factor V Leiden was found in 3.33%, the combined Activated Protein C Resistance homozygous for Factor V Leiden with the heterozygous form of the hyperhomocystienemia Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation were found in 3.33%,Double-Heterozygosity for both Activated Protein C Resistance factor V Leiden mutation and the G20210A Prothrombin gene mutation was found in 2.5%,also the homozygous form of the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation was found in 2.5%,both pure heterozygous form for the G20210A Prothrombin gene mutation and the combined Protein S with Protein C deficiency was present in 1.67%, both activated protein C resistance heterozygous for factor V Leiden mutation and the homozygous form of the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation was present in 0.83%,Double-Homozygosity for Activated Protein C Resistance for factor V Leiden mutation and the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation was present in 0.83%, Double-Heterozygosity for the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation and the G20210A Prothrombin gene mutation was found in 0.83%, both homozygous form of the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation and the heterozygous and the G20210A Prothrombin gene mutation was present in 0.83%,a rare Triple-heterozygosity for Activated Protein C Resistance factor V Leiden mutation, the Methylenetetrahydrofolate reductase (MTHFR) deficiency C677T mutation and the G20210A prothrombin gene mutation was found in 0.8 3%. Conclusion: In conclusion, thrombophilia is the main cause of familial or inherited thromboembolic diseases, that could be fatal in young patients, it should be suspected in young patients, having positive family history for thrombo-embolic diseases , having recurrence of symptoms, and if presented at an unusual site. 35

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Methods: This a descriptive study incorporating a retrospective analysis of the requests for thrombophilia screening sent to the haemocoagulation unit in King Hussein Medical Centre during the period June 2005-January 2007.

Neurological Challenges in Neuro-Rehabilitation Prof. Amir S N Al-Din, FRCP. MY Neurosciences Services, Mid Yorkshire NHS Trust, UK

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

It is not uncommon and quite challenging for the Neuro-Rehabilitation team to become the responsible for the long term care of patients with as yet undiagnosed but progressive neurology. In many such patients it is almost impossible to confirm such a diagnosis despite repeat investigations and multi-speciality involvement, but disease course modifications can be missed without specific medications. In his presentation the diagnostic and management difficulties of such patients are addressed. This is to include: 1. The accuracy of the diagnosis of multiple sclerosis, 2. Undiagnosed progressive spastic or spastic ataxic paraparesis, 3. The unusual syndromes of progressive ataxia, peripheral neuropathy with or without epilepsy. 4. The differential diagnosis of patients presenting with bilateral optic neuropathy and Multiple Sclerosis like illness. 5. Neurological deterioration after many years or decades of successful posterior fossa or spinal tumour surgery. 6. Medication refractory epilepsy in acquired brain injury patients.

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MANAGEMENT OF POSTSTROKE SPASTICITY

About a third of patients suffering from a stroke with motor deficits will develop increased muscle tone. In a third of those the muscle tone reaches an Ashworth score of 2 or more. Once increased the muscle tone usually remains increased permanently. Phenomenologically, the increased muscle tone can present as spasticity sensu strictu, dystonia, rigidity and spasms thus suggesting the term spasticity syndrome. Often they produce pain. Complications include contractures, arthritis and irritation of nerves and vessels. Impaired posturing can produce decubiti and may impair nursing. Spasticity syndromes require treatment to reduce pain, to improve physiotherapeutic rehabilitation programs, to facilitate nursing, to prevent complications and to improve function. Oral medications for spasticity include baclofen, tizanidine, benzodiazepines, memantine, dantrolene, and tolperisone. They usually exert mild effects only and their use may be accompanied by adverse effects. Intrathecal application of baclofen by using implantable pumps can intensify baclofen effects dramatically without producing major adverse effects. Surgical treatment includes neurotomies, myotomies, and tendotomies. In more severe cases botulinum toxin (BT) becomes the treatment of choice. BT is applied intramuscularly, remains almost entirely in situ, has a prolonged duration of action of up to 4 months and is metabolised completely without residuums. Typical target muscles in the upper extremity include the pectoralis, deltoid, biceps brachii, brachioradialis, the finger flexors, the flexor carpi radialis and the flexor pollicis longus. Typical target muscles in the lower extremity are the hip adductors, the hamstrings, the quadriceps femoris, the gastrocnemius, the tibialis posterior, the flexor digitorum longus and the short toe flexors. Total doses that can be applied safely can range up to 800mu Botox/Xeomin or 2000mu Dysport allowing treatment of hemispasticity syndromes and selected areas of generalised spasticity syndromes. BT therapy can be combined with oral medications and intrathecal baclofen. It can improve the outcome of surgical interventions. It should not be applied without appropriate physiotherapy expanding the ranges of motion, and facilitating functional abilities.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Dirk Dressler, MD, PhD Professor of Neurology, Head of Movement Disorders Section Hannover Medical School, Hannover, Germany [email protected]

Aphasia in Hemiplegic Patients Zaidan Alkhamiaseh,PhD, Speech pathologist*, Fawaz Alkhawaldeh, phyisotherapist**, Bassam Abu dayeh, Physio-therapist***

