Day 3 :
Keynote Forum
Ryan Blanck
Hanger Clinic, USA
Keynote: The ExoSym program, bridging the treatment and rehabilitation of the military and civilian limb salvage population
Time : 10:30-11:00
Biography:
Ryan graduated from the University of Washington in 1998 with a degree in Prosthetics and Orthotics and completed his Prosthetic and Orthotic residency with Harborview Medical Center in Seattle, Washington. In 2000, Ryan joined Northwest Prosthetic and Orthotic Clinic servicing the University of Washington and Harborview Medical Center and became Vice-President and Clinical Director of NWPOC in 2005. Ryan’s professional focus was the treatment and care of the trauma related amputee. He served as lead prosthetist for advanced Targeted Muscle Reinnervation and upper extremity myoelectric prosthetic fittings under the direction of Dr. Douglas Smith, Harborview Medical Center.
Abstract:
Introduction: In 2009, while working for the Department of the Army I developed the initial IDEO (Intrepid Dynamic Endoskeletal Orthosis). Th is unique system was modeled aft er the prosthetic energy storage and power delivery concept in a prosthetic run foot system as well as the off loading and support fundamentals of the prosthetic socket. One of the key features of this system is the utilization of a kinetic exoskeletal strut system which provides the energy storage and power to run, jump and achieve signifi cant levels of function not typically attainable by the limb salvage population or other condition that result in signifi cant weakness, instability and pain of the lower extremity. With the government system we instituted a novel rehabilitation and orthotic initiative, Return to Run (RTR) clinical pathway, designed to facilitate the return to duty of these high-functioning service-members.
Methods: Since 2013, we have begun incorporating a national program that will incorporate many of the fundamentals of treatment that were developed within the United States military system for the IDEO. This civilian based program was conducted in Gig Harbor, Washington and this was the location where on site patient treatment and functional training and rehabilitation took place. Th e facility was a place for clinical treatment of the limb salvage, partial foot, and nerve deficit patient utilizing the ExoSym as well as on site rehabilitation with the goal of optimizing the functional outcomes of the patient.
Results: Over the last three years, 100 of civilian cases were treated from all over the world. Each patient gone through device fitting, optimization and training that was assessed at various phases of treatment and training over 5-10 stay. Initial results showed that the ExoSym and associated rehabilitation program was a treatment protocol that had great benefi t for a previously unaddressed limb salvage patient not only in the United States but around the globe.
Conclusion: Th e ExoSym is a device that has been proven effective for thousands of military based patients. Initial data showed
equalized outcomes for the civilian patients who desires significantly increased function, reduced or eliminated associated pain, and the ability to return to work, recreation, running or other high impact activities. Th is technology also showed that it has application for the treatment of the pediatric patient with various lower extremity defi ciencies as well as modified versions of the device that can also assist the geriatric or other patient groups that requires fundamental need for limb stabilization and greater energy return from a device such as the ExoSym due to a variety of injuries or conditions.
Summary: In 2009 while working within the US military/ DoD and developed a device called the IDEO to address severe high energy lower extremity trauma related to combat as well as training accidents. In September 2013, I began working with Hanger Clinic to take this treatment concept and apply it to the civilian population as the ExoSym program.
- Track 6 : Spinal Cord Iniury
Track 7 Prosthetics & Orthotics
Session Introduction
Belabbassi Hanene
University of Blida, Algeria
Title: Risk factors for obstetrical brachial plexus palsy
Time : 11:00-11:20 am
Biography:
Belabbassi Hanène has completed his medical doctor study at the age of 23 years from Mohamed Maherzi University, Faculty of medicine of Algiers and postdoctoral studies from Blida1 University, faculty of Medicine. She is assistant professor researcher. She has published more than 04 papers in different journals.
Abstract:
Purpose: The study was aimed to identify risk factors for obstetrical brachial plexus palsy.
Methods: A retrospective case–control study was designed. A comparison was performed between cases of brachial plexus paralysis (n=32), with controls without brachial plexus paralysis (n=30) randomly selected from physical medicine and rehabilitation examination. Statistical analysis was performed using the SPSS package.
