33- دواء NVG-291 من شركة نرفجين فارما لعلاج الاصابات العصبية..ماهو فكرته وموقفه الان

 

32- كيف تحدد اصابة الحبل / النخاع الشوكي كاملة او غير كاملة...

 

إصابة الحبل الشوكي هي حالة خطيرة تتطلب الرعاية الطبية العاجلة. إصابة الحبل الشوكي تحدث عندما يتضرر أي جزء من الحبل الشوكي أو الأعصاب في نهاية القناة الشوكية، مما يسبب تغيرات دائمة أو مؤقتة في وظائفه. يمكن أن تؤثر إصابة الحبل الشوكي على قدرة المصاب على التحكم في حركة أطرافه والإحساس بالحرارة والبرودة واللمس، بالإضافة إلى وظائف أخرى مثل التنفس والتحكم في المثانة والأمعاء والوظيفة الجنسية.

لتحديد مدى إصابة الحبل الشوكي، يجب على الأطباء إجراء فحص عصبي شامل لمعرفة مستوى وشدة الإصابة. مستوى الإصابة يشير إلى أدنى جزء من الحبل الشوكي غير المتضرر، بينما شدة الإصابة تشير إلى مدى تأثيرها على وظائف الأعصاب. يمكن تصنيف شدة الإصابة بأنها كاملة أو غير كاملة. إذا فقد المصاب كل الإحساس والحركة تحت مستوى الإصابة، فهذا يعني أن الإصابة كاملة. إذا بقي لديه بعض الإحساس أو الحركة تحت مستوى الإصابة، فهذا يعني أن الإصابة غير كاملة.

31- فيديو حالة قطع كلي للنخاع الشوكي يمشي بالعكازين حسب التصنيف الأمريكي لاصابات الحبل الشوكي _________Paraplegia complete transection according to ASIA scale, walks with crutches

 

30- فيديو اول صديق تلقي برنامجنا الفريد لاستعادة المشي بمفرده وهو شلل نصفي سفلي قطع كامل حسب التصنيف الأمريكي لاصابات النخاع الشوكي_______First friend got our unique program to restore walking with crutches, paraplegia complete transection according to ASIA scale

 

29- بروتوكول علاج طبيعي تأهيلي لحالة تعديل اصبع سبابة يد مريض مكان اصبع الابهام المفقود______________________________________Physical therapy & rehabilitation program after pollicization surgery

What is the pollicization surgery?

Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers.

How it is done?

During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollex"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement.

The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint.

Case study..

A case of an adult admitted to the hospital after a gunshot.The bullet exploded the left thumb.A pollicization was done by replacing the left index finger to the thumb site.

This guy was 21 years old & working in a factory, so restoring the hand function is the main target.I started a physical therapy program depending on the problems he had.

Examination..

By looking to the movements, flextion is better than the extension, so extensor lag happened.

As a test for the function, he was asked to pick up a pen & write with the left hand (the affected hand) i found that he can grasp a pen but he can not control it to write.

Then he was asked to let it down but it was not easy to open his hand.

Some movements are missed like adduction & abduction .

And by examining the joints, PIP, DIP & MP i found PIP stiffness while the DIP has normal range of motion with passive movement test & lake of extension by active movement test.

But the MP joint i ignored testing it as this is not a real/normal joint.

The skin also play a very important role in the movement, as it gives more ranges to the joints to move further more so, paying attention to this factor is very important.

By examination, i found that the skin appears adherent on the dorsal surface & by testing its flexibility using my hand it was found rigid.

This adherence affecting the flexibility of the movement toward the flexion.

While the anterior surface is less adherence but still not permitting the normal flexibility.

No pain appear untill pressing on the metacarpophalangeal joint toward the flexion.

The program..

Exercises
Starting with strengthening exercises for the long flexors of the index and facilitating the extension using maximum resistance to the extensors to fire more fibers & neurons which improve the extension.

In addition , the functional exercises were done for improving the synchronization between all groups of the muscles and restore the function as quickly as possible.
Writing is very important as in this action we can get very specific feedback, as the action of writing linked with the perceptual & cognitive activities of the brain which improve the out put of the motor action.

Stretching exercises for the hand flexors, by opening the hand widely and extending the wrist to the middle range of wrist extension as we can not do full extension because the surgeon took a bone graft from the carpal bone.

Orthoses

As a way to overcome the extensor lag, using a splint to hold the DIP & PIP joints in extension for long time during the day.

Manual techniques
One of the big problems was the PIP stiffness that affecting the function of the transfered finger so, mobilization techniques are used to increase the limited range of motion.

Now the movement became smoother and easier but the skin stiffness was limiting the movement so, for the stiff skin over the dorsal surface, myofacial release & massage were used.

Also both were donefor the anterior surface adding the vibrator machine, ultrasonic waves & short wave to them.

Electrotherapy

Ultrasonic waves was used as it creates micro-massage which break down the adhesions if used in form of pulsed waves.

Deep heating generated by the short wave which used in form of continuous waves helps in gaining the flexibility.In addition hot packs & sometimes paraffin wax.

Every session i was using the vibrator as the shaking waves generated by this machine have the ability to release the adhesion mechanically & generating the heat in those tissues as a result of the friction and the shaking action of the vibrator.

Using faradic stimulation in the form of titanic contraction was done to the extensors of the fingers to facilitate the extension by firing more muscle fibers and more neurons.

The results
For three months of rehabilitaion, he can touch the little finger with the tip of the index (the O position), the DIP restored a good range allowing the hand to restore most of its functions & the skin was flexible enough at the anterior surface while the dorsal surface did not achieve more results.
Extensor lag decreased but still appear there.He can use the left hand well in his job without any barrier.I advised him to keep exercising the fingers using tools like pinch grip or flexible ball.

28- Strain-Counterstrain Technique ..?!! _______ طريقة د.جونز للعلاج اليدوي كجزء من علم الاستيوباثي

Jones Strain and Counterstrain

Strain Counterstrain is an Osteopathic manual medicine technique. It emphasizes correction of abnormal neuromuscular reflexes rather than simply addressing painful, postural or structural problems. Counterstrain recognizes that these structural, postural and painful problems are a result of the abnormal reflexes. Until these abnormal neuromuscular reflexes are addressed significant healing is difficult

So, what in the world is strain and counterstrain anyway? Counterstrain is a form of manual manipulative therapy that uses an indirect means of passively positioning a painful or restricted joint or muscle to relieve pain and mechanical dysfunction.

That is an over simplified definition, but it captures the essence of the technique. Technically speaking, counterstrain is “A passive positional procedure that places the body in a position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction. In addition, it is a mild overstretching applied in a direction opposite to the false and continuing message of strain from which the body is suffering.

This is one of the most gentle and powerful manual techniques that are currently employed in the field of rehabilitation. The reliability and effectiveness of this manual technique are rapidly becoming legendary, because they work so well!

Not only do the techniques work, they are applicable to a large range of musculoskeletal dysfunctions.

What is tenderpoints mean!!

Tenderpoints are manifestations of somatic dysfunction much as are the other TART changes. TART changes are seen as tissue Texture changes, Asymmetry, altered Range of motion, and Tenderness. The tenderpoint is a discrete pea sized area of tenderness that is uniquely a part of a somatic dysfunction. Each tenderpoint is a manifestation of a specific abnormal reflex that allows the practitioner to fashion a specific treatment for each patient.

How it works – The basics of physiology
Muscle origin and insertion

All muscles have a starting point on a bone (origin) and an ending point on a bone (insertion). Muscles are attached to the bone by a tendon. Think of a chicken drumstick. When you pull the meat away from the bone, it is adhered at the end by a clear or whitish tough cord. This is the tendon. A therapist can move a muscle into a lengthened position (stretch) or shortened position by knowing the origin and insertion of that particular muscle. By moving the bones, muscles can be put into a fully lengthened position, a shortened position or anywhere in between.

