PIPOS EXPLORER Volume VI

A Bi-Annual Magazine

PIPOS EXPLORER

PIPOSPakistan Institute of Prostheticand Orthotic Sciences

Volume VI (July - December, 2010)

PIPOS EXPLORERA Bi-Annual Magazine

Volume VI (July - December, 2010)

Prof. Dr. Bakht SarwarPatron in Chief

Mr. Liaquat Ali MalikManaging Director

Mr. Aziz AhmadChief Editor

Ms. Uzma JabeenChief Editor (Elect)

Mr. Riaz-ud-DinEditor

Ms. Sundas Khalid KhanCo-Editor

Mr. Mustafa KhursheedCo-Editor

Ms. Hina AroojCo-Editor

Ms. Fatima ShamsCo-Editor

Mr. Amir ShahzadCo-Editor

P I P O S E X P L O R E R - V O L U M E V I ( J U L Y- D E C E M B E R , 2 0 1 0 )

Page 02

C O N T E N T S

PIPOS

Plot# 6-B, Sector B-3, Phase 5, Hayatabad,

Peshawar, Pakistan.

+92 91 9217150/ 9217520

+92 344 9797980

Email: [email protected]

[email protected]

Electronic copy of PIPOS EXPLORER can

be obtained from: www.oppak.com/pipos.html

PIPOS

Plot# 6-B, Sector B-3, Phase 5, Hayatabad,

Peshawar, Pakistan.

+92 91 9217150/ 9217520

+92 344 9797980

Email: [email protected]

[email protected]

Electronic copy of PIPOS EXPLORER can

be obtained from: www.oppak.com/pipos.html

Editorial..................................................................................................................................

Introduction...........................................................................................................................

Collaboration of PIPOS with HI .........................................................................................

News and Events................................................................................. ..................................

PRSP Section.........................................................................................................................

Reminiscence........................................................................................................................

Articles Section......................................................................................................................

Students Corner.....................................................................................................................

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05

06

07

13

15

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EDITORIALALHAMDO-LLILAH! It's a source of great pleasure that, by the grace of Allah

thAlmighty, the 6 consecutive volume of the PIPOS EXPLORER has been published.

As an editor, today I am very happy to see that the seed that was planted three years back has grown into a fruitful plant, but at the same time I am cheerless as this would be my last magazine. We have our new Editorial Board members who would continue with this magazine in the future. Ms Uzma Jabeen (Assistant Professor and chairperson of APOS) is with us in this magazine as Chief Editor (elect) and would take the office of Chief Editor formally from the next volume of PIPOS EXPLORER. With her a new Editor would also be selected among the present co-editors.

PIPOS EXPLORER has gained a coveted position in the field of Prosthetics and Orthotics in Pakistan and abroad as well. We have been vigorously pursuing our dreams of achieving excellence and making this magazine as a platform of sharing knowledge among the Prosthetist and Orthotist of Pakistan and around the world. We have strived for this right from the beginning and therefore, we have great expectations from our readers that they would continue their contribution and support towards the magazine in future as well.

However, PIPOS EXPLORER to be of even more value to you and our readers many more practitioners need to share and use PIPOS EXPLORER as a means of sharing acquired knowledge. I recognize that, within the hectic clinical schedule, it is difficult to find time to write a manuscript, but please do not underrate the importance and value of sharing clinical and experimental observations.

At the end, I owe my heartfelt gratitude to the Prof. Dr. Bakht Sarwar (Chairman, PIPOS), Mr. Liaquat Ali Malik (Managing Director), Mr. Aziz Ahmed (Chief Editor) for their support and guidance throughout my Editorship and it's all because of their support that, I have been able to publish six consecutive issues of this Magazine. I would also thank all the co-editors who have worked in this magazine for their joint support, coordination, commitment and enthusiasm which have made the publications possible until now and I hope and pray that they all would continue to work with same devotion and enthusiasm in future.

May ALLAH bless all of us and our PIPOS, AmeenRegards,

Riaz ud DinEditor

ALHAMDO-LLILAH! It's a source of great pleasure that, by the grace of Allah Almighty, the 6 consecutive volume of the PIPOS EXPLORER has been published.

As an editor, today I am very happy to see that the seed that was planted three years back has grown into a fruitful plant, but at the same time I am cheerless as this would be my last magazine. We have our new Editorial Board members who would continue with this magazine in the future. Ms Uzma Jabeen (Assistant Professor and chairperson of APOS) is with us in this magazine as Chief Editor (elect) and would take the office of Chief Editor formally from the next volume of PIPOS EXPLORER. With her a new Editor would also be selected among the present co-editors.

PIPOS EXPLORER has gained a coveted position in the field of Prosthetics and Orthotics in Pakistan and abroad as well. We have been vigorously pursuing our dreams of achieving excellence and making this magazine as a platform of sharing knowledge among the Prosthetist and Orthotist of Pakistan and around the world. We have strived for this right from the beginning and therefore, we have great expectations from our readers that they would continue their contribution and support towards the magazine in future as well.

However, PIPOS EXPLORER to be of even more value to you and our readers many more practitioners need to share and use PIPOS EXPLORER as a means of sharing acquired knowledge. I recognize that, within the hectic clinical schedule, it is difficult to find time to write a manuscript, but please do not underrate the importance and value of sharing clinical and experimental observations.

At the end, I owe my heartfelt gratitude to the Prof. Dr. Bakht Sarwar (Chairman, PIPOS), Mr. Liaquat Ali Malik (Managing Director), Mr. Aziz Ahmed (Chief Editor) for their support and guidance throughout my Editorship and it's all because of their support that, I have been able to publish six consecutive issues of this Magazine. I would also thank all the co-editors who have worked in this magazine for their joint support, coordination, commitment and enthusiasm which have made the publications possible until now and I hope and pray that they all would continue to work with same devotion and enthusiasm in future.

May ALLAH bless all of us and our PIPOS, Ameen

th

Regards,

Riaz ud DinEditor


Page 04

EDITORIAL BOARD

Ms. Uzma Jabeen

Mr. Liaquat Ali Malik

Prof. Dr. Bakht Sarwar

Mr. Aziz Ahmad

Mr. Riaz-ud-Din

Mr. Amir Shahzad

Ms. Fatima Shams

Ms. Sundas Khalid Khan

Ms. Hina Arooj

Mr. Mustafa Khursheed

Chief Editor (Elect)

Managing Director

Patron in Chief

Chief Editor

Editor

Co-Editor

Co-Editor

Co-Editor

Co-Editor

Co-Editor

Sitting Row (L to R)

Standing Row (L to R)


Page 05

ABOUT PIPOSPakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) previously known as PETCOT, is the only unique institute of its kind in the field of Prosthetics and Orthotics in Pakistan. PIPOS was established in 1981 under bi-lateral assistance cooperation program between Pakistan and Germany and has transitioned into a centre of excellence awarding B.Sc (Hons) degree in Prosthetics and Orthotics from the University of Peshawar. PIPOS has been awarded as Category-II accreditation for training and education in the field of Prosthetics and Orthotics by ISPO (International Society for Prosthetics and Orthotics) based in Belgium, France. Each year 12 students including both locals and foreigners are trained in the field of Prosthetics and Orthotics. The students after graduation undergo an exam here in Pakistan conducted by a delegation of ISPO. After passing the exam; students are awarded a Category II certificate of orthopaedic technologist. Along with the provision of B.Sc (Hons) degree, PIPOS is also

providing all types of Prosthesis (Artificial limbs) and Orthosis (Braces) for almost every kind of physical disability. For this purpose institute maintains a model production centre providing assessment, rehabilitation services to thousands of people annually. Each year more than 6000 orthopaedically disabled patients including amputees are fitted with the artificial limbs and supports in PIPOS rehabilitation centre located at Hayatabad, Peshawar.

PROSTHETICS: It is the branch of orthopaedic science that deals with the study of design, manufacture, and use of prosthesis (Artificial limbs) as a replacement for a patient's limb loss caused through amputation or congenital limb loss. The aim of this replacement is to provide an artificial limb, which looks and functions in a manner, close to the natural limb as modern technology allows. The professionals in this field are called as Prosthetist.

ORTHOTICS: It is the branch of orthopaedic science that deals with the rehabilitation of weakened or disabled segment of the body, to prevent physical deformities from progressing or to relieve pain through orthosis (Mechanical supporting device).The professionals in this field are called as Orthotist.

COLLABORATION OF PIPOS WITH NATIONAL AND INTERNATIONAL ORGANIZATIONS

National Level:Chal Network, AFIRM (Armed Forces Institute for Rehabilitation Medicine), PPL (Pakistan Petroleum Limited), ERRA ( Earthquake Reconstruction and Rehabilitation Authority), PSRD (Pakistan Society for the Rehabilitation of Disabled, Lahore), Al Khidmat Foundation Quetta, UET Peshawar, DOW Medical University Karachi, MARDEA ( Medical Rehabilitation of the Disabled in Earthquake Affected Area).

International Level:ISPO (International Society for Prosthetics and Orthotics), ICRC (International Committee of Red Cross), WHO (World Health Organization), HI (Handicap International, France), DRI (Direct Relief International, USA), The Parkwood Institute USA, University of Stathclyde Glasgow, Nippon Foundation Japan, APOS (Alliance of Prosthetic and Orthotic Schools, Asia), George Brown College for Prosthetics and Orthotics, Toronto, Canada.

Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS) previously known as PETCOT, is the only unique institute of its kind in the field of Prosthetics and Orthotics in Pakistan. PIPOS was established in 1981 under bi-lateral assistance cooperation program between Pakistan and Germany and has transitioned into a centre of excellence awarding B.Sc (Hons) degree in Prosthetics and Orthotics from the University of Peshawar. PIPOS has been awarded as Category-II accreditation for training and education in the field of Prosthetics and Orthotics by ISPO (International Society for Prosthetics and Orthotics) based in Belgium, France. Each year 12 students including both locals and foreigners are trained in the field of Prosthetics and Orthotics. The students after graduation undergo an exam here in Pakistan conducted by a delegation of ISPO. After passing the exam; students are awarded a Category II certificate of orthopaedic technologist. Along with the provision of B.Sc (Hons) degree, PIPOS is also

providing all types of Prosthesis (Artificial limbs) and Orthosis (Braces) for almost every kind of physical disability. For this purpose institute maintains a model production centre providing assessment, rehabilitation services to thousands of people annually. Each year more than 6000 orthopaedically disabled patients including amputees are fitted with the artificial limbs and supports in PIPOS rehabilitation centre located at Hayatabad, Peshawar.

: It is the branch of orthopaedic science that deals with the study of design, manufacture, and use of prosthesis (Artificial limbs) as a replacement for a patient's limb loss caused through amputation or congenital limb loss. The aim of this replacement is to provide an artificial limb, which looks and functions in a manner, close to the natural limb as modern technology allows. The professionals in this field are called as

: It is the branch of orthopaedic science that deals with the rehabilitation of weakened or disabled segment of the body, to prevent physical deformities from progressing or to relieve pain through orthosis (Mechanical supporting device).The professionals in this field are called as

Chal Network, AFIRM (Armed Forces Institute for Rehabilitation Medicine), PPL (Pakistan Petroleum Limited), ERRA ( Earthquake Reconstruction and Rehabilitation Authority), PSRD (Pakistan Society for the Rehabilitation of Disabled, Lahore), Al Khidmat Foundation Quetta, UET Peshawar, DOW Medical University Karachi, MARDEA ( Medical Rehabilitation of the Disabled in Earthquake Affected Area).

ISPO (International Society for Prosthetics and Orthotics), ICRC (International Committee of Red Cross), WHO (World Health Organization), HI (Handicap International, France), DRI (Direct Relief International, USA), The Parkwood Institute USA, University of Stathclyde Glasgow, Nippon Foundation Japan, APOS (Alliance of Prosthetic and Orthotic Schools, Asia), George Brown College for Prosthetics and Orthotics, Toronto, Canada.

PROSTHETICS

ORTHOTICS

Prosthetist.

Orthotist.

COLLABORATION OF PIPOS WITH NATIONAL AND INTERNATIONAL ORGANIZATIONS

National Level:

International Level:


Page 06

PIPOS is committed to provide quality services in the field of Prosthetics and Orthotics to the patients. PIPOS through its national and international collaborators has been able to bring its educational and rehabilitation services up to the international standards.

Arms and legs, hands and feet: These unique and wonderful extensions of our bodies allow us to touch, to feel and to manipulate our environment. They provide us with the invaluable capability of propulsion and allow us to move freely throughout the world. Loss of part or all of a limb will forever change how we move, touch, work and play. The individual who loses a limb faces enormous emotional, psychological and physical challenges. PIPOS being the pioneer in the field of Prosthetic and Orthotic services recognizes the feelings of its patients and care for them and is always in struggle to provide its patients the best available rehabilitation. PIPOS has always realized its responsibility of making every disable person an active contributor in the society.

PIPOS and Handicap International have good collaborative linkages and both the organizations are always energized to help the people of Pakistan in every hour of need.

Handicap International is an international organization specialized in the field of disability. Non -governmental, nonreligious, nonpolitical and nonprofit making, it works alongside people with disabilities, offering them assistance and supporting them in their efforts to become self reliant.

Handicap International came to Pakistan following the earthquake in October 2005, which affected between 3.2 and 3.5 million people. The disaster resulted in many spinal cord injuries and amputations; some as a result of relatively minor injuries being untreated at the time of the earthquake. HI set up emergency rehabilitation projects to help those people with injuries related to the disaster, and to support people with disabilities whose needs were being overlooked by the relief effort.

In this regards HI is working with PIPOS since the earthquake. Late 2006, HI and PIPOS signed a partnership agreement for 3 years, with the objective to support PIPOS to run, manage and Follow-up the activities of the 5 rehabilitation centres created during emergency phase in the earthquake affected area, and to ensure the quality of the services delivered.

In February 2010, PIPOS in collaboration with HI provided rehabilitation services for PWDs in district Buner. Under this project, a well qualified and experienced physiotherapist of PIPOS and a group of technical persons including social mobilizers from Handicap International assisted 62 physically disabled persons in 5 days in district Buner who were in need of Prosthetic and Orthotic appliances. For these patients 76 assistive devices were manufactured out of which 58 were Orthotic devices and 18 were Prosthetic devices. The Orthotic appliances were fitted at Daggar Hospital Buner and Prosthetic appliances were fitted at PIPOS. Durable jogger shoes were also provided to all of these patients.

PIPOS is committed to provide quality services in the field of Prosthetics and Orthotics to the patients. PIPOS through its national and international collaborators has been able to bring its educational and rehabilitation services up to the international standards.

Arms and legs, hands and feet: These unique and wonderful extensions of our bodies allow us to touch, to feel and to manipulate our environment. They provide us with the invaluable capability of propulsion and allow us to move freely throughout the world. Loss of part or all of a limb will forever change how we move, touch, work and play. The individual who loses a limb faces enormous emotional, psychological and physical challenges. PIPOS being the pioneer in the field of Prosthetic and Orthotic services recognizes the feelings of its patients and care for them and is always in struggle to provide its patients the best available rehabilitation. PIPOS has always realized its responsibility of making every disable person an active contributor in the society.

PIPOS and Handicap International have good collaborative linkages and both the organizations are always energized to help the people of Pakistan in every hour of need.

Handicap International is an international organization specialized in the field of disability. Non -governmental, nonreligious, nonpolitical and nonprofit making, it works alongside people with disabilities, offering them assistance and supporting them in their efforts to become self reliant.

Handicap International came to Pakistan following the earthquake in October 2005, which affected between 3.2 and 3.5 million people. The disaster resulted in many spinal cord injuries and amputations; some as a result of relatively minor injuries being untreated at the time of the earthquake. HI set up emergency rehabilitation projects to help those people with injuries related to the disaster, and to support people with disabilities whose needs were being overlooked by the relief effort.

In this regards HI is working with PIPOS since the earthquake. Late 2006, HI and PIPOS signed a partnership agreement for 3 years, with the objective to support PIPOS to run, manage and Follow-up the activities of the 5 rehabilitation centres created during emergency phase in the earthquake affected area, and to ensure the quality of the services delivered.