Results: Independent risk factors for brachial plexus paralysis were macrosomia (birth weight [4,000 g]; OR=12.353; 95% CI 2.510–60.802, p<10-3), labor dystocia and instrumental vaginal delivery ([forceps delivery, vacuum extraction] OR=8.8; 95% CI 2.743–28.234, p<10-3), vaginal breech delivery ([breech presentation or extraction] OR=3.231; 95% CI 0.598–17.456, p=0.258), parity(OR=2.545; 95% CI 0.677–9.565, p=0.206), shoulder dystocia (OR=1.957; 95% CI 0.571–6.702, p=0.367), prolonged pregnancy(OR=1.28; 95% CI 1.066–1.538, p=0.011), and after caesarean section (OR=1.103; 95% CI 0.987–1.234, p=0.238).
Conclusions: In our population (n=62), macrosomia, labor dystocia, instrumental vaginal delivery and prolonged pregnancy were significant risk factors for neonatal brachial plexus paralysis, while shoulder dystocia, breech deliveries, parity, and caesarean section were not. Despite our small sample we found three significant risk factors associated with brachial plexus paralysis.
Trent Jackman
Idaho State University, USA
Title: Exploratory comparison of credentialed clinical instructors’ and non-credentialed clinical instructors’ report of frequency and importance of professional behaviors in clinical education
Time : 11:40-12:00
Biography:
T Jackman is an Assistant Professor in the Physical Therapy Program at Idaho State University, Pocatello, Idaho. He is an Academic Coordinator of Clinical Education. His clinical expertise is in the area of Clinical Education, Professionalism, Ethics, and Ergonomics.
Abstract:
Purpose: Professional behavior characteristics are important to maximize student learning during clinical education affiliations. The purpose of this study was to explore the comparison of credentialed and non-credentialed clinical instructors’ report of importance and frequency of professional behaviors during clinical education affiliations.
Number of Subjects: Th e number of subjects taken for this study is 60.
Materials & Methods: Using the clinical instructor characteristics statements developed by Emery et al., a survey was developed on SurveyMonkey®. It contained the 43 statements about professional behaviors. The survey was sent to 142 clinical instructors (CIs) actively serving as CIs. The CI was asked to self-report the importance of each behavior and the frequency with which she/he demonstrated the behavior using a 5 point Likert scale. The CI was also asked to report whether or not she/he was a credentialed clinical instructor (CCI) through the APTA credentialed clinical instructor program (CCIP).
Results: 60 CIs completed and returned the survey (42% return rate). 30 were credentialed CIs (CCI) and 30 were non-credentialed (NCCI). According to all the CIs, the most important characteristics were teaching behaviors and professional skills behaviors. Using Mann Whitney U comparison, we identified possible diff erences between the CCIs and NCCIs. In 8 questions, the CCIs
rated themselves as more frequently demonstrating the following skills. Th e CCIs were more available to their students, provideda greater variety of patients, provided useful feedback, communicated in a non-threatening manner, were open in discussing issues with students, provided feedback in private, provided appropriate support for student concerns, and were more empathetic. The
CCIs also seemed to fi nd it more important to make themselves understand, observe student performance in a discreet manner, and provide appropriate support for student concerns. However, if corrected for multiple comparisons none of the diff erences remained significant.
Conclusion: The data provided in this study compares the self-reported importance and frequency of professional behaviors of CCIs and NCCIs to better understand professional behavioral characteristics and their role in maximizing the effectiveness of clinical education. It further begins to explore any differences between CCI and NCCI behaviors.
Clinical Relevance: Exploring the differences in importance and frequency of credentialed versus non-credentialed clinical instructors professional behaviors will provide our field with insight into what areas CIs need to improve to better prepare students to practice as physical therapists.