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Aim: The aim of this study was to define aphasia frequency and its clinical types together with the relationship between the clinical types and age, gender, hemiplegic side, etiology and educational level of the hemiplegics patients. Methods: All hemiplegic patients who admitted to Royal Rehabilitation Center (RRC) in king Hussein Medical center from February 2006 to June 2006 were included in this study. During this period, 35 hemiplegic patients were hospitalized for rehabilitation. 28 of these patients were identified to have speech disorders; The Mann-Whitney U test and Pearson chi-square test were used to investigate gender differences and predictive association among the variables of age, gender, educational levels and type of aphasia. Results: Mean age of aphasic patients was calculated as 57.2 years (21-82) years. (82.3%) were non-fluent, and (17.7%) were fluent. There was no statistically significant difference between the mean ages of fluent and non-fluent aphasics (P > 0.05). Mean age of Broca aphasics (48.7) was younger than of Wernicke (56.3) and global (62.1) aphasics, and this difference was of statistical significance (P < 0.01). There was no significant relationship between gender and etiology, dominant hand, hemiplegic side, educational level and types of aphasia (P > 0.05). Conclusions: Aphasia is one of the most common complications to develop due to cerebrovascular accident (CVA). Accordingly, further research is in progress to examine the relation between age, gender and etiology and to probe its causes, using a criterion other than the presence of aphasia. Key Words: Aphasia, hemiplegia, age, gender, type of aphasia.

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Vital Stim Therapy for Treating Dysphagia (Swallowing Disorders) in Stroke & TBI Patients Dr.Mufeed Al Jeady, Ph.D Consultant SLP & Stroke/TBI Rehab Manager Certified Vital Stim Therapy Provider Certified Vital Stim Therapy Instructor

Vital Stim Therapy is an FDA cleared method (FDA clearance notice, 2001) to promote swallowing through the application of Neuromuscular Electrical Stimulation (NMES) to the swallowing muscles with goals to strengthen and re-educate the muscles and improve motor control of the swallowing mechanism. In the case of Vital Stim Therapy, which is a NMES device the current will cause a depolarization of the peripheral motor nerve, usually where the nerve enters the muscle belly (the neuromuscular junction or motor end plate). This in turn will elicit a muscle contraction and aid in creating laryngeal elevation, both in strength and speed. This method benefits a very high percentage of the dysphagia population.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

What is Vital Stim Therapy?

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

PATIENT #

Age & Gender

Diagnosis

Way of feeding on admission

# of Vital stim sessions (one session= 1 hour)

Way of feeding on discharge

1

68, Female

CVA

NG. No oral feeding. MBS showed Neurogenic oropharyngeal dysphagia in terms of delayed swallowing reflex, penetration and aspiration with all consistencies and weak basal tongue retraction

12

Oral. In 2nd MBS all previous problems were disappeared.

2

44, Male

CP

Oral. But, in MBS there was aspiration, residual in pharyngeal walls, pyriform sinuses and vestibule and delayed swallowing reflex

3

20, Male

TBI

Peg tube feeding. MBS showed Neurogenic oro-pharyngeal dysphagia in terms of very weak oral stage, very weak tongue mobility and basal tongue retraction, residuals in pharyngeal walls, pyriform sinuses and vestibule. Very delayed swallowing reflex and Penetration and silent aspiration.

12

24

Oral. In 2nd MBS all previous problems were disappeared. Oral. In 3rd MBS no residual or penetration or aspiration was detected. Strong and positive swallowing reflex. Good tongue mobility and complete basal tongue retraction. Oral. In 2nd MBSS all mentioned problems were disappeared. Peg tube is still there because pt is Diabetic and on calory counting by Dietician and medical follow up for Blood Sugar control .. Oral. In 2nd MBS all mentioned problems were disappeared.

4

62, Female

Multiple CVAs

Peg tube. MBS showed Neurogenic oro-pharyngeal dysphagia in terms of delayed swallowing reflex, weak epiglottis movement, weak laryngeal elevation and residual in pharyngeal walls, pyriform sinuses. Very weak basal tongue retraction.

15

5

70, male

CVA

NG. MBS showed Neurogenic oro-paryngeal Dysphagia in terms of silent aspiration, very weak basal tongue retraction and residuals in pharyngeal walls, vestibule and pyriform sinuses.

12

6

70, male

CVA

Peg tube for one and half years.

12

Oral. Peg tube was removed

7

17, male

TBI

Peg tube for 2 years

12

Oral. Peg tube was removed.

8

16, male

TBI

NG Tube for 1 year

12

Oral. NG tube removed

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DIAGNOSIS OF ULNAR NEUROPAYHY AT THE ELBOW USING MIXED LATENCY DIFFERENCE STUDY BY SAMEER GUBOUG M.D MOHAMMAD ABU ZAID M.D Department of Rehabilitation & Neurophysiology, Al Bashir Hospital, M.O.H, Amman Jordan.