In February 2010, PIPOS in collaboration with HI provided rehabilitation services for PWDs in district Buner. Under this project, a well qualified and experienced physiotherapist of PIPOS and a group of technical persons including social mobilizers from Handicap International assisted 62 physically disabled persons in 5 days in district Buner who were in need of Prosthetic and Orthotic appliances. For these patients 76 assistive devices were manufactured out of which 58 were Orthotic devices and 18 were Prosthetic devices. The Orthotic appliances were fitted at Daggar Hospital Buner and Prosthetic appliances were fitted at PIPOS. Durable jogger shoes were also provided to all of these patients.

COLLABORATION OF PIPOS WITHHANDICAP INTERNATIONAL


Page 07

Every year during spring semester PIPOS arranges a three days stay tour for its students. This year the three days thstay tour was arranged to Kaghan/Naran from 22-24 May, 2010. Students of all the semesters were accompanied

by their module in charges. Tour was made delightful by the students by arranging Bar-B-Que programs. The most interesting part of the tour was hiking to the jheel Saif ul Malook. The expenses for travelling and accommodation were provided by PIPOS and the students contributed some nominal amount for their food expenses.

Every year during spring semester PIPOS arranges a three days stay tour for its students. This year the three days stay tour was arranged to Kaghan/Naran from 22-24 May, 2010. Students of all the semesters were accompanied by their module in charges. Tour was made delightful by the students by arranging Bar-B-Que programs. The most interesting part of the tour was hiking to the jheel Saif ul Malook. The expenses for travelling and accommodation were provided by PIPOS and the students contributed some nominal amount for their food expenses.

th

NEWS AND EVENTSStay Tour to NaranStay Tour to Naran

thA science exhibition was arranged by the Islamia University-Peshawar on 6-7 June, 2010. In this exhibition student from different schools, colleges and universities participated. A group of students from PIPOS also participated in the exhibition. They organized a stall on which different Prosthetic and Orthotic appliances were displayed. PIPOS stall attracted a large number of viewers who were briefed by the students about the Prosthetic/Orthotic field, its scope, Prosthetic and Orthotic appliances fabrication and their usage. The aim of this stall was to bring awareness among the people of Peshawar regarding Prosthetic and Orthotic treatments and its outcome. In this regard different brouchers, pamphlet and magazines were distributed during the exhibition.

thA science exhibition was arranged by the Islamia University-Peshawar on 6-7 June, 2010. In this exhibition student from different schools, colleges and universities participated. A group of students from PIPOS also participated in the exhibition. They organized a stall on which different Prosthetic and Orthotic appliances were displayed. PIPOS stall attracted a large number of viewers who were briefed by the students about the Prosthetic/Orthotic field, its scope, Prosthetic and Orthotic appliances fabrication and their usage. The aim of this stall was to bring awareness among the people of Peshawar regarding Prosthetic and Orthotic treatments and its outcome. In this regard different brouchers, pamphlet and magazines were distributed during the exhibition.

PIPOS Students Participated in Science ExhibitionPIPOS Students Participated in Science Exhibition

Students at Jheel Saif Ul Malook Students enjoying in bus

PIPOS students at their stall Students briefing the viewer about Prosthetic appliance


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Every three years, the members of the International Society for Prosthetics and Orthotics (ISPO) meet up in a different arena for their World Congress. After Glasgow, Hong Kong and Vancouver the ISPO this year held the

thcongress in Leipzig, Germany for the first time. The congress dates were from 10-15 may, 2010. 630 speakers from 55 countries presented the latest developments and research results in the field of orthopaedics technology. The congress was attented by thousands of visitors.

From PIPOS; Prof. Dr. Bakht Sarwar and Mr. Aziz Ahmad participated in this congress. Dr. Sarwar and Mr. Aziz attented different meetings on the development of Prosthetic/Orthotic field in the developing countries. Mr. Aziz Ahmad also presented his two papers at the congress on the topic of “Challanges faced by Prosthetist in the management of Transtibial Amputation” and “Correlation between pyschosocial issues and non-complaince in patients with adolsecents idiopathic scoliosis”.

Every three years, the members of the International Society for Prosthetics and Orthotics (ISPO) meet up in a different arena for their World Congress. After Glasgow, Hong Kong and Vancouver the ISPO this year held the congress in Leipzig, Germany for the first time. The congress dates were from 10-15 may, 2010. 630 speakers from 55 countries presented the latest developments and research results in the field of orthopaedics technology. The congress was attented by thousands of visitors.

From PIPOS; Prof. Dr. Bakht Sarwar and Mr. Aziz Ahmad participated in this congress. Dr. Sarwar and Mr. Aziz attented different meetings on the development of Prosthetic/Orthotic field in the developing countries. Mr. Aziz Ahmad also presented his two papers at the congress on the topic of “Challanges faced by Prosthetist in the management of Transtibial Amputation” and “Correlation between pyschosocial issues and non-complaince in patients with adolsecents idiopathic scoliosis”.

th

PIPOS Faculty at ISPO World Congress 2010PIPOS Faculty at ISPO World Congress 2010

Prof. Dr. Bakht Sarwar and Mr. Aziz Ahmad at ISPO World congress Mr. Aziz Ahmad presenting his paper at ISPO World Congress

Staff Exchange ProgramStaff Exchange Program

A Staff Exchange program aimed at to utilize the faculty staff to visit the regional Prosthetic and Orthotic schools in order to draft proposals for improving the weaknesses and share the strengths. These areas might include; the P&O fabrication skills, curriculum, management, administration and financial dealing in the schools. The regional schools of the developing countries consist of PIPOS-Pakistan, CSPO-Cambodia, SLSPO-Sri Lanka, Vietcot-Vietnam, SSPO - Thailand etc. This program started in year 2003 and till now many fruitful visits have been done in the regional PO schools.

Under this program Mr. Muhammad Hussain Khattak (Finance Director) of PIPOS visited CSPO (Cambodian th

School of Prosthetics and Orthotics) from 1-30 June, 2010. The objectives of this visit were: (1) To learn about ISO Quality Management System:-9001-2000, (2) To observe the recording of financial/Accounting transaction procedures adopted at the Cambodia Trust /CSPO, (3) To observe and collect information about the internal and external audit system being used at The Cambodia Trust and CSPO, (4) To observe and collect information about the annual budget and plan of operation being used at the CSPO/CT, (5) To observe and collect information about the Financial Reporting System, (6) To observe the logistic system used at Cambodia Trust/CSPO

A Staff Exchange program aimed at to utilize the faculty staff to visit the regional Prosthetic and Orthotic schools in order to draft proposals for improving the weaknesses and share the strengths. These areas might include; the P&O fabrication skills, curriculum, management, administration and financial dealing in the schools. The regional schools of the developing countries consist of PIPOS-Pakistan, CSPO-Cambodia, SLSPO-Sri Lanka, Vietcot-Vietnam, SSPO - Thailand etc. This program started in year 2003 and till now many fruitful visits have been done in the regional PO schools.

Under this program Mr. Muhammad Hussain Khattak (Finance Director) of PIPOS visited CSPO (Cambodian School of Prosthetics and Orthotics) from 1-30 June, 2010. The objectives of this visit were: (1) To learn about ISO Quality Management System:-9001-2000, (2) To observe the recording of financial/Accounting transaction procedures adopted at the Cambodia Trust /CSPO, (3) To observe and collect information about the internal and external audit system being used at The Cambodia Trust and CSPO, (4) To observe and collect information about the annual budget and plan of operation being used at the CSPO/CT, (5) To observe and collect information about the Financial Reporting System, (6) To observe the logistic system used at Cambodia Trust/CSPO

th


Page 09

This year PIPOS in collaboration with Nippon foundation offered six scholarships for studying at Sirindhorn School of Prosthetics and Orthotics(SSPO) Bangkok, Thailand. The SSPO offers a 4 years Bachelors degree of Prosthetic and Orthotic Program accredited by ISPO as Cat-1. The school is within the Department of Rehabilitation Medicine Faculty of Medicine Siriraj Hospital, Mahidol University.

The scholarship will cover tuition and other fees, accommodation, stipend and return tickets for each student.th

The entry test for this scholarship was conducted at PIPOS on 25 April, 2010 and six students were selected on the basis of merit. The merit was prepared by assigning the weightages as follow:

FSC (Intermadiate) marks= 50 %Entry test marks= 30%Interview= 20 %

This year PIPOS in collaboration with Nippon foundation offered six scholarships for studying at Sirindhorn School of Prosthetics and Orthotics(SSPO) Bangkok, Thailand. The SSPO offers a 4 years Bachelors degree of Prosthetic and Orthotic Program accredited by ISPO as Cat-1. The school is within the Department of Rehabilitation Medicine Faculty of Medicine Siriraj Hospital, Mahidol University.

The scholarship will cover tuition and other fees, accommodation, stipend and return tickets for each student.

The entry test for this scholarship was conducted at PIPOS on 25 April, 2010 and six students were selected on the basis of merit. The merit was prepared by assigning the weightages as follow:

FSC (Intermadiate) marks= 50 %Entry test marks= 30%Interview= 20 %

th

Entry Test at PIPOS for Thailand Scholarship SeatsEntry Test at PIPOS for Thailand Scholarship Seats

Short Prosthetic Training Course at PIPOSShort Prosthetic Training Course at PIPOS

A short training course on Trans Femoral Prosthesis with Quadrilateral socket was organized at PIPOS from 12th - 16th July, 2010. The course instructor was Mr. Nizar Akhtar (Assistant Professor and Head of Prosthetic Department). The number of participants was limited to 5 with some nominal course fee. The course included demonstration and practice on patient assessment, casting, fabrication and fitting processes and lectures on gait deviation and applied Biomechanics. The program provided the opportunity to the participants to reflect on their own practice and develop skills to improve the quality and reliability of their Quadrilateral socket fittings. At the end of the course certificates were distributed among the participants.

A short training course on Trans Femoral Prosthesis with Quadrilateral socket was organized at PIPOS from 12th - 16th July, 2010. The course instructor was Mr. Nizar Akhtar (Assistant Professor and Head of Prosthetic Department). The number of participants was limited to 5 with some nominal course fee. The course included demonstration and practice on patient assessment, casting, fabrication and fitting processes and lectures on gait deviation and applied Biomechanics. The program provided the opportunity to the participants to reflect on their own practice and develop skills to improve the quality and reliability of their Quadrilateral socket fittings. At the end of the course certificates were distributed among the participants.

Selected students Entry test at PIPOS

Lecture during the short course Learning of modification techniques


Page 10

thEntry test for 2010 fall intake was conducted at PIPOS on 20 August, 2010. Students with both pre-medical and pre-engineering background of all the provinces were eligible to appear in the test. The test included both written and practical exam. This year 14 students were selected out of which 07 were given scholarships on the basis of merit. The scholarships had different categories which are as follow:

The merit list was prepared by assigning the weightages as follow:

SSC (Matriculation): 10%

FSc (intermediate): 20%

Written test: 20%

Practical test: 30%

Interview: 20%

thEntry test for 2010 fall intake was conducted at PIPOS on 20 August, 2010. Students with both pre-medical and pre-engineering background of all the provinces were eligible to appear in the test. The test included both written and practical exam. This year 14 students were selected out of which 07 were given scholarships on the basis of merit. The scholarships had different categories which are as follow:

The merit list was prepared by assigning the weightages as follow:

SSC (Matriculation): 10%

FSc (intermediate): 20%

Written test: 20%

Practical test: 30%

Interview: 20%

Entry Test for 2010 Intake (Fall Semester)Entry Test for 2010 Intake (Fall Semester)

Practical testWritten test at PIPOS


Page 11

PIPOS Faculty Member Gets Golden Key International Honour Society Membership.

Mr. Aziz Ahmad Appointed as Director Training and Education, PIPOS

PIPOS and Dow University of Health Sciences Sign MoU

Mr. Nizar Akhtar (Assistant Professor, PIPOS) has honored PIPOS by achieving Golden key International Honour Society membership. This membership has been offered to him on the basis of his outstanding academic performance in the bachelors program of Prosthetic and Orthotic at La Trobe University, Australia.

The Golden Key International Honour Society provides international recognition of academic achievement to the top 15 percent university students across all faculties. Golden key is a non-profit organization that offers its members a range of valuable benefits and opportunities, including:

! Certificate of membership recognizing the academic achievement

! Member-only undergraduate and postgraduate scholarships and awards

! Member-only access to golden key career library

! Regional and international member-only conferences

! Student leadership opportunities and much more.

Mr. Aziz Ahmad (Assistant Professor, PIPOS) has been appointed as Director Training and Education of PIPOS for a period of three years with effect from April, 2010.

Mr. Aziz Ahmad after graduating from PIPOS in 1996-97 joined PIPOS again in 1998 as a Prosthetist/Orthotist. He was then appointed as a lecturer in 2004. Mr. Aziz was awarded a scholarship and went to La Trobe University for higher studies in 2005. He was then promoted to the post of Assistant Professor in 2008. Mr. Aziz Ahmad has been appointed on different important posts of PIPOS previously which includes head of Prosthetic department and Controller of examinations.

PIPOS and Dow University of Health Sciences has recently signed a Memorandum of Understanding. Under this MoU PIPOS would upgrade the school of Prosthetic and Orthotic of DUHS according to the ISPO(International Society for Prosthetics and Orthotics) Cat-I standards. The faculty members of PIPOS would visit Dow University of Health Sciences for the demonstrations and lectures in the beginning of every semester. They would also help in the upgradation of the curriculum and the examination protocol for the school of Prosthetic and Orthotic, DUHS. Mr. Nizar Akhtar is the coordinator of this program and would look after the day to day activities.

PIPOS Faculty Member Gets Golden Key International Honour Society Membership.

Mr. Aziz Ahmad Appointed as Director Training and Education, PIPOS

PIPOS and Dow University of Health Sciences Sign MoU

Mr. Nizar Akhtar (Assistant Professor, PIPOS) has honored PIPOS by achieving Golden key International Honour Society membership. This membership has been offered to him on the basis of his outstanding academic performance in the bachelors program of Prosthetic and Orthotic at La Trobe University, Australia.

The Golden Key International Honour Society provides international recognition of academic achievement to the top 15 percent university students across all faculties. Golden key is a non-profit organization that offers its members a range of valuable benefits and opportunities, including:

Certificate of membership recognizing the academic achievement

Member-only undergraduate and postgraduate scholarships and awards

Member-only access to golden key career library

Regional and international member-only conferences

Student leadership opportunities and much more.

Mr. Aziz Ahmad (Assistant Professor, PIPOS) has been appointed as Director Training and Education of PIPOS for a period of three years with effect from April, 2010.

Mr. Aziz Ahmad after graduating from PIPOS in 1996-97 joined PIPOS again in 1998 as a Prosthetist/Orthotist. He was then appointed as a lecturer in 2004. Mr. Aziz was awarded a scholarship and went to La Trobe University for higher studies in 2005. He was then promoted to the post of Assistant Professor in 2008. Mr. Aziz Ahmad has been appointed on different important posts of PIPOS previously which includes head of Prosthetic department and Controller of examinations.

PIPOS and Dow University of Health Sciences has recently signed a Memorandum of Understanding. Under this MoU PIPOS would upgrade the school of Prosthetic and Orthotic of DUHS according to the ISPO(International Society for Prosthetics and Orthotics) Cat-I standards. The faculty members of PIPOS would visit Dow University of Health Sciences for the demonstrations and lectures in the beginning of every semester. They would also help in the upgradation of the curriculum and the examination protocol for the school of Prosthetic and Orthotic, DUHS. Mr. Nizar Akhtar is the coordinator of this program and would look after the day to day activities.