Maziad Abed Al Karim Al Adwan
Zarqa University College, Jordan
Title: Variables affecting the amputees’ reaction to the artifi cial limb
Time : 12:00-12:20
Biography:
Maziad Abed Al Karim Al Adwan is a Jordanian Assistant Professor in Balqa Applied University. Over the past 22 years, he worked in wide varieties of professional papacies in both private and public sectors (like Royal Medical Service, Jordan University Hospital, Jordanian Academic for Individuals with Autism and Balqa Applied University, etc.). He earned BSc in Nursing in 1987, Master’s degree in SLP in 1996 and PhD in Special Education in 2014, on the topic Minor Mobility Impairment. He has published some articles in subjects ranging from nursing to visual and hearing impairment to mobility disorders. A recent article titled, “Variables affecting amputee reaction to artifi cial limbs, and the relationship between demographic variables and diabetes self- management among diabetic patients” is published in Global Journal of Health Science, Vol 5 No 2, 2013), and “Knowledge and training competencies needed for the teachers of visual impaired children in Amman institutions” is under review process.
Abstract:
Background: Amputee reaction to artificial limb is an important issue faced by amputated individuals and the team who deliver caring to these individuals.
Aim: To investigate the variable associate with reaction to artificial limb, and the relationship between certain variables and the quality of response to the artifi cial limb by some amputees who own artificial limb.
Method: The data were collected through self-administered questionnaire with individuals having amputation who visited an artificial limb centers in Jordan.
Results: Strong positive relationship was found between type of artificial limb and the reaction of the amputee (r=0.99) (p<0.001). A negative relationship found between age, site of amputation, level of amputation (r=-0.39,-0.01, and -0.30) respectively.
Conclusion: There were many factors that impact the reaction to artificial limb, some variables affect the relationship positively, and some affect the relation negatively.
Mehdi Kasbparast Jui Ray
Azad University, Iran
Title: How does the eccentric contraction in functional ankle instability among male student Soccer players?
Time : 12:20-12:40
Biography:
Mehdi Kasbparast Jui Ray is faculty member of Physical Education and Sport Sciences, Karaj branch, Islamic Azad University, Karaj and he is doctoral student in
sport injury and member of Asian Society for physical Education and Sport for 15 years.
Abstract:
During everyday activities, concentricactions start movements while eccentricactions slow activity down. For example,during running, the quadricep muscles willpropel the runner forward with concentricactions, while the hamstrings can brakerunning by slowing down the forwardmotion. To maintain sport performance andprevent injury throughout the whole range of motion, strengthening both phases ofmuscle contraction is important. Isokinetic invertor and evertor torques were assessed eccentrically and concentrically at speeds of 60 and 120 degrees •s (-1) in 16 subjects with unilateral ankle instability. Absolute peak torque values were compared between the injured and non-injured limbs to determine whether strength defi cits existed. No eccentric or concentric evertor strength deficit was found in the injured limb. Interestingly, for the injured limb, a significant interaction effect was found whereby eccentric inversion strength was reduced. Functional ankle instability is notassociated with deficits in evertor strength. Deficits in eccentric invertor strength were found, and this may contribute to the symptoms of functional ankle instability. Weak invertors may contribute to functional ankle instability because of a reduced ability to assist in controlling lateral displacement of the shank over the weight bearing foot. Excess lateral postural sway outside of the base of support results in the foot’s medial border rising from the floor once the limits of closed chain eversion is reached, which may result in the foot being forced into rapid inversion.
Mehul Raval
Himalaya University, India
Title: Ayurvedic Guggulu formulations as support therapy to physiotherapy in treating neurological disorders
Time : 12:40-13:00
Biography:
Mehul Raval holds Physiotherapy degree from Himalaya University, India. Besides, he also holds a Diploma in Homeopathy and Panchakarma and Yoga. He has keen interest in Ayurvedic Formulations. He is a Consultant Physiotherapist as well as a Panchakarma Practitioner. He has delivered many talks and lectures on above subjects. He has also lead students to take up various challenging practicums in Ayurvedic Formulations.