Objective: To provide reference values and to compare this technique with the standard motor conduction velocity (MCV) of the ulnar nerve. Setting: Department of Rehabilitation & Neurophysiology, Al Bashir Hospital, M.O.H—Amman Jordan. Participants: The reference group included 60 healthy volunteers. Patients included 120 subjects with suspected ulnar neuropathy at the elbow (UNE) referred for neurophysiologic evaluation. This group was subdivided into 2 groups: Group A was composed of 50 patients with UNE confirmed by MCV of ulnar nerve and Group B included 70 patients with suspected UNE in whom the diagnosis could not be established by MCV of the ulnar nerve. Main Outcome Measures: Differences between peak latencies of ulnar and median mixed nerve action potentials at the arm, after stimulating these nerves at the wrist. This was called Mixed Latency Difference. RESULTS: The upper normative limit of the mixed latency difference was 1.1ms and was a significant correlation with height. In group A, the mixed latency difference was abnormal in 80% of the cases and could not be calculated in 18%. In group B, the mixed latency difference was abnormal in 15% patient. All of these had abnormal inching of the ulnar nerve across the elbow. CONCLUSIONS: The mixed latency difference was particularly useful in cases of mild UNE.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

ABSTRACT Introduction: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy, and paresthesia at the 4th and 5th fingers is its most common symptom.

“Past and present of the UEMS Section and Board of Physical and Rehabilitation Medicine” Pr Alain Delarque*, Pr Franco Franchignoni** *President of the UEMS PRM Section, **President of the UEMS PRM Board http://www.euro-prm.org/

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

1 The Past

The monospecialist Section of Physical and Rehabilitation Medicine obtained an effective juridical form under European Law in 1974, thanks mainly to the work of Amedeo Tonnazzi (General Secretary from 1974 to 1990) and Andre Bardot (President). Both of them, after having played an active part in the birth of the Section, together with a group of delegates from different European countries, formed the team that laid the foundations of the present structure. Among the numerous documents produced by the PRM monospecialist Section during that period, the most decisive was the first edition of the “White Book of Physical and Rehabilitation Medicine ” in 1989,which was published under the triple patronage of the European Academy of Rehabilitation Medicine, the European Federation of PRM and the PRM Section of the UEMS. From 1990, the members of the Section have started the creation of the European Board of Physical and Rehabilitation Medicine in the form of an autonomous European Association, whose statutes were registered in the Hague, in 1991. Every year since 1993,the Board holds an annual examination based on an already established training curriculum for PRM trainees. In the years that followed the PRM Section and Board continued to meet twice a year in different participating countries under the statutes and rules of the UEMS and have contributed to the harmonization of the way PRM specialists are trained in Europe. During the following years a huge work has been done by the delegates whilst the number of participating countries has grown considerably and new functioning rules had to be drafted, as well as new definitions and new missions etc. The present structure of the Section and Board of PRM has started to be set up after 2001 and gave a breath of new life and enthusiasm to the work of the delegates. PRM Section and Board have published beginning of 2007 “the White Book on Physical and Rehabilitation Medicine in Europe” available on http://www.euro-prm.org/ The work done by all the delegates under the coordination of the three publishers, on behalf of the three European PRM bodies (Section and Board, European PRM Society and European Academy of Rehabilitation Medicine) has been printed in two PRM journals, the Journal of Rehabilitation Medicine and Europa Medicophysica, the 42

copyright belonging to the European PRM bodies. Further to the English publication, translations in different languages used in EU and in the world have been done.

2 The Present and future,

After publishing the White Book on PRM in Europe, PRM Section and Board have worked to set up an Action Plan 2008-2010, the aim of which is to improve the quality of life of disabled persons.

The strengths and weaknesses of our PRM Section, The strengths of our PRM Section: - The very active participation of about fifty delegates involved in our general assemblies. Following the enlargement to 27 full member countries added to the associated and observers countries the number of delegates has increased a lot; - The clear definition of the main topics for each of the three committees: Education for the Board, Quality of Care for the Clinical Affairs Committee and PRM Field of Competence for the Professional Practice Committee; - The well organized General Assemblies and reports; - The rules of the three committees which have been updated in a clear way; The weaknesses of our PRM Section, - There are not enough exchanges between PRM Section and Board on one side and PRM national bodies on the other side; - The PRM Section and Board fruitful activities follow the rhythm of the General Assemblies, without enough regular and continuous work in-between these meetings involving the delegates. Only the Board has another peak of activity during the year with the examination scheduled last November and the jury’s meetings twice a year. - The access to information, registration and payment is not enough clear and easy for European PRM trainees or physiatrists willing to involve themselves in the Section and Board activities.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

What factors influence the Action Plan 2008-2010? The efficacy of our Action Plan will depend on several factors.

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

The Environmental (or external) factors influencing PRM Section and Board activities: - European Union (EU) bodies and structures The EU has celebrated in 2007 the 50th anniversary of its founding. EU Erasmus program established by the former EU commission president Jacques Delors, has helped about 1,5 million young European to spend a year studying in European universities outside their own countries. PRM Section and Board teaching programme “European School Marseille on Motor Disabilities” benefited from the Erasmus Socrates support during its first years. - The European Union of Medical Specialists (UEMS) UEMS is the oldest medical specialists association in EU. It will celebrate its 50th anniversary in April 2008. UEMS is a strong support for us. - The other European PRM bodies PRM Section and Board have links with the other European PRM bodies, European PRM Society and European Academy of Rehabilitation Medicine. European PRM Board, Section and Academy acted as copyright holders for the White Book publication in international and national journals. It has been agreed, on proposal of the PRM Section, by these European PRM bodies, in order to clarify their presentation, that PRM Section is working in three main topics: education, quality of care and the PRM field of competence; the European Society of PRM is mainly involved in research activities and the European Academy of Rehabilitation Medicine is mainly involved in ethics. - The European PRM journals PRM Section and Board have regular relations with international PRM journals such as the Journal of Rehabilitation Medicine (JRM) and EuropaMedicoPhysica (EMP). The White Book on PRM in Europe has been published in these two journals. - The Disabled persons demography, associations and rights The increasing number of disabled persons in Europe (ageing adds impairments to impairments, acute care save people with heavy sequels) combined with technical advances in medical and surgical care, have led to an increasing demand for rehabilitation facilities. - The Concepts in the field of handicap The World Health Organization (WHO : http://www.who.int/classifications/en/) family contains two core, or reference, classifications: the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) The UEMS PRM Section has adopted these two classifications. The modalities of the use of ICF by our specialty have been defined by the Committee of Clinical Affairs and voted by the general assembly in Bucharest, September 2007.