Page 12

2010 INTAKE STUDENTS (SEMESTER FALL)2010 INTAKE STUDENTS (SEMESTER FALL)

Mr. Asif Iqbal, Mr. Mustafa Khursheed, Mr. Amir Shahzad

Ms. Zarish Afridi, Mr. Bostan Muhammad, Ms. Rakhshanda

Mrs. Shaista Afridi (Lecturer), Mr. Hussam-ud-Din

Mr. Nizar Akhtar (Assistant Professor), Mr. Waseem Ahmad, Ms. Rahat-ul-Ain

Mr. Hamad Ali, Ms. Fatima Shams, Ms. Syeda Gohar Abbas

Sitting Row (L to R)

Standing Row (L to R)


Page 13

PRSP (PIPOS Rehabilitation Services Project)

PRSP (PIPOS Rehabilitation Services Project) is an extension of PIPOS (Pakistan Institute of Prosthetic and Orthotic Sciences) whose mission is to provide high quality patient care by providing assistive devices and related services to anyone no matter whatever their affordability maybe. PRSP developed radically, particularly with the creation and establishment of 09 centers in KPK and one in AJK. This growth has its toll on quality of services, management and education. It is further aggravated by the demand of national and International organizations to extend PRSP services further in the KPK, FATA, AJK and other provinces of Pakistan.

July- Dec , 2010 Patient Record

PRSP (PIPOS Rehabilitation Services Project)

PRSP (PIPOS Rehabilitation Services Project) is an extension of PIPOS (Pakistan Institute of Prosthetic and Orthotic Sciences) whose mission is to provide high quality patient care by providing assistive devices and related services to anyone no matter whatever their affordability maybe. PRSP developed radically, particularly with the creation and establishment of 09 centers in KPK and one in AJK. This growth has its toll on quality of services, management and education. It is further aggravated by the demand of national and International organizations to extend PRSP services further in the KPK, FATA, AJK and other provinces of Pakistan.

July- Dec , 2010 Patient Record

PRSP SECTIONPRSP SECTION


Page 14

Bannu:Bannu is located in the heart of the southern region about 192km away from Peshawar with its boundaries touching the districts of Karak, Lakki Marwat and North, South Waziristan Agencies. Bannu itself is a district and tehsil consisting of 49 union-concils. The total Population is 677346 with area covered 1227km square. The literacy rate of district Bannu is 32.11%.

Due to its locality acting as a bridge between north - south waziristan agencies and ongoing war conflicts it has great importance.

PRSP-Rehab centre Bannu:PRSP-rehab centre Bannu lies in DHQ hospital Bannu which was developed in july 2008. The aim was to provide rehabilitation services to disable people present in Bannu distrist and remot areas which had to cover long distance for getting rehabilitation services. Currently PRSP-rehab centre Bannu is providing orthotic services along with prosthetic minor repairs.

As per needs of the Disable community (Patients with Disabilities) PRSP-Bannu is also working on out reach program part of Medical Mobile unit which focuses to raise awareness amongst the PWDs in local community that disability is correctable and preventable through Orthotic and Prosthetic management and also to reach and treat every PWD at their door steps who is unable to approach the rehab centers.

PRSP-Bannu Clinical statistics:

Total registered patients = 844 Prosthetic patients = 75Orthotic patients = 769 Checked out patients= 1589Visits of patients = 2682 Treatment sessions = 4068Assistive devices delivered = 2223 Prostheses delivered = 42Orthoses delivered = 2181

Bannu:

PRSP-Rehab centre Bannu:

Bannu is located in the heart of the southern region about 192km away from Peshawar with its boundaries touching the districts of Karak, Lakki Marwat and North, South Waziristan Agencies. Bannu itself is a district and tehsil consisting of 49 union-concils. The total Population is 677346 with area covered 1227km square. The literacy rate of district Bannu is 32.11%.

Due to its locality acting as a bridge between north - south waziristan agencies and ongoing war conflicts it has great importance.

PRSP-rehab centre Bannu lies in DHQ hospital Bannu which was developed in july 2008. The aim was to provide rehabilitation services to disable people present in Bannu distrist and remot areas which had to cover long distance for getting rehabilitation services. Currently PRSP-rehab centre Bannu is providing orthotic services along with prosthetic minor repairs.

As per needs of the Disable community (Patients with Disabilities) PRSP-Bannu is also working on out reach program part of Medical Mobile unit which focuses to raise awareness amongst the PWDs in local community that disability is correctable and preventable through Orthotic and Prosthetic management and also to reach and treat every PWD at their door steps who is unable to approach the rehab centers.

PRSP-Bannu Clinical statistics:

Total registered patients = 844 Prosthetic patients = 75Orthotic patients = 769 Checked out patients= 1589Visits of patients = 2682 Treatment sessions = 4068Assistive devices delivered = 2223 Prostheses delivered = 42Orthoses delivered = 2181

Mr. Farid Ullah, Center Manager

Staff members

CENTRE PROFILECENTRE PROFILEPRSP BannuPRSP Bannu


Page 15

My name is Sajjad Hussain and I am working as an Assistant Professor in Orthotic Department of the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS). My first appearance into PIPOS, former PETCOT, was some two decades before while my services with the institute took almost fifteen years and it really appears to be a matter of tomorrow in thinking of the past as the time that really flown. There is a lot of rejoicing memories in connection to PIPOS and in order to get into the past; there are still moments that were spent with my teachers, fellows, students, and they are of mixed natures with joy and sorrow.

It was January 1991 when I had a chance to appear in the entry test for admission to the first year in Orthopedic Technology in Peshawar Training Center of Orthopedic Technology (PETCOT) started mutually by Ministry of Health, Govt of NWFP (KPK) and German Agency for Technical Cooperation (GTZ), Federal Republic of Germany (FRG). I was very much moved by the grand structure of the department and the foreign teachers at PECOT. Luckily I got highest marks in the test and was very happy as my parents and siblings supported me very much. This was my first rejoicing moment.

In the session 1991-94 there were two batches and considered to be the first International students' session as it included 12 Pakistanis and 10 Afghans. It was also my first experience to study in a coeducation institute. Our session had 8 male and 4 female candidates and 10 male Afghan students. We had combined theoretical session and separate practical labs. It was also interesting to have individual work benches and hand tools issued to us. Due to really practical working atmosphere, we were so enthusiastic that we worked for more than 8 hours a day and 5 days a week. This attracted me a lot and I really enjoyed those days.

We got a chance to visit the Khyber Medical College (KMC) first for a one day seminar and for Anatomy lecture along with seeing the dissection hall and that was really an amusing moment in my life to see the real cadavers. During my first year we enjoyed too much in our visits to Engineering University for forging session, Technical College for welding classes, and Paraplegic center for visiting the facilities. We had tours to Muree, Swat, and Shogran where we enjoyed too much and I still have some pictures of those days to refresh our good memories. During the final days of our first year we had New Year parties and result of the exams and that was also an amusing instant to see our results with all the students passed with good marks.

My name is Sajjad Hussain and I am working as an Assistant Professor in Orthotic Department of the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS). My first appearance into PIPOS, former PETCOT, was some two decades before while my services with the institute took almost fifteen years and it really appears to be a matter of tomorrow in thinking of the past as the time that really flown. There is a lot of rejoicing memories in connection to PIPOS and in order to get into the past; there are still moments that were spent with my teachers, fellows, students, and they are of mixed natures with joy and sorrow.

It was January 1991 when I had a chance to appear in the entry test for admission to the first year in Orthopedic Technology in Peshawar Training Center of Orthopedic Technology (PETCOT) started mutually by Ministry of Health, Govt of NWFP (KPK) and German Agency for Technical Cooperation (GTZ), Federal Republic of Germany (FRG). I was very much moved by the grand structure of the department and the foreign teachers at PECOT. Luckily I got highest marks in the test and was very happy as my parents and siblings supported me very much. This was my first rejoicing moment.

In the session 1991-94 there were two batches and considered to be the first International students' session as it included 12 Pakistanis and 10 Afghans. It was also my first experience to study in a coeducation institute. Our session had 8 male and 4 female candidates and 10 male Afghan students. We had combined theoretical session and separate practical labs. It was also interesting to have individual work benches and hand tools issued to us. Due to really practical working atmosphere, we were so enthusiastic that we worked for more than 8 hours a day and 5 days a week. This attracted me a lot and I really enjoyed those days.

We got a chance to visit the Khyber Medical College (KMC) first for a one day seminar and for Anatomy lecture along with seeing the dissection hall and that was really an amusing moment in my life to see the real cadavers. During my first year we enjoyed too much in our visits to Engineering University for forging session, Technical College for welding classes, and Paraplegic center for visiting the facilities. We had tours to Muree, Swat, and Shogran where we enjoyed too much and I still have some pictures of those days to refresh our good memories. During the final days of our first year we had New Year parties and result of the exams and that was also an amusing instant to see our results with all the students passed with good marks.

REMINISCENCEREMINISCENCEWhen I was a student in PIPOSWhen I was a student in PIPOS

Mr. SAJJAD HUSSAIN(Assistant Professor, PIPOS


Page 16

There was an interesting moment as some staff miss lead me and Mr. Saleek by informing us that I got first position and my fellows took a party from me, but upon seeing the result I was second in the class and was sad for a while. There was a real healthy competition among us to secure high marks in the exams and it was really a very close contest among our fellows. I secure second position in aggregate of all the three years.

During my internship we travelled to Pakistan Society for Rehabilitation of Disabled (PSRD) Lahore and spent more than two months. We worked there in the prosthetic & orthotic section and also visited various parks like Changa Manga, Qaddafi Stadium, Sozo Water Park etc. We enjoyed travel, food, weather, culture, and places during our stay at PSRD. One of my close fellow and friend got a chance to serve that center.

I tried my luck from 1994-95 in various places such as; at HI center in Quetta, Ortho Workshop at Faisalabad, set Pak-Afghan workshop Peshawar, established clinic at Manakrao, Cant Peshawar, while the last center named Frontier Rehab Services at Dabgari Garden Peshawar under PIPOS. I was appointed as Assistant Lecturer in 1996 and assigned to assist the senior teacher to the first year. I was fully guided by my senior Miss Seema Ishaq and she was kind enough in trusting me to run the class after her demo session. That was one of my best teaching experiences in my life to teach metal work as one of the toughest module of making metallic short and long leg braces (AFOs and KAFOs).

I am serving this parent department from lecturer and promoted to Assistant Professor in 2006 having almost 15 years experience of Rehab and Teaching various modules. Now I am teaching theoretical and practical classes at training and education of PIPOS. I toured in staff exchange programme to CSPO Cambodia, SLSPO Sri Lanka which really helped me in updating my knowledge and vision.

During 2007-09, I found chance to avail Nippon Foundation Japan scholarship for the regional schools of the developing countries. It was two years up-gradation course through La Trobe University Australia via Cambodian School of Prosthetics and Orthotics (CSPO). The time there by me and my colleague will remain fresh for ever as this was the hardest time to stay away from home and family and to cope with the different culture, religion, language, temperature and food. It was a day of relief for us when we successfully completed this ISPO Cat-I training and returned back.

The time sorrow was the day when our B. Sc course finished and we all say farewell to each other. Our three years passed so quickly that we could not believe that we were going to be separated. Our intimacy and friendship was so closed that we respect each other as our family members. Also, it was a matter of sorrow when some of our members left the institute and got a job abroad. In 2010, the saddest moment was that our senior student, Waheed Ullah, of last semester lost his life in a serious road accident. May Allah Almighty bless his soul Ameen

To sum up, there is saying that past recollections truly hurt me; Oh my Lord snatch my memories so that I might be relieved. Some other proclaimed that I live in my past and plan for the future. In a true sense life is a struggle and everyone has lots of good and bad life experiences. I consider myself luckiest as I had a profession that I liked the most to serve the humanity and to train the students. May Allah bless us to achieve our true aims. Long live my nation, my countrymen, my parents and family, PIPOS and my teachers. Ameen.

There was an interesting moment as some staff miss lead me and Mr. Saleek by informing us that I got first position and my fellows took a party from me, but upon seeing the result I was second in the class and was sad for a while. There was a real healthy competition among us to secure high marks in the exams and it was really a very close contest among our fellows. I secure second position in aggregate of all the three years.

During my internship we travelled to Pakistan Society for Rehabilitation of Disabled (PSRD) Lahore and spent more than two months. We worked there in the prosthetic & orthotic section and also visited various parks like Changa Manga, Qaddafi Stadium, Sozo Water Park etc. We enjoyed travel, food, weather, culture, and places during our stay at PSRD. One of my close fellow and friend got a chance to serve that center.

I tried my luck from 1994-95 in various places such as; at HI center in Quetta, Ortho Workshop at Faisalabad, set Pak-Afghan workshop Peshawar, established clinic at Manakrao, Cant Peshawar, while the last center named Frontier Rehab Services at Dabgari Garden Peshawar under PIPOS. I was appointed as Assistant Lecturer in 1996 and assigned to assist the senior teacher to the first year. I was fully guided by my senior Miss Seema Ishaq and she was kind enough in trusting me to run the class after her demo session. That was one of my best teaching experiences in my life to teach metal work as one of the toughest module of making metallic short and long leg braces (AFOs and KAFOs).

I am serving this parent department from lecturer and promoted to Assistant Professor in 2006 having almost 15 years experience of Rehab and Teaching various modules. Now I am teaching theoretical and practical classes at training and education of PIPOS. I toured in staff exchange programme to CSPO Cambodia, SLSPO Sri Lanka which really helped me in updating my knowledge and vision.

During 2007-09, I found chance to avail Nippon Foundation Japan scholarship for the regional schools of the developing countries. It was two years up-gradation course through La Trobe University Australia via Cambodian School of Prosthetics and Orthotics (CSPO). The time there by me and my colleague will remain fresh for ever as this was the hardest time to stay away from home and family and to cope with the different culture, religion, language, temperature and food. It was a day of relief for us when we successfully completed this ISPO Cat-I training and returned back.

The time sorrow was the day when our B. Sc course finished and we all say farewell to each other. Our three years passed so quickly that we could not believe that we were going to be separated. Our intimacy and friendship was so closed that we respect each other as our family members. Also, it was a matter of sorrow when some of our members left the institute and got a job abroad. In 2010, the saddest moment was that our senior student, Waheed Ullah, of last semester lost his life in a serious road accident. May Allah Almighty bless his soul Ameen

To sum up, there is saying that past recollections truly hurt me; Oh my Lord snatch my memories so that I might be relieved. Some other proclaimed that I live in my past and plan for the future. In a true sense life is a struggle and everyone has lots of good and bad life experiences. I consider myself luckiest as I had a profession that I liked the most to serve the humanity and to train the students. May Allah bless us to achieve our true aims. Long live my nation, my countrymen, my parents and family, PIPOS and my teachers. Ameen.


Page 17

Case development: Upper Limb Prosthetics“I just wish I could flex this bloody elbow”

By: Mr. Nizar AkhtarAssistant Professor, PIPOS

Mr. X is a timber worker who underwent a transhumeral amputation as a result of serious crush injury 12 year ago. He is now 67. He remains very active. He enjoys woodwork, Including turning, Joinery and furniture restoration.

He currently wears a body powered limb with a locking elbow unit. He wears a chest strap 'shoulder saddle' type harness which allows him to actively flex/extend and lock the elbow as well as control his terminal device (a voluntary opening hook).

When he came to our clinic, his current prosthesis was pretty knocked-around. It clearly needed an overhaul or replacement- it was nearly 6 years old. During his consultation, he mentioned that he has seen a couple of stories on TV of 'blokes with these elbows that can actively flex.' He told us that he did not want any thing fancy but that 'I just wish I could flex this bloody elbow'.

When we asked him what he meant by that, he told us that it would make lifting things on to his workbench much easier. As it was, he found that it was the most awkward part of his activities as he has no active assistance from his prosthetic elbow and instead the entire load is through the shoulder. He has also damaged a few elbow joints over the years.

Case development outlining responses to the following questions:Describe the requirements for a prosthesis that would satisfy Mr. X's request.Describe the possible process for providing him with the prosthesis that you are suggesting.Itemize the key barriers that might face Mr. X if you provided that path, and suggest ways around each of them.Make a recommendation for ongoing treatment.