Sensory Input and Motor Output

All muscles communicate to the spinal cord and brain (central nervous system) via sensory nerves and receptors located in the tendon. These receptors called golgi tendon organs and muscle spindle fibers, relay information about the length of the muscles and how fast and in what direction the muscle is moving the bones and joints. They also communicate what state of contraction the muscle is in at rest (muscle tone). This is a part of our sensory feedback system which the nervous system uses to decide how to instruct the muscle what to do next (motor output). Our sensory system is highly sophisticated and sensitive. It provides our nervous system with the information to make rapid decisions to plot a course of action based on the desired activity of the brain while also avoiding injury.

Muscle Tone

Our central nervous system supplies a certain amount of constant output to each of our muscles. This is called the muscles’ tone. Without any input the muscle is flaccid (abnormal state) as seen in a stroke. With too much output a muscle is spastic and can make lengthening movement of a muscle nearly impossible. In between flaccid and spastic is a resting state for normal that varies with the individual.

Muscle tone continuum
l_______l______l_______l_________l______l________l________l
FLACCID RELAXED NORMAL TENSE SPASM SPASTIC(ABNORMAL) (ABNORMAL)

Muscle spasm – A vicious cycle.

A protective mechanism of the body based on these principles is called a muscle spasm. When the body perceives danger to a joint, the nervous system instructs the muscle to contract strongly to prevent movement that may cause damage. The muscle can stay in this state for a few minutes or a few days. It can become chronic and then this mechanism rarely serves to help or protect the body any longer and can become detrimental.





A vicious cycle is developed with pain, muscle guarding and muscle spasm.
A muscle in spasm is constantly sending signals to the nervous system, much like listening to music that is too loud. The nervous system reacts by sending strong signals right back. This is how a muscle can get into a vicious circle with the nervous system.


How it works – the technique




Dr. Jones developed a whole system based on understanding the tenderpoint. It is a unique finding with Strain/Counterstrain that the tenderpoint is found in the shortened muscle group, not in the muscle groups that most commonly present with pain. The treatment is achieved by placing a mild over stretching on the painful muscle thereby shortening the truly dysfunctional muscle group allowing for a reset of this abnormal reflex to a normal level.

-The therapist identifies the muscle in spasm.
-The muscle can be in visible or palpable spasm or can be identified by “tender points”. The therapist positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissues surrounding muscles and organs. More about this will be explained in future articles.)
-The therapist monitors tissue change and waits for optimum improvement to occur.

The shortened position of a muscle is a non-threatening position for a muscle in spasm. The communication from the muscle to the nervous system at this time is one of relaxation. The nervous system no longer receives the excessive feedback from the muscle and instructs the muscle tone to change from spasm to a resting tone. Relief and restoration of motion is often immediate. By disarming muscle spasm in major muscle groups the body is able to return to pain free function and pain free movement can be restored and built upon with exercise.

This technique lays the groundwork for rehabilitation of any painful condition. This technique is best used for:
-Spasm in any area of the body
-Post surgery in any area of the body
-Restoring more upright posture (tightened muscles can pull you into poor posture)
-Chronic pain

Can a muscle be in spasm (hypertonic) without a person knowing it?

Yes! People experience decreased mobility, tightness, or nothing at all if another muscle is compensating for it.

Advanced strain-counterstrain techniques have been pioneered by Sharon Weiselfish, PT, and PH.D. to release the muscle contained in the arteries, veins, lymph vessels and lining of some internal organs. These techniques relax the skeletal muscles of the immediate area surrounding the structure and sometimes can improve in a limited way the function of the structure released.

27- Osteopathy علم الاستيوباثي...ماهو وتفاصيلة..

About Osteopathy

is a system of medical practice based on the principle that health depends on the maintenance of proper relationships among the various structures of the body.Osteopathic medicine holds that true health involves complete physical, mental, and social well-being, rather than merely the absence of disease. In this system, the body has a capacity for health that the physician helps the individual attain. The osteopathic physician, therefore, treats the whole patient, considering such factors as nutrition and mental health in addition to physical symptoms of illness.According to osteopathic theory, defects in the musculoskeletal system—the muscles, bones, and joints—influence the natural function of internal organs. To correct structural abnormalities, osteopathic therapy, or manipulative treatment with the hands or related mechanical means, is used. The osteopathic physician uses this treatment when appropriate, either alone or in combination with other accepted therapeutic methods such as drugs, surgery, and radiologic treatments, depending on the medical symptoms of the individual patient.The fundamental principles of osteopathic medicine were formulated in 1874 by American physician Andrew Taylor Still, who established the first osteopathic medical school at Kirksville, Missouri, in 1892. Today more than 24 accredited osteopathic medical schools and more than 200 osteopathic hospitals operate in the United States. More than 38,000 osteopathic physicians treat some 35 million Americans annually. A doctor of osteopathy (D.O.), like a doctor of medicine (M.D.), is fully trained and licensed to practice all branches of medicine and surgery. Osteopathic physicians are licensed in all states and participate in all federally funded health programs. Posted by (Dr.\Hesham Khalil PT, DO (tw)statement 2007



Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. In most countries osteopathy is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions (Osteopathic Manipulative Medicine, or OMM in the United States) in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Many osteopaths see their role as facilitating the body's own recuperative powers by treating musculoskeletal or somatic dysfunction. According to the American Osteopathic Association, the difference between an osteopath and an osteopathic physician is often confused.In the United States, Doctors of Osteopathic Medicine (D.O.s) are fully licensed medical physicians and surgeons, practicing in all clinical specialties along with their M.D. colleagues . Just like M.D.s, D.O.s practice the full scope of medicine, but with an emphasis on the role of the neuromusculoskeletal system. D.O.s practicing in primary care, pediatrics, family, or internal medicine, are trained to have a more empathetic approach to patient care which has awarded them some level of distinction from M.D.s Outside the United States. The practice rights of U.S.-trained Doctors of Osteopathic medicine varies.


What do osteopaths treat?

Osteopaths treat a variety of common conditions including changes to posture in pregnancy; babies with colic or sleeplessness, repetitive strain injury, postural problems caused by driving or work strain, the pain of arthritis and sports injuries.

Osteopathic principles
These are the eight major principles of osteopathy and are widely accepted throughout the osteopathic community:

1-The body is a unit.
2-Structure and function are reciprocally inter-related.
3-The body possesses self-regulatory mechanisms.
4-The body has the inherent capacity to defend and repair itself.
5-When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue.
6-The movement of body fluids is essential to the maintenance of health.
7-The nerves play a crucial part in controlling the fluids of the body.
8-There are somatic components to disease that are not only manifestations of disease, but also are factors that contribute to maintenance of the disease state.
These principles are not held by osteopathic physicians to be empirical laws, nor contradictions to medical principles; they are thought to be the underpinnings of the osteopathic philosophy on health and disease.

Techniques of Osteopathic Manual Medicine
(Osteopathic Manipulative Medicine)

In the United States, physical or manual treatment carried out by D.O.s is referred to as Osteopathic Manual Medicine or Osteopathic Manipulative Medicine (both abbreviated OMM). In other countries, manual treatment by osteopathic physicians is simply referred to as osteopathic treatment.
The goal of OMM is the resolution of somatic dysfunction to reestablish the self-regulatory mechanisms of the body. There are various techniques applied to the musculoskeletal system as OMM. These are normally employed together with dietary, postural, and occupational advice, as well as counseling to help patients recover from illness and injury, and to minimize pain and disease. Most osteopathic physicians view manual therapies as a complement to physiotherapy, and use more invasive therapies (pharmaceuticals and surgery) where necessary.