Abstract:
Ayurveda is an ancient system medicine from India. There are various time tested formulations in ayurveda which are extremely useful in treating neurophysical disorders. There are six types of treatments off ered by Ayurveda of which we discuss Rasayana here as support therapy. It works along with physiotherapy in treating neurological disorders. Rasayana helps in promoting strength and vitality; in general it promotes general wellness and optimizes senses. One of the major benefits of Rasayana is that it treats wear and tear of the body and helps rebuilding it. Paralysis, hemiplegia, Parkinson’s, Alzheimer’s and stroke are most commonly seen besides various motor neuron diseases, inter-vertebral disc prolapse, facial paralysis, poly neuropathy and many such conditions can be treated with various Guggulu Rasayanas. Guggul or bdellium is a gum resin, produced from the stem of a small shrub (Commiphora wightii). It is mainly found in dry/arid forests of India. There are various forms of each of above herbs; for example Guggulu to be Trayodashng Guggulu, Yograj Guggulu, Maharasanadi Guggulu, and Punarnavadi Guggulu. Th ese Rasayana in combination with other herbs helps strengthening nerves, bones, joints, muscles and ligaments. Th ough Ayurveda is person specific therapy, Guggulu formulation being administered over thousands of years can be generalized; above Ayurvedic formulations of Guggulu has helped treating above conditions giving an alternate support to the patients. Th e paper describes various formulations of Guggulu and other herbs. It has been discussed in detail, their effects on patients. It concludes saying neurological conditions can be treated with help of Guggulu Rasayana.
Parag Sawant
Occupational Therapist at Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
Title: FUNCTIONAL APPROACH IN SPINOCEREBELLAR ATAXIA- OCCUPATIONAL THERAPY PERSPECTIVE
Biography:
Dr. Parag Sawant has completed his B.O.Th (Bachelor of Occupational Therapy) in 2010 and M. O. Th- Neurosciences (Masters in Occupational Therapy) in 2014 from Seth G. S. Medical College and K.E.M. Hospital, Mumbai, India. He has presented and won awards for papers and posters in many national and international conferences. He has 2 publications on his account as first author and 1 as second author in Indian Journal of Occupational Therapy and Physiotherapy at the age of 28 years. Currently, he is working as an Occupational Therapist in Neuro rehabilitation unit of Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
Abstract:
Functional approach in spinocerebellar ataxia- occupational therapy perspective: The cerebellum is known to play a strong functional role in both motor control and motor learning. Ataxia following degenerative cerebellar disease becomes a major cause of disability. Objective was to rate ataxia and assesses the Functional Independence and Balance in the context of Occupational Therapy. 3 male patients with diagnosis of Spinocerebellar ataxia, in the age group of 20- 30 years were screened on MMSE to rule out cognitive impairment and ensure the utility of intervention. Ataxia was rated using Scale for Assessment and Rating of Ataxia (SARA). The subjects underwent 3 months of Occupational Therapy (OT) intervention including physical exercises, therapeutic activities, Intensive coordination training, prescription of adaptive aids, Balance retraining and functional retraining using Top Down Approach and were assessed on Functional Independence Measure Functional Assessment Measure, Activities of Daily Living (ADL) scale and Berg Balance Scale (BBS) pre and post intervention and statistically analysed using paired’t’ test. Pre intervention mean score on FIM FAM scale was 199 ± 5.57 which increased to 202.66 ± 6.03 post intervention and was statistically significant at t = 11, P< 0.01.The mean score on BBS increased from 38 ± 2 to 39.66 ± 2.08 ; post intervention and was statistically significant at t= 5, P< 0.05. Scores on SARA were also maintained which shows there was no worsening of symptoms. It can be concluded that OT intervention was effective in improving functional independence in Patients with SCA in study population. Further research is recommended with larger sample size.
Sunday R. Akinbo
Professor Akinbo is presently the Head (Chairman), Department of Physiotherapy, College of Medicine of the University of Lagos and also; the Head (Chairman) and Consultant Physiotherapist, Department of Physiotherapy, Lagos University Teaching Hospital both in Lagos Nigeria.