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The Action Plan 2008-2010 A new action plan has been set up for the following years, 2008-2010, with the three committees, in the fields of Education for the Board, of Quality of Care for the Clinical Affairs Committee and in the PRM Field of Competence for the Professional Practice Committee. Action Plan for Education, A world action plan for initial education in PRM (WAPIE PRM) has been proposed. The three main targets are, to teach PRM activities to undergraduate medical trainees in all medical schools, to spread recent advances of knowledge to PRM trainees, to involve all the PRM trainees in research activities. Action Plan for Quality of Care, an European Accreditation for the Quality of PRM programmes will be opened in 2008. This accreditation programme is based on ethics and EBM. Action Plan for the Field of Competence of PRM, the specificities of PRM in diagnostic, evaluation and treatment procedures; the role of PRM from acute care to community based rehabilitation, will be defined during the following years. This action plan will need, to succeed, that we define step by step, the situation in these different fields of activity of our PRM Section and Board (Education, Quality 45

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

- The Evidence based medicine (EBM) Evidence medicine in the field of PRM needs to be dramatically developed. There is a need to teach EBM to our trainees, to train them using it and to support them participating to clinical research programmes. To be ethically valid EBM must be aimed at the patient’s best interests and not at the interest of others. - The Health care management The cost of health care is increasing, being a national problem in the European countries. In the following years, payers will compare and select the more efficient rehabilitation programmes for well defined categories of patients, at different stages of their evolution. - The Manpower in PRM The ratio physiatrist/population is different from country to country. We do not know accurately the evolution of the ratio and the factors which can influence this evolution in all EU countries. A low ratio physiatrist/population can lead either to a lower level of rehabilitation or to rehabilitation performed by other health professionals, other specialists or paramedics. On the basis of all these factors, aware of our strengths and weaknesses, PRM Section and Board have set up the Action Plan for the following years, 2008-2010.

of Care and Field of Competence), the main needs, the targets that we wish to reach and how we will act to reach these targets. We shall have to work a lot on this AP within the three committees and to communicate out of the section and board.

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

The improvement, in a more friendly way, of our methods for registration, payment, certification and communication, will be an important part of this action plan. We shall have to develop a strong and well defined cooperation with partners such as the PRM scientific societies and their congresses (European Society of PRM, International Society of PRM, national PRM societies) with the national academic associations of PRM, with the Chief Editors of the PRM Journals, with the disabled persons associations, the health policy makers, the European bodies such as the UEMS, the Council of Europe, the international bodies such as World Health Organization or United Nations and all the partners concerned.

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MAXIMIZING OUTCOMES FOLLOWING JOINT REPLACEMENT

Hip and knee replacement are two of the fastest growing surgeries be performed on aging adults. However, functional success of these surgeries can vary greatly. Maximizing a patient’s functional outcome depends on how well patients are guided to regain complete range of motion, motor activation and control as well as proprioceptive control. This presentation is designed to outline the “Stepping Back to Life” rehabilitation approach that maximizes functional outcomes following joint replacement surgery. Often these are elective surgeries and thus the rehabilitation process should begin in advance of surgery. Patients should be instructed in core exercises and ADL adaptations that will be needed postoperatively. Rehabilitation following surgery must initially focus on regaining or appropriately limiting range of motion and maintaining mobility of the soft tissue. Patients often suffer from a reflexive inhibition of the extensor musculature and thus rehabilitation should focus re-establishing motor activation in these groups followed by progressive strengthening. Proprioception is adversely effected due to the damage to mechano-receptors in the joint. Rehabilitation should include a progressive closed chain exercise program with attention placed on helping patients to re-establish a sense of body position in space. Addressing these factors will help ensure the maximum functional following joint replacement.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

David Lawrence, MSPT, ATC Physicians for Peace, 229 West Bute Suites 200, Norfolk, VA 23510 Email [email protected], [email protected] USA

Perspectives for Rehabilitation in Europe : a particular role for ESPRM Prof. Alessandro GIUSTINI, MD, PhD ESPRM President