Scope of manual therapies
There is now a well-established body of scientific literature that makes a strong case for the use of manual therapies in the treatment of many neuromusculoskeletal pain syndromes, such as low back pain and tension headache, alongside exercise and other rehabilitative techniques. In recent years, mainstream medicine has begun to accept the use of manual therapies to treat spinal pain of mechanical origin.
More controversial is the use of manual therapies in the treatment of seemingly organic conditions, such as asthma, middle ear infections in children, menstrual pain, and pulmonary infection. While research is beginning to shed some light in this area, exploration of the relationship between the NMS system and organic disease and the scope of manual therapies are in their infancy. Nevertheless, the sum of research and clinical experience to date suggests that osteopathic treatment can be a safe and cost-effective means of managing (or co-managing) certain diseases.

Cranial osteopathy

It has been suggested that this section be split into a new article entitled Cranial osteopathy.
( Craniosacral therapy )
Cranial osteopathy, although well-established, is a contested issue within the profession; it is not known what proportion of osteopathic physicians are practitioners. Cranial osteopathic physicians are trained to feel a very subtle, rhythmic shape change that is present throughout the head and body. This is known as the involuntary mechanism or the cranial rhythm.

The movement is said to be very subtle, and it takes practitioners with a very finely developed sense of touch (palpation) to feel it. This rhythm was first described in the early 1900s by Dr. William G. Sutherland.[6] The theory underlying cranial osteopathy is rejected by many physicians because it was previously understood that cranial bones fuse by the end of adolescence.
However, histological studies have demonstrated the presence of Sharpey's fibres between the adjacent bones forming the sutural margins, and it is known that these specialized fibers form only at areas where tissue movement is allowed. It is, of course, accepted by most modern osteopathic physicians working within the cranial field, that the spheno-basilar symphysis (a large joint in the skull base) does indeed ossify (turn to bone) and the original principles of cranial osteopathy have thus evolved alongside increasing knowledge.

Cranial osteopathic teaching refers to movement remaining within the thin bone of the sutures, and that flexibility within living bone occurs, in contrast to dried specimen bones. The brain does pulsate, but some research suggests this is related to the cardiovascular system. The same study looked at inter-operator reliability of palpating the 'cranial rhythm' and found there to be little agreement, although modern understandings in the cranial field describe a number of simultaneous rhythms with differing rates, relating to different aspects of function.

How this mechanism is related to health/disease has not been scientifically established. Some osteopathic physicians believe that healing dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow. Many without direct experience of the benefits of treatment dismiss cranial osteopathy as merely theoretical. However, patients of cranial osteopathic physicians have reported emotional releases, lightness and buoyancy, and visualizations.

This technique is increasingly being recognised as especially suitable for newborn babies and young children, with particularly good results in the treatment of colic and crying. It is claimed that as their bones have not fully fused and hardened, they are more susceptible to the treatment.
All in all, this practice appears to be popular with patients with an increasing demand for experienced practitioners.
Craniosacral therapy is based on the same principles but the practitioners have not attended medical school and are therefore not osteopathic medical physicians. Chiropractor & osteopathic physician, M.B. Dejarnette further developed craniopathic techniques inside of a complete Chiropractic system known as Sacro-Occipital Technique or simply "S.O.T."

Visceral osteopathy
Proponents of visceral osteopathy state that the visceral systems (the internal organs: digestive tract, respiratory system, etc.) rely on the interconnected synchronicity between the motion of all the organs and structures of the body, that at optimal health this harmonious relationship remains stable despite the body's endless varieties of motion. The theory is that both somato-visceral and viscero-somatic connections exist, and manipulation of the somatic system can affect the visceral system (and vice-versa).
Visceral osteopathy is said to relieve imbalances and restrictions in the interconnections between the motion of all the organs and structures of the body--namely, nerves, blood vessels, and fascial compartments. During the 1940s, osteopaths like H.V. Hoover and M.D. Young built on the pioneering work of Andrew Taylor Still to create this method of detailed assessment and highly specific manipulation. The efficacy and basis of this treatment remains controversial even within the osteopathic profession. Visceral manipulation was further promoted within osteopathic treatment by Jean-Pierre Barral in his recent series of books on the subject.

While neither cranial osteopathy nor visceral manipulation are the mainstay of most osteopathic medical practices, there is increasing interest in both of these areas from patients and practitioners alike. Training in cranial osteopathy in the UK has now reached validated MSc level, which aims to improve standards and contribute to the body of evidence with research-based studies carried out from within the profession.


Is osteopathy regulated?
The General Osteopathic Council (GOsC) is one of 13 organisations in the UK known as health and social care regulators. Each organisation oversees the health and social care professions by regulating individual professionals.
The Statutory Register of the General Osteopathic Council (GOsC) opened on 9 May 1998. The title "osteopath" became protected by law from 9 May 2000 when the transitional registration period ended. As a result it is a criminal offence, liable to prosecution, to describe oneself as an osteopath in the UK unless registered with the GOsC.
The GOsC regulates, promotes and develops the profession of osteopathy, maintaining a Statutory Register of those entitled to practise osteopathy. Only practitioners meeting the high standards of safety and competency are eligible to join this register. Proof of good health, good character and professional indemnity insurance cover is also a requirement.

What qualifications do osteopaths have?
Osteopaths undertake four to five-year honours degree programmes underpinned by thorough clinical training.

26- Walking, Recreational Exercise Do Not Increase Risk for Knee OA in Older Adults

January 31, 2007 — Walking and other 

recreational exercise do not

increase the risk for developing osteoarthritis (OA) in older adults without OA, according to the results of the Framingham Offspring Study reported in the January issue of Arthritis Care & Research.

"Regular exercise is recommended for middle-aged and older persons," write David T. Felson, MD, of the Boston University School of Medicine in Massachusetts, and colleagues. "The effect of regular exercise on the development of osteoarthritis (OA) in older persons, especially those who are overweight, is unclear."

This longitudinal study followed up 1279 community-dwelling adults who were older (mean age at baseline 53.2 years) and many of whom were overweight. Using a questionnaire about physical activity, subjects were asked about recreational activities, including walking or jogging for exercise, and working up a sweat, and they were asked to compare their activity levels with those of others. At baseline, subjects were also asked about knee pain and had weight-bearing anteroposterior (AP) and lateral knee radiographs.

Approximately 9 years later, subjects were reexamined for OA, and radiographs were evaluated for OA features in both tibiofemoral and patellofemoral compartments and scored for tibiofemoral joint space narrowing. Knees with OA at baseline were excluded for all analyses.

The main knee-specific endpoints were incident radiographic OA, symptomatic OA, and tibiofemoral joint space loss. After adjustment for age, sex, body mass index (BMI), knee injury history, and correlation between knees, the investigators evaluated the association of each recreational activity with OA development.

Recreational walking, jogging, frequency of working up a sweat, or high activity levels relative to peers were not associated with decreased or increased risk for OA or with joint space loss. Participants with BMI above the median (27.7 kg/m2 for men and 25.7 kg/m2 for women; mean BMI > 30 kg/m2 for both) had no increases in risk for OA with different types of activity.
Study limitations include lack of MRI imaging at baseline evaluation and insufficient number of joggers or runners to evaluate the effect of running on OA.

"Among middle-aged and elderly persons without knee OA, many of whom were overweight, recreational exercise neither protects against nor increases risk of knee OA," the authors write. "Although dynamic loading may have a trophic effect on cartilage, there is no measurable protective effect of recommended weight-bearing exercise on OA. Physical activity can be done safely without concerns that persons will develop knee OA as a consequence."

The National Heart, Lung, and Blood Institute of the National Institutes of Health's Framingham Heart Study and the Boston University School of Medicine supported this study.
In an accompanying editorial, Marian A. Minor, MD, of the University of Missouri in Columbia, called this "a useful and valid study that supports recommending regular moderate physical activity without undue fear that such activity may increase the risk for knee OA."