IntroductionThe basic objective of prosthetic management of an upper limb amputee is to provide the patient with maximum function of the prosthesis to be independent in the activities of daily living (Lehneis & Dickey, 2008).Today prosthetists have a wide-ranging selection of designs and components to select from when fabricating the prosthesis for the amputee. Different options available are cosmetic, body powered and myoelectric however one can hybridize the components to design most practical and best functioning prosthesis for the amputee (Fillauer, 2008; Lehneis & Dickey, 2008). Complete range of motion of elbow unit is one of the factors necessary for best functioning of trans humeral prosthesis that met by choosing appropriate components and socket designs and alignment (New York University Manual, 1971; Fillauer, 2008).

!

!

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Case development: Upper Limb Prosthetics“I just wish I could flex this bloody elbow”

By: Mr. Nizar Akhtar

Assistant Professor, PIPOS

Mr. X is a timber worker who underwent a transhumeral amputation as a result of serious crush injury 12 year ago. He is now 67. He remains very active. He enjoys woodwork, Including turning, Joinery and furniture restoration.

He currently wears a body powered limb with a locking elbow unit. He wears a chest strap 'shoulder saddle' type harness which allows him to actively flex/extend and lock the elbow as well as control his terminal device (a voluntary opening hook).

When he came to our clinic, his current prosthesis was pretty knocked-around. It clearly needed an overhaul or replacement- it was nearly 6 years old. During his consultation, he mentioned that he has seen a couple of stories on TV of 'blokes with these elbows that can actively flex.' He told us that he did not want any thing fancy but that 'I just wish I could flex this bloody elbow'.

When we asked him what he meant by that, he told us that it would make lifting things on to his workbench much easier. As it was, he found that it was the most awkward part of his activities as he has no active assistance from his prosthetic elbow and instead the entire load is through the shoulder. He has also damaged a few elbow joints over the years.

Describe the requirements for a prosthesis that would satisfy Mr. X's request.Describe the possible process for providing him with the prosthesis that you are suggesting.Itemize the key barriers that might face Mr. X if you provided that path, and suggest ways around each of them.Make a recommendation for ongoing treatment.

The basic objective of prosthetic management of an upper limb amputee is to provide the patient with maximum function of the prosthesis to be independent in the activities of daily living (Lehneis & Dickey, 2008).Today prosthetists have a wide-ranging selection of designs and components to select from when fabricating the prosthesis for the amputee. Different options available are cosmetic, body powered and myoelectric however one can hybridize the components to design most practical and best functioning prosthesis for the amputee (Fillauer, 2008; Lehneis & Dickey, 2008). Complete range of motion of elbow unit is one of the factors necessary for best functioning of trans humeral prosthesis that met by choosing appropriate components and socket designs and alignment (New York University Manual, 1971; Fillauer, 2008).

Case development outlining responses to the following questions:

Introduction

ARTICLES SECTIONARTICLES SECTION


Page 18

In this article I will discuss the possibility of hybrid prosthesis with myoelectric elbow and Voluntary opening terminal device and remedies to the key barriers associated with the use of this kind of prosthesis for Mr.X who is worried about his elbow flexion.

Prosthetic requirementsThere are many prosthetic considerations that can be discussed in great detail while reviewing this patient's case study. I will highlight only those that help to determine the final prosthesis. The body powered prosthesis used by Mr.X, on one hand is of moderate weight and has high sensory feedback but require more gross limb movements for flexion of elbow and opening/closing of terminal device(Kelly, 2008).He lacks various functions like pronation/supination of forearm and different positioning of hand and elbow because of losing the anatomical elbow (hope.edu, 2006).The provision of myo-electric elbow aims to fulfill functionality, ease of operation, active motion of elbow and good appearance(Millistein, Herger, & Hunter, 1986; Galiano, L., Montaner, E., & Flecha, A. 2007; Berbrayer & Farraday, 1994).Moreover, a Sierra wrist flexion unit installed on constant friction unit will permit for variable angulations when patient's elbow range is limited and is also very important for various activities near the body midline, such as personal hygiene (Lehneis & Dickey, 2008).The choice of terminal device is body powered hook because of its versatile grasp and reliability while patient is already used to with it, however patient can interchange it with a hand when participating in leisure time activities (Lehneis & Dickey, 2008).

Possible process of Prosthetic provisionIt is difficult to decide if an amputee is going to be a successful myo-electric wearer by general observation (Fillauer, 2008).He will be tested for myo-electric signals by placing the electrodes on biceps and triceps for flexion and extension of elbow respectively (Hudgins, Parker & Scott, 1993; Kelly, 2008).The contraction capabilities in these muscles will be analyzed by the amplitude of the signals (Salahi & Kohn, 1982).Pre-prosthetic training will be advised in mutual discussion with the physiotherapist, once it is confirmed that myo-electric prosthesis is to be used in order to ensure muscle conditioning, range of motion and muscle strength(Fillauer, 2008).Mr.X will be informed about the merits and demerits of prescribed prosthesis before taking measurements and negative impression from the stump. The patient will be evaluated with a trial fitting of a temporary prosthesis and also to confirm the best fitting of the socket (Fillauer, 2008).

Key barriers and solutionsThe human hand and arm are by nature so complex that replacing their functions with an ar tificial prosthetic device poses monumental problems(Sobotka, 2008).The myoelectric prosthesis is not usually recommended for patients involved in heavy work such as farming, timberwork or construction, however, they may find the myoelectric unit appropriate as a secondary unit(Sobotka, 2008).While all of the functions of a natural limb cannot be fully restored, a well-designed, upper-limb prosthesis can restore a patient's confidence and much of his or her job productivity(Sobotka, 2008).

One of the major inconveniences that Mr.X will face is the required battery system that needs certain level of maintenance, including charging, discharging, disposing and replacement (Dailami, 2008; Sobotka, 2008).Secondly, the weight also tends to be more than the other prosthetic options(Marrinek, et al. 2001). Moreover, the potential malfunctioning of the ar m results in costly repairs (Trost, 1986). Furthermore, the chronological control of myoelectric elbow unit is slow and aberrant (Meier III,

In this article I will discuss the possibility of hybrid prosthesis with myoelectric elbow and Voluntary opening terminal device and remedies to the key barriers associated with the use of this kind of prosthesis for Mr.X who is worried about his elbow flexion.

There are many prosthetic considerations that can be discussed in great detail while reviewing this patient's case study. I will highlight only those that help to determine the final prosthesis. The body powered prosthesis used by Mr.X, on one hand is of moderate weight and has high sensory feedback but require more gross limb movements for flexion of elbow and opening/closing of terminal device(Kelly, 2008).He lacks various functions like pronation/supination of forearm and different positioning of hand and elbow because of losing the anatomical elbow (hope.edu, 2006).The provision of myo-electric elbow aims to fulfill functionality, ease of operation, active motion of elbow and good appearance(Millistein, Herger, & Hunter, 1986; Galiano, L., Montaner, E., & Flecha, A. 2007; Berbrayer & Farraday, 1994).Moreover, a Sierra wrist flexion unit installed on constant friction unit will permit for variable angulations when patient's elbow range is limited and is also very important for various activities near the body midline, such as personal hygiene (Lehneis & Dickey, 2008).The choice of terminal device is body powered hook because of its versatile grasp and reliability while patient is already used to with it, however patient can interchange it with a hand when participating in leisure time activities (Lehneis & Dickey, 2008).

It is difficult to decide if an amputee is going to be a successful myo-electric wearer by general observation (Fillauer, 2008).He will be tested for myo-electric signals by placing the electrodes on biceps and triceps for flexion and extension of elbow respectively (Hudgins, Parker & Scott, 1993; Kelly, 2008).The contraction capabilities in these muscles will be analyzed by the amplitude of the signals (Salahi & Kohn, 1982).Pre-prosthetic training will be advised in mutual discussion with the physiotherapist, once it is confirmed that myo-electric prosthesis is to be used in order to ensure muscle conditioning, range of motion and muscle strength(Fillauer, 2008).Mr.X will be informed about the merits and demerits of prescribed prosthesis before taking measurements and negative impression from the stump. The patient will be evaluated with a trial fitting of a temporary prosthesis and also to confirm the best fitting of the socket (Fillauer, 2008).

The human hand and arm are by nature so complex that replacing their functions with an artificial prosthetic device poses monumental problems(Sobotka, 2008).The myoelectric prosthesis is not usually recommended for patients involved in heavy work such as farming, timberwork or construction, however, they may find the myoelectric unit appropriate as a secondary unit(Sobotka, 2008).While all of the functions of a natural limb cannot be fully restored, a well-designed, upper-limb prosthesis can restore a patient's confidence and much of his or her job productivity(Sobotka, 2008).

One of the major inconveniences that Mr.X will face is the required battery system that needs certain level of maintenance, including charging, discharging, disposing and replacement (Dailami, 2008; Sobotka, 2008).Secondly, the weight also tends to be more than the other prosthetic options(Marrinek, et al. 2001). Moreover, the potential malfunctioning of the ar m results in costly repairs (Trost, 1986). Furthermore, the chronological control of myoelectric elbow unit is slow and aberrant (Meier III,

Prosthetic requirements

Possible process of Prosthetic provision

Key barriers and solutions


Page 19

2004).It is also possible that videotape has raised the expectations of Mr.X to such a degree that he can become dissatisfied with his current prosthesis or prosthetist (Halacy, 1965; Webber, 2001).

To achieve success, the realistic goals and functions will be evaluated regularly during fitting process (Berbrayer & Farraday, 1994).Mr.X will be trained by specific expertise familiar with externally powered prostheses, EMG signals and adaptive devices(Spiegel, 1989; Herger, 1982). He will also be educated for the adeptly use of residual body parts and motions (Lehneis & Dickey, 2008).Moreover, he will be convinced that the videotape of amputee that he has seen on TV are special people who have wonderful talents and the idea that this option is available for everyday amputee is difficult (Hallacy, 1965; Webber, 2001).

Recommendations for ongoing treatmentA sound liaison is needed to be established among the members of multi disciplinary team about the functional performance of Mr.X with the prosthesis .He should be trained for controls (donning & doffing, control of motions), skills (prehension, manipulation, grasping, release) and functional activities (ADL, exceptional activities like wood work).The follow-up of the vocational counselor as relates to the Mr.X's job is recommended which is necessary for adaptations and general work setup. Finally, the treatment planning should be such that maximum independence is achieved with least amount of time, number of visits, energy expended and equipment necessary.

References

Berbrayer, D., & Farraday, W.T., (1994).Switch activated electrically controlled prosthesis following a closed head injury: A case study. Journal of prosthetics and orthotics, 6(2), 48-51.

Cyborg: evolution of the Superman by D.S. Halacy,Jr; Harper & Row, Publishers, New York, 1965.

Dailami, J., (2008). The Myoelectric Arm: It's Electrifying.

Fillauer, K. (2008).Upper extremity high level amputation and myoelectric prosthesis. Retrieved from http://www.fillauer.com/education/ED_myoelectric.html

Trost, F.J. (1986). Fitting Above-Elbow Amputees With Externally Powered prostheses. JACPOC, 21(3), 52.

Galiano, L., Montaner & Flecha, A. (2007). Research, Design & Development Project: Myoelectric th

prosthesis of upper limb. Journal of physics, Conference series 90, 16 Argentine Bioengineering th

Congress and the 5 conference of clinical engineering.

Graupe. D., salahi, J., & Kohn, K.H. (1982). Multifunction prosthesis and orthosis control via microcomputer identification of temporal pattern differences in single-site myoelectric signals. J Biomed Eng, 4, 17-22.

Herger, H. (1982). Adaptive devices for amputees and training for upper extremity amputees. In: Banerjee SN [edi: Rehabilitation management of amputees. Baltimore: Williams & Wilkins Co; 255-350.

2004).It is also possible that videotape has raised the expectations of Mr.X to such a degree that he can become dissatisfied with his current prosthesis or prosthetist (Halacy, 1965; Webber, 2001).

To achieve success, the realistic goals and functions will be evaluated regularly during fitting process (Berbrayer & Farraday, 1994).Mr.X will be trained by specific expertise familiar with externally powered prostheses, EMG signals and adaptive devices(Spiegel, 1989; Herger, 1982). He will also be educated for the adeptly use of residual body parts and motions (Lehneis & Dickey, 2008).Moreover, he will be convinced that the videotape of amputee that he has seen on TV are special people who have wonderful talents and the idea that this option is available for everyday amputee is difficult (Hallacy, 1965; Webber, 2001).

A sound liaison is needed to be established among the members of multi disciplinary team about the functional performance of Mr.X with the prosthesis .He should be trained for controls (donning & doffing, control of motions), skills (prehension, manipulation, grasping, release) and functional activities (ADL, exceptional activities like wood work).The follow-up of the vocational counselor as relates to the Mr.X's job is recommended which is necessary for adaptations and general work setup. Finally, the treatment planning should be such that maximum independence is achieved with least amount of time, number of visits, energy expended and equipment necessary.

Berbrayer, D., & Farraday, W.T., (1994).Switch activated electrically controlled prosthesis following a closed head injury: A case study. (2), 48-51.

Cyborg: evolution of the Superman by D.S. Halacy,Jr; Harper & Row, Publishers, New York, 1965.

Dailami, J., (2008). The Myoelectric Arm: It's Electrifying.

Fillauer, K. (2008).Upper extremity high level amputation and myoelectric prosthesis. Retrieved from

Trost, F.J. (1986). Fitting Above-Elbow Amputees With Externally Powered prostheses. (3), 52.

Galiano, L., Montaner & Flecha, A. (2007). Research, Design & Development Project: Myoelectric prosthesis of upper limb , Conference series 90, 16 Argentine Bioengineering Congress and the 5 conference of clinical engineering.

Graupe. D., salahi, J., & Kohn, K.H. (1982). Multifunction prosthesis and orthosis control via microcomputer identification of temporal pattern differences in single-site myoelectric signals.

, 17-22.

Herger, H. (1982). Adaptive devices for amputees and training for upper extremity amputees. In: Banerjee SN [edi: Rehabilitation management of amputees. Baltimore: Williams & Wilkins Co; 255-350.

Recommendations for ongoing treatment

References

Journal of prosthetics and orthotics, 6

JACPOC, 21

. Journal of physics

J Biomed Eng, 4

http://www.fillauer.com/education/ED_myoelectric.html

th

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Kelley, B.M., (2007). Upper Limb Prosthetics. Retrieved from mhtml:file://C:\Documents and Settings\Administrator\Desktop\eMedicine-Upper Limb P… 8/28/2008

Lehneis, H.R., & Dickey,R. (2008). Considerations: Fitting and Training the Bilateral Limb Amputee. Retrieved from www.google.com, dated 28/08/2008.

Marinic, (2001). The use of prosthesis for children with congenital deficiencies of upper limb. Assistive technology- Added value to the quality of life, IOS Press, 384-385.

Millistein, S.G., Herger,H., & Hunter, G.A. (1986). Prosthetic use in adult upper limb amputees: a comparison of body powered and electrically powered prostheses. Prosthetics Orthotics International, 10 , 2734.

Spiegel, S.R. (1989). Adult myo-electric upper limb prosthetic training. In Atkins, D.J., & Meier, R.H. [eds]. Comprehensive management of the upper limb amputee. New York: Springer Verlaq, 60-71.

Sabotka, R. (2008). The use of Myoelectric Control in Upper Extremity prostheses. Retrieved from www.google.com, dated 28/08/2008.

Upper-Extremity Prosthetics. New York, New York University, Post Graduate Medical School, Prosthetics and Orthotics.

Webber, P.T., (2001) “Great expectations” .Orthopedic Technology Review, January/February.

Kelley, B.M., (2007). Upper Limb Prosthetics. Retrieved from mhtml:file://C:\Documents and Settings\Administrator\Desktop\eMedicine-Upper Limb P… 8/28/2008

Lehneis, H.R., & Dickey,R. (2008). Considerations: Fitting and Training the Bilateral Limb Amputee. Retrieved from , dated 28/08/2008.

Marinic, (2001). The use of prosthesis for children with congenital deficiencies of upper limb. Assistive technology- Added value to the quality of life, IOS Press, 384-385.

Millistein, S.G., Herger,H., & Hunter, G.A. (1986). Prosthetic use in adult upper limb amputees: a comparison of body powered and electrically powered prostheses. , 2734.

