BUKU PROGRAM SCI 2019 v4

JABATAN PERUBATAN REHABILITASI DAN PERSATUAN PASCA IJAZAH HOSPITAL SUNGAI BULOH NATIONAL SYMPOSIUM REHABILITATION PERSPECTIVES IN SPINAL CORD INJURY “FACING THE CHALLENGES TOGETHER” DATE 01 APRIL 2019 TIME & PLACE 8.00AM -5.00PM AUDITORIUM, KOLEJ SAINS KESIHATAN BERSEKUTU SUNGAI BULOH

ORGANIZING COMMITTEE ORGANIZING COMMITTEE Chairperson: From Left to Right Dr Akmal Hafizah Zamli Front : Dr Shafiq Eiman, Dr Wan Mazrizman, Comittee members: Dr Nor Azira Ismail Centre Dr Akmal Hafizah, Dr Nor Azira, Dr Kelvin, Dr Kelvin Cheng Chek Siang Back Dr Senthilvel Dr Sumayya Shaharom : Dr Nur Amira, Dr Noorizatul Haneem, Dr Nor Yazmin Mohamed Ansari Dr Norhamiza Mohd Noor Cik Nur Hazrina, Dr Umi Azalin, Dr Siti Maisarah Dr Ahmad Baihaqi Hassan : Dr Hajar, Dr Nor Yazmin, Dr Summayya, Dr Wan Mazrizman Wan Mansor Dr Shafiq Eiman Abdul Razak Dr Yasothai, Dr Norhamiza, Dr Kelly, Dr Yasothai Sahadeevan Dr Nor Ashikin Dr Kelly Seow Hwui Choong Dr Nor Ashikin Mohamad Dr Siti Maisarah Samsi Dr Noorizatul Haneem An Dr Umi Azalin Abdul Sammad KJ Ruhini Mohd Isa and nurse team Photographer: Dr Nur Amira Abdul Rahim Master of Ceremony: Dr Mohd Hakim Zenian Dr Hajar Zainon

FOREWORD FOREWORD Assalamualaikum W.B.T and Salam Sejahtera, This event consisted of symposium lectures, demonstration and hands-on series with main objectives to share knowledge, On behalf of the organizing committee, I would like to extend our experience as well as to create awareness and interest in selected greatest pleasure in welcoming all respected participants to the SCI related clinical skills. It is meant to benefit not only the health National Symposium - Rehabilitation Perspectives in Spinal Cord care providers in the rehabilitation fraternity but also from other Injury Management 2019. specialties. We would like to extend our sincere gratitude to all participants for the inspiring interest to attend this event until it Spinal cord injury (SCI) is one of the most catastrophic events one reaches the maximum capacity of 300 auditorium seating! We could have in their life. In the Malaysian context, the commonest sincerely hoped that all of us here will gain what we expect for in this causes being road traffic accidents, work injuries and falls. It symposium. frequently results in multi-system impairments such as neurogenic bladder and bowel; neuropathic pain conditions; pressure ulcers; SCI Rehabilitation team provides comprehensive program with orthostatic hypotension; deep vein thrombosis; spasticity; primary goals of secondary complications prevention, maximization autonomic dysreflexia; pulmonary and cardiovascular problems; of physical functioning with the ultimatum of achieving full re- and depressive disorders. SCI leads to serious disability resulting in integration into the community. We are proud to portray the inability to work, which leads to enormous psychosocial and achievement of our SCI icons whom had graduated from their economic impacts not only to the affected individuals, but also rehabilitation programs, successfully re-integrated into the their families. community and further to that makes significant contribution to society. Their heart touching life-stories not only inspire other SCI With such extreme challenges, an interdisciplinary team approach rehabilitation consumers and their families but also us…their health comprises of Rehabilitation Physician, Physiotherapist, care providers! Occupational Therapist, Rehabilitation Nurse, Orthotist, Dietician, Psychologist, Speech Therapist, Medical Social Worker and other Last but not the least, we would like to sincerely thank Dr Hj consultant specialists as necessary is essential in SCI rehabilitation. Kamaruddin Hj Alias - the Hospital Director; Dr Yusniza Md Yusof - the Thus, the selected theme for this symposium - Facing the National Head of Rehabilitation Medicine Head Services; Dr Shaari Challenges Together. Md Yatim - the Selangor Head of Rehabilitation Medicine services for their enormous support; and everyone whom had directly and indirectly contributed to making this event a success. For all participants, we wish you an enriching, pleasant and also a memorable experience! Best Regards, DR AKMAL HAFIZAH ZAMLI ORGANIZING CHAIRMAN

FOREWORD FOREWORD Assalamualaikum W.B.T and The hospital management gives its full commitment and Salam Sejahtera, support towards this initiative, and we hope that your passion in the field of Rehabilitation Medicine will help you It is indeed a great honour for me to be a part of the benefit greatly by making full use of this event. National Symposium: Rehabilitation Perspectives in Spinal Cord Injury (SCI) “Facing the Challenges Last but not least, I would also like to congratulate our SCI Together”. icons for being excellent examples of true success in terms of rehabilitation. With proper help, they can return to the My sincere congratulations to the hardworking and society as functional individuals and contribute to the dedicated team of Rehabilitation Medicine Department community in various special ways. for successfully organizing this yearly event. Warm Regards, In conjunction with the theme “Facing the Challenges Together’, I believe that this event will provide the opportunity for health care participants to update their knowledge, competency and skills towards a more holistic management of patients with disabilities. DR HJ KAMARUDDIN HJ ALIAS HOSPITAL DIRECTOR, HOSPITAL SUNGAI BULOH

PROGRAMME OFFICIATING CEREMONY PLACEMENT OF WORKSHOP STATION Station Venue Station 1: Spasticity management in SCI Ultrasound Guided Alcohol Auditorium Neurolysis Skill Lab, Level 3 Skill Lab, Level 3 Station 2: Pain management in SCI Deep Dry Needling Lecture Hall 10, Level 4 Station 3: Selected Nursing Skills in SCI care Lecture Hall 10, Level 4 Station 4: Highlight of physiotherapy skills Auditorium Station 5: Essential occupational therapy in SCI Station 6: Sexuality and fertility

