World Physical Medicine and Rehabilitation Conference November 12-13, 2018 Istanbul, Turkey

Sediks interest in chronic pain and musculoskeletal disorders began as he was nearing the end of his BSc in physiotherapy, obtained from Nasser University, Libya. His dissertation was titled acupuncture approach for the management of chronic low back pain. He then continued his studies to in the UK, at North Umbria where he undertook a systematic review into the management of chronic low back pain for the completion of his MSc. Following this in 2005, he proceeded to work in the Libyan health Authority public sector for 10 years in musculoskeletal interventions. In 2007, he also began work as a physiotherapy lecturer in Libya and endeavored to teach physiotherapy elements, practice and neuro-management

Background: Chronic widespread pain conditions such as fibromyalgia syndrome are prevalent and costly to the economy. Diagnosis is based upon symptoms and although its existence as a distinct clinical entity is debated, it causes great suffering and distress for those affected. Due to the unclear pathophysiology, controversy regarding its existence as a clinical entity, and also variability in diagnosis, clinical management is often difficult and frequently employs heterogeneous interventions. There is a paucity of literature from Middle Eastern countries, where the diagnostic label is not used. Objectives: The purpose of this research study is to capture service users and service providers’ views and experiences of fibromyalgia and its management including their views of the journey to diagnosis, current practice and availability, emotional and lived experience, information seeking and experiences of seeking and receiving health care. It also aims to describe current practice for fibromyalgia in the UK compared with Libyan management procedures for chronic widespread pain. Methods: A mixed methods approach using a convergent parallel design was used in a two-phase study. Phase one consisted of 12 semi-structured interviews conducted with people diagnosed with Fibromyalgia (FMS). Participants also completed the Fibromyalgia Impact Questionnaire (FIQ) and Toronto Alexithymia Scale (TAS). Phase two consisted of a national survey of health and medical professionals from the British Pain Society and medical professionals in Libya regarding their views and management practices of fibromyalgia. Findings were synthesized with qualitative findings. Results: Using framework analysis, the following themes were identified from the qualitative study; the journey to diagnosis, coping with varying and unpredictable nature of symptoms, emotional impact and availability and satisfaction with healthcare practices and services. The primary qualitative study highlighted some difficulties participants faced regarding a perceived lack of understanding by health and medical professionals and also the general public regarding management of the condition and the emotional and physical impact of FMS. These findings suggested people were not managing daily living activities due to disabling fatigue and worsening pain. This was corroborated by high FIQ scores and high alexithymia scores. This part of the study illustrated that a variety of intervention approaches are used with varying and often limited success. A total of n=69 respondents completed the survey. Results indicated that increasing numbers of people are diagnosed with fibromyalgia though a range of differing diagnostic labels are used. Treatment approaches in both countries were primarily focused upon exercise and education, with CBT being used in the UK. Respondents from both countries agreed there was a strong psychological overlay, though there was a statistically significant difference between opinions regarding whether active management approaches should aggravate pain temporarily in order to achieve functional gains (p<0.05). Conclusion: The results indicate the high physical and emotional impact of fibromyalgia. Participants' perspectives have illuminated the need for support for people living with FMS and the need for education and standardization of approaches in clinical practice in both the UK and Libya.

Panita Thamnithis is a Neurological Physiotherapist and currently a Masters student in a Physical Therapy program at Khon Kaen University, Thailand.

Unilateral sensorimotor impairments usually result in patients with stroke walk with asymmetrical manners. However, levels of symmetrical lower limb loading are commonly assessed and trained while stepping. The researchers hypothesized that levels of asymmetrical lower limb loading would be obvious while the patients executed a challenging task. Therefore, this study assessed levels of lower limb loading symmetry while performing stepping and Sit-To-Stand (STS) in 10 patients with stroke as compared with data from 10 healthy individuals. Subjects were assessed for the amount of lower limb loading of the affected and non-affected limbs during stepping and STS using digital load cells for three trials/activities. The findings indicated healthy individuals had lower limb loading symmetry nearly 100% both during stepping (99.67%) and STS (100.78%). On the contrary, participants with stroke exhibited asymmetrical lower limb loading both while stepping (94.33%) and in particular while performed STS (71.26%). The findings suggested the more pronounced of asymmetrical lower limb loading, particularly while performing a challenging task. Thus the application of STS with the emphasizing on lower limb loading symmetry may enhance rehabilitation outcomes and steady walking for the patients.

Chattraporn Nantawanichakorn is a Neurological Physiotherapist and currently a Masters student in a Physical Therapy program at Khon Kaen University, Thailand.

