Medical Rehabilitation

Sunday, 15 Rajab 1439 AH - 1 April 2018 AD 1:30 PM-3:00 PM Round Auditorium

Session moderator : Dr Hisham Al Haidary


1- O-22 : Fall Prevention in Older Adults. Strategies for Community Based Programs

Speaker: Dr Judith Ismail

Time: 1:30 PM-1:50 PM

Dr Judith Malek-Ismail DHSc, OTR/L

Assistant Professor

Radford University


Judith Malek-Ismail, M.S.Ed., D.H.S.c, OTR/L, is an Assistant Professor in the Master of Occupational Therapy program at Radford University, where she has taught for the past 4 years. Dr. Ismail has been an occupational therapy educator at the university level for over 17 years. Judith has held positions as both Academic Program Director and Academic Fieldwork Coordinator in occupational therapy. Her current teaching includes training future occupational therapists to improve, enhance and restore occupational performance of the individuals and populations that are served by the profession, including community based occupational therapy practice. Prior to full-time academia, Dr.Ismail managed rehabilitation staff, and practiced occupational therapy in several comprehensive rehabilitation centers and outpatient clinics to provide rehabilitative services for children and adults. She was also the founder of a breast care center that treated women with post mastectomy lymphedema. Judith is certified in 'Sensory Integration' and 'Manual Lymphatic Drainage Therapy'. She is a 'Matter of Balance' fall prevention Master Trainer and a 'CarFit Trainer' to help senior drivers fit in their vehicles. Judith has presented at the American Occupational Therapy Association National Conference for the past five years on community based interventions and occupational therapy education. She serves on the American Occupational Therapy Associations Accreditation Council for Occupational Therapy Education as a reviewer of academic programs. She is a member of the World Federation of Occupational Therapy


Fall Prevention in Older Adults. Strategies for Community Based Programs


The population is aging. According to Saif, Waly and Alsenany (2012) there will be over 2.5 million older adults (over 60 years of age) in Saudi Arabia by the year 2010. Falls are considered as the main public health problem for older adults in the United States, with one in three older adults falling annually. In 2015 the United States Medicare program spent over $31 billion dollars treating fall related injuries in older adults. There are several factors that may contribute to falls, including a cluttered or inaccessible home environment, lack of regular exercise, and the use of some medications. According to the Centers for Disease Control and Prevention (2017) one out of five falls results in a fall fatality or a serious injury, such as a traumatic brain injury or a hip fracture. Falls related to the aging population is likely an international problem. These serious fall related injuries may lead to dependence in mobility, and activities of daily living. Even if a fall does not result in an injury, older adults frequently become afraid of falling again and further decrease their everyday activities, and limit their participation in social and other community activities. The home environment can be modified to prevent the likelihood of a fall. Older adults can participate in evidence based fall prevention programs in the community. These programs are designed to improve balance, strength and flexibility through group based exercise. Some evidence based fall prevention programs include cognitive re-structuring components designed to help the older adult overcome their fear of falling. This presentation will review how falls threaten an older adults’ health, independence and quality of life. The most common mechanisms of falls. Fall prevention strategies. A handout with a list of evidence based fall prevention programs, a summary of each program and a link to the website for each program.

2- O-23 : The AURORA Study: Achieving Breakthroughs to Improve Physical and Mental Health Outcomes after Trauma

Speaker: Dr Samuel McLean

Time: 1:50 PM-2:10 PM

Dr Samuel McLean


Institute for Trauma Recovery

University of North Carolina


Samuel McLean, MD, is an emergency medicine physician and Jeffery Houpt Distinguished Investigator at the University of North Carolina, where he directs the Institute for Trauma Recovery. He has developed and leads several national research networks dedicated to improving the mental and physical recovery of trauma survivors. These networks include networks dedicated to helping improve the recovery of individuals hospitalized after major thermal burn injury, the recovery of women experiencing sexual assault, and recovery after other types of trauma including motor vehicle collision. Dr. McLean’s current work includes serving as the organizing PI of the AURORA Study, a > 30 million dollar study funded by the National Institutes of Health, One Mind, and other partners and leveraged by public-private partnerships with Google’s life sciences company (Verily) and with Mindstrong Health.