SPEAKERS SPEAKERS Dr Kelvin Cheng Chek Siang Dr Lim Sze Wei obtained is practicing in Hospital Sungai Buloh as a his basic Medical Degree from Rehabilitation Medicine Physician. In the Rajiv Gandhi Unversity of Health year 2006, he has completed his MBBS in Science (India) in 2003. University of Malaya. After completing the Master of Orthopaedic Surgery from Subsequently he completed his House Officer training in Hospital University of Malaya, he continued with subspecialty training Raja Permaisuri Bainun, Ipoh. He was a medical officer in the in the field of Spinal Surgery. Medical Department for 3 years in Hospital Raja Permaisuri Bainun, Ipoh Dr. Lim Sze Wei received his Spine fellowship from Sahlgrenska university hospital (Sweden), London Bridge In the year 2011, he persued his passion in the field of Hospital (UK) and Nightingale Florence Hospital (Turkey) in Rehabilitation Medicine by joining the master program in 2017. He is certified by the Ministry of Health of Malaysia and University of Malaya. He graduated in the year 2015 and the Academy of Medicine of Malaysia as an Orthopaedic completed his gazettement in Hospital Rehabilitasi Cheras. He Spine Surgeon. joined the Rehabilitation Medicine Department of Hospital Queen Elizabeth, Kota Kinabalu in the year 2016. Apart from his busy clinical work schedule, he had participated in multi-centre clinical trials, and has authored in After serving two and a half years in the Land Below the Wind, a significant number of scientific papers and abstracts that he joined Hospital Sungai Buloh as the newest member of the are testimony to his clinical and research interests. Rehabilitation Medicine family. He is interested in a wide variety of rehabilitation medicine specialty including Acquired Brain Injury, Spinal Cord Injury, Amputee and Musculoskeletal Rehabilitation, Paediatrics Rehabilitation and Cardiac Rehabilitation.

SPEAKERS SPEAKERS Dr Wan Najwa binti Wan Dr Nor Azira Ismail is Mohd Zohdi is currently the Head currently a senior Rehabilitation of Rehabilitation Medicine Department Physician in Hospital Sungai Buloh since and lecturer at UiTM Medical Specialist 2015. Centre, Sungai Buloh. She obtained her MBBS degree from University of Adelaide She received her medical degree from National University in 2002 and later completed Master in Rehabilitation Malaysia (UKM) in 2005 and later graduated Masters in Medicine in 2012 from University of Malaya. She started Rehabilitation Medicine from University of Malaya in 2014. working as a Rehabilitation Physician in Hospital Tuanku Ja’afar Seremban whereby she actively managed cases of She is actively involved in research and publication, traumatic and non traumatic SCI. She was elected as the related to medical field as well as community based advisor and honorary member of OKUF9 (Negeri Sembilan education. Her special interests are spinal cord injury and physical disability support group) till now. neuropathic wound management. Dr Nor Azira also has an active network in the field of spinal She also actively involved in volunteer work and was cord injury rehabilitation. She is currently the Treasurer of appointed as a Deputy Chairman of IKRAM health and ASCoN Conference 2019. She is also involved in voluntary Head of Unit of people with Disability (OKU) of I – Bantu. work with Mercy Malaysia and has recently assisted in the completion of Mercy Malaysia – Nepal Capacity Building training post Nepal earthquake 2015-2018, in conducting training workshops for medical staffs involve in handling spinal cord injury and brain injury cases in Kathmandu, Nepal. Dr Nor Azira is also a visiting Rehabilitation Medicine Consultant to Thomson Hospital Kota Damansara and ReGen Rehabilitation Hospital. Her other areas of interests includes MSK rehabilitation, cancer rehabilitation, pediatric rehabilitation, pain management and movement disorder rehabilitation.

SPEAKERS SPEAKERS Ketua Jururawat Ruhini Cik Noor Asliza Ahmad Mohd Isa graduated from Kolej graduated from University of Malaya, Kejururawatan Kuala Lumpur in 1995. Kuala Lumpur with a degree in Bachelor of Biomedical Engineering. She started working in Hospital Kuala Lumpur(HKL) for 5 years in Neurosurgical Female Ward (N6A). She completed her training as Clinical Prosthetist and Orthotist (CPO) industrial trainee for three months in In 2001, she worked in K9 Spinal ward under orthopedic General Rehabilitation Centre, Iranian Red Crescent discipline for 1 year and subsequently further her studies in Society, Tehran, Iran before starting her service as CPO Post Basic Midwifery. since March 2014. In 2006, she worked in K8/K9 Rehabilitation ward for six Cik Noor Asliza is currently working under Bioapps Sdn Bhd years before she continued study in Post Basic and her special interest is in design specifications of Rehabilitation at Kolej Kejururawatan Seremban. scoliosis spinal brace. Currently she is the Ketua Jururawat at Ward 30 Rehab in At present, she is continuing her studies in Master in Hospital Sungai Buloh since March 2012. Engineering Science. With her 24 years of experience in nursing, she is now pursuing Bachelor of Science (Hons) Nursing (Post Registration) at University Mahsa

SPEAKERS SPEAKERS Madam Foo Kok Wee Puan Julianna Ibrahim graduated with diploma in graduated from the College of the physiotherapy in 1985 from Occupational Therapy, Kuala College of Physiotherapy in Lumpur with a Diploma of Hospital Kuala Lumpur. Occupational Therapy in 1977 She further her studies in a distant learning program with She then pursued and attained her Bachelor of University of Teesside, UK and awarded Bsc. Hon. Applied Occupational Therapy with Honours in 2009 from UKM. Rehabilitation (Physiotherapy) in 2004. She worked in Hopital Bahagia Ulu Kinta and HKL before She has been serving the government for 33 years for which her current service in Hospital Sungai Buloh. the first 21 years of her service was dedicated in HKL, five years in Hosp. Sg. Buloh and the remaining seven years was in Certified in Hand Rehabilitation from Klinert Institute Hospital Rehabilitasi Cheras, before she retired on 20th Kentuck USA. She currently is the Head of Occupational January 2019 at the age of 60 years old. She is currently a Therapy Unit of Hospital Sungai Buloh. freelance Physiotherapist. Her field of interest includes: Spinal Cord Injury, musculoskeletal , sport Injury, and Athletic classification. The highest achievement throughout her career is A.M.N (Ahli Mangku Negara) award from Yang Maha mulia Yang Di Pertuan Agong 2015