Title: RELATIONSHIP BETWEEN PAIN INTENSITY AND SLEEP (IDEX) PARAMETERS IN PATIENTS WITH CHRONIC LOW BACK PAIN
Biography:
His academic and professional qualifications include BSc Physiotherapy, MSc & PhD Musculoskeletal Anatomy, University of Lagos, Nigeria and FPC, Nigeria. He is member of several national and international academic and professional associations among which are, Nigeria Society of Physiotherapy (NSP), Society for the Study of Pain, Nigeria (SSPN), International Association for the Study of Pain (IASP), International Society of Physiotherapy Journal Editors (ISPJE). He has served as external examiner for both undergraduate and postgraduate professional examinations in most of the Physiotherapy training Universities in Nigeria. He has also served as external assessor for Physiotherapy promotion exercise in several hospitals in Nigeria, and chairman and member of several academic and professional accreditation panels in Nigeria and Ghana. Professor Akinbo is a recipient of several academic, professional and community distinctions awards. He has supervised 8 PhDs and 28 MSc theses and dissertations, and over 145 B. Physiotherapy research projects into completion. He has attended well over 100 conferences locally and internationally, and has presented papers in all the conferences attended, and has also served as a Guest/Keynote Speaker in over 40 meetings (Conferences and Workshops). He has published well over 80 full research studies and 100 research abstracts in peered reviewed journals and conferences proceedings. His professional areas of specialization are Musculoskeletal & Orthopaedics Physiotherapy and Sports Physiotherapy.
Abstract:
Background and Objective: Chronic Low back pain (CLBP) is a common problem that most people experience at some point in their lifetime. It is associated with various physical, emotional, economical and psychological dysfunctions that eventually cause deterioration in quality of life (QoL). This study investigated the relationship between pain intensity and sleep disturbance in patients with CLBP. Methods: The study is a cross-sectional survey in which 112 patients attending three tertiary hospitals in Lagos, Nigeria were evaluated for LBP of duration greater than 3 months. The survey employed a Visual Analogue Scale (VAS) and the Pittsburgh Sleep Quality Index (PSQI) to determine pain intensity and explore sleep variables respectively. The results were analysed using Pearson Product Moment correlation coefficient, independent t-test and Mann Whitney U. Level of statistical significance was set at p < 0.05. Results: There was a statistically significant correlation between pain intensity and overall sleep index (r= 0.22, p= 0.02). Furthermore, there was a significant correlation between pain intensity and sleep latency (r=0.26,p= 0.00) and sleep disturbance (r=0.27,p= 0.00). Conclusion: The study significantly established the adverse effect of CLBP on quality of sleep on patients. Therefore, sleep problems should be addressed as an essential part of management in patients with CLBP. Key words: Pain Intensity, Chronic Low Back Pain, Sleep Quality.
Mehdi Kasbparast Jui Ray
Department of Physical Education and Sport Sciences, Karaj branch, Islamic Azad University, Karaj, Iran
Title: Eccentric muscle strength in functional ankle instability among male student Soccer players
Biography:
Mehdi Kasbparast Jui Ray is faculty member of Physical Education and Sport Sciences, Karaj branch, Islamic Azad University, Karaj and he is doctoral student in sport injury and member of Asian Society for physical Education and Sport for 15 years
Abstract:
To investigate muscle strength in subjects (male student Soccer players) with unilateral functional ankle instability, with the specific aim of determining whether eccentric strength deficits exist. Isokinetic invertor and evertor torques were assessed eccentrically and concentrically at speeds of 60 and 120 degrees •s (-1) in 16 subjects with unilateral ankle instability. Absolute peak torque values were compared between the injured and non-injured limbs to determine whether strength deficits existed. No eccentric or concentric evertor strength deficit was found in the injured limb. Interestingly, for the injured limb, a significant interaction effect was found whereby eccentric inversion strength was reduced. Functional ankle instability is not associated with deficits in evertor strength. Deficits in eccentric invertor strength were found, and this may contribute to the symptoms of functional ankle instability. Weak invertors may contribute to functional ankle instability because of a reduced ability to assist in controlling lateral displacement of the shank over the weight bearing foot. Excess lateral postural sway outside of the base of support results in the foot’s medial border rising from the floor once the limits of closed chain eversion is reached, which may result in the foot being forced into rapid inversion.