The AURORA Study: Achieving Breakthroughs to Improve Physical and Mental Health Outcomes after Trauma


Hundreds of millions of individuals around the world experience traumatic and/or severely stressful events such as motor vehicle collision, physical or sexual assault, natural disasters, or the sudden unexpected death of a spouse or family member. Prolonged physical and mental health disability are common after such events, due to disorders such as posttraumatic stress, depression, minor traumatic brain injury, and regional or widespread pain. Currently it is not possible to identify individuals who are a high risk of developing prolonged disability in the immediate aftermath of trauma or severe stress. In addition, how these disorders develop is not understood, and no interventions exist which prevent prolonged disability in those at high risk. The AURORA Study is a large-scale prospective study of trauma survivors that is currently being conducted at more than 20 trauma centers across the US. Five thousand individuals who experience trauma or extreme stress are screened, recruited, and receive initial baseline evaluation including blood collection and psychophysical, survey, and neurocognitive evaluation. These individuals are then monitored over the next year using the following:  a wrist wearable designed by Google’s Life Sciences Company, Verily, for monitoring of physiology and sleep; a smart phone app designed by Mindstrong Health for continuous-time monitoring of GPS and daily “flash” surveys; weekly web-based neurocognitive tests; periodic mixed-mode surveys; serial saliva collection; and deep phenotyping assessments [blood collection, fMRI, psychophysical evaluation]). Adaptive sampling and state-of-the-art statistical methods will be used to develop predictive tools and biomarkers to identify trauma survivors at high risk of prolonged disability in the early aftermath of trauma, achieve breakthroughs in understanding their development, and develop new interventions to prevent disability in those at high risk.

3- O-24 : Prediction and prevention of disability in older population

Speaker: Dr Ahmad Al Habtar

Time: 2:10 PM-2:30 PM

Dr. Ahmed Alhabter

Fellowship of the Australasian Faculty of Rehabilitation Medicine

Spinal Cord Injury Medicine Fellowship, Australia

Consultant Rehabilitation Medicine, King Faisal Medical City

Predictors of physical activity limitation in community dwelling older Australian men: prospective cohort study (the Concord Health and Ageing in Men Project) 

The proportion of older people in many societies has been growing since the beginning of the twentieth century. Due to increased health care need for this group of people; their wellbeing and disability have been the focus of research during the past few decades. This includes understanding disability onset which has been an important goal of epidemiological studies Design. According to the WHO, activity limitations are difficulties an individual may have in executing activities.

4- O-25 : The evidence for hands-on therapy for children with Cerebral Palsy: results from two South African studies

Speaker: Dr Gillian Saloojee

Time: 2:30 PM-2:50 PM

Dr. Gillian Saloojee

Executive Director

Malamulele Onward


The evidence for hands-on therapy for children with Cerebral Palsy: results from two South African studies 



Ethical considerations of withholding therapy make it difficult to establish evidence for hands-on functional therapeutic handling for children with Cerebral Palsy (CP). Resource-constrained settings offer an opportunity to address this dilemma as standard care often comprises limited therapy (e.g. 30 minutes monthly, equating to five hours annually).



To establish whether direct therapeutic handling conferred any advantage on the functional performance of children with CP living in a poor rural South African district.



Two studies were conducted in different rural provinces in South Africa.

In the first, twenty children with moderate to severe CP received five consecutive days of intensive hands-on functional therapy; provision of appropriate equipment and caregiver training at one hospital. They were matched for age and Gross Motor Function Classification System (GMFCS) level with 19 children who continued their usual 45-minute, once-monthly passive movement based therapy sessions at a second hospital in the same district.