SPEAKERS Dr Senthilvel Govindaraju is currently practicing as Varmam Expert in Rehabilitation Medicine, Hospital Sungai Buloh since 2017. He has a PhD in Siddha medicine and previously was practicing in Rohini Hollistic Health Center in Chenai which catered more than 10,000 patients. Visited most of the southern part of Tamilnadu and Bangalore, Goa for conducting Medical camps by this firm. Frequent visits were made to Asian countries like Malaysia and Srilanka for the propagation of Siddha System of Medicine and Health care needs. He has been practising Varmam procedures for 20 years, providing treatment to Orthopaedic related complaints by this technique. He has interest to understand its philosophy through ancient way of learning and applying to recent scientific methods, comparing with other procedures of foreign counties for the betterment of human life

SPEAKERS SPEAKERS Dr Akmal Hafizah Zamli is Dr Mohan Raj Varutha Rajoo, the Reproductive Specialist currently the Head of Rehabilitation Medicine Department of Hospital Sungai and Obstetrics & Gynaecology (O & G) Buloh, Selangor, Malaysia. Consultant at KPJ Damansara Fertility Centre. She received her MBBS from the University of Malaya in 1998 and later graduated Masters in Rehabilitation Medicine from Dr. Mohan graduated and obtained MBBS accreditation in the University of Malaya in 2006. Dr Akmal held certificates in 1997 in India and later obtained a Masters degree in O & G Spinal Cord Injury and Brain Injury Rehabilitation from from University Malaya in 2007. Dr. Mohan Raj was selected by Hampstead Rehabilitation Centre, South Australia in 2010. She the Medical Board of Malaysia to Sub Specialise in later qualified as a Certified Medical Impairment Assessor of Reproductive Medicine at the Queen Mary Hospital in Hong the National Institute of Occupational Safety & Health Kong in 2014 under the supervision of Professor P.C.Ho and Malaysia. In 2011, she served as a Clinical Fellow in Spinal Professor Earnest and was accredited with a “Fellowship in Cord Medicine & Rehabilitation at Burwood Spinal Unit, Reproductive Medicine”. Christchurch, New Zealand. Dr. Mohan’s area of expertise in Reproductive Medicine She has interest in research related to spinal cord injury includes skills in the latest development in terms of ultrasound impairments and minimally invasive ultrasound guided scanning, follicular trekking by ultrasound, intrauterine musculoskeletal interventions for spasticity and chronic pain insemination, transvaginal ultrasound-guided oocytes retrieval management. She actively presented research and quality and embryo transfer which he gained during his attachment assurance projects especially related to SCI management in at the Reproductive Unit at Queen Mary Hospital in Hong local and international conferences. She also serves as Kong. clinical research reviewers for local and international medical journals. His other specialties include Assisted Reproductive Technology (ART) process, including ART laboratory process and quality control, surgical sperm recovery, and embryo transfer.

SPEAKERS SPEAKERS Dr Siti Norzalilah Abd Dr Natiara Mohamad Majid obtained her MBBS from the Hashim is currently serving as a rehabilitation physician and University of Malaya in 1999. She then pursued her studies in Masters in lecturer in Pusat Perubatan Rehabilitation Medicine in University Malaya in 2008 Universiti Teknologi MARA Dr Siti Norzalilah started working a Clinical Specialist in (PPUiTM). Rehabilitation Medicine in Hospital Kuala Lumpur, after which she then served as Rehabilitation Physician in She completed her undergraduate study in Hospital Raja Perempuan Zainab II, Kota Bharu. Moscow Medical Academy in 2008 and pursuit her master in Rehabilitation Medicine in University In 2012, she attained her area of interest training in Malaya which she completed in June 2018. Amputee Rehabilitation at the Queen Elizabeth Hospital and St Margaret Hospital in Adelaide, South Australia. She completed her gazettement in Hospital Sungai Buloh and continuing serving up until today besides After completion of her training, she was transferred to the PPUiTM. then newly established services at the Hospital Rehabilitasi Cheras. She develops interest in a minimally invasive procedure that is safe, applicable in outpatient Dr Siti Norzalilah actively practicing deep dry needling in clinical setting, acceptable to patient, and shows a her clinical services upon completion of David G Simmons promising outcome in pain management. Academy certification training in 2018. She is presently the Head of Amputee & Musculoskeletal Rehabilitation Service; Head of Diabetic Foot Wound Care services and Head of Day Care Unit in Hospital Rehabilitasi Cheras.

SPEAKERS SPEAKERS Dr Billy Tang Chee Being a co-founder of Aqua Hope proprietary Seng, an agriculture commercialization Aquaponic system, he truly believe PWD/OKU's URBAN SMART FARMS can indeed contribute scientist by profession, has to food purity, food security & food sovereignty of the been involved in agri-agro country. Thus, enjoying locally grown Organic fresh, tasty, based industries and private nutritious produce & most importantly to drive local research for two decades; economy that is environmentally sustainable. which inculcate in him the passion for sustainable farming Aquaponics is the combination of aquaculture (fish and in businesses which are farming) and hydroponics (farming without soil). The environmentally sustainable. system works in a cycle: Fish create waste, which is then used to fertilize the water where the plants grow. When Due to a serious car accident in December 2015, has blinded his the plants take in those nutrients, they clean the water, left eye but after an operation he had regained 70 per cent of which in turn is transferred back to the fish tanks. “You his vision, broken six ribs and transacted spinal cord which feed the fish, they create waste, plants grow.” Simple rendered him paraplegic changes the way he Farm again! enough. For the first six months he faced with depression BIG time and on Besides providing job opportunities to PWD/OKU to work in several occasions contemplating suicide just to end the pain is to his farm, his project also aims to contribute fresh premium end the life! He is still fighting chronic pain 24/7 and the latest MRI food produce to less fortunate communities including was not encouraging at all. Today, he is still coping how to do elder and orphanage homes. paraplegic! He had been chosen as one of the successful PWD/OKU With the unconditional love, encouragement, care and support icon at the Karnival Kerjaya OKU Selangor held on 24th of his beloved wife and two sons, schoolmates & friends, Perkeso November 2018. Malacca Rehab team & Sungai Buloh Rehab team with special thanks to Dr.Hafez Hussain, Dr.Ong Kuo Ghee and Dr.Akhmal Hafizah, he had finally come to terms with himself now as a PARAPLEGIC FARMER!