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

PRM now in Europe : Physiatry is in Europe not a very old Discipline but precisely for this reason it has vigorous young roots. The two components “Physical”and “Rehabilitative”, a sort of positive duality ,combine ever better, strengthening each other in research and in clinical practice. Precisely in the current transformation of health care demands they are showing their maximum potential and their enormous intrinsic value-The ICF has formalised for everyone a language and a way of thinking that were always ours in Rehabilitation; the research and the applications that are currently coming to fruition provide new elements for our growth in all fields, as is happening with the DAR Action Plan WHO 2005/2010 “A world for all”. PRM now claim to be qualified for the overall study of Functioning and Health of a Person (and of a Community), for research into those elements that characterize it and that can modify it in the Person and his relational context, and for the management of the multidisciplinary and multiprofessional collaboration necessary both in order to carry out this research and to perform the therapeutic interventions. The central point for PRM is the Individual Rehabilitation Plan which collects and distils all the previously mentioned concepts, and concretely expresses the true central status that the Person must hold in all stages and in all interventions. Realized by the Team. A role for ESPRM: The European Society of PRM was founded in 2003 and is concerned with research and teaching in PRM in Europe. It succeeded the European Federation of Physical Medicine and Rehabilitation (established in 1963) and aims to coordinate European activities and be a vehicle for scientific exchange. The ESPRM have an interactive electronic platform (www.esprm.eu ) and a periodical Newsletter to reach every PRM Specialist in the Continent , where information can be found on research projects, on grants and funding and offers updated information about courses, congresses, exchange funding, etc. These activities, during all these years, was realized in a very close cooperation together other 3 PRM Bodies : UEMS PRM Section; Académie Européenne de Médecine de Réadaptation –European PRM Academy. Mediterranean Forum of PM&R 48

Perspectives and Aims: So in the recent years are evident and urgent some problems (as previous presented): - The Community in Europe, the People (disabled and not ) needs a real and larger rehabilitation presence in health activities , but also in policy and cultural contents (also to cooperate in the evolution for the social security, for the quality of Life , quality of Living and quality of environment for all ages and conditions ). - PRM can be ready to receive and to carry out this role at european level, and in each Country at the same.

A) European Society will be able to be really a ” big open society”, a concrete large community involving every PRM Doctor in every Country, not only the Members of European Community as other PRM Bodies, engaging and supporting their wishes and efforts to advance. We have to work together the different national experiences and histories in PRM , different opinions and feeling of Disabled Associations and common people on Disability and Participation, involving the whole Community in enriching rights for Disabled and for all. “Enpowerment” can be the key-word not only for Disabled and for the European Community, but also for us as a main scientific and medical component in this tasks. We have to promote and support international scientific activities (Congresses and other events, education, researches and trials) to unify methodologies, standards and contents : Guidelines and Good Practice indications will be the Goals. To assure quality of Rehabilitation for all disabled people in every country. On my opinion very fast Europe will be, I hope, a kind of a really big sole country and Health Care is obviously one of the most important basis, due to ethical , cultural and scientific values. B) ESPRM in this transformation have to focus all the activities obviously on scientific (research, evidences, efficacy-effectiveness, outcomes etc.) matters , with the aim to offer to the European Union and to the Governments, the indications to face and to solve their main problems in the future perspectives . Promoting large consensus towards these concepts not only in medical world, but firstly in Disabled People Associations, in cultural, ethical political associations involving common communication means and general educational programmes . Another important perspective is in the “Mediterranean Area” to open more and more cooperation with many Countries in Africa and in Asia, in which there are Colleagues, Societies and Associations : they surely can contribute with their experiences and competences to enrich this common evolution.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

But the Key is if :

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

BRACING IN TREATMENT OF CONGENITAL CLUBFOOT

  Mahmoud M Odat, Feras Ibraheem, Mahmoud Ragad Pediatric Orthpedic Service, Orthopedic Department RJRC, KHMC Amman Jordan   Most orthopedic surgeons agree that the initial treatment of idiopathic congenital clubfoot should be serial gentle manipulations to stretch the contractures, with serial casting, splinting or strapping to maintain the correction obtained by stretching. The Ponseti method reliably obtains excellent results and Ponseti claims to avoid open surgery in 89% of cases by using his technique and we achieve in one of our studies 70% success rate at 5 years follow up. Bracing starts on the same day post cast removal. The feet must be externally rotated about 70 degrees and this hyper correction is needed to maintain calcaneal abduction. The foot abduction orthosis (FAO) keeps the medial soft tissues stretched.The FAO is worn all day for three months and then for nights until the child is 4 years old. The bar should be comfortably wide, so that the heels are approximately shoulder width. Bending the bar slightly away from the child gives additional dorsiflexion to the ankles. There are several types of FAO on the market. The shoes alone have no therapeutic function  and the magic is in the bar not the shoes therefore the ankle foot orthoses (AFO) of no value in clubfoot bracing. The Knee-ankle-foot orthoses (KAFO) may be an alternative, especially in the walking age child. The educated parent is a therapeutic partner and they must be firm with the children, leaving the brace on even if the child cries. In this presentation tips for success and common pitfalls in bracing will be discussed.  