Spiegel, S.R. (1989). Adult myo-electric upper limb prosthetic training. In Atkins, D.J., & Meier, R.H. [eds]. Comprehensive management of the upper limb amputee. New York: Springer Verlaq, 60-71.

Sabotka, R. (2008). The use of Myoelectric Control in Upper Extremity prostheses. Retrieved from , dated 28/08/2008.

Upper-Extremity Prosthetics. New York, New York University, Post Graduate Medical School, Prosthetics and Orthotics.

Webber, P.T., (2001) “Great expectations” . , January/February.

www.google.com

www.google.com

Prosthetics Orthotics International, 10

Orthopedic Technology Review


Page 21

By: Mr. SAJJAD HUSSAIN(Assistant Professor, PIPOS)

Introduction:It is possible for an orthopedist to rarely recommend insoles for resting faulty foot conditions and satisfy most of the clients, while it is also possible for another to seldom treat a single case of defective weight-bearing posture without the intervention of a rigid planter arch support (Osgood, 2008).

The significance of total-contact-insoles (TCIs) and metatarsal-pads (MPs) in abetting diseases like diabetes or peripheral neuropathy, saving the foot from planter sores, and unburdening the metatarsal heads when the peak-planter-pressure reaches up to 80% during push off phase (Chen, Ju & Tang, 2003; Mueller, Lott, Hastings, Commean, Smith & Pilgram, 2006).

With numerous abnormalities the forefoot is under severe body stress; orthotic management aims at redistributing weight-load onto the entire sole surface and relieving the overburdened metatarsal heads from pain and metatarsalgia such as in rheumatism (Batch & Carter, 1999; Jackson, Binning & Potter, 2004; Clark, Rome, Plant, O'Hare & Gray, 2005) (see figure 1).

Figure. 1. An orthosis that conforms perfectly to the plantar surface of the foot has the maximum surface contact with the foot; therefore minimum pressur e would be expected at each point under the foot.

Retrieved from http://www.podiatrym.com

Hitherto, no methods have compared the force effect in pre-made shoe-inserts and metatarsal pads in rheumatoid arthritis (RA), but the former can reduce metatarsal heads pressures efficiently (Jackson et al., 2004). Supplementary readings have looked into the consequences of metatarsal pads (MPs) on sole strains in healthy people to show effects varying from a 28% increase to a 60% decrease in pressure at over-roll area of forefoot (Mueller et al., 2006).

In this article I will explore the relative efficacy of the different orthotic techniques such as arch-supports, shoe-inserts, ankle-foot-orthoses and shoe modifications in relieving pressure on the metatarsal heads during gait.

By: Mr. SAJJAD HUSSAIN(Assistant Professor, PIPOS)

It is possible for an orthopedist to rarely recommend insoles for resting faulty foot conditions and satisfy most of the clients, while it is also possible for another to seldom treat a single case of defective weight-bearing posture without the intervention of a rigid planter arch support (Osgood, 2008).

The significance of total-contact-insoles (TCIs) and metatarsal-pads (MPs) in abetting diseases like diabetes or peripheral neuropathy, saving the foot from planter sores, and unburdening the metatarsal heads when the peak-planter-pressure reaches up to 80% during push off phase (Chen, Ju & Tang, 2003; Mueller, Lott, Hastings, Commean, Smith & Pilgram, 2006).

With numerous abnormalities the forefoot is under severe body stress; orthotic management aims at redistributing weight-load onto the entire sole surface and relieving the overburdened metatarsal heads from pain and metatarsalgia such as in rheumatism (Batch & Carter, 1999; Jackson, Binning & Potter, 2004; Clark, Rome, Plant, O'Hare & Gray, 2005) (see figure 1).

Hitherto, no methods have compared the force effect in pre-made shoe-inserts and metatarsal pads in rheumatoid arthritis (RA), but the former can reduce metatarsal heads pressures efficiently (Jackson et al., 2004). Supplementary readings have looked into the consequences of metatarsal pads (MPs) on sole strains in healthy people to show effects varying from a 28% increase to a 60% decrease in pressure at over-roll area of forefoot (Mueller et al., 2006).

In this article I will explore the relative efficacy of the different orthotic techniques such as arch-supports, shoe-inserts, ankle-foot-orthoses and shoe modifications in relieving pressure on the metatarsal heads during gait.

Introduction:

Figure. 1. An orthosis that conforms perfectly to the plantar surface of the foot has the maximum surface contact with the foot; therefore minimum pressure would be expected at each point under the foot.

Retrieved from http://www.podiatrym.com

Relative effectiveness of different orthotic techniquesused to relieve overloaded metatarsal heads

Relative effectiveness of different orthotic techniquesused to relieve overloaded metatarsal heads


Page 22

Biomechanics of the human foot:The medial-longitudinal-arch (MLA) is the main weight-baring structure of the foot that shifts the body weight forward onto the metatarsal heads (pushed against the floor) in the propulsive phase (Glasoe et al., 1999; Dyck & Boyajian, 2004; Schie, 2005) (see figure 2 below). The “planter plate”, which gives stability to the

Figure: 2. Hallux dorsiflexion coupled with plantar flexion of the first ray provides the first metatarsophalangeal joint with full range of motion at terminal stance. Adapted from Glasoe, Yack & Saltzman, 1999.

Importance of conservative treatment:In cerebrospinal disorders, rheumatoid arthritis (RA) and pescavovarus, the body's center-of-force translates antero-medially and pressure is exerted on the metatarsal heads where orthoses with supportive footwear can provide stability and correct mild cases of deformity (Shamp, 1990; Younger & Hansen, 2005; Magalhaes, Davitt, Filho, Battistella & Bertolo, 2005; Krause, Windolf, Schwieger & Weber, 2007). Stress fractures are common among sportsmen and armed forces personnel, with whom

ththe 5 metatarsal and the sesamoids of big toe are most frequently injured and require extensive conservative treatment (Boden & Osbahr, 2000). Obesity, elevated heel and oedema may shift the weight-line on forefoot, causing unequal distribution of body load over the metatarsals that can lead to metatarsalgia, bunions, neuromas, bursitis, and arthritis (Bottomley, 2000) (see figures 3 & 4 below).

metatarsophalangeal joint accentuates the undue pressure on metatarsal heads, requires conservative splintage after surgical treatment in more severe cases (Mainard, 1997).

Biomechanics of the human foot:

Importance of conservative treatment:

The medial-longitudinal-arch (MLA) is the main weight-baring structure of the foot that shifts the body weight forward onto the metatarsal heads (pushed against the floor) in the propulsive phase (Glasoe et al., 1999; Dyck & Boyajian, 2004; Schie, 2005) (see figure 2 below). The “planter plate”, which gives stability to the metatarsophalangeal joint accentuates the undue pressure on metatarsal heads, requires conservative splintage after surgical treatment in more severe cases (Mainard, 1997).

In cerebrospinal disorders, rheumatoid arthritis (RA) and pescavovarus, the body's center-of-force translates antero-medially and pressure is exerted on the metatarsal heads where orthoses with supportive footwear can provide stability and correct mild cases of deformity (Shamp, 1990; Younger & Hansen, 2005; Magalhaes, Davitt, Filho, Battistella & Bertolo, 2005; Krause, Windolf, Schwieger & Weber, 2007). Stress fractures are common among sportsmen and armed forces personnel, with whom the 5 metatarsal and the sesamoids of big toe are most frequently injured and require extensive conservative treatment (Boden & Osbahr, 2000). Obesity, elevated heel and oedema may shift the weight-line on forefoot, causing unequal distribution of body load over the metatarsals that can lead to metatarsalgia, bunions, neuromas, bursitis, and arthritis (Bottomley, 2000) (see figures 3 & 4 below).

Figure: 2. Hallux dorsiflexion coupled with plantar flexion of the first ray provides the first metatarsophalangeal joint with full range of motion at terminal stance. Adapted from Glasoe, Yack & Saltzman, 1999.

th


Page 23

Figure. 3. Pathologies related to metatarsal heads overloading. Retrieved on 4/19/08, from http://www.northcoastfootcare.com/footcare-info/foot-problems.html

ndFigure. 4. Metatarsalgia showing overweight 2 MPJs. Retrieved on 4/19/08, from

http://www.northcoastfootcare.com/footcare-info/foot-problems.html

Forefoot overloading:Extreme loading to the body can cause foot bones to adapt abnormally giving rise to pain and deformity where damage to one part will transfer stresses to other components thus causing the structure to fail (Davenport, Kulig, Matharu & Blanco, 2005). Unloading is essential for the healing process, while relieving pressure may be temporarily achieved by providing different weight reducing modalities consisting of walking splints, ankle-foot orthoses, total contact cast and removable or permanent cast walkers (Schie, 2005).

Reduction of pressure on planter surface by insoles:The outcome of custom-made insoles on plantar pressures and weight redistribution in neuropathic diabetics were more helpful than flat insoles in off-loading the first metatarsal head region, where these insoles successfully reduced pressures on first metatarsal head in 7/21 feet but with considerable variability between individuals (Bus, Ulbrect & Cavanagh, 2004).

Figure. 3. Pathologies related to metatarsal heads overloading. Retrieved on 4/19/08, from http://www.northcoastfootcare.com/footcare-info/foot-problems.html

ndFigure. 4. Metatarsalgia showing overweight 2 MPJs. Retrieved on 4/19/08, from

http://www.northcoastfootcare.com/footcare-info/foot-problems.html

Forefoot overloading:

Reduction of pressure on planter surface by insoles:

Extreme loading to the body can cause foot bones to adapt abnormally giving rise to pain and deformity where damage to one part will transfer stresses to other components thus causing the structure to fail (Davenport, Kulig, Matharu & Blanco, 2005). Unloading is essential for the healing process, while relieving pressure may be temporarily achieved by providing different weight reducing modalities consisting of walking splints, ankle-foot orthoses, total contact cast and removable or permanent cast walkers (Schie, 2005).

The outcome of custom-made insoles on plantar pressures and weight redistribution in neuropathic diabetics were more helpful than flat insoles in off-loading the first metatarsal head region, where these insoles successfully reduced pressures on first metatarsal head in 7/21 feet but with considerable variability between individuals (Bus, Ulbrect & Cavanagh, 2004).


Page 24

Readymade insoles of Dome and Bar-shaped metatarsal-pads, made of latex foam, considerably reduced pressure from 11.8% to 21.3% respectively as compared to shoes only where a bar metatarsal (MT) pad is used to control high stresses on MT heads in rheumatoid-arthritis (Jackson et al., 2004).

The peak-planter-pressure (PPP) and the pressure-time-integral (PTI), which reflects the magnitude of stress at a specific location over time, were 20% lower on average at the metatarsal heads in the total-contact-insoles (TCIs) as compared to shoes without insoles; while the load on metatarsal heads were reduced twice-over (40% average) with the addition of metatarsal pads (MPs) that increased the planter surface contact area (Mueller et al., 2006) (see table 1).

Table: 1. Mean % change in peak-planter pressure (TCI total-contact inserts, MP metatarsal pads)Adapted from Mueller et al., 2006.

The custom-made foot orthosis with a metatarsal dome (figure 5) was the most efficient out of the four FOs (prefabricated, standard custom moulded, custom with MT bar and custom FOs with a metatarsal dome) for minimizing metatarsalgia pain in rheumatoid arthritis (RA) (Hodge, Batch & Carter, 1999) (figure 6 & 7).

Figure. 5. Metatarsal pad/ dome. Retrieved on 05/13/2008, from http://tobiasmayer.com/birk_style

Figure. 6. A custom moulded soft arch-support. Retrieved on05/13/2008, from htt p://tobiasmayer.com/birk_style

Readymade insoles of Dome and Bar-shaped metatarsal-pads, made of latex foam, considerably reduced pressure from 11.8% to 21.3% respectively as compared to shoes only where a bar metatarsal (MT) pad is used to control high stresses on MT heads in rheumatoid-arthritis (Jackson et al., 2004).

The peak-planter-pressure (PPP) and the pressure-time-integral (PTI), which reflects the magnitude of stress at a specific location over time, were 20% lower on average at the metatarsal heads in the total-contact-insoles (TCIs) as compared to shoes without insoles; while the load on metatarsal heads were reduced twice-over (40% average) with the addition of metatarsal pads (MPs) that increased the planter surface contact area (Mueller et al., 2006) (see table 1).

The custom-made foot orthosis with a metatarsal dome (figure 5) was the most efficient out of the four FOs (prefabricated, standard custom moulded, custom with MT bar and custom FOs with a metatarsal dome) for minimizing metatarsalgia pain in rheumatoid arthritis (RA) (Hodge, Batch & Carter, 1999) (figure 6 & 7).

Table: 1. Mean % change in peak-planter pressure (TCI total-contact inserts, MP metatarsal pads)Adapted from Mueller et al., 2006.

Figure. 5. Metatarsal pad/ dome. Retrieved on 05/13/2008, from

Figure. 6. A custom moulded soft arch-support. Retrieved on05/13/2008, from

http://tobiasmayer.com/birk_style

http://tobiasmayer.com/birk_style


Page 25

Figure. 7. A soft, flexible insole. Adapted from http://www.mortonsfoot.com/faq.html (accessed on 05/20/2008).

Effectiveness of foot-orthoses (FOs) in diabetes & RA:Custom-made or prefabricated metatarsal-pads mitigate compressive forces by compacting soft tissues proximal to metatarsal heads at metatarsal shafts, helping the orthosis to alleviate undue planter pressures; especially in cases of diabetic and peripheral neuropathic subjects suffering skin trauma in the forefoot (Mueller et al., 2006; Clark et al., 2006).

An effective treatment for RA with metatarsalgia is a semi-rigid foot orthosis of plastazote and modified shoes used to support joints, relieve pressure on the forefoot, distribute weight-load onto the planter surface and provide stability; although pain during gait in some minor cases may still be prevalent due to toe movements (Magalhaes et al., 2005; Davenport et al., 2005).

Types of shoe inserts:Foot orthoses (FOs) are available readymade, custom moulded, as custom metatarsal bars and as custom metatarsal domes, fitted in orthopedic shoes with special systems employed to compute planter pressure during various stages of the gait, all of which can provide comfort to the subject's forefoot (Batch & Carter, 1999) (see figure 6 & 7 above).

Role of FOs:In splay-feet (reduced transversal arch) pathologies, the application of soft resilient insole aims at dispensing the load over full sole surface where open well fit shoe- wares with little heel height along with foot orthoses preventing the metatarsal heads from ulceric injuries (Bottomley, 2000) (see figure 8).

Figure. 8. Metatarsal pad relieves the ball of forefoot.Adapted from http://www.healthyfeetstore.com/gel-metatarsal-pad.html (accessed on 05/13/2008).

Figure. 7. A soft, flexible insole. Adapted from http://www.mortonsfoot.com/faq.html (accessed on 05/20/2008).

Figure. 8. Metatarsal pad relieves the ball of forefoot.Adapted from http://www.healthyfeetstore.com/gel-metatarsal-pad.html (accessed on 05/13/2008).

Effectiveness of foot-orthoses (FOs) in diabetes & RA:

Types of shoe inserts:

Role of FOs:

Custom-made or prefabricated metatarsal-pads mitigate compressive forces by compacting soft tissues proximal to metatarsal heads at metatarsal shafts, helping the orthosis to alleviate undue planter pressures; especially in cases of diabetic and peripheral neuropathic subjects suffering skin trauma in the forefoot (Mueller et al., 2006; Clark et al., 2006).

An effective treatment for RA with metatarsalgia is a semi-rigid foot orthosis of plastazote and modified shoes used to support joints, relieve pressure on the forefoot, distribute weight-load onto the planter surface and provide stability; although pain during gait in some minor cases may still be prevalent due to toe movements (Magalhaes et al., 2005; Davenport et al., 2005).

Foot orthoses (FOs) are available readymade, custom moulded, as custom metatarsal bars and as custom metatarsal domes, fitted in orthopedic shoes with special systems employed to compute planter pressure during various stages of the gait, all of which can provide comfort to the subject's forefoot (Batch & Carter, 1999) (see figure 6 & 7 above).