SPEAKERS SPEAKERS Puan Norazlina Zakaria Encik Mohd Nazri Mohd Zain sustained spinal cord injury sustained a spinal cord injury in 2006 following a motor vehicle accident. after a fall at his workplace at the age Surgery was done twice but her of 28. Little that this man knew that condition did not improve. She was such fall would leave him paralyzed wheelchair bound, felt helpless and from the chest down. Nazri became an depressed but later accepted her SCI survivor through his cheerfulness, faith. sheer motivation and immense hard work. She then joined and participated in the inpatient and outpatient rehabilitation programme at Sungai Buloh Hospital. Those are the keywords in his life. A holistic rehabilitation accompanied with self determination made him With God’s grace, her relentless perseverance and successful independent in all his activities of daily living with the aid of interdisciplinary intervention, she was able to walk again. a wheelchair. Based on her positive experience, she has created a spinal Stemmed from sympathy, love blossomed and has joined cord injury support group with her friends and has recently Nazri with our dear Norazlina. They tied the knot 3 years opened “Rumah Harapan Aafiyah” to help new spinal ago. Enthusiastic to help other SCI patients, both Norazlina patients with their rehabilitation program. and Nazri are now the founder of Rumah Harapan Aafiyah which was officiated in August last year. Aim of Rumah Harapan Aafiyah is to assist SCI patients in their rehabilitation program by providing a conducive, comfortable and friendly environment to perform their physiotherapy and activities of daily living.

ABSTRACT ABSTRACT ACUTE SPINAL CORD INJURY – CONCEPT AND APPROACHES SPINAL CORD INJURY (SCI) REHABILITATION Mr Lim Sze Wei - THE PANORAMIC VIEW Dr Wan Najwa Wan Zohdi Spinal cord injury (SCI) is a severe, often life threatening, traumatic condition leading to serious neurological dysfunctions. In the current world full of life challenges, it is of no less the challenge The final extent of the spinal cord damage results from primary for a patient with spinal cord injury (SCI) to climb the ladder of and secondary mechanisms that start at the moment of the hardship to achieve the optimum quality of life. Having complete SCI injury and go on for days, and even weeks, after the event. has taken away the major normal function of one which are walking and ability to manage their basic daily needs independently. In There is convincing evidence that hypotension contributes to general, SCI involve two large areas in medicine which are secondary injury after acute SCI. Surgical decompression aims at neurology and musculoskeletal. It has a spectrum of severity where relieving mechanical pressure on the microvascular circulation, the factors determining it are level of injury, completeness of injury, therefore reducing hypoxia and ischemia. The role of pathological degree and process of resolution. methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular Apart from that, there are many complications commonly use. encountered during post injury phase such as neurogenic bladder and bowel, multiple pressure sores, neuropathic pain and spasticity Neuroprotective therapies aiming to reduce further injury have that require long-term medical treatment with expert management been studied and many others are underway. as well as recurrent hospital admissions. Various descriptive studies Neuroregenerative therapies are being extensively investigated, have indicated the clear relation between rehabilitation programme with cell based therapy being very promising. and level of independency achieved by the SCI patients. It is the role the rehabilitation team to monitor and help to expedite every single improvement seen by using various modalities available in nowadays rehabilitation medicine.

ABSTRACT ABSTRACT DEEP BREATHING TECHNIQUES Symposium 1: Interdisciplinary Rehabilitation Perspectives Dr Senthilvel Govindaraju Esssential and updates – Rehabilitation Physician Dr Nor Azira Ismail Deep breath is a powerful tool to ease stress and make you feel less anxious. Some simple breathing exercises can make a big difference in Spinal cord injury was in the past deemed as an ‘ailment not to be our regular routine. The body temperature may be different for every treated’ resulting in the majority of SCI patients died of medical individual based on Vatham, Pitham and Kabam. Hence, that has to be complications following SCI. With the advancement of medical brought under control to a stable level. Breathing is a necessity of life knowledge and medical management, most SCI patients are now that usually occurs without much thought. When you breathe in air, expected to have similar life expectancy as normal population. blood cells receive oxygen and release carbon dioxide. Advances in the treatment of spinal cord injury continued in 21st More over, deep breathing leads to more efficient working of lungs, centuries, such that respiratory complications, heart disease, which means more oxygen is brought into contact with blood sent to septicemia, pulmonary emboli, suicide, and unintentional injuries the lungs by the heart. So, the heart doesn’t have to work as hard to became the major causes of death in patients with spinal cord injury. deliver oxygen to the tissues. Secondly, deep breathing leads to a Interdisciplinary rehabilitation management in SCI patients focuses greater pressure differential in the lungs, which leads to an increase in on the delivery of a comprehensive, integrated and intensive the circulation, thus resting the heart a little. program of medical, nursing and therapy care to address the complex needs of each SCI patient. A clear nasal passage is very important for the practice of Deep Breathing. Therefore breathing out with little force are to be practiced The primary goals of rehabilitation are prevention of secondary to cleanse the nasal passage. In deep breathing there are only deep complications, maximization of physical functioning, and inhalations and deep exhalations keeping the ratio of inhalation: reintegration into the community. Hence, SCI rehabilitation is a exhalation to 1:1. There is no question of retention of breath. Both the holistic process towards managing spinal cord injury which is best phases are almost equal. addressed by interdisciplinary team approach. Do and Dont’s Sit comfortably with your back straight in a comfortable chair. Wear comfortable clothes. Take a deep breath in through your nose Do this breathing 3 to 10 times. Don't force it. This can make you feel more relaxed. Try to do it at the same time once or twice a day. These is no bar of sex, however, women during pregnancy and menstrual cycle should do with moderation You should be aware of the passage of breath during the practice. Eat healthy, Be healthy, Live lively and Breath deeply for easy and relax life.