In the second study, children aged 1 to 17 years across all Gross Motor Function Classification levels attending a rural CP Clinic were randomized into one of three study arms based on geographical clustering: (i) a once off two hour caregiver training session (no intervention group); (ii) a daily three hour caregiver training workshop over five days (caregiver training group) or (iii) a daily two hour caregiver training workshop plus 75 minutes of daily hands-on therapy for five days (therapy group). All children were given equipment and continued with their monthly therapy appointments. In both studies, child and caregiver related outcomes were assessed at baseline, immediately pre- and post-intervention, and eight weeks later using validated tools.



There was a statistically significant improvement in Gross Motor Function Measure-66 (GMFM-66) and Pediatric Evaluation Disability Inventory (PEDI) scores for the intervention group from baseline to follow-up  (GMFM-66 mean change=3.41, 95% Confidence Interval(CI) = 1.10–5.07, p=0.004;  PEDI mean change=3.10, 95%CI = 0.72–5.47; p=0.01) in the first study. Caregiver outcomes as measured by the Family Support (FSS) and Mental Health Scales (MHS) also improved significantly (FSS mean change=3.20, 95%CI = 0.87–5.52, p=0.01; MHS mean change=10.00; 95%CI = 8.79-19.12; p=0.03). No changes were seen in the control group for any of the outcomes.


Sixty-eight children were enrolled in the second study. At 8 week follow-up, GMFM scores were significantly better for the therapy group compared to the other two groups (mean difference therapy group 1.9 [95%CI 0.05–3.8]; caregiver training group -0.64 [95%CI -1.3–2.8]; no intervention group 0.76 [95%CI -1.3–2.8]. Similarly, modified PEDI scores increased significantly in the therapy group (3.92 [95% CI _0.29–8.12] but not in the other groups. In contrast, caregiver related changes were greatest in the caregiver training group.



These studies offer the first evidence that in resource-constrained settings, a brief intensive once-off therapy intervention can significantly improve children’s functional performance in the short-term. Maximum gains can best be achieved through a combination of caregiver training and hands-on therapy

5- O-26 : Influence of the Spinal Manipulation on Muscle Spasticity in Cerebral Palsy, Randomized Controlled Trial

Speaker: Dr Taras Voloshyn

Time : 2:50 PM-3:10 PM

Dr Taras Voloshyn


International clinic of Rehabilitation


Born on September 26, 1984 in Lviv, Ukraine. Graduated from the Faculty of Medicine at the D. Halytsky Lviv National Medical University. From 2007 to 2009 completed his internship in neurology at the Rivne Central District Hospital and the Lviv Regional Clinical Hospital. He is a corresponding member of the European and Eastern European Academies of Childhood Disability since March, 2009. Dr. Voloshyn has published 25 articles. He is in charge of collaboration with the Karolinska Institute (Sweden), namely work on the international scale evaluating the severity of cerebral palsy (GMFCS), hand functions (MACS), video recordings of gross motor functions (GMFM), ASD.During 2016 visited Saudi Arabia, Qatar, Bahrain and UAE (business trips).


Influence of the Spinal Manipulation on Muscle Spasticity in Cerebral Palsy, Randomized Controlled Trial


Introduction. Resent research indicates possible influence of spinal manipulation (SM) on muscle spasticity. The aim of our study was to investigate the short-term influence of SM on wrist muscle spasticity and manual dexterity in Cerebral Palsy patients in a randomized controlled trial.
Patients and Methods. After baseline examination, 78 subjects with spastic CP (7-18 y) without contractures or hyperkinetic syndrome were randomly allocated into two groups. Experimental groups underwent SM, control group – imitation of the manipulation. Second evaluation was performed 5 min post intervention. Wrist muscle spasticity was gauged quantitatively with Neuroflexor, a device measuring resistance to passive movements of different velocities. Manual dexterity was evaluated by Box & Blocks test. Nonparametric statistics were used.
Results. In the experimental group muscle spasticity reduced by 2.18 newtons: from median 5.53 with interquartile range (IR) 8.66 to 3.35 (IR=7.19), the difference was statistically significant (p=0,002). In the control group reduction in spasticity was negligible. The between-group difference in change of muscle spasticity was statistically significant (p=0,034). Improvement of manual dexterity was not statistically significant (p=0.28).
Conclusions. Study indicates that SM causes reduction of spasticity in patients with CP. Long-term effects of spinal manipulation on muscle spasticity have to be studied.