"Future research, whether designed to evaluate the effectiveness of interventions or to identify risk factors for development or progression, should characterize subjects in terms of variables relevant to knee OA," Dr. Minor writes. "We must identify and agree upon meaningful characterization of research subjects and move beyond general statements of risk and efficacy in the aggregate.

In addition to improving the usefulness of knee OA research, our ultimate aim must be to produce evidence that assists clinical decision-making and individualized recommendations regarding safety and effectiveness of interventions, including physical activity."

Posted by Mostafa gala & Mohamed rizk

25- Bioreasonance...What is this?!

Bioreasonance refers to the process of using the body's own oscillations for diagnosis and treatment.Bioreasonance is based on the principle of measuring the body's energy system using equipment, in an objective form. We utilize several Bioreasonance devices in our Naturopathic Diagnostic Laboratory. Chief among these are the Vega and the Bicom and the Vega Diagnostic System for Functional Medicine.
THE CONDITIONS IT CAN HELP Aches and pain, chronic tiredness, arthritis, bacteria, chemical sensitivity, depression, eczema, formaldehyde poisoning, fungus, heavy metal toxicity, parasites, poisoning from mercury fillings leaking from your teeth, radiation poisoning from computers, skin problems, virus and others.

How it works?

o It painlessly records and measures your body's energetic imbalances in a very specific way. For example, testing will show what specific allergies or heavy metal toxins you have and name the allergy or toxin. The equipment will also precisely measure the seriousness of the problem. Every follow up session will similarly measure the improvement.
o These devices and all the technological advancements that followed the first invention in 1953, is based on the principle that imbalance can be measured precisely with the aid of sensitive electronic circuitry. The energetic changes brought about by symptoms such as fever, aches, tiredness, can be detected by electro-acupuncture. Even when the patient is unaware of a problem, electro-acupuncture can come up with results.

It's origin?

Bioreasonance Medicine began in 1953 with Dr. Reinhold Voll of Germany. He reasoned that it should be possible with the aid of modern technology to measure the energy inherent in each of the body's organs and, if imbalanced, to lead it back to balance and health. Together with an electronics engineer, Dr. Voll constructed a device which allows acupuncturists to measure the slightest reactions at the acupuncture points.
THE VEGA TEST

Imagine machines that can measure the precise health status of your internal organs. These are astounding systems that can tell you the name of the virus, bacteria or allergen that is affecting you. Your mineral, vitamin and amino-acid deficiency can also be pin-pointed. All this information is achieved without pricking your skin or drawing blood. And so safe that even children have taken this test.

How can the Vega Test help you?

1. Your allergies can be specifically identified. Individual sensitivity to foods, inhalants, environmental toxicity, drugs, pollens, molds, etc. can be the cause of your breathing problems, skin problems and increase hyperactivity or depression.

2. Identifies hard to detect causes of chronic illness like : A. Chemical poisons in your body from home or from working in polluted. buildings where you seem to fall ill often. B. Mercury poisoning from dental fillings. C. Parasites and disease causing organisms in your body. D. Pin-pointing unsuspected nutritional deficiencies leading to feeling tired is within this system's capacity. Vega can identify which vitamin, mineral or amino-acid you are deficient in.

3. You can test for your health status as a precautionary strategy . Prevention is cheaper and more comfortable then being sick. Vega testing is able to give you forewarning of disease so you can take preventive treatment.

4. The Vega system is used only for diagnosis and not treatment. Medication can be homeopathic, herbal or nutritional.

5. It gives us another diagnostic view of your body. Because energy is such a basic component to your overall health, the Vega system is used in clinics of natural medicine around the world as a pre-screening device for chronic illnesses.

What will your Vega Treatment be like?

The procedure is safe for babies and young children as it is non-toxic, natural and non-habit forming and is as follows :

1. Electrical / bio-energetic measurements on specific points on the surface of your hands and feet are taken with a rounded probe.

2. The Vega system then identifies the specific causes of your problem.

3. Follow-up sessions will measure your exact progress and the remedies are changed according to the changes in your condition.

BICOM RESONANCE THERAPY

The Bicom is used to investigate for root causes of ill health at a level even deeper then the Vega testing. The machine's measuring capacity allows for a more narrowed focus of diagnosis as well as treatment. The Bicom's electromagnetic treatment speeds up your healing process so that you get well more quickly.

How can the Bicom help you?

1. Neutralizing allergies and toxins.

2. Healing skin conditions, asthma, gastro-intestinal problems.

3. Identify and address the causes of chronic fatigue.

4. Identify the cause of your immune system failure.

5. Strengthen your immune system by bio-energetic rebalancing.

Our approach

1. Bicom is used as part of your overall treatment.

2. You could be treated on the Bicom if your Vega test or the Applied Kinesiology test indicate further investigation is necessary.

3. We use it to speed up recovery and lessen the period of illness.

How does the Bicom work?

1. A rounded probe measures certain points on your skin surface: your ears and hands. The Bicom receives these signals via the rounded probe.

2. Treatment is through electrodes which are held in your hands or held against special parts of your body.

3. Your electromagnetic oscillation is measured by the Bicom's computerized system. The treatment modifies your natural energy field increasing your natural immunity and starting your self-healing process.

4. Your organs, cells, tissues etc. emit electromagnetic signals in the form of oscillations. These oscillations are measured to identify imbalances in your body. In the treatment which immediately follows, the Bicom electronically changes the oscillations by mirror imaging and relays the new information back to the body, again via electrodes. The body immediately reacts to this new information and the self-healing power of the body is activated and strengthened. The healing begins.

5. You do not get medication with the Bicom.

6. The diagnosis and treatment is gentle for all अगेस

Not used in my clinic now...

24-Biofeedback

What is Biofeedback?

If you have ever taken your temperature you have participated in a form of biofeedback. "Bio" is a combining word form meaning "life". Feedback denotes giving back. Simplified, biofeedback means feeding back information about life responses: temperature, heart rate, brain wave activity, and/or muscle tension.
Biofeedback requires intensive patient participation. The patient's goal is to learn to control involuntary functions such as heart rate, blood pressure, breathing, skin temperature, and muscle tension. The biofeedback therapist teaches the patient how to affect a particular function specific to a problem through mental or physical exercises (e.g. tense neck muscles).

This treatment is not designed to take the place of a physician. The patient should continue to follow-up with their physician as prescribed.

What is the purpose of Biofeedback?

Biofeedback has helped many people combat the ill effects from involuntary muscle tension and related pain.
Other forms of biofeedback include Electromyography (EMG's) that measures muscle tension, Electroencephalographs (EEGs) that measure brain-wave activity, and Electrocardiographs (ECG's) known to measure heart rate.

How does the patient learn to apply the principles of Biofeedback?

The biofeedback therapist begins by applying sensors to specific points on the patient's body. The sensors are then connected to special equipment (e.g. computer) designed to monitor the patient's physiological responses.

The therapist teaches the patient mental/physical exercises designed to treat their disorder. For example, the patient may learn how to relax certain groups of muscles in the low back. In addition, the therapist may teach the patient visualization skills and deep breathing.
During instruction, the patient is made aware of their "bio" progress by means of the monitoring equipment. The equipment may beep, buzz, or make a dinging sound to assure the patient they are making progress in learning how to control a specific function. Some monitors are capable of providing a visual graphic.
Once the patient has learned the technique, the biofeedback equipment is no longer needed

.
Does it take a long time for the patient to learn the technique?

Biofeedback treatment may involve as few as 10 sessions to as many as 40 or 50. The number of sessions is dependent on the disorder and the patient. Each treatment will last between one-half hour and an hour. Some patients may need to attend up to 5 sessions each week.
This treatment is not for all patients. First, biofeedback does not work for everyone.

If results are not apparent after 8 or 10 sessions, that could mean the patient will not benefit. Secondly, patients with pacemakers should avoid biofeedback because the electrical impulses generated to monitor progress could interfere with the operation of a pacemaker.