ABSTRACT ABSTRACT Symposium 1: Interdisciplinary Rehabilitation Perspectives The specialist nurse has a vital role to play in supporting and Esssential and updates – Nursing preparing the patient and their family for transfer to the spinal centre. Ketua Jururawat Ruhini Once the patient’s condition has stabilised and they have been transferred to the specialist rehabilitation centre, the process of Patients with a spinal cord injury (SCI) require rehabilitation of the coping with a spinal cord injury becomes salient. highest standard to enable them to recover from this life-threatening injury, which presents a major life-changing event for the patient and Many health care professionals do not consider bowel management their family. SCI is often thought of as one of the most severe types of to be a priority of care for the acute spinal injured patient. However, injury, resulting in dramatic changes to all aspects of the individual’s for the patient this may become a life-threatening condition, for life and having a significant impact on their family and friends. Unless instance as a contributing factor in autonomic dysreflexia, health care professionals have special training or experience of SCI perforation of the intestine or an acute abdomen. they are often fearful of providing care and treatment, because of the legitimate concern of causing further trauma. Nurses working in SCI care need experience and knowledge around a range of rehabilitative interventions which will include bladder, Nursing patients with SCI is a challenging role both physically and bowel, and skin management; management of spasticity and emotionally. Nurses who choose to work in this field must be autonomic dysreflexia;sexuality and fertility; and psychosocial issues dedicated and passionate about the holistic care they provide to and patient education for self-care and management. these often highly physically dependent individuals. Patients in these situations are often emotionally traumatized and Consequently, knowledge of care needs and outcomes is so very vulnerable; aggression and challenging behavior is not uncommon important as the nurses are helping this person to begin the rest of his/her life with a body that now works differently. The goal should be to help that person, and his family, have hope, for tomorrow and realize that they can still live a full, independents, productive life, within the limits of their disability. There are very limited centres in our country that provide specialized courses, certification or post- graduation in Spine nursing care. The government should encourage and start the same in coordination with private spine institutions where nurses can get enough exposure and experience dealing with spine patients. .

ABSTRACT ABSTRACT Symposium 1: Interdisciplinary Rehabilitation Perspectives Symposium 1: Interdisciplinary Rehabilitation Perspectives Esssential and updates – Occupational Therapist Esssential and updates – Spinal Orthotics Puan Julianna Ibrahim Cik Noor Asliza Ahmad Spinal cord injury (SCI) is a catastrophic, life-changing event that Lower limb paralysis resulting from spinal cord injury (SCI) causes results in severe sensory, motor, and other neurological impairments. inability to walk. Trauma is one of the main causes of SCI that occurs Individuals with paraplegia and tetraplegia experience diminished mostly in young people (aged between 16 and 30 years). The desire physical capacities and face life-long challenges such as pain, to ambulate following traumatic spinal cord injury (SCI) is ever fatigue, depression, and anxiety, all of which influence their ability to present. However, the practicality of walking for most complete SCI lead healthy and fulfilling lives. clients is minimal to none due to the energy requirements. These patients usually require walking aids and orthotic devices. Occupational therapy practitioners enable people with SCI to return to productive lives. Fundamental to the philosophy and practice of The goal of rehab is to maintain as much mobility and activity as the profession is the concept that every individual has the desire and possible and prevent further injuries. Prosthetist and Orthotist plays a right to engage in meaningful activities (American Occupational key role in diagnosis, treatment, alignment and reconstructions thru Therapy Association, 2014). measurement, design, fabrication and fitting; ability to design prosthetics and orthosis devices for needful patients. Occupational therapy practitioners have the education and skills to facilitate collaborative goal setting and achievement by considering Proper understanding and designing of the orthotic devices will physical, psychosocial, occupational, and contextual factors that benefits and maximise patient’s ability to participate in daily impact occupational performance. tasks/activities. Many devices have been designed to enable people with paraplegia to ambulate in an upright position as a Occupational Therapist does analyzed activities and adapting tasks solution of these limitations such as mechanical orthoses, hybrid to help individuals develop the skills needed to accomplish their orthoses and powered orthoses. All these devices are designed to goals. As essential members of the health care team, occupational solve the problem of standing and walking, but there are some other therapy practitioners help individuals with SCI return to their home important notes, which should be considered. and community and successfully engage in meaningful occupations (AOTA, 2014).

ABSTRACT Symposium 1: Interdisciplinary Rehabilitation Perspectives Esssential and updates – Physiotherapist Madam Foo Kok Wee Spinal Cord injury (SCI) occurs when the spinal cord gets damaged following an accident, falls, sporting injuries, or following diseases, such as Polio, Spinal Bifida or Transverse Myelitis, and has disaster consequences. In the acute phase, physiotherapy is predominantly focused on treating respiratory complications and preventing secondary musculoskeletal problems related to prolonged bed rest. In the rehabilitation phase, Physiotherapy intervention focus on increase strength ease in motor task such as bed mobility, wheelchair transfer, pushing wheelchair manually, perform higher wheelchair skill and walking with or without aids. Prevention of shoulder pain and improve in exercise endurance added health benefit to enhance batter quality of life The overall aim of rehabilitation is to enable the person to return to a productive and satisfying life.