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The Treatment of Fractures and Orthopedics Deformities by llizarov

Aim: Deformity of lower limbs most frequently appeared in the course of congenital disorders or as posttraumatic changes of human locomotors system considering its complex anatomy and biomechanics, lower limbs seamed to be the most difficult segment for reconstruction.   Methods: From 1998 till 2005, 82 cases of congenital and posttraumatic lower limb deformities were referred. • There were 54 males and 26 females. • The number of previous operations range from 0-6. • The age ranges from 6-53 years. • 58 of cases were posttraumatic cases, and 24 were congenital deformities. • Physiotherapy was initiated on the first postop day.   Result: • Average llizarov external fixation was 7 months. • Knee and ankle ROM were satisfactory. • Complications can be listed as, 13 cases shortening (2-3 cm) elongation was done later, 2 cases refracture, and 1 cases n0n-union.   Conclusion: Our conclusion is the llizarov method for correction of lower limb deformities is a demanding technique technique. One must be expert with the technique and apparatus, with better understanding of the biology processes involved to achieve safe reconstruction.   

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

  Dr. Hamdi Negresh MD/PhD /-Dr. Assia Ozby / Dr. Duwairi Moh’d Dr. Zeed Fawares

ELECTRICAL BURN AND LIMB LOSS; A FOUR-YEAR EXPERIENCE Samer Haddad, MD / Awni Abulail, MD / Khaldoun Haddadin, MD Eman Hijazeen, RN Royal Rehabilitation Center- King Hussein Medical Center, Amman, Jordan

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

ABSTRACT Objectives: Electrical burn injury is one of the most devastating injuries in our practice with potential disability of functional and aesthetic sequelae. The damage of the electrical burn is the result of generation of local heat and the direct action of the current as it passes through tissues. The population affected is usually young children and young age group working men. Despite overwhelming consequences of burn injuries, most of them are preventable. We present our experience with the electrical burn patients admitted to the burn unit. Patients and Methods: During the period from January 2004 to December 2007, all patients with electrical burn admitted to the burn unit of the Royal Rehabilitation Center at King Hussein Medical Center- Jordan were analyzed. Patients were resuscitated accordingly. Other associated injuries were managed. They were monitored and managed for serious acute complications. Wound care was performed with topical antibacterial cream. Fasciotomy was performed in cases with compartment syndrome and patients underwent early debridement for the devitalized tissue. In cases of unsalvageable limbs, amputations were performed as soon as possible. Results: Out of 362 patients admitted to the burn unit, twelve male patients had an electrical burn with a mean age of 22.7 years. All were injured with a electrical high voltage current. The commonest cause was related to human error and lack of knowledge. The mean total body surface area (TBSA) burned was 30 %. All patients had hand and upper limb involvement; half the patients had lower limb involvement. The average limb amputation was 41.7%. Ten patients needed fasciotomy with split thickness skin grafting. One patient had upper gastrointestinal bleeding and the mortality was 25% due to acute renal failure and severe sepsis. The death was with the higher TBSA%. The average hospital stay was 24.4days. Conclusion: Electrical burn is a genuine health hazard with dreadful consequences. It forms a great challenge in management acutely and through the rehabilitation period. This serious injury is preventable with proper knowledge and education.

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Aggressive Orthotic treatment of the Spinal Cord involvement patient

This presentation will illustrate the physiologic and functional advantages of the Reciprocal Gait Orthosis for the Spinal Cord injury (T4 – L2) patient including reduction in hip and knee flexion contractures, increased bone density, increase respiratory volume and also lessen the number of bladder infections. The sociopsychological benefits of peer to peer interaction significantly increase their desire to ambulate thus increasing the above benefits. There is a consistently high acceptance of this device for ages 2 through adult. New generations of RGO’s systems link hip motion with knee stability as well. Guided hip motion can also be allowed with low grade Cerebral Palsy with Anti-Adduction Devices that prevent over adduction and scissoring. These actually descended from the use of RGO’s for hip motion guidance. Case studies of current patients will also be discussed where special components were created to allow ambulation while maintaining orthotic goals. The design of current componentry design will also be compared with regard to momentum, stability, dependability, and design restrictions.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

John F. Schulte CPO FAAOP [email protected]

Thrombembolic Disorder in Spinal Cord Injury Ali Otom MD Consultant and Head of Spinal Unit in RJRC – KHMC Dr. Aida Doughan / Dr. Defala Makableh. Thrombembolism which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common complication of Spinal Cord Injury (SCI) and remains a leading cause of morbidity and mortality in this population.

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

The major factors predisposing persons with acute SCI to venous thrombembolism include venostasis due to failure of the venous muscle pump and a transient hypercoagulable state. Despite a greater awareness of this life threatening condition and improved thromboprophylaxis measures, it continues to occur with significant frequency particularly in the acute period following injury. The incidence of venous thrombembolism in acute SCI varies greatly, principally due to variation in surveillance technique. Studies based on clinical parameters alone estimate the incidence of DVT in acute SCI at 14-16 percent while using sensitive measures such as Doppler ultrasonography and 125-I fibrinogen scan and employing serial examination, the incidence raises to be from 47-100 percent. In a recent review of morbidity aspects at our Spinal Unit, the incidence of thrombembolic events during the acute phase of SCI was found to be 18 percent. Venous thrombembolism should be regarded as a continuum of pathology of which DVT and PE are subgroups. The most striking evidence for the necessity of effective prevention of thrombembolic disease comes from studies of mortality in the first year after SCI where PE was found to be the third leading cause of death for all SCI accounting for 14.9 percent of death in this group. This talk is going to review the clinical and therapeutic aspects of this important topic while focusing on the treatment recommendation and guide lines by the American College of Physicians and the paralyzed veterans of America.