Are there any side effects?
There are no known side effects from biofeedback. The treatment is non-invasive.

Biofeedback device:

The SCENAR is a biofeedback device with patented technology. Developed by the Russian space program, it is particularly effective at its US FDA accepted use of muscular relaxation and re-education.
The SCENAR/BF is a biofeedback device indicated for use in relaxation training and muscle re-education.

Muscle Re-education
-Relaxing muscle spasm.
-Preventing or retarding disuse atrophy.
-Maintaining or increasing range of motionStimulating muscles in the leg and ankle of partially paralyzed patients to provide flexion of foot and thus improve the patient's gait.

Relaxation Training
-General muscle relaxation.
-Reduction of "secondary stress" that often accompanies disabling injuries and disorders.

Contraindications:

The SCENAR may affect the operation of cardiac pacemakers, particularly demand type pacemakers. Do not use the SCENAR to stimulate directly on the eyes or over the carotid sinus.

Posted by Mostafa galal & Mohamed rizk

23-Improving Motor Outcomes through Constraint-Induced Movement Therapy

(Stephanie Combs, MS, PT, NCS University of Indianapolis,
Valerie Bush Merriman, OTR, SPT Krannert School of Physical Therapy)

Upper extremity motor disability commonly occurs following stroke. Constraint-Induced Movement Therapy (CI therapy) is a novel therapeutic approach which emphasizes recovery of upper extremity movement dysfunction through intense, short-term repetitive practice. An overview of current concepts and evidence related to CI therapy will be presented. Theoretical foundations underlying CI therapy, protocol components, and recent findings will be discussed. CI therapy procedures and protocol modifications will be explored for application to the neurorehabilitation clinical environment.

References:

-Hakkennes S, Keating JL. Constraint-induced movement therapy following stroke: A systematic review of randomized controlled trials. Australian Journal of Physiotherapy. 2005;51:221-231.

-Morris DM, Taub E. Constraint-induced therapy approach to restoring function after neurological injury. Topics in Stroke Rehabilitation. 2001;8(3):16-30.

-Winstein CJ, Miller JP, Blanton S, Morris DM, Uswatte G, Taub E, Nichols D, Wolf SL. Methods for a multi-site randomized trial to investigate the effect of constraint-induced movement therapy in improving upper extremity function among adults recovering from a cerebrovascular stroke. Neurorehabilitation and Neural Repair. 2003;17:137-152.

22-Cystic fibrosis physiotherapy

Introduction:

Cystic Fibrosis (CF) is a genetic disorder which causes mucus in the body to be very sticky, which can lead to chest infections and lung damage and can affect the way food is used by the body. In 1964 the average life expectancy of a baby born with CF was only 5 years, whereas today it is 31 years. The dramatic increase in life expectancy in a relatively short period of time has led to a shortage of specialist facilities for adults and teenagers.

What is the Autogenic Drainage & Active cycle for breathing technique ?

-Autogenic Drainage

Autogenic drainage uses the patient's own airflow to release and move secretions, through controlled, graduated inspiratory and expiratory maneuvers. This airway clearance technique does not require any assistive devices; however, it is sometimes difficult to learn how to do correctly.
-Active Cycle of Breathing (ACB) Technique

ACB is an airway clearance technique that combines the forced expiratory technique (which uses "huffing" from various lung volumes to assist in removal of secretions) and thoracic expansion exercises. ACB requires training with a respiratory therapist to learn how to do correctly.

A comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage

BACKGROUND--

Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage.

METHODS--

Eighteen patients with cystic fibrosis took part in a randomised two- day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end of each day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (SaO2) and heart rate were measured before, during, and after each session.

RESULTS--

Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean SaO2 over the series, but four patients desaturated during ACBT.

CONCLUSIONS--

Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best.
Infants and toddlers suffering from Cystic Fibrosis have a difficult time loosening and coughing up the mucus that accumulates in their lungs and airways.
Here's a quick tip on how to use Postural Drainage to help your child loosen and expel the mucus to improve their breathing:
Position your child on his/her side on a pillow.
Tilt your child's head downward, with his/her bottom above the level of his/her head.
Gently tap your child's side, just under the armpit, and back.
Reverse sides and repeat until your child is able to expel some mucus and breathe easier.
zSB(3,3)


Another techniques>>

-Intrapulmonary Percussive Ventilation (IPV)
IPVis an airway clearance technique that uses compressed gas to deliver a series of pressurized gas mini-bursts to the respiratory tract usually by a mouthpiece. The IPV device is a pressurized aerosol machine that delivers aerosolized medications through a mouthpiece under pressure and with oscillations that vibrate the chest and loosen airway secretions.

21-The Amputation of Limbs

Introduction:



Removal of limbs or parts of limbs may be necessary at any age as a result of various conditions, mostly peripheral vascular disease, but causes may include malignant disease, injury (trauma), or congenital deformity. A common reason for amputation in adults, particularly in elderly people, is gangrene of part of the lower limb as a complication of peripheral vascular disease - often associated with diabetes mellitus. 60% of all amputees are over 60 years old. Congenital absence of limbs or parts of limbs may have much the same effect as amputation

An artificial limb, or part of a limb, is known as a prosthesis. It is important to realise that such a prosthesis may be
Functional : i.e. able to reproduce much of the function of the lost limb
Cosmetic: Many upper limbs protheses are purely cosmetic, though some have a relatively good degree of functional capability.
Where a large part of an arm is lost, both functional and cosmetic prostheses may be used at different times, and training in their fitting and use is required.
In general, lower limb prostheses are all functional, but their effective use depends on the level of amputation, the person's age, build, motivation and state of health.




The complications of amputation surgery :



The most important complication is the risk of dying. However, there are other complications.

General complicationsThese mainly consist of problems such as chest infections, angina, heart attacks and strokes. Because your mobility is restricted after an amputation, pressure sores can also develop. The nursing staff particularly will make great efforts to avoid this occurring. Special mattresses and beds are used to reduce pressure on areas at risk of sores. Regular turning to relieve pressure is also important.
Local complicationsThese mainly consist of wound infections that can develop in the stump. Antibiotics are given to reduce the risk of infection developing at the time of surgery. The stump can sometimes fail to heal or breakdown either as a result of a fall, infection or a poor blood supply. When this happens it can sometimes mean a further operation to revise the amputation or to remove more of the leg.


Role of Physiotherapy (PT):



The physiotherapist works with you during the rehabilitation phase to improve muscle function through exercise. While in the hospital and sometimes even before the operation, you may undergo a daily physiotherapy routine including exercises. The physiotherapist will demonstrate how to wrap your residual limb in an elastic bandage or a shrinker sock .
You will also learn how to use assistive devices (such as crutches) and how to transfer between different places (like to a chair) if needed.
As an out-patient, you will continue regular physiotherapy sessions to build the physical strength and range of motion .

in your residual limb. Your rehabilitation plan might also include a conditioning program to increase endurance ? this can help certain amputees become more mobile, like senior amputees who have respiratory problems, for instance. If you are a lower limb amputee, you will be given gait training (the process of learning how to walk with your artificial limb) by your physiotherapist and prosthetist. The physiotherapist can also suggest mobility aids or adaptations that might be helpful around the house.


The Stages of Rehabilitation:



There are several stages an amputee may go through during the first year following an amputation. Keep in mind that everyone goes through the stages of rehabilitation at his or her own pace and many factors like age, health and type of amputation come into play. Some stages will be shorter or longer than others, and certain stages may overlap. The clinic
team will develop a rehabilitation plan to guide the amputee along the way. It is important that the amputee remain an active participant throughout the whole process.