ABSTRACT ABSTRACT Symposium 2: The unspoken topics in SCI Rehabilitation Although some men with SCI are unable to have erections, many Intimacy Tips & Traps Following Spinal Cord Injury still maintain the ability to have some erectile function, albeit of Dr Akmal Hafizah Zamli insufficient quality and duration for intercourse. Treatments options are wide ranging which includes oral medication such as While most cases of spinal cord injury (SCI) often result from a Phosphodiestrease 5 Inhibitors (PDE-5 I); mechanical devices such traumatic aetiology, a non-traumatic aetiological causes may also as vibrators and vacuum erection devices as well as the injection of be possible. In our local perspective, most SCI occured due to a vasoactive drugs into the penis motor vehicle accident with the majority affected the young productive age population. In addition to paralysis and loss of Infertility is an issue for men with SCI more than with women. Male sensory perceptions; individuals with SCI will likely experience infertility results from the combination of ejaculatory dysfunction problems with bladder and bowel control, as well as alterations in and abnormal sperm quantity and quality. Techniques to sexual functioning. remediate erectile dysfunction and ejaculation have vastly improved the fertility potential of men with SCI.Vibrostimulation to The impact of a SCI on sexual functioning depends on the degree obtain ejaculate for insemination for diagnostic and therapeutic of the injury and its location on the spinal cord.Sexual dysfunction in indications is now routinely performed. Electroejaculation is also an persons with SCI may have both physiologic and psychological option, however this technology is not available locally. (e.g. body image, self esteem) elements that can be distressing regardless of the individual's gender, age, or culture. The Consortium for Spinal Cord Medicine has identified the issue of Studies reported that both men and women report a decreased sexuality and reproductive health to be a high priority topic for desire for sexual activity following their SCI.Frequency of sexual improving the quality of life for individuals with SCI. Hence, the activity is also known to decrease after injury in both men and increased awareness of health care providers of the importance of women.In men with SCI, factors affecting sexuality typically include sexual functioning in the comprehensive interdisciplinary erectile and ejaculatory dysfunction.Factors affecting women with rehabilitation process. This symposium lecture shall highlight the SCI may include difficulties having comfortable intercourse, specific key elements and cautions in dealing with sexual decreased vaginal lubrication and the inability to reach or feel functioning involving the individuals with SCI. orgasm.

ABSTRACT ABSTRACT Symposium 2: The unspoken topics in SCI Rehabilitation Intra uterine insemination (IUI) may be utilized using conservatively The Fertility Options retrieved semen in men with SCI with reported pregnancy rates per Dr Mohan Raj Varutha Rajoo treatment cycle of 12% and a pregnancy rate of 28% per couple. Literature suggests that the total motile sperm counts minimum Infertility in patients with neurologic disorders including SCI is a threshold of 5 to 10×106 per mL is required. As with non-SCI couples complex entity, resulting from a combination of hormonal, who are being treated for infertility, pregnancy rates can be immunologic, sexual, and ejaculatory disturbances. As such, attaining improved with administration of clomiphene citrate and hCG fertility in neurologic disorders can require a multidisciplinary and injection 38–40 hours prior to insemination. stepwise approach. The associated high failure rates require a strong commitment from both the patient and the practitioner. Western literatures suggested that if the initial conservatively retrieved specimen has a total motile sperm counts of less than 5×106 per mL, it The overall reported chances of attaining pregnancy in SCI, is recommended to proceed directly to in vitro fertilization (IVF) which regardless of ejaculatory assistance or fertilization technique was has demonstrated a pregnancy rate of about 70% per couple and estimated about 51% (DeForge et al 2003). This symposium lecture 37% per cycle. shall focus on the available treatment approaches including assisted ejaculation techniques, assisted reproductive technology including Surgical methods of sperm retrieval are available for SCI patients in surgical sperm retrieval and intracytoplasmic sperm injection (ICSI). whom ejaculation cannot be attained by conservative means. Among men with SCI seeking fertility, about 1 out of 10 require Home intra-vaginal insemination (IVI) - a useful technique for those surgical extraction. A variety of surgical sperm retrieval techniques men with SCI who have been previously evaluated in clinic to be are available, including TESA, testicular sperm extraction (TESE), responsive to PVS, demonstrated understanding of safe usage, have microsurgical epididymal sperm aspiration (MESA), and adequate total motile sperm counts, and whose spouse has percutaneous epididymal sperm aspiration (PESA) predictable normal ovulatory cycles without uterine or tubal abnormalities. Overall, the average rate of success of achieving pregnancy with this method ranged between 20–40% per couple.

ABSTRACT ABSTRACT Lunch Talk: Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis (PRECISION) Pfizer Sdn. Bhd.

ABSTRACT ABSTRACT Workshop Station 1: Spasticity management in SCI This workshop session highlighted alcohol neurolysis as a treatment Ultrasound Guided Alcohol Neurolysis option for severe spasticity especially involving the lower Dr Akmal Hafizah Zamli extremities. This comprises the injections of dehydrated alcohol98% at the closest proximity ofthe relevant nerve; Spasticity is a motor disorder characterised by a velocity- commonly targetted is the popliteal sciatic nerve. dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, This treatment produces myelin loss, axonal degeneration, and as one component of the upper motor neurone syndrome. It is a ultimately results in local neuromuscular activity deficits. However, common clinical manifestation of SCI with reported prevalence these injections can produce a variety of complications including of between 68-75%; especially among individuals with cervical sensory paralysis, thrombosis following accidental injection into and upper thoracic lesions; and those with complete lesions. local blood vessels, and even local muscle fibrosis or contracture resulting from repeated injections. Spasticity has some clinical benefits such as maintainance of muscle bulk; prevention of atrophy, minimizes the risk of deep The efficacy, safety and success of the neurolysis procedure vein thrombosis and facilitate standing. However, severe depends largely on accurate localization of the nerve. General spasticity may cause pain, fatigue and may become a barrier to anatomical landmarks; descriptions of muscle shapes and nerve execution of functional daily activities, difficulties in nursing care, trunk courses; electrical stimulator guidance permits rough ambulation, positioning and sleep. In the extreme cases or sub- estimations of actual nerve localization. optimally treated spasticity, it may lead to contractures and musculoskeletal deformities which may results in more serious The combination of ultrasound modality use in performing alcohol complications such as pressure injuries or nerve compressions. neurolysis adds value by enhancing accurate nerve localization, hence improving outcome. In our local setting, treatment for spasticity often involves a combination of therapeutic exercises;orthoses and serial casting; oral antis-spastic medications such as Baclofen, Clonazepam, Tizanidine or Myonal; mechanical denervation using deep dry needling techniques and chemo-denervation using Botulinum neurotoxin ol alcohol neurolysis procedures. In severe refractory cases neurosurgical and orthopedic referral for surgical options such as tendon lenghtening, rhizotomy, intra-thecal Baclofen or neuroablative proceduresmay be required.