In splay-feet (reduced transversal arch) pathologies, the application of soft resilient insole aims at dispensing the load over full sole surface where open well fit shoe- wares with little heel height along with foot orthoses preventing the metatarsal heads from ulceric injuries (Bottomley, 2000) (see figure 8).


Page 26

A stiff UCBL (University of California Biomechanics Laboratory) foot orthosis will impede compensatory movements of the foot which is necessary to relieving pressure under the metatarsals where flexible FOs allow easier acceptance during ambulation (Bowman, 1997).

The pronation control foot orthosis (PCFO) is fabricated by taking a cast of the foot with the patient in a sitting position (Bowman, 1997).

Manual pressure is supplied to keep the foot in neutral alignment and during cast rectification plaster is removed from the longitudinal arches and added at metatarsal heads to give relief and support to the foot (Bowman, 1997).

Trimlines are designed primarily to allow flexibility in the orthosis and are based on removal of material from posterior, medial and lateral areas where no pressure is needed, to ensure flexibility in all three planes (Bowman, 1997) (see figures 9, 10, 11 & 12).

Figure. 9. Plaster removal: plantar aspect. Retrieved from Bowman, 1997.

Figure. 10. Medial view of the PCFO. Retrieved from Bowman, 1997.

Figure. 11. Lateral view of the PCFO. Adapted from Bowman, 1997.

A stiff UCBL (University of California Biomechanics Laboratory) foot orthosis will impede compensatory movements of the foot which is necessary to relieving pressure under the metatarsals where flexible FOs allow easier acceptance during ambulation (Bowman, 1997).

The pronation control foot orthosis (PCFO) is fabricated by taking a cast of the foot with the patient in a sitting position (Bowman, 1997).

Manual pressure is supplied to keep the foot in neutral alignment and during cast rectification plaster is removed from the longitudinal arches and added at metatarsal heads to give relief and support to the foot (Bowman, 1997).

Trimlines are designed primarily to allow flexibility in the orthosis and are based on removal of material from posterior, medial and lateral areas where no pressure is needed, to ensure flexibility in all three planes (Bowman, 1997) (see figures 9, 10, 11 & 12).

Figure. 9. Plaster removal: plantar aspect. Retrieved from Bowman, 1997.

Figure. 10. Medial view of the PCFO. Retrieved from Bowman, 1997.

Figure. 11. Lateral view of the PCFO. Adapted from Bowman, 1997.


Page 27

Figure. 12 . The PCFO made of polypropylene. Retrieved from Bowman, 1997.

Effectiveness of Total Contact Cast (AFOs):The fiberglass Total-Contact-Cast (TCC) ankle-foot orthosis keeps the full planter surface of the foot and leg in contact with orthosis, minimizing weight-load by transmitting weight along the wall of the appliance and accommodates the client's personal sense of comfort (Schie, 2005; Mueller, Lott, Hastings, Commean, Smith & Pilgram, 2006).

The most primitive methods used to endorse healing of the neuropathic planter foot ulcers were the application of plaster of paris total-contact casts to ease pinpoint pressure, to immobilize the toe joints and conserve ambulation (Novic, Birke, Graham & Koziatek, 1991).

The plaster of paris (POP) casts were mostly unaccepted by the attendants, so alternative methods were adopted such as customized footwear, posterior walking splints, rocker shoes and patellar-tendon-bearing

st rd thorthoses to reduce pressure under the 1 ,3 and 5 metatarsal heads with the use of padding (Novic et al., 1991; Luca & Ezio, 2006). The innovation in foot-wear designs with the attainment of new advanced materials and technologies for fabrication of the devices like rubber, silicon, plastics, leather shoe has proven to be clinically effective in the healing of planter lesions to reduce planter forces efficiently (Novic et al., 1991) ( see figure 13) .

Figure. 13. Total contact cast with the cast boot (TCCI CB). Adapted from Novic et al., 1991.

Figure. 12 . The PCFO made of polypropylene. Retrieved from Bowman, 1997.

Figure. 13. Total contact cast with the cast boot (TCCI CB). Adapted from Novic et al., 1991

Effectiveness of Total Contact Cast (AFOs):The fiberglass Total-Contact-Cast (TCC) ankle-foot orthosis keeps the full planter surface of the foot and leg in contact with orthosis, minimizing weight-load by transmitting weight along the wall of the appliance and accommodates the client's personal sense of comfort (Schie, 2005; Mueller, Lott, Hastings, Commean, Smith & Pilgram, 2006).

The most primitive methods used to endorse healing of the neuropathic planter foot ulcers were the application of plaster of paris total-contact casts to ease pinpoint pressure, to immobilize the toe joints and conserve ambulation (Novic, Birke, Graham & Koziatek, 1991).

The plaster of paris (POP) casts were mostly unaccepted by the attendants, so alternative methods were adopted such as customized footwear, posterior walking splints, rocker shoes and patellar-tendon-bearing orthoses to reduce pressure under the 1 ,3 and 5 metatarsal heads with the use of padding (Novic et al., 1991; Luca & Ezio, 2006). The innovation in foot-wear designs with the attainment of new advanced materials and technologies for fabrication of the devices like rubber, silicon, plastics, leather shoe has proven to be clinically effective in the healing of planter lesions to reduce planter forces efficiently (Novic et al., 1991) ( see figure 13) .

.

st rd th


Page 28

According to Duncan's multiple range tests there were significant differences of forces measured in three treatment conditions; total-contact-cast with cast boot (TTC/CB), total-contact-cast with walking heel (TTC/WH) and splint, demonstrating a greater reduction in percentage of forces on the metatarsal heads in comparison to shoe types (Novick et al., 1991) ( see in figure 14 below).

Figure. 14. Plantar view showing percentage of mean force compared to the Shoe (Duncan's multiple test). Adapted from Novic et al., 1991.

Shoe modification:Footwear can provide different combinations of structural and material designs of pressure distribution on soles, for which the custom-moulded shape was found to be the most effective design in subsiding excess stress on the forefoot (Cheung & Zhang, 2008).

The therapeutic footwear and custom-made orthotic devices reduced pressure and soft tissue strain at the second ray of the foot where these two variables were strongly related in the healing of the tissue strain, distributing plantar forces and improving the design of orthotic devices (Lott, Hastings, Commean, Smith, Pilgram & Mueller, 2007).

A shoe functions as an orthosis by affecting minor changes, such as by reducing heel-height and lowering nd

pressure on the metatarsals; a sesamoid-stand, for example, shields the 2 metatarsal head from extreme load and, together with the metatarsal-bar, transfers weight-bearing stress to the rear of the foot (Edelstein, 1987). A “Healthy”, or orthopedic, shoe serves to protect the foot planter surface, reduces stress, provides support, acts as a buffer to absorb the ground reaction forces; and with a soft sole works as a toe-rocker for the metatarsophalangeal hyperextension during the terminal stance and pres-wing phases of gait (Bottomley, 2000).

A perfectly new postoperative altered rigid shoe might be easy to wear and guard the foot during recovery from surgery or injury while a hard sole and rocker bottom reduces climax stresses considerably on the forefoot by approximately 20% (Fuller, Schroeder & Edwards, 2001).

Conclusion:Few periodicals have explored the comparative efficacy of the various designs to date, and no studies have

ndinspected the relationship between planter pressure and 2 metatarsal head pain in R.A (Hodge et al., 1999).

According to Duncan's multiple range tests there were significant differences of forces measured in three treatment conditions; total-contact-cast with cast boot (TTC/CB), total-contact-cast with walking heel (TTC/WH) and splint, demonstrating a greater reduction in percentage of forces on the metatarsal heads in comparison to shoe types (Novick et al., 1991) ( see in figure 14 below).

Footwear can provide different combinations of structural and material designs of pressure distribution on soles, for which the custom-moulded shape was found to be the most effective design in subsiding excess stress on the forefoot (Cheung & Zhang, 2008).

The therapeutic footwear and custom-made orthotic devices reduced pressure and soft tissue strain at the second ray of the foot where these two variables were strongly related in the healing of the tissue strain, distributing plantar forces and improving the design of orthotic devices (Lott, Hastings, Commean, Smith, Pilgram & Mueller, 2007).

A shoe functions as an orthosis by affecting minor changes, such as by reducing heel-height and lowering pressure on the metatarsals; a sesamoid-stand, for example, shields the 2 metatarsal head from extreme load and, together with the metatarsal-bar, transfers weight-bearing stress to the rear of the foot (Edelstein, 1987). A “Healthy”, or orthopedic, shoe serves to protect the foot planter surface, reduces stress, provides support, acts as a buffer to absorb the ground reaction forces; and with a soft sole works as a toe-rocker for the metatarsophalangeal hyperextension during the terminal stance and pres-wing phases of gait (Bottomley, 2000).

A perfectly new postoperative altered rigid shoe might be easy to wear and guard the foot during recovery from surgery or injury while a hard sole and rocker bottom reduces climax stresses considerably on the forefoot by approximately 20% (Fuller, Schroeder & Edwards, 2001).

Few periodicals have explored the comparative efficacy of the various designs to date, and no studies have inspected the relationship between planter pressure and 2 metatarsal head pain in R.A (Hodge et al., 1999).

Figure. 14. Plantar view showing percentage of mean force compared to the Shoe (Duncan's multiple test). Adapted from Novic et al., 1991.

Shoe modification:

Conclusion:

nd

nd


Page 29

The principal aims of conservative care, therapeutic footwear and orthotic devices are to protect the foot from further deformities and from extreme planter stresses during walking that may lead to serious injuries in certain neurovascular diseases such as ulcers and skin lesions deformities (Mueller et al., 2006; Clark et al., 2006).

The speculation behind both the total-contact inserts and the metatarsal pads is its significance and preservative outcome in easing the stresses under the metatarsal heads as compared with normal footwear only (Chen et al., 2003; Mueller et al., 2006).

Even though it is believed that the footwear is useful in protecting the foot from ground forces, there is space for advancement in shielding the foot with orthopaedic shoe-wears (Fuller et al., 2001).

Additional research is needed to elucidate the effectiveness and mechanism of total-contact-inserts and metatarsal pads concerning weight distribution on the sole of the foot and to assess various materials for orthosis production, as well as present extra proof of the usefulness of FOs and provide grounds for their improvement (Magalhaes et al., 2005; Mueller et al., 2006 ).

References:

Bach, T.M., & Carter, G.M. (1999). Orthotic management of planter pressure and pain in rheumatoid arthritis. Clinical Biomechanics, 14(8), 567-575.

Boden, B.P., & Osbahr, D.C. (2000). High-Risk Stress Fractures: Evaluation and Treatment. The Journal of the American Academy of Orthopaedic Surgeons, 8(6), 344-353.

Bottomley, J. M. (2000). Footwear: foundation for lower extremity orthotics. In Lusardi, M., & Neilson, C. (Eds.), Orthotics and Prosthetics in rehabilitation. (pp 112-120). U.S.A: Butterworth-Heinemann.

Bowman, G.D. (1997). New Concepts in Orthotic Management of the Adult Hyperpronated Foot: Preliminary Findings, Journal of Prosthetics & Orthotics, 2(1), 14-32.

Bus, S.A., Ulbrecht, J.S., & Cavanagh, P.R. (2004). Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity. Clinical Biomechanics, 19(6), 629-638.

Chen, W.P., Ju, C.W., & Tang, F.T. (2003). Effects of total contact insoles on the planter stress redistribution: a finite element analysis. Clinical Biomechanics, 18, S17-S24.

Cheung, J.T., & Zhang, M. (2008). Parametric design of pressure-relieving foot orthosis using statistics-based finite element method. Medical Engineering & Physics, 30(3), 269-277.

Clark, H., Rome, K., Plant, M., O'Hare, K & Gray, J. (2006). A critical review of foot orthoses in the rheumatoid arthritic foot. Oxford Journals, 45(2), 139-145.

Davenport, T.E., Kulig, K., Matharu, Y., & Blanco, C.E. (2005). The EdUReP Model for Nonsurgical Management of Tendinopathy. Physical Therapy Journal, 85(10), 1093-1103.

Dyck, D.D., & Boyajian, L.A. (2004). Plantar Fasciitis. Clinical Journal of Sports Medicine, 14(5), 305-309.

The principal aims of conservative care, therapeutic footwear and orthotic devices are to protect the foot from further deformities and from extreme planter stresses during walking that may lead to serious injuries in certain neurovascular diseases such as ulcers and skin lesions deformities (Mueller et al., 2006; Clark et al., 2006).

The speculation behind both the total-contact inserts and the metatarsal pads is its significance and preservative outcome in easing the stresses under the metatarsal heads as compared with normal footwear only (Chen et al., 2003; Mueller et al., 2006).

Even though it is believed that the footwear is useful in protecting the foot from ground forces, there is space for advancement in shielding the foot with orthopaedic shoe-wears (Fuller et al., 2001).

Additional research is needed to elucidate the effectiveness and mechanism of total-contact-inserts and metatarsal pads concerning weight distribution on the sole of the foot and to assess various materials for orthosis production, as well as present extra proof of the usefulness of FOs and provide grounds for their improvement (Magalhaes et al., 2005; Mueller et al., 2006 ).

Bach, T.M., & Carter, G.M. (1999). Orthotic management of planter pressure and pain in rheumatoid arthritis. (8), 567-575.

Boden, B.P., & Osbahr, D.C. (2000). High-Risk Stress Fractures: Evaluation and Treatment. (6), 344-353.

Bottomley, J. M. (2000). Footwear: foundation for lower extremity orthotics. In Lusardi, M., & Neilson, C. (Eds.), U.S.A: Butterworth-Heinemann.

Bowman, G.D. (1997). New Concepts in Orthotic Management of the Adult Hyperpronated Foot: Preliminary Findings, (1), 14-32.

Bus, S.A., Ulbrecht, J.S., & Cavanagh, P.R. (2004). Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity. (6), 629-638.

Chen, W.P., Ju, C.W., & Tang, F.T. (2003). Effects of total contact insoles on the planter stress redistribution: a finite element analysis. , S17-S24.

Cheung, J.T., & Zhang, M. (2008). Parametric design of pressure-relieving foot orthosis using statistics-based finite element method. (3), 269-277.

Clark, H., Rome, K., Plant, M., O'Hare, K & Gray, J. (2006). A critical review of foot orthoses in the rheumatoid arthritic foot. Oxford (2), 139-145.

Davenport, T.E., Kulig, K., Matharu, Y., & Blanco, C.E. (2005). The EdUReP Model for Nonsurgical Management of Tendinopathy. (10), 1093-1103.

Dyck, D.D., & Boyajian, L.A. (2004). Plantar Fasciitis. (5), 305-309.

References:

Clinical Biomechanics, 14

The Journal of the American Academy of Orthopaedic Surgeons, 8

Orthotics and Prosthetics in rehabilitation. (pp 112-120).

Journal of Prosthetics & Orthotics, 2



Medical Engineering & Physics, 30

Journals, 45

Physical Therapy Journal, 85

Clinical Journal of Sports Medicine, 14


Page 30

Edelstein, J.E. (1987). If the Shoe Fits: Footwear Considerations for the Elderly. Physical and Occupational Therapy in Geriatrics, 5(4), 1-16.

Fuller, E., Schroeder, S., & Edwards, J. (2001). Reduction of Peak Pressure on the Forefoot with a Rigid Rocker-Bottom Postoperative Shoe. Journal of the American Podiatric Medical Association, 91(10), 501-507. Glasoe, W.M., Yack, H.J., & Saltzman, C.L. (1999). Anatomy and Biomechanics of the First ray. Physical Therapy Journal, 79(9), 854-859.

Hodge, M.C., Batch, T.M., & Carter, G.M. (1999). Orthotic management of planter pressure and pain in rheumatoid arthritis. Clinical Biomechanics, 14(8), 567-575.

Jackson, L., Binning, J., & Potter, J. (2004). Planter Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal Padding. Journal of the American Podiatric Medical Association, 94(3), 239-245.

Krause, F., Windolf, M., Schwieger, F., & Weber, M. (2007). Ankle joint pressure in pes cavovarus. The Journal of bone & Joint Surgery, 89(12), 1660-1665.