6- O-27 : Studying the Impacts of Body Posture and Mental Workload on Office Workers' Health to ‎Prevent Injuries and Disabilities

Speaker: Dr Hani Alnakhli

Time : 3:10 PM-3:30 PM

Dr Hani Al Nakhli

Consultant Physical Therapist

Ministry of Health


Dr. Al-Nakhli is Currently a Consultant Physical Therapist at Al-Madinah Specialist (Takhassusi) Hospital. He has held a variety of positions during his endeavor, one of which was the Head of the Physical Therapy and Rehabilitation Department at the Madinah Maternity & Children’s Hospital (MMCH). He is also a primary member of the Rehabilitation Education and Training Committee at the Ministry of Health.Dr. Al-Nakhli received his Doctor of Philosophy Degree (PhD) in Rehabilitation Science from Loma Linda University in California on 12/2011. During that period (and onwards), he worked on a number of research proposals, and had several scientific articles published in his area of expertise. He also carries a Doctoral Degree in Physical Therapy (DPT), and a Master's Degree in Physical Therapy (MPT).


Studying the impacts of body posture and mental workload on office workers’ health to prevent injuries and disabilities.


 Recent data has shown increasing rates of musculoskeletal and psychological disorders among the working community. These health-related complications are considered to be amongst the leading causes of disability, and limitation of motion within the modern office. Many of these disorders are commonly caused by an improperly accommodated workplace. However, office caused injuries have not yet received the required attention in the Saudi Arabian working community. The importance of this study surfaces as challenges will be faced; if this topic is not addressed adequately.

The study aims to detect and prevent office related injuries; in order to investigate their associations with improper workstation ergonomics. This was conducted within the framework of studying the current situation of office ergonomics with focus on sitting postures and mental workload. Correlations between workers' musculoskeletal and psychological pains, and their habits were evaluated. Proper design and healthy practices of the workstation were then advertised to minimize disabilities.

To collect the needed data, the study employed a thirty-item questionnaire distributed to more than one thousand randomly selected workers within Saudi Arabia. This questionnaire was developed to better study the personal demographics, medical information, muscular pain, physical therapy history, workstation ergonomics, sitting practices, and psychological comfort of the participants. The continuation of the data collection process was performed by conducting a randomized controlled trial consisting of thirty-six individuals, divided equally into three groups. This trial hypothesized significant variations of the subjects' heart rates and blood pressures in accordance with different postures and mental workloads.

After filtering and analyzing the collected data using the necessary statistical methods, sitting posture and mental workload were found to have significant effects on the studied vital signs. The results also indicated that approximately 78% of the participants experienced some sort of muscular pain, but only 30% of them visited a physical therapy clinic. While, improper sitting postures and/or incorrect workstation designs generated more than 30% of the muscular pain issues, benefits from physical therapy treatments had minimum impact. The study also revealed that more than 44% of the participants were supplied with inconvenient workstations, suggesting that the use of anthropometry and workplace ergonomics is not up to standards. Therefore, further studies regarding this finding is strongly recommended. As per the psychological comfort, the study was able to safely conclude that more than 55% of the participants were distressed and uncomfortable with their work environment.

In conclusion, raising the awareness of the population regarding the importance of workplace ergonomics is proposed; after highlighting the risks of bad sitting postures and psychological comfort. It is worth mentioning that the appropriate employment of office ergonomics requires the cooperation of both; employees and employers. Only by this alliance, ergonomics contributes in increasing productivity, and decreasing time loss leading to the maintenance of healthy individuals, and maximizing organizations profits.