Introduction:Diabetes is high in the agenda of public health issues with significant prevalence of diabetic-related amputations. Prosthetic restoration post-amputation is imperative to reduce disability, but its success is influenced by several factors. This study analysed the practice, and the determining factors affecting prosthetic restoration among major lower limb amputees with diabetes in Sabah. Methods: Retrospective cross-sectional study among 65 major lower limb amputees with diabetes referred for rehabilitation medicine services at Queen Elizabeth Hospital from 1st January 2015 to 31st December 2017. Demographics data, pre-morbid diseases, levels of amputation and prac-tice on prosthetic restoration (suitability for restoration, duration from prosthetic application to restoration, funding issue) are primary evaluated factors. Results: Forty-nine, fifteen and one amputees had below knee amputation, above knee amputation and hip disarticulation respectively. Forty-three amputees (66.2%) were deemed suitable for prosthetic restoration but only 27 were prosthetically restored, with mean duration from prosthetic application to res-toration of 5.92±2.189 months. Having additional pre-morbid diseases did not reduced the likelihood of suitability for prosthetic restoration compared to those only with diabetes (p=0.082). Funding issue is the key factor affecting prosthetic restoration with higher likelihood for restoration among those eligible through governmental agencies funding (p=0.027). Conclusion: In Sabah, low rate of suitability for prosthetic restoration is observed among major lower limb amputees with diabetes. A larger study is warranted to investigate causes of such low rate of suitability for prosthetic restoration among this specific population in the effort to reduce public health burden from major lower limb amputation-related disability.
Children’s occupational performance are activities of daily living, play/ leisure, social participation, education, and work. In developed countries, school-based therapy services are being provided for schoolchildren with special needs. The importance of these services in Malaysia is timely to be explored. This exploratory cross-sectional study identified occupational performance levels of primary schoolchildren with special needs in integrated special education programmes in Malaysia; children with intellectual disability, autism, attention deficit hyperactive disorder, Down syndrome, speech impairment, visual impairment, hearing impairment, and specific learning disorder. Researchers conducted Motor-Free Visual Perceptual Test Third Edition (MVPT-3), Beery-Buktenica Developmental Test of Visual-Motor Integration Fifth Edition (Beery-VMI), Test of Gross Motor Development – 2 (TGMD-2), Test of Hand Writing Skills-Revised (THS-R), and School Function Assessment (SFA) for 121 students. Results showed that 69.5% of the students scored very low to low average in MVPT-3 (median standard score = 70.0, Std. IQR = 37); 69.4% were very low to below average in Beery-VMI (mean standard score = 78.8, Std. deviation = 20.5); 73% were below age level raw score in TGMD-2; 72.8% were below average in THS-R (median standard score = 74.0, Std. IQR = 27.0); and 81% were below the criterion cut-off in school function. The children with below-normal MVPT, VMI, TGMD2, and THS scores, compared to the children with normal scores for these tests had significantly lower scores (p < 0.001). All the students had impairment in occupation performance at least in one area. This study recommends school-based occupational therapy and other rehabilitation services in the school system in Malaysia.
Introduction:Stroke is a major public health concern and treating its complications is important for functional recov-ery. Heterotopic ossification (HO), a condition where bone is developed in non-skeletal tissue, is not an uncommon stroke-related complication with reported occurrence up to 12%. It typically presents with joint range of motion (ROM) limitation, pain and swelling. Detecting HO is important to prevent forceful joint manipulation during reha-bilitation that can cause pain and fracture. Two cases of diagnosing HO during the course of stroke rehabilitation are presented. Case description: First case was a subacute stroke in 25 year-old male with right-sided hemiparesis and right hip joint ROM limitation. He did not consent to have passive ROM exercise and refused to be seated due to severe right hip pain. Second case was a 41 year-old male with chronic right-sided hemiparetic stroke exhibiting ipsilateral lower limb neurological recovery but inability to perform bed mobility and walking despite regaining motor function. The right hip joint ROM was limited in the absence of pain. Radiographs demonstrated presence of HO in the affected hip of both patients. Gentle hip ROM exercise was prescribed and noted improvement in ROM with subsequent ability for sitting (first case) and short-distance ambulation (second case). Conclusion: HO should be considered as a differential diagnosis in stroke patients having limited ROM, hence the importance of thorough physical examination. Presence of HO would guide rehabilitation process by encouraging gentle ROM exercise in the attempt to reduce public health burden from halted functional recovery in stroke.