ABSTRACT ABSTRACT Workshop Station 1: Spasticity management in SCI It is suggested that functional benefits of botulinum toxin may be Ultrasound Guided Botulinum Toxin Injection enhanced by careful patient selection and individualised Dr Nor Azira Ismail treatment. Its reversible yet long lasting action, ease of administration, and favourable safety and adverse effect profile Spasticity is a condition involving overactive muscle are factors that contribute to its usefulness. contractions. It can be described as hyperactivity of reflexes that normally protect against sudden stretching of a muscle. This However, nerve endings usually grow new connections to muscles condition can interfere with mobility and performance of that have not yet been exposed to Botulinum toxin. So, treatment activities of daily living. Over time, spasticity may lead to may be repeated as often as every three months. Botulinum toxin contractures, which involve loss of range of joint motion. usually takes full effect within two to four weeks after injection. Patients should resume physical activity slowly and carefully after Botulinum toxin has been a major advancement in the Botulinum toxin injection. The most common side effects include management of spasticity. The clinical effects of botulinum toxin discoloration, redness, pain, or discomfort at the injection site. have been recognised since the end of the 19th century. It is the most potent neurotoxin known which is produced by the gram This session will highlight the usage of Botulinum toxin in spasticity negative anaerobic bacterium Clostridium botulinum. management using ultrasound guidance and hands on experience of how it is done. The paralytic effect of the toxin is due to blockade of neuromuscular transmission. Injection into a muscle causes chemodenervation and local paralysis and this effect has led to the development of the toxin as a therapeutic tool. It is now used clinically for a wide range of conditions, particularly focal dystonias, and spasticity. Botulinum toxin is given by injection directly into the affected muscles.

ABSTRACT ABSTRACT Workshop Station 2: Pain management in SCI MTrP is defined by Travell and Simons as the most tender Deep Dry Needling (hyperirritable) spot in a palpable taut band of skeletal muscle Dr Akmal Hafizah Zamli fibers. Pressure stimulation of a typical MTrP can elicit pain, referred pain, and local twitch response (LTR). The pain elicited by In acupuncture practice, illness results from blockage of energy compression of this spot is familiar to the patient as the usual pain flow or interrupted Chi; and acupuncture seeks to remove these complaint (pain recognition). It has been suggested that “spot blockages and return the energy flow to a state of balance. tenderness”, “taut band”, and “pain recognition” are the three While using the similar acupuncture needle, dry needling (also important criteria for the diagnosis of MTrP, and “referred pain” known as intramuscular manual stimulation, or intramuscular and “local twitch responses” can be “confirmatory signs” for MTrP needling) is a specific modern treatment modality perfomed by diagnosis. an appropiately trained health care professionals to provide relief for soft tissue dysfunction symptoms. Conservative treatment, such as appropriate systemic nonsteroidal anti-inflammatory drug (NSAID) or local NSAID gel or Needling and needling-induced lesions activate built-in biologic patch, thermotherapy, manual therapy, and other physical self-regulatory mechanisms to normalize pathophysiology of soft modalities, should be performed prior to more aggressive therapy, tissues. Itis an excellent modality used to provide relief of such as dry needling or local steroid injection. myofascial trigger points (MTrPs) commonly experienced by the individuals with SCI. The most likely mechanism of pain relief by It is important to eliminate any perpetuating factors causing needle stimulation is hyperstimulation analgesia via the persistent existence or recurrence of active MTrPs such as chronic descending pain inhibitory system. Other commonly postulated repetitive minor muscle strain, poor posture and ergonomics, mechanism is that needling induces endogenous opiates stressfull lifestyle or poor sleep by providing adequate patient release from the pituitary gland into plasma and cause education. analgesia in the central nerve system. In addition to the opioids, serotonin had also been speculated to be an important analgesic transmitter induces by needling. By treating the myofascial trigger points, joint flexibility and range of motion may also be improved. While it is a generally safe procedures, potential effects includes local pain, bruising and bleeding; and muscle soreness for 2-3 days post treatment.

ABSTRACT Workshop Station 2: Pain management in SCI Neuroprolotherapy Dr Natiara Hashim Peri- neural prolotherapy is a minimal invasive procedure by injecting 5% dextrose solution towards the affected cutaneous nerve to reduce pain. The concept of neurogenic inflammation plays important role in the mechanism of perineural prolotherapy treatment. Soft tissues are innervated by peptidergic sensory nerves with transient receptor potential vanilloid-type 1 (TRPV-1) receptors. The pro-inflammatory signals from injured tissues leads to the upregulation of TRPV-1 receptors, which in turn responses by producing substance P and calcitonin gene-related peptide (CGRP) by the peptidergic nerves which responsible for the pain sensation and cause breakdown of the surrounding soft tissue. Dextrose has shown to have the properties of reducing the neurogenic inflammation by binding to presynaptic calcium channels, inhibiting the release of neurodegenerative peptides which may give rise to analgesic effect. During this hands-on session, participant will be taught of identifying the cutaneous nerve that commonly involve in back pain and other cutaneous nerve that can be potentially benefit from peri-neural therapy, and technique of injection towards the nerve will be demonstrated. A short case study will be presented to illustrate the clinical application of this minimally invasive treatment in managing pain.