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Pressure Ulcers Following Spinal Cord Injury Mr. Mofid Saif MD, FRCS UK

It has an impact on the quality of life. It may disrupt the rehabilitation process, extend hospital stay, interfere with the physical, psychological, and social well-being, and affect community reintegration. It may prevent individuals with S.C.I. from working or pursuing their education. Due to the recent increase of life expectancy following S.C.I., the risk of developing pressure ulcers is even greater, thus making the prevention thereof a priority and a daily concern for individuals with S.C.I. and health care professionals. Pressure ulcers are among the leading causes of readmission, lengthening of hospital stay and costly treatments; therefore, it should receive more special attention within rehabilitation and public health professionals who manage individuals with S.C.I. Prevention and management of pressure ulcers following S.C.I. will be discussed in oral presentation.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Spinal Cord Injury has a major impact on the affected individuals and their families. Along with the direct consequences of the injury, there is always a high risk of developing secondary complications, which could devastatingly increase the morbidity and mortality. Among these complications are pressure ulcers which are common, serious and life-long risks.

Complications following SCI during the Acute Phase Firas Sarhan Email :[email protected]

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

M Saif ** ** Specialist Registrar at Royal National Orthopaedic Hospital, Brockley Hill Stanmore, UK Aim of Study: To explore the incidence of complications in 2 centres, Explore the possible relation of complication development and the time lapse from injury to admission to a spinal unit, Compare results in both centres and those in literature. And establish and develop recommendations and guidelines to improve our practice Material and Methods Retrospective study has been taken to determine complications following SCI during the acute phase, Random samples from the RNOH and Stoke Mandeville (25 patients from each hospital during their first admission post injury. Data collected is from patient’s medical records, Data collection tool designed to explore the following aspects: Completeness of the notes, Referrals forms/ outreach services, Aetiology and level of injury, Pre & post admission management, Time between injury and admission to spinal unit, Type of complications reviewed include skin, respiratory, urinary, bowels, cardiovascular/ DVT/PE, psychological, surgical, GI, Pre and post admission complications. Results: Study suggested that early admissions to specialised spinal centres reduce the incidence of complication development. A high incidence of at least one complication on admission documented, the most common complications detected: skin, urinary, respiratory and psycho. The study findings highlighted the poor documentation of the multidisciplinary team. Other findings will be outline within poster presentation Conclusion It is evident from the finding of the study that a uniform standard of SCI treatment will soon be provided throughout the country As a result this will serve to improve the quality of care given to SCI patient groups, This will lead to diversion of resources to improve services of SCI management further, further recommendations will be outline within poster presentation.

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Assessment of bladder and bladder program in SCI patients in Syria Ahmad Samer Alkawadri, M.D., Alassad University Hospital – Damascus – Syria Email: [email protected]

We assessed and followed up 58 SCI patients got period of rehabilitation (including bladder program) at the spinal cord injury rehabilitation unit in Iben Alnafees Hospital (age range, 12–54yrs). The way of bladder emptying were: 1- normal voiding 2- voiding by maneuvers 3- Intermittent catheter 4- Indwelling catheter (urethral or suprapubic) 5- irregular uncontrolled emptying (collective tools like external catheter or diaper). To assess the kidneys and Urinary Tract Safety we rely on a recent echography of kidneys urinary tract and the number of UTI per year the patient needed to be treated with antibiotic and a recent urea and creatinine serum levels. We could not depend on the U.D. because only 23 of our patient (40%) have undergone Urodynamic (U.D.) due to some technical and geographical difficulties. The results showed that there was no difference between males and females regarding the safety and no big difference between cases for less than 5 years and cases for more than 5 years regarding the safety, The lower the neurological level the better the safety, The safety was better in patients with nontraumatic SCI than traumatic SCI specially gun shot and direct trauma, The safety was the best in patients who were voiding normally, and the results was good and similar in patients using CIC or maneuver to void, but not for those using condom or diaper (reflexic voiding) , the results were the worst among patients using indwelling catheter We conclude that CICs and maneuvers are good and safe ways to empty the bladder of SCI patients, but we should make sure that all medical staff members working with SCI patients have a good knowledge about the importance of the bladder program specially CICs and we recommend that all SCI patients with neurogenic bladder have a U.D. at least once after the injury.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Objective is to assess the bladder of spinal cord injury patients and the safety of ways of bladder emptying the patients are using, in order to be able to choose the safest and typical way of management.