Stage 1: Healing and Starting Physiotherapy


Stage 2: Visiting the Prosthetist

Stage 3: Choosing an Artificial Limb(s)

Stage 4: Learning to Use Your Artificial Limb

Stage 5: Life As a New Amputee

Stage 1: Healing and Starting Physiotherapy
Overview Following the amputation, there will be a healing phase - during which time the incision and surrounding tissue will recover. This timeframe can vary between a matter of weeks, a couple of months or even more depending on the type of amputation, how much scar tissue may be involved and how the limb heals. In the hospital, the physiotherapist (PT) will teach exercises to improve muscle function and will show how to get around on crutches or a wheelchair (if it is required). The clinic team will recommend any rehabilitation therapy, prosthesis and physio- or occupational therapy that may be needed.
In the early days following the amputation, healing of the incision and the residual limb (the part of your limb remaining after surgery) is the main goal. Part of the healing process involves promoting shrinkage. Swelling is always an issue after surgery and bandaging the residual limb helps with this. The nurse and physiotherapist are the professionals you will deal with most frequently at the beginning of your rehabilitation, and may coordinate your care.
The nurse changes the bandages on your residual limb or checks your cast depending on the type of dressing you have. Be sure to tell the surgeon or nurse about any pressure points in the dressing, any pain you feel in your residual limb, or if you are experiencing phantom limb sensations (the conscious sensation that the amputated limb is still there) or phantom limb pain.
Shortly after surgery, your physiotherapist will begin massaging and stretching the residual limb (or teach you to do so) a few times a day. The physiotherapist helps you gradually restore physical function and movement to the area around your amputation. As your strength improves, you will play a more active role in your physiotherapy, exercising a few times a day to increase circulation, strengthening muscle tone and the range of movement you can achieve with your residual limb (range of motion). The exercises also reduce swelling and the chance of developing contractures (muscles tightening around a joint). Lower-limb amputees may also do upper-body strength-training exercises if they will be using crutches or a walker.
If you are a lower-limb amputee, you will probably be moving around the hospital on crutches or using a wheelchair within a few days. Your physiotherapist will complete any training on walking aids before you leave the hospital if it is needed. If you are an upper-limb amputee, you will probably become mobile as soon as you recover from the effects of the anaesthetic.
On returning home, a post-operative dressing is applied to the residual limb. Commonly, you may visit the physiotherapist around three to five times a week. You may also return to the hospital to have your bandage or cast changed/removed; alternatively, a local nurse or health care professional may be requested to handle this. After the sutures are removed, a compressive sock called a "shrinker sock" or a tensor bandage helps reduce swelling (edema), and molds and shapes the limb so the prosthesis will fit more comfortably.

Stage 2: Visiting the Prosthetist
Overview A prosthetist is the professional who makes the artificial limb (prosthesis). Once the clinic team is satisfied that the residual limb has healed well enough, a prosthesis can be fitted. A temporary prosthesis (more common for leg amputees) provides early mobility while allowing the residual limb to continue to shrink and change shape (which is normal following any amputation). Once the residual limb has settled into its final shape and the incision has healed, a "definitive" prosthesis (for permanent use) will be made. Arm amputees, unlike leg amputees who need a limb for mobility, are usually fitted once their limb has finished shrinking and changing shape. Many amputees are fitted with a simple prosthesis at first (for example a passive arm that has no grip function), which allows them to get used to wearing a limb and to help early on with balance. Later on, the amputee and prosthetist often decide together on a more complex and functional limb



Working Closely With Your Prosthetist
The prosthetist (often with the help of prosthetic technicians) is the professional who will fabricate your prosthesis. The clinic team, working with you, recommends the type of fitting appropriate for you and a prescription will be provided to the prosthetist. In many cases (especially in larger centres), the prosthetist attends a clinic right at the hospital at which the other rehabilitation professionals are present. Sometimes you are referred to a prosthetic facility.
It is important to remember that you have the choice of which prosthetic facility in your province you will attend. As the person who makes, adjusts and repairs your artificial limb, visits to the prosthetist will be part of your life from this point on. Having an open relationship with your prosthetist and feeling comfortable discussing your needs is critical.
The Process of Being fitted
Once your residual limb is healed and the swelling is reduced, you are ready for your first fitting for an artificial limb. This is usually about one to two months following surgery, but underlying medical conditions such as vascular disease or an infection might extend this time period.
During a fitting, your prosthetist will examine your residual limb closely. It is a very personal experience and it can take some time to feel at ease with the process. When going for your first fitting, wearing a t-shirt will make fitting easier if you are an arm amputee. If you are a leg amputee, it is a good idea to wear shorts as well as a comfortable shoe and bring its mate for the foot of your artificial limb. Do not forget to bring your prescription or any other relevant documents that you may have been given.
The first step in making your prosthesis is to create a mold; this usually starts with a plaster cast being taken of your residual limb. Generally, the prosthetist uses a "hands-on" method, as he/she manually checks the residual limb for cysts or similar conditions which may need special consideration during the fitting process. However, some prosthetists use "CAD-CAM," a computer-aided design method, instead - after entering your measurements into a computer, a milling machine carves out a reproduction of your residual limb. The finished product in both cases is the mold, which is used to fashion a socket to custom fit your residual limb. Prosthetists use a "check socket," a test socket often made of clear material, to visually inspect the fit. Stump socks and liners can help provide proper padding and comfort within the socket.
The most important considerations during a fitting are that the socket fits properly and that the artificial limb is aligned well with the rest of the body.

Your feedback to the prosthetist is needed to help him/her provide the best fitting for you. For example, be sure to tell the prosthetist if your residual limb is slipping up and down (called pistoning) inside the socket, or if your artificial limb "feels" too long or too short if you are a leg amputee.
Your First Limb
Depending on your situation, you may be fitted with a temporary limb early on. Before a fitting is considered your clinic team will want to ensure your residual limb has completely healed.
As the name suggests, the temporary limb is worn temporarily as the residual limb continues to gradually change shape. The temporary limb allows you to improve your balance and, if you are a leg amputee, learn how to walk. The prosthetist will make adjustments to the temporary prosthesis if necessary. A leg amputee may often have a metal pylon (a rigid central shaft) attached to a basic prosthetic foot as a temporary limb. An arm amputee may be fitted with a passive prosthesis as a first limb - one that has no grip function but which helps with balance and gets you used to the weight of wearing an artificial arm - you may be fitted later with a more functional prosthesis or may decide to stay with the passive prosthesis.
Wearing the temporary limb for short periods everyday will allow your body to adjust; you can then gradually increase the time until you are able to wear it comfortably all day. Physiotherapy exercises will help strengthen your residual limb and allow you to wear the artificial limb for longer periods.
A definitive or permanent limb can be fitted once the residual limb has stabilized and you are comfortable wearing the temporary prosthesis. Your definitive prosthesis is customized to your body and is made for long-term use. Usually, it will last about three years or more for an adult amputee. A child amputee may need a new limb once a year or even more often because of growth spurts. Some amputees have a spare limb to use when their definitive limb is being repaired or a new limb is being made.

Stage 3: Choosing an Artificial Limb(s)

Overview There are many different components and prostheses available and a detailed discussion with the prosthetist will help in making the right choices. Factors to consider include level of activity, health, level of amputation(s) and the importance of cosmetic look versus the functionality of the prosthesis.
Artificial limbs have come a long way from the early wooden and aluminum versions used after the First and Second World Wars. New technology is making artificial limbs more cosmetically appealing and functional. Artificial legs are very useful for providing mobility and stability, and artificial arms can help with many daily household activities.