The unilateral impairments limit ability of lower limb loading and daily movements of patients with stroke. External feedback has been suggested as an effective rehabilitation strategy but there was no clear evidence on effects of verbal commands on the ability to execute daily activities for these individuals. Thus, the study compared effects of verbal commands on the Lower Limb Loading during Sit-To-Stand (LLL-STS) in 21 ambulatory individuals with stroke. The participants sat on a standard armless chair with their feet placed separately on two digital load cells. Then they were instructed to perform a sit-to-stand movement in two conditions, including, at their usual manner and at their optimal manner with the attempt to equally put their body-weight on the lower limbs as good as they could. The levels of LLL-STS were automatically recorded while they executed the tasks by digital load cells. The findings indicated that the amount of LLL-STS on the non-affected leg was approximately 24% greater than that of the affected leg while they performed the task at their usual manners. However, these differences were obviously reduced to only 15% of their body-weight when they were told to performed the task at their optimal manners. The findings suggest that the participants retained some capability that they did not usually access. Verbal commands played crucial roles to promote symmetrical LLL-STS that may subsequently benefit stability, ability of walking completion, and risk of future musculoskeletal disorders of these individuals.

Luai Alhallaak has completed his Category II ISPO Diploma from the International Society for Prosthetics and Orthotics. He is the Head of Training Department of Ulusal Proje Protez Sağılık Derneği. He has published 3 posters and 1 oral presentation in ISPO congresses.

Prosthetic & Orthotic (P&O) and Physical Training (PT) services are provided in the developing world countries, zone torn regions through local and international organizations. The war in Syria has created significantly high and disproportionate numbers of amputations in a region where access to PO/PT services is very scarce. One of the most challenging condıtıons is to provide the full Treatment “orthotics and rehabilitation ” for the Syrian war related spinal cord injuries. He Describe Reasons, limitation, difficulties and alternative solutions in NSPPL as example. Solutions by academic, training, education with ISPO program, evolvement of PO services and Physiotheraby services and statistics.The aim of this article is to describe the unique experience of the National Syrian Project for Prosthetic Limbs for the PO/PT since establishing in putting communication solutions between PO services and PT services. Retrospective collective review of all available information about all centers in NSPPL since establishment 2012 up to November 2018 including:1. Internal audit itself looking at numbers and types of causes, devices and patients. 2. Interview of published reports. 3. Interviews with the establishing members of NSPPL. 4. Interviews with the clinics administrators in Syria and the Syrian Turkish borders. There are several excellent examples of similar P&O projects in deprived and war torn countries. In our opinion NSPPL present relatively a new approach of dealing with P&O needs in a very hostile and complex struggle. This situation forced a start in Turkey and extended next to the border into to Clinics in Syria.

Raad Alholani Almasre has completed CAT II from ISPO. He is the General Director of NSPPL.

The numbers of amputated in Syria during continue of wars is estimated about 120,000 in unofficial statistic gathered by non-governmental organization. These numbers are distributed geographical in a wide space. There is a fixed prosthetic center in west-north of Syria, but there is an interested stories some patients told us about how to cross short distances during continuing wars, it is death roads. The idea of Mobile Prosthetic Clinic (MPC) quoted from Pakistan after earthquake, but this situation is different because the war hasn't finished yet and it is increasing every day. Movement in relatively save of conflict areas, patients service like take measurement, prosthetic fitting and adjustments on their last limbs which was made before in our fixed center. Psychologist support for the patient, free service and the availability in their areas. Increasing of patients because of the situation in Syria, the movement in conflict zone is too dangerous and too expensive, also there isn't just one fixed center in the northern of Syria, in this area there is limited access for some patients. In addition to some difficulties which was faced by the center such as movement of technicians, sending products, provide material and preparing the workshop. Because of the mentioned previous reason the idea to create mobile clinic which has unlimited access to the biggest numbers of area which has patients, supply our free service to them in their areas and lighten them physically, psychologically and morally.

Ismahene Halima Beressa has completed her PhD from University of Oran and Postdoctoral studies from University of Oran. She is working as an Associate Professor at University of Oran since 2016. She is a Hand Surgeon and Obstetrical Brachial Plexus Palsy Surgeon. She has published many papers in national and international reputed journals.

The glenohumeral deformity results from a muscle imbalance between internal rotator and external rotator muscles of the shoulder. This muscle imbalance is expressed clinically by the decrease of the shoulder’s passive external rotation. Their study is fundamental in order to assess the repercussions of this imbalance, especially preoperatively. We compare the results of shoulder’s CT scan or Remote Medical Imaging of 36 children presenting a POPB with the extent of the paralysis but also with the degree of passive external rotation. The patients were followed since their birth. Shoulders passive and active external rotations were noted regularly during the first three years of life (every month the first year, every three months in the second years and at last every six months). Finally shoulders CT scan or RMI were performed at three years of age the result was as follow: 61 percent of the shoulders were classified (stage-3 or plus according to Friedman). The importance and frequency of glenohumeral deformities are the same in both C5C6 and C5C6C7 paralysis. They are much more serious in total paralysis (100 percent of children were classified Friedman IV or V). The glenohumeral deformities are more important when the passive external rotation decreased lower than 30°. In our study clinical and radiological evaluation of obstetrical shoulders has objectified: The glenohumeral deformities were most serious at three years age, joint stiffness can be observed during the first months of life and the importance of glenohumeral deformity is inversely proportional to the degrees of shoulders passive external rotation. For this reason they must be researched during the first years of life especially when we observe shoulders joint stiffness.