Transferring Patients to Spinal Cord Injury (SCI) Centres

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Firas Sarhan Buckinghamshire New University / Stoke Mandeville Hospital UK Email :[email protected] SCI patients who are accepted for admission to a specialist SCI centre are usually transferred from their receiving hospital after an initial period of physiological stabilisation. The timing of this transfer can vary between a few hours post-injury, up to several weeks after their initial hospital admission. Most delays in transferring SCI patients are related to either the patients’ fitness to transfer, the availability of an appropriate mode of transportation for the distance involved or the ability of the SCI centres to admit the patient at the time that the referral is made. Their fitness for transfer and the most suitable method of the transfer should be determined between the medical teams of the transferring hospital and the receiving SCI centre. Aims of Spinal Patients Transfer Audit • To establish the Aetiology of spinal cord injury • To establish the quality of current transfers • To develop effective guidelines and services to maintain the safety of patients during transfers Result of Audit: 64 % of patients were transferred without continuing prescribed analgesia, 71% of patients, for whom NG tube was requested, traveled without one in situ. 40% of these patients required NG tube insertion within the first hour on arrival to receiving centers. 77% of patients requiring oxygen therapy were transferred without it being continued during the journey. All of these patients required oxygen therapy on arrival to receiving centers. Conclusion: Patients whose ongoing care requires the support of information or advice from tertiary specialist centres, or their transfer for further management to such tertiary centres, must be assured of safe and effective management to facilitate access to such advice and information and condition details between the A&E department and tertiary centre; ensure patients are transferred to tertiary centres with full regard to their support and handover.

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POST OPERATIVE PYOGENIC INTERVERTEBRAL DISKITIS Abdulzahra Kzar Ibn Alkuf Hospital for Spinal Cord Rehabilitation. Baghdad, Iraq E-mail: [email protected]

Method :All the studied 30 adult patients 25 males and 5 females were complaining of sever agonizing pain in the back or the neck 3 days postoperatively mostly after pelvic surgery with sever stiffness with no signs of intervertebral disk prolapse , but high erythrocytic sedimentation rate ( E S R ) and fever. In the early stages of the disease spinal X rays showed no change while in the late stages the X rays showed moderate disk space narrowing. The protocol of therapy was to use triple antibiotics for 6 weeks, bed rest and NSAI drugs. MRI was able to show the early changes in three suspected cases. Results :All the treated patient with rest and triple therapy protocol responded well and regained free mobility of the spine although some of them left with intervertebral disk narrowing with good tolerance to the drugs used. Conclusion :Unless we keep this condition in mind in any patient suffering of sever back pain or neck pain post – operatively we would miss a definite curable disease. Dr. Abdulzahra Kzar. MBChB. MRD RCP RCS England. Consultant in Rehab. Med. President of Iraqi Association of Rehabilitation and Arthritis.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Objective:To discus the importance of early diagnosis and management of Post operative pyogenic intervertebral diskitis to prevent destruction of the affected disk space and to avoid formation of spinal abscess and neurological sequely.

Evidence based tragedies for patient handling in Rehabilitation settings Prof X. MICHAIL M.D.-PhD. Rehabilitation Specialist, Professor in Rehabilitation Medicine, Technological Educational Institution (A.T.E.I.) of Athens, Greece

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

The chasm between current practice and scientific evidence is huge, when assessing interventions to prevent or minimize the risks associated with patient handling. Various types of interventions have been implemented in an attempt to reduce high risk patient handling tasks. These solutions can be considered as controls and are therefore divided into three categories, namely engineering, administrative, and behavioural controls. Despite strong evidence, published internationally over three decades, most rehabilitation settings have used significant resources to implement strategies that are not evidence-based. There is a growing body of evidence to support interventions that are effective or show promise in reducing musculoskeletal pain and injuries in care providers. To date, the interventions with the strongest level of evidence include: (a) use of patient handling equipment/devices, (b) patient care ergonomic assessment protocols, (c) no lift policies, and (d) patient lift teams. Effective use of evidence based tragedies for patient handling creates a safe healthcare environment.

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NON-SURGICAL MANAGEMENT OF RESISTENT ACHILLES TENDINOPATHY USING HIGH VOLUME IMAGE GUIDED INJECTION. Chan, 01., Padhiar, N2,3., Dowd, D3., King, JB1., Jalan, R2., Maffulli, N4., Crisp, TA1. 1 3

The London Independent Hospital Queen Mary, University of London

2 4

The Royal London Hospital Keele University

The chronic collagen degeneration associated with Achilles tendinopathy belies a common overuse injury that is often problematic to treat. Resistant Achilles tendinopathy presents a significant management challenge, with up to 25% of patients requiring surgery following failed conservative management. Current treatment is relative rest, assessment of predisposing factors, Physiotherapy and steroid injections, followed by eccentric loading for up to 6 months. After this, significant numbers of patients still experience pain and functional deficits and often resort to surgery, further prolonging return to normal activity. Recent studies have shown that neo-vascularisation may be related to the pain experienced by patients. This study aimed to evaluate the effectiveness of a novel treatment for resistant Achilles tendinopathy using high volume image guided (HVIGI). Method 30 consecutive patients (mean age 37.2 years, range 24 – 58 years) with midterm symptoms (mean 35.81 months, range 2 – 276 months) who had failed to improve after eccentric loading were injected with 10 ml of 0.5% Marcaine, 25 mg Hydrocortisone, and 40ml of injectable 0.9% normal saline. The VISA-A and a study-specific questionnaire were then retrospectively administered to all of the patients. The study specific questionnaire measured changes in pain and function using 100mm visual analogue scales (VAS) and collected background data about patient profiles and medical history.

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The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

Introduction

Results

The 4th Jordanian & 3rd Pan Arab Congress in Physical Medicine, Arthritis & Rehabilitation

21 patients (70%) responded. Patients reported a significant mid-term (mean 30.33weeks) improvement in symptoms, mean 31.48 points (SD 27.98 points) using the VISA-A questionnaire (P