There are many specific types of prostheses, including special limbs or devices for certain tasks and activities so it is very important to discuss your expectations and requirements with the prosthetist.
To make the best use of the time during your appointments with the prosthetist, it is a good idea to write down any questions you think of in advance. You do not want to forget anything. Taking notes during these meetings that you can refer back to later is also helpful - with so much information coming your way these notes can be reviewed when you have more time.
If you are an arm amputee, your choices range from a passive to a more functional prosthesis. Passive arms have no grasping function but have a good cosmetic appearance. Functional arms can either be body-powered or electric (most often myoelectric). Cable-operated hands and hooks are known as "body-powered" prostheses and are operated by means of a cable and harness system. By using the back and shoulder muscles, the cable is pulled which either opens ("voluntary opening") or closes ("voluntary closing") the hand. A "myoelectric" prosthesis is operated when the electrodes pick up muscle (Greek: myo) impulses from your residual limb. These are then translated into electrical signals that are sent to the electric hand to open or close it. The power is provided by a battery in the prosthesis. Although less common than myoelectric arms, there are also electric arms that are operated by other means, like a switch that you can turn on and off. Some types of arms have the option of either being myoelectrically controlled or switch-controlled.
If you are a leg amputee, you will be fitted with one of two types of limbs. An exoskeletal prosthesis has a hard outer shell made primarily of plastics and laminates. An endoskeletal, or modular prosthesis, has the tube or pylon frame that acts as a type of "skeleton." A soft foam cover is usually applied over the prosthesis, which is shaped to match the sound limb.
There are many pros and cons for different types of artificial limbs and with your prosthetist you will discuss which characteristics are the most important for you. Some of the considerations are:
Your level of activity
Artificial limbs are designed for low, medium and high-level activities. Usually low-activity limbs are simpler in design and may be lighter in weight than high-activity ones, which may contain more complex components.

Endoskeletal components are lightweight, require few adjustments, and have parts that are easily interchanged. Exoskeletal components are durable, last longer and can endure strenuous wear.
Your health
Amputees with an active lifestyle may require limbs with more advanced function (though there might be extra maintenance involved). Sometimes less active amputees, and those who have conditions like diabetes and vascular disease, choose to use simple artificial limbs that are comfortable, easy to use and/or expend less energy. For example, a "slide-on socket" which is easy to slip on with a lightweight activity belt could be useful if you are a senior amputee. Stance control safety knees are useful for leg amputees with limited muscle control since they contain a weight-activated safety brake.
Your level of amputation(s)
Leg amputees will need to consider the type of foot that is suitable for them. For instance, a partial foot amputee can use a shoe filler for better function. Some leg amputees will consider an articulated ankle (with jointed parts that move) and an above-knee amputee will also consider the type of knee joint they require.
Similarly, partial hand amputees might be interested in an opposition post (a device that allows partial hand amputees to grasp while retaining sensation). Arm amputees will consider the type of terminal device they will use for hand function as well as possibly a wrist joint. Above-elbow amputees will also consider the type of elbow joint. Hybrid fittings that incorporate at least two different features - such as a body-powered and myoelectric hybrid arm combining an electric hand and a cable-operated elbow - are common in above-elbow fittings.
The weight of each component becomes an important consideration for high-level amputees. Most bilateral and multiple amputees can be fitted with (an) artificial limb(s), but sometimes other mobility aids like a wheelchair are more suitable. Some amputees who use prostheses for certain activities rely on their wheelchair for activities involving long distances.
Cosmetic look versus functionality
There is sometimes a trade-off between the cosmetic look (cosmesis) of an artificial limb and its function. If you are a leg amputee, for example, highly cosmetic coverings are expensive and may be easily damaged if you lead a very active lifestyle.



If you are an arm amputee, hooks are very functional because of their good pinch and grasp function, but do not look as natural as a passive or myoelectric hand. You have to find the right balance of cosmesis and function to suit your needs.
Other options
In addition to the standard limb, you may consider whether you need additional specialized limbs. Many amputees have different artificial limbs for specific activities. A prosthetist can make a recreational arm or leg specially designed for sports, such as skiing or swimming. Specific devices, like a simple ring attached to the handlebars of a bicycle for upper-limb amputees, can also be made. Remember, the prosthetist is an expert on artificial limbs, but you are an expert on yourself and what you need! Please refer to the artificial limb section of this Web site for more in-depth information

Stage 4: Learning to Use Your Artificial Limb
Overview Prosthetists or physiotherapists (PTs) teach leg amputees how to walk with their artificial limb (gait training). Arm amputees will be trained by an occupational therapist (OT) on how to use their prosthesis for daily activities; this may take longer and be more involved depending on the type of prosthesis being fitted. Occupational therapists also teach amputees adaptive skills, such as how to get dressed with one hand or with an artificial arm.

Learning How to Fall and Get Up
Gait Training for Leg Amputees
Occupational Therapy for Arm Amputees

Your centre of gravity is determined by balancing your body's weight. As a new amputee, you have lost a percentage of your body weight during your amputation (from 0.84% for a hand to 18.7% for an entire leg), and you will need to learn how to redistribute your weight accordingly. Sometimes, while still in the hospital, weights are strapped to your residual limb to help with balance control, and to get you used to added weight before you are fitted with an artificial limb.
Learning How to Fall and Get Up
Most physiotherapists or occupational therapists include a lesson in falling safely during your training. If you are a leg amputee, falling is part of the process of learning how to walk with your artificial leg(s). Since falling is something you probably will encounter, learning the proper techniques that minimize injury to your body and to the artificial limb is important.
Gait Training for Leg Amputees
Gait is the individualized manner in which each person walks, and gait training is the process of learning how to walk with your prosthesis. Developing a "good gait" is key to having a comfortable and efficient walking stride. It reduces the stress and wear and tear placed on your residual limb and the rest of your body. Gait also affects posture and energy expenditure. Either a physiotherapist or prosthetist will provide gait training to teach you proper techniques. Bad habits are hard to break later on, so it is in your best interest to learn the right way from the start. Later on, if you feel you are developing bad patterns, you can analyze your gait yourself in the mirror or visit your physiotherapist again for correction.

Occupational Therapy for Arm Amputees
An occupational therapist teaches arm amputees how to operate their artificial arm(s) and terminal device(s) as well as adaptive skills. The lessons begin with general functions like learning how to move your arm and hand in a smooth manner, and progress to task-oriented functions like eating with a knife and fork. If your dominant arm was amputated, the occupational therapist sometimes helps you learn how to write with your sound limb. Since myoelectric arms are sophisticated devices, more training is necessary to learn how to control the muscles so your artificial limb can function properly. Training will progress to more complex tasks that include fine motor skills.
Stage 5: Life As a New Amputee
Overview Once an amputee is regularly wearing an artificial limb and rehabilitation is coming to an end, the individual may gradually return to their regular lifestyle and activities. Bigger stepping stones, which may take longer to achieve, can include driving a car (with modifications if needed) and returning to the workforce.
When it comes to rehabilitation, both in gait training for leg amputees and learning how to use your terminal device for arm amputees, the process may at times seem a little daunting or frustrating. Your rehabilitation team may suggest certain daily living aids and adaptations to the home or workplace to make life easier. Mobility aids can also help you stay active. Keeping a positive attitude is very important - the training you will undergo is an investment for a more independent and fulfilling future!
During the first year, you will acquire a great deal of knowledge about amputation and deal with many professionals involved in your care. There is a lot to handle, and you may at times feel overwhelmed but this should not take away from the sense of accomplishment in how far you have come on your journey. By the end of the first year, you will likely be wearing your artificial limb regularly and have returned to your usual lifestyle.

Skin Care & Stump Hygiene
The skin on a residual limb sustains many stresses - making good skin care essential. The skin and tissue of the stump was not designed for weight-bearing nor the uneven pressures and friction against the skin, especially near the brim of the prosthetic socket. These stresses on the skin of the stump create issues in skin care that must be addressed.
Proper stump hygiene is essential. An amputee has a smaller surface area of skin, making the body's natural cooling mechanism less efficient. Prosthetic sockets trap sweat against the skin of the stump, and prevent air from circulating around it to dry it. Small disorders quickly get out of hand in the warm, moist environment of the socket and, if not properly treated, could lead to a more serious condition preventing the amputee from wearing the artificial limb until the condition heals.
Over time the skin and tissue on the residual limb starts to show the effects of years of trauma from wearing artificial limbs - so the longer you have been an amputee the more important these issues become.