ABSTRACT ABSTRACT Workshop Station 3: Selected Nursing Skills in SCI care Intermittent catheterization is widely advocated as an effective ✓ Abdominal massage bladder management strategy for patients with incomplete bladder ✓ Intermittent cathterization emptying due to neurogenic bladder dysfunction. Catheterization is ✓ Single Channel Cystometry performed by either sterile or clean technique. ✓ Vaccum Assited Closure Intermittent catheterization helps protect the kidneys, prevent Ketua Jururawat Ruhini incontinence and decrease the number of infections a patient may acquire by promoting adequate drainage of the bladder while Nurses working in SCI care need experience and knowledge lowering intravesical pressure. Trained nurses and staffs are able to around a range of rehabilitative interventions which will include educate patients for intermittent catheterization as it is a simple yet bladder, bowel, and skin management; management of effective method of voiding. spasticity and autonomic dysreflexia; sexuality and fertility and psychosocial issues and patient education for self-care and The use of single channel cystometry (SCC) is considered for management. objective confirmation of neurogenic bladder diagnosis following spinal cord lesion in centers with access to UDS. The technique and Bowel management often plays a significant part in the lives of interpretation of SCC is important to diagnose a neurogenic bladder people with SC. Initial management of NBD includes with the help of experienced doctors. conservative measures such as modification of diet and fluids, laxatives or constipating medication, rectal interventions such as Vacuum-assisted closure is an active wound therapy rather than a digital rectal stimulation and manual evacuation of stool, wound dressing by applying negative pressure to the wound bed via suppositories/enemas progressing to more invasive and the VAC pump. VAC dressing help to remove excess exudate and expensive interventions such as rectal irrigation and surgery (e.g. promotes a moist, rather than wet, wound-healing environment. It stoma) also reduces oedema in the surrounding tissues that, if left, can impair wound-healing by reducing localised blood flow. Abdominal massage, which may sometimes be referred to as stomach massage, is a gentle, noninvasive treatment that may One of the main strengths of the VAC is its ability to promote healing have relaxing and healing effects for some people. It's used to in wounds with complex etiology and in those that have failed to heal treat a wide variety of health concerns, especially those related with conventional therapy. to the stomach, such as digestion issues, constipation, and bloating.

ABSTRACT ABSTRACT Workshop Station 4: Highlight of physiotherapy skills Workshop Station 5: Essential occupational therapy in SCI ✓Motor task training ✓UL & LL splint concept & designs ✓Wheel chair skills ✓Specialized orthoes for tentraplegia ✓Tenodesis training strategies Madam Foo Kok Wee Puan Juliana Ibrahim Spinal cord injury gave raise to disaster consequences. Patient do not know how to move with their new acquired paralysis. All splints are designed and fitted by an Occupational Therapist to address the individual needs of the person with SCI. There are Wheelchair mobility is fundamental to the independence for many other types of splints that may be used to address individual those who are unable to walk. Appropriate motor tasks and higher needs. A variety of static splint designs were used, depending on wheelchair skill training are essential to enhance independence level of injury, muscle strength, and the patient's acceptance. hence to improve quality of life. Splints are provided if upper limb strength and function is impaired following damage to the spinal cord above T1. Learning objective. After followed the workshop of motor task training and higher Splint is use to assist tenodesis movement which allow an wheelchair skill, you will be able:- individual without active finger movement to grasp and release objects. It utilizes passive tension in the tendons of the finger and 1. To increase understanding the impairment in different level of thumb in relation to the wrist position to allow the individual to spinal cord injury. grasp or release an object. 2. To understand how to move optimally with their newly The ability to properly apply splints is a technical skill easily acquired paralysis. mastered with practice and an understanding of basic principles. 3. To provide better handling skill in patient to perform higher wheelchair mobility.

ABSTRACT Low and high amplitude vibrators are use for semen retrieval for seminal fluid analysis (SFA) or fertility treatment via intrauterine Workshop Station 6: Sexuality and fertility insemination (IUI) or in vitro fertilization (IVF). Men with spinal cord ✓Vaccuum devices injury can frequently achieve erection and have sexual intercourse; ✓Low and High Amplitude Vibrators however the percentage who can successfully ejaculate is very low. ✓Intracavernosal injection Penile vibratory stimulation (PVS) is a clinic procedure that is painless Dr Kelvin Cheng Chek Siang and requires no anesthetic or sedation. PVS is performed by placing a vibrator on the dorsum or frenulum of the glans penis and delivering In Malaysia, the most common cause of spical cord injury (SCI) is mechanical stimulation until ejaculation occurs. In this station, there motor vehical accident. Therefore the SCI survivors are of the will be a step by step guide on the usage of vibrators. younger age group. Sexuality and fertility will be a main concern among these SCI survivors. Healthcare workers will need to arm Intracavernosal injection therapy is the process whereby a small themselves with adequate knowledge in these topics in order to amount of a medication is injected directly into the corpora provide medical services to their clients. cavernosa. These medications are smooth muscle relaxants and thus help increase blood flow into the penis. The advantage of injection The aim of the workshop is to increase the knowledge of participant therapy is that it does not depend on oral absorption and does not regarding the effect of spinal cord injury towards sexuality and depend on absorption through the tissues. The disadvantage is that it fertility. requires a small injection. Most men are anxious when they initially start with injection therapy but find that the procedure itself is usually For the vacuum devices station, it will be an educational process on not that uncomfortable. This station will provide a step by step guide the vacuum devices application for SCI patients to maintain regarding the injection technique. erection. There will be a showcase of various manual and electrical vacuum devices and the hands-on trial of usage of these vacuum devices on model. A vacuum constriction device (VCD) is an external pump with a band on it so that a patient with erectile dysfunction can use to get and maintain an erection. The VCD consists of an acrylic cylinder with a manual or electrical pump that may be attached directly to the end of the penis. A constriction ring or band is placed on the cylinder at the other end, which is applied to the body. The cylinder and pump are used to create a vacuum to help the penis become erect; the band or constriction ring is used to help maintain the erection.

ACKNOWLEDGEMENT ACKNOWLEDGEMENT Our sincere appreciation and big thank you Acknowlegement of Industrial Supporter: to: PLATINU Dr Hj Kamaruddin Bin Hj Alias, Director of Hospital Sungai Buloh M Dr Yusniza Md Yusof, National Head of Rehabilitation Medicine GOLD Services Ministry of Health, Malaysia Dr Shaari Md Yatim, Selangor State of Rehabilitation Medicine Services, Ministry Of Health Malaysia Dr Shahidan Md Noor, President of Post Graduate Society Hospital Sungai Buloh En Mizhar Hj Mazlan, Director of Ministry of Health Training Institute , Sungai Buloh All invited guest speakers Aqua Hope Sdn Bhd Rumah Harapan A'afiyah Rehabilitation Patient Support Group of Hospital Sungai Buloh Staffs of Rehabilitation Medicine Department Vendors Participants And all those whom had directly and indirectly contributed for the success of this event

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