Lott, D.J., Hastings, M.K., Commean, P.K., Smith, K.E., Pilgram, T.K., & Mueller, M.J., (2007). Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot. Clinical Biomechanics, 22(3), 352-359.

Luca, D.P., & Ezio, F. (2006). Treatment of Diabetic Foot Ulcer: An overview strategies for clinical approach. Bentham Science Publication, 2(4), 431-447

Magalhaes, E.P., Davitt, M., Filho, D.J., Battistella, L.R., & Bertolo, M.B. (2005). The effect of foot orthoses in rheumatoid arthritis. Oxford Journal, 45(4), 449-453.

Mainard, D. (1997). The second ray syndrome: detailed pathological, clinical and therapeutic aspects. European Journal of Orthopaedic Surger y & Traumatology, 7(3), 159-164.

Mueller, M.J., Lott, D.J., Hastings, M.K., Commean, P.K., Smith, K.E., & Pilgram, T.K. (2006). Efficacy and Mechanism of Orthotic Devices to Unload Metatarsal Heads in People With Diabetes and a History of Planter Ulcers. Physical Therapy, 86(6), 833-842.

Novick, A., Birke, J.A., Graham, S.L., & Koziatek, E. (1991). Effect of a Walking Splint and Total Contact Casts on Planter Forces. Journal of Prosthetics & Orthotics, 3(4), 168-176.

Osgood, R.B. (2008). The treatment of faulty weight-bearing in “weak” and “flat” feet. Journal of Bone & Joint Surgery, 2(4), 137-149.

Phillips, R.D. (2006). Podiatry Management. Retrieved on: 05/20/2008, from http://www.podiatrym.com

Schie, V. (2005). A review of the biomechanics of the diabetic foot. International Journal of Lower Extremity Wounds, 4(3), 160-174.

Shamp, J.K. (1990). Neurophysiologic Orthotic Designs in the Treatment of Central Nervous System Disorders. Journal of Prosthetics, 2(1), 14-32.

Younger, S.E., & Hansen, S.T. (2005). Adult Cavovarus Foot. The Journal of the American Academy of Orthopaedic Surgeons, 13(5), 302-315.

Edelstein, J.E. (1987). If the Shoe Fits: Footwear Considerations for the Elderly. Physical and Occupational Therapy in Geriatrics, 5(4), 1-16.

Fuller, E., Schroeder, S., & Edwards, J. (2001). Reduction of Peak Pressure on the Forefoot with a Rigid Rocker-Bottom Postoperative Shoe. Journal of the American Podiatric Medical Association, 91(10), 501-507. Glasoe, W.M., Yack, H.J., & Saltzman, C.L. (1999). Anatomy and Biomechanics of the First ray. Physical Therapy Journal, 79(9), 854-859.

Hodge, M.C., Batch, T.M., & Carter, G.M. (1999). Orthotic management of planter pressure and pain in rheumatoid arthritis. Clinical Biomechanics, 14(8), 567-575.

Jackson, L., Binning, J., & Potter, J. (2004). Planter Pressures in Rheumatoid Arthritis Using Prefabricated Metatarsal Padding. Journal of the American Podiatric Medical Association, 94(3), 239-245.

Krause, F., Windolf, M., Schwieger, F., & Weber, M. (2007). Ankle joint pressure in pes cavovarus. The Journal of bone & Joint Surgery, 89(12), 1660-1665.

Lott, D.J., Hastings, M.K., Commean, P.K., Smith, K.E., Pilgram, T.K., & Mueller, M.J., (2007). Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot. Clinical Biomechanics, 22(3), 352-359.

Luca, D.P., & Ezio, F. (2006). Treatment of Diabetic Foot Ulcer: An overview strategies for clinical approach. Bentham Science Publication, 2(4), 431-447

Magalhaes, E.P., Davitt, M., Filho, D.J., Battistella, L.R., & Bertolo, M.B. (2005). The effect of foot orthoses in rheumatoid arthritis. Oxford Journal, 45(4), 449-453.

Mainard, D. (1997). The second ray syndrome: detailed pathological, clinical and therapeutic aspects. European Journal of Orthopaedic Surger y & Traumatology, 7(3), 159-164.

Mueller, M.J., Lott, D.J., Hastings, M.K., Commean, P.K., Smith, K.E., & Pilgram, T.K. (2006). Efficacy and Mechanism of Orthotic Devices to Unload Metatarsal Heads in People With Diabetes and a History of Planter Ulcers. Physical Therapy, 86(6), 833-842.

Novick, A., Birke, J.A., Graham, S.L., & Koziatek, E. (1991). Effect of a Walking Splint and Total Contact Casts on Planter Forces. Journal of Prosthetics & Orthotics, 3(4), 168-176.

Osgood, R.B. (2008). The treatment of faulty weight-bearing in “weak” and “flat” feet. Journal of Bone & Joint Surgery, 2(4), 137-149.

Phillips, R.D. (2006). Podiatry Management. Retrieved on: 05/20/2008, from

Schie, V. (2005). A review of the biomechanics of the diabetic foot. International Journal of Lower Extremity Wounds, 4(3), 160-174.

Shamp, J.K. (1990). Neurophysiologic Orthotic Designs in the Treatment of Central Nervous System Disorders. Journal of Prosthetics, 2(1), 14-32.

Younger, S.E., & Hansen, S.T. (2005). Adult Cavovarus Foot. The Journal of the American Academy of Orthopaedic Surgeons, 13(5), 302-315.

http://www.podiatrym.com

Studen

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Page 32

The Less You

Know, The

More You Make

“Salary Theorem” states that “Engineers and Scientists can never earn as much as Business Executives and Sales People.”

This theorem can now be supported by a mathematical equation based on the following two postulates:

1. Knowledge is Power.2. Time is Money.

As every engineer knows:Power = Work / Time

Since:Knowledge = PowerTime = Money

It follows that:Knowledge = Work/Money.

Solving for Money, we get:Money = Work / Knowledge.

Thus, as Knowledge approaches zero, Money approaches infinity, regardless of the amount of work done.

Conclusion:The less you know,the more you make.

By: Syed Abdul Haqth

Semester 6

“Salary Theorem” states that “Engineers and Scientists can never earn as much as Business Executives and Sales People.”

This theorem can now be supported by a mathematical equation based on the following two postulates:

1. Knowledge is Power.2. Time is Money.

As every engineer knows:Power = Work / Time

Since:Knowledge = PowerTime = Money

It follows that:Knowledge = Work/Money.

Solving for Money, we get:Money = Work / Knowledge.

Thus, as Knowledge approaches zero, Money approaches infinity, regardless of the amount of work done.

:The less you know,the more you make.Conclusion

By: Syed Abdul Haqth

Semester 6

Amazing

Anonymous

Quotes“A strong positive mental attitude will create more miracles than any wonder drug.”

“One moment of patience may ward off great disaster.One moment of impatience may ruin a whole life.”

“Patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish.”

“Darkness cannot drive out darkness; only light can do that.Hate cannot drive out hate; only love can do that.”

“Love is the condition in which the happiness of another person is essential to your own.”

“Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.”

“He that is good for making excuses is seldom good for anything else.”

“Happiness is the only good. The time to be happy is now. The place to be happy is here. The way to be happy is to make others so.”

“Anger and intolerance are the twin enemiesof correct understanding.”

“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.”

By: Anum IshtiaqthSemester 6

“A strong positive mental attitude will create more miracles than any wonder drug.”

“One moment of patience may ward off great disaster.One moment of impatience may ruin a whole life.”

“Patience and perseverance have a magical effect before which difficulties disappear and obstacles vanish.”

“Darkness cannot drive out darkness; only light can do that.Hate cannot drive out hate; only love can do that.”

“Love is the condition in which the happiness of another person is essential to your own.”

“Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful.”

“He that is good for making excuses is seldom good for anything else.”

“Happiness is the only good. The time to be happy is now. The place to be happy is here. The way to be happy is to make others so.”

“Anger and intolerance are the twin enemiesof correct understanding.”

“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.”

By: Anum IshtiaqthSemester 6


Page 33

Long time ago, there was huge tree Use my trunk to make your boat, the tree said “you can It loved a little boy very much. The boy loved to come sail far away and be happy”and play around it So the man cut the tree trunk to make his boat. He went He climbed to the tree top, ate apples, take a nap under sailing and never showed up for a long timeits shadows The tree was happy, but it was not trueHe loved the tree, the tree was so happy Finally, the man returned after many years. “Sorry my Time went by… boy, But I do not have anything more for you, no more After some time, the boy came back to the tree apples for you…” the tree said.The tree said “come and play with me” “no problem I do not have teeth to bite them” the man He said “I am no longer a kid; I do not play around a repliedtree anymore” “I really cannot give you anything…the only thing left is I want toys; I need money to buy them my drying roots” the tree said with tearsSorry but I don't have money, but you can take all my “I do not need much now, just a place to rest. I am tired apples and sell them, so you will have money after all these years”, the man repliedThe boy was so excited; he grabbed all the apples on the “Good, old tree roots are the best place to lean and rest. tree and left happily. Come, come sit down with me and restThe tree was happy…. The man sat down and the tree was glad and smiled The boy never came back after he picked the apples with tearsThe tree was very sad

EVERYBODY HAS AN APPLE TREE IN One day, the boy who now turned into a man returned. HIS LIFE. AND THEY ARE YOUR The tree was excited “come and play around me”PARENTSI don't have time to play. I have to work for my family.

We need a house for shelter. Can you help me?No matter how busy you are…share some time with your

“sorry, but I don't have houses, but you can cut my parents

branches to build your house”So the man cut all the branches of the tree and left happily.The tree was glad to see him happy but he never came back since.The tree was again lonely and sad.One hot summer day, the man returned and the tree was delighted. “Come and play with me”, the tree said.“I am getting old. I want to go sailing to relax myself, can you give a boat”, Said the man

Long time ago, there was huge tree Use my trunk to make your boat, the tree said “you can It loved a little boy very much. The boy loved to come sail far away and be happy”and play around it So the man cut the tree trunk to make his boat. He went He climbed to the tree top, ate apples, take a nap under sailing and never showed up for a long timeits shadows The tree was happy, but it was not trueHe loved the tree, the tree was so happy Finally, the man returned after many years. “Sorry my Time went by… boy, But I do not have anything more for you, no more After some time, the boy came back to the tree apples for you…” the tree said.The tree said “come and play with me” “no problem I do not have teeth to bite them” the man He said “I am no longer a kid; I do not play around a repliedtree anymore” “I really cannot give you anything…the only thing left is I want toys; I need money to buy them my drying roots” the tree said with tearsSorry but I don't have money, but you can take all my “I do not need much now, just a place to rest. I am tired apples and sell them, so you will have money after all these years”, the man repliedThe boy was so excited; he grabbed all the apples on the “Good, old tree roots are the best place to lean and rest. tree and left happily. Come, come sit down with me and restThe tree was happy…. The man sat down and the tree was glad and smiled The boy never came back after he picked the apples with tearsThe tree was very sadOne day, the boy who now turned into a man returned. The tree was excited “come and play around me”I don't have time to play. I have to work for my family. We need a house for shelter. Can you help me?

No matter how busy you are…share some time with your “sorry, but I don't have houses, but you can cut my

parentsbranches to build your house”So the man cut all the branches of the tree and left happily.The tree was glad to see him happy but he never came back since.The tree was again lonely and sad.One hot summer day, the man returned and the tree was delighted. “Come and play with me”, the tree said.“I am getting old. I want to go sailing to relax myself, can you give a boat”, Said the man

EVERYBODY HAS AN APPLE TREE IN HIS LIFE. AND THEY ARE YOUR PARENTS

The Boy and The Apple TreeThe Boy and The Apple TreeBy: Muhammad Usman

Semester 4thBy: Muhammad Usman

Semester 4th

1. Answer the phone by left ear. 5. Motion creates positive emotions. Try to do 2. Do not take medicine with cold water. some type of activity you enjoy daily. Exercise 3. Think about the time when you were really at least 3 times a week. Pick something that you

happy. enjoy doing. 4. When mobile battery is down on the last bar do 6. For losing weight eat six small meals a day.

not answer the phone as the radiation is 1000 7. Eat plenty of fresh fruits and vegetables.times stronger.

1. Answer the phone by left ear. 5. Motion creates positive emotions. Try to do 2. Do not take medicine with cold water. some type of activity you enjoy daily. Exercise 3. Think about the time when you were really at least 3 times a week. Pick something that you

happy. enjoy doing. 4. When mobile battery is down on the last bar do 6. For losing weight eat six small meals a day.

not answer the phone as the radiation is 1000 7. Eat plenty of fresh fruits and vegetables.times stronger.

Quick Health TipsBy: Najla habib

rdSemester 3

By: Najla habibrd

Semester 3


Page 34

Try to answer these questions… ……. 13) If corn oil is made from corn, and vegetable oil is made from vegetables, then what is baby oil 1) If all the nations in the world are in debt(am not made from? (No comments)joking. even US has got debts), where did all the

14) What should one call a male ladybird? (No money go? (weird) comments) 2) When dog food is new and improved tasting,

15) If a person suffered from amnesia and then was who tests it? (give a thought) cured would they remember that they forgot? 3) What is the speed of darkness? (absurd)(can somebody help ) 4) If the “black box” flight recorder is never

16) Can you blow a balloon up under water? (yes u damaged during a plane crash, why isn't the can)whole airplane made out of that stuff ? (Very

17) Why is it called a “building” when it is already good thinking) built? (strange isnt it) 5) Who copyrighted the copyright symbol? (who

18) If you were traveling at the speed of sound and knows)you turned on your radio would you be! able to 6) Can you cry under water? (let me try) hear it? (got to think scientifically)7) Why do people say, “you've been working like a

19) If you're traveling at the speed of light and you dog” when dogs just sit around all day? (i think turn your headlights on, what happens? (i dont they meant something else) have a change to try) 8) Why are the numbers on a calculator and a

20) Why is it called a TV set when theres only one? phone reversed? (God knows)(very nice)9) Do fish ever get thirsty? (let me ask and tell)

21) If a person owns a piece of land do they own it 10) Can you get cornered in a round room? (by all the way down to the core of the earth? (this one's eyes) is nice) 11) Why do birds not fall out of trees when they

22) Why do most cars have speedometers that go sleep? (tonight i will stay and watch) up to at least 130 when you legally can't go that 12) What came first, the fruit or the color orange? fast on any road? (stupid, break the law)(seed)

Try to answer these questions… ……. 13) If corn oil is made from corn, and vegetable oil is made from vegetables, then what is baby oil 1) If all the nations in the world are in debt(am not made from? (No comments)joking. even US has got debts), where did all the

14) What should one call a male ladybird? (No money go? (weird) comments) 2) When dog food is new and improved tasting,

15) If a person suffered from amnesia and then was who tests it? (give a thought) cured would they remember that they forgot? 3) What is the speed of darkness? (absurd)(can somebody help ) 4) If the “black box” flight recorder is never

16) Can you blow a balloon up under water? (yes u damaged during a plane crash, why isn't the can)whole airplane made out of that stuff ? (Very

17) Why is it called a “building” when it is already good thinking) built? (strange isnt it) 5) Who copyrighted the copyright symbol? (who

18) If you were traveling at the speed of sound and knows)you turned on your radio would you be! able to 6) Can you cry under water? (let me try) hear it? (got to think scientifically)7) Why do people say, “you've been working like a

19) If you're traveling at the speed of light and you dog” when dogs just sit around all day? (i think turn your headlights on, what happens? (i dont they meant something else) have a change to try) 8) Why are the numbers on a calculator and a

20) Why is it called a TV set when theres only one? phone reversed? (God knows)(very nice)9) Do fish ever get thirsty? (let me ask and tell)

21) If a person owns a piece of land do they own it 10) Can you get cornered in a round room? (by all the way down to the core of the earth? (this one's eyes) is nice) 11) Why do birds not fall out of trees when they

22) Why do most cars have speedometers that go sleep? (tonight i will stay and watch) up to at least 130 when you legally can't go that 12) What came first, the fruit or the color orange? fast on any road? (stupid, break the law)(seed)

Adversary is my instructor. Obstacle is my lesson.Beauty and perfection are my life. Order is my attitude.Conscience is my guide. Pain is my warmingDifficulty is my stimulant. Peace is my shelter.Experience is my school. Struggle is my opportunity.Form is my manifestation. Time is my promise.God is my everything. Truth is my worship.Light is my realization. University is my outlook is my slogan.Love is my law Vigor is what I save to build up.Nature is my companion. Work is my blessing.Neighbour is my brother. Youth is what I am and I feel.