How The Skin Works
The body's skin is a resilient, elastic covering, which is able to repair itself after injury, and shore up weaker areas that endure additional wear. It will thicken, or form callouses in response to repeated stress - amputees notice this at areas where the socket of the artificial limb causes pressure.
The skin helps regulate body temperature by producing sweat, which evaporates and cools the body. Amputees deal with several issues when it comes to how the body regulates temperature. Amputees have a reduced skin surface due to the missing limb(s) making the body's natural cooling system less efficient. The residual limb may get wet with perspiration because it is enclosed within the socket and air does not reach it - this perspiration cannot naturally evaporate from the skin surface. As well, the amputee uses more energy to get around than than those without amputations which naturally will increase the body's temperature, and thus, perspiration. These issues are dealt with in depth in other sections.

Skin Disorders Affecting Amputees
Skin, as the first point of contact with the socket of an artificial limb, needs to be healthy to enable amputees to be as active as possible without experiencing pain or discomfort - so prevention of skin disorders is a very important consideration.
The following are some problems that may result from these factors:
Rashes and Abrasions - these are the most common skin disorder which may occur intermittently or even frequently thoughout the amputee's life time.
Edema - characterized by skin swelling, drying and roughening at the end of the stump, and a red-brown pigmentation, this can usually be prevented by gradual compression using an elastic bandage. Although this may seem like a minor affliction at first, it can develop into a serious complication - a doctor should always be consulted.
Contact Dermatitis - this is caused by an irritant, whether in the materials of the socket, or from an outside source, such as a cleaning agent, powder, lubricant or ointment used in amputee care. Once the cause is discovered and treated, the problem usually disappears.
Cysts - this usually occurs after a limb has been worn for months or even years. They commonly plague above-knee amputees, occurring on the inside of the leg along the upper edge of the artificial limb, but below-knee amputees can experience them as well. They start as small bumps, or nodules which vanish when the artificial limb is temporarily removed, but the constant rubbing of the artificial limb can make the problem worse as cysts become larger and more numerous. Cysts should always be treated by a doctor, as they can become infected and cause further damage.
Folliculitis - a bacterial infection of the hair follicle which produces small, itching, solid areas. If left untreated, these may later develop into boils in which deep-red, painful nodules rise to the surface of the skin.
Anti-bacterial soaps may cut down on the bacteria which cause these conditions. Experienced amputees recommend not shaving the residual limb.
Fungal Infections - another product of the moist, warm conditions in the socket of an artificial limb, these require special creams or powders, which can eventually clear up the condition.
Eczema - this is found in dry, scaly skin which becomes moist for no discernable reason. A cause needs to be established or the condition will recur. Allergies, or secondary conditions following edema can contribute to the condition.
Adherent scars - when there has been repeated infection or ulceration damage to the skin, scar formation may be so intense that scar tissue may become attached to the underlying layers of skin. Surgical revision to free the scar is often necessary.
Ulcers - these sores come from bacterial infections, or from circulation problems. They may become chronic if not diagnosed and treated immediately.
Keeping the Residual Limb Clean & Healthy

The Stump
Cleansing the residual limb should be done at night. Morning washes are not advised unless a stump sock is worn because the damp skin can swell and stick to the inside of the socket.
Wet the skin thoroughly with warm water.
Use mild fragrance-free soap or an antiseptic cleaner.
Work up a foamy lather. Use more water for more suds.
Rinse with clean water, making sure all traces of soap are gone. A soapy film left on the skin may be an irritant.
Dry skin thoroughly.

The Socket
The socket should be cleaned often - every day in warm weather, to cut down on the accumulation of dried perspiration on the inner surface.
Wash with warm water (not hot!) and mild soap.
Wipe out with a cloth dampened in clean water.
Dry thoroughly before putting on.

The Sock
Wearing a sock can help wick perspiration away from the skin. Wearing a light sock may have a cooling effect, as well as providing additional padding for the stump. Also some amputees report that using strong anti-perspirants - like the new Secret Platinum which is pH balanced - can help reduce the amount of perspiration produced within the socket.
The stump sock needs to be changed every day (and sometimes more often in hot weather), and should be washed as soon as it has been taken off so perspiration doesn't dry in it. Use mild soap and warm (never hot!) water.
Rinse thoroughly.
A rubber ball of a similar size can be put inside to help retain its shape.

Products For Stump Care
Serious or persistent stump problems should be assessed by a doctor. For minor skin irritations, however, there are many products to help, and we highlight just a few of them here.
Many amputees find regular use of moisturizing lotions or creams condition the skin which helps it hold up better against abrasions. Vitamin-based creams and lotions are often used, such as EDAP (containing vitamins A and D), which is available through your prosthetist. Other amputees have had recommendations from their prosthetist and/or local pharmacist for off-the-shelf lotions. One suggestion has been Uremol for dry, itchy skin (containing Urea in an emollient cream base).
If you apply a layer of protection on the stump before the socket is donned, particularly in areas that are most stressed, it can lessen the likelihood of sores or abrasions developing. Some amputees use lotions like ALPS Skin lotion (silicone based) or Derma Prevent (Otto Bock; more information below), a film like OpSite (Smith & Nephew) or a silicone gel sheet like Cica Care (Smith & Nephew; for scar care).
Once an abrasion occurs, it is time to consider a medicated lotion. Some amputees use triple antibiotic ointment, available at drugstores, that has zinc oxide as its healing agent. Antibiotic ointments are often used to treat and prevent infections in minor cuts and abrasions. The products simply differ in their active healing ingredients
-- some examples include Bactroban (mupirocin), Polysporin (polymixin), and Ozonol (bacitracin, lidocaine hydrochloride). Some conditions may require the attention of a doctor who might prescribe Betamethafone (0.1%).
Second Skin products promote healing and protect the skin through a combination of medicated gel and adhesive bandage. The parent of a CHAMP member who uses Second Skin shares a great tip -- normally it is painful to pull off the adhesive bandage that covers the gel, but soaking in the bathtub loosens the adhesive, making it painless to remove.
Some prosthetists provide Natural Liquid Body Powder to their clients. Based on the age-old healing properties of potatoes, it is applied as a creamy lotion but dries to a powder to control chafing and odours while soothing areas of friction. A member of CHAMP found it worked well in her myoelectric prosthesis as she was unable to shake other kinds of powder into the socket for fear it would damage electrode function.
Controlling perspiration is a large part of preventing abrasions and reducing odour. Dehydral is an anti-perspirant/anti-bacterial cream. Many amputees also find anti-perspirant roll-ons help control perspiration build-up in sockets. Secret Platinum is a new product being recommended. Another product available is the Pure & Natural Crystal Deodorant Stone, which is consumer friendly as it contains no aluminum.
Some amputees use anti-bacterial cleansers on their stumps to limit bacteria that cause skin problems ones like Tersaseptic and pHisoderm are available at drugstores.


Otto Bock has introduced its Derma Skin Care products Derma clean (anti-bacterial cleaner for the stump and socket), Derma prevent (protective coating lotion to cover and protect the skin), and Derma repair (anti-bacterial lotion that relieves and repairs irritated skin while moisturizing it). The products come as a set that is available through your prosthetist.
If you are considering products at your drugstore, bear in mind a lightly medicated powder or lotion (such as zinc oxide as mentioned above) can help treat minor skin irritations; an antihistamine cream can help treat a pink rash over the stump (a rash that is not from weight bearing) and an antibiotic cream can help treat actual abrasions.

Posted by Fairouz el-sherief & Mohamed rizk