Zeal is my tonic

Adversary is my instructor. Obstacle is my lesson.Beauty and perfection are my life. Order is my attitude.Conscience is my guide. Pain is my warmingDifficulty is my stimulant. Peace is my shelter.Experience is my school. Struggle is my opportunity.Form is my manifestation. Time is my promise.God is my everything. Truth is my worship.Light is my realization. University is my outlook is my slogan.Love is my law Vigor is what I save to build up.Nature is my companion. Work is my blessing.Neighbour is my brother. Youth is what I am and I feel.

Zeal is my tonic

23 Brilliant Doubts Unanswered23 Brilliant Doubts UnansweredBy: Sheharyar Khan

Semester 4thBy: Sheharyar Khan

Semester 4th

By: Saad Mehmoodrd

Semester 3By: Saad Mehmood

rdSemester 3

ABC of life


Page 35

1) A foolish man tells a woman to stop talking, but a I use my work telephone.wise man tells her that she looks extremely beautiful Son: Me too, I never use the home phone. I always use when her lips are closed. my company mobile.2) One good way to reduce alcohol consumption : All of them now in a state of shock and together they Before marriage Drink whenever you are sad look at their maid who until now is patiently listening After marriage Drink whenever you are happy to them.3) Three fastest means of Communication : Maid (un baffled): So what is the problem? We all use

1. Tele-Phone our work telephones! (Hahaha)2. Tele-Vision 10) A doctor and a lawyer were talking at a party. 3. Tell to Woman Their conversation was constantly interrupted by

Need still faster tell her not to tell anyone. people describing their ailments and asking the 4) Love your friends not their sisters. Love your doctor for free medical advice.sisters not their friends. After an hour of this, the exasperated doctor asked 5) A man got two wishes from GOD. He asked for the lawyer, “What do you do to stop people from the best wine and best woman. asking you for legal advice when you're out of the Next moment, he had the best wine and Mother office?”Teresa next to him. “I give it to them,” replied the lawyer, “and then I Moral : BE SPECIFIC send them a bill.”6) Let us be generous like this : Four Ants are The doctor was shocked, but agreed to give it a try.moving through a forest. The next day, still feeling slightly guilty, the doctor They see an elephant coming towards them. p r e p a r e d t h e b i l l s . Ant 1 says: we should kill him. When he went to place them in his mailbox, he found Ant 2 says: No, Let us break his Leg alone. a bill from the lawyer.Ant 3 says: No, we will just throw him away from 11) A mechanic was removing a cylinder head from our path. the motor of a Harley motorcycle when he spotted a Ant 4 says: No, we will leave him because he is well-known heart surgeon in his shop.alone and we are four. The surgeon was there, waiting for the service 7) Question : When do you congratulate someone manager to come and take a look at his bike. for their mistake. The mechanic shouted across the garage, "Hey, Doc, Answer : On their MARRIAGE. can I ask you a question?" 8) when your life is in darkness, pray god and ask The surgeon a bit surprised, walked over to the him to free you from darkness. even after you pray, if mechanic working on the motorcycle. The mechanic you are still in darkness - please Pay the electricity straightened up, wiped his hands on a rag and asked,bill. "So Doc, look at this engine. I open its heart, take 9) The phone bill was exceptionally high and the valves out, fix them, put them back in, and when I man of the house called for meeting… on a Sunday finish, it works just like new. So how come I get such a morning… after breakfast… small salary and you get the really big amount, when Dad: People this is unacceptable. OK I do not use you and I are doing basically the same work?" this phone, I use the one at the office but you too The surgeon paused, smiled and leaned over, and have to limit the use of the phone. whispered to the mechanic… Mum: Same here, I hardly use this home telephone as "Try doing it with the engine running.”

1) A foolish man tells a woman to stop talking, but a I use my work telephone.wise man tells her that she looks extremely beautiful Son: Me too, I never use the home phone. I always use when her lips are closed. my company mobile.2) One good way to reduce alcohol consumption : All of them now in a state of shock and together they Before marriage Drink whenever you are sad look at their maid who until now is patiently listening After marriage Drink whenever you are happy to them.3) Three fastest means of Communication : Maid (un baffled): So what is the problem? We all use

1. Tele-Phone our work telephones! (Hahaha)2. Tele-Vision 10) A doctor and a lawyer were talking at a party. 3. Tell to Woman Their conversation was constantly interrupted by

Need still faster tell her not to tell anyone. people describing their ailments and asking the 4) Love your friends not their sisters. Love your doctor for free medical advice.sisters not their friends. After an hour of this, the exasperated doctor asked 5) A man got two wishes from GOD. He asked for the lawyer, “What do you do to stop people from the best wine and best woman. asking you for legal advice when you're out of the Next moment, he had the best wine and Mother office?”Teresa next to him. “I give it to them,” replied the lawyer, “and then I Moral : BE SPECIFIC send them a bill.”6) Let us be generous like this : Four Ants are The doctor was shocked, but agreed to give it a try.moving through a forest. The next day, still feeling slightly guilty, the doctor They see an elephant coming towards them. p r e p a r e d t h e b i l l s . Ant 1 says: we should kill him. When he went to place them in his mailbox, he found Ant 2 says: No, Let us break his Leg alone. a bill from the lawyer.Ant 3 says: No, we will just throw him away from 11) A mechanic was removing a cylinder head from our path. the motor of a Harley motorcycle when he spotted a Ant 4 says: No, we will leave him because he is well-known heart surgeon in his shop.alone and we are four. The surgeon was there, waiting for the service 7) Question : When do you congratulate someone manager to come and take a look at his bike. for their mistake. The mechanic shouted across the garage, "Hey, Doc, Answer : On their MARRIAGE. can I ask you a question?" 8) when your life is in darkness, pray god and ask The surgeon a bit surprised, walked over to the him to free you from darkness. even after you pray, if mechanic working on the motorcycle. The mechanic you are still in darkness - please Pay the electricity straightened up, wiped his hands on a rag and asked,bill. "So Doc, look at this engine. I open its heart, take 9) The phone bill was exceptionally high and the valves out, fix them, put them back in, and when I man of the house called for meeting… on a Sunday finish, it works just like new. So how come I get such a morning… after breakfast… small salary and you get the really big amount, when Dad: People this is unacceptable. OK I do not use you and I are doing basically the same work?" this phone, I use the one at the office but you too The surgeon paused, smiled and leaned over, and have to limit the use of the phone. whispered to the mechanic… Mum: Same here, I hardly use this home telephone as "Try doing it with the engine running.”

Just LaughJust LaughBy: Fazl-e-Haq

Semester 3rdBy: Fazl-e-Haq

Semester 3rd


Page 36

There once lived a great mathematician in a village hand and a gold coin in other. He asks me to pick up outside Ujjain . He was often called by the local king the more valuable coin. I pick the silver coin. He to advice on matters related to the economy. His laughs, the elders jeer, everyone makes fun of me. reputation had spread as far as Taxila in the North And then I go to school. This happens every day. and Kanchi in the South. So it hurt him very much That is why they tell you I do not know the value of when the village headman told him, "You may be a gold or silver.”great mathematician who advises the king on

The father was confused. His son knew the value of economic matters but your son does not know the gold and silver, and yet when asked to choose value of gold or silver.”between a gold coin and silver coin always picked the

The mathematician called his son and asked, "What is silver coin. "Why don't you pick up the gold coin?" he more valuable gold or silver?" "Gold," said the son. asked. In response, the son took the father to his "That is correct. Why is it then that the village room and showed him a box. In the box were at least a headman makes fun of you, claims you do not know hundred silver coins. Turning to his father, the the value of gold or silver? He teases me every day. He mathematician' s son said, "The day I pick up the gold mocks me before other village elders as a father who coin the game will stop. They will stop having fun and neglects his son. This hurts me. I feel everyone in the I will stop making money.”village is laughing behind my back because you do not

The bottom line is :know what is more valuable, gold or silver. Explain Sometimes in life, we have to play the fool because this to me, son.”our seniors and our peers, and sometimes even our

So the son of the mathematician told his father the juniors like it. That does not mean we lose in the game reason why the village headman carried this of life. It just means allowing others to win in one impression. "Every day on my way to school, the arena of the game, while we win in the other arena of village headman calls me to his house. There, in front the game. We have to choose which arena matters to of all village elders, he holds out a silver coin in one us and which arenas do not.

There once lived a great mathematician in a village hand and a gold coin in other. He asks me to pick up outside Ujjain . He was often called by the local king the more valuable coin. I pick the silver coin. He to advice on matters related to the economy. His laughs, the elders jeer, everyone makes fun of me. reputation had spread as far as Taxila in the North And then I go to school. This happens every day. and Kanchi in the South. So it hurt him very much That is why they tell you I do not know the value of when the village headman told him, "You may be a gold or silver.”great mathematician who advises the king on

The father was confused. His son knew the value of economic matters but your son does not know the gold and silver, and yet when asked to choose value of gold or silver.”between a gold coin and silver coin always picked the

The mathematician called his son and asked, "What is silver coin. "Why don't you pick up the gold coin?" he more valuable gold or silver?" "Gold," said the son. asked. In response, the son took the father to his "That is correct. Why is it then that the village room and showed him a box. In the box were at least a headman makes fun of you, claims you do not know hundred silver coins. Turning to his father, the the value of gold or silver? He teases me every day. He mathematician' s son said, "The day I pick up the gold mocks me before other village elders as a father who coin the game will stop. They will stop having fun and neglects his son. This hurts me. I feel everyone in the I will stop making money.”village is laughing behind my back because you do not

The bottom line is :know what is more valuable, gold or silver. Explain Sometimes in life, we have to play the fool because this to me, son.”our seniors and our peers, and sometimes even our

So the son of the mathematician told his father the juniors like it. That does not mean we lose in the game reason why the village headman carried this of life. It just means allowing others to win in one impression. "Every day on my way to school, the arena of the game, while we win in the other arena of village headman calls me to his house. There, in front the game. We have to choose which arena matters to of all village elders, he holds out a silver coin in one us and which arenas do not.

3 THINGS TO LOVE, 3 THINGS TO DELIGHT IN, Courage, gentleness, and sincerity Truth, freedom, and beauty3 THINGS TO ADMIRE, 3 THINGS TO HATE,Wisdom, dignity, and self control Cruelty, arrogance, and deceit

3 THINGS TO AVOID, 3 THINGS TO GOVERN,Idleness, carelessness, and intemperance Temper, tongue, and conduct

3THINGS TO FIGHT FOR, 3 THINGS TO CHERISH,Honor, country, and home Health, friends, and character

3 THINGS TO LOVE, 3 THINGS TO DELIGHT IN, Courage, gentleness, and sincerity Truth, freedom, and beauty3 THINGS TO ADMIRE, 3 THINGS TO HATE,Wisdom, dignity, and self control Cruelty, arrogance, and deceit

3 THINGS TO AVOID, 3 THINGS TO GOVERN,Idleness, carelessness, and intemperance Temper, tongue, and conduct

3THINGS TO FIGHT FOR, 3 THINGS TO CHERISH,Honor, country, and home Health, friends, and character

Always RememberAlways RememberBY: Syed Ali Haider

rdSemester 3BY: Syed Ali Haider

rdSemester 3

Play Wise, Play Fool To Achieve Your Goal By: Ijaz Ali Khan

thSemester 6

By: Ijaz Ali Khanth

Semester 6


Page 37

There are a few tips to keep your confidence up;

1. Focus on the positives: It is very easy to get sucked in by past failures but success comes when you make the experience a learning one.

2. Everything is not your responsibility:At time people take too much upon themselves and start feeling dishearted and pressurized. Learn to accept that everything is not under your control.

3. Paradigm shift:When something is important to feel that you are being assessed watch to an extent that can lead to paranoia .Try to remember that focus is on what you are doing and not on you.

4. Convince yourself:Believe it or not; no one knows you better than yourself. Believe in your abilities to get a job done or in doing it better you will naturally see a lift in your spirits, change in your mood , tone and body language.

5. Strength, serenity and wisdom:Learn to keep balance so that you can do things better. know the right time for aggressive ,passive and assertive moods. Diverting and re diverting of attention may help.

6. Appreciate:If you do not know how to appreciate yourself you won't be able to appreciate others as well. Celebrate your success it helps in boosting yourself esteem.

There are a few tips to keep your confidence up;

It is very easy to get sucked in by past failures but success comes when you make the experience a learning one.

At time people take too much upon themselves and start feeling dishearted and pressurized. Learn to accept that everything is not under your control.

When something is important to feel that you are being assessed watch to an extent that can lead to paranoia .Try to remember that focus is on what you are doing and not on you.

Believe it or not; no one knows you better than yourself. Believe in your abilities to get a job done or in doing it better you will naturally see a lift in your spirits, change in your mood , tone and body language.

Learn to keep balance so that you can do things better. know the right time for aggressive ,passive and assertive moods. Diverting and re diverting of attention may help.

If you do not know how to appreciate yourself you won't be able to appreciate others as well. Celebrate your success it helps in boosting yourself esteem.

1. Focus on the positives:

2. Everything is not your responsibility:

3. Paradigm shift:

4. Convince yourself:

5. Strength, serenity and wisdom:

6. Appreciate:

Work With ConfidenceWork With ConfidenceBy: Hina Arooj

rdSemester 3By: Hina Arooj

rdSemester 3


Page 38

Styles tho koi insai seikhayStyles tho koi insai seikhay Muft kay khanay ka maza hi kuch aur haiMuft kay khanay ka maza hi kuch aur hai

A shelter for hopeA shelter for hope Kash! Khuda tumhain teesra hath bhi daithaKash! Khuda tumhain teesra hath bhi daitha

Lagtha hai ajj is nay dant brush kiye hainLagtha hai ajj is nay dant brush kiye hain Allama Iqbal (version 2010)Allama Iqbal (version 2010)

Funny MomentsFunny MomentsThis section has been included in the magazine on the demand of students and faculty membersThis section has been included in the magazine on the demand of students and faculty members


Page 39

Chal mairay goray…Tik Tik T ikChal mairay goray…Tik Tik T ik

Hum sai jo takrai ga, pash pash ho jaye gaHum sai jo takrai ga, pash pash ho jaye ga This is called a teacher-student relationshipThis is called a teacher-student relationship

Sleeping beautiesSleeping beauties

The Mummy ReturnsThe Mummy Returns

Yakh lagi badonaYakh lagi badona


Page 40

Eik din mai bhi superman bano gaEik din mai bhi superman bano ga

Short barbar training courseShort barbar training course Shaheed-e-PIPOSShaheed-e-PIPOS

Main eik chota sa bacha hunMain eik chota sa bacha hun Attack karnai say pehlay..Rangay hathon pakra gayaAttack karnai say pehlay..Rangay hathon pakra gaya

Practicing for future jobPracticing for future job

PIPOSPlot#6-B, Sector B-3, Phase 5, Hayatabad, Peshawar-Pakistan.

Tel: +92 91 9217150/ 9217520 / +92 344 9797980Email: [email protected] [email protected]

Electronic copy of PIPOS EXPLORER canbe obtained from: www.oppak.com/pipos.html Des

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Volume III (Jan-June, 2009)Volume II (July-Dec, 2008)Volume I (Jan-June, 2008)

Volume IV (July-December, 2009) Volume V (January-June, 2010)

PIPOSPakistan Institute of Prostheticand Orthotic Sciences

Volume V (January - June, 2010)

A Bi-Annual Magazine

PIPOS EXPLORER

PIPOS EXPLORER Volume VI

Documents

Transcript of PIPOS EXPLORER Volume VI